The effects of a substance abuse problem on a family can be devastating. The behavioral and psychological changes wrought by drugs and alcohol can ruin relationships and tear people apart. Treatment for a loved one in addiction is always possible, but it is extremely important for family members to have a treatment guide of their own. The more that is understood about the nature of substance abuse, and the more that is understood about what treatment aims to do, the better the chances of a lasting recovery and a healthy life.
Dealing with Substance Abuse in Your Family
Dealing with the issue of addiction in the family is never easy, because it entails acknowledging that a sibling, spouse, parent, or child (or other family member) has a serious medical problem, one that requires a significant and immediate lifestyle change. Talking to a loved one about their actions (what they do in private, as well as out in public) is always challenging; to attribute unwanted behavior to a drug and alcohol problem entails confronting issues that may be very tempting to ignore.
But for the health of the family unit (especially when children are involved), it is vitally important to identify the signs of an addiction problem when are present. If there is a reasonable cause to suspect that a loved one’s alcohol or drug use is getting out of hand, properly (and observantly) interpreting the symptoms can be the difference between the substance abuse splitting the family apart, and saving a life and a future.
Identifying Signs of Substance Abuse in a Loved One
What signs should a family look for? The National Council on Alcoholism and Drug Dependence lists some of the most frequent indicators of someone abusing alcohol and then becoming addicted to it.[1]
A family member who will take their alcohol or drugs for even the slightest of reasons may be fighting a losing battle with substance dependence. If that behavior goes beyond moderate levels of consumption, this should throw up the first red flag. A person who drinks at the first available opportunity (and then doesn’t stop until intoxication levels are past the point of acceptability), or who takes extra, unnecessary amounts of prescription medication, could be reasonably suspected of having a problem moderating their intake of drugs and alcohol. Such behavior might be the first indicator to a family member that their loved one needs help.
Other signs might be that any attempt to broach the subject of cutting back on drinking or drug use is rebuffed, usually with anger. Someone with a dependence on controlled substances will try to justify their use, blaming the problem on stress or unhappiness (and even accusing the concerned family member of contributing to the situation). A person who is truly not struggling with dependence issues will be able to step away from alcohol or medication voluntarily, for long periods of time, without feeling any ill effects. A person with an addiction, on the other hand, is psychologically and physically compelled to keep consuming their drugs and to increase the rate of consumption.
Following from this, any sense of shame or guilt about drinking or taking drugs – even as the consumption continues – is an indicator that something is wrong. There should be no issue with enjoying alcohol responsibly or taking prescription drugs according to a doctor’s orders; but if the loved one tries to hide evidence of drugs or alcohol (using only cash to pay for drinks or prescriptions, or throwing away receipts and bottles immediately), then this suggests that the person is struggling with the temptation to drink and losing. Researchers from the University of British Columbia found that the more a person is ashamed of drinking, the higher the chance of that person relapsing, further indicating that shame is actually a hindrance to recovery. If a loved one drinks only in private or tries to keep medication use out of sight, a family member should be concerned about this behavior.[2]
Life Changes and Substance Withdrawal
One of the clearest signs that a problem is in full effect is when the person’s life suffers as a result of the drug intake. This might mean that academic and professional performance slumps; it might also mean a loss of interest in hobbies and activities, as all attention and focus are given to getting more drugs and then using those drugs. If birthdays and anniversaries are consistently forgotten, and if the person gradually (and then completely) withdraws from all social engagements, then a family member should consider if any other signs of drug or alcohol intake might explain the change in behavior.
A possible reason for the change is because of what happens when someone who has been using drugs or alcohol for a period of time suddenly discontinues their intake. The body and brain become so used to the chemical effects of the substances, that the person can only function after drinking or using drugs (behavior that might be all too familiar to a family member). When the consumption is stopped, the body’s systems are thrown into a state of panic and overdrive, desperately trying to compensate for the abrupt loss of the powerful chemicals that warped and shaped the person’s thinking for months or even years.
On the outside, this may present as a number of physical and behavioral symptoms that a family member should be on the lookout for, as signs of a possible drug problem in effect:
- Unpredictable mood swings
- Fatigue
- Nausea and vomiting
- Depression and anxiety
- Muscle cramping and pain
If a loved one refuses to get medical help for these concerns, or insists that there’s nothing wrong, then this might suggest that they are trying to hide (or ignore) any evidence of a drug and alcohol problem that has gone too far.
Starting the Process of Professional Help
If family members have enough reason to believe that their loved one is abusing drugs and alcohol, then they should move quickly. There may be a temptation to keep denying the reality of the situation or hope that the addiction resolves itself; but as comforting as such ideas are, what this does is give time for the addiction to deepen, rendering it harder to treat and making it more likely that the behavioral, physical, and psychological effects will have permanent harm, both on the loved one and the entire family.
