Monday, January 31, 2011

Rehabilitation Attempt Failed

Early July CADS Thames renewed the Methadone prescription, but for twice weekly 'pick-ups', not once weekly, and also at this time the caseworker suggested Shane was to be given back partial responsibility for his Methadone.   Reluctantly and hesitantly I agreed to Shane uplifting his take home doses of Methadone from the pharmacy, on the condition that the Methadone was put in my possession immediately upon doing so.   But Shane's Methadone withdrawal didn't commence until the September, and then only reducing down, if I remember correctly at 2mgs a month.   The Methadone withdrawal rate apparently is entirely up to Shane and the CADS Medical practitioner.

I had been advised at the beginning of my attempt how difficult the Methadone withdrawal aspect of Shane's drug rehabilitation was going to be, and also of the low success rate for complete Methadone withdrawal outside a professional residential facility.   However, I felt confident that with Shane's desire and my determination, Methadone withdrawal and drug rehabilitation within our home environment could still be successfully accomplished.   But as the months ticked by, Shane's drug abuse or 'topping-up' once again started spiralling out of control and my confidently aspired rehabilitation effort slowly, but surely crumbled into dismal failure.

On December 20th 2007, after a three day, what I knew to be Methamphetamine or (P) drug binge, Shane was removed from our home, with intructions not to return to us until he was clean of all drugs, including the Methadone.   Shane was effectively being discarded out of our lives, so he now had to go it alone, without a home or any family support.   It is an extreme measure often referred to as 'tough love', and one we had considered of recent weeks but always veered away from using because of the risks and implications involved.   Shane had no savings, his income was the sickness benefit and his few associates were persons also with addictions living on the streets, a lifestyle we knew Shane would probably end up living as well without our support.   However, this fateful day in December I finally had to concede defeat, and acknowledge Shane really did need to be in a professional residential environment to safely withdraw off the Methadone and overcome his battle with drugs.   Hence, the 'tough love' option was actioned, in the hope it would eventually ensure that result, of Shane entering into a residential addiction rehabilitation centre.

Although well intentioned, it was still a difficult, heartrending decision to make and action on the day because of his state.   But due to Shane's no fixed abode circumstances and for his own safety, he was thankfully admitted into a hospital unit for a few days to undergo partial detoxification.

The 'co-dependency' or 'enabling' theory springs to mind, and yes, maybe that theory does apply to all Shane's family over those years of his drug addiction, to us though it was just purely love and support, nothing else.

Friday, January 21, 2011

MMT Campaign News

I periodically Google the title of my own blog site to chart it's progress and activity, and recently in doing so I came across a particularly important web site that had incorporated a link to my blog and posting of MMT Campaign.   The web site was that of Dr Kevin Snee, Chief executive, Hawkes Bay DHB.    To have my MMT Campaign recognized and acknowledged in such an important, significant way was extremely encouraging and exciting, and indicated that the campaign information and proposals forwarded out were regarded as worthwhile and constructive.

However, there are many Addiction Professionals, DHB Chief executives and Government Officials that have not responded, or in some cases not even acknowledged receipt of my MMT Campaign information, which frankly only indicates their level of, or lack of courtesy towards others opinions and suggestions.   And we wonder why!!  there are major failures and blunders occurring within our Government, and Government funded Organizations and Departments.

Tuesday, January 11, 2011

The Rocky Road Of Rehabilitation

Two weeks after discharge, the heavy leg plaster cast came off and a new fibro-plaster cast was put on, and what a difference this made to Shane's, and ours I might add whole well being.   It had been a difficult, frustrating two weeks with the heavy, cumbersome cast on, especially keeping the leg elevated in bed at night, and also dry when showering.   However, after much thought and perseverance both these problems were solved within days of Shane being home.   We ended up having to elevate the end of the bed with big blocks of wood, and wrapping the cast in plastic for showers although it was a chore, proved to be semi successful.   I attended the hospital clinic appointment with Shane to view the leg wound when the old cast was removed.   I was amazed how well the surgeon had stitched the leg wound considering how swollen it must have been on the day.   Admittedly Shane would be left with a long, large scar down the front of his leg but, nevertheless, the stitching was beautiful work.

