Overcoming Addiction

Alcohol, drugs, and even many behaviors (such as eating disorders) fall under the classification of “addictive.”

Let’s cut straight through the jargon.   According to the Merriam-Webster dictionary, addiction is the “compulsive need for and use of a habit-forming substance….”  Does your loved one seek his/her drug of choice even when there are significant negative consequences?  If so, your loved one might be a person with substance use disorder.

A second, simple way to discern whether or not you’re dealing with addiction is as follows.  If your loved one can be honest with himself, have him answer these two questions.  First, when you drink or use drugs, can you control how much you use every time you use?  Second, can you predict what will happen when you use your drug of choice?  (In other words, do you know that you will have only one glass of wine with dinner and then watch a movie, or once you start drinking, are all bets off?)  If you cannot control your drug intake or predict your behavior when you use, you likely have a problem.

A third definition is this: If you cannot enjoy AND control your drinking, you probably have a problem.

Addiction is no more complicated to understand than that.  If a substance or behavior becomes more important than the relationships in your life, addiction is an issue.

You don’t need a clinical definition of addiction to recognize that one of your family members or friends has a severe issue.  But as you well know, interacting with someone who is addicted to alcohol or drugs is at best a challenge.  Allow me to take you for a moment into the mind of a person with substance use disorder to help you understand her worldview.

The addict lives in the tension between denial and death.  Sometimes, she believes that nothing can touch her.  At other times, depending on how far her addiction has progressed and how many people around her have already died from addiction, she will know that she is on death’s door.

The addict may or may not be able to tell you this.  She is like a child whistling in the dark when she tells you she doesn’t have a problem…because she lives in a constant state of fear that her drug either will not be available to her and she’ll get sick or on her next binge she won’t be as lucky as on her last.  If you can understand this tension, you will go a long way toward understanding the addict’s mind.

That said, perhaps the only thing more frightening to a person with substance use disorder than dying is treatment.  The addict does not know how to live without his drug.  Dying is a natural progression of addiction.  Treatment is a foreign idea.  The addict isolates in part to protect his habit and in part to protect those he still loves from watching him die.  The addict in the throes of addiction does not believe recovery is possible.

To help the addict you love, you must replace the addict’s isolation with support and accountability.  This is what interventions try to do; in an intervention, the family says to the addict, “We love you enough that we are going to be here for you as you recover and you will be accountable to us if you do not.”  Providing the addict with a promise of emotional support and accountability gives your loved one something to hold onto as she delves into the unknown.

Please note, that in order to provide this support to a person with substance use disorder, you likely will need counseling and guidance also.  The addict is not alone in practicing her addiction.  The entire family system must change for the addict to recover long-term.

There is a theory called the “Stages of Change” model.  It was created based on the research of James Prochaska and his colleagues at the University of Rhode Island, beginning in the 1970s, forming into a complete model in the 1990s.  What Prochaska found was that for those who want to make a significant change in their lives, there is a series of “stages” that make that change possible.  The theory begins with “pre-contemplation,” a stage where you don’t even know there is a problem; this would be the addict in denial.  It ends with a stage called “termination” or “transcendence,” in which the problem literally no longer exists.  This is the stage of the person who was a smoker forty years ago and doesn’t consider smoking an option in his life no matter what trials or circumstances he faces.

Though the Stages of Change model has come under fire from some scholars, particularly those who suggest that there are other factors that can complicate or undermine a person’s efforts to change, addiction treatment centers have found that in conjunction with other treatment protocols, the Stages of Change model is a proven tool to support long term sobriety.  Therapists who use the Stages of Change model, along with other interventions, are able to help a person with substance use disorder deepen her commitment to change and prepare for difficult situations when relapse is possible.  The Stages of Change model has a strong evidence-base in addiction treatment.

Your loved one will recover or not – and his recovery has absolutely nothing to do with you.  That’s hard to hear, but it is true.  Whether your loved one overcomes addiction or not, you must take care of yourself.

The best thing you can do for yourself and the addict you love is to set strong, loving boundaries.  This means saying clearly and firmly that you will no longer participate in activities that support the addict’s addiction.

