Addiction and Recovery: Guide for Families
Having a family member who is struggling with drug abuse can leave you feeling stressed, overwhelmed, and unsure of what to do next. We’re here to help. In this guide, you can learn warning signs to watch for, understand your treatment options, and discover ways to take care of yourself as you navigate the rocky waters of trying to get help your family member.
Is My Mom (or Dad, Son, Daughter, etc.) Really Addicted?
Knowing when someone you love is addicted can be difficult – in many cases, your spouse, child, parent, or sibling may hide their use or insist they have it under control. Addiction can look very different in different people. Someone addicted to a stimulant like cocaine may be up for days at a time and then crash, while someone addicted to opioids may regularly appear sleepy to the point of nodding off but also intermittently ill and anxious.
However, in many cases what will be apparent are changes (e.g., in routines, appearance, behaviors) in connection with your family member’s growing compulsion for continued substance use despite overt negative consequences. All told, there are several physical, mental, and behavioral warning signs that may arise to indicate that your family member needs help.
When a loved one such as a parent or child begins to display signs of a problem, it can be tempting to deny something is wrong. However, it’s important to pay attention to the signs because intervening with treatment at the earliest possible opportunity can save their life.
Though effects vary according to the specific substance(s) being used, some general physical signs of drug use include:”:1
- Weight loss or gain paired with a change in eating habits.
- Changes in the eyes—for example, abnormally large or small pupils or red, glassy eyes.
- Dental changes with tooth decay and discoloration.
- Skin may show the signs of substance abuse with:
- Burn marks on the mouth or fingers
- Redness or bruises around injection sites
- Sores and scratches
Your family member’s emotional or mental state may change, as well. You might notice:1,2
- Mood changes or mood instability.
- Increased worry and anxiety.
- Signs of hallucinations.
- Signs of delusional thinking.
You may also notice significant behavior changes in your family member, including:3
- Changing interests and friends.
- Decreased communication.
- Increasing isolation.
- Energy changes (feeling abnormally energetic or lethargic).
- Worsening performance at work or school.
- Neglect of personal or social responsibilities.
- Financial trouble/increasing requests for money.
- Criminal activity/legal repercussions.
Why Does My Loved One Choose Drugs Over Our Family?
If your mother, brother, son or other family member continues to use alcohol and other drugs in the face of negative consequences, you may wonder why they cannot simply stop. It’s easy to feel like they have picked drugs over you. Unfortunately, due to certain environmental, biological, and developmental factors involved, for some people, it is not as easy as “just saying no”. Brain changes that occur as addiction progresses make quitting very difficult (though not impossible).4
People are normally rewarded through activities like eating, procreating, and nurturing others/being nurtured.5 However, some substances provide a neurochemical reinforcement that surpasses these naturally pleasurable rewards and, over time, drug and/or alcohol use begins taking precedence over the seeking out of natural rewards.
A person who’s abusing drugs may eventually start to feel little pleasure from activities they used to enjoy. For example, a father may notice his son seeming depressed and demotivated, no longer excited to participate in his favorite hobbies. At the same time, the son may be increasingly unable to control his impulses or make good decisions. He may also be physically dependent on the substances he’s using, feeling sick whenever he tries to cut back. On the top of all that, as substance use continues, the brain’s response to the drug will diminish and even the drug will not cause the same reward it used to, so the individual will be more prone to compulsively taking more and more to get the sought-after reward.6 All of the ways the body and brain adapt to substances make it increasingly difficult for someone stop even when he wants to.6
If you’re watching someone you love continually using drugs even though it’s ruining your relationship, try to remember that they are not choosing drugs over you—they are suffering from a substance use disorder and may need the help of treatment to stop using.7
Helping or Enabling?
Those struggling with substance use and/or other mental health issues stand to benefit greatly from the positive support of family; however, helping an addicted person can be a difficult path to navigate.
The best support takes into account the long-term benefit of your family member. Focusing on the short-term needs or trying to make everything tolerable now could lead to additional problems in the long-term. For example, you may want to handle your sister’s legal problems or pay her rent, but you may simply be enabling her to keep using.
Enabling behaviors may be counterproductive to recovery by protecting your family member against the consequences of their own substance use. A mother may enable her daughter, giving her money or calling in sick for her, because she blames herself for her daughter’s use and feels responsible. However, while her attempts to help are well-intentioned, the long-term effect is that her daughter’s substance use is likely to continue and get worse.8
Enabling can drain you of energy and resources and is unlikely to improve the situation in the long term. A better approach is to set healthy boundaries while continuing to encourage your family member to enter treatment.
One of the best ways to avoid enabling is by setting limits and not changing them. If you constantly adjust them, they will become meaningless. Setting clear limits and boundaries and staying consistent provides you the space you need to take care of yourself, while putting the responsibility of your family member’s actions where they belong: on them.9
You alone cannot make your family member stop using. The best you can do is to set boundaries, while providing encouragement, support, and reinforcement. The rest of the journey is in their control.2,10
Find Treatment for a Family Member
When your mother, father, brother, sister, or child is struggling with addiction, one of the best decisions you can make is to stress the importance of professional addiction treatment. For many, addiction is too imposing an issue to tackle alone, and becomes even more difficult to address when there are co-occurring disorders such as depression that may be contributing to substance use.
What to Look For
If your family member is ready to enter treatment, you can help them follow through by assisting with choosing a program. When considering treatment, look for centers with:
- Facilities conducive to recovery. Too many distractions or poor conditions can remove the focus from sobriety.
