Question: My son is a heroin addict. He is 19 years old. He has been to rehab twice already. Is he too young to be on methadone? I don’t know if this is giving up on him or being realistic. He says he wants to stop but he simply can’t seem to accomplish this since he has relapsed within 2 weeks both times after feeling so good after rehab.

James Cloughley Says...:

Thank you for contacting ChooseHelp.com with your important question concerning your son's use of heroin and his challenges.

I can assure you that by supporting his use of methadone as an alternative is a good first step in his recovery process. It is much safer for him to be using methadone as an alternative than for him to continue to risk his life using heroin. When he is working a program he will be able to function normally once he is settled on an appropriate level of medication.

We all learn at different speeds and because he was unsuccessful keeping his recovery in tact previously doesn't mean that he can't be successful this time. Using methadone as a temporary measure is a great start for him. I see it as a bridge between detoxing and learning how to make different life choices based on his ability to self manage. That may take 6 months it may take a year to learn how to manage himself differently but It shouldn't take a life time. When he decides it's time to live his life without methadone he simply goes to his physician and asks him to help him, systematically, reduce his dosage until he gets down to zero. That time frame will also help your son develop a sense of self worth and self confidence that will help carry him to living a successful life without the use of drugs.

There are two medications that have been quite successful treating opioid addicts. Methadone, which you have mentioned already, and a drug called 'Suboxone'. To answer your initial question about your son being old enough to begin taking methadone. His age will not be a barrier to participating in a program. He would need to find a methadone provider (his physician should helpful in this regard) and have his physician refer him to methadone clinic. He would begin taking the methadone by going to a local pharmacy which provides the methadone and after about a month he would get 'carries' which means that he would have enough supply at home to last him for the week. It is done this way for two reasons.

One: to build a trust level between the doctor and the client and for the methadone doctor to be certain that the addict is not using any other drugs. They are quite strict around this and non-compliance could easily result in being asked to leave the program. He could be asked to provide a urine sample to ensure any client reports are accurate.

Two: to monitor the efficacy of the dose and to make any changes deemed necessary. Once he is stable on the medication meaning he is able to function quite normally he would be allowed his carries. As with any medications there are usually some pros/cons to taking it and this is no different:

Methadone

1. There can be a risk of becoming addicted to the Methadone but that problem is taken care of by weaning down off the Methadone in a systematic and monitored way so that any risk and discomfort are almost non existent.

2. Methadone (is a synthetic opioid) has been around for approximately 60 years. There are no surprises about using methadone as a treatment for opioid addiction. Methadone is also relatively inexpensive so it you don't have any coverage you wont have to mortgage the farm.

3. It is possible to ingest a fatal dose of methadone but far less a risk than taking a fatal dose of heroin.

4. The effectiveness of Methadone is very high especially when using it to treat heavy users.

5. Some reports suggest that prolonged use of methadone can be hard on the liver but that is a question for your son to clarify with his physician while weighing the pros and cons of using methadone.

The common range for those starting out in this program is 50-100mg per day.

Suboxone

Suboxone is the other commonly used medication that is used to treat opioid users. it has been around since 2002 so it, as well, has a track record of note. There are a few differences to consider when thinking about using Suboxone as a treatment option.

1. The risk of becoming addicted to Suboxone is lower than methadone. That is because it works somewhat differently than Methadone. In both cases (Methadone and Suboxone) there is always the 'psychological' addiction that can occur when using either medication. That is a topic that would be dealt with with the clinic physician and perhaps a support group of some kind.

2. The risk of ingesting a fatal overdose is lower with Suboxone as well. Again in either case whether the addict uses Methadone or Suboxone he/she has to be committed to the process and the decision to get clean and sober if either program is to be successful.

3. Suboxone has been found to be less effective when treating heavier users

4. Suboxone is more expensive than Methadone so if finances are a consideration this may make a difference in how a decision is made.

5. The restrictions are not quite as intense around the use of Suboxone and your son could begin the program immediately without daily visits to a clinic or a pharmacy

6. Suboxone is not as proficient at managing the withdrawals from opiate use as is Methadone

The active ingredient in Suboxone is called 'buprenorphine'. If you are looking for any information on this drug before you decide on which program to access a quick look on Google should connect you to as much information as you require.

This is a very powerful way of beginning to live life without the use of substances. The decision as to which program is important and should not be made lightly. In many cases it is a life changing experience. But most importantly what it does provide is an opportunity to live life without the confusion, disorientation and unrealistic thinking that is a daily part of living a life with substance use as its main partner. This is a chance to learn how to live and maintain a lifestyle that can provide a more satisfying life experience. Isn't that the goal of most of us--just to be 'happy'? Choose wisely and work hard at it. He can have that good life if he wants it.

