Watching a loved one struggle with addiction can be one of the most heartbreaking things life throws at you.
Addiction is a disease that doesn’t always look the same for everyone. For some, addiction can be drinking excessively on a regular basis. For others it can be daily drug use. In 2018, an estimated 20.3 million people aged 12 and higher have a substance abuse disorder with 89.8% not receiving treatment.1
In this guide, you’ll find helpful information about the nature of addiction, finding the right treatment for your loved one, and how to take care of yourself during this stressful time.
Signs Your Loved One May Have a Substance Use Disorder
It’s hard to admit that someone you love—whether it’s a parent, child, significant other, or close relative—may have a problem with alcohol or drugs. Family and loved ones can play a critical role in motivating people struggling with addiction to enter and remain in treatment. In a 12-year follow-up study of opioid addicts, 75% acknowledged family as a major reason for entering a treatment program.2 For both your and his or her sake, it’s paramount to be aware of some of the signs.
Although different substances have varied effects, some general signs can indicate that someone you care about might have a problem. These signs may be a result of intoxication or they could be a result of withdrawal following physical dependency. When looking for warning signs of addiction, you should consider physical, mental/emotional, and behavioral changes.
General physical signs of a substance use disorder can include:3
- Slurring or rambling speech.
- Weight loss or gain.
- Constricted or dilated pupils.
- Psychomotor agitation or incoordination.
When monitoring your loved one for mental/emotional changes, keep an eye out for:3, 4
- Nervousness and anxiety.
- Sudden changes in personality and/or mood.
- Trouble with memory or attention.
- Drowsiness or restlessness.
Behavioral changes also often occur when a substance use disorder is present. These warning signs may include:3, 4
- New or different groups of friends.
- Missing days at work or school.
- Quitting hobbies.
- Missing out on family events.
- Impaired judgment.
Helping vs. Enabling A Loved One: What’s the Difference?
Unfortunately, addiction doesn’t just affect the person who has a substance use disorder—it often affects the entire family. Your loved one may be in denial, rationalizing their addiction, or projecting onto members of the family. In cases like these, family members often respond in complementary ways to protect themselves from the consequences of their loved one’s addiction ultimately resulting in isolation of the affected individual as well as family members.5
Sometimes, behavior you may feel is helping a loved one could actually enable their substance use by minimizing the consequences of their actions.6, 7
A parent bailing his or her child out of jail repeatedly, or a spouse reporting to his or her partner’s employer that they are sick when actually they are unable to get up for work after staying up late drinking or getting high, are just two examples of what enabling behavior looks like.
Although enabling doesn’t often feel like a negative action, it can help reinforce the behavior you may be trying to prevent.6 By helping your loved one avoid the full consequences of their actions, you could be unintentionally making it possible for them to continue problematic alcohol or other drug use.
Learning how to establish healthy boundaries is part of the recovery process.6
Helping Your Family Member Find the Right Treatment Center
If your loved one has exhibited signs of addiction, it may be time to talk to them about their substance use and motivate them to seek treatment. This can be a difficult conversation, so it may be helpful to have a professional—like a doctor or therapist—assist you and your family at this time to keep the conversation objective, and help you to display a positive view toward your loved on while exhibiting a negative attitude toward the addiction.4
The use of confrontational and coercive interventions, such as those shown on television, is not supported by the evidence as an effective tool for creating lasting change. There are, however, supportive interventional approaches that have been effective in guiding a resistant family member into accepting and entering treatment. These approaches are typically done in concert with certified mental health professionals.4
The ARISE method gently eases your family into intervention and is part of the recovery method for 6 months after. Certified ARISE interventionists work with the substance user, his or her family, as well as the treatment center to help guide the person through the beginning of recovery.8
Community Reinforcement and Family Training (CRAFT) is another non-confrontational approach to intervention, where Concerned Significant Others (CSOs) learn how to motivate their loved one who is using drugs to slowly change their behaviors. This approach could help the substance user lower his or her use of drugs even before entering treatment.9
When deciding how to approach your loved one, you might consider consulting with a medical or mental health professional to get some tips to prepare or assist in developing a supportive interventional approach.