Shane was a good patient though and I enjoyed fussing over him.   He started getting good colour back in his face and having him straight, not out of it, was a real delight for us.   At week four Shane was weaned off the pain medication, but remained on the sleeping sedative and his doctor also prescribed anti-anxiety medication, to prepare him for Methadone withdrawal.   In those early weeks Shane appeared to be coping alright having the correct daily dose of Methadone, and he was talking positively about long term goals and plans, which was all very encouraging.    But it was early days and I feared getting to hopeful, knowing the real hard yards of rehabilitation were yet still to come, when Methadone withdrawal commenced.

Our first introductory meeting with Shane's new CADS caseworker was in early May, approximately two weeks after his discharge from hospital.   Shane's appointment was for one hour but my visit with him was brief.   It was just a 'getting to know you kind of meeting' and to discuss my authority for the Methadone, the reasons for it and how we would proceed with Shane's withdrawal and rehabilitation.

The caseworker was a nice, approachable young man, about Shane's age, whom appeared eager and enthusiastic to help Shane, and work with me to ahcieve a successful end result.   Although it wasn't spoken, I did detect at this meeting the caseworkers slight hesitation about my personal involvement, and felt perhaps he wasn't totally agreeable with me having authority over Shane's Methadone.   However, I was aware authority being granted for the Methadone was quite unique within Community Alcohol & Drug Services, so his reaction didn't surprise or perturb me.   I was very thankful though, at this point that Shane was still under Manukau City, when the request was made.

The Methadone withdrawal protocol required Shane to have regular visits with his caseworker.   These were weekly to begin with, extending to fortnightly, and his caseworker was prepared to travel to our home at Te Mata for some of these appointments.   Having regular contact with the caseworker I felt would certainly aid Shane's withdrawal and rehabilitation process, but only if some form of professional counselling was incorporated as well.   Of course, as with all counselling, trust and a general rapport must exist between both parties for the hope of a successful outcome.   Sometimes, to achieve this goal, qualifications work well, other times it maybe the benefit of the counsellor's personal or professional experience.   I was hoping Shane's caseworker, albiet that he was new to the service, therefore possibly inexperienced, was still a bloody good one because if he wasn't 'switched on', Shane would leave him sitting on the other side of the fence every session, especially if rehabilitation wasn't what Shane really wanted.

Like I've said, Shane's a really nice, pleasant, respectful guy.   However, he is a very clever manipulator and a bit of a dark horse!   He's been in the programme long enough to know what, when and how it all works.   He is also extremely knowledgable about addictions and addictive behaviour, so it takes an experienced person in addiction to successfully unravel him.   Over the years his manipulative, masterful approach has seen him very successfully manoeuvre his way out of many unpleasant situations.   And considering Shane applies these techniques while under the influence of drugs does vindicate just how skilful he is.

I'm not putting Shane down, or being unloving by saying these things.   Shane would agree with me, in fact these aren't bad qualities to have, I admire him for them.    I just hope, one day, he'll get the chance to use them all for the right reasons, other than for his drug addiction.

In the June Shane's fibro-plaster cast was removed.   Our weekly town days now became a tense time for us, wondering what Shane was up to, where he'd go and whom of the drug scene he may have seen.   He wasn't as mobile on crutches and never ventured very far, so town days over the last weeks hadn't been a concern.   At this point though Shane hadn't mentioned moving out, so again I assumed my rehabiliation plan was acceptable.

The six doses of Methadone that I picked up from the pharmacy on Thursdays were safely secured in my handbag while we were in town.   Upon arrival home the Methadone would, discreetly, be taken downstairs to the basement garage and locked away in my husband's gun ammunition cupboard.   If I was unable to do so immediately I would hide the bagged bottles of Methadone in my bedroom drawer until Shane was otherwise occupied.   Each day's dose of Methadone was labelled, dated and it was dispensed in small individual brown bottles.

