Signs of Addiction
An addiction doesn’t develop or happen overnight. In general, the path leads first to abuse and then, in some people, to addiction. So the most important thing you can do is to avoid that path, or get help in stepping off of that road as soon as you recognize a possible problem. In most cases, an addiction typically starts with experimental use and progresses over time into a need to use regularly, even at the expense of health and safety.
Over a period of time (how long depends on the individual and the substance or behavior), the addict compulsively seeks out and craves the substance or behavior, needing more and more to attain euphoria or the “high.” At this point, the addict is no longer able to stop using. Because addiction is a disease, treatment and ongoing support are typically necessary, and relapses are common and to be expected.
It can be extremely difficult to admit to a possible problem – and even harder for the addict to recognize that he or she is addicted. Here are some of the most common signs of addiction, from the U.S. Department of Health and Human Services:
· Change in friends and hangouts
· Changes in mood, motivation, attitude
· Absenteeism at work or school
· Increased need for cash
· Bloodshot eyes or enlarged pupils
· Sudden weight changes (gain or loss)
· Secretive behaviors; lying
· Tremors in the hands
· Ignoring once-loved activities
Answering “yes” to the following questions can also indicate a problem:
· Are you feeling more irritable or angry? Are you more often aggravated with those around you at home, work or school?
· Do others accuse you of being lazy or inattentive – not getting your work or assignments done well and/or on time – or criticize you for missing important events or obligations? Are you disappointing those in your life you care about so you can use?
· Do you find yourself being secretive about your use, hiding it or lying about it?
· Do you feel agitated?
· Are you sleeping less in order to devote more time to an activity or substance?
· Are you using eye drops or sunglasses to cover up tired or bloodshot eyes?
· Are you losing or gaining a significant amount of weight? Have others noticed a change in your weight or appearance?
· Are you buying breath sprays, mints, perfume, air fresheners or body mists to hide odors from substances you’re using?
· Do you crave and seek out the substance or behavior?
· Do you need to use more often to achieve the same pleasure or high?
· When you can’t use do you experience physical symptoms of withdrawal (vomiting, muscle aches, sweating, tremors, fever, diarrhea, yawning and/or insomnia)? Do you experience psychological symptoms of withdrawal (anger, upset and sadness)?
· Has your mood deteriorated to the point where you feel desperate or hopeless? Have you contemplated, planned or attempted suicide? (Call 911 immediately if you have any suicidal thoughts or plans.)
· Have you changed your daily routine to allow more time or opportunities to use?
· Are you hanging out with friends who use?
· Are you spending more time in places where you have easier access to a substance or problematic behavior?
· Do you need more cash to fund your use?
· Have you missed bill payments?
· Are you asking friends and family to fund your use or to cover expenses you cannot pay as a result of your use?
· Do you make secret withdrawals, get cash advances from the bank, or have you set up a credit card in your own name (without telling your partner or family) so that you can hide your spending?
· Are you stealing money or things or considering doing so to pay for your use?
If you answered “yes” to any of the questions above, it’s worth reaching out to your doctor or a counselor for additional screening. If you’re diagnosed with an addiction or compulsive behavior a health care professional can help you find the types of treatment that are right for you.
Sources: Diagnostic and Statistical Manual of Mental Disorders (5th ed.); Substance Abuse and Mental Health Services Administration; U.S. Department of Health and Human Services.
Just as addiction is unique to every person who experiences it, addiction treatment should be tailored to the individual, too. Fortunately, there have never been so many options for addiction treatment geared toward the specific needs of groups of people who share similar life experiences, background, language or beliefs. By choosing a treatment program designed especially with your needs in mind, you’re likely to feel a lot more at ease. When you feel comfortable in an addiction treatment program, you’ll be able to focus completely on the task at hand: your recovery. Here are some options tailored to address the unique needs of special groups when it comes to treating addiction:
If You’re an Executive/Professional
Addiction treatment for high-achieving executives is typically tailored to the needs of each individual and conducted in the company of other experienced professionals. These programs often emphasize effective communication, teamwork and goal-setting. You’ll work with skilled clinicians and clients to address not only your addiction(s) but also mental health issues, pain management and sleep and other lifestyle problems (including stress), if any. In choosing a treatment program with executives in mind, you’ll learn more about your addiction and work toward recovery with the help of both individual and group therapy. You may find there’s more emphasis on learning to balance work with the rest of your life; you’ll also learn to sidestep triggers, using effective coping strategies that will be helpful in managing your recovery in the midst of whatever the demands your professional and personal life may bring.
If You’re 50+
Substance use disorders are on the rise among Baby Boomers. According to the National Institute on Drug Abuse, 6.2% of those 50-and-over had substance use disorders in 2009 compared to 2.7% of those in that same age group in 2009. And with over 76 million Boomers in the U.S. and their typically more tolerant attitudes toward drug use, it’s easy to see that there’s more need than ever for treatment programs for those over 50 struggling with addiction. By choosing addiction treatment with those who are roughly your age and generation, you’re likely to find a powerful community of like-minded supporters to help you reach recovery. They, too, may be facing other health conditions or chronic pain common to getting older. As with most treatment programs, you should expect education on substance abuse (this will help you learn how to recognize and identify triggers to using), one-on-one therapy and group counseling and possibly medication to help with withdrawal symptoms and cravings. To prevent relapses, you’ll learn coping skills to help you reach sustained recovery.
If You’re a Woman
Addiction doesn’t discriminate, of course: It touches people from every walk of life, age, race and ethnicity and certainly both genders. But that doesn’t mean that women and men can’t benefit a lot from participating in single-sex addiction treatment. That’s because there tend to be some important differences in how men and women are affected by or deal with addiction. When it comes to seeking treatment for alcoholism, for example, women, on average, seek help four years earlier than do men. What’s more, addiction has other social and health concerns for women, including the problem of substance use in pregnancy, and the fact that women who seek treatment for drug abuse are more likely to have a history of physical and sexual trauma as well as post-traumatic stress disorder (PTSD). Women often have different emotional and health side effects from these, too, which can include more intense withdrawal symptoms.
Seeing addiction through the lens of its impact on a woman’s body, mind and life can create the right climate for change for you. A history of rape, trauma, neglect or abuse is a contributing factor to many addictions, as are relationship difficulties, body image and self-esteem issues and depression and anxiety, among other mental health issues. Treating these in concert with the addiction tremendously benefits women. For some, simply being among other women while in addiction treatment can provide a non-threatening environment of support and caring.
If You’re a Teen or Young Adult
Adolescence through young adulthood is often a tumultuous time of life, not least because of the increased risk of drug abuse. In fact, it’s during these years that people are most likely to begin abusing drugs, according to the National Institute on Drug Abuse (NIDA). Because the needs and perspectives of younger people aren’t necessarily the same as those of older adults dealing with addiction, treatment programs should also be different. First and foremost, addiction treatment is a safe refuge for an adolescent (defined as ages 13 to 17) and for his or her family. Second, a teen-focused program allows a younger person to benefit from being in an environment with their peers; adolescents, after all, are not mini-adults — their brains, bodies and identities are still developing. Substance addiction in particular is more problematic in adolescents because it disrupts normal brain function, which in turn affects motivation, memory, learning, judgment and behavior, says NIDA. Adolescents, who are hard-wired to be risk-takers, also tend to abuse different drugs than adults, experience withdrawal symptoms to a lesser extent, are more apt to hide their use and are less likely to seek treatment on their own. Treatment may also vary in another way: Many medications that are FDA-approved for addictions are not approved for adolescent use, another reason adolescents need a setting all their own.
If you attend a treatment program specifically for teens or for young adults, you can also expect to find an emphasis on academics; that may mean you’ll attend on-site education in core courses for three to four hours a day, so you can continue working toward recovery while not missing out on your diploma. Similarly, young adults may choose day or outpatient treatment so they can continue attending college classes. Adolescent programming is often gender-specific, with males and females housed and treated separately. In addiction treatment, teens learn to overcome destructive behaviors and practice the coping and communication skills they’ll need to live happy, productive lives and sustain their recoveries.
If You’re a Christian
If your faith is at the center of your life, you may want to choose a spiritually-based addiction treatment program that allows you to be led to recovery in a religious-minded environment. Bible teachings and passages are used to inspire change and to encourage the finding of strength and support through Christ, giving over your burdens to the Lord. Through Bible study, prayer and meditation, treatment will focus on strengthening your faith and your resistance to temptation, along with traditional methods for treatment, which may include a combination of medication, counseling (individual, group and/or family therapy) and/or 12-step or other mutual-support self-help groups.
Types of Treatment Programs
Picking the right addiction treatment program is a personal choice. You may opt to stay at a center (called inpatient residential treatment, or rehab), but there are also outpatient treatment centers, day treatment programs and sober living communities, where the person moving into recovery lives for a time with other people who are learning to live sober.
During and after treatment, it’s common to go to community in-person support groups (like AA meetings) on a long-term basis and/or to attend Web-based meetings to help stay on track. Here are more specifics about addiction treatment programs to help you find the one that best fits you:
Sometimes the best treatment requires getting away from work, school, family, friends (and yes, the things that trigger using), so you can focus on one thing: getting better. At a residential or inpatient addiction treatment program, the addict has the chance to retreat from daily stressors that may have contributed to his or her developing an addiction in the first place.
The first step in a residential treatment program is to give the addict a safe, secure place with qualified professionals to monitor their care during detox, which is the period when the substance(s) or behavior(s) is removed. A health care team is there to help you with physical and psychological withdrawal symptoms; medication may be used to ease these symptoms. This team also puts together a treatment plan that typically involves counseling, including both group and individual therapy. A psychotherapist’s goal is to help with the addiction as well any mental health issues (especially those that are not well-managed) and to help the addict re-learn or learn coping skills and healthy habits so he or she is ready to start life again, clean.
