It was Bea Duncan who reached for the phone at 2 a.m. on a January morning nine years ago. Her son Jeff had been caught using drugs in a New Hampshire sober home and was being kicked out.
Bea and her husband Doug Duncan drove north. On the ride back home, to Natick, Massachusetts, the parents delivered an ultimatum: Jeff had to go back to rehab, or leave home.
Bea Duncan says her son chose the latter. She remembers a lot of yelling, cursing and tears as they stopped the car, in the dead of night, a few miles from the house.
“It was really, really difficult to actually just drop him off in a parking lot on our way home and say, you made the decision — no rehab — so we made the decision, no home,” says Bea Duncan. “It was exquisitely difficult.”
But it was not unexpected. Doug Duncan says many parents had told him to expect this moment.
Your son, Duncan remembers parents saying, will have to “hit rock bottom, you’re going to have to kick him out of the house.”
Two torturous days later, Jeff Duncan came home. While he returned to rehab, the Duncans decided their approach wasn’t working. They sought help, eventually connecting with a program that stresses empathy: CRAFT or Community Reinforcement and Family Training.
“There was more compassion and ‘wow, this is really difficult for you,’ more open questions to him instead of dictating what he should and should not behave like,” says Bea Duncan.
The Duncans say the training helped them shift from chaos to calm.
“I started to feel an immense sense of relief,” Bea Duncan says. “I stopped feeling like I had to be private investigator and controlling mom. I could kind of walk side to side with him on this journey, instead of feeling like I had to take charge of it.”
The Duncans credit switching from family consequences, like kicking Jeff out of the house, to outside ones, like losing a job due to drug use, with helping their son stick to recovery. He’s 28 now and has sober for nine years.
Many drug users say, in hindsight, they appreciate being forced into treatment. But many studies show that a compassionate approach and voluntary treatment are the more effective ways to engage drug users in recovery and keep them alive. That’s a critical consideration for families in this era of fentanyl, which can shut down breathing in seconds.
“The concept of letting their children hit bottom is not the best strategy because in hitting bottom they may die,” says Nora Volkow, director of the National Institute on Drug Abuse.
But desperate parents often don’t know how to avoid hitting bottom with their children as the Duncans did on that dark, frigid January morning. They have found ways to help: Doug is a parent coach through the Partnership for Drug-Free Kids and now, in collaboration with the Grayken Center for Addiction at Boston Medical Center.
The Grayken Center will help fund an expansion of the partnership’s helpline where bilingual specialists will work with parents on a plan to address their child’s immediate needs. Parents will be referred to local resources and coaches for five or six sessions via the phone, text or live chat. Families do not need to be patients at or seek services from Boston Medical Center.
Grayken Center director Michael Botticelli says the collaboration will close a gap in services for families caught up in the opioid epidemic.
“They don’t call this a family disease for no good reason,” Botticelli says. “The whole design of these services [is] to promote tools and information for families so they know how to approach a situation and can heal.”
There is no uniform path to healing for the drug user or parents and no widespread agreement on the best approach for families.
Joanne Peterson, who founded the parent support network Learn to Cope, says there are reasons why some parents ask older children to leave the house — if there are younger children at home or if the parents don’t feel safe.
“So it depends on what tough love means; it can mean many different things,” Peterson said.
She applauds the Grayken Center for expanding access to parent coaches, but “we also need more professional help.” Peterson says she routinely hears from parents who can’t find counselors and doctors who understand their daily traumas.
Some critics suggest the CRAFT model is too soft, that it enables drug use.
“That’s a misconception,” says Fred Muench, president of the Partnership for Drug-Free Kids. “CRAFT is authoritative parenting, creating a sense of responsibility in the child and at the same time saying ‘I am here for you, I love you, I’m going to help you, but I can’t help you avoid negative consequences if you’re not looking to do that on your own.’ ”
Some families are skeptical about the Grayken Center’s affiliation with the Partnership for Drug-Free Kids. They’re angry at the partnership for accepting money from drug companies the families blame for igniting the opioid epidemic. The partnership says it has severed many of those ties. But it argues that pharmaceutical firms “have an urgent responsibility help bring forth effective and actionable resources to help the millions of families who are dealing with an opioid use disorder at home.” The partnership says it is not “influenced by any financial contributor” but that funding from drug companies can help advance its mission.
The parent coaching extends beyond periods of crisis.
On a recent afternoon, Doug Duncan is on the phone with Doreen, a mom whose daughter is in recovery. (We’re only using Doreen’s first name to protect her daughter’s identity.) Doreen is upset about an angry text from her daughter that sounds like the young woman who overdosed twice.
“It brings me back there. In two seconds I am back on that scene thinking she’s on the heroin, she’s not going to live,” Doreen tells Duncan, expressing a fear of relapse that is common among families during the opioid epidemic.
In a panic, Doreen wants to respond with a question — is her daughter using heroin again?
Hold on, says Duncan, let’s talk about it.
Doreen pauses, then says she could ask her daughter about work, whether it’s been stressful, or about her grief after a friend’s recent death. There are many reasons, Doreen realizes, that her daughter might be angry. Her tone doesn’t have to signal a relapse.
“You talk yourself off the cliff,” Duncan says.
“Oh yes, I know all about that cliff, I’ve visited a few times before,” Doreen laughs. “You know that ties in with what you said before about focusing less on what your feelings are and the terror or fear that you’re going through and more on what they’re feeling and what they’re going through — turn the tables a bit. That’s an excellent point.”
“That’s true compassion,” says Duncan, “and oddly enough it’s very therapeutic for you too.”
“Absolutely,” says Doreen.
More compassion in the home fits the shift away from criminalizing addiction — toward accepting and treating it as a medical condition.
If a child has cancer, parents “wouldn’t disengage with them or be angry with them,” says Botticelli. “So I do think it aligns our scientific understanding that addiction is a disease and not a moral failure with some of the practices that we know to be helpful and effective.”