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Acknowledgments This publication was prepared for the Substance and Services Administration (SAMHSA) by the Knowledge Application Program (KAP), a Joint Venture of The CDM Group, Inc., and JBS International, Inc., under contract number 270-99-7072, with SAMHSA, U.S. Department of Health and Human Services (HHS). Karl D. White, Ed.D., and Andrea Kopstein, Ph.D., served as the Government Project Officers. Disclaimer The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. Public Domain Notice All materials appearing in this publication except those taken from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access and Printed Copies This publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://store. samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). Recommended Citation Center for Substance Abuse Treatment. What Is Substance Abuse Treatment? A Booklet for Families. HHS Publication No. (SMA) 14-4126. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004. Originating Office Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA) 14-4126 First Printed 2004 Revised 2005, 2006, 2007, 2008, 2010, 2011, 2013, and 2014 What Is Substance Abuse Treatment?

A Booklet for Families

U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857

CONTENTS

Introduction ...... 1

What Is Substance Abuse? ...... 2

What Is Substance Abuse Treatment? ...... 5

Just for You ...... 19

I’m Afraid It Won’t Work ...... 22

Especially for Young People ...... 24

Glossary ...... 26

Resources ...... 28

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INTRODUCTION This booklet is for you, the family mem- ber of a person dependent on or . Whether your family member is dependent on alcohol, , , marijuana, prescription medications, or other drugs, his or her dependence affects you and your family, too. This booklet answers questions often asked by families of people entering treat- ment. The “Resources” section, at the back of this booklet, lists a selection of sources for more information and sup- port groups available to you during this stressful time. Take advantage of this help, ask treatment providers questions, and talk with supportive friends or other family members about your feelings. Millions of Americans abuse or are dependent on alcohol or drugs. All of these people have families—so remem- ber, you are not alone. The fact that your family member is in treatment is a good sign and a big step in the right direction. People with alcohol or depen- dence problems can and do recover.

1 WHAT IS SUBSTANCE ABUSE? and drug dependence and , known as substance use disor- ders, are complex problems. People with these disorders once were thought to have a character defect or moral weakness; some people mistakenly still believe that. However, most scientists and medical researchers now consider dependence on alcohol or drugs to be a long-term illness, like asthma, hypertension (high blood pressure), or diabetes. Most people who drink alcohol drink very little, and many people can stop taking drugs without a struggle. However, some people develop a —use of alcohol or drugs that is compulsive or dangerous (or both).

Why Do Some People Develop a Problem but Others Don’t? Substance use disorder is an illness that can affect anyone: rich or poor, male or female, employed or unemployed, young or old, and any race or ethnicity. Nobody knows for sure exactly what causes it, but the chance of developing a substance use disorder depends partly on genetics— biological traits passed down through families. A person’s environment, psycho- logical traits, and level also play major roles by contributing to the use of alcohol or drugs. Researchers have found that using drugs for a long time changes the brain in important, long-lasting ways. It is as if a switch in the brain turned on at some point. This point is different for every person, but when this switch turns

2 on, the person crosses an behavior that often accom- invisible line and becomes panies it. Your loved one dependent on the substance. is not at fault for having People who start using drugs a , but he or she or alcohol early in life run a is responsible for getting greater risk of crossing this treatment. line and becoming depen- dent. These changes in the brain remain long after a What Are the person stops using drugs or drinking alcohol. Symptoms of Substance Use Even though your family member has an illness, it Disorders? does not the bad One of the most important signs of substance addiction Q: My husband says that he or dependence is continued is an addict. How can this be use of drugs or alcohol possible when he still has a despite experiencing the good job? serious negative consequences of heavy drug or alcohol use. A: Understanding how a Often, a person will blame person can be dependent other people or circumstances on alcohol or drugs and still for his or her problems keep a good job is difficult. instead of realizing that the The media often portray difficulties result from use of people with substance use drugs or alcohol. For example, disorders as unemployed, your partner may believe he unproductive, criminal, and was fired from jobs because homeless. However, many his bosses didn’t know how to people who are dependent run a business. Or your on alcohol or drugs do not daughter may believe she got fit this stereotype; they have a ticket for driving under the jobs and live with their fami- influence of alcohol because . The disease does tend to the police were targeting her. worsen over time. Eventually, Perhaps your loved one has your husband’s drug use may even blamed you. People with increase, and, with no help, this illness really may believe he may begin to experience that they drink normally or more serious problems. The that “everyone” takes drugs. earlier your husband can get These false beliefs are called treatment, the better chance , and denial is part of he has of recovery. the illness.