A stay in a residential treatment center may last for a few days or several weeks or months, depending on the nature and extent of the addiction and any co-occurring issues (meaning other addictions or mental disorders). It’s essential to address all of these to help prevent relapse.
Maybe you feel that you have good support from your partner, family and friends and you want to attend treatment while living at home. Perhaps it’s not possible for you to take a lengthy absence from work or school. In cases like these, an outpatient treatment center — in which you’re treated at a facility during the day and/or evening, but you don’t stay overnight — might be the right choice for you. There are outpatient programs that meet, for example, two to three hours for a few evenings each week. These centers offer the same types of treatment as residential programs, but because you don’t reside there, you can more easily continue to go to work or attend school while still fulfilling your treatment plan. If, though, living at home means you may be tempted to resume using, an outpatient treatment center may not be as effective and another option may be necessary.
Day Treatment/Partial Hospitalization
As a kind of outpatient treatment program, if you participate in day treatment for your addiction, you’ll continue living at home and will receive much the same detox, withdrawal and counseling support as you would at a residential treatment center. For about seven to eight hours every day, you’ll work with doctors, therapists and/or psychiatrists; in the evenings, there are often 12-step meetings and life-skill education sessions to attend. Parents of young children and others who have obligations at home may prefer day treatment over a live-in option.
Sober Living Communities
It can be tough to leave the safe haven of a residential treatment program (or even an outpatient treatment program) and immediately return home and resume your life. You might feel like a changed person, but practicing everything you’ve just learned is sometimes more effective in a sober environment – meaning one where you and your fellow residents are removed from addictive substances and behaviors and continue focusing on maintaining sobriety.
To integrate newly developed healthy habits, it’s recommended that some people live in a sober house (once called a halfway house and also known as a recovery house or a therapeutic community) for several months to up to a year. There, you can continue learning healthy living and coping skills and also benefit from therapy sessions and regular 12-step meetings. The structured environment can make it easier to break free from toxic friends and contacts and learn to balance life’s competing demands in an emotionally stable way.
Types of Therapies
There’s no one “right” treatment for someone trying to overcome an addiction. That means that you and any health care professionals you’re working with can and should use different types of treatment to find a way to recovery that works best for you. After all, when it comes to addiction every person has a different recovery story, just as with any disease or illness.
When you enter treatment, the first thing you’re likely to experience is detoxification, or the removal of the substance(s) or behavior(s). Detox brings with it the symptoms of withdrawal. These can include physical symptoms such as nausea, vomiting, muscle aches, headaches, shakiness, seizures and even coma, as well as psychological symptoms: feeling depressed, anxious, sad, angry and/or upset. If you commit to treatment for your addiction, chances are you’ll encounter several of the following approaches as part of your treatment plan:
Drug therapy: Medication can be used to help ease the symptoms of withdrawal and to prevent cravings that lead to relapse. When drugs are used to treat addiction, it’s called medication-assisted therapy (MAT). According to the Substance Abuse and Mental Health Services Administration (SAMHSA), prescription medications can also be used to restore normal brain function (namely the production of dopamine) in addicts. Here are some of the ways that prescription medications are used to treat specific types of addiction:
· For opioid addiction: Opioids are a type of powerful painkiller that includes both the illicit drug heroin and prescription medications like morphine, oxycodone and hydrocodone. Addictions to these drugs can be treated with methadone, buprenorphine hydrochloride (brand name: Subutex) or buprenorphine hydrochloride and naloxone hydrochloride tablets (brand name: Suboxone). Methadone and Subutex help suppress withdrawal symptoms, including cravings, while Suboxone blocks opioids’ ability to elicit a reaction from brain receptors. All of these drugs alleviate drug-seeking behavior, too. (Methadone should be used cautiously due to its risk for life-threatening breathing problems, says the National Institutes of Health). The drug naltrexone (brand names: Depade, ReVia and Vivitrol, an injectable form) is also approved for treating opioid addictions; it works by erasing the effects of opioids so that cravings eventually diminish. Your doctor may also prescribe an anti-anxiety medication if you’re dealing with post-traumatic stress disorder (PSTD) or anxiety issues; both are fairly common in people with addiction.
· For tobacco addiction: Tobacco products contain nicotine, which is addictive. Various nicotine replacement therapies — patches, sprays, gums, lozenges — are available over-the-counter to curb nicotine cravings. Bupropion (brand names: Wellbutrin, Zyban) and varenicline (brand name: Chantix) are both FDA-approved for smoking cessation.
· For alcoholism: Naltrexone (brand names: ReVia, Depade and Vivitrol, an injectable form) is used to quell cravings for alcohol, while acamprosate (brand name: Campral) reduces withdrawal symptoms. Disulfiram (brand name: Antabuse), the oldest medication for alcoholism, causes unpleasant symptoms when you drink like nausea and skin-flushing to deter patients from drinking.
· For video gaming addiction: The antidepressant bupropion (brand names: Aplezin, Budeprion, Buproban, Wellbutrin, Zyban) is sometimes used to treat gaming disorders; as with its use in treating some substance use disorders, it can help reduce cravings for gaming.
In addition, several medications are under investigation for the treatment of gambling disorder, but none have been approved by the Food and Drug Administration. And drugs are being developed for treating addictions to stimulants such as cocaine and methamphetamine as well as marijuana addiction, but all are still in the pipeline, reports NIDA. People who are addicted to more than one substance (what are called “poly-drug” users) will need help for each drug they abuse.
Psychotherapy: If you seek medical help for your addiction, it’s very likely that at some point your doctor or another health care professional will suggest counseling. That could mean one-on-one “talk therapy” between you and a therapist, social worker, psychologist, psychiatrist or an addiction counselor. You could also have group therapy (in which you meet and talk with a group of about six to 10 other people, often with the same addiction or issues as you have).
Your treatment plan could include other types of therapy, too, and the approach that’s used could change over time. For instance, in the beginning the work you do in counseling sessions may focus on recognizing your triggers and stopping them and finding ways to soothe yourself when you feel anxious or upset. When your recovery is better established, you and your therapist may then turn to exploring your past in more depth. As with any other part of your treatment regimen, how counseling works will be unique to you and your path to recovery.
Here are some of the more common, and more successful, approaches to counseling when it comes to treating addiction:
Cognitive Behavioral Therapy (CBT): CBT is a very popular treatment approach for mental disorders and also for both substance and behavioral addictions. CBT focuses on questioning and changing negative and unproductive thoughts and beliefs in order to improve behavior and emotions that lead to addictive tendencies. If you do opt to use counseling as part of your treatment, it’s very likely that your therapist will incorporate CBT.
Dialectical Behavioral Therapy (DBT): Sometimes patients need more support and acceptance to overcome addiction and other problems that stem from a difficult childhood or trauma. In Dialectical Behavioral Therapy, the clinician lets a patient know when a behavior or belief is unhealthy, while always offering total acceptance. DBT follows a standard protocol: At every session, the patient reports the problems he or she faced in the previous week. The therapy attempts to teach the addict strategies and coping skills for dealing with life’s difficulties while being mindful to react to situations in the present and not to layer on problems of the past.
Motivational Interviewing: In this type of psychotherapy, a counselor helps an addict to gradually feel more capable of making positive changes in his or her life.
Group Therapy: As mentioned above, therapists who hold group sessions work with people who share similar issues, such as the same type of addiction or the same co-occurring disorders, such as depression and alcoholism. In sessions the therapist poses questions or proposes a problem for members to discuss, acting primarily as a guide and keeping the conversation productive and focused. Group therapy is a lot like talk therapy except that it utilizes group dynamics to help members change behavior and thought processes.
Family & Couples Therapy: Family therapy (also sometimes called Multidimensional Family Therapy, or MDFT) is structured so that every member of the family has a voice with the goal of improving relationships, communication and the family’s home life. When a family goes to therapy because one member has an addiction, it’s a step toward solving ongoing problems of daily living and healing past hurts; doing so can address factors within the family that are perpetuating an addiction.
In couples therapy, the therapist works with a couple dealing with an addiction to help both partners come to terms with the ways in which the problematic drug and/or behavior has hurt their relationship and to help the couple reconnect, or, if necessary, part ways. If unresolved issues, such as childhood trauma or neglect or unmanaged mental disorders, are at play, these may need to be dealt with in individual therapy sessions.
Other Treatment Options:
You may also encounter these therapies as part of your treatment for addiction:
Adventure therapy: Nature can be a big part of healing. These programs — which might include rock climbing, orienteering and zip lining, among other activities — focus on using the outdoors to learn how to overcome challenges, both in the wilderness and in ordinary life.
Art therapy: Certified art therapists use different media (watercolors, oil pastels, clay) to help patients explore their feelings. Through art, the therapist helps you to resolve inner conflicts, gain self-awareness, manage behavior, increase social skills, reduce anxiety and improve self-esteem, according to the American Art Therapy Association.
Equine therapy: When addicts work with, care for and ride horses, they develop a connection that can be powerful and healing.
Eye Movement Desensitization and Reprocessing (EMDR): This form of psychotherapy claims to relieve anxiety, trauma, post-traumatic stress disorder (PTSD) and depression. A specially trained EMDR therapist uses a technique in which the client follows the therapist’s fingers with their eyes from side to side while recalling a negative memory. The combination of the repetitive eye movement and memory recall is said to help the client process the memory and relieve negative emotions, such as past trauma that may be contributing to a drug addiction. The process is repeated in session until the client’s distress over past events is relieved.
Motivational incentives: Clinicians offer rewards, such as special privileges (like an outing, voucher or prize), as encouragement to help clients in residential treatment programs and sober living communities to stay clean.
Recreational therapy: Scrapbooking, knitting, going to a baseball game or bowling — all are examples of recreational therapy. This approach is based on the simple premise that through such experiences the addict can learn healthy ways to have fun, relieve stress and form relationships.
