Samantha comes home from the pharmacy and plops the weightless brown paper bag on the kitchen counter, as she has done a half dozen times before. It contains a box of needles—syringes her son Eric, now twenty-four years old, is expecting. As soon as he hears the door slam shut, he glides down the stairs into the kitchen, grabs the bag, thanks his mom, and heads out to Jefferson Avenue to get a fix. Samantha makes sure the unused needles and her son are gone before her husband, Tom, comes home from work. Tom knows she is supplying their son with opioid paraphernalia, but he only begrudgingly approves. So, as far as Samantha is concerned, the less he sees, the better.
Samantha’s sister doesn’t approve at all. She calls it enabling. Samantha’s parents think she is crazy and that she should call the police when Eric comes home high. Only “tough love” will get Eric to stop. The pharmacist has started rolling his eyes slightly in a show of contempt when Samantha asks for more needles. But she turns a blind eye to the criticism. It is not that she approves of Eric’s use. It’s just that she’d rather see him graduate from college someday and maybe even walk down the aisle than be “right.” She wants her son. Her real son. But she will take him here on earth as he is, alive and shooting up heroin, rather than reject him or watch him waste away from a drug-related infection caused by something as preventable as dirty needles.
Samantha knows that Eric is going to use whether she approves or not. She’s already tried every trick in the book to get him to stop, all to no avail. She could kick him out of the house, but that won’t help her cause. Samantha knows that opioid use disorder (OUD) is the most lethal of substance use and psychiatric disorders. Every time Eric decides to use an opioid, there’s a small chance he’ll die, from an overdose or infection, in an accident, or by dealing with the wrong people in the wrong neighborhood. She’s well aware that opioid use comes with some irreversible consequences. So, she does what she can to keep him alive.
Supplying him with clean needles means keeping him from contracting hepatitis C, HIV, or some other dangerous skin or vein infection—helping him to cheat death or a lifelong illness, at least in one small way. But she does more than buy needles. Samantha has provided Eric with the location of the nearest opioid harm reduction center, where he can learn which drugs not to mix and how to use safely, as well as get his street drugs tested before injecting them so he knows he’s not taking enough to knock out an elephant. She also stocks her home with items she’ll need if Eric goes through withdrawal or overdose—over-the-counter medications and naloxone, the opioid overdose antidote. She does all this to keep her son alive in preparation for the inevitable—that point in time when he is ready to seek help.
So, in spite of the criticism from others, Samantha doesn’t waver. She goes to the pharmacy and buys the hypodermic needles. Religiously. Every month.
Samantha, at the advice of a counselor, is employing two strategies—harm reduction and a practice known as motivational interviewing—to help get Eric to want to seek treatment. These strategies are rooted in love and forgiveness but based on foresight and evidence. They are counterintuitive, so doing them can feel confusing. Committing to them is not always easy, but it is doable. Employing them requires strength, courage, diligence, and a certain level of trust and compassion. Not everyone has these traits—especially those of you who have been dealing with someone with OUD for a long time. Regardless of how much compassion you have for the person with OUD, I encourage you to read through this chapter. Its approach is based on the work of doctors William R. Miller, Stephen Rollnick, Robert J. Meyers, and Jane Ellen Smith, among others, and has been widely adopted. At some point, you might find the skills outlined here to be useful.
We covered harm reduction strategies used by social workers in chapter 3. You can use the same strategies at home: provide clean needles, food, clothing, and a bed. And, like Samantha, you can send your loved one to a harm reduction center to have their drugs tested and more. Here, we will focus on how you can inspire change.
Awakening the Motivation to Change
The opioid-addicted patients I see generally fall into one of three categories: the people who sit in my office by court order or some other force and want to keep using; those who recognize they have a problem and genuinely want help; and those who are apathetic—that is, they have lost interest in life, feel too defeated to care, or simply don’t see their use as a big problem. All of them are scared stiff of going through withdrawal and keep using for now, as they cannot think of an alternative. Although not all of my patients are motivated to change when I first set eyes on them, most of them gradually desire to stop using and improve their life.
What happens between day one and the day a patient decides that not using is better than using? I do not wave some kind of magic wand. Along with many other therapists, I work toward one goal: to engage the person in thoughtful conversation in an effort to awaken their motivation to change.
