Your Family and Addiction: How To Get Treatment for Your Loved One
Family and Addiction: A Process
According to the National Council on Alcoholism and Drug Dependence, addiction is a family disease1. The link between dysfunction in the family and addiction is well-established. Addiction brings uncertainty and chaos, and it puts families under a great deal of stress as it becomes difficult to maintain normal household routines. The addicted person and other family members may bend or try to deny reality in an attempt to maintain order. Repairing damaged familial relationships and restoring order to the household typically depends on the addicted family member getting professional help for the addiction. But what if your addicted loved one doesn’t want help or doesn’t feel like they need it? What if they want help, but doesn’t know where to turn, or doesn’t have insurance, or can’t leave their job or the family to get treatment? In many cases, family takes the initiative to find help for the addicted family member. But navigating the world of addiction treatment isn’t easy, and finding an adequate, reputable treatment program can be difficult if you don’t live in a large city. If your loved one is willing and ready to get help, you’re halfway there. If not, getting treatment for your loved one may require an intervention. Either way, this step-by-step guide will help you help your loved one.
Substance abuse is the act of using drugs or alcohol in a way that causes problems in your life. These problems may be related to relationships, physical or mental health, finances or the law. They may stem from engaging in risky behaviors while under the influence. The most common form of substance abuse is binge drinking, which is drinking enough alcohol in the space of two hours to raise your blood alcohol level to .08 percent. For men, this is around five drinks. For women, it’s around four. Any use of an illegal drug is considered substance abuse, since using illegal drugs -including prescription drugs that belong to someone else- can lead to serious problems.
Addiction is characterized by compulsive drug or alcohol abuse despite the negative consequences it causes. People who are addicted may want to quit or try to stop, but they usually find that they can’t alone- at least, not long-term.
Addiction is a disease of the brain, marked by changes in the brain’s physical structures and chemical functions. Heavy substance abuse leads the brain’s reward system to become re-wired in a way that causes the brain to equate liking using with wanting to use. Powerful cravings develop, driven by the same mechanisms that are designed to keep us eating or other actions to survive as a species. Compulsive drug-seeking behaviors develop, and the addiction typically alters thought patterns. This further perpetuates the addiction and can lead to denial or to minimizing the problems that are caused by the substance abuse.
A Progressive Disease
Addiction is progressive, which means that it will grow worse with time. It’s chronic, which means that it can’t be cured, although it can be sent into remission. And it’s relapsing, which means that using again after a period of abstinence can lead back to the addiction, once again characterized by compulsive use despite negative consequences.
When Use Leads to Addiction
Heavy substance abuse doesn’t always lead to addiction. Around 23 percent of people who try heroin, 15 percent of people who try alcohol and nine percent of people who try marijuana eventually become addicted. Whether someone develops an addiction depends on a number of factors, about half of which are genetic. Other factors include biological, environmental and cultural influences.
The National Institute on Drug Abuse stresses that once an addiction develops, willpower and good intentions are not enough to end it2. Professional help is almost always needed. That’s because addiction almost always has underlying causes that lead to the heavy substance abuse in the first place and must be adequately addressed to end the addiction. The most common underlying causes are chronic stress, a history of trauma and co-occurring mental illnesses like anxiety or depression.
Dependence is characterized by withdrawal symptoms that set in when you stop using drugs or alcohol. Dependence, like addiction, is the result of changes in brain function due to heavy substance abuse.
Drugs and alcohol act on the brain’s chemical messengers, known as neurotransmitters. Different drugs affect different neurotransmitters, and different neurotransmitters produce different effects. Heavy drug or alcohol use causes the brain to change its chemical function in order to compensate for the effects of the substance. For example, alcohol increases the activity of the neurotransmitter GABA, which is responsible for feelings of calm and wellbeing. It reduces the activity of the neurotransmitter glutamate, which produces feelings of excitability. With heavy alcohol use, the brain compensates by reducing the activity of GABA and increasing the activity of glutamate in an attempt to normalize brain function.
As a result, tolerance develops. Tolerance means that you need increasingly larger doses of drugs or alcohol to get the desired effects. As you increase the amount you use, the brain continues to change the way it functions. At some point, brain function may shift so that it now functions more comfortably when the substance is present. Then, when you stop using suddenly, normal brain function rebounds. The chemicals that were suppressed flood the brain, and those that were increased are now reduced. The result is physical withdrawal symptoms, which can be excruciating enough to send someone back to using to make the discomfort stop.
