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Guide for Families on Dealing with Addiction

If you suspect that a family member may be addicted to drugs or alcohol, know that you’re not alone. Millions of families in the United States are struggling with the same issue. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2018, 20.3 million people had a substance use disorder (SUD), 1 which means that millions of families are in the same situation as you.

This guide will help you understand more about addiction and practical ways you can help your family member.

Warning Signs of Drug Abuse in a Family Member

People who are abusing drugs or alcohol may display at least some of the following physical, social, and behavioral warning signs, including:2

  • Bloodshot eyes.Sisters hugging
  • Abnormally large or small pupils.
  • Sudden weight loss or gain.
  • Declining physical appearance.
  • Strange odors on the body or clothes.
  • Tremors.
  • Impaired speech.
  • Lack of coordination.
  • Change in group of friends.
  • Legal problems related to drug or alcohol use.
  • Unexplained requests for money (asking for loans, etc. without a good reason).
  • Lacking motivation.
  • Frequently missing work or school.
  • Getting into trouble (fights, accidents, etc.).
  • Changes in appetite or sleep patterns.
  • Secretive behavior (sneaking around, lying, etc.).
  • Sudden mood swings (e.g., angry outbursts or seeming depressed one minute and excitable the next).
  • Seeming anxious, paranoid, or fearful for no apparent reason.

Keep in mind that these signs can vary by person as well as substance. Your family member may display only a few of these or none at all.

Signs of a Substance Use Disorder

Though there may be some similarities, these general physical, social, and behavioral warning signs of drug abuse aren’t exactly the same thing as the diagnostic criteria for a substance use disorder (SUD). This is a defined set of symptoms that the American Psychiatric Association has laid out to help professionals determine whether a person has an SUD. These criteria include the following:3

  • Consistently using more than intended.
  • Wanting to stop or cut down but failing.
  • Spending a lot of time in getting, using, or recovering from a drug.
  • Craving the substance.
  • Abandoning home, school, or professional obligations because of substance use.
  • Continuing to use substances when doing so causes interpersonal conflicts and other social problems.
  • Giving up hobbies and other important activities in favor of using substances.
  • Using drugs or alcohol in physically hazardous situations.
  • Continuing substance use even when aware that doing so is contributing to physical or mental health problem.
  • Tolerance (needing increasingly larger doses to get the desired effects).
  • Withdrawal when they try to stop using (symptoms vary by substance but include a range of physically and psychologically uncomfortable symptoms).

When Drugs Take Priority

Sad woman sitting in the dark

It can be incredibly disheartening to watch a family member begin to fall into a pattern of compulsive substance use and start prioritizing alcohol or drugs over their family relationships. If your husband begins to isolate himself and drink alone, for example, and ignores the rest of the family and his normal obligations, you might begin to believe he loves alcohol more than you.

However, it’s important to know that certain changes in the brain associated with addiction may underlie increasingly compulsive patterns of use as a person begins to put drugs and alcohol ahead of important people and areas of their life. Although it can certainly feel like it, it doesn’t mean they love drugs more than family. What it does mean is that they have lost control of their lives due to addiction.4

Addiction is a brain disease, the development of which is accompanied by certain neurochemical alterations and changes in brain functioning. While the person does make a choice to begin using drugs or alcohol, they gradually lose self-control over time. This is at the core of addiction; an addicted person will lose the ability to control their drug use despite all the problems it causes in their life. Brain imaging studies suggest that people who use drugs experience critical alterations in regions of the brain responsible for judgment, decision-making, learning, and control.  These changes are associated with compulsive substance use. 4

Many substances of abuse exert a significant influence in the brain’s reward system by increasing the activity of dopamine. Dopamine is a neurotransmitter often referred to as the “reward chemical” because it causes good feelings associated with healthy and life-sustaining activities, such as eating and procreating. But when a person abuses drugs, they experience a euphoric high that reinforces drug use and makes natural rewards pale in comparison. Natural rewards simply cannot compete with the reward provided by drugs of abuse, and over time the brain adapts in ways that make it difficult for the person to person find any pleasure in healthy, rewarding activities. Even the drugs themselves won’t produce the same pleasure that they once did due to tolerance; however, the brain will continue to seek it out in attempts to recreate the original high. Additionally, many drugs are associated with physical dependence, which means just attempting to quit can cause the person to feel physically sick and/or experience troubling psychological symptoms. 4

Your loved one is not voluntarily choosing drugs over your family; they have a complex disease that often requires professional help to overcome.

