Medication-Assisted Treatment: A Solution to the Statistics?

A three-part series by Guest Blogger Gloria Englund, MA. Suboxone, Naltrexone, Methadone

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Part I

I was very uneducated about medications that are affective for substance use disorder (SUD), especially opioid use disorder when my son, Aaron, was still alive. Although he was familiar with Suboxone and methadone, now I believe both of us could have been better informed about how to use methadone along with other support tools that were needed in order to make the treatment the more effective.

Prince’s death has brought the use of Suboxone, a medication that is used to treat opioid use disorder, and the idea of medication-assisted treatment (MAT) for substance use disorders to the forefront of the opioid overdose epidemic. The latest statistic from the National Institute on Drug Abuse (NIDA) is that 129 people are dying every day in the United States from drug overdose; 80 of those deaths involve the use of an opioid.

I believe the stigma and discrimination that accompany substance use disorders, also accompanies the medications that can be used to quell withdrawals symptoms and lesson cravings for those with substance use disorders as they seek recovery.

MAT can greatly reduce the possibility of relapse which often lead to drug overdose that can result in death.

Suboxone

Suboxone, the MAT treatment that didn’t get in Prince’s body soon enough, is one of these medications that is often used to quell withdrawal and cravings for opioids. What exactly is Suboxone? It’s referred to as a partial agonist because it doesn’t bind to the opioid sites as does a full agonist so it produces much fewer endorphins. Because of its “partial” nature, it is much easier to withdraw from than a full agonist like methadone. Suboxone is the commercial name for buprenorphine (partial agonist) combined with naloxone, an opioid antagonist which is very effective at blocking euphoria when combined with the buprenorphine.  Used alone, naloxone (Narcan®) is used to reverse an opioid overdose if administered in a timely manner. Suboxone is also available as a film which is dissolved under the tongue thereby lessening the potential for abuse even more. In May of 2016 the FDA approved a buprenorphine body implant that will dispense medication for up to 6 months but has not stated when in will be available for use.

Methadone

Other readily used medications are methadone (mentioned above) and naltrexone. Methadone is a long-acting opioid agonist medication that is very effective in treating heroin and prescription pain medication addiction. It can only be distributed at specifically licensed clinics. Initially it needs to be dispensed every day requiring the user to make daily trips to the clinic. When the specific dose is determined that stabilizes the patient, then patients can begin to lessen their visits by receiving seven days of doses divided between two or three days a week and eventually, only coming in once a week to receive all seven days for the next week. This daily commitment combined with the difficulty many have in tapering off the medication (and its potential abuse as a full agonist that can be sedating) often outweighs, for some, the positives of its effectiveness in quelling withdrawal and cravings. Methadone is also much less costly than Suboxone if the user needs to pay out of pocket.

Naltrexone

Naltrexone is another MAT drug, but is an antagonist. This means it blocks any opioids from connecting to the receptor sites and can only be used after a patient has completed detoxification from all opioids and all opioid medications like Suboxone or methadone. If a patient uses it while any opioids are in the body, they will go in the immediate withdrawal. Naltrexone is not addictive or sedating and does not result in physical dependence as does Suboxone or methadone. However, poor patient compliance with the daily tablets has limited its effectiveness. A long-acting form of naltrexone called Vivitrol® is now available in a once per month injection eliminating the need for daily use which improves patient compliance. Unlike methadone or Suboxone, anyone licensed to dispense medications can prescribe naltrexone, but the cost may be prohibitive for many.

Note to readers: Part II will run on Thursday, June23, and Part III will run on Thursday, June 30. We will post the full three-part series in our Resource section.

About our Guest Blogger: Gloria Englund, founder of Recovering u breaks new ground in the field of addiction recovery and support. As an ally of the recovery community, she honors all pathways of recovery. She is a psychotherapist, who holds a Master of Arts degree in Human Development. As a certified Recovery Coach, she works with individuals and families dealing with an addiction to alcohol, drugs, food, and relationships. Gloria has personal as well as professional knowledge of addiction and recovery; her oldest son, Aaron, died of a heroin overdose in 2007. As an accomplished public speaker, advocate and published author, Gloria brings a message of hope and recovery to others.

