Your son or daughter has promised countless times to seek treatment for opioid addiction.
Yet, their addiction worsens. They steal. They turn violent. The sanctity of the family home is diminished.
So who could blame a mother or father for throwing their addicted son or daughter out of the house?
Many parents feel they have no choice. As a result, doors and hearts are closed to their children.
Yet some say they live to regret it when opioids take their final toll and kill their child.
So far this year, 55 people in Erie County have died from suspected opiate overdoses, and that comes on top of last year's 324 confirmed and unconfirmed fatal overdoses.
But now there's an alternative to the tough-love practice of severing ties.
The Save the Michaels House of Hope and Community Resources, which opened its doors three weeks ago, teaches parents about addiction and how to work with their son or daughter by setting up rules and goals that can lead to long-term recovery.
And 25 parents who have either lost children to opioids or whose children are now addicted have enrolled in a course that begins next month to train them in becoming recovery coaches.
"Family members often think that it is only the addict that needs to start changing, but it is really about the dynamics in families, how people communicate, the respect, the understanding and that is usually not the case in a lot of these use situations, " said Karen Knab, a licensed therapist who volunteers at the facility. "It is so important to work with everyone in the family."
The House of Hope and Community Resources is actually several rent-free offices and meeting rooms donated by Horizon, the region's biggest mental health provider, which also has offices in the building at 11 Summer St., set back from the intersection of Main Street.
"Parent education is essential in helping us to deal with the current crisis. Treatment providers can't provide everything. We can't provide every role, not to the extent of the need. The need exceeds our capacity," said Anne Constantino, Horizon's executive director and CEO.
Avi Israel says the facility, named for his late son, caps two years of efforts to provide the community with a more humane approach in working with loved ones caught up in the throes of addiction.
"Never throw a kid into the street. When you do that, you show them how much you don't care," Israel said. "You know drugs make the kid into a monster, and it is up to parents to find ways to get their loved one out of the monster."
Israel says he was never able to free his son of the monster because he lacked an understanding of addiction's complexities. Michael Israel took his life in June 2011 in his parents' North Buffalo home. His death followed years of addiction to painkillers that had been prescribed to him after he was diagnosed as a teenager with Crohn's disease.
It was only after he started reading his son's journals, long after Michael was gone, that Israel realized how much he and other parents in similar situations needed to educate themselves.
Sitting in his first-floor office at the House of Hope and Community Resources, Israel gets choked up as he makes a case for families to work with children suffering from substance use disorder.
"I knew every little detail about Crohn's disease. I knew what Michael could eat and not eat. I knew his medicines. But I didn't know anything about addiction. I didn't give him the right support. I listened to counselors repeating the same nonsense about tough love. I didn't realize all Michael wanted was love," Israel said.
In one of the 20-year-old son's final journal entries, he wrote of his challenges and anguish:
"Sure quitting is scary but I can't let boredom get in the way of sobriety. My father and mother are trying to trust me and the lying and betrayal is terrible. The amount needed for intoxication is way too much.
"No one can succeed while using drugs. I just have to let it all go and can't look back. …I can't use alcohol or cigarettes to fill the gap left by pills."
When Michael Israel moved into an apartment in the months before his death, his family changed the door locks at their house and he was forbidden to return home. That did not stop him. He found a way back in through an unlocked window.
"All he said was 'I want to be with you guys,' " Israel recalled of the conversation. "His mother told him he needed to go into treatment."
Their son left the house with a heavy heart and "very dejected," Israel said.
Parents often lack sound information in how to work with a child struggling with addiction and as a result may not make the best decisions in trying to help their loved one, according to Knab, a state-licensed marriage and family therapist who has started a three-month lecture series at the Summer Street facility.
The topics include "Addiction Is a Family Disease," "Relapse Prevention" and "Maintaining Recovery."
Knowledge on those subjects, Knab said, can help head off addictive behavior from becoming unbearable for all concerned. A good start involves setting rules and goals that everyone agrees upon.
Erie County Mental Health Commissioner Michael Ranney says there is room for compassion in these circumstances.
"The best approach I think would require a balance between tough love and some tendencies to enable. That would be an approach that demonstrates caring for the person and support as well as establishing boundaries and limits," Ranney said.
No drug use in the home and a commitment to seek treatment are reasonable conditions, he said.
"The goal would be to help the person get into treatment or help get them ready for treatment," Ranney said. "What we need to remember is that addiction is treatable."
But what if the individual continues using drugs in the home? Is it still realistic to let that person continue to live there?
Knab says addicts can be asked to leave the house if they continue with drugs, but not before alternative arrangements are made.
"Having someone using drugs in your home is not a long-term solution. It may be appropriate very temporarily while you are looking into treatment options or interventions," she said.
A painful perspective
Pam Russell, whose 22-year-old daughter died from a fentanyl overdose two years ago, said it is admirable what the House of Hope and Community Resources is trying to accomplish, though some situations are beyond the efforts of family members.
"In an ideal world, that is great. But what Avi doesn't realize is that when you have a child hating you and blaming you for everything that has possibly gone wrong in their life, they don't use the family for resources," Russell said.
She and her husband followed the way of tough love, and their daughter was asked to move out of the family's home in Cambria.
"I did it and I regret it and so does my husband, but she was bringing her addiction habits into our home," Russell said.
If they had it to do over again, they would have found "a proper treatment facility, but these places are not available," the mother said.
Kelsey Russell started using drugs in high school to cope with bullies, depression and anxiety. Pam Russell says when her daughter needed help at crucial points, she fell through the cracks. The mother cited a lack of beds at long-term area treatment facilities and a lack of follow-up at an outpatient treatment program Kelsey had stopped attending, despite a court order.
"I have talked to so many of my daughter's friends who are still struggling with addiction and they say that long-term care is essential followed by expensive long-term outpatient care," Russell said in explaining that not all outpatient treatment is equal. "My daughter needed to be transferred from the outlying court in Cambria to a hub court or drug court with more authority in dealing with these situations. There she could have been either placed in jail or into a treatment facility."
Ranney says there is a need for more inpatient treatment beds.
"Additional beds would be beneficial to the system, but we have to remember that medication-assisted outpatient treatment can also be beneficial," he said.
Russell also wanted to stress that her daughter, despite all the anguish she and the family experienced, was not a bad person, but rather suffering from a disease.
"She was a great person who made a bad choice that ended up causing her to face the struggle of her life and eventually face her death," Russell said. "One of the last conversations my daughter had with me was that if she could do anything over she would have never tried drugs because they have ruined her life and taken everything from her."
And while Russell believes it will take more than the House of Hope and Community Resources to head off future drug-related tragedies, she commends Israel and the other parents involved for wanting to set up a strong support system for families.
"Parents need to open their eyes and not think that 'No, it can't happen to my child,' " she said of the insidious nature of addiction.