Motivation isn’t something you can pull out of a hat or command at will. It’s internal, a drive that comes from within. Insisting that your loved one do things your way doesn’t motivate. Addiction is too powerful against even the harshest words. Human nature at its core resists as well. In fact, these typical reactions do more harm than good: They push the person away. Consider the situation from the perspective of a person with OUD: After another blowup, your loved one—say, your son—decides not to come home. He is tired of hearing the lectures. Feeling judged, alone, and resentful, he does not speak up when he truly does want help. Who can he talk to? Who will understand? Anxious about all the strife in the house, he uses to ease his mind. He knows that what he is doing is hurting everyone he loves, including himself. He feels awful, a disgrace. And so he uses to feel better. It is the only way out.
Reprimands are the default, black-and-white response. Your loved one is wrong, you are right, and there is no in-between. So you hurl insults to get your point across. It’s natural, this defense. It is also rooted in fear—you are scared to death about what is happening and how little control you have over it.
If “attacking” is the most intuitive but least helpful reaction, what would happen if you made a conscious effort to do the opposite? What if you supported your loved one so that they saw some hope? What if you had their trust, so that when they were ready, they came to you to seek help?
The approach is confusing for most people, who feel they are acting against their values. But look at it this way: I would wager that, deep down, nearly all opioid-addicted people reach a point where they want to end their misery and seek help. They just do not see how it is possible. Having someone in their corner supporting them, however, is like a ray of hope.
It may not seem fair, but the onus to create an environment for change falls on family and friends. Samantha was bound and determined to help Eric. She made a conscious decision to create a new normal. She cast aside the idea that her son was an ungrateful heroin user and accepted that he had a treatable disease and needed support. Instead of attacking Eric, Samantha opened up an honest and respectful conversation about opioid use with him—just as a therapist would. They talked. At first, their conversations were short and shallow. But Samantha’s consistent, engaging approach left the doors open. More and more, Eric shared with his mom his feelings about using. She learned about how he hated what was happening to him, and she felt a shift. Eric was less secretive, more trusting. So was she.
What if you could do the same? It is not as if the opioid use is a secret. And if it is, it won’t be for long. Imagine a calm, collected, mature conversation about what is going on in your addicted loved one’s life. No judgment. Anger set aside. Just questions and answers. Empathy and compassion.
Lest this sound too unrealistic, let’s compare this conversation to the “sex talk.” Not talking about sex doesn’t eliminate unsafe sex. Talking to your children about safe sex is the only way you learn how much they know about the subject. Your children may have sex whether you approve or not. If they trust you not to lose your mind if they tell you they are planning on or having a sexual relationship, you might have an opportunity to help them stay safe—or maybe get them to confess they are not ready. If you discover they are having sex, you can offer to buy condoms. You can also use the opportunity to set up some rules, such as that they need to see a doctor, practice effective birth control, do it in privacy, and cannot have sex when younger siblings are in the house. Avoiding the conversation about safe sex does not make sex safer for your children. Yelling and screaming closes the door to healthy conversation. The same holds true for drug use.
Your Strategy: Keep Asking the Right Questions
The idea is to ask insightful questions—about your loved one’s life, use, concerns—so they see for themselves that what they are doing conflicts with their true goals. You repeatedly engage your loved one in respectful, empathetic conversation, and in doing so earn their trust. These conversations lead to self-awareness and, ultimately, the desire to change.
Motivational interviewing is fairly simple under normal circumstances. But addiction in the household doesn’t feel anything close to normal, and, under duress, it is tempting to criticize and blame. Avoid these kinds of jabs. Postpone your talk if you are feeling vulnerable or angry. Your questions and remarks should show your loved one that you empathize with them. You want to understand where they are coming from.
Once you understand the framework and the steps needed to ask the right questions in the right way, you will see how everything falls into place. Yet, because motivational interviewing is based on conversation, it is a dynamic process. It goes back and forth. One day you will think you have made great progress, and the next day you are back where you started. What prevails throughout, however, is that you talk to your loved one. When you keep the conversation open, the person with addiction feels less ambivalent about seeking help. You focus on their strengths and respect their autonomy. Over time, you earn their trust as someone who will not judge them.
An Added Benefit
Motivational interviewing comes with some additional perks: it also helps you.