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Proud MAT Mom

wrestling

My youngest son is a wrestler – athletically and intellectually. Wrestling didn’t come easy to him, but he simply loved the sport and being part of the school team. At first I would watch his matches with my hands covering my eyes just peeking through my fingers and praying he wouldn’t get hurt. It was a foreign sport to me, but I made it to as many wrestling matches as possible and began tagging Facebook photos with the hashtag #ProudMatMom. He became a better wrestler and I became a more comfortable spectator and supporter of his choice to wrestle.

When he started wrestling in sixth grade in 2011-2012, his older brother (affectionately known in many of my blog posts as #SoberSon), was struggling with addiction and losing the battle. Little did I know that in July 2014 #SoberSon would eventually find his sobriety on a “mat” of his own: Medication Assisted Treatment (MAT)*.

Today, #ProudMATMom has double meaning and I am an avid proponent of MAT as a viable, preferred – and even necessary – treatment for opioid-use disorder.

 Finding a Solution

Not unlike his younger brother, #SoberSon got pinned and lost quite a few matches before experiencing a “win” and committing himself to ongoing training.  After trying several different treatment approaches, and experiencing relapse, #SoberSon through his own anecdotal research came to the conclusion that he wanted to try Suboxone, a form of Medication-Assisted Treatment. He had some other criteria, too: not 12 step and not in-patient.

That trifecta proved a difficult find. Ironically, the option that we found was one I’d never encountered in the years leading up to this and it was within a few miles of our home. Imagine that! Sometimes the solutions are so close, but we don’t even realize it.

Suboxone (Buprenorphine combined with Naloxone)

Gloria Englund, MA, a recovery coach and author of Living in the Wake of Addiction – Lessons for Courageous Caregiving, defines Suboxone as follows:

Suboxone is a partial agonist because it doesn’t bind to the opioid sites as does a full agonist so it produces much fewer endorphins. Because of its “partial” nature, it is much easier to withdraw from than a full agonist like methadone. Suboxone is the commercial name for buprenorphine (partial agonist) combined with naloxone, an opioid antagonist which is very effective at blocking euphoria when combined with the buprenorphine. Used alone, naloxone (Narcan®) is very effective in reversing opioid overdose if administered in a timely manner. Suboxone is also available as a film which is dissolved under the tongue thereby lessening the potential for abuse even more. In May 2016 the FDA approved a buprenorphine body implant that will dispense medication for up to 6 months but has not stated when in will be available for use.”

Note to readers: I’m excited to share an upcoming blog by Gloria on MAT and also an interview with her about her book, which is a must-read for parents.

Be Open-minded to Treatment Options

For my son, Suboxone has provided the stability he needed to focus on his recovery. He tried Naltrexone (also available as Vivitrol) during an in-patient treatment program but didn’t find relief; he was still craving opiates, which meant his head was anywhere but the treatment group. All he could think about was getting out so he could get his fix. He was just passing time, counting days, and was convinced he could moderate his use upon discharge.

Of course, he couldn’t and he returned to use within a few months of completing in-patient treatment. He was overwhelmed with freedom, a poor-fit after-care plan and insufficient means through employment, housing, and support. He wasn’t interested in coming home and we weren’t sure we were ready either. It was an awkward, difficult time of transition that went the wrong direction quickly.

From Relapse to Recovery

That relapse and its devastating demise unified our family and son’s friends. Together, we conveyed our concern for his well-being and voiced our very real fear that he was going to die soon.

He said, “Thanks but no thanks” to returning to treatment.

He wasn’t ready to stop using, but with hindsight, he was shifting from needing to stop to wanting to stop, and he learned that Suboxone might just be the best way for him to treat his opioid-use disorder.

Suboxone accomplishes three things for my son: 1) It takes away withdrawal symptoms; 2) It eliminates cravings; and 3) It makes it impossible to get high (for at least 48 hours) if he were to use an opiate. This combination provides incredible stability as he actively works an integrated treatment plan.

Right away, he enrolled in a high-intensity out-patient (HIOP) treatment program offered by the MAT clinic. In addition, he met one-on-one with a counselor. He has progressed from dosing daily at the clinic to picking up a week’s supply at a time. He passes all of the random, monthly UAs and sees his counselor regularly. More importantly, his self-confidence and self-esteem is returning: He got a job within a few months of starting Suboxone and has held it ever since, and he enrolled in college courses and has gotten straight A’s.