Wilderness therapy: Participants (usually teens and young adults) learn skills that will enable them to rely completely on themselves to survive in nature. These programs generally include treatment plans and 12-step work and can last for several weeks.
Self-Help Support Groups
Like most any other problem in life, it can help a lot to talk to people who know exactly what you’re dealing with because they’ve been there, too. You’ll find that there’s a wide variety of self-help groups for people grappling with addiction as well as for their families and friends; most are free (some have an optional pass-the-basket donation) and meet regularly. You may find that many other people at these meetings are facing the same or similar challenges as you and that you can benefit greatly from the mutual support and lack of judgment offered in these communities.
On the other hand, you may also say to yourself, “I’m not that bad off,” or “I’m not as hooked as some people,” and reason that a support group is only for people dealing with “serious” problems — and that you don’t fit that description. In fact, whether your problem is mild, moderate or severe, you can learn from others in a self-help support group (and also help others). Joining a support group can help you to:
· Avoid feeling isolated and alone in your struggle
· Regain control of your life
· Learn from others who’ve experienced the same or a similar struggle
· Surround yourself with people who don’t judge you
· Talk openly about your experiences and feelings
· Relieve stress, anxiety and depression
· Gain a new perspective on your problems and your addiction
· Better understand addiction as a disease in which relapses happen and find ways to sidestep triggers
· Get referrals for treatment centers, therapists and doctors and others who can be helpful to your recovery
Many support groups are associated with a larger national or international organization such as Alcoholics Anonymous (AA), AL-ANON, Narcotics Anonymous (NA), Gamblers Anonymous (GA), among many others. You may prefer to join an online support group or supplement the support you get at in-person meetings with online meetings.
Since 1935, Alcoholics Anonymous (AA) — a community-based, mutual-support program – has been helping alcoholics get and stay sober. AA’s 12-step model has been adapted and applied to other types of addiction treatment. As mentioned above, there are 12-step-inspired programs for every kind of addiction, from Crystal Meth Anonymous and Internet & Tech Addictions Anonymous to Food Addicts Anonymous and Sexaholics Anonymous. The bottom line is that if you’re struggling with an addiction, you’ll soon find that so are a lot of other people, and chances are good there’s a 12-step program that can help.
The 12-step approach is also often woven into treatment plans at rehab centers, residential programs and in hospitals and sober living homes. And meetings are held in cities and towns across the country – and around the world. Just how effective AA and spin-off groups are in treating alcoholism and other addictions, though, is not so clear. “Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals,” states the National Institute on Alcohol Abuse and Alcoholism. But for those who attend meetings, the principles are ones that have been relied upon time and again. The basic 12-step philosophy is founded on a dozen consecutive processes (each step builds on the one(s) before it):
The Twelve Steps of Alcoholics Anonymous
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Copyright 1952, 1953, 1981 by Alcoholics Anonymous Publishing
(now known as Alcoholics Anonymous World Services, Inc.)
Alternatives to 12-Step Programs
If you’re someone who does not want to use a 12-step program to overcome your addiction, more and more there are other options, including SMART Recovery® (SMART is an acronym for “Self-Management and Recovery Training”) which taps into a community of support to help you manage your own recovery, building self-reliance through education and supportive meetings.
SMART Recovery’s four-point plan focuses on being motivated, overcoming urges, managing feelings and living a balanced life. Created by physician Joseph Gerstein in 1992, it offers face-to-face and online meetings, as well as chat rooms and message boards to connect addicts with one another. The organization says it helps people recover from all types of addiction and addictive behaviors, including drug addiction and substance abuse, alcohol abuse, gambling addiction, prescription drug abuse, sexual addiction and problem use of other substances and activities.
Another alternative still is to decide that you want your doctor or other healthcare professionals (which could include, for example, a nurse practitioner, therapist or social worker) to help manage your treatment and offer motivation. In this case, your provider(s) might use the BRENDA approach — in which you’ll work together as a team or group, focusing on the goals and priorities you have for yourself. Your healthcare provider(s) using this model will usually prescribe FDA-approved medications to help you control cravings and do assessments to determine what your needs are. You’ll work collaboratively with your provider(s), so it’ll be up to you if you want to go to anonymous meetings or try SMART Recovery®, for example, as part of your treatment.
BRENDA is an acronym that stands for a method of counseling that is used to treat any addiction or mental health issue. It includes six core components that a counselor focuses on with each client: Biopsychosocial evaluation; Report to the patients on assessment findings; Empathy; Needs identified by patient and treatment provider; Direct patient advice; and Assessing the patient’s reaction to advice and adjusting treatment when needed.
BRENDA uses a type of psychotherapy called cognitive behavioral therapy (CBT) that focuses on questioning and changing negative and unproductive thoughts and beliefs in order to improve behavior and emotions that lead to using – whether that means drugs or alcohol or a compulsive behavior like sex, gambling or shopping — in combination with prescription medication to help quell cravings and relapse.
How to Choose Treatment
Once you’ve decided to pursue treatment, how do you know which options might be right for you? If you can, start by talking to a trusted health care professional, such as your doctor. If it’s too much for you to consider researching treatment options right now, don’t put it off; instead, ask your physician, a family member or a close friend to help. You may well find that your loved ones are concerned about you and will welcome the chance to help you find the assistance you need. After all, addiction touches everyone in an addict’s life.
Here are some important questions to ask when looking for the treatment center that’s right for you:
1. Is the facility licensed and accredited?
The best way to check is to look for a license issued by the state in which the center is located and accreditation by such national organizations as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF). These accrediting bodies require programs to meet high standards of patient care. When deciding on a center, also be sure to ask if they have experience treating your particular type of addiction. Consider centers that give you the option of a gender-specific setting or ones with professional/executive, Spanish-speaking, teen/young adult, faith-based or LGBTQ programs if you would benefit from one of these – this way you can recover in a setting personally tailored to your needs.
2. Does the program work with insurance?
Many facilities will check your insurance benefits for free if you’re a potential patient — meaning the center will reach out to your insurer to see how much of your care would be covered at their facility. You can also go to SAMHSA’s Behavioral Health Treatment Services Locator and search for a facility both by payment/insurance accepted and by whether the facility offers payment assistance (such as a sliding fee scale).
3. Does the staff have the credentials to provide expert care?
The therapists and staff will be the ones working closely with you and offering guidance on how to stay healthy and sober. While their own life experience — and their personal recovery stories — can make staff inspirational, it’s also important that they have top-notch qualifications. Your treatment team should include certified alcohol and drug counselors (CADCs) or licensed alcohol and drug counselors (LADCs) — these individuals may go by a variety of titles — as well as master’s-level therapists and social workers, among other specialists such as consulting psychiatrists and an around-the-clock nursing staff. A high staff-to-patient ratio is another important consideration; more staff generally means more supportive, individualized care.
4. Does the treatment center treat co-occurring mental health disorders?
Many people who struggle with addiction also are dealing with co-occurring mental health disorders such as depression, anxiety or a personality disorder. All of these issues require treatment, so you’ll need a center with a team of experts that might include a psychiatrist, 24-hour nursing staff, case managers and other therapists (social workers, art therapists, addiction counselors). Research shows that integrated treatment (meaning you’ll be treated for both addiction and mental disorders simultaneously) is most effective.
5. What is the center’s environment like?
Look online at pictures or, if you can, visit and tour the property. Some addiction treatment centers offer the amenities of a resort, such as swimming pools, private rooms and beautiful views in desirable locales. Others have a more home-like atmosphere that can be equally comforting. Choose the center where you feel most at ease.
6. What types of therapies and activities are offered?
Most programs offer medical detox, individual, group and family therapy. Others might also have art therapy, equine therapy, Eye Movement Desensitization and Reprocessing (EMDR) for trauma and other ancillary treatments. You might want to choose a program that has on-site activities for mind, body and spirit, like yoga, acupuncture, massage and other holistic therapies. Also be sure to take into account that the types of activities are ones you enjoy. Some programs promote outdoor recreation such as hiking or rock climbing, while others schedule outings to theaters, shops and local entertainment venues. All of these activities offer ways to learn or re-learn how to have fun while still maintaining your sobriety.
7. Will my partner or family be involved in my treatment?
Healthy family relationships should be fostered in treatment. Many centers involve family members in couples or family therapy sessions, and loved ones may be asked to attend a family weekend. In some settings, partners and family members may be included more than in other programs. If it’s important to you that your loved ones have easy access to you, and you to them, be sure to say so.
8. What happens when I’m ready to leave treatment?
An after-treatment plan will help you stay healthy and clean. Ask about a facility’s relapse prevention and continuing care planning as well as long-term treatment options (whether sober living, therapeutic communities or something else). Sometimes there will be support team, transportation to 12-step meetings or visiting nurses to keep an eye out for signs of relapse.
Getting straight answers to these questions will give you a clear direction, helping you to make a treatment choice with confidence.
Sources: Commission on Accreditation of Rehabilitation Facilities; Joint Commission on Accreditation of Healthcare Organizations; Substance Abuse and Mental Health Services Administration.
Paying for Treatment
Addiction takes a huge toll on those it touches: emotionally, physically, spiritually and certainly financially. Beyond the anguish and heartache of having to deal with the mental illness of addiction itself — whether to alcohol, drugs, sex, gambling or another type of behavioral addiction, and often in combination with another disorder like depression, anxiety or ADHD — for many, there’s the added burden of somehow figuring out how to pay for treatment. This can be layered on top of other financial difficulties, like a lost job or wages, medical bills and huge sums lost to gambling, shopping, drug use or other activities.
Treating addiction can be (but isn’t always) very expensive. To successfully reach recovery, some combination of the following types of treatment and therapies may be necessary:
· Inpatient residential treatment
· Outpatient rehabilitation
· Individual, group and/or family counseling
· Relapse prevention
And it may take more than one attempt for recovery to last: Forty percent to 60% of patients who receive substance abuse treatment will relapse within one year, according to the Journal of the American Medical Association. To make matters more complicated, while undergoing treatment, you may not be receiving a regular paycheck either.