- Expert staff. Staff should be credentialed and experienced in addiction treatment.
- Evidence-based treatments. Make sure the staff are using sound therapeutic tools backed by research, such as cognitive-behavioral therapy and medication-assisted treatment.
- A comprehensive approach. The best treatment centers look at more than only the addiction. They look for ways to improve the overall well-being and health of your family member.
- Individualized care. Rather than providing the exact same treatment to all patients, a customized treatment plan may better accommodate each patient’s unique needs.
What Is the Right Treatment?
All reputable providers will start the treatment process with a thorough assessment of your family member to determine an appropriate course of treatment.11
If your husband is frequently using high doses of benzodiazepines, for example, he may need a period of inpatient detox to begin his treatment in a safe, structured way to minimize the physical and mental health risks of withdrawal.12 Inpatient medical detox is generally recommended for withdrawal from alcohol, sedatives, and opioids.11
Inpatient or residential treatments involve living at the treatment center while receiving treatment. This type of care is suitable for people who want and need the high level of support and structure that an inpatient environment provides. 11
Outpatient programs allow the person to live at home and work while participating in treatment throughout the week, which is ideal for someone with a supportive home life and responsibilities they need to attend to.13 Oftentimes, people will step down from an inpatient or residential program to an outpatient setting of care for continued treatment.
Different family-based treatments may take place in inpatient, outpatient, and community settings. The goals of family treatment include:12
- Improving family relationships and communication.
- Providing addiction education to family members, including the best ways to support the recovery of loved ones.
Specific types of family-based treatment include:12,14
- Community reinforcement approach (CRA). This 24-week intensive outpatient program focuses on improving family relationships while teaching skills needed to minimize substance use and develop healthier habits.
- Community reinforcement approach and family training (CRAFT). CRAFT is an alternative to a stagedd intervention that involves training family members to no longer reward unwanted behaviors and improve their communication styles.
- Family behavioral therapy (FBT). This approach combines behavioral contracts and contingency management and engages the family in helping the addicted person to apply new skills learned in therapy.
If you have a teenage son or daughter, you have other specific treatment options designed specifically for adolescents:12
- Multidimensional family therapy (MDFT). This includes family and individual sessions to improve communication skills and modify the teen’s network of influence.
- Functional family therapy (FFT). FFT is based on the notion that the teen’s behaviors are part of larger family dysfunction and works to restore the health of the family system.
Paying for Treatment
Whether inpatient or outpatient, many treatment programs will be covered, at least in part, by health insurance. If your family member has insurance or your insurance covers that person, consider calling the company directly to learn more about how much coverage a specific plan provides and which programs are in-network.
Alternatively, you and your loved one could phone or visit the facility to learn more about the programs, types of insurance accepted, and payment options.2
Self-Care and Support
Many people who love someone who is suffering from addiction invest all their energy into worrying about and taking care of that person and, in the process, end up neglecting themselves entirely. Attending to your own health, however, can you help you better support your loved one.
Methods to Care for Yourself
You can take care of your physical health by:15,16
- Eating well. Choose fresh foods and water, and avoid too much caffeine or sugar.
- Increasing physical activity. Finding small ways to add activity to your day, like taking walks with a friend, can help reduce stress and keep your energy up.
- Getting adequate sleep. When you’re well-rested, you may be better equipped to handle the stresses of supporting a family member who is struggling with addiction.
You can support your mental and emotional health by:15,16
- Trying relaxation techniques. With a wide array of options like progressive muscle relaxation (PMR), guided imagery, deep breathing, and mindfulness, there is a relaxation technique for you.
- Asking for help. The pressure to manage caretaking alone can become unbearable. Try to let people help you.
- Writing down your thoughts and feelings can help you work through troubling issues and find solutions.
- Setting boundaries. Creating appropriate and sustainable boundaries may be uncomfortable at first but will prevent you from overextending your resources an enabling the addiction.
- Engaging in pleasurable activities. Spending time outside of the house doing activities you enjoy will refresh your body and your mind while giving you the opportunity to reflect on the situation with a clear mind.
Additional options for self-care and support include: 15,16
- Outpatient individual, family, or group therapy.
- Toll-free hotlines to discuss your concerns.
- Support groups like Al-Anon and Nar-Anon.
You Are Not Alone
If you need help for a family member, don’t try to do it all alone. We are here for you with many treatment options for your family member from medical detox to sober living.
- National Institute on Drug Abuse. (2018). Commonly Abused Drugs Charts.
- National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association
- National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction.
- National Institute on Drug Abuse. (n.d.) The Neurobiology of Drug Addiction.
- National Institute on Drug Abuse. (2017). Neurological Effects.
- National Institute on Drug Abuse. (2018). Understanding Drug Abuse and Addiction.
- 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. (2015). Family Checkup: Positive Parenting Prevents Drug Abuse.
- National Institute on Drug Abuse. (2016). What to Do If Your Teen or Young Adult Has a Problem with Drugs.
- Center for Substance Abuse Treatment. 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, 2006.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- National Institute on Drug Abuse. (2018). Types of Treatment Programs.
- Department of Veterans Affairs, South Central Mental Illness Research, Education, and Clinical Center (MIRECC). (2001). Community Reinforcement.
- Office on Women’s Health. (2019). Caregiver Stress Fact Sheet.
- U.S. Department of Veterans Affairs. (n.d.). National Caregiver Training Program Caregiver Workbook.