The reality that a loved one is abusing drugs or alcohol and fighting an addiction can be a hard one to face. Many families struggle with this news. It can be known for quite some time that a particular family member—a child, a sibling, a spouse or partner, or a parent—has been abusing addictive substances. Or it can be a total surprise that no one saw coming. These “hidden addictions,” as they are called, can seemingly sneak up on loved ones who had not suspected anything at all. Or they could be hiding in plain sight and have finally reached a breaking point where something must be done.
Either way, once this information comes to light, it is time to make a decision about what to do about it. There is no one way to approach how to get a loved one help for addiction, but having a road map helps when navigating the challenges that addiction and substance abuse treatment present.
Millions of people are affected by substance addiction every day. It could be a neighbor, a co-worker, or a stranger in the grocery store. All of them are someone’s relative, spouse, partner, or friend. In some cases, they may be your family member. According to the 2015 National Survey on Drug Use and Health, an estimated 27.1 million people aged 12 and older were illicit drug users in 2015. And in the three years since that survey was taken, addiction continues to take lives, whether people were recreational users or chronic users.
The U.S. Centers for Disease Control and Prevention has reported that nearly 64,000 Americans died from drug overdoses in 2016, an increase of almost 22 percent from 2015. According to its data, the overdose epidemic in the U.S. is spreading geographically and increasing across demographic groups, according to an analysis of its 2015 and 2016 U.S. data. Men and women of all ethnicities in urban, rural and suburban areas of the U.S. are battling addiction.
“No area of the United States is exempt from this epidemic–we all know a friend, family member, or loved one devastated by opioids,” Anne Schuchat, M.D., the CDC’s principal deputy director, said recently to ABC News.
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Looking for signs of addiction can be akin to looking for a needle in the haystack or it could be like getting run over by a bus. It depends on the people involved. Those who have an addiction do not always show it, so it’s not always easy to spot it just by looking at someone. And then there are people who don’t hide it well, but some will notice the signs and not catch on because they may be going through a form of denial themselves. The specific signs and symptoms noticed can vary according to the substance(s) abused, but there are some general signs in different categories. If you notice any of these signs, your loved one may be struggling with an addiction.
Two or more of these could possibly mean that your loved one is battling substance abuse if you’ve also seen them using drugs, alcohol, or other addictive substances while exhibiting these behaviors.
What you’re looking for is a pattern of use and abuse and the results of those changes.
Someone who is facing increased pressures at home, work, or in other settings and situations may be at increased risk of developing an addiction to drugs or alcohol.
If the family member you are concerned about demonstrates any of these behaviors, they could be struggling with addiction. Now’s the time to consider getting professional addiction treatment at a drug or alcohol rehabilitation center.
The entire family unit is affected when substance abuse enters the picture. The effects of addiction can also extend beyond the nuclear family unit and continue for generations to come. Addiction often is called “the family disease” because everyone can feel shame, pain, stress, and loss of trust, confidence and even respect as a result of a person’s drug or alcohol use.
Family members also may feel anger, betrayal, or even helpless in the face of their relative’s illness. Other families may go into enabling mode, covering up and hiding the person’s addiction to drugs and/or alcohol. This involves lying on a regular basis, which also destroys trust.
The stability of the family’s household can be jeopardized as family members deal with their loved one’s problems. Some of those problems are:
Emotions can run high upon the discovery that loved one is using. The news can be a lot to take in as the family tries to make sense of why their loved one has a substance addiction. Common reactions include blaming the user, attempting to change or control the user’s behavior or putting distance between the family and the person who is addicted. There’s sadness, frustration, and even anger. But none of these emotions are reactions that help the situation or the person who’s struggling.
“Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to,” writes NIDA. “In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to.”
Part of processing the news of a loved one’s addiction is figuring out what to do about it and what can be done about it. It often is difficult for families to know how to approach their loved ones about an addiction or substance abuse problem. Like addicted people, families and friends need time and support as they face the pre- and post-recovery period.
The relatives and friends of a person battling a substance abuse problem must prepare to deal with their loved one’s denial that they have a problem in addition to facing their own. Denial is a coping mechanism, or it can serve as a defense.
Common things people in denial say include:
“I don’t have a problem.”
“I can stop anytime I want to.”
“It’s my life, and I can make my own choices.”
“I only drink at [X] time.”
“I’m not as bad as [a certain] person when I smoke, drink [or insert other activity here].”
Concerned family members may even be accused of exaggerating their loved one’s substance use. The idea of talking to a family member about a substance use disorder can be intimidating and uncomfortable. It’s not an easy decision. Should you wait it out and let the person continue to struggle before they “hit rock bottom,” the belief that a person must go through a life-changing hardship before they wake up and seek help? Or should you say something now?
Also, consider that thousands of people struggle and fail to seek addiction treatment.
