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Acknowledgments

This publication was prepared for the Substance Abuse and


Mental Health 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
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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

Im Afraid It Wont Work . . . . . . . . . . . . . . . . . . . . 22

Especially for Young People . . . . . . . . . . . . . . . . . . 24

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

iii
INTRODUCTION
This booklet is for you, the family mem-
ber of a person dependent on alcohol or
drugs. Whether your family member is
dependent on alcohol, cocaine, heroin,
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 familiesso 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 drug depen-
dence problems can and do recover.

1
WHAT IS SUBSTANCE
ABUSE?
Alcoholism and drug dependence and
addiction, 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 substance use disorderuse of alcohol
or drugs that is compulsive or dangerous
(or both).

Why Do Some People Develop


a Problem but Others Dont?
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 persons environment, psycho-
logical traits, and stress 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 disease, 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 excuse 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 didnt 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
lies. The disease does tend to
the police were targeting her.
worsen over time. Eventually,
Perhaps your loved one has
your husbands 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
denial, and denial is part of
he has of recovery.
the illness.

3
Physical dependence or
withdrawal symptomsIn
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.
ToleranceA 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
CravingA person will feel doesnt 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 cant 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 controlA 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, psychologists,
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 persons treatment, it starts at or just
before a persons 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
honestthis is not the time
to cover up your loved ones
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 persons 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 members 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 opioids
(e.g., heroin, OxyContin,
or codeine), barbiturates or
sedatives (downers), pain
either alone or togethermay
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
Whats that about? once had hallucinations or
seizures from alcohol with-
A: Federal and State laws drawal or who has another
protect an individuals priva- serious illness or (in some
cy in treatment. Before the cases) a mental disorder
counselor can talk to anyone that could complicate detox-
(including you) about your ification may need medical
wifes 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 cant 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 methamphetamine do Residential programs
not generally need to be
hospitalized for detoxification. Partial hospitalization 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.
Methadone clinics (also
Social detoxification can called opioid 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
persons 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 adults 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 womens 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 persons 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
persons 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, social skills, commu-
nication skills, anger manage-
Build new friendships ment, stress management,
with people who dont 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 persons
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 substances 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), Narcotics or using drugs, and many of
Anonymous (NA), Cocaine your partners 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; lesbian, 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
depression, anxiety, or post-
traumatic stress disorder.
Adolescents in treatment also
may have behavior problems,
English. Internet chat groups
conduct disorder, 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 antidepressants.
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 peoples 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 Buprenorphine 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 naltrexone to treat heroin
or other opioid dependence
because it blocks the drugs
effects. It is important for
people who use heroin to go
Disulfiram (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 dont
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
Q: If substance use disorder not work well for this purpose
is a disease, why arent there unless a person has a strong
medicines that will help? social support system, includ-
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 addictions. 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-
sons 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 prison-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
coping 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 persons 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 persons 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 yourselfget 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 treatmentit 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 ones 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 diseases. 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 ones 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 familys 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 members 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 ones 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
ones employer. Ask the recovery.

21
IM AFRAID IT WONT
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 doesnt 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 relapseonly 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, its 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 abuses 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
members 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 persons substance use
disorder. It is nobodys 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 violence.
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 Cs: You you should be careful about
didnt Cause it, you cant drinking alcohol or taking
Control it, and you cant Cure drugs. This information is
it. Remembering the three Cs 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 familys. 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 relatives
in counseling sessions. Its 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. Its
more about the disease and your choice.
the effect it has had on your
family and on you. Talking to Remember, you didnt 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.
Halfway house/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 persons 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 treatments
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)
AAs 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 Administrations
(SAMHSAs) 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


Alcoholics Anonymous (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
Marijuana Anonymous
http://www.ca.org
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 Youth
http://www.nar-anon.org/ (NCFY)
naranon 301-608-8098
http://ncfy.acf.hhs.gov
Narcotics Anonymous
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 Nicotine 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 Lesbians 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

31
Place clinic sticker here

HHS Publication No. (SMA) 14-4126


First Printed 2004
Revised 2005, 2006, 2007, 2008, 2009,
2010, 2011, 2013, and 2014