Stigma from Unexpected Sources

Unfortunately, like many aspects of addiction, Suboxone users, proponents and supporters encounter stigma. Interestingly, the stigma – from my perspective – comes from the broader recovery community and not from the general public.

These folks (certainly not everyone) seem to feel that recovery must not include medication assistance – they say it’s trading one drug for another, that it’s just another form of addiction.

This simply isn’t true as my son and many others will attest.

More encouraging, however, is the open-mindedness that friends, family and the general public seems to take regarding Suboxone, and perhaps more so with the news that Prince was about to start using Suboxone. They are amazed to learn that such an option exists. They see it as comparable to taking an anti-depressant or anti-anxiety medication to treat those brain disorders. They see it as taking insulin for diabetes, as taking cholesterol-lowering medication … they see medication as a form of treatment for a chronic disease. In this case, the chronic disease is a brain disorder known clinically as substance-use disorder or opiate-use disorder, or more familiarly as addiction (which takes us down a whole other rabbit hole of lexicon vs stigma).

Like any medication – prescribed, over the counter, or illegal street drug – Suboxone can be abused, it can be used to get high, and it can be sold on the street. UNLESS, it’s being used with integrity as prescribed and under the care and guidance of a physician who specializes in opiate addiction. AND, when it’s used in conjunction with other treatment protocols – group, individualized therapy, mental health, support, etc.

Future Plans

We’re fairly new to Suboxone – just two years in July 2016 – but the benefits are amazing. I understand that some physicians and people believe in life-long maintenance; others believe it’s possible to taper off Suboxone, slowly and with full support.

My son’s clinic believes in an individualized approach to MAT offering a general guideline that it takes 18 to 24 months for a person to stabilize (their life) using Suboxone in conjunction with ongoing counseling services. My son would like to taper off, very slowly, at some point. Our family will support him in that decision and remain open minded to the possibilities that it brings.

But, as he says, “Why mess with what’s working?” I wholeheartedly agree.

With MAT, Suboxone in particular, our family is no longer wrestling with opioid addiction and that makes me a very, very #ProudMATMom.

*Medication-Assisted Treatment (MAT): This is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful

Midwestern Mama

©2016 Our Young Addicts            All Rights Reserved

Wrapping Up 30 Days of Gratitude

Midwestern Mama counts her blessings this Thanksgiving season with “30 Days of Gratitude.” Among her most grateful reflections? Relationships, Community, Family, Friends, and her son’s Sobriety & Recovery. Thank you for joining us in a celebration of #Gratitude2014

Thank you for reading along as I gave great consideration to all that is good, all that I am grateful for this season. What I truly realized it that I am grateful for far more than one thing each day, far more than 30 things in one month. I am blessed to have multitudes of things for which I am eternally grateful. The more I thought about things, the more I realized I could put on the gratitude list.

In sharing some of these thoughts with my husband, he shared a wonderful realization that he’d recently come to: He shared that since our son’s commitment to recovery, he is beginning to think about the future and is no longer dwelling so much in the past.

I, too, find myself better able to look forward. For so many days, months, years, it has been all we could do to just focus on the here and now, taking things one day at a time (sometimes even one minute at a time). We would replay the past. We would long for the good ‘ol days.

Now, we are excited to see what’s next for our son. And, our son is excited, too. He’s working part time with hopes of a promotion and perhaps finding an even better job. He’s registering for spring-semester courses at a local college. He’s appealing academic suspension by writing an honest and sincere account of his young-adult life and showing that he’s ready to be a drug-free, committed student. He’s turning his life around, and we are so happy for him.

Here is a quick recap of Days 21 – 30 of #Gratitude2014.

Day 21: I am grateful for information sharing and gathering. Smarter is better, when it comes to addiction.

Day 22: I am grateful for truth even when it’s difficult.

Day 23: I am grateful.

Day 24: I am grateful my son is alive in spite of so many past situations that could have killed him.

Day 25: I am grateful for how far my son and our family have come since last year – it was getting bleak; now it’s full of hope.

Day 26: I am grateful that family and friends will gather in our home to celebrate Thanksgiving tomorrow.

Day 27: I am grateful my son is here to help me make the cornbread stuffing for our Thanksgiving meal!

Day 28: I am grateful for leftovers. Today, I am making turkey soup to warm the soul.

Day 29: I am grateful for the upcoming holiday season

Day 30: I am grateful all year round – Thanksgiving is more than a day, more than a month. It is a way of life.