One particular Thursday, towards the end of June, Shane didn't retreat immediately to the bedroom to rest his leg, as was normal, so I hid the bottles of Methadone in my drawer until I could lock them away.   To my bewilderment, there was only five little brown bottles in my drawer when I went to retrieve them, about half an hour later.   Now, my responsibility for this Methadone was taken very, very seriously, so you can only imagine the sheer panic that run through me at that moment.   I stood, for some seconds, just looking into the drawer at these bottles, hoping the missing bottle would suddenly materialize.   My first thought in those few seconds, was that maybe the pharmacy only gave me five doses, instead of the correct six.   Although, logically I knew the pharmacy would never have made a mistake like that, I was confused enough to consider it.   Funny, it didn't occur to me at all that one dose may have been pinched.  Foolish I know.   But honestly I was freaking out, thinking 'oh my god, I'm going to have to declare I'v lost a bottle of Methadone, I better tell Shane first.'

Normally I would respect Shane's privacy and knock before I entered his bedroom, but as the door was ajar I just barged in, all upset about my loss.   And, there he was, sitting on the bed, with a syringe in hand and the missing bottle of Methadone.   Until that moment, I thought everything was going so well, suddenly realizing that it wasn't, made me feel betrayed, stupid and so angry.   I think, seeing the syringe, was what shocked me.   I could've handled Shane pinching the Methadone to drink it, but to shoot it up, no way!   It was an awful moment and Shane never uttered a word.   He couldn't deny it, he just, silently, put the syringe down on the bed.   I picked up the syringe and the brown empty Methadone bottle, left the bedroom screaming abuse, and went straight to the lounge and threw them both on the fire.

Once calmed down, and in control, I re-entered Shane's bedroom to discuss the matter further.   He was visibly upset and apologetic for his actions, and was insistant he hadn't used the syringe.   I responded to his plea, saying;   "Well Shane, I didn't really care whether you'd used the syringe or not, actually seeing you with it was sickening enough, so tough, it's all gone in the fire now."   Shane was horrified, and stated I'd just burnt one of his doses of Methadone.   Still reeling with anger I sarcastically replied;   "Tell somebody who gives a shit, it's your muck up Shane not mine.   We're down one days dose of Methadone now,so you just let me know which day you're going without."   I left the room stating I was going to phone the caseworker and inform him of what's happened.   Shane's morale was pretty low by then, so I don't really think he cared what I done at that point.

I telephoned Shane's caseworker, and in a very upset, agitated state explained what Shane had done and how, by chance, he'd found the Methadone.   Ironically, the week prior to this slip-up, Shane's caseworker had made his first home visit and he'd checked the security of our Methadone lock-up downstairs.   Funny that though, CADS protocol obviously never required Shane's Methadone lock-up to be checked, because in all the years he was in charge, it wasn't.   I was a bit bemused by that requirement, wondering why my addict son was trusted more with the Methadone than myself.   Ok Diane, let's just move, don't dwell.   Of course, the caseworker wasn't emotionally involved like me, so this slip-up didn't affect him the same way.   I was advised that a minor slip-up like this wasn't to be seen as a complete failure, and that it would be discussed with Shane at his next appointment.   The conversation ended and I was left thinking  'Okay, that's all very well, I didn't see this slip-up as complete failure but I sure as hell did see it as possible failure.'   His comment insinuated I'd over reacted, which of course didn't ease my agitated state, so phoning the caseworker proved pointless and unhelpful.

Later that day though Shane and I did talk about the incident.   He admitted to knowing where I was putting the Methadone until it was locked up.   For two weeks he'd resisted the urge to act on his temptations.   This day, he wasn't strong enough to resist and temptation simply got the better of him.   He did it on the spur of the moment when the opportunity arose.   He was desperately trying to resist even after he'd put the Methadone into the syringe, and that's why he still hadn't injected it when I walked in.   Shane was aware of how disheartened and disappointed I felt and assured me it wouldn't happen again.

The issue of trust can be a major drawback when you're emotionally involved with an addicted person.   You want so much to trust them and believe their broken promises, but you never can.   Although I was trying to trust Shane, it was usually my gut instinct that I trusted the most.   My instincts only failed me that day because I'd become a little complacent, and maybe naive about Shane's rehabiliation, which had allowed this slip-up to occur.   However, you learn to move on quickly from upsets and problems when dealing with addiction, if you don't, disappointments can be to devastating and deflating.   Although this incident would soon be forgotten, the message behind it wouldn't, that there are consequences for every action.   Shane was reminded there is a fine line that separates advantage and disadvantage, and he certainly would be disadvantaged if my love and good intentions were continually going to be abused.  