The best way to help the person is to call on the services of a professional interventionist, someone who is trained on how to best present the facts of the situation to the loved one, in such a way as to be humbling and motivating, but not judgmental or condemnatory. Trying to force a loved one into treatment in this way can make the problem worse, so much so that it might actually drive the person deeper into substance abuse.[3] In order to be most effective, an intervention should compel the person to seek treatment, and this requires a very deft touch.
To that effect, interventions have to be meticulously structured and planned processes; they should not be attempted by people without expert background and experience in psychology, addiction treatment, and group moderation.
Going down this route entails an interventionist working with family members for weeks before an actual intervention takes place. They may ask for painful, embarrassing details on the loved one’s substance abuse and behavior, so as to better present a vivid image of the scope of the addiction. Family members may be reluctant to bring such issues up to their loved one, but a professional interventionist can help to structure these messages in a motivational, nonjudgmental way.
Spurring Productive Change
Psychology Today explains that one of the goals of a family intervention is to “produce the most productive change in all of the participants.” A family that places the blame for their loved one’s substance abuse solely on that person’s shoulders alone, without casting a critical (but constructive) eye inward, is not ready to confront the deeper issues that led to the development of an addiction. In order to best help their loved one, family members will have to ask some hard questions of themselves:
- How have we enabled or contributed to our loved one’s addiction?
- What can we do to eliminate our family member’s drug or alcohol use?
- What can we do to encourage our loved one to move away from substance abuse and toward healthier habits of dealing with stress, anxiety, or unhappiness?
For a family torn apart by an addiction problem, these questions are difficult to contemplate, let alone answer. A professional interventionist’s job is to delicately introduce these topics into the conversation, and then help the family find the answers.[4]
Planning Treatment Details
A professional interventionist will also help the family plot out the next big step of the treatment process: finding the right rehabilitation facility for their loved one and determining the appropriate nature of the treatment, such as inpatient or outpatient treatment, based on the longevity and severity of the substance abuse problem. Inpatient care is appropriate for chronic cases of substance abuse, where the person should be removed from the home environment for the safety of everyone involved; and outpatient care is generally for less severe cases, where the person (and family) can be trusted to be unmonitored for large parts of the day.
Both options present different pros and cons for the loved one and the rest of the family, and both have different policies regarding payment and insurance.
Such details may seem banal in the face of persuading a family member to check in for treatment; but having this information in hand before the intervention is crucial, as it will impress upon the person that the family is serious, and that this path of treatment is the only way to go. A person who is dependent on drugs or alcohol will look for any excuse to quit the treatment process, and if a family does not have a solid, tangible rehabilitation plan in mind, convincing a loved one to seek professional help will have a very weak foundation.[5]
With the assistance of a professional interventionist, however, the person will theoretically be left with no realistic option but to accept the ultimatum presented in the intervention: get help or face the consequences.
Invoking Consequences
Consequences have to be a part of the conversation; a loved one who is abusing drugs or alcohol is putting the entire family unit at risk. If the person refuses to accept the offer of help, the family should present a list of things that will happen, which might include:
- Eviction/moving out
- Revoking visitation rights with children
- Termination of financial support
- Loss of employment (for example, in a family business)
It is very important that the members of a family be willing to carry out these consequences if their loved one refuses to accept the truth of the addiction or refuses to enter treatment. Obviously, it is not easy to prepare for such an eventuality, but the role of the professional interventionist is to guide the family through a very difficult period like this. Drawing a line in the sand, and communicating compassionately (but clearly) to the loved one that the substance abuse is unacceptable, is necessary to force open the door to treatment. The National Council on Alcoholism and Drug Dependence stresses the importance of interventions being carried out on a basis of love and support.[6]
Mayo Clinic explains that interventions have to present a tangible, solid, and immediate plan to change your loved one’s life. Everything – from the living arrangements at the treatment center, to who takes care of the children and the house, to what happens when treatment is over – has to be explained at the intervention. For this level of detail to be researched and prepared for, a family must secure the services of a professional interventionist.[7]
Medical Detox
The first step of formal treatment will be to purge the client’s body of the craving for drugs and alcohol. This is a process known as medical detox, where your loved one will be gradually (and carefully) weaned off the chemical dependence(s) of their addiction.
Medical detox is not an easy process. It could last from five days to multiple weeks, based on the nature of the drugs being abused and the duration of the abuse. Even with healthcare professionals providing medication and support, detox can be a painful and distressing process, similar to the withdrawal symptoms that might have tipped off a family member to a substance abuse problem.
A loved one going through detox will need a lot of love and encouragement to make it through the most physically taxing part of the recovery spectrum. Many treatment facilities will allow for visiting hours, where family members can praise and inspire the client to keep going, despite the difficulty of cleansing the body of the potent chemicals upon which it had become dependent.