All the best,

Midwestern Mama

The Dog Days … of Recovery

Midwestern Mama is pleased to share an update on her son’s recovery in what she likens to the “dog days.” Find out why and let us know if you can relate!

He’s sober. He’s still sober. Oh, how pleased I am to share that!

Beyond sobriety, I am even more pleased to share that my 22-year-old son is taking a daily dose of Suboxone and faithfully is attending a high-intensity out-patient (HIOP) program – which meets for three hours, three days a week. He even sees a counselor for a one-on-one hour once a week, although the counselor has been out of town the last three weeks … but I digress.

Since mid-July to present, my son, our family dog and I have made trips to the clinic each morning. We head out around 8 a.m. on Monday through Thursday, and at 7:15 on Fridays so he can see his counselor before group, and on Saturday, we get there before the clinic closes at 11 a.m. On Monday, Thursday and Saturday, the dog and I wait in the parking lot five to 30 minutes while we wait for him to dose. On Tuesday, Wednesday and Friday, his group meets until noon, so the dog and I go about our business of errands, work or meetings.

This routine will continue until the middle of October, when he graduates from HIOP and at which time he may be eligible for take-home Suboxone a week at a time and then up to 30 days at a time. Currently, since the clinic is closed on Sundays, all clients take home their Sunday dose on Saturday, in a lock box.

It’s been our routine. A good routine. A routine we hoped, dreamed about and prayed for. A routine for which we are grateful. A routine that we don’t take for granted. Yet a routine that is routine, that is at times mundane, and at times harder than it is easy.

Early on in my son’s addiction, I was very much like my cohort Mid Atlantic Mom in thinking that drug treatment equaled success, equaled putting addiction behind us. I quickly learned through research, networking, reading, counseling, Al-anon, and more, that this might not in fact be the outcome. At least not the immediate outcome.

The underlying situation. The one that existed before the drug use. The one “we didn’t cause, can’t change, can’t control and can cure,” exists whether our young addicts are using, are sober or are recovering.

Without the substance, the reality of their mindset or mental illness is immediately front and center. It’s no longer masked. It exists and it is painful without the relief of substance. It remains to be diagnosed and treated. It is. It is. It is. It is there.

Some days, my son will share. Other days, he is silent but seemingly content. And still, other days, he is irritated, agitated, moody and resistant. We don’t always know how he will feel, how he will be. It often feels it’s all about him. In some ways, it is. Yet, the family must continue on, and for the first time in several years, I think he understands and respects this even if he remains sensitive to it, perhaps even hyper sensitive to it since he’s dealing with it sans chemicals.

It’s almost like the wound is far more open and raw than ever before.

The difference this time – now on his third or fourth experience with treatment and recovery – is that he wants to change and that we are more open and patient about small evidences of change. However, he wants it to go quickly and on his terms. I dare say, we do to.

Through all of this, and I come back to the “dog days” headline, our family dog has been as influential as anything in our son’s recovery progress. I’ll go it one more and say that our family dog has been the motivation and encouragement for him.

Every day, since having our son return home, he has taken great interest and pleasure in our young dog. They take walks together. They take naps together. The more they do together, the more they have bonded, and the more our dog has grown from a frisky puppy into a well mannered adolescent dog.

Our dog has responded exceptionally well to consistent, caring training, not to mention the positive rewards of pats and “good boy.” Our dog, has increased his listening and willingness – even in the face of dog training challenges: distance, duration and distraction — because our son has exhibited kind-hearted, positive discipline. Our dog has learned patience as he awaits clarity and permission. Our son has learned that setting and enforcing expectations works.

Through these “dog days” of recovery, we are all learning albeit at different paces, with differing expectations and with varied perceptions of progress.

Midwestern Mama

The New Normal

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One month into treatment, Midwestern Mama contemplates the new normal for her son and family.

The first time I heard the descriptor “The New Normal,” it was in economic terms referring to how families were faring in 2009. I understand that more recently there was a short-lived television series with this title about gender and families.

Whatever its origin and original intent, it’s an expression that seems to capture our family’s connection to addiction and recovery. Ironically, this coincides with the timing when it first manifested for us. Since then, we’ve accepted and adapted to many new normals. If you’ve been reading this blog or any of my other writings, patterns emerging as the new normal and the next new normal and the next one after that … these have been the mainstay of our family experience.