How do you set boundaries?  First, articulate clear guidelines of what you will and will not do for your loved one.  Perhaps you will no longer pay for a grown child’s cell phone and car or you will not cover for your spouse by lying to his employer when he cannot show up to work.  Second, you will need to get support for yourself.  There are local support groups, professional therapists, crisis centers and clergy who are available to support you in this process.  If you are financially dependent on your loved one or fear for your safety, you should consider immediate steps to ensure your financial and physical safety.  This could include setting aside money and making an escape plan, if necessary.  Finally, consider engaging in activities that don’t involve your addicted loved one.  Do you like to go to church or ride horses?  Go to the movies.  Take a walk.  Do something that requires you to turn off your cell phone so the addict cannot reach you for awhile; enjoy your life.  You deserve to get back your joy for living.

Many times, families believe that it is only the addict who has a problem.  If the addict gets better, they reason, the problem is resolved.  These families offer up the “sick” family member to the therapist or treatment center with the direction, “Fix him!”  — Recovery from addiction does not work like that.

There are relationships within the family that cause family members to behave with one another in the ways that they do.  Changing these relationships, so that the entire family functions in a healthier way, should be a family’s goal when one or more members is in a treatment facility.

The family might consider “family systems” counseling.  The goal of family systems therapy is to help family members understand and take responsibility for how the family group functions.  By learning to recognize charged situations and interactions, as well as how anxiety and conflict build within the family, family members can learn to manage their emotions and relationships in more appropriate ways.  These better functioning relationships may diminish some of the causes of conflict in the family, thereby helping to prevent relapse by the addict.

Things may be awkward when your loved one returns home.  You may be resentful that you were left home paying bills, taking care of children, and otherwise keeping a household running.  You may feel that you are walking on eggshells around the addict, in fear that she will relapse.  These are reasonable emotions to have.  Share them with your therapist, friends, support group, and when appropriate, your loved one.  Open and honest communication can foster the recovery process.

Balance is important not only for you, but also for the recovering addict.  Schedule time for therapy, work, recreation, and spiritual pursuits.  Plan time together, with friends, and alone.  You will need it.

Finally, you have the right to expect accountability and for your loved one to be accountable for his actions and whereabouts.  While it is not appropriate to stalk your loved one, it is acceptable to expect to know where he is, who he’s with, and what he’s doing.  If he says he’ll be home at ten, he should be home at ten or call to let you know what’s going on that will delay him.  These are reasonable expectations that show respect.  An addict who is unwilling to be accountable or angrily resents you for asking for such respect is likely not being honest and headed for relapse.

If you’re ready to take the next step in finding help for yourself or someone you love, it’s time to choose a treatment facility.

If you have medical insurance that covers addiction treatment, you should explore what those benefits cover.  This will give you some indication of which treatment centers you can afford.  Feel free to call a treatment center you are considering using and ask for their help in understanding your insurance benefits.  Many have dedicated full time staff members that will negotiate with your insurance company to find out what your maximum benefit is.  They have experience working with insurance companies and are there to help you clarify exactly which services your loved one is entitled to.

Look for a facility that offers a wide variety of programs and services, has fully qualified counselors, and at least three hours of individual therapy a week.  This is the most important part of your research.  Your loved one is entering treatment to recover from addiction.  Her days should be filled with psychotherapy, physical activity, meditation, writing – learning how to live a balanced, happy life without drugs or alcohol.

Consider any potential need for a facility that treats co-occurring disorders.  Eliminate treatment centers that do not provide services for all your loved one’s issues.

Be aware of a treatment center’s philosophy.  Some are religious-group sponsored.  Know whether or not a particular religious view, if that’s part of the center’s treatment philosophy, will work for your loved one.

Most important, seek out a treatment facility that emphasizes a long term “continuum of care.”  The most effective treatment centers have programming that evolves with the client’s sobriety.  These programs are not “28 days and you’re back at home,” but have graduated levels of care depending on the client’s progress.  Additionally, you need to know what kind of after-care support and plans are provided by the facility and how the organization responds to relapse.

Once you have found one or two facilities that you believe meet your loved one’s needs, call and speak to the intake staff.  Ask hard questions.  If you do, you will soon become confident in your choice and know that your loved one will be well cared for as he begins his path of recovery.