The 2015 NSDUH study presented data that showed an estimated 19.3 million people age 12 and older who were classified as needing substance use treatment did not receive it at a specialty facility in 2015. That’s almost 20 million people who needed services for a substance addiction but did not receive them.
Don’t let your loved one become a part of that population. Help is available.
NIDA describes addiction as a “chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” It also explains that addiction is considered a brain disease because of how drug use changes the structure and functioning of the brain. As a result of these changes, people who have addictions are said to be unable to control the impulse to use drugs despite the negative consequences.
It is important for the addict, as well as the addict’s loved ones, to understand this. While there is debate over whether addiction is a disease or actually a series of repeated habits that change the way the brain functions, there is agreement that a failure to stop using drugs is not about a lack of willpower or self-control.
The American Society of Addiction Medicine offers a short definition of addiction that wraps up with why addiction treatment is important. “Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death,” it writes.
For many people, it is difficult to stop using drugs once an addiction is in progress. In many cases, the only way they are going to stop using it is if they receive outside help. Therefore, your loved one may need to seek treatment to stop the urge to use addictive substances. While addiction may never be cured, effective addiction treatment can help a person break these destructive patterns and start a new life that promotes health, well being, and a presence of mind. It is important that you get help for your loved one as soon as possible. Waiting only delays help and increases the possibility that your loved one will continue to use.
As you research a treatment center for your family member, there are things to keep in mind. Perhaps the first thing to tackle is stigmas often linked with addiction treatment. Going to rehab to address addiction or alcoholism brings many images to mind, most of them negative or fitting into a stereotypical view of addiction treatment. But addiction recovery isn’t just one setting or place or one idea.
There are many kinds of treatment facility and therapies. There also various levels of care to treat addiction, from more intensive to less intensive. All addiction recovery and care are tailored to a person’s specific needs, including psychological, emotional, and social. Upon entering treatment, a person can experience any of these depending on their situation:
Medical detox: Effective treatment for addiction starts with a medical detoxification (detox for short). During this stage, users achieve medical stability by being slowly and safely weaned off harmful drugs as they experience mild-to-severe withdrawal symptoms. This process can take place from three to 10 days. Detox also may involve administering medications to help recovering users manage their health in this critical period. An assessment also takes place to figure out the best treatment program for the user.
Inpatient treatment: In this setting of high-level care, clients undergo intensive detox and rehabilitation services for substance addiction in medical clinics or hospital units. It is appropriate for people in substance abuse recovery who have serious medical conditions or mental health disorders. Therapeutic treatment administered in this setting can include group therapy, psychotherapy, and family counseling.
Residential treatment: Residential treatment allows clients to fully focus on recovering from substance abuse in a structured setting with medium-to-high intensity. There is 24-hour medical support available in a setting that feels more like home and less like a jail or hospital. Recovering substance users can stay in these programs for longer times, if necessary. Residential programs can run from a month to 12 months. The severity of a person’s addiction along with other factors are taken into consideration before a residential program is recommended.
Partial hospitalization (day treatment): Partial hospitalization programs (PHPs) are the connecting bridge between residential and outpatient programs. They provide a medium-to-high-intensity setting for clients who have completed higher levels of care, so they also allow more independence. Clients can still live away from a treatment center, but they are required to attend four to eight hours of treatment daily, or 20 or more hours a week. No 24-hour supervision is provided and clients do not receive around-the-clock medical assistance. PHPs are suitable environments for people with co-occurring mental disorders.
Outpatient treatment: Clients who are at this level of care receive their treatment in a low-to-medium in intensity setting. Outpatient clients commonly receive no more than nine hours of treatment a week at a specialty facility while continuing to live either at home or another place that is outside the center.
This amount could be less for recovering teen users. Some centers offer evening or weekend outpatient services so people can continue to meet outside responsibilities such as work or school.
Intensive outpatient treatment: Clients receiving intensive outpatient care can attend between 10 hours and 20 hours of treatment a week at a center while living away from the treatment center. It, too, is a medium-to-high intensity setting and offers evening or weekend services so clients can tend to their personal obligations. People who need a higher level of care than outpatient treatment may also find an IOP to be an appropriate fit.
Transitional housing: When clients transition out of treatment, they need a place to land as they learn or relearn how to live on their own and rejoin a community and society. Sober living homes (SLHs) is a common option for people who have achieved sobriety and wish to live in an environment that promotes and supports abstinence from using addictive substances. SLH residents are expected to maintain household chores and pay rent and be employed or actively seeking a job as they live in the home.
The Substance Abuse and Mental Health Services Administration offers a free Behavioral Health Treatment Services Locator for people who are seeking a treatment facility. Click the link to access it. If you’d rather call its national helpline, dial 1-800-662-HELP (4357).