More recently, we’ve been party to yet another new normal – treatment and recovery. At the end of 2013 and early part of 2014, we got a preview of what this might entail. Then, in a blink, it all unraveled. Our son’s immediate and lower-than-ever-before relapse hit. It hit hard, for all of us.

We met this new normal with the same resolve as times past, yet something was very different, and thankfully so.

So what is it like to parent a young adult who is earnestly participating in treatment and recovery? It’s far from anything we’ve experienced to date. Will it be the be-all, end -all? I can’t answer that, but I do know it is laying the strongest foundation for ongoing and future success than we’ve seen. The experts are just as good as the experts we’ve been fortunate to work with in the past, but this time it seems to be the right experts at the right time.

What’s different? Our son. He truly seems to want this. Not for us, but for himself. It’s not something we could have made him want, although we’ve certainly tried to influence, encourage and support it. I encourage every parent to keep trying, no matter what but to not drive yourself nuts when it doesn’t turn out like you want it to. In due time, in due time.

So what else is different? He is slowly and selectively reconnecting with former friends who are not addicts and who he’s been honest with and that support his efforts without being in his face about it. These friends accept it and applaud him, but not in a way that makes him feel self conscious. Having a social component has given him a positive outlet for his energy and interests. Too much treatment, too much recovery, is an overload. Having an outlet to just be a 22-year-old is extremely important.

What else? Suboxone, a medication that curbs cravings, negates the ability to get high, and offsets withdrawal symptoms for opiate use. It’s not without its downside, but for now the upside seems to be worth it. (Downsides: It’s daily trips to the clinic for at least the first 90 days before he can get take-home doses. This eliminates being able to go out of town for family vacation this summer. It means having transportation available. It causes constipation, which of course, the heroin did too. It initially messed with his sleep pattern. It generally requires a long-term commitment. There’s conflicting research on the benefits and precautions, but overall, it seems to be just what he needs now and is making an immediate and noticeable difference.)

Our new normal impacts the whole family, but it is such a welcome change. We have a long way to go to reestablish trust, communication and to support our son toward independence, but for now I just hope he can stick with it. Each day with it, is a day stronger. For all of us.

We’ve been waiting and praying for The New Normal. Now we are here, embracing this stage and optimistic for the next new normal and the one after that. I guess that’s normal, too.

As parents and families, we are often ready long before our young addicts are ready. In my own exploration and effort to understand addiction, I was encouraged by many of the writings of Buddha. In particular, the blessing of a good guide and for the readiness and willingness to let the guide to their job, while I did mine. Until I was ready, it was going nowhere. When I got ready, WOW!

It seems the same enlightenment is starting to happen for my son.

Midwestern Mama

“When the student is ready, the teacher will appear.”
Buddha

Not That Far From Home.

Midwestern Mama discovers a community of opiate users in recovery — just miles from her suburban home – as her son begins Suboxone treatment and counseling for Heroin addiction.

Less than five miles from my suburban home is an outpatient treatment center that offers Methodone and Suboxone dosing in addition to individual counseling, group sessions and training. Although it’s close to where I live, it’s not on a road I ordinarily take and even though I’ve driven that road many times over the 20 plus-years that I’ve lived here, it’s not a structure that I ever noticed.

The past two days, however, changed that. I have taken notice and I have spent several hours there. It has been eye opening and I actually look forward to seeing and experiencing more in the days ahead. As part of my son’s journey with addiction, I have yearned for an insider’s perspective to better understand the complexities of substance use disorder – if not his, that of others.

Sitting in the waiting room for several hours yesterday as he met with a physician, had a lab test and met with the intake coordinator, I busied myself with a proposal, client emails and some trade publications. All the while, I engaged in people watching and caught snippets of their conversations with each other.

It was clear that most of the men and women were regulars, although there were definitely some other first-timers and perhaps a few other supportive parents. The regulars were animated in their talk, joking and catching up with each other. Their faces and bodies evidenced difficult times, but their conversation indicated hope and commitment to better times. Many of them carried backpacks stuffed to the gills and I wondered if they were transient. Quite a few had large beverage containers from the convenience store across the street – sodas, chocolate milk, juice. Several of them had small lock-boxes.