It’s natural to feel overwhelmed at even the thought of paying so much to get help. In fact, cost is one of the biggest barriers to getting treatment, along with not being ready to stop using and not knowing where to go for assistance, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH) for 2013.
While there’s no denying that addiction treatment can carry a hefty price tag – in 2011, the average out-of-pocket cost (co-payments, deductibles, and coinsurance) per admission for a patient getting treated for substance abuse was nearly $900, according to the Healthcare Cost Institute — the costs (financial and otherwise) of not getting proper treatment are often much higher. Without help, you may be at a greater risk for lost jobs, failed relationships, incarceration, health complications, overdose and suicide.
According to a cost analysis published in the journal Health Services Research, every $1,583 spent on nine months of addiction treatment saves $11,487 that would otherwise be lost during the same time period to unearned wages and the costs of crime, injury or illness associated with addiction.
Fortunately, there are affordable, even free, options when it comes to treating addiction. Perhaps most important, you’ll pay nothing to attend a self-help support group, either online or in-person (although you may opt to make a small contribution if an in-person group passes a donation basket). Whatever your type(s) of addiction, chances are very good there’s a 12-step support group that can help. These include:
Those in treatment or recovery can attend as many meetings as they like — all free — to support their sobriety, and most cities offer dozens of options for meeting locations and times.
What’s more, many treatment facilities offer sliding scale fees for people without health insurance. This means that the cost of treatment will be calculated based on your income. Still other centers make available their own financing to create affordable packages, either directly from the treatment center or through third-party lenders. Visit SAMHSA’s Behavioral Health Treatment Services Locator to find a facility near you; you can search by both payment/insurance accepted and by whether the facility offers payment assistance (such as a sliding fee scale).
The passage of the Affordable Care Act (ACA) opened up new options in health insurance coverage by making treatment for mental health and substance abuse what the ACA calls an “essential health benefit” for most plans. This means that most major insurers and Medicaid must include mental health and substance abuse care as part of their plans, including free preventative services like adult and adolescent depression screening, alcohol-misuse screening and counseling and tobacco use screening and cessation interventions.
The law also requires mental health and substance use services to be covered at parity — meaning on fair and equal terms — as with other health issues. And insurance companies are also prohibited from denying coverage to people with pre-existing conditions, which include schizophrenia, depression, bipolar disorder and drug or alcohol dependence.
While the ACA does cover substance abuse treatment, how much is paid for and how much you will need to pay out–of-pocket depends on your individual health insurance plan as well as your state. According to the National Alliance on Mental Illness, plans may differ on the following:
· Types of services covered (for example, the types of therapy for addiction)
· Treatment limits (including the length of rehab stays and which medications are paid for)
· Which health and mental health providers are covered
While insurance is a great way to reduce the cost of treating a mental illness (which addiction is considered to be), it can be hard to sort out the terms and conditions of the insurance policy. Call your insurance company to find out the specific details of your coverage. The ACA also requires health insurers to provide an easy-to-understand summary of your benefits. Or contact your state Consumer Assistance Program (CAP) for more information. If your state doesn’t have one, the CAP can point you to other consumer resources and links to the state’s Department of Insurance that may provide answers to your questions.
Many treatment facilities offer a free benefits check for potential patients — meaning the center will reach out to your insurer to see what you qualify for. To call for a benefit check, have the following information on hand to share with any facility you’re considering:
So How Much Will Treatment Cost?
Since addiction treatment is not one-size-fits all the truth is that what you will pay can vary a lot depending on the type of addiction you has, whether you also have a mental disorder like depression or anxiety and factors such as location and health insurance.
What’s more, the type of facility you choose and the services offered there, medication and length of stay will naturally have a big impact on the total price. For instance, a six-month inpatient stint at a luxury rehab center that bills separately for every therapy or group-work session will cost much more than a community center that you attend during the day and which offers one all-inclusive price for services. (Typically, treatment for addiction begins with detoxification, or purging your system of the drug(s) or toxic behavior(s), followed by intense counseling and self-help support groups. In addition, medication may be used to manage withdrawal symptoms, reduce cravings and/or manage a mental illness.)
While you may not need all (or any) of these approaches, here’s what to expect when it comes to paying for the different types of addiction care:
Inpatient (residential) treatment: As its name implies, inpatient treatment involves staying for a period of time at a specialized facility. How long you remain on-site depends on the length and severity of your addiction(s) and any co-occurring disorders, like depression, anxiety, ADHD and other mental illnesses. When you live at a rehab for a period of time, you should expect that your treatment will be intensive and involve a multifaceted approach that includes one-on-one counseling, group therapy, educational discussions and lectures, physical exercise and group activities, family counseling (if applicable) and relapse prevention.
The cost of residential treatment centers can range hugely, from free to $80,000 a month, depending on the center’s location and the treatments and amenities offered. An inpatient program for technology addiction (which isn’t recognized as an official mental disorder and therefore is not covered by insurance), for example, can cost $14,000 for a 10-day stay.
Outpatient treatment: These centers offer the same types of treatment as residential programs — one-on-one psychotherapy, group therapy, 12-step meetings, medication therapy and other holistic approaches like yoga and mindfulness meditation — but because you don’t stay overnight, you can more easily continue to work or attend school while still fulfilling your treatment plan. In general, outpatient addiction treatment is much more affordable with an average weekly cost under $500.
Day treatment/partial hospitalization: A day treatment program (which is a type of outpatient treatment) may be an ideal choice if you’re looking for more structure and intensive treatment than a regular outpatient program can provide. Day treatment is often affiliated with a hospital or private residential facility, and you may attend up to seven days a week for several hours each day, including evening 12-step meetings or educational seminars. Costs vary but day treatment is generally more expensive than an outpatient treatment program but less costly than residential treatment.
Sober living homes (formerly called halfway houses/homes): These are live-in, drug-free living environments that offer peer support for recovery and long-term sobriety. While it’s less common to find a sober house for behavioral addictions like gambling or sex addiction, those who are addicted to substances, including alcohol, cocaine, heroin and methamphetamine, have been found to benefit from transitioning to recovery with the help of these sober environments.
Prices for sober living homes can range from $450 to $10,000 per month and vary depending on the location, utilities, meals, laundry facilities and other amenities. You will also pay more to have just one roommate or a room to yourself. Most sober-living houses are privately owned and will bill residents directly, though some accept insurance or Medicaid.
· Cognitive behavioral therapy (CBT): This is the go-to psychotherapeutic treatment for a variety of mental illnesses, including anxiety and mood disorders as well as addiction. CBT is a leading form of one-on-one psychotherapy that focuses on questioning and changing negative and unproductive thoughts and beliefs in order to stop the triggers, behavior and underlying emotions that contribute to mental illness(s) and addiction(s). While very effective, CBT can also be expensive, costing $100 or more per hour, according to the Anxiety and Depression Association of America. Some therapists and clinics offer therapy on a sliding scale, which means they charge based on your income and/or insurance coverage; ask about payment options when you call or visit a therapist for an initial consultation.
· Group therapy: This type of therapy is a lot like “talk therapy,” except that it typically involves a group of people with the same or a similar type of addiction or the same co-occurring disorders, such as depression and alcoholism. The therapist acts primarily as a guide, keeping the group conversation productive and focused. Group-therapy sessions typically last 90 minutes and cost roughly half as much as one-on-one counseling — between $35 and $80 per person, according to the American Group Therapy Association.
· Family and couples therapy: Family therapy (also sometimes called multidimensional family therapy, or MDFT) is structured so that every member of the family has a voice. With the guidance of a professional therapist, the goal is to improve the interworking of each family’s relationships and their home life. In couples therapy, the therapist works with a couple dealing with an addiction to help both partners come to terms with the ways in which the problematic drug and/or behavior has hurt their relationship and find ways to reconnect, or, if necessary, part ways. According to the National Directory of Marriage and Family Counseling, rates vary from about $75 to $200 per hour, and some therapists will offer sliding scale fees based on income.
· Drug therapy: Medication can be used to help ease symptoms of withdrawal and to prevent cravings that can lead to relapse (starting to use again); this is called medication-assisted therapy (MAT). Prescription drugs are also used in treating addictions to some drugs (specifically opioids like oxycodone and heroin and alcohol), tobacco and even video gaming.
Prescription drug coverage is what’s called an “essential health benefit,” meaning that under the Affordable Care Act it is required. That said, the specifics of exactly which medications will be covered vary by plan; some insurers offer different coverage for “preferred” drugs, for generics and for “specialty” drugs. If you take a prescription medication to treat a mental illness and/or addiction, check your insurer’s formulary (the specific list of the drugs included on your plan) to find out exactly what’s covered.
According to Consumer Reports, retail prices for commonly prescribed antidepressants, for instance, range from about $21 a month (sometimes even less) to more than $1,000 monthly. Certain generic antidepressants may cost as little as $4 for a month’s supply through drug programs offered by large chains such as Kroger, Sam’s Club, Target and Walmart.
If you’re having trouble paying for medication that you need for an addiction or a mental health issue, there are several non-profit organizations that offer help with prescription costs, co-pays and premiums; these include NeedyMeds, Partnership for Prescription Assistance, RxAssist and RxHope.
Similarly, many pharmaceutical companies have patient-assistance programs that make available medication at little or no cost to uninsured patients. Visit the National Alliance on Mental Illness for a list of commonly prescribed psychiatric drugs and information about how to contact each pharmaceutical company directly to ask about their drug-discount programs. You can also ask if your doctor has any free samples of the drug(s) you’re taking.
Sources: Consumer Reports; Health Care Cost Institute; Healthcare.gov; Health Services Research; Journal of the American Medical Association; National Alliance on Mental Health.
Q: How can I tell if I’m addicted?
