Help A Loved One With Substance Abuse
It can affect any age, race, sex, gender, socioeconomic status, religious background or ethnicity. No one is immune to the possibility of becoming enslaved to a substance.
Help A Loved One
The ideas and information in these questions and answers were borrowed from the Commission on Accreditation of Rehabilitation Facilities; Joint Commission on Accreditation of Healthcare Organizations; Health Cost Institute; Health Services Research; HHS.gov/HealthCare; National Institute on Drug Abuse; Substance Abuse and Mental Health Services Administration; United States Department of Labor. The original document source for questions 1-10 may be found at the following location: https://www.addiction.com/get-help/loved-one/faq-for-loved-one/
How can I tell if my loved one is addicted?
If you’re questioning whether your loved one has an addiction, it’s probably because you have long recognized that his/her use of a substance or a compulsive behavior is disruptive to their life as well as your own, and perhaps many other people’s lives as well. However, an addiction isn’t the same as using a lot of drugs or alcohol or too frequently partaking in an activity like sex, overeating or gambling. You can tell if your loved one is heading towards an addiction when he/she is no longer able to steer clear of the substance or activity and can’t cut back even if the desire to do so is there. You may have noticed uncontrollable cravings and that your loved one continues to use the substance or repeat the behavior no matter how much the addiction is hurting himself and those who he/loves most. The addict will miss important deadlines, obligations and activities he/she once loved in order to use leaving you and others feeling disappointed, exhausted and emotionally spent.
If you’ve reached this point, the “drug” of choice has become your loved one’s single pleasure in life. When something or someone interferes with your loved one’s ability to use, he/she will become angry, frustrated, tearful, anxious and even worse. Signs your loved one might be using vary greatly depending on the substance(s) used, how it is taken and if a loved one recently used the substance or is currently experiencing intoxication or withdrawal symptoms. But in general here are some changes to notice:
- Elevated mood; heightened confidence
- Increased relaxation
- Extreme anxiety; exhibiting paranoia
- Slurred speech
- Problems concentrating or thinking
- Memory problems
- Involuntary eye movements
- Increased energy and restlessness
- Rapid or rambling speech
- Enlarged pupils
- Mood and attitude shifts
- Weight changes
- Nasal congestion; bloody noses
- Chills, sweats, shakes (tremors)
- Memory difficulties; cloudy thinking
- Not responding to pain appropriately
- Coordination problems
- Impaired judgment
- Sensitivity to loud noises
- Experiencing flashbacks
How can I get my loved one to go to treatment?
Actually getting an addict to accept treatment can be one of the biggest hurdles families face, especially when the loved one is someone over which you who you have no legal influence. At this point, you may need to find a way to finally convince your friend or family member that treatment is necessary. It’s a good idea, though, not to go it alone. Instead, enlist the help of a professional interventionist. Using various methods, an interventionist can help persuade your loved one to enter a treatment program and even help deliver him/her there. Because interventionists have been in many intense situations with addicts who became angry or violent or who flee, they know how to make a plan that will work and perhaps most important, they have a plan of action when the addict reacts. Many interventionists were once addicts themselves, so they offer a “been there, seen that” perspective that often allows an addict to trust that treatment is a positive step.
Can I force my loved one into treatment?
In most cases you can’t force your relative or friend into treatment. The one exception is that a parent of an underage child can send their child to treatment, and some states have legislation – such as Casey’s Law in Kentucky and Ohio – that allows parents to force treatment on adult children who don’t recognize they need it. So find out what your state has already on the books to help you help your child. Here’s something else really important to know: The National Institute on Drug Abuse states that treatment doesn’t have to be voluntary to work. That means that your loved one can be helped even if he/she goes begrudgingly in order to fulfill terms of employment or to save a marriage or retain parental custody. Intervention experts tend to agree that you should try to persuade your loved one to agree to treatment using a variety of techniques. Since it’s now understood that addiction is a chronic brain disease (not a question of willpower or a moral failing), getting an addict to buy into treatment in a more loving, respectful manner is a good idea if you can manage it. Still, treatment can become the only viable option for someone who is confronted by jail time, child welfare agencies, an employer who makes treatment a requirement of employment or a spouse who’s ready to divorce.