All the best and thanks again for selecting ChooseHelp.com for your source of support and feedback

Jim

Question: I am not really sure if I have a problem, or if I am going through the normal college experience. I am a junior in college, and almost every time I drink I black out and always wake up in the morning and feel so much regret. All of my friends think it's funny, no one ever expresses concern with the amount I drink. I almost always throw up, resulting in my friends having to take care of me, as well as me feeling embarrassed. This has been a problem since I was a junior in high school. I have gotten kicked out of public places for being too drunk, my best friend went to rehab to treat alcoholism two years ago, and my parents tried to threaten me with rehab too. They have even tried to call the cops on me when I come home drunk. Now that I am away at college, they don't address it as an issue anymore. I would just like to stop feeling so much regret when I drink, I want to drink and have a good time just like everyone else, but for me I always get too drunk and feel terrible.

James Cloughley Says...:

Thank you for connecting with ChooseHelp.com.

The question you pose is a good one and a very real one. I commend you for taking the risk to ask it. I encourage you to recognize it is not our job here at ChooseHelp.com to convince you that you have a drug or alcohol problem. Our job is to provide honest, accurate and unbiased information so that those who are concerned can decide, on their own, what has to happen next in order to shape their lives in a more positive way.

When I hear someone say they aren't sure if they have a problem with alcohol or drugs, it suggests to me that the person who is seeking some clarity is reasonably certain what the answer is but needs to hear it from someone outside his/her social or family circle. So let me run some thoughts by you and hopefully they will help you with your understanding about the severity of your problem.

The stories about college life and how it is supposed to be a time for cutting loose and experimenting with alternate lifestyles and so on are legendary. To some degree they are true and many folks do just that--experiment. However, what you have described here is not 'experimenting.' The majority of those who play with alcohol and drugs at school are likely away from home for the first time and become intoxicated with the freedom from the 'eye in the sky' that was their parents. Most times they recognize when they are over-doing the free and fun stage and cut back or go to abstinence on their own. You seem to be moving in the opposite direction. This would be the first serious indicator for you to consider.

The next serious indicator to be concerned about is the 'blackouts'. You need to understand what they are and what they mean to your overall well being so I suggest you go to our home page and type in 'alcoholic blackouts' in the space provided for questions. There is a good deal of explanation about what they are, what they mean and how you are affected by them.

There is always uncertainty when people are seeking the truth about what behaviours they are involved in and what the real truths are. Friends can't always be depended upon because they don't want to lose a buddy to party with. As well, If YOU decide to cut back does that mean that they may be in over their heads as well? Often times our decisions will influence how our close friends see themselves and they may not be prepared to look at themselves quite yet. Family tends to be over invested in your well being because they don't want anything awful to happen to you. So they persist in telling you all the horrible stories they have ever heard regarding substance abuse hoping they will frighten you enough to quit. Those good friends who love you and care about you have another agenda in mind. They feel obligated sometimes to save you from yourself because that's what people who care about other people do and so they try to convince you that what you are doing is wrong. again, they tend to focus on the negative things that could happen. At the end of the day you need to decide what you need to do that is in your own best interest and to do that you need accurate, honest and unbiased information to go on.

The following insights are offered to help you see the situation you have described from an arms length perspective:

-- Do all students who attend college go through this?

-- Do all students who party get to the blackout stage on a regular basis?

-- When you go out do you plan to drink heavily? Is blacking out the goal?

-- Do you feel the need to become intoxicated in order to fit in or to be a part of the 'crew'?

-- You used to have some fun when you went out socially but now you no longer enjoy what is happening. What has changed for you?

-- What does alcohol provide you with that you don't already have?

Let's go back to to your question. If you are asking if you have a problem or not I would say, based on the information that you have provided, that if you don't have a problem yet you soon will have, and a serious one. I would also suggest  reading "Evaluating Your Drinking or Drug Use: 5 Questions". It is an article I wrote a while back that poses 5 questions that will help you to reach a decision. It also outlines an exercise you could undertake starting right now that might be of help when trying to quit or cut down and, coincidentally, help you to evaluate the level or severity of your use.

I understand that you may have some serious nagging questions about being abstinent such as: How will I have fun if I'm not using like the others I hang with? Will I have any friends if I stop using or, at least, cut down? Will I bring others down if I'm not partying like I used to? What kind of a social life will I have? What about girls?--how will I get along there if I'm not partying any more? I get that these are all stumbling blocks to your decision making. If your good friends are your good friends they will accept your choice(s) and carry on. As for your social interactions allow your 'real' self show forth. You may be surprised how many people like you just for who you are and not for what you do.

I wish you well on your journey and feel free to connect with me again if you want. Just send your request to ChooseHelp.com

All the best, Jim