It’s not easy to admit that someone you love may be struggling with drugs or alcohol. Substance use disorder is a staggeringly commonplace health concern, with over 20 million Americans aged 12 or older struggling with substance use disorders in 2017.1
Whether you’re concerned about your mother, brother, niece, uncle, or another family member, this guide will help you identify signs of addiction, understand what treatment programs are available for substance abuse, and find ways to take care of yourself.
Signs of Substance Abuse
Though there may be a tendency to ignore the more subtle signs of drug or alcohol abuse, after a while they may be too noticeable to push to the side. Identifying the signs of addiction in a family member or significant other gives you the opportunity to talk to them about it and help them get the treatment they need.
Not all substances have the same effects, but addiction has some common warning flags to be aware of. These fall under three categories.
General physical signs can include: 2, 3
- Changes in weight.
- Flushing or sweating without increased activity.
- The user being more or less active than usual.
- Pupils that are larger or smaller than usual.
- Slurring or speaking faster.
Outside of physical signs, your loved one might also be exhibiting some mental or emotional changes if they are abusing drugs or alcohol. Look for your loved one: 2, 3, 4
- Acting uncharacteristically nervous or anxious.
- Exhibiting mood swings.
- Having changes in their typical personality traits.
- Becoming aggressive.
- Having problems paying attention or remembering things.
Some general behavioral changes in someone that is addicted to a substance can include: 2, 3, 4
- Acting irresponsibly.
- Changing social groups.
- Quitting sports or pastimes they used to enjoy.
- Showing up late or missing school/work.
- Skipping social or family gatherings.
Am I Helping or Enabling My Loved One?
When someone we love has a problem, our first instinct is generally to help. However, with an addiction, what feels like helping could be enabling. Some examples of enabling are:
- Bailing them out of messes they’ve created.
- Making excuses for their behavior.
- Providing money or resources.
Enabling isn’t only unhelpful; it can reinforce the addiction by helping your loved one skip out on consequences.5, 6
Is My Loved One Choosing Drugs Over Our Family?
Substance use disorders and long-term substance abuse is associated with certain brain changes that may remain long after the person has quit drinking or using drugs; these changes help to explain why it is difficult for your loved one to control the compulsion to resume substance use even after successfully achieving abstinence for some time.2, 7
Understanding Substance Abuse Treatment
If you’re concerned that a loved one has an addiction, you may not know how to talk to them about it. But an intervention like you’ve seen on TV often may not be the most effective way to address the issues.4
A good place to start is to ask your loved one’s doctor or a counselor for help,4 as talking to a professional can assist you with coming up with a plan beforehand.
Discuss any special needs your loved one has with his or her care provider when choosing a program. After meeting, you and the medical professional should talk to your loved one together, and help them develop the motivation to change.4
Treatment Facility: What To Look For
With so many treatment facilities to choose from, it can be hard to know which one to pick. You may want to look for:
- Continuum of care. A spectrum of treatment options may benefit someone at their various points of recovery. A person’s recovery progress should be continually assessed to help shape the course of treatment based on his or her ever-changing needs. There should be a seamless transition between detox and other treatment types can also be beneficial even if the treatment takes place between different facilites.7 This allows people to receive effective care that will give them the tools for a successful recovery.
- Specialized care for substance use and/or dual diagnoses. Look for a facility with experience in treating your loved one’s specific substance use disorder as well as any co-occurring mental health issues (if applicable). In many instances, an integrated, dual diagnosis treatment protocol may provide better treatment outcomes people with both substance use and mental health disorders.
- Medical detox and withdrawal management. Some substances are associated with extremely uncomfortable and, in some cases, dangerous withdrawal syndromes. Certain medications and other medical intervention may be required to keep a person safe and on-track during early recovery, so it will be important to know if such care is available.8
- Medication-assisted treatment. Beyond the withdrawal period, there are a cohort of FDA-approved treatment medications designed to treat certain types of substance use disorders, such as alcohol use disorder and opioid use disorder, in the longer-term. Inquire to see if a program you’re considering can implement a medication-assisted treatment approach.8
- Evidence-based clinical programs. Treatment methods should be thoroughly evaluated, as evidence-based practices are more likely to keep people in treatment and help them stop using substances, manage stress better, and improve relationships with family.7
- Licensed staff. Counseling should only be provided by a licensed or credentialed professional, while licensed nurses should be available to monitor patients and administer medications. In facilities running medical detox protocols, the program should be overseen by a doctor.8
- Customized care. Certain facilities have programs for adolescents or adults only, while others accept a wider range of groups. Many facilities will have therapy groups for veterans, ones that are gender-specific, geared towards the LGBTQ+ community, etc.
What’s the Right Treatment for My Loved One?