When you are hopeless, when you don’t know what to do, when you are stuck, you likely get angry. Anger is a huge element when dealing with an addicted family member. When angry, people tend to do one of two things: withdraw in defiance or lash out. Neither response is usually helpful. Not talking creates more distance. When lashing out, the tendency is to demean the person: call them names, label them, or tell them how worthless they are. This helps you release your anger but settles nothing. You are left to regurgitate your negative thoughts, over and over for hours on end, which only brings you further down. And feeling your wrath does little to help the addicted individual change. They are already very hard on themselves. They already know and believe what you are telling them. When you face the truth calmly and with compassion, you rise above your negative thoughts, worry, and anxiety. You feel you are making progress, making a positive difference. For the first time in a long time, you feel good.
If your loved one is addicted to opioids, eventually they will experience some of the negative consequences of using. When they do, you will want to have kept the conversation open so that they will turn to you and be able to ask for help. When they do, you will be ready.
Tips
Let’s take a closer look at why something so simple as asking questions can motivate someone to change. Motivational interviewing is a strategy developed by Drs. William R. Miller and Stephen Rollnick that helps people recognize and do something about their problem. It is a unique style of talking to individuals who use substances. It has three main characteristics:
Collaboration
Motivational interviewing is rooted in the spirit of collaboration—not confrontation. You talk to your loved one about their substance use. You voice an openness to change by asking open-ended questions: What do opioids do for you? How do you feel when you can’t take them? What happens during withdrawal? I know it’s difficult; it looks like you’re struggling. I want to know how to help. Tell me what I can do for you.
When you take on a peer-like role of adviser, you give your loved one permission to tell you things they might otherwise hold back. You elicit their point of view. You are truly interested in what they want out of life, in knowing what they value, and how they want their life to look. You are not concerned with educating them about how bad they’ve been. Your main concern is to keep the conversation open and work together toward the same goal, which is to make things better.
Conversation Starters
Evocation
Feeling heard and understood is sometimes the most powerful medicine. The addicted person lets down their guard and starts thinking about the possibilities. You help them evoke memories and images of how they want their life to look and feel. They see the large discrepancies between how they want to live and how they are living. As they do this, feelings of motivation begin to stir within, even if ever so slightly.
Autonomy
All the while, you allow the addicted person to live their life as they must. You give them autonomy—they control their actions and you support their choices—to a point. This does not mean they can do whatever they want to you and your family. They do not get to wrap you around their finger. You are supportive and nonjudgmental, consistent, trustworthy, reliable, calm, and cool, but you stand behind established limits—that is, you have your boundaries. For example: You can live here but don’t ask me for money for drugs. If you try to intimidate me, you need to leave. You cannot curse me out. I expect you to be respectful. Threatening behavior of any kind, to anyone in this house, is unacceptable. Be as specific as possible: Curfew is 11:00 p.m. If you come home later, the rest of us lie awake fearing the worst.
The person who uses drugs has the right to use—which is something they feel they cannot deny themselves—provided they heed their known limits about using in the house or leaving tainted needles lying around. Because both of you know that they use, you are free to offer clean needles, a roof over their head, or a hot meal. You do not dictate how the addicted individual lives, but you protect yourself and your family as best you can by setting and standing by limits. This approach leaves little room for resentment—how can this person resent you for letting them live their life?
These conversations are not intuitive. Speaking in this way requires you to give up the idea of being right and foster as much empathy as possible—even as the addicted loved one tears your heart out. It requires trusting someone who has repeatedly betrayed your trust in the past. But it is effective. The worst thing you can do is not talk to your loved one, which only further alienates them. Now they are not only using but angry. Genuine conversation leads to impact, and you must bend over backward to keep the conversation open. If you are not in the habit of speaking to your loved one this way when you are hurt and angry, you will be pleasantly surprised when you see how they respond and how much better you feel.
Setting Limits
Motivation Versus the Traditional “Rock Bottom”
“Hitting bottom” is the traditional way to enter treatment: The consequences of using are so bad that the addicted person is finally motivated enough to surrender. While this can work with some addictions, it is risky with opioid addiction. With the strength of the opioids available today, all too often rock bottom is the final consequence.
Capture your audience while you can. Talk, listen, understand, and make every effort to earn your loved one’s trust. When they are ready to make a change—and at some point they will be ready—you’ll be there to take their hand and help them to do what they cannot do for themselves.
