Addiction destroys many things – a career, a future, a person’s life – but perhaps one of the most evil things about addiction is that it destroys relationships. One person’s substance abuse can spell the end of an entire family, as bridges are burned and things said and done that cause irreparable damage and break hearts. That’s why the family unit plays such a critical role in catching a substance abuse problem before it becomes an addiction, and then guiding their loved one through the process of rehab, treatment, and aftercare support.
How to Spot Addiction
Addiction has many sources and mediums, but the signs of a problem are typically standard, often giving concerned and observant family members an opportunity to step in before it’s too late.
More Signs of addiction
In the case of an alcohol problem, for example, a spouse, sibling, or parent (or even a child) might notice the following habits and behavior from their loved one:
- The person has a strong compulsion to drink. Casual or social drinkers can enjoy themselves without having to drink, but a problem drinker is tempted and compelled to make alcohol a part of everyday life. While many people save their drinks for the weekend or a special occasion, someone who finds any chance to drink to celebrate everything from the end of the workday to taking the edge off every single day is exhibiting a clear sign that they are abusing alcohol.1]
- The person has withdrawal symptoms if he stops drinking. Someone who drinks moderately or infrequently can go for days, weeks, or months without drinking and not feel any ill effects. Someone who drinks too much alcohol too frequently will experience a wide range of symptoms if they stop drinking, such as depression, mood swings, muscle cramps, sleeplessness, and nausea. While this should be an obvious sign that their drinking has gone too far, an alcoholic might be so deep in their addiction that their first recourse is to seek comfort in the bottle again (thereby deepening the problem), instead of seeking help.2]
- The person has an increased tolerance. Casual and moderate drinkers don’t need much alcohol to experience a buzz, but a problem drinker pushes their threshold for intoxication so high that they knock back drink after drink just to feel any effect. If a loved one is unable to enjoy herself with a moderate amount of drinks, this is sign that her required intake level is dangerously high.
- The person is unwilling to stop drinking. Even a responsible drinker will make a mistake once or twice, and they know when to step back. For someone with an alcohol addiction, however, having that kind of willpower is easier said than done. They may refuse to believe that they have a drinking problem, or they may agree that they do, but insist that they are in control, that they can stop drinking whenever they want, and they resist lines of inquiry from family and friends on the topic. Someone who is truly in control of their drinking should have no issue about abstaining for a period of time; someone who isn’t in control will react with anger and offense.
- The person’s life suffers as a result of drinking. Many people will have a bit too much to drink on a Saturday night but still be at their office desk at 9 am on a Monday morning. For a person who has a real alcohol problem, however, punctuality and work (or academic) obligations are usually the first things to go. Also affected are their hobbies or activities, since all those things seem less important when the desire to drink and get drunk becomes all-consuming. An observant family member might notice that their loved one is spending less time socializing, or letting their schoolwork or professional life slide, at the same time that they seem to have upped their drinking habit.3]
- The person is ashamed of his drinking. Enjoying alcohol socially and responsibly should carry no stigma, but a problem drinker usually knows that their behavior is out of control and dangerous. Nonetheless, their addled mind still compels them to drink, so they do it in private, away from judgment, questions, and condemnation. If there are signs of clandestine alcohol consumption – receipts, credit card statements, and empty bottles and cans that have been stashed away or disposed of – this is a massive red flag that an addiction is present.
Some dangerous substances – like heroin, for example – leave some very distinct calling cards that can alert a family member to a loved one’s use. In the case of a powerful depressant like heroin, they might be:
- Lethargy: Someone taking a hit of heroin may feel an initial rush of euphoria, but the drug is primarily injected (and in rare cases, inhaled) for the powerful sense of relaxation it forces on its users. A user will exhibit sudden drops in energy, constant fatigue, going to sleep frequently, or nodding off in the middle of a conversation. Further signs of heroin addiction could include slurred speech, uncharacteristic clumsiness (by way of a lack of muscular coordination), or an inability to think clearly.4]
- Needle marks: It’s impossible to inject heroin into your veins without leaving telltale marks. The arms are the most obvious place to inject, which is why some users resort to using parts of their body that are usually covered up or out of sight: the ankles, thighs, buttocks, and between the toes are the most popular areas. An observant family member will keep an eye out for unexplained marks in those places as evidence suggesting a heroin addiction.