3 •• or withdrawal symptoms—In some cases when alcohol or drug use is stopped, a person may experience withdrawal symptoms from a physical need for the substance. Withdrawal symptoms dif- fer depending on the drug, but they may include nausea, sweating, shakiness, and extreme anxiety. The person Other important symptoms of may try to relieve these symp- substance use disorders include toms by taking either more of the same or a similar substance. •• Tolerance—A person will need increasingly larger amounts of alcohol or drugs Q: My mother says there is no to get high. cure for this disease, so she •• Craving—A person will feel doesn’t need treatment. Is a strong need, desire, or urge that true? to use alcohol or drugs, will A: Perhaps your mother does use alcohol or not understand the purpose a drug despite negative of treatment. She is correct consequences, and will feel to some degree; a substance anxious and irritable if he use disorder is often chronic— or she can’t use them. but it is treatable. This is also Craving is a primary true of many other long-term symptom of addiction. illnesses, such as diabetes •• Loss of control—A person and hypertension. Treatment often will drink more alcohol for substance use disorders or take more drugs than he is designed to help people or she meant to, or may use stop alcohol or drug use and alcohol or drugs at a time remain sober and drug free. or place he or she had not Recovery is a lifelong process. planned. A person also may Staying in recovery is a try to reduce or stop drinking difficult task, so your mother or using drugs many times, will need to learn new ways but may fail. of thinking, feeling, and acting. Treatment can help your mother accept, manage, and live with her illness.

4 WHAT IS SUBSTANCE ABUSE TREATMENT? Who Provides Treatment? Many different kinds of professionals provide treatment for substance use disorders. In most treatment programs, the main caregivers are specially trained individuals certified or licensed as substance abuse treatment counselors. About half these counselors are people who are in recovery themselves. Many programs have staff from several different ethnic or cultural groups. Most treatment programs assign patients to a treatment team of professionals. Depending on the type of treatment, teams can be made up of social workers, counselors, doctors, nurses, , psychiatrists, or other professionals.

What Will Happen First? Everyone entering treatment receives a clinical assessment. A complete assess- ment of an individual is needed to help treatment professionals offer the type of treatment that best suits him or her. The assessment also helps program coun- selors work with the person to design an effective treatment plan. Although clinical assessment continues throughout a person’s treatment, it starts at or just before a person’s admission to a treat- ment program. The counselor will begin by gathering information about the person, asking many questions such as those about •• Kinds, amount, and length of time of substance or alcohol use

5 The counselor may invite you, as a family member, to answer questions and express your own concerns as well. Be honest—this is not the time to cover up your loved one’s behavior. The counselor needs to get a full picture of the problem to plan and help implement the most effective treatment. It is particularly important for the counselor to know whether your family • Cultural issues around use member has any serious medi- of alcohol or drugs cal problems or whether you suspect that he or she may • Effects of drug or alcohol have an emotional problem. use on the person’s life You may feel embarrassed • Medical history answering some of these questions or have difficulty • Current medical problems completing the interview, but or needs remember: the counselor is there to help you and your • Current medications loved one. The treatment (including pain medication) team uses the information Mental health issues or gathered to recommend the • best type of treatment. No one behavioral problems type of treatment is right for • Family and social issues and everyone; to work, the treat- needs ment needs to meet your fam- ily member’s individual needs. • Legal or financial problems After the assessment, a coun- • Educational background and selor or case manager is needs assigned to your family mem- • Current living situation and ber. The counselor works with environment the person (and possibly his or her family) to develop a • Employment history, stabil- treatment plan. This plan lists ity, problems, and needs problems, treatment goals, and • School performance, prob- ways to meet those goals. lems, and needs, if relevant Based on the assessment, • Previous treatment experi- the counselor may refer your ences or attempts to quit family member to a physician drug or alcohol use. to decide whether he or she

6 needs medical supervision to stop alcohol or drug use safely. Medically supervised withdrawal (often called detoxification or detox) uses medication to help people withdraw from alcohol or drugs. People who have been taking large amounts of (e.g., heroin, OxyContin®, or ), or (“downers”), pain either alone or together—may medications, or alcohol— need medically monitored or managed withdrawal services. Q: My wife just started Sometimes, alcohol withdraw- treatment. I called the pro- al can be so severe that people gram yesterday to ask the hallucinate, have convulsions, counselor some questions. or develop other dangerous The counselor said that she conditions. Medication can “could not confirm or deny” help prevent or treat such that my wife was even there! conditions. Anyone who has What’s that about? once had hallucinations or seizures from alcohol with- A: Federal and State laws drawal or who has another protect an individual’s priva- serious illness or (in some cy in treatment. Before the cases) a counselor can talk to anyone that could complicate detox- (including you) about your ification may need medical wife’s treatment, the program supervision to detoxify safely. must first have her permis- Medically supervised with- sion, in writing. Even if the drawal can take place on a counselor knows that you regular medical ward of a hos- know your wife is there, she pital, in a specialized inpatient still can’t even say that your detoxification unit, or on an wife is in the program until outpatient basis with close your wife signs a “release of medical supervision. Detoxifi- information” or “disclosure cation may take several days authorization” form. You may to a week or more. During want to talk to your wife and that time, the person will be sure she understands that receive medical care and may you would like to be involved begin to receive education in the treatment program. about his or her disease.

