Navigating after care when you're clean
by Rachel Butler-Pardi, LSW
As with many of you, I am no stranger to addiction issues in people I love. I could list off the many people in my life that have struggled in one way or another, but my story today is going to focus on the journey of my cousin (not named here, but written with his permission). Addiction is often generational, and my cousin's story starts with his father, my uncle. My uncle struggled with addiction for the better part of his life and dealt with many common issues, such as losing jobs, being arrested, spending time incarcerated, and ultimately overdosing which resulted in an untimely, and devastating, death. It was around this time that my cousin started using himself. He was in high school. One of his drugs was heroin, although he never injected it. Even so, getting clean was a long struggle. Tens of thousands of dollars in rehab, 3 stints in treatment programs, multiple outpatient therapists, follow up treatment, suboxone, and at this time it's been about 10 years since he used.
The thing that remains the most remarkable to me in this journey is that even now, 10 years later, he needs to continue with therapy (at times) and suboxone. When he doesn't take his suboxone, his cravings for opioids return. It's stunning. It's stunning to me as a clinician, and stunning to me to watch the struggle he is tasked with daily, especially as someone whom I love.
A few years ago, he called me. He has a full time job, and is the manager of the store he works in. His work performance was suffering, productivity was down, he was frustrated with himself, and was having trouble staying on top of the tasks he had to accomplish. He explained he had been off suboxone for some time, and needed help finding a provider of suboxone. We had an in depth conversation so I could figure out what it was that he needed. Ultimately, what it appeared was that he also takes Adderall, which is used to treat ADHD, which he was diagnosed with when he was still in school. The complication he was having was finding a provider that was comfortable prescribing Adderall and Suboxone simultaneously. For some reason, he had to switch doctors (I don't recall exactly why...I think perhaps a change in insurance, or maybe when he moved back to the area...I don't remember now.) New doctors would ask for things like the evaluation that diagnosed him with ADHD more than a decade ago...my cousin no longer has access to the initial evaluation. This was one of multiple barriers to him. Doctors were concerned about him being on two controlled substances, and wanted him to consider a different medication for ADHD, although Adderall is the one that has consistently provided what he needs to manage his symptoms.
In my mind, I thought it would be a simple phone call to another friend in the field to get a list of doctors that would help. Turns out, I was wrong. I had reached out to multiple friends in the field...friends who worked at case management, drug and alcohol agencies, colleagues who worked in probation, and contacts at the Drug and Alcohol Commission. I have worked in this county (and field) for more than 2 decades and even with the people I know personally, people who want to help, this process took more than a month to actually secure a doctor who was willing and able to see him, and ultimately prescribe this combination of medications.
We were able to get him a doctor he could call. My cousin was able to get an appointment fairly quickly - luckily - and had a good experience at this doctor's office. He is able to take the medications he needs to continue to function well. He is doing better at work, and is not as frustrated as he was when he first contacted me.
What continues to strike me to this day about this story is that even after 10 years of being clean, he still gets cravings for this drug, which is more striking when I think of folks who are addicted and did inject heroin, which is even more addictive than when you don't. Then to find a doctor who is willing and able to prescribe the combination of medications that you know works for you, and even when you have a family member, for instance, who works in the field, it takes over a month and reaching out to various resources to get the support you need. And then I think of other people I have worked with who have different challenges and barriers to getting and remaining clean...folks who are unable to get a job with benefits, and then are without medical insurance. Folks who are struggling with more complications, such as having families, young children, or caring for aging parents. Folks who are filled with shame and embarrassed to ask for help. Or, maybe they ask for help, but ask the wrong person who can't help, or perhaps casts judgment for what they need. There are so many things that can complicate this picture for folk.
I hope that reading this, whether you are an individual that needs help, the family member of an individual, or a clinician trying to provide help, that you don't stop asking questions or looking for the helpers that are out there...because we exist! Success stories exist. And help exists. You are not alone.
Rachel Butler-Pardi, LSW
Social Worker, Norwin High School