- Behavior changes: Heroin, like any addictive substance or problem behavior, makes a person change their habits, to either enable their addiction or try to hide it. Similar to the signs of alcohol abuse, a decline in hobbies, activities, professional, or academic life would indicate a heroin problem. Other clues (such as wild mood swings, constant lethargy, asking for money, etc.) might indicate a heroin (or other drug) problem.
- Physical effects: As a very potent depressant, heroin causes users to have constricted pupils and difficulty breathing. Like alcohol, not using heroin after a period of abuse causes withdrawal symptoms like cramps, vomiting, anxiety, and diarrhea.5] A heroin addiction makes even eating take second place to getting high, so a concerned family member might watch out for drastic weight loss.
- Drug paraphernalia: Heroin can be snorted, but the most common method of administration is intravenous injection. A syringe is used to inject the liquefied heroin into a vein. Belts or shoelaces might be tied around an arm to make a vein stand out more.6]
- Behavioral changes to prolong heroin use: As an addict becomes increasingly desperate for their next hit, they may resort to stealing money, or covering up their own expenses, to buy more heroin. Unexplained financial losses or strange spending patterns over a period of time might point to a user trying to fund their habit. Also, an addict will employ constant secrecy and deception to keep their habit going, lying about their comings and goings or the reasons behind their constant fatigue and need for sleep.
What to Do When It’s True
If you discover that a loved one is addicted to drugs, alcohol, or some kind of compulsive behavior (gambling, eating, shopping, etc.), time is absolutely of the essence. The longer you wait – either because the topic is difficult to broach or because you don’t want to believe that a member of your family is using drugs – the greater the risk that their addiction is deepening.
Hire a Professional Interventionist+
When you are confident that your loved one is using drugs or abusing alcohol, the time to call an interventionist is right at that moment. Too often, people wait until the last moment, or until they hit rock bottom, to make that call, but too much damage can be done at that point. Furthermore, the sooner an intervention is scheduled, the sooner treatment can begin and the easier it will be for the patient during the multiple stages of recovery.8]
Even though it is your family member who has the addiction problem, you don’t have the training in the psychologies of addiction, family dynamics, and group moderation. A professional interventionist does. They know how to present the case to the addict in such a way that he sees the need for treatment. The interventionist also knows how to make the family members and friends who are participating in the intervention feel like their voices have been heard. An addict should feel motivated, not pushed, into seeking treatment, and emotionally distraught and angry family members may have difficulty achieving this on their own.
It’s advised that family members don’t try to conduct the intervention themselves. PsychCentral called doing so “dangerous and very counterproductive.” There are so many loaded balls in the air during an intervention – feelings of resentment, betrayal, anger, and condemnation – that only a professional interventionist (who is educated and experienced in the mechanics of domestic communication) knows how to channel them in a way that leads the addict into acknowledging her substance abuse problem and agreeing to accept help for it.
Because of all this, the key to an intervention is that it must be very controlled. Improvisation and off-the-cuff remarks can derail the entire process, so planning the intervention can take time and effort.9]
Professional interventionists either work independently or are affiliated with a rehabilitation center. This may influence their fee structure, how you choose the interventionist, and the follow-up options after the intervention. 10]
Planning an Intervention+
In the planning stage, family members will have to decide who should be present. This could be people (friends, siblings, parents, romantic partner, etc.) who are close to the addict, who have firsthand experience of how the addiction has negatively affected their relationship. If appropriate, a priest, mentor, or someone in a similar advisory or mentor-like capacity who knows the patient well, and who also feels that the patient has an addiction problem, could also be made part of the intervention.
Ideally, there should be no more than a handful of participants, not counting the interventionist. All the goodwill and encouragement in the world can still be overwhelming if there are simply too many people in the room.
Once a list of participants has been finalized, their job (with the guidance of the interventionist) is to prepare what they plan on saying at the intervention. This could be done in the form of writing out their side of the story in a letter that they would read out loud to the patient. In the letter, they would detail specific instances where their loved one’s addiction caused personal and negative damage – for example, how they were embarrassed because he showed up drunk to a social gathering, or how their home life has suffered because the patient is too high, too stoned, or too wasted to be involved.
