How do you get help for a loved one who refuses to admit there’s a problem?

My question is regarding my boyfriend, who is currently living with me and doesn’t seem to want help.

He had a car accident in December 2013, causing 11 surgeries within about nine months. He became addicted to his pain medication. He would be prescribed 90 tablets of oxycodone 30mg every month, which he would somehow finish in about two to three days. He then decided to start injecting drinking alcohol into himself through his PICC line to lessen the pain—and I think his withdrawal symptoms, too. After numerous ER visits for this, all the specialists he had been seeing refused to treat him anymore. He’s also had two pain management doctors drop him as a patient and refuse to treat him. He says that both of these doctors told him it was because they can’t treat his shoulder pain, only his back. But it’s doubtful this is true at all. Right now, his primary care physician prescribes him 60 tablets of oxycodone 20mg every four to six weeks, which he will finish in 48 to 72 hours by crushing and sniffing them up his nose. But worse yet, once they are gone, he will use heroin, mostly, but also meth, marijuana, or buy more pain pills on the streets.

He has been abusing his pain pills for a little over two years and has been using heroin since last July.

My question and dilemma is that my boyfriend keeps denying that he uses heroin. Even after I confronted him with his text messages asking people where to buy heroin, he keeps on saying that he’s not addicted to anything, that he’s not withdrawing, that his pain is just increasingly worse sometimes.

I have tried calmly talking with him about how dangerous heroin and the other drugs he buys are, but he refuses to get any type of help.

What family members he does have left are on either meth or heroin and refuse to help, so I’m on my own here to help him become clean again.

I know I’ve read somewhere that an addict must admit he’s an addict and want help, or rehab won’t help. What can I do or say to help him? Is it possible to convince an addict to go to rehab?

Sorry this is so long, I just wanted you to understand my boyfriend a little better. He really is a wonderful man and father.

Percy Menzies: It is quite evident that your boyfriend has developed a serious case of addiction to opioids and also needs psychiatric services. Although you have not mentioned it in your email, it is likely that your boyfriend may have been using drugs and/or alcohol before the accident.

We have known for a long time that opioids are not appropriate for chronic pain. The tolerance build-up forces the patient to use escalating doses and use other opioids like heroin, and ingest these drugs by snorting or injecting. The use of opioids was initially triggered by the post-op pain, but now it is driven by the withdrawal symptoms. Negative feedback of withdrawal symptoms is the single biggest factor in sustaining an addiction to opioids.

The first step is to detox this patient off the opioids by utilizing buprenorphine—Subutex would be more appropriate than Suboxone, as even a small amount of the naloxone could exacerbate the withdrawal. Buprenorphine is a potent analgesic, but is much safer and less likely to cause tolerance. It is both a very good detox medication and an effective maintenance drug for patients with legitimate chronic pain.

You need to choose the “rehab” facility very carefully. Most patients addicted to opioids are terrified of seeking treatment because they associate rehab with “cold turkey” detox. The medical detox should not only treat the withdrawal, but also the other symptoms like nausea, vomiting, muscle cramps, insomnia and anxiety associated with withdrawal. This patient may need to be on buprenorphine for a long time.

At our clinics, the patients and their families feel a lot more assured when they are told how the detox is going to be done by the physician, and that they are not going to be left with excruciating pain. Many clinics are willing to meet with the patient in person and explain the detox and stabilization protocols in detail. The present situation is not an option for your boyfriend.

Of course, none if this will be of assistance if your boyfriend continues to refuse to accept that he has a problem, despite your efforts. There is one problem that your boyfriend is willing to acknowledge, and that is his worsening pain. I’m wondering if he would allow you to go with him to his next appointment with his primary care doctor so that you could take part in a discussion about the long-term strategy for managing his pain. That could be a good opportunity to discuss the variety of effective, non-opioid-based strategies for pain management, including other (non-addictive) medications, yoga, certain forms of psychotherapy, relaxation training, etc. If he can come to realize that opioids are not the (only) answer for him and begin engaging in a more holistic, long-term approach, hopefully some progress can begin to be made.