I’ve tried everything; how can I get my loved one to stop drinking/using?
You must feel terribly frustrated, sad, angry and disappointed – among other emotions – that your partner, friend or relative won’t stop using in spite of all the times and ways you’ve tried to convince them to stop. You may already know that addiction is a chronic brain disease that’s progressive, so without help of some kind it is typically gets worse, not better. Unfortunately, though, once someone has become addicted, he/she cannot usually stop the behavior on their own, and that can mean that professional treatment is necessary. This process usually starts with going through detox (a period of time when the chemical(s) and/or behavior(s) is removed or stopped), followed by counseling and perhaps support groups to learn about addiction, how to sidestep triggers, relapse prevention and how to choose healthy activities to replace the problem use or behavior.
What kind of treatment is right for my loved one?
Unfortunately, there’s no one-size-fits-all when it comes to treating addiction. Because your loved one has his/her own values, beliefs and history of addiction and possibly mental illness, trauma and other factors, all of these come into play and need to be addressed to enable your partner, friend or relative to live a healthy, sober life. In addition, where your loved one lives, his/her career and insurance coverage are other major considerations that determine what kinds of treatment are available and what he/she can afford. Several treatment settings are available:
- Inpatient (or residential) treatment: A rehab facility where your loved one will stay for a period of weeks or months.
- Outpatient/day treatment: This means your loved one sleeps at home but attends either a day treatment/partial hospitalization program for seven or eight hours a day or an evening outpatient program for a couple of hours several times a week.
- Sober Living Communities: Learning to live sober can be easier in a place where addictive substances and activities are not allowed, and there are rules about steering clear of substance use to continue residency. Also known as therapeutic communities, recovery houses or transitional homes (and once called halfway houses), people committed to recovery can live in one for a period of months to a year to help transition into sober life after an inpatient or during or after an outpatient program to help sustain their recovery.
Which option you or your loved one chooses should depend, too, on how much his/her home, work and social environments are contributing to using. If it’s impossible for him/her to get away from triggers to use while living at home, for example, residential treatment may be necessary. For more details on these and other options, read more in Types of Therapies. Another great resource is the Behavioral Health Treatment Services Locator directory offered by the Substance Abuse and Mental Health Services Administration (SAMSHA); or call their 24-hour Treatment Referral Line at (800) 662-HELP.
What if my loved one is addicted to more than one substance/behavior?
If the person you love is struggling with multiple addictions (as well as other mental disorders), they’re definitely not alone. Those who treat addiction say this is very common. Some addicts may have what’s called a “co-occurring disorder” – meaning they have an addiction(s) and a mental health issue(s) such as depression, anxiety or ADHD as well. Research shows a connection between substance use (meaning drugs and/or alcohol) and also having a problem with excessive gambling, video gaming, disordered eating, Internet use and sexual behavior.
How can I find a treatment center?
When your loved one is diagnosed with an addiction, his/her doctor, therapist or an interventionist may recommend a type of treatment center based on the addict’s – and your family’s – needs, whether inpatient, outpatient or day treatment. That recommendation should help you start the research process. SAMHSA’s Behavioral Health Treatment Services Locator is another resource to try; you can reach them by calling (800) 662-HELP too. Your loved one’s health insurance company, as well as friends and family, may also provide referrals for a treatment center. When choosing inpatient treatment, be aware that your loved one may not need to stay close to home, so you can broaden the search to include inpatient treatment centers across the country if you choose.
How can my loved one afford to pay for treatment?