How Do I Stop Enabling a Family Member?

Enabling is sometimes hard to distinguish from helping, and it often stems from good intentions, making it all the more difficult to avoid. For many people, family comes first, and the urge to protect family can be incredibly strong. But sometimes what actually helps can be counterintuitive. It could be that refusing to provide immediate help could be more beneficial to your family member in the long run.

Helping becomes enabling when it allows your loved one to avoid the consequences of their drug or alcohol use. 6 Without having to face the ramifications of their substance use, your family member may be more free to continue on as normal while, in some cases, you are left to deal with the consequences yourself. This can put extreme stress on you and does little to motivate your loved one to change.

Helping becomes enabling when it allows your loved one to avoid the consequences of their drug or alcohol use.

Sometimes it can be painful to avoid enabling behaviors, especially when it’s an established pattern to which the family has become accustomed. As an example, you may feel compelled to bail your daughter out of jail when she’s arrested for a DUI, but this only shows her that she can continue this behavior because you’ll always be there to rescue her. Or you may continue to allow your brother to live with you despite threatening to kick him out because of his drug use. You make excuses for the person’s behavior, such as by saying, “If I kicked him out, he’d be homeless.”

Other examples of enabling include:

  • Not following through on threats to leave a spouse or partner.
  • Looking for a job for your family member.
  • Calling in sick for someone in the family when they have a hangover.
  • Not disciplining your child/taking away privileges when they come home intoxicated or past their curfew.
  • Doing your child’s chores while they stay in bed recovering from a night of partying.
  • Paying your family member’s cell phone bill even though you know they are using it to contact their dealer.

The best way out of enabling is to set limits and maintain healthy boundaries. This isn’t always easy;  it takes practice, but it will help you stay healthy and let your family member know that they cannot continue to take advantage of your good will. Some of the ways you can set boundaries include: 7 p. 8

  • Setting clear rules. Explain what you will and will not tolerate and outline the consequences for breaking the rules. Make sure the person understands the rules and consequences.
  • Following through with consequences any time the rule is broken. Remember that you’re not trying to punish the person; you’re trying to disincentivize negative or maladaptive behaviors and reinforce healthier ones.
  • Avoiding arguments and threats. Don’t get into a debate about rules or boundaries if your family member tries to argue with you.

Getting a Family Member into Treatment

Man in the dark looking at the light

Talking to your family member about treatment can be challenging, especially if they don’t want help. Remember that you can’t force your loved one to seek treatment, but you can provide encouragement and help them see the benefits of starting a recovery program.

Explain that it takes a lot of strength and courage to recognize the need for help. Listen to their concerns and let them know that you will be there to support them.

Research treatment programs that best suit your family member’s needs and present them with a list of appropriate options. Call around to treatment centers or look online—you can find recovery centers on SAMHSA’s Treatment Finder website. Some of the things to look for in a treatment program include:8