My assumptions weren't wrong about Shane accepting my rehabiliation plan, he did declare his genuine desire to be clean and free of drugs.   But I think, he was also like myself, a bit fearful of the process that's all.   This was a mere bump in the road, and I'd be foolish to even contemplate it would be the last.

Tuesday, January 4, 2011

Discharge Day. Will Rehabilitation Be Accepted?

Well as the doctor had indicated, Shane was discharged on Friday the 30th April 2007 from Waikato hospital.   This day my rehabilitation plans were going to be revealed.   My husband and I travelled the nearly 2 hour trip to Hamilton tp pick Shane up from hospital in complete silence.   It wasn't that we didn't have anything to say, we were both just in deep contemplation of what may lay ahead of us.   I think, I was more anxious about Shane's reaction and attitude to forced rehabilitation, than fearful of taking the task on.   Shane had good virtue's though, so I'd concentrate on those and, with tact, understanding and, above all, patience, maybe we would both reach a successful conclusion.

Walking into the hospital ward and hearing all the chatter and laughter amongst the four men made me realize Shane was going to miss this sort of company once he was home.   I almost felt like taking them all with me just to keep his spirits up.   However, Shane was eager and 'ready to roll' as he put it, so I quickly located the charge nurse for discharge paperwork, prescriptions and advice regarding his convalescence.   The nurse stated that even on the Wednesday, the swelling had made Shane's ankle and leg wound surgery difficult.   So for this reason, it was imperative, the leg was kept elevated until the swelling had decreased, and also why Shane still had a high level of pain and discomfort.   The doctor had prescribed a weeks supply of the pain medication Tramadol and a sleeping sedative, thereafter the prescription was to be renewed by Shane's own general practitioner.

Shane was 'chirpy' enough and didn't seem to mind me dealing with the discharge paperwork, even asking if I'd got all his prescriptions as we departed the hospital ward.   Which should've eased my anxiety, but it didn't.   His compliance only indicated that he understood the discussion about me being responsible for his Methadone and prescriptions, not so much that he was accepting of it.   And I wouldn't dare presume otherwise knowing Shane hadn't been told as yet just what that responsibility entailed.   This dreaded task of explaining all to him, re: my rehabilitation plans and authorities were proposed for the trip home.   I couldn't delay either as my first Methadone pick up from the pharmacy was scheduled for the following morning.   I felt sure, even if reluctantly, he would accept my authority over medications but probably not so for his Methadone.   But that's just the way it had to be now.   My husband and I had decided we couldn't continue living with Shane's drug addiction the way it was before the accident, and yet we didn't want to kick him out of our home either, so this was our only other option.   Shane on the other hand, had two options, to agree and accept what I was doing to stay with us, or disagree and leave our home, it was his choice.   We were both desperately hoping of course, that he would realize we'd taken this action out of love and concern for him, not out of bitterness for what he was, therefore, would choose to stay with us.

Helping Shane into the back seat of the car and noticing how swollen and black looking his toes were reinforced my discussion with the charge nurse, and why elevation of the leg was important.   But it was how well he'd handle the pain and discomfort of his leg on the long trip home that concerned me most, knowing what had to be conversed.   I was praying the pain relief Shane had at miday would suffice, well at least until the dreaded task was accomplished anyway.   I'd planned how and what I was going to say in my head, many, many times over, when to say it all though was my problem.   I knew choosing the right moment for my conversation was imperative, if not, all 'hell' could break loose.   The trip started with a reasonably cheerful, 'chatty' Shane, even humorous telling us all about his week in hospital and I kept prolonging the task, wanting to savour the mood and humour for as long as possible.   However, Shane commenting about having to travel back into Thames the next morning for his Methadone and then again the following Monday morning prompted me to finally pursue the subject.   I braced myself, and lovingly and tactfully told Shane how his dad and I felt and conveyed how much we loved him, so he would understand our reasons why.   Then I went on to explain, as brief as I could, about the measures I'd taken and how they were going to be carried out.

