A year ago, I shoved naloxone, the medication used to reverse an opiate overdose—into my son’s backpack as he took off again in search of heroin. He’d just been released from a prolonged stint in county jail, and 48 hours later, he simply had to get high. As I cautioned him to please not use alone, to obtain his drugs from a known source, to “taste” his dose first (inject a small amount very slowly to test the drug’s potency and avoid overdose) and to please call me and let me know he was still alive, he became visibly shaken and began to cry.
Doubt overwhelmed me: “Is this only encouraging further drug use? Am I giving my son permission to shoot heroin?” I’d recently abandoned the tough love approach, but I wasn’t sure this was better. As noon gave way to dusk and the phone still hadn’t rung, I was petrified—as I had been so often in the past—that my son may have died, and that my enabling was to blame.
The Ironic Gateway
As a child, my son was rambunctious and full of energy, although, at times, shy. Focusing in class was a struggle, yet he excelled in sports—little league baseball, soccer and hockey. His greatest love was his guitar. He spent hours embracing the smooth cedar of that Ibanez, learning new tunes which he played with an earthy, mellow ease all his own. I can only imagine the pain and conflict he must have felt when he pawned even that love to buy heroin.
An experiment with marijuana at age 16 obliged him to a court-ordered 12-step program for teens. In a tragic twist to the gateway theory of addiction, it was at one of those meetings that he discovered heroin. As other teens were in the church library chanting “keep coming back—it works if you work it,” my son was down the hall in the restroom learning how to shoot up.
The last moment of peace I would know ended abruptly on a bright spring day in 2008 with a call from the police informing me that my son had been apprehended with a needle. He was well into the throes of heroin addiction and whatever warning signs there may have been, even with my background as a nurse, I had missed them all. I was on guard for many things as a parent, but in middle-class suburbia, the need to search for potential signs of heroin use had never crossed my mind.
The opioid epidemic had yet to become front-page news, so I wrestled alone with my son’s shameful secret. Terror and misplaced guilt became constant companions, yet the thought of reaching out for support only induced an acute sense of isolation. What would people think of me? That I hadn’t taught my son better than to use drugs? That I must be a failure as a mother? Consequently, I rarely spoke of my son’s struggles outside of Al-Anon meetings (a program for the loved ones of those who struggle with addiction) or the walls of a therapist’s office.
A Tough Descent
When the first two or three attempts at rehab only resulted in escalating heroin use, I became desperate for solutions. How could I get through to my son? Rehab counselors urged me to “detach with love,” explaining that his only hope for recovery was to “hit bottom.” Desperate and exhausted, I complied. Interactions with my son became wrought with an excruciating internal debate—providing a bus pass, shoes or a cell phone triggered the inquiries of “Is this enabling? Am I helping or harming my son?”
At the conclusion of another failed attempt at rehab in 2009, a trusted counselor relayed a message that she had undoubtedly expressed to many parents before me—the best thing I could do for my son was to immediately, as of that day, not allow him back into my home.
The notions of tough love and enabling—ubiquitous in American culture—are tossed about casually by self-help gurus, armchair psychologists and well-meaning friends. Yet the tough love concept became a terrifying and cumbersome tool, akin to bringing a chainsaw to a duel, when I was confronted with the idea that even providing my son with housing might contribute to his demise. I desperately wanted him to survive. By any means necessary, I needed him to find hope.
I choked back every maternal instinct that screamed at me to protect my son as I left him and his suitcase sitting on the side of a county highway next to that rehab, like so much discarded debris. In order to allow him any hope of recovery, any chance to survive, I felt forced to abandon him. I was naive in hoping that a few weeks on the streets would snap him to his senses. Instead, for the next six harrowing years he only became increasingly isolated and entrenched in his addiction. He repeatedly suffered near-fatal overdoses in dark stairwells and public restrooms as he cycled between rehabs, jail and the streets.
Counselors and peers continued to encourage me to combat enabling by diligently questioning my own behavior to determine if I was loving my child or loving my child to death. A single glimpse of my son’s emaciated frame made it shockingly clear that, in practicing tough love, I was doing the latter. As the world abandoned him, my son came to believe that he’d been given a death sentence, and had hopelessly resigned himself to it. Flirting with death became a daily routine; yet even death held no bottom.
A Frantic Search
It was early in the spring of 2013 and I hadn’t heard from my son in weeks. Calls to ERs, jails and morgues had been fruitless. I was panicked at the thought that I’d soon get a call telling me that he had been found, alone, in an anonymous dark corner, dead from an overdose. Pacing at home became unbearable, so, instead, I paced the hectic streets of downtown Denver with a photo of him in hand, looking for help. A boy, all of 16, wild hair skirting the torn collar of his well-worn t-shirt, recognized my son, but had not seen him in weeks. He knew my worry well. He shared stories of loved ones he had lost to overdose and his concern for a friend who was still missing. Overdose was a looming fear on the street, just as it was in my home.