Samantha had a lofty goal. It was not to keep Eric using. Her goal was to get him to stop. And she planned to do it first by doing all she could to keep Eric alive and second by establishing herself as an advocate rather than an enemy. Talking to him, asking him what he was going through and what opioids did for him, lending an ear, and listening to his struggles—empathizing. To Eric, his mom became someone he knew he could turn to for help. Someone he could talk to without feeling judged, without fear of punishment. Someone who would be there for him if he overdosed, ready to give him lifesaving medicine. Samantha had earned Eric’s trust. And when he hit another low—severe withdrawal—and was feeling most vulnerable, he was ready to start talking about treatment.
Signs and Symptoms of Opioid Intoxication
House Rules
A Mother’s Story
While Michael (whose story begins in chapter 3) is in treatment, his parents attend the center’s family program. JoAnn, his mom, describes how the four-day program changed her view of addiction forever. “I learned a lot. The neurologist explained how the brain works and how people react differently to drugs. I found it fascinating. This resonated with me. I will never again look at addiction as something people really choose to do.”
JoAnn also notices a common theme: Everyone in the program confesses that they kept their loved one’s addiction a secret for as long as possible. During the worst of times, no one shared their struggles. “I did the same thing until I started getting sick to my stomach. I realized I can’t keep this in. I started talking to friends. If anyone had a problem with it,
I cut them off. I didn’t need judgment. Addiction can happen to anyone. I saw this at the center—people from good backgrounds, older people, businesspeople, moms.”
Signs and Symptoms of Withdrawal
JoAnn’s saving grace has been her support system—her husband and two other sons, a long list of nonjudgmental friends, and God. “My faith really kicked in. I kept praying. I still pray a lot. Anyone who goes through this must, must, must have a great support system at home. I wouldn’t have made it without it.”
How to Help an Opioid User Through Withdrawal
Withdrawal is perhaps the most feared word in an opioid user’s vocabulary. Fear of going through withdrawal likely keeps more people out of treatment than finances or long waiting lists, which is why educating opioid users about methadone and buprenorphine is so important. Withdrawal is what happens to the bodies of daily opioid users when their drug of choice is either not consumed or taken in smaller quantities than usual. Going through withdrawal is another way of talking about detoxing off opioids.
Your loved one may have on more than one occasion decided to stop using opioids and go “cold turkey,” or detox at home with no medications. I would estimate that 99 percent of the time, opioid withdrawal is not dangerous, unlike like alcohol withdrawal, which in severe cases can lead to confusion, high body temperature, seizures, and death (delirium tremens, aka the DTs). Opioid withdrawal is highly uncomfortable but self-limiting. It usually comes on gradually, is most severe one to two days after the last dose, and resolves gradually in five to seven days. Withdrawal symptoms will stop on their own.
Withdrawal is best done under a doctor’s supervision using prescription medications, but most people actually go through opioid withdrawal on their own at home. Most people can do this safely, provided they follow a few simple rules. Ideally, they will have a family member with them or a medical professional checking on them frequently. Going through withdrawal in the hospital is always a good idea, but this option may not be available to everyone because of cost or accessibility. If your loved one becomes confused, disoriented, or unable to respond during withdrawal (which is rare), falls and hits their head, or has a medical illness and goes into withdrawal, take them immediately to the ER, where they can get more advanced medical attention.
Otherwise, do your best to respect your loved one’s wishes, short of supplying them with opioids. Withdrawal is a negative consequence of opioid addiction. While you don’t want them to suffer, you are not responsible for supplying them with drugs. If they want a medically supervised withdrawal in the hospital, which is far more comfortable than white-knuckling it, take them to the ER. If they prefer to detox at home, help keep them as comfortable as possible. Treat them as you would treat someone who has a severe flu. Being well hydrated is the key to making withdrawal more tolerable. Keep a glass of water at bedside at all times. Stock plenty of sports drinks or fluid replacement drinks made for children (such as Pedialyte) to replace electrolytes, as well as broth or chocolate milk for easily digestible nourishment. Avoid serving your loved one regular food for a few days. Stick with crackers and other easily digestible snacks.
Medications used during withdrawal to counteract specific symptoms may not shorten withdrawal but will make it much less severe, encouraging the person to stick with the plan to detoxify rather than go back to using opioids. It is rare for someone to die from opioid withdrawal itself (although people might feel as if they are going to die), but if your loved one has a chronic or preexisting illness, such as high blood pressure, asthma, or diabetes, you will want to take precautions. Likewise, if they have an active infection, flu, pneumonia, or acute hepatitis, or a serious injury, going through withdrawal should be postponed or done under medical supervision. In withdrawal, the body goes through a state of intense arousal and major stress. Already-weak organs may fail when stressed. In the case of diabetes, for instance, the pancreas may shut down, causing sugar levels to shoot up and put the person who is withdrawing in a diabetic coma.