A: If you’re asking this question about addiction, it may be because you can see that your use of a substance or a compulsive behavior is disrupting your life. An addiction, though, isn’t the same as using a lot of drugs or alcohol or frequently indulging in an activity like sex, shopping or gambling. If you’re truly heading towards an addiction, you won’t be able to stay away from the drug or the activity or cut back, as much as you want to. You’ll experience cravings and will continue to use the substance or repeat the behavior, no matter who or what it hurts: your relationships, your career, your finances, your health. Addicts often miss important family, social and work/academic obligations and forego hobbies and other activities in order to use. The addiction becomes their single focus, crowding out the rest of life. If something interferes with your ability to use, you’ll experience psychological withdrawal symptoms, which vary depending on the addiction; these can include feeling angry, upset or anxious. For substance users, physical withdrawal symptoms can include vomiting, headaches, muscle aches, fevers, chills and/or seizures.
Q: Is it true that you can be addicted to more than one substance/behavior at a time?
A: Yes, and in fact this is common. Those who have an addiction are also likely to have what are called “co-occurring disorders,” such as a mental health issue(s) like depression or anxiety. And it is common for people to have more than one substance or process/behavior addiction. Research clearly links substance use to problems with gambling, video gaming, disordered eating, Internet use and compulsive sexual behavior. Not every addict has multiple addictions or another psychological problem, but in general, there is a lot of overlap between these issues.
Q: What if I have a mental health issue (like depression), too?
A: First, if you’re struggling with addiction and a mental disorder, you’re definitely not alone; many people are in the same situation. If you decide to seek treatment, it’s essential that whatever program you choose addresses both issues at the same time. Treatment that factors in both addiction and mental health will give you the best possible chance for a successful, lasting recovery.
Q: What kind of treatment is right for me?
A: There’s no easy or short answer to that question about addiction. That’s because everyone dealing with addiction has their own history, values and beliefs. Plus, factors like where you live, your job and what health insurance you have are bound to play big roles, too. Simply put, professional treatment can take place on an inpatient basis (at a rehab facility where you stay for a period of weeks) or on an outpatient basis. Outpatient means you sleep at home but attend either a day treatment program (for seven or eight hours a day) or an evening outpatient program for a couple of hours several times a week. If your home environment is contributing to your addiction or is not a supportive place that’s conducive to recovery, an inpatient facility might be your best bet. For more details on the various options available, go to Treatment Options. You can also use the Behavioral Health Treatment Services Locator directory offered by the Substance Abuse and Mental Health Services Administration (SAMSHA).
Q: How can I find a treatment center for my type of addiction?
A: Once you’re diagnosed with an addiction, your physician or counselor may strongly recommend a type of treatment center based on your needs — whether inpatient, outpatient or day treatment. That recommendation should help you to start researching options. SAMHSA’s directory is one resource to try; you can also reach them by calling 800-662-HELP. Other good resources for recommendations include your health insurance company, friends and family. Keep in mind that if you’re choosing inpatient treatment, you may not need to stay close to home and can broaden your search to include inpatient treatment centers across the country.
Q: How do I find a therapist/counselor who understands my type of addiction?
A: Almost any accredited treatment center you choose — whether inpatient, outpatient or day treatment — will have experienced staff to help you. That should include master’s-level counselors or other psychotherapists and a consulting psychiatrist or physician, along with a team that includes care coordinators, recovery coaches, case managers and nursing staff. Ideally, your team should have expertise in the type of addiction(s) you’re struggling with, but for some newer problematic behaviors such as technology and video game addictions, it may be harder to find someone with deep experience, training or credentials in that particular field. Fortunately, many of these addictions are treated in ways that are very similar to substance use disorder and other addictions. Make sure you always check that any center you’re considering is certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF). To learn more, go to How to Choose Treatment.
Q: What if I’m not ready for treatment?
A: Some addicts know when they’ve had enough and that it’s time to get some kind of help. Others may debate their readiness to quit for months, years or decades. Even if you’re not convinced you’re ready — and even if you flat-out don’t want to stop using — it’s important to understand that treatment can still be successful. Put another way, you don’t need to be willing to stop or have “hit bottom” in order to move toward a life of recovery. And that includes being forced into treatment by a loved one, your employer or even the court system. As the National Institute on Drug Abuse (NIDA) puts it, “Treatment does not need to be voluntary to be effective.”
Q: Do I have to stop using forever?
A: The idea of giving up something you crave for the rest of your life can seem daunting at best and impossible at worst. In most, but certainly not all cases, addicts find they must permanently abstain from using the substance they’ve become addicted to, and they must limit or stop a problematic activity (depending on what it is). That’s because these substances and behaviors powerfully affect the brain of someone who’s addicted. Through effective treatment, though, addicts can and do recover and learn to seek pleasure through healthier outlets. And sometimes, of course, complete abstinence simply isn’t possible or reasonable. For example, food addicts cannot avoid eating and someone with an addiction to love, relationships or technology likely still needs these to be part of their life in recovery. Your treatment might include signing a “sobriety contract,” too, in which you agree to not indulge in some problematic behaviors, but that others when used responsibly are okay; in this case, the goal is to help you learn how to use things like the Internet or sex in ways that are reasonable and healthy.
Q: Do I really need to attend a treatment program? Can’t I just go to 12-step meetings?
A: Millions of lives have been changed with the help of AA and similar self-help support groups for other types of addiction. And there are certainly people who start attending 12-step meetings and find that the support, information and camaraderie they find there is enough to help them start and stick with sobriety. If, though, you find that you need more intensive treatment and the help of credentialed professionals — perhaps you’re dealing with multiple addictions or a mental health issue, too, or your doctor has recommended professional treatment for your addiction or you’ve relapsed and want to try something else — there are lots of options to suit your needs and situation. Most treatment programs will include some version of a 12-step program, in addition to individual, group and/or family counseling and/or medication therapy. “Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention,” reports the National Institute on Drug Abuse. This multifaceted approach helps address every aspect of your addiction, giving you the best shot at living a healthy, happy life in recovery.
Q: How can I afford to pay for treatment?
A: While addiction treatment can carry a hefty price tag, there are also many low- or no-cost options. Self-help support groups, for example, are free and available for all sorts of addictions either in-person or online. (These include Alcoholics Anonymous, Narcotics Anonymous (NA), Marijuana Anonymous, Crystal Meth Anonymous, Gamblers Anonymous, Food Addicts Anonymous and Sex Addicts Anonymous, to name a few.) They are offered nearly everywhere with dozens of locations and times — and you can attend as many meetings as you’d like. Treatment for mental health and substance abuse is also likely covered by your insurance — 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 the ACA, 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 it’s important to call your insurance company to find out the specifics of your plan. For more information on ACA, visit Healthcare.gov.For those without health insurance, many treatment facilities and healthcare providers offer sliding scale fees, or fees based on your 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. You can also contact your state substance abuse agency to find out if your state will help pay for substance abuse treatment. For more information, visit Paying for Treatment.
Sources: 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.
Prevention for a Loved One
If you’re reading this, chances are you’re already concerned about a loved one – a child, spouse, parent or friend who is near and dear to your heart. You may be wondering what makes some people become addicted while others don’t. More important, you want to know how you can you help your loved one avoid becoming a statistic.
The answer to why some people become addicted while others can try a substance or behavior and never develop a problem lies in the brain. A potentially addictive substance (like alcohol, tobacco products and heroin) or behavior (like gambling, video gaming, compulsive eating, shopping and sex) stimulates the brain’s reward center. It is this area of the brain that releases a powerful brain chemical called dopamine, which helps us feel pleasure – even euphoria or a “high.” Over time, when repeatedly overstimulated in this way, the brain changes and begins producing less and less natural dopamine to compensate for the rapid (and unnatural) chemical surges it experiences from compulsive use.
Because addiction affects the brain in these ways and changes the brain’s circuitry over time, the National Institute on Drug Abuse (NIDA) considers substance addiction to be a chronic brain disease that is progressive. That means people with substance use disorders gradually get worse over time if they keep using a substance; and relapses are all too common as well with this disease. Similarly, if your loved one has a problem with a behavior such as gambling, this, too, is considered an addictive disorder similar to substance use since both activate the brain’s reward system in a comparable way, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guide clinicians use to diagnose mental disorders. Compulsive behaviors are often called behavioral, or process, addictions and include video gaming addiction, sex addiction, food addiction, porn addiction, work addiction, love addiction, exercise addiction and shopping addiction, among others. These, though, are not currently recognized in the DSM-5 as addictive disorders.
Because an addiction generally develops over time – not after a single use – you can help prevent a problem from starting by discouraging experimental or recreational use so that it doesn’t have a chance to develop into something more serious. How long it takes for casual use to progress into an addiction varies from person to person and also depends on the specific substance(s) or behavior(s) involved – as well as the individual, because relatively few people who use ever become addicted.
There’s no single root cause of addiction. But there are a variety of factors that can increase your loved one’s risk. These include:
· Easy access to drugs or other substances or ways to behave compulsively
· A family history of addiction
· Stressful and traumatic life events
· Personality traits such as aggression or impulsivity
· A lack of knowledge about harmful outcomes related to drugs or other behaviors
· A diagnosis of a co-occurring mental health issue, such as depression, ADHD or anxiety
Sometimes your loved one’s risk factors simply cannot be helped or changed. These might include experiencing trauma, such as being a victim of rape, incest or physical abuse; having a family history of addiction or being raised in a dysfunctional home. While you might not be able to prevent your loved one from developing an addiction, it is possible to intervene, especially early on, and perhaps have a powerful and meaningful impact on the life of someone you care about.
What you will be able to do to help largely depends on the strength and closeness of your relationship to this person. If you’re a parent and your child is under 18 you will, of course, have more rights and responsibilities to help your child. But regardless of the legal relationship you share with your loved one, what’s most important is that you care enough to recognize there could be an issue and that you’re arming yourself with important information about prevention.