Diagnosing a Substance Use Disorder
The terms substance abuse, addiction and dependence are widely used, but these are officially diagnosed under the umbrella of “substance use disorder,” or SUD. An SUD is characterized as mild, moderate or severe, depending on how many of the eleven criteria apply. Meeting two or three of the criteria indicates a mild SUD. Meeting four or five denotes a moderate SUD, and meeting six or more indicates a severe SUD. The criteria cover past-year use and are as follows:
- Using for longer periods of time than intended or using more than intended
- Wanting to quit or cut down but finding you can’t
- Spending excessive amounts of time seeking, obtaining, using and recovering from using
- Experiencing intense cravings that make it difficult to think about anything else
- Continuing to use despite problems at work, school or home
- Continuing to use despite problems with relationships resulting from the substance use
- Losing interest in activities you once enjoyed
- Engaging in risky behaviors while under the influence, such as driving or walking alone in a dangerous area
- Continuing to use even though it’s causing physical or mental health problems or making existing problems worse
- Developing a tolerance so that you need more drugs or alcohol to get the same effects
- Experiencing withdrawal symptoms when you stop using suddenly
Whether a substance use disorder is mild, moderate or severe, treatment can help end it for the long-haul.
Medical detox is a medically supervised detoxification process. During medical detox, medications are provided as needed to reduce the severity of withdrawal symptoms and shorten the time it takes to detox. Medications also help prevent dangerous or fatal symptoms from occurring, which is possible during withdrawal from alcohol or benzodiazepines like Xanax or Valium. A number of assessments during medical detox help providers develop a comprehensive, individualized treatment program that begins once detox is complete. Detox only addresses physical dependence on drugs or alcohol and does very little to address addiction, which is far more complex.
The Substance Abuse and Mental Health Services Administration stresses that a holistic treatment program offers the best possible outcomes of treatment3. A holistic approach to treatment addresses issues of body, mind and spirit for whole-person healing. In order to successfully end an addiction, multiple needs must be met. This includes addressing:
- Underlying causes of the addiction
- Troublesome thought and behavior patterns that developed because of the addiction.
- Problems the addiction caused, including relationship, health, legal and financial
Purpose of Therapy
The point of treatment is to bring people to a point where they no longer have a need or desire to return to using. In order to do this, a variety of traditional and complementary therapies are used. These therapies help individuals:
- Identify and change self-destructive thought and behavior patterns
- Evaluate attitudes and beliefs and change those that are outdated
- Address underlying issues like stress or trauma
- Identify inherent strengths and values and align behaviors with these
- Develop coping skills for handling stress, cravings, negative emotions and other relapse triggers
- Identify personal triggers and high-risk situations and develop a plan for dealing with these
- Address co-occurring mental illnesses, including anxiety or depression
- Repair damaged relationships
- Restore function to the family system
- Develop healthy communication, social and relationship skills
- Set and maintain personal boundaries
- Identify purpose and meaning in a life of sobriety
- Learn to relax and have fun without drugs or alcohol
Complementary therapies are experiential, hands-on therapies that are shown through research to be effective for treating addiction when they’re used along with traditional therapies. Complementary therapies commonly used in treatment programs include:
- Yoga, which reduces stress, increases self-awareness and promotes physical and mental strength, balance and flexibility.
- Art or music therapy, which helps people express difficult emotions, improve self-awareness and ease feelings of guilt and shame.
- Meditation to reduce stress and improve the way the brain and body respond to external events.
- Horticultural therapy, which improves planning and decision-making skills, reduces negative emotions and increases self-confidence and self-awareness.
- Biofeedback therapy, which helps individuals learn to control their body’s stress response to reduce stress and cravings and cope with negative feelings.
- Acupuncture, which helps improve the function of the body’s systems and reduce physical and emotional pain.
Traditional therapies are “talk” therapies that are shown through research to be effective for treating addiction. Traditional therapies used in high quality treatment programs include:
- Cognitive-behavioral therapy, which helps individuals examine and change dysfunctional patterns of thinking and behaving.
- Dialectical behavior therapy to improve mindfulness, emotional regulation, distress tolerance and interpersonal skills.