There are more than 14,000 specialized drug treatment centers in the U.S., so choosing the right one for your loved one and your family just got just that much more challenging. Not to worry, though, because the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) both offer solid guidance about what to ask and look for so you can have a clear idea of whether a center is the right one for your or your loved one.
The institute says there are five questions to ask when reviewing treatment program options. They are:
SAMHSA also offers guidance on what to inquire about when reviewing treatment options. Its questions cover accreditation, medication, evidence-based practices, families, and supports.
First, you should ask: Is the treatment center licensed by the state and certified by The Joint Commission?
The Joint Commission (JCAHO) is a nonprofit organization that provides independent accreditation and certification of health organizations. Organizations that seek accreditation from The Joint Commission must first be approved by JCAHO. Those facilities must demonstrate high quality and performance levels before they receive accreditation from JCAHO. You can search for find accredited organizations on the Joint Commission’s’ website.
Here are other areas to consider and questions to ask concerning them as SAMHSA advises.
Getting a loved one into drug or alcohol rehab also may require some convincing on your part as well. The family should know the benefits of treatment, which can help them persuade their loved ones to get help. NIDA has outlined the principles that make treatment effective, which emphasizes that no single treatment is appropriate for everyone and that treatment varies according to the kind of drug used and clients’ characteristics. It also notes that treatment doesn’t have to be voluntary to be effective. Drug treatment interventions can be successful, even if they are ordered by a court, a job or as an ultimatum from concerned loved ones.
Here are other factors that the agency says makes addiction treatment effective.
Treatment needs to be readily available. Time is critical when it comes to getting addiction treatment for the people who need it. The idea of going to a professional treatment center fills many addicted individuals with doubt, so it’s important that they have access to services when they are ready to get help. “Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes,” NIDA writes.
Effective treatment must be multifaceted. This means it should address other needs in addition to the ones related to substance abuse. This includes any medical, psychological, social, vocational, and legal issues clients have, NIDA advises. Other factors such as age, gender, ethnicity, and cultures should also be considered.
Approved medications may be part of treatment plans. It is common to use medication for treatment along with counseling and therapies for some clients, NIDA explains. People who are recovering from heroin addiction or opioid addiction may be given methadone, buprenorphine, and naltrexone to wean them off their dependence. Recovering alcohol users may be given acamprosate, disulfiram, and naltrexone for treating alcohol dependence.
Treatment programs should test for the presence of infectious diseases and provide targeted risk-reduction counseling. They also should connect clients to treatment if needed, NIDA advises. The agency goes on to say, “Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases.
Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness.” HIV/AIDS, hepatitis B, and C, tuberculosis, are some of the health conditions that treatment should screen for when clients come into their care.
Treatment must last for the proper length of time. According to research cited by NIDA, recovering substance abusers need at least three months, or 90 days, in treatment “to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.” Getting back on the path to health will not be a short process.
Treatment plans should be continually reviewed and changed as needed to fit the individuals’ current needs. Clients often need different kinds of services and components combined during the course of their treatment, NIDA writes. For example, clients may need medication or medical services In addition to counseling or psychotherapy, NIDA explains. Continuing care ensures clients are getting their best shot at recovery.
Treatment services are not without cost, and that is an important consideration when looking at programs. Even people with insurance benefits may find it challenging to figure out what is and what isn’t covered under the insurance plan.
If you don’t have insurance, SAMHSA says each state has funding to provide addiction treatment for people who don’t have insurance coverage. Find where to call for information about payment for services at samhsa.gov/ sites/default/files/ssa-directory.pdf. There are publicly funded treatment services. Click here to learn more about them.
If you do have insurance, it’s important to know what kinds of substance abuse treatment your plan covers. Many insurers generally do provide full coverage to clients who receive outpatient care over inpatient or residential care. The last two care levels run for a longer time, so they cost more. The key thing to remember is that you choose the treatment program and services that are most effective for your loved one’s recovery.
Depending on the health plan used, these services may be covered:
Some health insurance plans include coverage for all substances to simplify things, but that doesn’t mean the provider will cover all treatment or therapies, or even medications. Aftercare services, which are essential to the addiction recovery process, may not be covered by a particular insurance company.
In short, the longer a person stays in a treatment program that provides around-the-clock care, and room and board, the higher the costs will be. Inpatient or residential treatment can last at least 30 days or more. Some treatment center residents stay for more than a year. It just depends on the person receiving the treatment.
NIDA advises that clients stay in a treatment program at least 90 days or three months to be effective. “Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes,” it writes.
If you’re unsure about which services or programs your insurance plan covers, call your insurance provider or job’s benefits department to learn about your options. Check to see if aftercare services are offered and any kinds of therapies that have been recommended for your family members treatment or ones you or your loved one are interested in. Also ask:
SAMHSA recommends reviewing the websites of the providers and see if they have the five signs of quality treatment. To access care, the agency advises calling the facility for a timely appointment.