Addiction treatment can be pricey, but there are also affordable options that are available for your loved one. If your loved one has insurance treatment for mental health and substance abuse is likely covered, at least in part and without restrictive co-pays, deductibles and visit limits, thanks to the new Mental Health Parity and Addiction Equity Act and the Affordable Care Act (ACA). Under these laws, most major insurers and Medicaid are required to cover services for mental health and substance abuse care as one of 10 “essential health benefits” categories. They must be covered at parity (equal cost) with other health issues and insurance companies can’t deny coverage to those with pre-existing conditions, including drug or alcohol dependence. That said, coverage can vary by plan and state, so make sure your loved one contacts his/her insurance company directly to learn more about the specifics of the plan. For more information on ACA, visit www.healthcare.gov.If your loved one doesn’t have health insurance, many treatment facilities and healthcare providers offer sliding-scale fees, or fees based on your loved one’s income. Some treatment centers even offer financing options through their own facility or through third-party lenders. To learn more about payment options, try the Behavioral Health Treatment Services Locator, provided by the Substance Abuse and Mental Health Services Administration. This free tool offers payment information for each of the treatment services listed, including information on sliding-fee scales and payment assistance. Your loved one can also contact his/her state substance abuse agency to find out if his/her state will help pay for treatment.
How can I support my loved one in treatment?
Knowing your loved one well, you’re in a unique position to understand what he/she might need most during this very difficult time. But because addicts often behave in unusual and atypical ways, it may useful to ask this very question to your loved one’s treatment provider(s) to find out how best you can help them. In general, however, it’s important to tell your loved one that you admire his/her courage for admitting to the addiction and seeking help and that you’ll continue to offer encouragement and support as long as he/she sticks with the treatment plan. Treatment facilities often encourage families to be involved in the recovery process through family or couples therapy. These sessions are designed to improve relationships, address family problems that could perpetuate addiction (such as enabling and codependence behavior), heal past hurts and teach new, healthier ways of communicating. A loved one who enters a residential treatment program, at which contact with the outside world may be limited, will need a lot of support once the program ends. At this point, you may need to be there even more to help your loved one identify and avoid any triggers, like reconnecting with friends who still use. You may also remind your loved one that you’re just a phone call or drive away, should temptation arise. Another important step – for your loved one and for yourself – is to join a support group for family members of people with addiction, like Al-anon, Alateen and Families Anonymous. Held around the nation, these free groups are dedicated to providing ongoing support and education to the family and friends of addicts. While you can do your best to learn the details of your loved one’s treatment and offer love, support and encouragement, it’s important to note that the majority of the work has to come from your loved one.
I feel like I’m falling apart. What are some ways to help me cope with my loved one’s addiction?
First, take heart in the fact that you’re not alone. The actions of addicts, whether their “drug” of choice is heroin, alcohol, sex, gambling or something else, affect most everyone in their lives. And those they love are often hurt the most. If you have been living with an addict it’s pretty common to feel like you’re at the end of your rope. You’ve been patient and understanding. You’ve offered help. You’ve been an active member of the treatment and recovery process – and you’re exhausted and perhaps even feeling hopeless. Unburdening yourself to people who understand first-hand what you’re going through can be a powerful and healing process. That’s why joining a support group for friends and families of addicts, like Al-anon, Alateen and Families Anonymous, is so often beneficial, even for people who never thought they’d join a group like this. This type of free self-help group will let you unburden difficult feelings, share your experiences and get helpful strategies for keeping it together. And while you may not feel like it, you have to take care of yourself. As much as you’re able, take time to exercise, eat right, get enough sleep and find ways to cope with the tremendous stress you’re feeling. If you want to keep making an effort to encourage and support your loved one, it can’t be said often enough: You have also take care of yourself.
5 Steps to Freedom
"I’M NOT READY TO DEAL WITH MY ADDICTION."