If you are a parent or caregiver, you can:
Adjust your parenting style. Having a strong family bond can help children avoid developing an addiction down the road, according to NIDA. Researchers have conducted studies to find out which parenting style seems to be most effective at preventing substance abuse problems in children. One such study in the journal Drug and Alcohol Dependence looked at nearly 8,000 adolescents across Europe and found that both an authoritative parenting style (characterized by warmth and strictness) and an indulgent parenting style (warmth without strictness) were both protective against adolescent substance use. But parents who were authoritative (strict and not warm) and neglectful (neither warm nor strict) were less effective at preventing adolescent substance abuse in the six countries studied. NIDA suggests trying to keep the lines of communication open with your teen; not leaving him/her alone for large blocks of unmonitored time; and doing your best to handle emotional conflicts collaboratively and effectively. To brush up on these and other skills, check out NIDA’s Positive Parenting Family Checkup.
· Bolster self-esteem. How your child feels about him/herself is critical in preventing substance abuse. Research links low self-esteem to current and past substance use. Problems such as poverty, parental marriage problems, physical abuse, bullying and poor grades can all factor into how someone values him/herself.
· Get involved. Strong social connections help protect against a substance use problem, according to the Substance Abuse Mental Health Services Administration (SAMHSA). Go to your child’s school performances, and invite him/her to come with you to religious services, sporting events or other local activities. You might be surprised how much these experiences could affect even the most taciturn teenager, and you may find that your relationship with your child is strengthened in the process.
· Offer support during transitions. Change can be hard under the best of circumstances, but adolescents can find transitions, like a move from middle to high school, graduation or a relationship break-up, particularly hard to navigate. These are the times when drug use can take hold, according to NIDA. Do what you can to offer extra support and attention when your teen or young adult is in a sensitive stage of life.
· Attend anti-drug programs together. These types of early-intervention programs can help prevent risky behavior in adolescents, research shows. Even just starting the conversation about what your child learned in a school anti-drug program gives you an opportunity to encourage him/her to stay drug-free and refuse anyone who offers them a drug or alcohol.
· Support healthy choices. NIDA research shows that when drinking or using drugs starts in the early teens, the risk for addiction dramatically rises. Therefore, preventing an addiction from starting in the first place means discouraging your child from even casual use and offering them healthier options such as participating in sports, developing hobbies and hosting drug and alcohol-free parties.
Here are some more ways to reduce the chances your loved one will develop an addiction. You can help them:
· …learn how to deal with past hurts and trauma. Perhaps it’s time to suggest counseling to help your loved one achieve better mental health. You can suggest that he/she attend a support group, see a therapist or read a self-help book – just lending your loved one a book that you think will resonate may be enough to start the healing process. A gentle suggestion may be useful in helping your family member or friend begin to sort out the past for a healthier tomorrow.
· …improve self-control. If you see that your loved one tends to be aggressive, impulsive, anti-social or a risk-taker who seeks out extreme experiences and sensations, therapy may also be in order. According to NIDA, each of these personality traits are common predictors of later problems with drugs and alcohol. And if you can’t get a loved one to go to a counselor, you can still go yourself. Sometimes, changing the way we interact with a family member or friend can trigger changes itself. A therapist might be able to give you strategies you can use that may encourage your loved to act out less, be more social and make fewer risky choices. Perhaps most important, therapists and 12-step groups can help you and other family members or friends how to stop enabling unhealthy behavior.
· …feel accepted. If your loved one is lesbian, gay, bisexual, transgender or queer (LGBTQ), feeling surrounded by love and support is essential. It’s not at all uncommon for substances to be a sort of Band-Aid for dealing with difficult feelings related to self-esteem, homophobia, discrimination, trauma and violence. According to the Centers for Disease Control (CDC), people in the LGBTQ community are more likely to have substance abuse issues into later life.
· ….choose healthy friendships and social situations. Easy access to drugs or alcohol is obviously a big contributor to substance abuse, and this is especially true for young people. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the earlier someone starts drinking, the greater the odds that he/she will develop an alcohol use disorder. So in your home and at family gatherings and parties, think about the food and beverage choices you offer and whether these support or hinder your loved one. In addition, peer pressure can be a huge factor, so you may need to talk to your loved one about choosing friends who don’t use; drug-abusing friends are a major risk factor for your loved one — and that doesn’t just mean teenagers. Working with colleagues who drink heavily or use drugs can be just as influential. In your words and in your actions, you can be a good example, too, by modeling healthy limits.
· …get informed about the dangers of drug use. According to SAMHSA, simply believing that drugs and alcohol aren’t that harmful is another risk factor. So educate the person you love about how drugs increase the chances of losing a job, dropping out of school, participating in risky sexual behavior and even developing certain mental disorders that are substance-induced. You know best how to start the conversation. The important thing is that you care enough to have the talk, even knowing they may not want to hear what you’ve got to say.
While there’s no surefire way to keep your loved one safe and addiction-free, following this advice can help raise the odds that your loved one will not veer into addiction and all that it entails.
If you think it may be too late for prevention and it’s instead it’s time to consider treatment for the person you love, go to SAMHSA’s Behavioral Health Treatment Services Locator, or call (800) 662-HELP. Getting help early on, before the problem becomes too serious, is the best course of action if you think your loved one’s substance use or behavior has turned the corner and might be crossing over into addiction.
Sources: American Journal on Addictions; American Journal of Drug and Alcohol Abuse; Centers for Disease Control; Diagnostic and Statistical Manual of Mental Disorders (5th ed.); Drug and Alcohol Dependence; International Journal of Eating Disorders; Journal of Behavioral Addictions; National Institute on Drug Abuse; National Survey on Drug Use and Health (2013); Psychiatria Danubina; Substance Abuse and Mental Health Services Administration.
Signs Your Loved One is Addicted
An addiction isn’t something that crops up overnight. People who work with addicts say it typically starts with recreational use, and over time, in some people, repeated use or behavior can progress into a need to use regularly – even though it puts one’s health, safety, relationships, career, education and finances on the line. Over a period of time – this varies from person to person – the addicted person feels compelled to compulsively seek out a substance or behavior due to very strong cravings. Because addictive substances and behaviors give a “high” or euphoric feeling, if your loved one is addicted, he/she will not be able to just stop using. Addiction takes away the ability to choose to stop, even if your loved one desperately wants to.
As you probably know, it can be very difficult to recognize early on that your friend or family member is involved in drugs or another addictive behavior. You should also know that your loved one is unlikely to admit to a problem. Addicts tend to cover their tracks. But there are a variety of signs that you might be seeing now – even ones you may have brushed aside, not wanting to believe that an addiction could be at play. See how many of these common warning signs of addiction, from the U.S. Department of Health and Human Services, that your loved one may have:
· A shift in mood, attitude and motivation
· A new friends and new hangouts
· Poor performance at school or work and/or being absent
· Secretive behavior such as lying
· Sudden weight loss or gain
· A sudden, unexplained increase in spending
· Bloodshot eyes or enlarged pupils
· A giving up once-favorite pastimes and hobbies
· Strange body odors; trembling hands
· Unusual changes in sleeping patterns or schedule
In addition, you may notice that your loved one now has angry outbursts and is more volatile or unpredictable. He/she may be inattentive and not follow through on assignments or obligations on time or at all. You may find your loved one making secretive, unexplained phone calls or cash withdrawals, concealing what’s on his/her computer screen, or creating new bank or online accounts. His/her schedule may change frequently, often without your knowledge. Your loved might also be sleeping more or suffering from insomnia, choosing to wear sunglasses often, making an effort to cover up unusual breath or body odors and in general is changing in ways you cannot explain, excuse or understand.
It’s also possible that your loved one is not paying the bills, asks to borrow money or is taking or stealing money from you and others. You may notice your partner, friend or relative feeling more melancholy and depressed (these can be psychological symptoms of withdrawal). And then there are common physical symptoms when an addict tries to quit a substance; these withdrawal symptoms may include muscle aches, vomiting, sweating, trembling, fever, insomnia and/or diarrhea.
If these signs are confirming your suspicions rather than allaying them, you may wonder what you should do now. Before you confront your loved one, take some time to cool down, so you’re more level-headed and you’re sure to get your facts straight. It’s understandable if you’re feeling angry, nervous and afraid. But a first conversation with a loved one will go better if you first figure out what you want to say and what you’re feeling.
Take a Closer Look
If your loved one is your spouse, a minor child or a friend or partner who lives with you, you may have access to bank and credit card statements, phone bills and paystubs; all may contain useful information to confirm absenteeism, cash withdrawals or unusual spending patterns. Be sure, too, to look over your shared phone bills; there may be a pattern of outgoing or incoming calls, 800 or 900-numbers that look suspicious – and you may decide to call those numbers yourself to find out more about your loved one’s behavior if you’re not sure:
Start a journal. It can help to start recording when your loved one leaves for his/her job or classes and when he/she return and to check activity on computers you share. By simply checking the browsing history on a shared computer, you can gain a lot of insight into what your loved one may be up to, whether that may mean online gambling, video gaming, pornography or excessive shopping, for example. That said, many addicts learn to hide their behavior well, so you may find that he/she has cleared their browsing history, so it isn’t easy to find out details of how they spend their time online.
Trust your instincts. Investigate if you suspect there is a problem based on other signs you’ve seen over time, especially if that behavior is worsening. It’s best to have solid information, as much as you can, before you talk to your loved one; without some factual information, you may be swayed by your loved one’s likely denials. Remember, addiction is a disease that causes people to act out of character; simply put, addicts will lie and cover their tracks so they can keep using. But by having evidence in front of you, it will be easier to see through lies or attempts at deception.