Addiction Treatment Facilities: What to Look for
If you’ve made it this far, congratulations: your loved one is willing to enter treatment. But there are several things to consider when your loved one makes this decision.
Here are some factors to think about before choosing a treatment facility.
The Right Fit for Your Loved One
Some treatment facilities cater to specific populations, such as male or female only or adolescent or adult only. Others have programs for LGBTQ clients, veterans, or those who are involved in the criminal justice system. Some facilities are faith-based.
Keep these factors in mind when choosing a facility to make sure that it’s a good fit.
Evidence-based Clinical Programs Are a Must
There are several different behavioral therapies that can be used to treat substance use disorder, including cognitive-behavioral therapy, contingency management, a community reinforcement approach, motivational enhancement therapy, and family therapy. 10
When successful, these therapies can help people stay in treatment, give them a reason to stay sober, help them change their beliefs and behaviors regarding substance use, and improve their ability to manage stressful situations and location triggers that can lead to cravings and relapse. 10
Some facilities provide medication to assist patients with detoxification to maintain sobriety, manage cravings, or to treat underlying mental health issues that may have contributed to the substance use disorder.10 These facilities will have a medical professional on staff, like a doctor, and a support team like nurses, as well.11
Counseling or psychotherapy should be provided by a licensed professional as well, such as a social worker, mental health counselor, or licensed professional counselor, depending on the requirements in your state.10 If you aren’t sure how to find a reputable treatment provider, a good place to start is the Substance Abuse and Mental Health Services Administration’s behavioral health treatment services locator.
Managing Co-occurring Conditions
Many people with substance use disorders also have a co-occurring condition. This can be a mental health condition, such as depression, anxiety, or PTSD, or a physical health condition, like HIV infection, hepatitis, or liver disease. If your loved one has a co-occurring disorder, you may want to look for a facility that can treat all of their conditions at the same time.10
Continuum of Care
Substance use treatment involves more than just stopping substance use. Over time, a person in recovery’s needs change, and their treatment plan must change as well to meet their needs.10 p4 Ideally, you want to find a treatment facility that will help set your loved one up for success by establishing a plan for care from start to finish.
The Right Treatment Path
Once your loved one agrees to treatment and a facility is chosen, the next likely step will be a provider conducting an assessment.11 This will evaluate what type of treatment your loved one will need and any other conditions that may need to be addressed while in treatment. The following are some of the more common treatment areas:
- Detox: This is generally the first step in treatment, in which a person comes off of drugs. Medications are available to ease the discomfort and manage the potentially dangerous aspects of withdrawal. It’s important to be aware that detox does not address the underlying cause of addiction, and must be followed by additional treatment to be effective.10
- Inpatient: After completing detox, many patients attend inpatient treatment, where they reside for a period of time determined by them and the facility. Intensive counseling is provided in both group and individual settings.11
- Outpatient: After detox and/or inpatient treatment, people can attend outpatient treatment several times a week for group sessions and generally once a week for an individual session.11 This allows patients to work or attend school and fulfill responsibilities at home while still receiving treatment.
- Aftercare: Once formal treatment is finished, patients may still attend individual sessions as needed, or attend support groups or 12-step groups to maintain sobriety.11 Sober housing may also be available.
Outpatient Community- & Family-Based Treatments
Outpatient treatment strategies differ widely in intensity and approach and is based on the individual patient’s needs. Extensive social (community and/or family) support is critical to successfully overcoming addiction in outpatient settings.
Some different kinds of outpatient community- and family-based treatments include:10
- Community reinforcement approach. This method uses a variety of reinforcements as well as material rewards to improve family communication and make a sober lifestyle appealing.