“If they can’t see you or your family member within 48 hours, find another provider. One indicator of quality is the ability to get an appointment quickly,” it writes. “Many programs offer walk-in services. Look for programs that can get you or a family member into treatment quickly.”
Treatment programs are customized for each person so their needs and preferences met. Most offer a combination of services to ensure the needs of the recovering person are met. Some of those services are:
When you’re looking for a rehab for a family member with an addiction, take time to find out what programs and supports there are for the family. A program that offers therapy and ongoing support for all affected family members—from spouses/partners to children, parents, and grandparents—is important. Families are a support system for substance users, and everyone has a vested interest in their loved one’s recovery. Support programs are not just for the person in recovery either. Anyone who has felt the effects of a loved one’s addiction could benefit from family therapy.
You may want to consider family therapy if:
A loved one’s decision to overcome addiction can only be strengthened with the help of family members. NIDA writes, “Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy can also be important, especially for adolescents. Involvement of a family member or significant other in an individual’s treatment program can strengthen and extend treatment benefits.”
Many substance abuse rehabilitation centers offer families a place to heal with a comprehensive family program. Such a program allows family members to participate in their loved one’s recovery process and healing. Facilities that offer residential services typically offer families regular visitation times that allow them to spend time with residents who live on-site at the facility 24/7 for a specified time as they receive recovery treatment.
Family programs are designed to encourage families to participate in educational programs that allow them to learn more about topics, such as how family dynamics play a role in the addiction process, and how they use strategies and techniques to improve communication and boundary setting. These programs also allow for role-playing and group discussions so everyone has the chance to be heard.
Addiction treatment is not just for the person who needs it. Clients and their families can both work on recovery from substance abuse together. For many families going through this challenge, therapy is the starting point for figuring out how to move forward together.
Clears the air. Everyone gets their chance to be open and honest about how substance abuse has affected them and their daily lives.
Focuses on support. The family of the recovering user and the user learn resources that are available to them and provide the need support as they work recovery.
Helps the family regain resilience and strength. Family counseling can keep people on track as they experience the ups and downs of addiction recovery. There often are feelings of powerlessness, but with honesty and openness, and families can find their way back to trusting one another. Empowering family members is also about allowing them to achieve a healthy perspective about what is happening as well as learning what their personal limits are and what role they play in their family member’s healing.
Teaches how to curb enabling behaviors. The desire to help the people we love is normal. However, there is such a thing as performing actions that only helps one along in their addiction, and these are highly discouraged. Examples of enabling include allowing the person with an addiction to stay in your home; giving the loved one money when they ask; bailing them out of jail when they land in legal trouble; paying off their bills; and more. Family therapy teaches people how to avoid scenarios such as these and helps them learn new strategies that help them set boundaries and reinforce them. Each person must take responsibility for their own behavior during the recovery process, the person in active addiction and every family member.
Educate against addiction stigma. Family members must remain as supportive as possible as their loved one recovers from substance abuse. Part of that support requires changing how addiction is viewed. When it is viewed as a moral failing, a weakness of character, or any other negative thing, there is room for addiction stigma to grow and that only hurts everyone who is working toward recovery. Social stigmas are negative attitudes and beliefs that lead people to avoid, label, reject, stereotype or discriminate against others. Friends, family, and community members can impose those attitudes and beliefs anywhere, and this is dangerous because many people who struggle with substance abuse will internalize these negative views and won’t reach out for the help they need.
You may want to seek help from sources outside of the family to broach the subject of addiction with a loved one during a formal meeting. This is called an intervention. There are different ways to approach and carry out an intervention. You have to find the method that best suits your family’s needs. The primary goal, however, is to get the person help as soon as possible.
This gathering also presents an opportunity to talk about any co-dependent behavior of family members, who may not be aware that they are playing a role in one’s behavior. They could be engaging in destructive behaviors and encouraging them, which doesn’t help anyone involved. This is why such a meeting is needed.
Even with the best intentions, unexpected things can happen during an intervention. Here are a few before-and-after tips that can make the process flow easier.
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NCADD. (n.d.) “Intervention – Tips and Guidelines.” National Council on Alcoholism and Drug Dependence. from https://www.ncadd.org/family-friends/there-is-help/intervention-tips-and-guidelines
Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US) ( 2004). (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 2 Impact of Substance Abuse on Families. from https://www.ncbi.nlm.nih.gov/books/NBK64258/
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SAMHSA. (n.d.) “Finding Quality Treatment for Substance Use Disorders.” Substance Abuse and Mental Health Services Administration. from https://store.samhsa.gov/shin/content//PEP18-TREATMENT-LOC/PEP18-TREATMENT-LOC.pdf
SAMHSA. (September 2015). “Insurance and Payments.” from https://www.samhsa.gov/medication-assisted-treatment/treatment/insurance-payments