Over-the-counter medications can relieve most of the symptoms. Have handy products that relieve diarrhea, nausea, and vomiting; antacids to counteract stomach pain; as well as remedies for muscle pain, sleep, and anxiety.
The Only Reason to Go Through Withdrawal
People put themselves through opioid withdrawal either because they do not have any opioids or intentionally as a first step toward quitting opioids altogether. The only reason your loved one should go through withdrawal is if they are planning to start relapse prevention treatment with naltrexone. Detoxification is very dangerous otherwise. Going through withdrawal, or detoxing off opioids, is not by itself a treatment for OUD. Completing withdrawal will not “cure” OUD. A great majority of people who finish
detoxing will relapse and use opioids again. However, OUD treatment medication decreases the risk of relapse. If your loved one goes through withdrawal because they cannot get drugs, it is an opportunity to talk to them about treatment. Once they’ve detoxed, they can start naltrexone. Or, if they do not want to face a week or more of withdrawal symptoms, they can start methadone or buprenorphine.
People who detox and do not continue treatment with medications are vulnerable to overdose. Only a small percentage die, but there is no way to tell who will fall within that statistic. Medication reduces the risk of overdose many times over. Withdrawal is an opportunity to talk about treatment options and take action. Every crisis is an opportunity for change, because people in crisis are often willing to accept help. Suffering through withdrawal is often a wake-up call. So is overdosing.
Dealing with Overdose
Overdose is common in people who use opioids. Some are more likely to overdose than others. Most often, overdose happens when a person starts using again after a period of abstinence—after returning home from an inpatient detox unit or a residential treatment program that does not use medication to treat OUD. It happens to people released from prison or college students returning home for a break. We do not know why some overdose repeatedly and others never do. We know that people with a history of overdose are six times more likely to overdose again. Injecting opioids and combining them with alcohol or sedative drugs, such as Xanax, also increases that risk.
Most overdoses are not lethal. Emergency medical staff manages half of them, while the other half are self-managed by family or friends. Fewer than 5 percent of them end in death. In most people, overdose is not instant. Death comes after minutes or even hours of gradually slowing respirations. More often than not, there is time to reverse the overdose before it can result in death. Sometimes, when help comes a bit late, the lack of oxygen to the brain results in permanent neurological damage. But often, breathing can be restored in time for a complete recovery with no lasting damage.
911 Good Samaritan and Naloxone Access Laws
Signs and Symptoms of an Opioid Overdose
Naloxone (Narcan): The New Normal
Many a heroin user has been force-fed, had ice-cold water thrown on their genitals, been slapped hard across a cheek, or even injected with milk to bring them out of an opioid overdose. This was common in the past, but things have changed. A cheap and highly effective antidote to overdose called naloxone, better known by its brand name, Narcan, is now widely available, so much so that stocking it in the kitchen cupboard has become the new normal.
Friends, relatives, or even strangers may witness an overdose. Witnesses who have access to naloxone and know how to use it can save lives. Overdose-reversal kits can be purchased at the local pharmacy in communities where a health-care commissioner has issued a community-wide prescription. Where this is not available, a family doctor can prescribe naloxone. In either case, the pharmacist will dispense the naloxone, no questions asked. The pharmacist will not usually provide training on how to use it, although some preparations of naloxone may include instructions in their packaging materials. Another way to get kits is to attend overdose-prevention trainings for families. These trainings exist in a few states, run by either the Department of Health or a grassroots organization. If your loved one is in treatment, the program should offer trainings and dispense naloxone to family members. If they don’t, ask for it. Patients receiving painkillers should be given naloxone as an antidote. Again, ask for it.
Naloxone is safe and easy to use, and most of the time administering it to a person suffering an opioid overdose can reverse the overdose before permanent damage occurs. Learning how to perform CPR may prove to be an added benefit, as opioids can stop an overdose victim from breathing. So, I will go so far as to say that everyone who lives with or is in regular contact with a person who uses opioids, or has painkillers in the house—whether addiction is present or not—should be sure they:
Like it or not, this is the new normal. The good thing is that administering naloxone is not as hard as you might think. Here are the steps you need to be aware of:
Confirm that the person has overdosed on opioids: They do not wake up, are not breathing, or are breathing really slowly (about one breath every five or more seconds); have blue or gray lips and fingernails and pale or clammy skin.