Understandably, there was complete silence for some minutes from the back seat of the car.   Finally Shane spoke and, in a curt manner, he asked if I was going to escort him into the pharmacy to pick up his Methadone, because that would make him feel like and idiot.   I reaffirmed I had the authority to uplift the Methadone myself, therfore it wasn't necessary for us to attend the pharmacy together, and reassured him that he wouldn't be demeaned in anyway because of it.   His next worry was what the pharmacist and staff's attitude would be towards him now.   "With this authority you've got", he said, "they'll all know I've been a naughty boy".   The tone of his voice and the way he spat the comment out did portray how 'pissed off' he was, but I understood why.

There is somewhat of a stigma attached to being on The Methadone programme.   Having to consume your dose of Methadone in front of other customers in the pharmacy is demeaning in itself, so being respected and liked by the pharmacist and staff is the only pride you can hope to retain about being on the programme.   And it was obvious Shane had achieved this, going by the concern all in the pharmacy had shown about his accident, and general well being.   I conveyed this and told him their genuine concern was an indication of just how much they thought of him, so he didn't need to worry or be embarrassed.

Shane's final, but probably most important question, well to him anyway, was the length of time my authority for the Methadone went for.   This was the sensitive, dreaded part of the conversation, and the part that was definitely going to test all those good virtue's Shane had.   So, once again, I braced myself, and conveyed my authority was for as long as it took to withdraw and rehabilitate him off the Methadone.   I quickly turned and looked at him and said, "Im not going to be a 'bitch', Shane, about being in charge of your Methadone and all, you'll see."   Although the look, and the way his jaw was set certainly depicted his anger, it wasn't actually expressed.   Shane just went quiet.   But I think he handled it all very well, considering how miserable he must have felt with his leg, and I believe this was testament to his true strength of character.

Shane's next challenge upon arrival in Te Mata was getting into our home.   With the heavy, cumbersome cast and leg being so painful he was fearful of knocking it, so we all sat in the car and pondered which entrance Shane should attempt.   To access the front door he had ten steep steps to negotiate, and to the back door there was a steep concrete path up the side of the house to negotiate.   After much contemplation the front entrance was chosen, and accomplished with his dad's help.   It wasn't long though before Shane found an easier and less stressful way of entering and exiting the house by going up and down the steps on his botom, slowly one step at a time.

Up until the accident, Shane had been on twice weekly pick-ups for his Methadone.   I believe, more for my convenience and authority, Shane's Manukau City CADS doctor and caseworker had renewed the Methadone prescription for weekly pick ups for the following two months.   After this time the Methadone prescription would have to be renewed by CADS Thames.   I was so thankful we only had to attend the pharmacy once a week for Shane's Methadone, especially in those first intial 2 -3 weeks of his injury recovery.

Shane, as explained, still had to consume his dose of Methadone in the pharmacy on my pick up days, which happened to be the day after he'd come home from hospital.   The deal was that Shane would attend and consume his Methadone first, and then I'd go in and uplift his take home doses.   Understandably, it was an awkward, embarrassing first visit to the pharmacy for him that day, so he entered rather hesitantly, but exited absolutely 'chuffed' that the staff had made a fuss of him.   As demeaned as Shane may have felt about my authority for his Methadone, at least his pride remained intact, thanks to the kind, understanding approach by pharmacy staff.

Shane's doctors appointment to renew his medication prescription was a week after discharge, and I attended this visit.   With Shane's approval it was recorded that I was to be responsible for all his prescriptions.   For Shane to retain the privacy of these visits though, it was arranged with the doctor that all prescriptions were to be left at reception, for me to collect.

Shane hadn't verbally agreed or disagreed with my plans and changes, but he appeared settled and content to stay living with us, so acceptance was assumed.   Although everything so far indicated that, I did realize that Shane was a bit incapacitated with the leg injury and would be until the plaster cast was removed at about six weeks.   Only then would I really know how acceptable my rehabilitation plans were.