One of the most difficult situations a family can deal with is a loved one who may be addicted to drugs or alcohol. In some cases, the addiction can be obvious, where overdoses, arrests, or job loss punctuate changes in attitude and personality. For other people, addiction may not be as easy to see at first, as he or she may continue to work and fulfill other obligations.
This guide details warning signs of addiction as well as the different types of available treatment.
Signs of Addiction in Your Loved One
The warning signs of addiction vary from one substance to another, but there are some common signs. If you know your loved one uses substances, you may see signs of increased use leading to tolerance, dependence, or addiction. Signs of an escalating issue with substances include:1, 2
- Using alcohol or drugs in situations that can be dangerous, such as driving while under the influence.
- Using despite knowing that use can lead to serious emotional or physical outcomes.
- Using a substance even when it causes issues with family members, such as increased arguments and conflict.
- Telling you they only intend to have a couple of drinks and then end up having 5 or 6.
- Wanting to stop using, but they are unable to do so.
- Using substances knowing that it could lead to loss of a job or being expelled from school.
- Neglecting family or job responsibilities.
- Giving up things they used to enjoy, such as family time or hobbies.
At times, it can be hard to see a pattern with these types of behaviors, particularly if you do not see your loved one daily, such as a cousin or a child who lives in another state.
Please note that these signs are general and may not always be caused by an addiction, as behaviors can be the result of certain medical conditions.2
What’s the Difference Between Helping & Enabling?
When faced with the possibility that your loved one has a problem with substance use, it can be difficult to know what to do next. At times, your efforts to help might instead be enabling them.
For example, you may call into work for your spouse when they are too high or drunk to go to work. You may even call in favors from people in law enforcement that you know to help your son or daughter avoid legal charges for possession of cocaine or another illicit narcotic.
These examples are typical enabling behaviors, but in helping the person avoid consequences of behaviors, you are assisting them in continuing the addictive behavior. If the person with an addiction does not face consequences, they will not be motivated to change their behaviors and will most likely continue with these behaviors.2
Is My Loved One Choosing Drugs Over Us?
It may feel as if the person with addiction chooses drugs over you and other family members.
However, the chemical process of your loved one’s brain is influencing their addictive behaviors. Substances can cause the brain to release a much higher amount of dopamine than usual, and over time, “normal” behaviors that would give a person a release of dopamine no longer cause the brain to feel that reward.3
Most likely, your loved one isn’t choosing to use drugs over the well-being of your family, but rather substance use over time has changed how his or her brain works—which leads to them requiring the drug to get that boost of dopamine that used to come from activities or relationships.3
Choosing the Right Treatment
Talking to a family member about their addiction isn’t an easy thing to do, but is most likely needed to help your loved one get into treatment. While you may have seen aggressive interventions on television, these ambush-style sessions are not the best way to handle the situation.1
Often, getting the family member to agree to at least talking to a doctor or other professional about the issue works better. The medical professional will be able to raise concerns with the family member in a more fact-based way, which doesn’t leave as much room for arguing.1
The right treatment options for addiction vary from one person to another.
What Makes a Good Treatment Facility?
There are a lot of different factors to consider when helping a family member choose the right treatment facility. When you are looking for the right approach to treatment, remember to consider the following.
- Continuum of Care. This is a whole collection of different treatment options that take place over the recovery process. Your loved one’s continuum of care should be reviewed and revised as necessary over the course of his or her treatment to make sure that the treatment they are getting meets their needs. From detox to treatment to aftercare, your loved one’s continuum of care should stand strong even from facility to facility.4
- Specialized Care for Substance Use and/or Dual Diagnoses. Certain treatment facilities may only treat certain substance use disorders—make sure to find one that treats your loved one’s. Also consider if your loved one has a co-occurring disorder, or a mental disorder that accompanies their substance use disorder. Not every facility is equipped to properly treat both concurrently, even though this is a key aspect to successful treatment for many.
- Medical Detox & Withdrawal Management. Some substances, such as opioids and alcohol, have associated withdrawals that can be uncomfortable, painful, or even life-threatening. For these and other substances, there are drugs that medical professionals can administer to lessen the side effects of withdrawal. Treatment centers that offer medically supervised withdrawal management will work to keep its patients safe and comfortable during the withdrawal stage.5
- Medication-Assisted Treatment. After your loved one has withdrawn from substance use, he or she still might need long-term medical care to help overcome their tolerance and cravings for their substance of choice. Some disorders, like opioid use disorder and alcohol use disorder, have a handful of FDA-approved medications to assist in addiction treatment.5
- Evidence-Based Clinical Programs. The types of therapy and treatment your loved one receives while in the beginning stages of their recovery should be based on scientific evidence. These practices are more likely to keep people in treatment and help them stop using substances, manage stress better, and improve relationships with family.4
- Licensed Staff. Much like evidence-based programs, those who work with your loved ones in a medical or therapeutic capacity should be licensed or credentialed in their discipline. 5
- Customized Care. Addiction is not a one-size-fits-all disease, and treatment for a substance use disorder shouldn’t be either. Many facilities have therapies that focus on specific groups in the community, such as military veterans, gender-specific, LGBTQ+, etc. Some facilities may even have tracts for adolescents.