Reliving memories like this can be difficult, both for the participants and their loved one, so the interventionist will coach them on how the participants can express themselves in a way that is straightforward and comprehensive, but nonetheless supportive and without any connotation of shame or humiliation. The idea of this step is to restore their relationship with the addict, and also to develop a sense of solidarity with the other participants by sharing the burden of their negative experiences. Strengthening the relationships between affected friends and family members becomes key in the event that the intervention is unsuccessful and the loved one refuses to accept help.11]
To this effect, the participants should practice reading their letters out loud. They may be interrupted by the addict during the actual intervention, but a crucial element of the intervention is how well the friends and family members can hold their ground in the face of tears and anger – both the patient’s and their own. So, the surer the participants are of themselves and what they’re going to say, the more effective the intervention will be.
No intervention is complete without a concrete and clear path forward. As part of preparing for the intervention, the family members should – again with the guidance of the interventionist – research and find a rehabilitation facility that they feel would be a good place for their loved one to get treatment.
Failing to do this provides the addict with a loophole to avoid making any kind of lasting commitment to getting treatment, no matter what they say during the intervention. Many addicts will tearfully agree to get help, only to delay taking any actual action if there is no follow-up plan in mind (promising that they will go somewhere the next day, the next week, etc.).
The actual intervention should be set up by having the patient arrive at the location – private and quiet – with no prior knowledge of what is going to happen. When he gets there, the interventionist should get things rolling, and it’s the interventionist who should direct proceedings from beginning to end.
For starters, the interventionist will affirm that the intervention is taking place, and the participants are present because they love the addict and want what’s best for him. When it is made clear that the event is taking place because the patient has a drug problem and their family wants the drug use to stop, the patient will usually react negatively. He may:
- Deny that he has an addiction problem
- Try to excuse or justify his behavior
- Try to turn the tables on the participants, accusing them of having problems of their own or of enabling the drug problem
- Agree that he has an addiction problem but refuse anyone’s help in combating it
- Reject the leadership and moderation of the interventionist (seeing him or her as an outsider)
If the intervention goes down this road, then the interventionist will call on the participants, one by one, to read out their prepared remarks.
A proper, professional intervention must be conducted from a foundation of love and support for the patient; but by that same measure, the patient must be made aware that her addictive behavior will no longer be tolerated, and that if she refuses to terminate that behavior, or otherwise reject the premise of the intervention, consequences will be enacted. Each participant should make the nature of their respective consequence quite clear in the letter that they read out. Examples of such measures can include:
- Ending financial support
- Moving out
- Denying visitation rights to see children
- Breaking off contact
It will not be easy to say these things to the patient, let alone carry them out. However, it is vital for this die to be cast, to drive home the gravity and finality of the situation. This is why an intervention should be thought of as an ultimatum,12] and an intervention that does not draw a line in the sand will not succeed.
If you have clear and indisputable evidence that a family member is using drugs or drinking too much alcohol, you should seek help. Confronting an addict about their problem can be difficult, even dangerous, due to the high level of emotions involved. They may reject your claims, refuse to discuss the matter, and be driven even further into their behavior.7]
For that reason, outside help in the form of a trained, professional interventionist is the best way to go to save your family member – and your entire family – from the effects of addiction.
Getting a Family Member into Rehab
If the patient admits that she has an addiction problem and accepts the intervention’s follow-up plan, getting her into rehab should begin as soon as possible. Any delays increase the risk of the patient changing her mind or using substances again “just one more time” (when, of course, the intervention is meant to be a turning point, not a last call).
To ensure this, the journey to the treatment center should be made that very day, right after the intervention. If that is not possible, then it should be done the first thing the next day (with one of the intervention participants spending the night with the patient to ensure that there is no last-minute relapse or change of plan).
This may seem very sudden for the patient and may be a source of fear or delaying tactics. However, interventions followed by a comprehensive course of treatment have long-term recovery rates of more than 50 percent, which The Independent calls “exceptionally high.”13] For that reason, it is imperative that the gap between the intervention and treatment is either very minimal or nonexistent.
