Unplanned Intervention over. Now what?

July 27, 2009 10:46 AM

Unplanned Intervention over. Now what?

Over the weekend I participated in an improptu intervention in my mom's hospital room. There have been ongoing issues with her for about 20 years or so for depression and meds, and after an on the job injury over a year ago and subsequent back surgery she is pretty much hooked on pain pills. According to her she tried to quit and ended up in the hospital after puking for several days. She's been battling with pills (pain, antidepressants) since I was a child, and I don't have a lot of sympathy for her anymore. I can't trust her. She says she wants help, and the social worker that showed up in the middle of the intervention said that was a good thing, but what she says and does are usually not the same. In her purse we found large bottles of oxycontin, vicoden, percoset, norco, and some other stuff. All her perscriptions. Don't know if it was all the same doctor or not.

My brother is trying to drag me into dealing with this, but to be honest (this is really sad) I don't care. She has burned me and played me and my family against each other for too long. In my mind if she knows that I am done that should help her come around. My wife disagrees.

So now we have to move forward. She was discharged yesterday and I think was sent home (with more norco. Thanks DOC!). My brother thinks they only away she is going to get help is an inpatient rehab, but we have no idea how that works/costs (social worker said insurance will not cover). He wants to help her find a place, but I think (and the social worker agrees) that SHE has to make the calls and get in somewhere. We cannot do this for her.

Here's the catch and the reason this is anon: She is a liscensed nurse in the state of California. I do not want to see her hurt someone on the job, but she needs to get clean and I want her to be able to work after she does. There is some discussion of her losing her liscense over this, even though she has been on disability for over a year becuase of the back damage. She is supposed to return to work next month.

So here are my questions. Any and all advice is welcome:

What does Rehab cost? Outpatient/Inpatient?
Will outpatient rehab work?
Is my hands off attitude going to help or hinder?
Will she lose her liscense?
Someone had mentioned support for addicted nurses programs, but I can't seem to find any on the web. Anyone heard of this?

Throwaway email: [e-mail]

posted by anonymous to human relations (5 answers total)

All Nurses has a Nurses and Recovery forum. You can also search at this link for recovery programmes for health-care professionals.
posted by Lolie at 11:03 AM on July 27, 2009

Inpatient rehab is a ton of money tens of thousands for a month. Some insurance programs still cover it so don't take the social workers word for it look into it yourself - or get your brother to do it. Your health care professionals obviously have easy access to drugs, there are often sub-rosa 12 step groups for health care professionals. I only know people on the east coast but if you MeMail me I can look into it. There is probably a EAP - employee assistance plan - where she works which is set up to deal with this. You or your brother can contact them, check into confidentiality and report back to mom.

There are no sure things with addition in any circumstances. Your mom's recovery is up to her. You may - or may not - like to check out some AlAnon meetings, which are for people who love an addict or alcoholic.
posted by shothotbot at 12:13 PM on July 27, 2009

California's Board of Registered Nursing has a Diversion program that may be able to help. That's the support for addicted nurses program that you're looking for.
posted by gingerbeer at 12:40 PM on July 27, 2009 [1 favorite]

For someone who has an ongoing pain problem (and the docs *wouldn't* prescribe for her if they didn't believe that she genuinely did), the best solution is likely to be some kind of maintenance: either buprenorphine (suboxone, subutex) or methadone.

Buprenorphine should be tried first because it is less stigmatized and GP's can prescribe it. If she has serious issues with depression, she probably *needs* to be on antidepressants-- I'm not sure why you are lumping them in with the addictions, but antidepressants do not cause any high and if you try to treat depressed people with addiction without using them, you are dramatically reducing the odds of success. Yes, CBT and other talk therapies can help-- but typically, if you have lasting depression associated with addiction, meds are likely to be needed as well. The two together are the state of the art care.

A great deal of addiction is self-medication gone wrong-- sounds like she's trying to treat pain and depression and if you don't *somehow* treat pain and depression effectively otherwise, relapse is likely to be the most common outcome. And, she may need to be on opioids for pain-- that doesn't mean she's an "addict" if she's taking as prescribed. Sometimes, poorly treated pain can create a condition called pseudo-addiction, which resolves if the pain is resolved.

So, what you want is first an extensive psychiatric and physical examination to determine what's going on with the pain and the depression. Then, you probably want an outpatient buprenorphine doc in conjunction with ongoing psychiatric and pain care.

There are a lot of myths about addiction-- some of the biggies are that addicts don't really have pain, that the addiction probably caused the depression so stopping the drugs will fix it, that simply treating the addiction will fix the depression, that 12 step programs and total abstinence are the only way, that inpatient is superior to outpatient (unless person is homeless, completely uneducated, unemployed it usually isn't) and that maintenance means that someone isn't "really" in recovery and is always high, that addicts should never use opioid pain medication, that tough love is the best way and that families are "powerless."

I wrote about this here and you can find my book (written before buprenophine was FDA approved but otherwise pretty much up-todate) Recovery Options here-- it's the first evidence-based consumer guide to addiction treatment.

This is a type of therapy that-- unlike traditional interventions, which can sometimes backfire-- has been shown to help families move addicted people towards recovery. The idea that you shouldn't make calls for her may be misguided-- obviously, if she doesn't want to get clean, she won't, but family support makes a huge difference and depressed people sometimes need others to aid their motivation because they literally are too amotivated to lift up the phone.
posted by Maias at 4:16 PM on July 27, 2009 [6 favorites]

Maias: I bow to your superior knowledge regarding addiction treatment and recovery, but I'd assume that when anon mentions his mother "battling with" antidepressants, they're not referring to addiction per se but the numerous side effects and issues that people have with them, including just finding one that works well or switching when they stop working and problems when they stop using them, both of which many people of my acquaintance have experienced. I'm not anti-antidepressant at all and I agree that the depression needs to be treated with appropriate medication; I'm just guessing that she's already spun the meds roulette wheel a few times.
posted by Halloween Jack at 5:51 PM on July 27, 2009