7 through the most difficult part of withdrawing from alcohol and drugs. It is important to know that detoxification is not treat- ment; it is a first step that can prepare a person for treatment.

What Types of Treatment Programs Not everyone needs inpatient Are Available? medically supervised detox. People with mild withdrawal Several types of treatment symptoms from alcohol or programs are available: drugs and people using Inpatient treatment cocaine, marijuana, opioids, •• or do •• Residential programs not generally need to be hospitalized for detoxification. •• or However, they may need out- day treatment patient medical care, a lot •• Outpatient and intensive of support, and someone to outpatient programs ensure their well-being. •• clinics (also Social detoxification can called treatment meet this need. Sometimes programs). social detoxification centers are part of a residential treat- Inpatient treatment, provided ment program; other times in special units of hospitals they are separate facilities. or medical clinics, offers both Social detoxification centers detoxification and rehabilita- are not hospitals and seldom tion services. Several years ago, use medication, but the many hospital-based treatment person does stay there from programs existed. Today, several days to 1 week. The because of changes in insur- social detoxification staff ance coverage, inpatient treat- includes nurses and coun- ment is no longer as common selors. The staff watches each as it used to be. People who person’s medical condition have a mental disorder or seri- closely, and counselors are ous medical problems as well available to help him or her as a substance use disorder are

8 the ones most likely to receive inpatient treatment. Adoles- cents may also need the struc- ture of inpatient treatment to make sure a full assessment of their substance use and mental disorders can be done. Residential programs pro- vide a living environment with treatment services. Several models of residential treat- ment (such as the therapeu- tic community) exist, and Often residential programs treatment in these programs last long enough to offer lasts from a month to a year general equivalency diploma or more. The programs differ (GED) preparation classes, in some ways, but they are training in job-seeking skills, similar in many ways. and even career training. In residential programs for Residential programs often adolescents, the participants have phases of treatment, with attend school as a part of the different expectations and program. Some residential activities during each phase. programs are designed to For example, in the first phase, enable women who need an adult’s contact with family, treatment to bring their friends, and job may be children with them. These restricted. An adolescent may programs offer child care be able to have contact with and parenting classes. his or her parents but not with friends or with school. This Residential programs are best restriction helps the person for people who do not have become part of the treatment stable living or employment community and adjust to the situations and/or have limited treatment setting. In a later or no family support. Resi- phase, a person may be able dential treatment may help to start working again, going people with very serious “home” to the facility every substance use disorders who evening. If your loved one is in have been unable to get and a residential treatment program, stay sober or drug free in it is important that you know other treatment. and understand the program rules and expectations.

9 hours per day but lives at home. These programs usually last for at least 3 months and work best for people who have a stable, supportive home environment. Outpatient and intensive outpatient programs provide treatment at a program site, but the person lives elsewhere (usually at home). Outpatient treatment is offered in a variety Partial hospitalization or of places: health clinics, com- day treatment programs also munity mental health clinics, may be provided in hospitals counselors’ offices, hospital or free-standing clinics. In clinics, local health department these programs, the person offices, or residential programs attends treatment for 4 to 8 with outpatient clinics. Many meet in the evenings and on Q: My brother is in a residen- weekends so participants can tial treatment program. He go to school or work. Out- says he can leave the program patient treatment programs at any time. Is this true? have different requirements for attendance. Some pro- A: Yes. Everyone has the grams require daily atten- option of leaving. All alcohol dance; others meet only one and drug abuse treatment to three times per week. is voluntary, although there may be consequences for Intensive outpatient treat- leaving if the person is in ment programs require a treatment, for example, as person to attend 9 to 20 hours part of probation or parole. If of treatment activities per your brother chooses to leave week. Outpatient programs last and treatment has not been from about 2 months to 1 year. completed, the treatment People who do best in an staff may ask him to sign outpatient program are willing papers stating that he is leav- to attend counseling sessions ing treatment against med- regularly, have supportive ical advice. The staff also will friends or family members, try to find out why he wants have a place to live, and have to leave early and will try to some form of transportation address any concerns he has. to get to treatment sessions