What Will Treatment Entail?
Treatment for addiction is dependent on many factors, such as the number and type of substances the person is using, the length and severity of the addiction, and underlying medical and/or emotional issues.
For some, detox is the first stage of recovery. Sometimes, withdrawal management can be completed on an outpatient basis. However, due to the potential for medical complications with many substances such as benzodiazepines, opioids, and alcohol, medically-assisted detox and inpatient detoxification is often recommended.5
After detox, a person can be admitted to either an inpatient 24/7 program or an intensive outpatient program (IOP). If your loved one completes an inpatient program, he or she could step down to an IOP as the next phase of treatment.4
After IOP, many people then go on to outpatient treatment.4 Some treatment facilities like Sunrise House also offer aftercare planning.
Healing at Home: Family-Based Treatments
Families are a critical component in the treatment of people with addictions and can help a person get into treatment, stay in treatment, and maintain recovery. The goals of family-based treatment can include:4
- Exploring other family issues, such as marital conflict, child behavioral management, or financial issues, which may impact addiction.
- Helping the family understand addiction, and how to best help the person with the addiction in their aftercare and recovery process.
There are a handful of models of family-based treatment, but a couple common ones include:
- Community Reinforcement and Family Training (CRAFT). This is a good place to start for those loved one who may be struggling with recognizing their substance abuse and who do not yet want to attend treatment. CRAFT dials in on education about addiction and recovery, improving how you and your loved one communicate, positive reinforcement, and self-care.6
- Family Behavior Therapy. This approach is helpful for both adolescents and adults. It gathers family members to help their loved one apply skills learned in therapy. Specific goals set by your loved one, once progress is made or the goal is met, will be celebrated by those supporting him or her.4
Therapy that’s supported by other family members is key for teens in treatment for a substance use disorder. A collection of treatment methods used with teenagers include:7
- Brief Strategic Family Therapy (BSFT). Are your interactions with your loved one contributing to their substance abuse in some way? BSFT analyzes the possibility of this and provides templates for improving communication patterns in the family, rather than with just the substance user.
- Functional Family Therapy (FFT). Similar to BSFT, therapists who practice functional family therapy will look into the issues of the family unit—not just the substance user—to help increase helpful communication and to resolve conflict in healthy ways.
- Multidimensional Family Therapy (MDFT). Keeping in mind what may influence the behavior of adolescents (family, friends, and society), practitioners of MDFT consider these factors and help families focus on problem-solving skills in various settings.
How Does My Loved One Pay for Substance Use Treatment?
If the person has health insurance, there’s a decent chance it may cover a portion or the entire cost of treatment. But if insurance doesn’t cover it, there are still a few options. Some treatment programs will offer sliding scale fees based on incomes, as well as payment plans to pay off the cost of treatment over time. In addition, there are other options to explore.1
If your loved one is a veteran, the VA has multiple treatment options available for which your loved one may qualify.
There are many low-cost programs for people who are uninsured, or who have limited insurance coverage, Medicaid, or Medicare. These programs can be located through the Substance Abuse and Mental Health Services Administration (SAMHSA) website.
Self-Care and Support
Even though it feels as if the seriousness of your loved one’s situation is the most important thing in your life, it’s important to also look out for yourself. If you are so focused on the other person’s needs and issues, you may neglect your own mental and physical health to the point of it being detrimental to your well-being.
Methods to Care For Yourself
Self-care for your physical well-being can include:8, 9
- Eating healthy.
- Getting exercise.
- Getting adequate sleep.
Mental and emotional self-care can include:8,9
- Practicing relaxation techniques.
- Asking for help from others as needed.
- Journaling and writing down your thoughts and feelings.
- Setting boundaries, which may be hard at first.
- Attending groups for people who deal with family who have an addiction, such as Al-Anon.
- Going to individual or group therapy, even if your loved one refuses.
- Doing things to make you happy, such as engaging in hobbies you enjoy.
- National Institute on Drug Abuse. (2016). What to do if an adult friend or loved one has a substance abuse problem.
- 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(3–4), 194–205.
- National Institute on Drug Abuse. (2007) The Neurobiology of Drug Addiction.
- National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research based guide.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment improvement protocol (TIP) series, No. 45. Rockville, MD: Center for Substance Abuse Treatment.
- Scruggs, S.M., Meyer, R., & Kayo, R. (2014). Community reinforcement and family training support and prevention (CRAFT-SP). Department of Veterans Affairs, South Central Mental Illness Research, Education, and clinical Center.
- National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction.
- S. Department of Health and Human Services. Office of Women’s Health. (2019). Caregiver stress.
- S. Department of Veteran Affairs. National caregiver training program: Module 1: Caregiver self-care.