- Acceptance and commitment therapy, which increases psychological flexibility, emotional control and self-respect.
- Motivational enhancement therapy to help people resolve any ambivalence they have toward recovery.
- Family therapy, which helps families work through a variety of issues and improve their communication skills. The importance of family in the involvement of addiction recovery can’t be overstated.
- Psychoeducational classes, which provide education on a wide range of topics related to addiction.
- Pharmacotherapy, or the use of medications to help improve brain function, reduce cravings and treat medical or mental illnesses.
In addition to traditional and complementary therapies, a variety of other services and interventions may be used to help restore function to your loved one’s life. These may include educational, vocational, legal or housing assistance; medical or dental care; and psychiatric services.
Once the treatment program is complete, an individualized aftercare plan will be developed to help your loved one navigate the early weeks and months of sobriety. The aftercare plan will generally include ongoing therapy and participation in a support group. Other components will be added based on unique needs and issues. A case manager will oversee the aftercare plan and make amendments as needs change.
The Treatment Setting: Inpatient vs. Outpatient
Treatment programs take place through inpatient and outpatient programs. The evaluations conducted during medical detox or during the admissions process helps providers place individuals in the right setting.
Inpatient rehab involves living at a residential treatment center while undergoing treatment. The benefits of inpatient treatment include:
- A high level of support, structure and supervision
- The opportunity to focus solely on recovery
- Intensive therapies to help precipitate change more quickly
- The opportunity to develop healthy relationships with others in recovery
Inpatient rehab is essential for people who have:
- A long history of addiction or a severe addiction
- An unsafe or unstable living environment
- A co-occurring mental illness
- Little support at home or in the community
- Little motivation to recover
Outpatient rehab involves living at home while receiving treatment at an outpatient center during the day or in the evenings. The benefits of outpatient treatment include:
- It’s a more affordable option than inpatient treatment
- The ability to continue working, going to school or caring for the family while in treatment
- The opportunity to put skills and strategies to use right away in the “real” world
Outpatient treatment can work for people who have:
- A safe, stable living environment at home
- A high level of support at home and in the community
- Good physical and mental health aside from the addiction
- A high level of intrinsic motivation to recover
Individuals are placed in the setting that’s the least restrictive for their needs. They travel along a continuum of care until treatment and support are no longer needed.
Types of Treatment Programs
Some rehab programs offer specialized treatment for certain populations.
Trauma-informed treatment helps people with a history of trauma recover in a highly safe and stable environment with therapists who specialize in treating trauma. Trauma changes the brain and leads to dysfunctional coping mechanisms, including substance abuse. Treating it involves helping individuals learn to separate themselves from the trauma and the resulting negative emotions. Trauma-informed treatment puts a strong focus on developing self-esteem and self-confidence, setting personal boundaries and developing feelings of safety and wellbeing.
Dual diagnosis treatment
Dual diagnosis treatment is essential for people who have a mental illness that co-occurs with the addiction. For treatment to be successful, both the mental illness and the addiction must be addressed at the same time, each in the context of the other. Treating just the addiction or just the mental illness is largely ineffective for ending substance abuse for the long-term.
Gender-specific treatment is ideal for some people in recovery. Both men and women who have experienced sexual abuse may prefer a women-only or men-only program. Some men and women are likely to feel more comfortable opening up and expressing difficult emotions or recounting troubling experiences in a gender-specific program rather than a co-ed program.
Additional Treatment Programs
Other types of programs include those that focus on LGBTQ+ issues, are religious-based or which focus on a certain age group, such as adolescents, young adults, midlife adults or aging adults.
What to Look For in a Quality Treatment Program
An accredited treatment program has been carefully and extensively audited by a third-party accreditation body. An accredited program will meet or exceed strict standards for care, programming, administration, accounting and transparency. It will use research-based treatments and best-practices protocol. The largest and most prestigious accrediting organizations are the Joint Commission and CARF International.
A quality program will hire only state-licensed therapists and board-certified physicians. All staff members should be skilled professionals and adhere to professional standards of conduct.
A reputable treatment program will use only evidence-based therapies that have been shown through research to be effective for treating addiction. It will not use experimental or controversial treatment therapies or methods.