10 (some programs will provide transportation if needed). Opioid treatment programs (OTPs), sometimes known as methadone clinics, offer medication-assisted outpatient treatment for people who are dependent on opioid drugs (such as heroin, OxyContin, or vicodin). These programs use a medication, such as methadone or LAAM, to help a person not use illicit opi- nurses come to the program oids. OTPs provide counseling site for a few days each week, and other services along with or a person may be referred to the medication. other places for medical care. Medical care typically includes screening and treatment for HIV/AIDS, hepatitis, tuberculo- What Actually sis, and women’s health issues. Happens in A Treatment Plan Treatment Programs? The treatment team, along Although treatment programs with the person in treatment, differ, the basic ingredients of develops a treatment plan treatment are similar. Most based on the assessment. A programs include many or all treatment plan is a written elements presented below. guide to treatment that includes the person’s goals, Assessment treatment activities designed As we discussed earlier, all to help him or her meet those treatment programs begin goals, ways to tell whether a with a clinical assessment of a goal has been met, and a person’s individual treatment timeframe for meeting goals. needs. This assessment helps The treatment plan helps in the development of an both the person in treatment effective treatment plan. and treatment program staff stay focused and on track. Medical Care The treatment plan is adjust- Programs in hospitals can ed over time to meet chang- provide this care on site. Other ing needs and ensure that it outpatient or residential pro- stays relevant. grams may have doctors and

11 feelings and problems, and find out that others have simi- lar problems. Groups also may explore spirituality and its role in recovery. Individual Assignments People in treatment may be asked to read certain things (or listen to audiotapes), to complete written assignments (or record them on audio- tapes), or to try new behaviors. Group and Individual Counseling Education About At first, individual counseling Substance Use Disorders generally focuses on motivating People learn about the symp- the person to stop using drugs toms and the effects of alcohol or alcohol. Treatment then and drug use on their brains shifts to helping the person and bodies. Education groups stay drug and alcohol free. use videotapes or audiotapes, The counselor attempts to lectures, or activities to help help the person people learn about their ill- ness and how to manage it. •• See the problem and become motivated to change Life Skills Training •• Change his or her behavior This training can include learning and practicing •• Repair damaged relation- employment skills, leisure ships with family and friends activities, , commu- nication skills, manage- Build new •• ment, , with people who don’t use goal setting, and money and alcohol or drugs time management. Create a recovery lifestyle. •• Testing for Alcohol or Group counseling is different Drug Use in each program, but group Program staff members regu- members usually support and larly take urine samples from try to help one another cope people for drug testing. Some with life without using drugs programs are starting to test or alcohol. They share their saliva instead of urine. They experiences, talk about their also may use a BreathalyzerTM to test people for alcohol use.

12 Relapse Prevention Training Relapse prevention training teaches people how to identify their relapse triggers, how to cope with cravings, how to develop plans for handling stressful situations, and what to do if they relapse. A trigger is anything that makes a person crave a drug. Triggers often are connected to the person’s past use, such as a person he Q: What are these “sober or she used drugs with, a time life skills” my partner talks or place, drug use parapher- about? nalia (such as syringes, a pipe, or a bong), or a particular A: Sober life skills are the situation or emotion. new behaviors and ways of living that your partner will Orientation to Self-Help need to work on. Before treat- Groups ment, your partner spent a Participants in self-help great deal of time obtaining groups support and encour- a substance, using drugs or age one another to become or drinking alcohol, and getting stay drug and alcohol free. over the substance’s effects. Twelve-Step programs are per- Most of his or her activities haps the best known of the centered on drugs or alcohol. self-help groups. These pro- Most of his or her fun activi- grams include Alcoholics ties included drinking alcohol Anonymous (AA), or using drugs, and many of Anonymous (NA), Cocaine your partner’s friends used or Anonymous, and Marijuana abused substances, too. For Anonymous. Other self-help these reasons, people recov- groups include SMART (Self ering from substance use dis- Management and Recovery orders need to learn a whole Training) Recovery® and new way to live and to make Women for Sobriety. new friends. Members themselves, not treatment facilities, run self- meetings for young people; help groups. In many places, women; , gay, and self-help groups offer meet- bisexual people; newcomers; ings for people with particular and those who need meetings needs. You may find special in languages other than

13 as Al-Anon and Alateen (see the “Just for You” section of this booklet). Treatment for Mental Disorders Many people with a substance use disorder also have emo- tional problems such as , anxiety, or post- traumatic stress disorder. Adolescents in treatment also may have behavior problems, English. Internet chat groups , or attention and online meetings are also deficit/hyperactivity disorder. available for some groups. Treating both the substance Many treatment programs rec- use and mental disorders ommend or require atten- increases the chances that the dance at self-help groups. By person will recover. Some attending, many people make counselors think people new friends who help them should be alcohol and drug stay in recovery. The number free for at least 3 to 4 weeks of meetings required varies before a treatment professional by treatment program; many can identify emotional illness programs require participants correctly. The program may to attend “90 meetings in 90 provide mental health care, days,” as AA and NA recom- or it may refer a person mend. Some treatment pro- to other sites for this care. grams encourage people to Mental health care often find a “sponsor,” that is, includes the use of medica- someone who has been in tions, such as . the group for a while and Family Education and can offer personal support Counseling Services and advice. This education can help you Self-help groups are very understand the disease and its important in most people’s causes, effects, and treatment. recovery. It is important to Programs provide this educa- understand, however, that tion in many ways: lectures, these groups are not the same discussions, activities, and as treatment. group meetings. Some pro- grams provide counseling for There are self-help groups families or couples. for family members, too, such