Be aware of suicidal behavior. If you find out that your loved one may be contemplating, planning or attempting suicide, call 911 immediately. Another resource is the Suicide Prevention Lifeline, at (800) 273-TALK. If your friend or family member is experiencing withdrawal symptoms from stopping a drug or alcohol, it’s wise to seek medical attention as soon as possible, as certain medications and drugs can cause dangerous side effects when stopped cold turkey and should be medically monitored.
Make an appointment with a medical professional. Even if you don’t have any emergency medical concerns, it’s still a good idea to reach out to a doctor or counselor for proper screening for addiction. If a professional confirms your suspicions of a drug addiction, mental health problem, compulsive behavior or process (behavioral) addiction, your loved one’s physician may be able to advise him/her one on treatment. You may also decide to enlist the help of an interventionist who can guide you through the process of confronting your loved one about his/her problem; this can be particularly effective in getting the person you love into treatment as soon as possible and on the way to a healthier, sober life.
Sources: Diagnostic and Statistical Manual of Mental Disorders (5th ed.); Substance Abuse and Mental Health Services Administration; U.S. Department of Health and Human Services.
Treatment for Your Loved One
Because addiction is a chronic disease – just like diabetes or high blood pressure – continuous care over time is needed. This means that overcoming an addiction and moving into successful, long-term recovery isn’t a matter of having willpower, though this is a common misconception. It usually takes a lot more than a desire to stop using to enter into and sustain recovery.
Initially, your loved one may require emergency medical care if he/she overdoses from alcohol or drugs or has an eating disorder – this can sometimes be the first step to getting well. Seek immediate medical attention for any medical emergency; an overdose and withdrawal from certain drugs or combination of drugs can be life-threatening, and so can complications from issues related to eating. Short-term hospitalization is sometimes necessary, but this is not treatment for addiction.
Treatment begins with detoxification (“detox”) from the substance and/or behavior and intensive counseling. Detox can take place in the hospital if your loved one is hospitalized for an overdose or withdrawal symptoms, or it can happen after your loved one is admitted to an accredited treatment program or center. During detox, which lasts for several days or longer, your loved one will be medically and emotionally supported while the substance(s) or behavior(s) the person is addicted to is removed. Sometimes during detoxification, your loved one will be given a prescription medication that’s FDA-approved to help with the intense physical and psychological symptoms of withdrawal, which can include:
· Abdominal pain
· Muscle aches
Medications such as Subutex, methadone or naltrexone (Vivitrol) may also be prescribed for a period of time during treatment as medically necessary. But sometimes, depending on the nature of the addiction, physicians may decide to prescribe medications (Suboxone or methadone) long-term to prevent the kinds of intense cravings that can lead to relapse.
What won’t happen in the hospital but will happen in a drug treatment program is the intense psychotherapy that addiction experts say is typically needed. Psychotherapy usually includes one-on-one counseling as well as group therapy and support groups. Even if your loved one is steadfastly against treatment or goes begrudgingly due to pressure from a family member, employer or the court system, treatment can still be effective, according to the National Institute on Drug Abuse. In other words, your loved one doesn’t have to volunteer to go or want to stop using for treatment to work.
For most people, simply removing a drug or compulsive behavior is not enough to stop the person from using for good. Psychotherapy – whether individual, group, couples and/or family – is also needed to address any mental health issues, past trauma or problems related to self-esteem and relationships; all of these are likely to be the fuel behind an addiction. But counseling isn’t just about digging up the past: During therapy sessions, the addict learns healthier habits, coping strategies and how to make better choices as he/she learns new ways to deal with all of life’s complexities in recovery.
Sources: Alcoholics Anonymous; American Art Therapy Association; Centers for Disease Control; Diagnostic and Statistical Manual of Mental Disorders (5th ed.); Dialectalbehavioraltherapy.net; EMDR International Association; Equine Assisted Psychotherapy and Equine Assisted Learning; Food and Drug Administration; Journal of Psychiatric Practice; National Association of Cognitive Behavioral Therapies;National Directory of Marriage and Family Counseling; National Institute on Alcohol Abuse and Alcoholism; National Institute on Drug Abuse; National Survey on Drugs Use and Health (2013); OpenSkyWilderness.com; Greg Simpson, LCSW; SMART Recovery.org; SoberLivingHomes.com; Substance Abuse and Mental Health Administration
You’ll find that there’s no one-size-fits-all approach to treating an addiction, no matter what kind. Addiction is a very complex disease and no single treatment has been found to be 100% successful. Statistics also show there’s a high relapse rate with addiction. But what many fail to understand is that the relapse rate of addiction (about 40% to 60%) is right in line with other chronic diseases, including diabetes (20% to 50%), hypertension (50% to 70%) and asthma (50% to 70%), according to research from the National Institute on Drug Abuse (NIDA). If your loved one does relapse, it doesn’t mean treatment was a failure. What it does mean is that your spouse, child, family member or friend might need more treatment or an adjustment to his/her maintenance plan.
And you certainly shouldn’t give up on the idea of trying treatment because you’re afraid it will be a waste of time or money. The cost of not getting treatment can be far higher; experts estimate the total savings-to-cost ratio for addiction treatment is 12 to one. Addiction costs individuals, families and society a tremendous amount in accidents, injuries, property damage, incarcerations (lost wages), job loss, medical expenses, overdoses and death.
Whatever treatment your loved one chooses, it should be tailored to the individual. Mostly this means that the person receives a combination of therapies — typically a mix of psychotherapy (counseling), medication, support groups or 12-step meetings and possibly a stint in rehab to start their recovery. NIDA notes that whether the person you love enters residential (where the person lives at a facility for a period of time and receives treatment there) or outpatient treatment (in which they just attend during the days and/or evenings but sleeps at home), it’s advised that he/she participates in some combination of treatment for an extended time period. According to NIDA, participation for three months or longer has been found most effective at “maintaining positive outcomes.” Of course, however, this will vary depending on your loved one’s addiction and individual progress as well as his/her financial situation.
By contacting your loved one’s primary care doctor for an appointment, you can get help identifying the types of treatment programs that may be the best fit for him/her depending the addiction type, gender, age, language, interests, beliefs, sexual orientation and any mental health issues. More and more treatment facilities offer programs for similar-minded groups of people. Often, the bonds made in these programs continue long after people exit treatment, and “alumni” may help each other sustain recovery through continued friendship and support.
If you’re choosing a treatment program, or helping your loved one select one, it can be overwhelming to consider all the choices. Read on for a brief overview of what to think about depending on your relationship with the person in need of treatment:
For a Spouse/Partner
Marriage and long-term relationships are tough enough to manage without the havoc that addiction can cause. Spouses and partners, in fact, may be the ones hardest hit by substance use or a problematic behavior, because while addicts can often hide using from friends, co-workers and even their children, it’s much harder to keep an addiction secret from the person who’s closest to you.
Getting your loved one to enter treatment is one of the best things you can do for him/her – and for your relationship. Since there’s no one-size-fits-all treatment, start by reaching out to an addiction specialist who can help you identify the type of program likely to best suit your loved one. This can be based on his/her addiction type(s), any mental illness, gender, age, interests, beliefs and more. As a loved one you’ll also need to consider the setting of the treatment, the types of programs available and the kinds of therapy that will be used to help your loved one heal. It can be overwhelming; you’ll find an overview of various treatment options in the Get Help for a Loved One section to make this process a little easier.
As a partner or spouse, it’s likely that you’ll be involved in your partner’s treatment in some way through learning more about addiction and couples counseling or family therapy. Consider getting or therapy together as a couple and separately; in many cases both spouses benefit greatly from individual sessions to work on individual issues. This may be especially true if your loved one suffers from sex, porn and/or love addiction. Experts in treating sexual addiction note that the partner of a sexual addict often internalizes a tremendous amount of guilt, shame, anger and other very intense feelings. Without psychotherapy to understand what’s behind their partner’s compulsive behavior and how to cope with the difficult feelings his/her actions bring up, the relationship – already under severe strain – is even further jeopardized. Similarly, it’s important to address any underlying issues that existed prior to the addiction. If the problems in your relationship or marriage aren’t treated, the stage is set for both ongoing conflict and possibly relapse.
Attending self-help meetings and support groups with your loved one or on your own can be very helpful, too. Some groups, like Alcoholics Anonymous, Narcotics Anonymous, have “open meetings” in which loved ones can attend and there are also groups specifically designed for family members or friends of addicts, like Al-Anon or S-Anon, that can give you added support and a greater understanding of your loved one’s addiction. Even if you only listen to the experiences of others, it can be very comforting.
Also essential to helping your loved one is taking care of yourself. This isn’t selfish. When you’re physically, psychologically and emotionally healthy you’re better able to assist your partner during his/her addiction treatment and recovery. Make sure you eat properly, get enough sleep and exercise regularly; all will help mitigate the effects of stress during this very difficult time. It’s also crucial to maintain your social support network, the people who are there to take care of you. Simply put, you need to have outlets for your own sanity, whether that’s a hobby, workout, class or just going to movies or concerts or taking a walk in the neighborhood. Self-care also means considering your own long-term needs; and that may mean ending your relationship if your loved one continues to relapse or mistreat you or you’re simply unable to repair the damage caused by addiction.
For a Teen/Young Adult
There’s simply nothing more devastating to a parent than seeing his/her child hurting. Watching your teenager or young adult succumb to addiction — often feeling like there’s almost nothing you can do — is a pain beyond measure. It takes a lot of courage to seek help for your child; it’s the start of a long road of hard work for both of you.
A good starting point is to reach out to a doctor or counselor for proper screening for addiction and any mental health issues. Once a health care provide confirms your suspicions of a drug or behavioral (also called “process”) addiction(s) and/or mental health problem(s) the next step is deciding on the best for your child. It’s also possible that if you know your teenager or young adult has an addiction because of a drug test, health crisis (such as an overdose) or other overwhelming evidence, that you’ll need to enlist a professional interventionist who can help guide you through the process of confronting your loved one about his/her problem, rather than going it alone.