A person enslaved to a substance in this stage…
- May be so distracted and/or discouraged by their addiction they are not able/willing to change
- Is often not thinking about changing and is trying to pretend to be a happy user
- Has learned/convinced themselves they are helpless in their addiction and feels that change is impossible and that they must ignore the negative consequences of their addiction
- Cannot imagine the possibility of a different life
- May feel defeated by prior attempts to change
- Will often minimize/justify their problem, be argumentative, and be in denial that there is a problem
- May minimize their addiction by saying things like "It's not that big of a deal" or "I'm not as bad as…"
"I’M STARTING TO THINK ABOUT DEALING WITH MY ADDICTION."
A person enslaved to a substance in this stage…
- Is starting to have increased awareness of the negative impact of their addiction
- Is struggling with whether or not changing their life will be worth the effort – will the benefits of sobriety (getting clean) outweigh the cost of using
- Is unsure, reluctant, or ambivalent to commit to a particular course of action
- Is feeling “stuck‟ - often procrastinating for an average of 6 months
- May experience greater guilt and shame as they begin to evaluate their life
- Might say things like, “I’ll make a change one of these days” or “I should probably make a change”
“I’M MAKING PLANS TO ADDRESS MY ADDICTION.”
A person enslaved to a substance in this stage…
- Is beginning to see that they are responsible for their choices
- Is starting to realize that they have the power to make life-changing decisions
- Is beginning to gather resources, while looking for and evaluating different options
- Has made the decision to change and acted upon it by beginning to develop a timeline and realistic plans to do so.
- May be worrying about and/or comparing new plans to previous failed attempts to change
- Is seriously planning to change a behavior in the next 30 days and has taken the beginning steps
“I’M STARTING THE PROCESS.”
A person who is becoming free from being enslaved to a substance in this stage…
- Has immersed themselves in addiction recovery and is actively pursuing activities to change or modify their behavior
- Has begun their life makeover and is pursuing holistic life restoration and health in five areas of their life (Physical, Psychological/Emotional, Intellectual, Relationships, and Spiritual)
It is important that both the addicted person and their loved ones understand the differences between treatment programs before selecting a treatment program. Finding the right treatment program can put you or a loved one on the road to sobriety.
- Detox Program - Some people may need to get “clean” (get the effects of the drugs out of their system) so that they can begin their rehabilitation (life makeover). The first step for many addicts’ treatment is medically-assisted detox. Physicians and addiction specialists monitor patients’ vital signs and medical and mental effects while the drugs exit the system. Drug cravings are often intense during detox and can be difficult to overcome, which is why, during this period, many relapse.
- Inpatient Program (Residential Treatment) - This is an intensive program designed to treat serious addictions. These programs require patients to check themselves into a controlled environment to overcome their addictions. Patients stay at a clinic with 24-hour medical and emotional support. During inpatient treatment, residents are able to completely focus on getting well and sober without the distractions of everyday life.
- Out-Patient Program - Outpatient drug rehabs are part-time programs, allowing the recovering user to keep going to work or school during the day. These sessions focus on drug abuse education, individual and group counseling, and teaching addicted people how to cope without their drug. Outpatient drug rehab can be a good standalone option for someone with a mild addiction, or it can be part of a long-term treatment program.
“I’m staying clean.”
A person who is no longer enslaved to a substance in this stage…
- Has established new behaviors (i.e. alternative coping mechanisms or “go-to’s”) over a long term basis and is now able to sustain the healthy patterns of sobriety
- Has made the specific modifications in their lifestyles as needed, and now they are adopting measures in order to prevent relapse
- Has continued involvement in 12-step program or similar support groups
- Is experiencing momentum because of their new self-sustaining behavior, and it is becoming second nature
- Is constantly aware of risks/temptations and the possibility of relapse
NOTE: This stage can be compared to a person who has begun to workout at the gym for the first time. On the first day you are not as strong, flexible, and energetic as you will be a year later. The more you practice, the easier it gets. People are more aware of triggers and stressors that could lead to relapse. It is more than merely a routine exercise, but rather an integrated aspect of themselves.
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