You felt a huge sense of relief when your loved one started treatment. You thought this was it—the turning point. Then, you discover they are still using other drugs, even while on methadone or Suboxone. It can be a deeply confusing and discouraging moment, leaving you to wonder, “Is this even working? What am I supposed to do?”
TL;DR:
It’s common for people to continue to use other substances, at least for a time, after starting Opioid Agonist Treatment (OAT) like methadone or Suboxone. This is not a sign that treatment is failing.
Reasons for continued use can include an unmanaged co-occurring disorder (like anxiety), the medication dose not yet being stable, or the powerful force of habit.
The best way to respond is with compassionate curiosity, not judgment. Focus on reinforcing the positive step they’ve taken by being in treatment.
Your role is to maintain healthy boundaries to protect your own well-being while encouraging them to be honest with their doctor, who can adjust their treatment plan.
Street Drug Use on OAT
If you have a loved one who you find out was using while in treatment, please know two things: first, this is a very common part of the recovery process. Second, it does not mean the treatment has failed. Understanding why this happens and how you can respond effectively is key to supporting your loved one and protecting your own well-being.
Why Does This Happen? Understanding Concurrent Use
Starting Opioid Agonist Treatment (OAT) is a huge, life-saving step. It stabilizes a person, stops opioid withdrawal, and reduces cravings. However, it doesn’t instantly solve every underlying issue. There are several reasons why a person might continue to use other substances:
The Dose Isn’t Stabilized Yet: It can take weeks or even months to find the perfect “stable dose” of methadone or Suboxone—the dose that holds them for a full 24 hours. During this stabilization period, they may still experience some withdrawal or cravings and use other drugs to manage those feelings.
Use of a Different Type of Substance: OAT is specifically designed to treat opioid use disorder. If your loved one also struggles with another substance, like stimulants (e.g., cocaine) or benzodiazepines (e.g., Xanax), the OAT won’t address the cravings for those drugs.
Co-Occurring Mental Health Issues: Many people use substances to self-medicate untreated mental health conditions like anxiety, trauma, or depression. As we explore in our guide to dual diagnosis care, until they learn new coping skills, they may fall back on old patterns during times of stress.
The Power of Habit and Triggers: Addiction creates powerful, deeply ingrained habits. The social cues, people, and places associated with past use are still powerful triggers, and it takes time to build new routines and coping mechanisms.
Is the Treatment Failing? A Shift in Perspective
It’s natural to see continued drug use as a failure, but it’s more helpful to reframe it. Instead of seeing OAT as a simple “on/off” switch for all drug use, think of it as a powerful tool that makes recovery possible.
Harm Reduction in Action: Even if they are still using sometimes, being on OAT is providing a massive benefit. Their risk of a fatal opioid overdose is drastically reduced. They are connected to healthcare, often for the first time in years. This is the core of harm reduction—it keeps people alive and creates a platform for positive change.
Success is Not a Straight Line: Recovery is a journey with ups and downs. A “slip” or a period of continued use is not the end of the story. It’s a sign that the treatment plan may need to be adjusted, not abandoned.
How to Respond: A Guide for Families
Your response can either open the door to communication or shut it down.
AVOID:
Accusations and Anger: “I knew you weren’t trying! You’re still using!” This will only lead to shame and secrecy.
Lecturing: They likely already know the risks and feel guilty. A lecture won’t help.
Ultimatums (without a plan): Saying “If you use again, you’re out!” without offering a path to getting more help can backfire.
TRY INSTEAD:
Lead with Compassionate Curiosity: “I’ve noticed some things that make me worried you might be struggling. How are things going at the clinic? Is there anything I can do to support you in being open with your doctor?”
Reinforce the Positive: “I am so proud of you for going to the clinic every day. That is a huge accomplishment, and I know it isn’t easy. Let’s focus on how we can make that treatment work even better for you.”
Maintain Your Boundaries: It is crucial to protect yourself. This means sticking to boundaries you may have set, such as not giving them money. You can say, “I love you and I support your recovery, which is why I can’t give you cash. But I can drive you to the clinic or help you buy groceries.” Our guide to supporting without enabling has more on this.
The Critical Role of Honesty with Their Doctor
The most constructive thing your loved one can do is be honest with their doctor at Arrow Medical. We are here to help, not to punish.
When a patient tells us they are still using, it gives us critical information.
It might mean their dose is too low.
It might mean we need to screen for and address a co-occurring mental health issue.
It might open a conversation about trying a different medication or approach.
Encourage your loved one to be honest. Reassure them that the clinic is a safe, non-judgmental space and that honesty is the fastest path to feeling better.
Frequently Asked Questions
Q: Will they get kicked out of the clinic for using other drugs? No. At Arrow Medical, we practice harm reduction. We would never discharge a patient for relapsing or using other drugs. Our response is to increase their support and adjust their treatment plan to better meet their needs.
Q: How long should this last? When should they be completely “clean”? There is no magic timeline. Every person’s journey is unique. For some, concurrent use stops quickly as their dose stabilizes. For others, it can be a longer process. The focus should be on progress, not perfection. Any reduction in street drug use is a victory.
Q: What if they are using stimulants like meth or cocaine? This is very common. While OAT doesn’t treat stimulant use directly, the stability it provides can help a person address it. Being honest with the doctor is key, as they can provide strategies and referrals for the stimulant use as well.
This is a challenging situation, but it is a normal part of the recovery process. Your patience, compassion, and firm, loving boundaries can make a world of difference. Encourage your loved one to lean on the support available at their Arrow Medical clinic.