14 Family counseling is especially critical in treatment for ado- lescents. Parents need to be involved in treatment plan- ning and followup care deci- sions for the adolescent. Family members also need to participate as fully as possible in the family counseling the program offers. Medication Many programs use medica- tions to help in the treatment long periods of time or for life, process. Although no medica- which is called methadone tions cure dependence on maintenance treatment. drugs or alcohol, some do People receiving this treatment help people stay abstinent and often have good jobs and lead can be lifesaving. happy, productive lives. Medication is the primary If your family member is focus of some programs, such taking medications for HIV as the medication-assisted infection or AIDS or for any OTPs discussed earlier. other medical condition, it is Methadone is a medication important that OTP staff mem- that prevents opioid with- bers know exactly what he drawal symptoms for about or she is taking. Mixing some 24 hours, so the person must medications with methadone take it daily. Taken as direct- or LAAM may mean that your ed, it does not make a person family member will need high but allows him or her special medical supervision. to function normally. In is another fact, methadone blocks the medication that may be used “high” a person gets from an to treat opioid dependence opioid drug. and is sometimes used by Some people stay on metha- OTPs. Buprenorphine recently done for only 6 months to was approved for treatment by 1 year and then gradually primary care doctors in their stop taking it; most of these offices. A doctor treating a people relapse and begin to patient with buprenorphine use opioids again. However, generally will provide or refer others stay on methadone for the patient for counseling, also.

15 Another medication, naltrex- one (ReVia®), reduces the craving for alcohol. This med- ication can help keep people who drink a small amount of alcohol from drinking more of it. Programs also sometimes use to treat heroin or other opioid dependence because it blocks the drug’s effects. It is important for people who use heroin to go (Antabuse®) is through detox first, so they a medication that causes a are heroin free before starting bad reaction if people drink to take naltrexone. alcohol while taking it. The Because it is very difficult for a reaction is flushing, nausea, person to detoxify from opi- vomiting, and anxiety. Because oid drugs, many people don’t people know the medication make it that far; buprenor- will make them very ill if they phine is sometimes used to drink alcohol, it helps them help people make that transi- not to drink it. Antabuse is tion. If a person does detoxify taken daily. from opioids and begins to take naltrexone, it still will not work well for this purpose Q: If substance use disorder unless a person has a strong is a disease, why aren’t there system, includ- medicines that will help? ing someone who will make A: There are medicines that sure that he or she continues will help, though only for to take the medication regu- some . No “magic larly. When an adolescent is pill” exists to cure substance taking naltrexone to treat opi- use disorders, but medicines oid dependence, it is particu- can often be an important larly important that parents part of the treatment. provide strong support and Medications are used to supervision. detoxify a person, to prevent him or her from feeling high Followup Care (Also from taking drugs, to reduce Called Continuing Care) cravings, or to treat a per- Even when a person has suc- son’s mental disorder. cessfully completed a treat- ment program, the danger of

16 returning to alcohol or drug use (called a “slip” or relapse) remains. The longer a person stays in treatment, including followup, the more likely he or she is to stay in recovery. Once a person has completed basic treatment, a program will offer a followup care pro- gram at the treatment facility or will refer him or her to another site. Most programs recommend that a person a -based or residential stay in followup care for at program. People usually stay least 1 year. Adolescents often from 3 months to 1 year, and need followup care for a counseling is provided at the longer period. site or at an outpatient facility. Followup care is very Supportive living or transi- important to successful tional apartments provide treatment. Once a person is small group living arrange- back in his or her community, ments for those who need a back in school, or back at sober and drug-free living work, he or she will experi- environment. The residents ence many temptations and support one another, and cravings for alcohol or drugs. involvement in outpatient In followup care, your family counseling and self-help member will meet periodically groups is expected. with a counselor or a group to determine how he or she is and to help him or her deal with the challenges Why Does Treatment of recovery. Take So Long? For some people, particularly Substance use disorders affect those who have been in resi- every part of a person’s life. dential treatment or prison- For that reason, treatment based programs, more inten- needs to affect every part of a sive forms of followup care person’s life as well. may be helpful. Halfway houses or sober houses are Treatment involves more than alcohol- and drug-free places helping someone stop drink- to live for people coming from ing alcohol or using drugs.