One 50-something man, in particular, had an Irish accent, immediately introduced himself as Chillin’ McDillon, and complemented me on my smile telling me that it may him very happy to see. Without prompt or hesitation, he began telling me his life story. My son was signing in at the reception desk or he probably would have had a fit that I was interacting with Chillin’ McDillon

A younger woman used the clinic phone (sign posted above stating a 3-minute limit for calls). She was trying to get a school transcript to enroll in community college and it sounded like she’d been through a number of hoops already. Yet another woman was quite angry and punctuated her account of the last night’s activities with four-letter words to describe her boyfriend’s shortcoming.

In dress pants and a button-down shirt, another man filled out paperwork and checked his mobile device. He kept looking up hoping his was his turn to get called back to the lab.

Meanwhile, staff with lanyard nametags and jangling sets of keys came and went calling names and taking clients back for various appointments. In addition, someone was job shadowing and someone else was there for a site visit. Clinic staff were giving a tour and explaining the programs they offer.

A few years ago, let alone a days ago, I would not have imagined being here. Although we had suspected opiate use, this drug of choice was quite foreign to us. It’s only been recently that I began learning more and more about it and the challenges of overcoming this highly addictive substance. I had heard about Methadone and Suboxone, and more recently about Naltrexone (a medication our son took while inpatient earlier this year). Now, we were in the midst of it and it was not far from home.

After another round of “now you see me, now you don’t,” our son arrived home last Tuesday evening unannounced and coming down from a high. Our family was united in our expectations and the conditions under which he could stay in our home. We were not feeling very tolerant of another breech and initiated a straightforward conversation – with loving intention but resulting in a somewhat ugly verbal exchange.

My husband’s direct and strong voice expressed the message. We were clear, come morning he had to honor our agreement to do something positive and productive every day toward sobriety and it would begin with a call to some treatment places and start a program or he could not stay with us. His choice.

Midway through this ultimatum, and I hate that it was an ultimatum, he zoned out. I don’t think we realized he was coming down from a high or perhaps we would not have started this conversation, but as cognizant as we are of his use we simply didn’t see this.

For the next 30 minutes, he was half asleep but not at all engaged with the rest of us. We just watched. Finally, we said, it’s late and time to go to bed. My son went upstairs and climbed in bed. We tucked in our younger son and my husband and I proceeded to toss and turn the rest of the night.

True to our word, the next morning, I woke my son and handed him a list of places to call before the day was up. Groggy, crabby and feeling dope sick, he begrudgingly got up and spent the day with me. By late afternoon, he’d talked to one place but didn’t think it was the right place for him (a common theme) and left a message for the other. He didn’t want to talk about any of it and seemed resentful. There was lots of silence.

The next morning, I woke him up and he went with me again. I encouraged him to call back the place he’d left the message because sometimes getting through means being persistent. I’ll be darned, but he reached them and they had an opening with the physician for the next morning. Without hesitation, I changed a meeting to be able to take him.

Again, I had to wake him up. He ate a bagel and cream cheese. Without showering or changing out of his baggy PJ bottoms and sweaty t-shirt, we drove to the clinic. Throughout the morning of him meeting one-on-one with their staff, he would return to the waiting room and gradually began filling me in, being more conversational.

That afternoon, my husband and I took him for a haircut and we ate a late lunch together. He was energetic and pleasant. When we got home, he showered and trimmed his beard. He was feeling better and looking better, too.

Then, of course, he made a last-minute departure to hang with friends instead of attending a family birthday dinner. We know for certain he lied about which friends and we were 50-50 on whether he’d let us know his plans let alone whether he’d come home that night. We were unsettled, but decided to let go and accept that we had done all we could to include him in the family. Shortly after 10 p.m., he texted to see if we were home yet as he was on his way back. Didn’t really expect that.

This morning he woke up on his own and ready to get his Suboxone dose at the clinic. He came out with a list of dates for seeing the physician and counseling appointments. He talked about the upcoming group sessions that he’d be attending. He even gave me the sheet of paper to read, which he’s previously stuffed these things in his pocket and resisted letting us see them.

We had a short conversation about honesty and being a support system, but didn’t belabor it. It remains wait-and-see, but I am ever grateful for some positive motion and the possibilities that this could yield for him to get back on the recovery track. As much as he has fled from home in the past, it’s interesting that he’s sticking so close to home these days and that this current endeavor is not that far from home.

Midwestern Mama