The gritty wear and tear of lives lived on concrete may have been all that defined these faceless junkies to the casual passerby. However, the young souls I met that day yearned to be seen as caring, worthwhile human beings. Undoubtedly, their capacity for compassion far outweighed any they might receive. They offered advice on where to look for my son. They asked if he carried naloxone. They told me I could find it at the syringe exchange and that perhaps the staff there had seen him.
Every reality I had come to accept about addiction was brought into question as I walked into that needle exchange and glimpsed the raw truth of my son’s struggle. What initially caught my eye and incensed me wasn’t the line of people, young and old, well groomed and disheveled, who waited to exchange used syringes for sterile ones. Even the bins filled with works—all the supplies needed to prepare and inject drugs—while foreign and shocking to me, didn’t evoke my anger. Instead, I found myself livid over a piece of literature. A thin booklet, it described how to shoot up, how to safely access a vein and where to find the cleanest water to prepare one’s drugs for injection if sterile water is inaccessible:
If a toilet is the only source of water, always draw from the tank, never the bowl. And at any cost, avoid scooping water from ditches and creek beds. On the one hand, I was appalled. “They’re teaching my son to shoot up!” On the other hand, I was even further horrified thinking, “People are so desperately trapped in addiction they’re willing to shoot up sludge from a creek bed?” It was a pivotal moment. These were the bottoms I had left my son to pursue. If the daily potential of death had no power to deter him, the thought of shooting up sludge from a ditch wouldn’t either.
Would it not make more sense than tough love, not to mention be more humane, to offer my son tools and options to keep him alive and safe until effective help could be found? I lifted my eyes from the page and I saw suffering human beings, at their lowest, who had been written off by society and even their own families. They had just this tiny 600-square-foot sliver of space in the entire world where they knew they’d be treated with dignity and respect in exactly the condition they presented themselves. There was no judgment here—only grace.
The syringe exchange staff not only met their participants right where they were, connecting them with an array of services all aimed at reducing harm and protecting health, they also met me exactly where I was, embracing me in all of my distress, anger and confusion. They provided me with tools, like naloxone, and advice on ways to restore my relationship with my son, even as he continued to use. Although I wouldn’t find him for several days yet, what I found that day, in that cramped space of grace, was hope.
In the spring of 2015, my son was released from a yearlong jail sentence for having failed drug court. He returned home to what I hoped would be a fresh start for us both. My visit to the needle exchange left an indelible impact on me, and I experienced a paradigm shift away from the tough love ideology. While my son was incarcerated I visited homeless outreach centers, trained in overdose prevention and poured over harm-reduction literature. I found support for taking a harm-reduction approach on Facebook from advocacy groups such as Moms United to End the War on Drugs, United We CAN (Change Addiction Now), Broken No More and Families for Sensible Drug Policy.
So when my son was determined to find heroin after being released from jail last year, although I was shocked and just as fearful for him as I had been in the past, I was prepared with better tools. I had learned that it wasn’t feasible to mandate that the only two options for his struggle be either immediate abstinence and rehab or abandonment to the streets. I could no longer unwittingly take it upon myself to determine for my son how his readiness would be defined.
The message I sent by giving him naloxone and instructing him on how to prevent an overdose wasn’t permission to get high, but to stay safe and alive and to know that he was a valuable human being—whether or not he continued to use drugs. That pragmatic discussion, as difficult as it was, pulled him out of shame and stigma instead of pushing him further into it. He was back home in hours, rather than showing up weeks later disheveled, sick and 30-pounds underweight, as had routinely been the case before.
Handing my son naloxone didn’t prevent him from shooting heroin that night, nor did it result in an overdose reversal, but its effect was powerful nonetheless. He began to trust that I was no longer judging, but trying to understand and show him support. He talked with me more openly about his experiences than he ever had in the past. Within a week he asked for help, sincerely—and on his own terms. He chose to pursue medication-assisted treatment, which has saved his life.
I occasionally visit my son at the busy local diner where he now works as a server. I watch him scramble to deliver club sandwiches and refill drinks on his way to a hard-earned lunch break. I marvel at how healthy he now appears, with clear skin and eyes bright with life, and a blend of surreal joy and gratitude inhabit my smile when I think that just a month ago he celebrated a year free from heroin.
It has been a challenging year for him, spent learning basic life skills and shedding almost a decade of street-life habits. But today he is no longer the target of disdainful sneers from strangers and he finds happiness in things heroin once stole. Simple pleasures, such as playing guitar or enjoying a meal, make him happy once again. My tendency to compulsively wait for the other shoe to drop is gradually giving way to the anticipation of daily life and plans for the future as our painful, tough-love past becomes a distant memory.