  • Staff credentials. Ask whether staff members are licensed and inquire about credentials.
  • Evidence-based treatments. Ask about the full range of evidence-based interventions and therapies a specific program regularly utilizes.
  • Treatment for co-occurring disorders. If your family member has a mental health condition in addition to their substance use disorder, ask if the center is able to provide integrated treatment for both conditions.
  • Individualized treatment. Everyone has unique requirements and treatment should address your family member’s individual drug abuse patterns and psychiatric, social, and medical needs.
  • Medical detox. This involves a set of interventions designed to help your family member stay safe and comfortable during withdrawal. Depending on the substances your family member uses, medical detox may be necessary—inquire at the recovery center whether they offer this service.
  • The levels of care offered. The form of treatment (e.g., inpatient or outpatient) your family member requires is largely dependent on their specific needs. People who have severe addictions usually benefit from inpatient care where 24/7 support is available and there is no access to substances, while people who are unable to commit to a residential stay due to work or family obligations may benefit from outpatient treatment, provided they have support at home. Some people move through several levels as they progress in recovery and prefer to stay in one treatment program as they do so. Ask any prospective centers what types of care they offer and where their programs are located.

Treatment that Incorporates Family

The impact of substance abuse is rarely isolated to the addicted individual alone.

The impact of substance abuse is rarely isolated to the addicted individual alone. Family-based treatments involve family members in the recovery process. These treatments include:9,10

  • The community reinforcement approach, which supports the person’s recovery through family involvement, works to increase family, social, vocational and/or educational reinforcement, and helps to increase problem-solving, coping, and behavioral skills.
  • Community reinforcement and family training (CRAFT), which focuses on the role significant others play in a loved one’s recovery. CRAFT supports close family and friends in using a variety of methods to repair their relationship with their loved one and encourage treatment.
  • Family behavior therapy, which addresses not only substance abuse but other co-occurring problems, such as conduct disorder or family conflict. This method focuses on setting behavioral goals and teaching skills to improve the home environment.
  • For teens/adolescents:
    • Multidimensional family therapy, an outpatient form of therapy designed to reduce unwanted behaviors and promote desirable behaviors using a variety of family-based techniques.
    • Functional family therapy, which recognizes that a teen’s substance use and behavior problems take place in the context of dysfunctional family behaviors. It is based on family engagement and techniques to change problematic behaviors.

Paying for Treatment

Paying for treatment can seem daunting, but insurance and other options may be available to cover the costs. Many insurance plans cover all or part of the costs of treatment. You can check insurance coverage for free by completing a quick and easy benefits verification here.

If your family member doesn’t have insurance or their insurance doesn’t cover the entire fee, you can also consider financing or other flexible payment options. Some people use credit cards or ask family members for loans. A number of recovery centers also offer sliding scale fees or scholarships based on ability to pay.

Caring for Yourself

Having an addicted family member can be stressful and draining, so it’s important to take care of yourself and attend to your needs. Some of the ways you can do this include:

  • A therapist can help you deal with the issues related to having a family member in recovery.
  • Family-based recovery groups. This could be a 12-step group like Al-Anon or Nar-Anon, or a non-12-step group like SMART Recovery for Family and Friends.
  • Personal time. Take time for yourself, whether that means spending time with friends or participating in your own hobbies. Make an effort to get out of the house.
  • Relaxation strategies. Meditate, practice yoga, exercise, or engage in another form of stress management.

At Laguna Treatment Hospital, we know firsthand how difficult living with addiction can be. You are not alone. Learn more about our program and how we can help you bring your family back together.

References:

  1. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
  2. MentalHealth.gov. (2019). Mental health and substance use disorders.
  3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
  4. National Institute on Drug Abuse. (2010). Drugs, brains, and behavior: the science of addiction.
  5. National Institute on Drug Abuse. (2017). The neurobiology of drug addiction.
  6. Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practiceSocial Work in Public Health28(3-4), 194–205.
  7. National Institute on Drug Abuse. (2015). Family checkup: positive parenting prevents drug abuse.
  8. National Institute on Drug Abuse. (2016). What to do if your adult friend or loved one has a problem with drugs.
  9. National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: a research-based guide.
  10. Department of Veterans Affairs, South Central Mental Illness Research, Education, and Clinical Center (MIRECC). (2014). Community Reinforcement and Family Training Support and Prevention (CRAFT-SP).

 

About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More