Use your knuckles to rub the person’s sternum (the hard bone in the middle of the chest), to try to rouse them.
If they do not wake up, call 911 and say you may have an opioid overdose victim.
Give naloxone according to your training or the instructions on the package. You may have a naloxone injection or a nasal spray. If you have a spray, simply remove the spray from its package, insert it fully in the victim’s nose with their head tilted back, and press the plunger firmly until all medication is released. If you have an injection kit, open the cap on the naloxone vial, insert the provided syringe with needle into the vial, draw all the naloxone from the vial (1 cc), pull it out, expose the person’s skin on their upper arm, thigh, or buttock, quickly insert the needle deep into the muscle in the selected area, and push the whole content of the syringe into the muscle over a few seconds. The order of Steps 3 and 4 can be reversed. If someone else is with you, one of you can call 911 while the other administers naloxone.
It may take one to three minutes for the naloxone to start working. If the person’s chest does not rise and fall with respirations, perform mouth-to-mouth resuscitation to prevent brain damage while you wait for the naloxone to start working.
If you see no effect in three to five minutes and the individual is still unconscious and not breathing, take out another dose of naloxone and repeat. You want to see breathing restored. The person does not need to be fully alert. If their chest does not rise and fall with respirations, continue to perform mouth-to-mouth resuscitation while you wait for the ambulance.
After you give naloxone and the person starts breathing, keep them calm, do not let them use again, and stay with them until the paramedics arrive. If you cannot wait because you are afraid of getting arrested, leave the person in a stable position on their side. Bend their top knee and ensure both arms are positioned in the same direction as the top knee. Leave the space around their nose and mouth clear so they do not choke if they vomit. Leave the naloxone packaging nearby so paramedics will see what medication has been administered.
Naloxone wears off in thirty to ninety minutes, and breathing may stop again. Overdose victims need to go to the emergency room for further treatment and observation. It is possible to deliver too little naloxone, so call 911 if you have not yet done so.
Dos and Don’ts of Opioid Overdose Reversal
Do always call 911 or take the overdose victim to the ER after administering naloxone. Paramedics may give the person oxygen to assist their breathing. Hospital staff will monitor the patient for at least a few hours, measure oxygen levels, and readminister naloxone as necessary. Professionals will evaluate the individual for addiction and may even offer treatment on the spot. Your loved one may be receptive to treatment in this time of crisis.
Do administer naloxone even though the person might have overdosed on other drugs. Sometimes fentanyl can be present in fake sedatives (e.g., fake Xanax bars) or even cocaine. Naloxone will not reverse overdose on sedatives, sleeping pills, cocaine, or alcohol, but if the person overdosed on a combination of drugs, it may be enough to bring their breathing back.
Do administer additional doses of naloxone if the first one does not produce any effects. The person might have overdosed on a fentanyl-like substance, which is a very powerful opioid. Naloxone in usual doses may not be sufficient to counteract fentanyl, methadone, or injected buprenorphine, so it is important that you give more than one dose if you have it. There is little harm from giving too much naloxone if the person is not breathing, but not giving enough can lead to death or permanent brain damage.
Do get certified to provide mouth-to-mouth resuscitation/CPR to supplement breathing. If the person is not breathing and you are waiting for naloxone to start working or you have no more naloxone to give, you can do mouth-to-mouth resuscitation to give the overdose victim some oxygen. Basically, you lay the person flat on their back, tilt their head back, check that there is nothing in their mouth, and pinch their nose shut. Using a mouth barrier (which can be purchased at any drugstore and prevents the spread of HIV) or not, cover their mouth with your lips and blow air in, as many times as you can, giving one breath every five seconds. Short training sessions on resuscitation are available in most clinical settings for a nominal fee, and many employers offer courses for free.
Don’t administer naloxone unless the person has overdosed. If they are only sleepy from having too much heroin and you give them naloxone, you will cancel their high and put them in the very unpleasant state of withdrawal. When in doubt, however, do administer the naloxone, as withdrawal is better than brain damage.
Don’t give naloxone to someone who is awake and breathing normally. This can put them in severe withdrawal and injure the lungs.