17 Many people enter treatment only because of pressure from the legal system, employers, parents, spouses, or other family members. The first step in treatment then is to help them see that they do have a problem and to become moti- vated to change for them- selves. This process often takes time. Your family member also will Actually, stopping alcohol use need time to understand and or drug use is just the begin- begin to use the support of the ning of the recovery process. self-help groups mentioned Your family member will need before. These groups will be to learn new ways to cope important to his or her recov- with daily life. He or she will ery for many years to come. need to relearn how to deal Remember: It can take a long with stress, anger, or social sit- time for the disease to develop uations and how to have fun and it is often chronic; there- without using drugs or drink- fore, it can take a long time to ing. Learning these new skills treat it. is a lot of work.

18 JUST FOR YOU Now that your family member is in treat- ment, things are starting to change. Some of the tension and turmoil that probably were part of your life may be starting to ease. But the first weeks of treatment are stressful. Each family member is adjusting to changes, starting to deal with past con- flicts, and establishing new routines. Amid all these changes, it is important that you take good care of yourself—get enough sleep, eat right, rest, exercise, and talk to supportive friends and relatives. Your church, mosque, synagogue, temple, or other spiritual organization also may be a good source of support. Recovery is not just an adjustment for the person in treatment—it also is an adjust- ment for you. For the past few years, you may have assumed roles or taken care of tasks that were your loved one’s responsi- bilities. Now, as time passes, you and he or she may need to learn new ways of relat- ing to each other and learn different ways of sharing activities and chores. If you are the parent of an adolescent in treatment, you will need to be closely involved in treatment planning and treatment activi- ties. You may need to adjust your life and family relationships to allow for the extra time this involvement will take. You may have many questions about how your family member will behave in these early stages of recovery. Everyone acts dif- ferently. Some people are very happy to be getting treatment at last; others suffer a great deal while they adjust to a new life and attempt to live it without alcohol and drugs. They may be sad, angry, or confused. It is important for you to

19 find contact information in the “Resources” section of this booklet. Many treatment professionals consider substance use disor- ders family . To help the whole family recover and cope with the many changes going on, you may be asked to take part in treatment. This approach may involve going to a family education program realize that these are normal or to counseling for families reactions and to get support or couples. for yourself. It is important to remember Al-Anon is the best-known and the following points as you most available resource for and your family member family members and friends of recover: alcoholics. Al-Anon was found- ed 50 years ago to provide sup- •• You are participating in port for those living with treatment for yourself, not someone with alcoholism. just for the sake of the per- Alateen, for older children and son who used substances. adolescents, was founded somewhat later on. Today, •• Your loved one’s recovery, many family members of peo- sobriety, or abstinence does ple who use drugs also par- not depend on you. ticipate in Al-Anon or Alateen. •• Your family’s recovery does These meetings are free and not depend on the recovery available in most communities. of the person who used sub- Your community also may stances. have Nar-Anon meetings. This •• You did not cause your fam- group was founded for fami- ily member’s substance use lies and friends of those using disorder. It is not your fault. drugs. Other groups also may be helpful, such as Co- You still may have hurt feel- Dependents Anonymous and ings and anger from the past Adult Children of Alcoholics. that need to be resolved. You The treatment program need support to understand should be able to give you and deal with these feelings, schedules of local meetings and you need to support your of all these groups, or you can loved one’s efforts to get well.

20 Remember: Help is always there for you, too. Ask the counselor for some suggestions, and check the “Resources” section of this booklet.

What if I Need Help With Basic Living Issues? You may need very practical counselor about different help while your family mem- types of assistance that may ber is in treatment. If your be available to help you meet family member is the sole various needs. Most treatment financial provider and unable programs work with other to work because he or she is community programs. These in treatment, how will the programs may include food bills get paid? If your family pantries, clothing programs, member is the primary care- transportation assistance, giver for children or an elder- child care, adult day care, ly adult, how will these needs legal assistance, financial be met? The treatment pro- counseling, and health care gram may be able to help you services. Your family may be arrange disability leave or eligible for help from pro- insurance through your loved grams that help those in one’s employer. Ask the recovery.

21 I’M AFRAID IT WON’T WORK Treatment is just the first step to recovery. During this process family members sometimes have mixed feelings. You may feel exhausted, angry, relieved, worried, and afraid that, if this doesn’t work, nothing will. You may feel as if you are walking on eggshells and that, if you do something wrong, you may cause your loved one to relapse. It is important for you to remember that you cannot cause a relapse—only the person who takes a drug or picks up a drink is responsible for that. No one can predict whether your family member will recover, or for how long, but many people who receive treatment do get better. The longer people stay in treatment the more likely they will remain drug and alcohol free. About half the people who complete treatment for the first time continue to recover. Of course, this means that about half will return to drinking alcohol and using drugs (called relapse) before they finally give them up for good. Adolescents are even more likely to use drugs or alcohol or both again. It is not uncommon for a person to need to go through treatment more than one time. Often the person needs to return to treatment quickly to prevent a slip or relapse from leading to a chronic problem. It is important for you to understand that relapse is often a part of the recov- ery process. Do not be discouraged if your family member uses alcohol or drugs again. Many times relapses are short and the person continues to recover.