- Family behavior therapy. This technique uses behavioral contracts plus contingency management to have the family assist their loved one to practice the skills they learned in therapy sessions.
If your loved one is a teenager, there are several therapies developed specifically for adolescents. Two of those are:10
- Multidimensional family therapy. This treatment improves family interactions in a variety of settings to reduce negative behaviors and increase positive behaviors.
- Functional family therapy. This approach views the adolescent’s behavior as part of a dysfunctional family network and works to improve the whole system.
Family support and involvement is valuable for anyone seeking to overcome addiction. Family therapy can be a valuable component to inpatient or outpatient treatment as well as during aftercare. It can help you to motivate your loved one to stay sober and maximize treatment progress.10 It also provides the family with positive coping skills, an understanding of how to support their loved one, and the knowledge of how to manage a relapse.7
Paying for Substance Use Treatment
Health insurance generally covers at least part of the cost of substance use treatment.3 You can discuss payment options and insurance coverage with your insurance company, or with the facility when scheduling an appointment. If you don’t have insurance, low-cost options are available, and the facility may help your loved one apply for benefits.
You Matter, Too: Self-Care and Support
Helping a loved one with an addiction can be draining, so make sure you’re taking care of yourself as you take care of them. Practicing self-care is a good way to deal with stress and frustration.
Why Does My Loved One Choose Drugs Over Our Family?
It may feel like your loved one is choosing drugs over the family, but addiction changes circuits in the brain that can make it difficult for them to know how to function without drugs.3, 10 These changes can make it difficult for them to stop using, even after they have detoxed. 3, 10 While it’s difficult, recovery is possible with proper treatment and support.
Methods to Care for Yourself
It can be easy to get lost in caring for a loved one with an addiction, but it’s essential to make time to care for yourself as well. Some great self-care strategies are:12, 13
- Support groups. Al-anon and Nar-anon are well-known support groups for loved ones of those with addictions and a great way to get peer support from people who have been in your shoes. Houses of worship, local hospitals, and treatment centers may also have family support groups.
- To ask for help. You may be used to being the one that others rely on, but it’s okay to need help too. It can be as simple as having someone listen or talk to you or help with things around the house.
- Do something you enjoy. Reading, dancing to your favorite music, spending time with friends, or engaging in a hobby are good ways to have fun.
- Take care of your health. Eat healthy food, get enough rest, and find time to exercise. Eating right and getting enough sleep are important for your physical and mental health. Exercise is also a great stress reliever and mood booster.
- Stress relief. Meditation, journaling, yoga, spending time with a pet, taking a bath, deep breathing, and relaxation techniques are good ways to relieve stress.
- Substance Abuse and Mental Health Services Administration. (2019) The national survey on drug use and health: 2018.
- Simpson, D. D., & Sells, S. B. (Eds.). (1990). Opioid addiction and treatment: A 12-year follow-up. Malabar, FL: Krieger Publishing Co.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2016). What to do if your adult friend or loved one has a problem with drugs.
- Isaacson, E.B. (2012). Chemical dependency: theoretical approaches and strategies working with individuals and families. New York, NY: Routledge.
- Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28(0), 194-205.
- Scruggs, S.M., Meyer, R., & Kayo, R. (2014). Community reinforcement: Community reinforcement and family training support and prevention (CRAFT-SP).
- Landau, J. (2000). Strength in numbers: the ARISE method for mobilizing family and network to engage substance abusers in treatment.
- Meyers, R.J., Miller, W.R., Hill, D.E., & Tonigan, J.S. (1999). Community reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment. Journal of Substance Abuse 10(3), 291-308.
- National Institute on Drug Abuse. (2012).Principles of drug addiction treatment: A research-based guide (3rd edition).
- Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
- Office on Women’s Health. (2019). Caregiver stress.
- S. Department of Veterans Affairs. National caregiver training program caregiver workbook.