Family participation in treatment has been shown to improve treatment outcomes. Family and addiction programming may include psychoeducational classes, workshops, support groups and family therapy. A proven track record A high-quality program will be able to back up its claims of effectiveness with documentation, and it will be happy to provide you with this information.
A holistic approach to treatment promotes whole-person healing. This approach will involve a variety of traditional and complementary therapies that address issues of body, mind and spirit and attend to multiple needs of the individual.
An inpatient treatment center should feel warm and welcoming rather than cold and institutional. It should be clean, calm, and well-managed with clear expectations for behavior. You can arrange to visit a facility to get a first-hand look and talk to staff members.
Paying for Treatment
Treatment is expensive, and high-quality treatment programs will do their best to help you find a way to pay for it. Under the Affordable Care Act, insurance companies can’t deny benefits for essential services, which include mental health and substance abuse treatment. The Mental Health Parity and Addiction Equity Act of 2008 requires insurance plans to offer the same level of benefits for substance abuse services as they offer for primary medical services.
A quality treatment program will help you determine whether it accepts your insurance, whether the program is considered in or out of network and whether you need a referral for the program. It will help you understand what, exactly, the insurance covers and what will need to be paid out of pocket.
If your loved one doesn’t have insurance and doesn’t qualify for Medicaid, the program will help you look for funding. Many programs offer sliding scale fees based on income, and some offer payment plans that allow you to pay for treatment over time.
Willing and Ready
If your loved one is willing to go to treatment and has been part of the process of finding an appropriate program, all that’s left to do is to call the center and start the admissions process. Reputable treatment centers understand that you’re going through a tough time, and the admissions counselors and other staff can patiently answer any questions you have and will help you through the admissions process every step of the way.
If your loved one is unwilling to go to treatment, or in denial that substance abuse is a problem that requires professional help, you will need to convince them otherwise. If you feel that simply talking to your loved one will do the trick, find a time to talk when they’re sober. Avoid passing judgment or placing blame. Let your loved one know how the addiction has affected you and how you see it affecting them. Express love and concern, and ask them to agree to get help. If they agree, get into contact with the treatment program to arrange admission.
If you believe convincing your loved one to get help is going to be more complicated than a single conversation, or if you’re certain they’ll refuse treatment, a professional intervention can help. An intervention is a planned meeting between your loved one and concerned significant others, or CSOs. During an intervention, CSOs explain to the addicted loved one how the addiction is affecting their own lives. The meeting ends with an offer for professional help along with CSOs outlining consequences that will be put in place if treatment is refused, such as no longer giving the loved one money or asking him to move out of the house. Interventions that are planned and executed with the help of a professional have a 90 percent success rate in getting the loved one to agree to treatment, according to the National Council on Alcoholism and Drug Dependence. An intervention can be tricky, and attempting to hold one without professional help can quickly backfire, and in some cases, can make things worse. Many treatment programs offer intervention services, or you can ask an addiction specialist or mental health professional to recommend an interventionist.
Step Five: Get Support
Healing Unhealthy Behaviors
Family members often develop unhealthy coping skills while living with an addicted person, and may engage in codependent and enabling behaviors that can sabotage their loved one’s recovery. Just because your loved one enters recovery doesn’t mean these unhealthy coping mechanisms and behaviors will automatically end. Individual therapy can help you and other family members identify and change unhealthy coping strategies as well as recognize and stop codependent and enabling behaviors. Since children of an addicted parent are at a higher risk for substance abuse down the road, individual therapy for younger family members can help reduce the risk of continuing the cycle of addiction. Therapy also helps you and other family members understand how to best support your loved one in recovery and how to recognize the subtle signs of an impending relapse.
Support Groups for All
Family members should also engage with a support group. Al Anon is a large support network for adult family members of an addicted loved one5 Alateen is a support group for younger family members6 Your loved one’s treatment program may also offer a support group for family members. A support group offers crucial emotional support while your loved one is in treatment as well as during the early weeks and months of solo recovery. The support group will provide a safe place to express difficult or negative emotions as well as celebrate recovery milestones. It will offer resources, tips and encouragement and provide you with opportunities to help others in the same situation. If your loved one refuses treatment, participating in a support group nonetheless can help you better help your loved one come to the realization that they needs treatment, and it can help younger family members cope with the addiction in healthy ways.