22 Q: My partner says a lot of people in his group have relapsed. What does that mean? A: Not all people in recovery are able to stay sober. When they cannot, it’s called relapse. Many people relapse a few times. As with other chronic illnesses, such as diabetes or asthma, the symptoms can come and go. Most treatment A treatment program may programs discuss relapse involve you in relapse preven- openly and often. It is impor- tion planning and may help tant that the person who you learn what to do if your relapses return to treatment family member relapses. Your right away, learn more about family member will benefit if his or her relapse triggers, and you do not drink or use drugs improve his or her coping around him or her, especially skills. Returning quickly is a in the first months after his or sign of health (rather than her treatment begins. When something to be ashamed of) you choose not to use drugs and a desire to begin working or alcohol, you help your toward a life free of alcohol loved one avoid triggers. As and drugs. It is important to you both begin to understand understand the concept of and accept the illness, the risk relapse. It means that a per- of relapse decreases. The son who had stopped drinking changes in attitudes, behav- alcohol or taking drugs for a iors, and values that you both period has started to drink are learning and practicing alcohol or use drugs again. will become part of your new Relapses may be very dis- recovering lifestyle. heartening. However, a relapse does not mean that your fami- ly member will not recover.

23 ESPECIALLY FOR YOUNG PEOPLE You may be having difficulty handling some of your concerns about living with a person who alcohol or drugs. Whether this person is your mom, dad, grandparent, brother, or sister, it is important that you talk about your prob- lems, fears, and concerns with people who are understanding and sympathetic. You may feel that you caused your family member’s substance use disorder or that it is somehow your fault. You may think that if you had behaved better, done bet- ter in school, or been different in some way your mom or dad or the person you care about would not drink so much alcohol or take drugs. You did not in any way cause their disease. No one ever causes another person’s substance use disorder. It is nobody’s fault that some- one you care about has become ill. Your family member may have embar- rassed you in front of friends, teachers, or another person. You may have stopped bringing friends home or stopped telling your parents about school activities. Now that your relative is in treatment, his or her behavior should improve. You may have lived with fighting and stress, and you may have been abused or witnessed other kinds of . You may feel very angry and sad because of these experiences. Now you can talk about this and other feelings with your family or the staff at the treatment pro- gram. It will be important for you to share your thoughts and feelings about what has happened. You may want to go

24 to self-help groups such as Al- than those who do not. This Anon or Alateen. Some young means that you may have people find these meetings inherited a tendency to devel- to be helpful. These groups op a problem yourself, and talk about the three C’s: You you should be careful about didn’t Cause it, you can’t drinking alcohol or taking Control it, and you can’t Cure drugs. This information is it. Remembering the three C’s meant to educate you, not to can help. scare you. It is important to know that The situation at home will substance use disorders run probably improve because in families. People who have a your relative is in treatment. blood relative with a sub- Like treatment for people with stance use disorder are about other illnesses, treatment for four times more likely to substance use disorders is develop the same disorder helpful, but not everyone knows or believes it is. A great deal of stigma and shame are Q: My father is the one who still associated with substance drinks too much alcohol. Why use disorders. What and how do the counselors want to much you tell your friends or talk to me? teachers is your decision and A: Treatment professionals your family’s. You may just know that substance use want to say something like, disorders affect the whole “My mom is ill, but she will family. It makes sense, then, get better and come home to offer help to the whole soon. Thank you for asking.” family. Some programs offer You may choose to help family education, and others educate some of your close involve the family or couples friends about your relative’s in counseling sessions. It’s illness and his or her progress hard to grow up with a parent in treatment. Or, you may who uses alcohol or drugs. decide not to share this It can be helpful if you learn information with them. It’s more about the disease and your choice. the effect it has had on your family and on you. Talking to Remember, you didn’t create someone who understands this problem, but you can substance use disorders can play an important role in make a big difference for you. helping everyone heal. Hang in there.

25 GLOSSARY Denial The thought process in which a person does not believe he or she has a problem, despite strong evidence to the contrary. It is a way of protecting oneself from painful thoughts or feelings. Detoxification (or “detox”) A process that helps the body rid itself of substances while the symptoms of with- drawal are treated. It is often a first step in a substance abuse treatment program. Followup care Also called continuing care. Treatment that is prescribed after completion of inpatient or outpatient treatment. It can be participation in individual or group counseling, regular contact with a counselor, or other activities designed to help people stay in recovery. /sober house A place to live for people recovering from substance use disorders. Usually several people in recovery live together with limit- ed or no supervision by a counselor. Inpatient treatment Treatment in a setting that is connected to a hospital or a hospital-type setting where a person stays for a few days or weeks. Outpatient treatment Treatment provided at a facility. The services vary but do not include overnight accommodation. Sometimes it is pre- scribed after inpatient treatment. Relapse A recurrence of symptoms of a disease after a period of improvement; that is, a person in recovery drinks or uses drugs again after a period of abstinence.