There are inpatient, outpatient and day treatment programs tailored just for adolescents (which is defined as ages 13 to 17). These programs provide a safe environment for your child; he/she will be surrounded by other teenagers or young adults batting addiction, with males and females housed and treated separately. There’s even a focus on academics; some inpatient programs offer on-site education in core courses for several hours a day, so your child can continue working toward recovery and his/her diploma.
Your child’s treatment will likely include cognitive behavioral therapy (CBT) and/or another type of psychotherapy. Family involvement is a core part of your child’s treatment, so make it a top priority to attend all family therapy sessions, even if you need to set aside other commitments to do so. During therapy, you’ll learn how to work with – rather than against — your teen to ensure his/her best chance at long-term recovery. While it can be hard for some parents to reconcile, addiction can never be cured and therefore recovery is a lifelong process. This is why follow-up care and recovery support through mutual-help groups like 12-step programs are also crucial for helping your child continue to stay sober.
While it’s natural to put your recovering child at the center of your world, it’s not healthy to ignore your own needs. Consider joining a support group for families of people with addiction, like Al-Anon or Nar-Anon. Many offer in-person, online and call-in meetings, so there’s always help and support. Even if you’re not ready to participate, you’ll undoubtedly benefit from hearing what other parents are going through, too.
Try to schedule in time for activities that nurture your own health and soul. It’s also important to make time for your spouse or partner and for your other children, if you have them, taking time away from the stress and strain of dealing with an addicted teen or young adult. It’s easy for a family to get so wrapped up in one child’s troubles that other relationships in the home suffer greatly.
For a Parent
No one wants to admit that their mother or father may have an addiction problem and need treatment. It may be that your parent’s use has been building up over the years, or it may be a more recent change, perhaps in combination with depression, anxiety or another mental health issue. When we see our mom or dad drinking too much, using medication or drugs recreationally or otherwise indulging in a problematic behavior, it’s natural to feel perhaps more inclined to ignore the behavior. Substance use disorders are on the rise among Baby Boomers: 6.2% of those 50 and over had a substance use disorder in 2009, as compared to 2.7% of Boomers in 2002, according to the National Institute on Drug Abuse.
Either way, getting your parent to admit to a problem and seek treatment is unlikely to be easy. For one, it may be hard for them to accept advice from their kids and your mom or dad may become very defensive and angry even when you express concern. Your parent may also genuinely be unaware of the problem and/or the health risks of an addiction. For example, many Boomers are simply used to taking a variety of medications for various heath conditions and may not realize that taking this pharmacopeia of pills, when combined with a daily glass of wine (or more), could easily increase their risk for addiction and even an overdose. Also, the effects of drinking may affect an older person more rapidly because the body and brain aren’t able to metabolize alcohol as well or regenerate brain cells as quickly.
Given all of these challenges, your best bet may be best to consult an addiction specialist, social worker, clergy member (if your mother or father belongs to a religious community) or their physician before addressing your parent directly about his/her addiction. Before you do sit down to talk to a professional, make sure to get a list of all your parent’s medications as well as details about how the drug, behavior and/or mental health issues have affected his/her quality of life and behavior.
Once your parent agrees to get help, an addiction specialist can help you find a treatment program tailored to your mom or dad’s needs; it’s increasingly easy to find ones catered to those over 50. With most treatment programs your parent will receive addiction education (in which they’ll learn how to identify triggers that increase their risk of relapse), one-on-one therapy, group counseling and possibly medication to help with withdrawal symptoms and cravings. To prevent relapses, your loved one will learn coping skills for sustained recovery.
Caring for a parent who is struggling with addiction can be very draining, both emotionally and physically. If possible, seek counseling on your own to help you talk through tough feelings like sadness, anger, frustration and disappointment; talking to a mental health professional will also help you identify any tendencies toward addictive behaviors yourself. If your parent and another close family member both have a substance use problem, your own risk will be higher, too. It’s also important to attend a support group for families of people with addiction, like Al-Anon or Nar-Anon, or to talk to a friend, clergy member, or another trusted advisor. And while it can be easy to ignore your own needs now, one of the best ways you can help your parent is to safeguard your own health by exercising regularly, eating healthfully and getting enough sleep.
For a Friend or Relative
It’s probably been very hard to face the fact that a dear friend, or perhaps a relative you’re very close to is struggling with addiction. And a big part of you likely hopes that the problem is one that will resolve itself,, that this person you care so much about will “get it together” and your and friendship will return to normal. You may even have enabled your relative or friend without realizing it; for example, lent him/her money, set him/her up on your couch after a binge or covered up or made excuses for his/her behavior. While cleaning up various messes arose from your friend’s using may seem like genuine acts of friendship, this kind of help will only keep him/her from facing reality. While it isn’t your role to diagnose your relative or friend, if you suspect there is a problem, it’s very likely you’re right.
Whatever you do, don’t ignore your friend’s addiction for the sake of maintaining camaraderie and memories of good times. You may want to sit down and have a heart-to-heart with your friend/relative. Without accusation, compassionately express your concern, what you have observed and your wishes for your friend’s health and well-being. Or, you may want to first share your observations with family members or another friend to determine how they see the situation. If you all agree there’s a problem, contact an addiction specialist, mental health professional, guidance counselor, clergy member or another health care professional. Be ready to provide details, including:
· The type of substance(s) of abuse
· How much you think the person is using
· How often and for how long you believe they’re using
· Any negative incidents or behaviors surrounding their possible addiction
· The person’s reaction when confronted about the possible addiction
If your relative or friend agrees to get help, offer to accompany him/her to an informational appointment with a rehab facility or to an open meeting at a self-help meeting or support group. You might even seek out support for yourself. Al-Anon, for example, is not just for immediate family members; friends and other loved ones of the addict are welcome as well. Attending a few meetings can give you some helpful perspective on how to deal with his/her disease; you’ll learn what works and what doesn’t, how to set boundaries and how to avoid enabling your friend/relative. You may also well find a sense of relief in being among a group of people who have struggled with relationships affected by addiction, too.
Types of Treatment Programs
Treatment for addiction happens in a variety of settings. It may be best for your loved one to stay at a center (called inpatient residential treatment, or rehab). Or, your child, partner, friend or relative may do better at an outpatient treatment center and receive services during the day and/or evening but sleep at home. Sober living communities are also available, where a person in recovery lives for a time with other people who are also learning to live sober.
Your loved one may attend community in-person support groups (like AA meetings) both during and after treatment. It’s typical for people to attend in-person or Web-based meetings over a long period of time (even a lifetime) to help them maintain their recovery. Here are more specifics about all the treatment types available to your loved one:
It may be hard to let go, but sometimes a loved one may need to get away from family, friends, work or school and from those things that trigger use. Residential or inpatient treatment means your loved one will be living somewhere else – it may nearby or across the country – for a period of weeks or even months. Rehab isn’t a vacation, but a retreat from the stresses of life that likely underlie your loved one’s addiction and may have contributed to a problem in the first place.
When someone arrives at rehab, the first step is to provide a safe, secure, supported place for your loved one to detox, which is the time when a substance(s) or damaging behavior(s) is removed or stopped. The detox process is monitored and managed by qualified professionals who provide supportive care. These individuals manage your loved one’s physical and psychological withdrawal symptoms, and non-addictive, FDA-approved medications may be used to ease symptoms and cravings. This specialized team also develops and puts in motion a treatment plan that typically involves counseling to address the addiction(s) as well any mental health issues your loved one may have. It’s essential to address all of these to help prevent relapse; this is what’s known as an integrative approach. Therapy will help your loved one to gain needed coping skills and healthy habits, so he/she learns to handle life’s challenges and maintain a healthy recovery.
Rehab may last for several days, weeks or months, depending on the nature and extent of the addiction and any co-occurring issues (meaning the individual also has another mental health issue in addition to addiction). For example, a stay for video gaming addiction may last 10 days, whereas eight weeks or more may be recommended for methamphetamine use.
If your loved one has healthy support from a partner, spouse, family member or friend and wants to attend treatment while living at home, outpatient treatment can be a great choice, and a more cost-effective one than going to a residential treatment center. This is especially true in cases in which it’s not possible to take an extended break from work or school to attend treatment. With outpatient treatment, your loved one is cared for at a facility during the days and/or evenings, but he/she doesn’t stay overnight. There are outpatient programs that meet for two to three hours a few evenings each week. If continuing to live at home while undergoing treatment means that your loved one may have easy access to old networks that will tempt him/her to keep using, this is, of course, not an option and residential treatment may be necessary.
Day treatment for addiction is just what its name implies: Your loved one will receive treatment during the day for addiction while continuing to live at home. This is considered “partial hospitalization” outpatient program because patients receive care for seven to eight hours a day, working with doctors, drug treatment counselors, therapists and/or psychiatrists. Patients might even be asked to attend evening 12-step meetings or other educational sessions. Parents of young children and others who have obligations at home may gravitate toward day treatment over a live-in option.
Sober Living Communities
Sober houses (also known as halfway houses, therapeutic communities and recovery houses) are for people who need a sober place to live and to practice living in recovery. While patients typically move into a sober living community after leaving a residential treatment program, sometimes people live in sober houses while attending an outpatient, day treatment or other program. The idea behind sober living houses is that it can be difficult for someone who’s brand-new to recovery to avoid falling into old habits and succumbing to old triggers when they move back home. (We all have a tendency to revert to old patterns when we’re around people from our past, for example.) Relapses are common with addiction, and maintaining recovery takes vigilance and ongoing effort. A sober-living house offers residents a chance to practice coping skills just learned in treatment and can be the perfect setting for someone to find their fit as clean and sober for six months to a year or more after treatment. These homes typically also provide a very structured day-to-day-life, offering therapy sessions and regular 12-step meetings on the premises. In this setting your loved one can learn to incorporate healthy living and coping skills for a balanced,