An addiction problem, and the intervention to end it, involves everyone who has a close connection to the patient. They may learn things about themselves, their loved ones, and their family dynamics that could be surprising and distressing. When it comes to treating a member of the family for addiction, education is a vital aspect of the process. Parents, siblings, children, spouses, cousins, and other members should understand what role their behavior played (if any) in unwittingly enabling the substance abuse problem, or missing the signs of the patient’s mental or emotional distress that led to the problem.14]
Family therapy might involve members of the family meeting with a psychologist, who will see if there are any factors in your relationships with each other and your loved one that might have created a scenario where turning to drugs or alcohol felt like an option. For example, is there verbal or emotional abuse or neglect in the family? Has there been a history of physical violence? Or a history of mental illness in previous generations?
If any of these triggers exist, the therapist’s job will be to clarify the connections those triggers have to your loved one developing a substance abuse problem. Once these connections are understood, then the therapist and family members can work together to remove or control these triggers so the patient can safely reintegrate back into their home following treatment.15]
Of course, there will have to be a lot of new behaviors learned and old behaviors unlearned on the part of both the patient and his family members. To better tackle this challenge, a family therapist will focus on the importance of communication within the family unit: how to properly bring up and deal with the topics that may have created the unhealthy environment that led to the substance abuse problem; how to address concerns in a way that makes everyone’s voices heard, with respect, affirmation, and love; and how to move forward in a way that respects the patient’s new boundaries and newly abstinent life.16]
Another vital component of family therapy is providing mental health assistance to the family members themselves. Addiction can devastate everyone it touches, directly or indirectly, and spouses, children, siblings, and parents may well need to talk to someone who can help them reconcile their feelings of loss, anger, resentment, and guilt because of their loved one’s substance abuse problem.
More Aftercare Information
Once your loved one has completed detox and psychotherapy and has returned home, the support of aftercare groups can help them take their first steps back into everyday life. Support groups consist of people who are in a similar situation to the patient – people who fell prey to a substance abuse problem, were given a humbling ultimatum by their families, went through treatment, and are learning how to live life again, one day at a time. Through sharing experiences, success stories, and experiences of failure, the members of a support group build each other up to face each day anew.
This is not merely a feel-good idea. Relapse is most likely to happen within the first three months of an addict leaving the cocoon of formalized treatment,17] and aftercare programs like 12-Step groups are there to ensure that the addict stays on the recovery path during that critical time. And evidence backs it up: according to the Journal of Substance Abuse Treatment, sticking to an aftercare program suggested “improved outcomes” among patients.18]
Every family goes through some period of stress and tension, but there are ways to resolve those periods without starting the domino effect that leads to someone you love finding refuge in the jaws of addiction. If you notice your children, your sibling, or your partner acting strangely or uncharacteristically, ask them what’s going on; do not dismiss or ignore their behavior.
Parents should model healthy behaviors for their children: this might mean adjusting a work-life balance, doing family activities together, resolving conflict with communication and compromise, or vocally and visibly exhibiting love and support.19] By fostering an atmosphere of openness and approachability, family members can be there for each other in a way that leaves little room for addiction.
8] “7 Common Misconceptions About Addiction Interventions.” (2013). Psych Central. Accessed January 28, 2015.
9] “Intervention: Help a Loved One Overcome Addiction.” (September 2014). Mayo Clinic. Accessed January 28, 2015.
12] “8 Steps to Intervention: What to Do When Your Child is Using Drugs.” (April 2013). The Huffington Post. Accessed January 28, 2015.
13] “The Power of Intervention: America’s Most Successful Addiction Treatment Has Been Slow to Catch on Here — Until Now.” (April 2013). The Independent. Accessed January 28, 2015.
14] “Making Treatment for Bipolar Disorder a Family Affair.” (July 2007). Psychiatric Times. Accessed January 28, 2015.
17] “Aftercare: A Fundamental Tenet in Attaining Long-Term Recovery.” (January 2013). Addiction Today. Accessed January 25, 2015.
18] “Increasing Adherence to Substance Abuse Aftercare Group Therapy.” (January 1999). Journal of Substance Abuse Treatment. Accessed January 25, 2015.