When you suspect a child has been exposed to opioids
Opioid overdose can happen to anyone who takes opioids, including children who accidently swallow a painkiller or touch heroin powder. More than one parent has come across a child who is not responding because of an accidental overdose. You should call 911, but it may take too long for first responders to arrive. Overdose reversal needs to happen as soon as possible, within minutes for powerful opioids such as fentanyl. Overdose reversal kits work the same for children as they do for adults, though the dose may be too high for children. If you suspect overdose in a child, it is best to first call 911, describe the situation, tell them that you have naloxone, and wait for their instructions. You may also administer mouth-to-mouth resuscitation to a child, but your breaths will be lighter than they are for adults. Infants, especially, can only handle so much air in their lungs. I recommend resuscitation training for all parents who have opioids and children in the house.
When Talking Isn’t Enough
Motivational interviewing is one of several effective approaches to inspire your loved one to get help. I also recommend a more formalized method of working with a drug-using family member called community reinforcement and family training (CRAFT), which involves the entire family as well as friends. CRAFT teaches people how to interact with the addicted individual. As with motivational interviewing, the idea is to reduce harm and keep inching the loved one with a drug problem toward treatment. A big piece of CRAFT is improving the lives of everyone involved with the person struggling with addiction, especially family members. CRAFT is not specific to opioid addiction, but the methods apply. And CRAFT success rates are quite high.
Staging an intervention is another option, especially when there is an urgent concern about your loved one’s safety and other methods of getting help have not worked. You can hire a professional interventionist who instructs family and friends to write honest letters to the addicted individual and conducts a meeting. Each person at the intervention lovingly reads their letter to the addicted person (who is caught off guard). A daughter, for instance, might describe how empty she feels when her dad doesn’t show up for her baseball games or her embarrassment when Dad stumbles in front of her friends.
Interventions can and do work for many people, but if they backfire, the person who is sitting center stage feels completely alienated. Instead of taking a step forward, you have taken many steps back. When interventions work, an added benefit is that everything is planned—from a reserved room at a select treatment center to the airplane tickets and packed bags, leaving little time or opportunity for the individual to change their mind. Interventions can work at times of crisis, when the addicted person may be desperate for a solution and ready to accept it. But before you schedule an intervention, I recommend that you first meet with an addiction psychologist or physician to discuss whether other options might be available. You might want to try a CRAFT strategy first before organizing an intervention.
When to Call in the Troops
I have given you a tall order in this chapter. What I’m asking you to do is not for the faint of heart. On paper, it might sound straightforward. But real life has a way of showing us that things aren’t always as simple as they sound. Addiction is called a family disease because it affects everyone in the household. The person with addiction gets all the attention (albeit negative). Parents have much less time to tend to other children or their spouses. Feeling ignored, children act out. Parents or spouses spend an inordinate amount of time worrying and isolating. Too ashamed to talk about the family problem or too stressed to want to talk, adults abandon relationships with friends and family. Work suffers, as one family member or another must tend to another crisis—bailing their son out of jail or picking up a husband from the ER postoverdose. Everyone walks on eggshells. And it never ends. The worry, fear, crises. It never ends and as the addiction gets stronger, the family gets weaker, less sure of itself, and easily thrown into a rapidly descending whirlpool of lies and confusion.
When you feel you are not the one to help your loved one, you can help yourself. If you are too lost in the person’s behavior, you can’t control your anger, you can’t think straight, or the addiction has gone on for too long and taken too large a toll on you, work with a therapist. In therapy, you can acknowledge all the feelings of anger, hopelessness, powerlessness, failure, fear—all of these legitimate feelings that surface when you are dealing with an impossible situation. Even one session with a therapist can sometimes put years of emotional pain into perspective and even offer ways to bring out feelings of compassion and acceptance to replace harmful negative emotions.
The Beauty Behind Preparation
Samantha was prepared. She had read as much about opioids, addiction, and overdose as she could. She attended an overdose reversal training and took a resuscitation class. She kept a steady supply of clean needles and condoms for her son, as well as over-the-counter medications to help with withdrawal. She walked tall when confronted with backlash from family and turned to her supports when it became too overwhelming. On the side of her refrigerator hung a list of emergency phone numbers, including nearby detox centers, hospitals, harm reduction centers, personal contacts, and select treatment centers. She updated it as needed. Samantha also met with a local addiction professional, so she knew about all treatment options and which places offered the kind of treatment Eric needed. When Eric could not find the money he needed to buy drugs and started going through withdrawal, she was at his side, helping him through his misery. Twenty-four hours later, Eric confided that he was ready to seek help.
Samantha was ready, too.