Since addiction isn’t the same for everyone, treatment shouldn’t be either. Finding the right treatment for your loved one starts with matching them to the proper resources by assessing their needs and determining if any other areas of physical or mental health may require care during treatment.7, 8 Along the continuum of care, you can expect to hear terms like:
- Detox. Withdrawal can be difficult or even dangerous, and medications can make the transition into sobriety easier and safer.7 Detox doesn’t constitute comprehensive substance abuse treatment, it just allows the body to clear itself of substances as safely and comfortably as possible so that people can better focus on their longer-term recovery work.7, 8
- Inpatient. This is a residential facility geared for longer-term stays, and clinicians provide individual and group counseling.7, 8 Inpatient rehabs have trained staff available 24 hours a day to provide monitoring and support.8
- Outpatient. These facilities provide group and individual counseling sessions in an office or other clinical setting while patients live at home.7, 8 Outpatient treatment settings may be best suited to someone who has already completed an inpatient or residential program, who has school or work obligations, and/or has strong sober supports.7
- Aftercare. This may involve continued recovery work in the form of self-help meetings, sober living, and/or ongoing, regularly-scheduled counseling appointments.2, 8 Recovery is a life-long commitment, and effort shouldn’t stop once treatment ends.
Family-based treatment can help your loved one stay in treatment and have better outcomes, as well as help the whole family heal, learn how to be supportive of recovery, and know what to do if your loved one slips up.5, 6, 7
Since addiction has an impact on how the family functions as a unit, it’s important to include the family in the therapy process.5 Some evidence-based family therapy techniques include:
- Community Reinforcement Approach (CRA). Reinforces positive behaviors and provides tangible incentives to reward sobriety, as well as focusing on fostering better communication between family members.6
- Community Reinforcement and Family Training (CRAFT). This focuses on education about addiction and recovery, improving communication techniques, positive reinforcement of desirable behaviors, allowing consequences to occur in the event of relapse, and self-care. Note, however, this is geared towards individuals who are having trouble accepting they have a substance abuse problem and are reluctant to go to treatment.6
- Family Behavior Therapy (FBT). This technique is good for adults and teenagers, and enlists family members to help their loved one apply skills learned in therapy. Your loved one will set a specific goal and progress made towards achieving that goal is rewarded by loved ones involved in treatment.7
Family therapy is especially important for teens in substance use treatment. Specific treatment methods used with adolescents include: 7
- Brief Strategic Family Therapy (BSFT). This looks at the family as a whole, and how interactions between members that play a role in substance use. It works on improving behavior patterns in the family rather than focusing on just one member.
- Functional Family Therapy (FFT). This is another approach where it looks at issues within the family as a unit and works to improve communication and the ability to resolve issues as a group.
- Multidimensional Family Therapy (MDFT). Personal choice, family, friends, and society can influence teenage behavior. This approach examines all of those factors, and focuses on communication and problem-solving skills in various settings.
Paying for Drug or Alcohol Abuse Treatment
If you have health insurance coverage, it may pay for some of the cost of substance use treatment for your loved one.4 If you aren’t sure of what is covered, you can call the insurance company or call the treatment facility directly for additional information. If you can’t afford the treatment, many facilities offer treatment plans or may offer sliding scale payment schedules. If your loved one has no insurance coverage, treatment center staff may help them apply for insurance.
Oxford Treatment Center has resources to help you determine the best way to pay for treatment.
Caring for Yourself
There’s a proverb that says, “You can’t serve from an empty cup.” Don’t get so wrapped up in caring for your loved one that you forget to take care of yourself.
Making Time for You
Caring for others is stressful and draining and takes a toll on your physical and mental health. Incorporating self-care helps you stay healthy and help your loved one more effectively. You can do this by: 9, 10
- Making your health a priority by eating a balanced diet, getting sufficient sleep, regular exercise, and visiting your doctor for annual check-ups.
- Managing stress in a way that works for you. There are many different ways to relieve stress, like yoga, journaling, relaxation techniques, spending time with friends, participating in your hobbies.
- Attending support groups for families of people with addictions or in recovery. Places of worship, hospitals, libraries, and treatment centers may offer support groups. Al-Anon or Nar-Anon are 12-step support groups for families of people with addictions.
By taking care of yourself, you’re setting a positive example to your loved one and helping them progress through their recovery. Recovery isn’t easy, but it is possible, and it’s easier to do together.
- Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 national survey on drug use and health (HHS Publication No. SMA 18–5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2019). Commonly abused drugs charts.
- National Institute on Drug Abuse. (2016). What to do if you adult friend or loved one has a problem with drugs.
- 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).
- 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.
- Nation Institue of Drug Abuse General physical signs can include.