26 Relapse prevention skills and attitudes needed for Any strategy or activity that independent living can be helps keep a person in recov- learned, practiced, and sup- ery from drinking alcohol ported. It provides a bridge or using drugs again. It may between supervised care and include developing new cop- independent living. ing responses; changing Therapeutic community beliefs and expectations; and changing personal habits, Long-term residential lifestyles, and schedules. treatment that focuses on behavioral change and per- Residential treatment sonal responsibility in all Treatment in a setting in which areas of a person’s life, not both staff and peers can help just substance use. with treatment. It provides Treatment plan more structure and more intensive services than out- A plan that provides a patient treatment. Participants blueprint for treatment. It live in the treatment facility. describes the problems being Residential treatment is long addressed, the treatment’s term, typically lasting from 1 goals, and the specific steps month to more than 1 year. that both the treatment pro- fessionals and the person in Self-help/12-Step groups treatment will take. Support groups consisting of Treatment team people in recovery that offer a safe place where recovering A team of professionals (e.g., people share their experi- clinical supervisor, counselor, ences, strengths, and hopes. therapist, and physician) AA’s 12 Steps help the mem- responsible for treating a bers recover from addiction, person and helping his or addictive behavior, and emo- her family. tional suffering. These groups Trigger are free and are not support- Any event, place, thing, smell, ed by any particular treatment idea, emotion, or person that program. sets off a craving to drink Supportive living alcohol or use drugs. Also called transitional apart- ments. A setting in which the

27 RESOURCES

Federal Government Resources Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Behavioral Health Treatment Services Locator http://findtreatment.samhsa.gov

SAMHSA http://store.samhsa.gov

28 Other Resources The following is a sampling, not a complete list, of avail- able resources. Inclusion on this list does not imply endorsement by SAMHSA. Most State and local gov- ernments have an office on substance abuse issues that can be an excellent resource. There also may be an office of the Council on Alcoholism Co-Dependents ® and Drug Dependence in your Anonymous (CoDA ) area; consult your local tele- 888-444-2359 phone book. http://www.coda.org

Adult Children of Dual Recovery (DRA) Central 562-595-7830 Service Office http://www.adultchildren.org 913-991-2703 http://www.draonline.org Al-Anon Family Group Headquarters, Inc. Jewish Alcoholics, (Al-Anon and Alateen) Chemically Dependent 888-4AL-ANON (meeting Persons and Significant information line) Others (JACS) http://www.al-anon.alateen.org 888-523-2769 Spanish Web site: http://www.jbfcs.org/ http://www.al-anon.alateen. programs-services/ org/inicio jewish-community-services-2/ jacs/#.UeQri6wdHcw Alcoholics Anonymous 212-870-3400 Join Together http://www.aa.org 855-378-4373 Cocaine Anonymous http://www.drugfree.org/ World Services (CAWSO) join-together 800-347-8998 http://www.ca.org Marijuana Anonymous World Services 800-766-6779 http://www.marijuana- anonymous.org 29 National Association on Alcohol, Drugs and Disability (NAADD) 650-578-8047 http://www.naadd.org

National Black Alcoholism & Addictions Council (NBAC) 877-622-2674 http://nbacinc.org/home.html

Nar-Anon National Clearinghouse 800-477-6291 on Families and http://www.nar-anon.org/ (NCFY) naranon 301-608-8098 http://ncfy.acf.hhs.gov World Services Office National Families in 818-773-9999 Action (NFIA) http://www.na.org 404-248-9676 http://www.nationalfamilies.org National Asian Pacific American Families Anonymous Against Substance 877-879-6422 Abuse (NAPAFASA) http://www.nicotine- 213-625-5795 anonymous.org http://www.napafasa.org Parents, Families and National Association for Friends of and Children of Alcoholics Gays (PFLAG) (NACoA) 202-467-8180 888-554-COAS http://www.pflag.org http://www.nacoa.org

30 Secular Organizations for Sobriety/Save Our Selves (SOS) Clearinghouse 323-666-4295 http://www.sossobriety.org

SMART Recovery 440-951-5357 http://www.smartrecovery.org

Su Familia: The National Hispanic Family Health Helpline 866-SuFamilia (866-783-3645) http://www.valleyccc.org/ lausd-district-2.php?id= 833&printerFriendly=1

White Bison 719-548-1000 http://www.whitebison.org

Women for Sobriety, Inc. 215-536-8026 http://www.womenforsobriety. org

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Place clinic sticker here

HHS Publication No. (SMA) 14-4126 First Printed 2004 Revised 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2013, and 2014