For this reason, it is important that detox not be carried out at home. At worst, the process can be traumatizing, both for the client and their loved ones who have to bear the brunt of its effects. The temptation of the client to relapse, and for family to give in to pleas and demands for more drugs, can be very difficult for laypeople to bear. There is also the danger that giving drugs and alcohol to a client who is relapsing during detox could cause an overdose. Treatment staff at a rehabilitation center have access to a wide variety of anti-anxiety and anticonvulsant medications that can be administered in safe doses to help the client get through the worst parts of the detoxification process.
The family’s role in this stage would be to provide emotional support, which will not only complement the physical element of medical detox, but also set their loved one up for the next stage of treatment.
Therapy and Counseling
In the way that medical detox addresses the physical side of your loved one’s substance abuse problem, therapy and counseling will address the psychological element. As any family member knows, addiction can warp thinking and behavior. A trained therapist knows how the addicted mind works and can understand the client’s perspective in a way that family members cannot.
But family is nonetheless important; indeed, it may have been unhealthy tensions in the family unit that contributed to the loved one’s substance abuse problem. If there are issues of communication, power, abuse, stress, or general malaise in how the family works, a therapist can identify those issues and whatever is causing them, and explain how they manifested in your loved one falling hard on drugs or alcohol.[8]
This will not be an easy part of the process, as the family members will be asked to examine themselves (and their relationships) for culpability, however indirect or unwitting, for their loved one’s drug abuse. However, for the treatment to be successful, it is absolutely necessary for the client to return to a home environment that is free from the same problems that might have played a role in the development of the drug problem.[9]
This may mean the family has to change its behavior; no more open consumption of alcohol around their now-sober loved one; no more arguing, fighting, or doing anything that raises levels of stress, unhappiness, or tension. Instead, the therapist might show the family how they can resolve disputes in positive, healthy ways – ways that not only show the loved one that the home environment is a safe and uplifting one, but that also bring the family closer together by means of improved communication and understanding of differences.
To facilitate this, the therapist will convene group sessions with both your loved one and the members of your family. In the safe, welcoming space of a treatment center, you, your family member, and the therapist will work on rebuilding the relationships that were affected by the addiction. This will not be a quick or easy process, and it will have to continue long after the client has been discharged from treatment. Once home, the standards set out by the therapist will be put to the test; and the more involved the family is in treatment, the better those standards can be met (or even exceeded).
Aftercare Support and Engagement
Even outside the home, your family’s participation in your loved one’s sober life will have far-reaching effects. A key component of addiction recovery is to get involved in programs and activities that celebrate life, without the expectation or temptation to drink (or do drugs) to enjoy the experience. People who graduate from treatment programs often join gyms, take up hobbies, or become members of social groups that focus on healthy and fun living. As important as it will be for your family member to find an activity that is challenging and exciting, it is equally important to show support for your loved one’s new adventures. This could mean occasional engagement or even full involvement in whatever the pursuit is.
Such a gesture will show your loved one that you’re invested in the recovery and that they don’t have to do it alone. Recovery can be difficult and frustrating when life returns to normal; being there for your spouse, sibling, child, or parent shows that you’re in it for the long run, and that is hugely motivating for someone who is learning how to live sober.
The American Psychological Association quotes one of the researchers of an article published in the September 2005 issue of the Journal of the American Academy of Child and Adolescent Psychiatry who explains that, in addiction treatment, “families are the medicine,” but only if the families can channel their feelings into “the right skills and postures.” With the help of professional interventionists and counselors, the different members of a family unit can come together to help their loved one overcome the stumbling block of a substance abuse problem and return to the fold happy and healthy.
[1] “Signs and Symptoms.” (July 2015). National Council on Alcoholism and Drug Dependence. Accessed July 9, 2016.
[2] “Being Ashamed of Drinking Prompts Relapse, Not Recovery.” (February 2013). TIME. Accessed July 8, 2016.
[3] “7 Common Misconceptions About Addiction Interventions.” (August 2013). Psych Central. Accessed July 9, 2016.
[4] “The 411 On Addiction Interventions…” (August 2012). Psych Central. Accessed July 10, 2016.
[5] “How to Confront Someone With a Drinking Problem.” (July 2015). Livestrong.com. Accessed July 9, 2016.
[6] “Intervention — Tips and Guidelines.” (July 2015). National Council on Alcoholism and Drug Dependence. Accessed July 9, 2016.
[7] “Intervention: Help a Loved One Overcome Addiction.” (September 2014). Mayo Clinic. Accessed July 9, 2016
[8] “Family Involvement is Important in Substance Abuse Treatment.” (October 2015). Psych Central. Accessed July 10, 2016.
[9] “Family Therapy.” (n.d.) WebMD. Accessed July 10, 2016.
[10] “Family Therapy Enhances Treatment For Children’s Mental Disorders.” (December 2005). American Psychological Association. Accessed July 10, 2016.