Love is a funny thing; sometimes it makes a lot of sense and other times it’s quite bewildering. Similarly, addiction appears in the same fashion. What we’ll be exploring today is what happens when your love interest develops a substance abuse problem or an outright addiction and how you can help them (and yourself).
What you’ll find below is the result of a large collaboration between three Austin mental health professionals, William Schroeder and Julie Osofsky of Just Mind, and Dr. Daniel Hochman of SelfRecovery.org. Together, we understand the intricacies of addiction and the human mind, as we discuss it regularly amongst ourselves and within our patient sessions. We hear the same questions arise, so we’ve attempted to answer some of the most common concerns and questions below.
What are some character or behavior traits an addict might display?
Addiction affects individuals differently, but there are some commonly seen behavior changes that could be cause for alarm. Most of these are identified by a quick or dramatic change in areas of their life where they used to be very consistent and reliable. Examples of this can include, them not showing up to work or commitments on time, pulling back from mutually-enjoyable and healthy relationships and diving into toxic ones, becoming unreliable, being irritable or on the defensive, disappearing for hours on end, and getting short on once available money coffers. Many of these actions occur because the user is most likely feeling a wave of guilt and shame for their addiction and are trying their very best to keep it a secret. In general, rapid changes in money and/or appearance can be some of the first major indicators of when their controlled-habit is unraveling into full-blown addiction and they’ve saddled up for the ride.
If I become suspicious that a loved one is battling an addiction, what should I do?
There are several things you can do if you suspect your loved one is grappling with addiction, which are meant to help them and protect your own health and happiness. To begin, we suggest talking to them about it, but not in a combative or accusatory way. So many people (with great intentions) jump into this moment in the perfectly wrong way and say something like: “I think you’re an alcoholic and you need to stop.” That’s actually one of the quickest ways to make them defensive and shut down about it. One of the trickier things about addiction is the isolation a person experiences. Many people find themselves using a substance as a way to cope with some turmoil or uneasiness, so shaming them about it is counterproductive.
Many times, addiction is an indicator of something else that the patient is struggling with, so our suggestion is just to try to connect with them in a safe and loving way, while showing your concern. Address some specific changes you’ve noticed in their behavior or actions. Something similar to, “I’ve noticed you’ve been more upset with people recently and you’ve been drinking a lot more… I’m worried about you. What’s bothering you?” This is much easier and inviting for them to respond to or at least begin the conversation.
Lastly, you also need to seek help for yourself. Get your own support through some sort of group or therapist. Ultimately, you cannot control or change what your loved one does. Being able to accept that can be a difficult process, but it’s a needed one for both of you.
How can I best show support? What are some things I should avoid saying?
Like we’ve agreed upon before, we’d avoid judgment or shaming. This helps no one. You’ll likely need to set boundaries, but if done in a transparent and loving way, this is more effective than making them feel badly about their addiction. We’ve considered this next point a lot and we agree, once someone gets to this point, it is not enjoyable for them. Sure, the first drink or hit might provide them with a rush of euphoria, but we assure you that’s followed with anguish and torture.
Research indicates how important it is to have a supportive community for those who are struggling with addiction. This is partially behind the practice of sober houses and the decriminalization of drug crimes in most European cities. Community support and alternative thinking is how Iceland got kids to say no to drugs and essentially wiped out a massive “epidemic” they were experiencing. It’s also quite helpful to distinguish the difference between the person and their addiction; treat the addiction as its own being. You might say, “I love you, but I’m becoming anxious the addiction might come back.” Instead of, “What is wrong with you? Why don’t you just stop?” This depersonalizes the addiction, which can help the person to be less defensive, as it’s a separate entity.
Remember, your goal is to convey that you care and emphasize your willingness to be leaned on as support, while they navigate their options for help. When different approaches are compared, the best ones outcomes come from those that that treat a person suffering in addiction no differently than another illness, such as cancer. Nobody wants a life of addiction (or cancer). Both are absolutely horrible, and we have to understand that.
If my loved one already has a therapist or psychiatrist, should I call them? Can the therapist or doctor speak with me or is that a confidentiality issue?
This is something that has come up in the past, so we thought we should answer this definitively. We have received voicemails or emails from a friend or family member who is expressing concern regarding the patient. This is usually triggered by a recent event, such as suspecting a relapse or displaying troubling behavior like we highlighted above. Other times, it’s overt displays of struggle, like being hospitalized with a high blood alcohol level or overdosing. No matter how much we would love to comfort you in this time of uncertainty, unless we have a signed agreement allowing us to talk with others about the patient (signed by the patient), we can’t reply due to confidentiality. That being said, if you think you have valuable information that could assist in their recovery, a good provider will appreciate your disclosure and will make use of it, albeit discreetly and without acknowledgment, we received your correspondence.
Another approach you could present to the patient is to join them in one of their sessions. This not only strengthens your commitment and resolve, but it also will give you the opportunity to potentially have a voice with them and their counselor. So long as the patient is fine with your joining, most providers won’t have an issue with your addition.
I’ve had it! Can I have someone committed into rehab involuntarily?
Not really, and for good reason, as it is difficult to legally force a free person into any kind of treatment (yes, even while intoxicated). It is feasible to involuntarily commit someone for a detox program and most states have a system in place for that. This involves proving (with documentation) that the likelihood of imminent physical harm (beyond intoxication) or a fundamental lack of capacity to provide for their own basic needs. However, this is exceedingly rare in practice, considering the amount of people harming themselves with their addiction every day. It can also be impractical to force detoxification without the patient being completely on-board, as they might not be ready for it. So the answer to the question relies on which situation and state you’re in.
Anything else I should know?
With certain substances, it is best not to stop cold-turkey without the guidance of a medical doctor, as some addictions can prove fatal if stopped suddenly. This should not deter any addict from seeking recovery, it just means that should be honest with their desires to stop. Alcohol, benzodiazepines (also called benzos), and opioids are of the gravest concern. To provide the patient with their best foot forward, medically-supervised detoxification should be considered as an option or at the very least, get your doctor’s approval to wean off at home.
Secondly, addiction recovery can take many forms. The evidence shows that most people can improve greatly at a traditional outpatient clinic that’s well-versed in how to address underlying mood issues that drive addiction. When it comes to recovery, many people often incorrectly believe the best (or only) solution is to arrange for a 30-day on-site rehab. The evidence is quite clear that it’s typically not needed, on top of being only 5-10% effective. Why is the effective rate so low in rehab facilities if I see my favorite celebrities going to them all the time? Well, there are many reasons for this, including very few regulations on the standards of care and the lack of utilizing evidence-based treatments. Additionally, there’s a type of fallacy when you’re part of an in-patient rehab program, as it’s “easier” to get well in this removed and idyllic setting. However, many patients that show promise while in rehab have been known to struggle when they return to their “real life” and all the toxic opportunities, situations, and/or people present themselves. This was the idea behind SelfRecovery.org: to make evidence-based strategies available to everyday people in their everyday environments. One thing we can all do to help is to destigmatize addiction so more people reach out for the help they need and get there earlier.
Finally, a common misunderstanding is around the topic of relapses, which are unfortunately an expected part of the journey. We typically educate clients to not think of a relapse as the worst thing that can occur, but a possible hurdle they might experience. We want to be clear here, we don’t recommend relapses, so don’t strive for them or allow yourself a weekly “cheat day”, as that won’t get you into the clear, but it could happen. The truth of the matter is that if a relapse occurs, the goal is to make them less frequent, less intense, and to decrease the duration. It’s not so much what happens when you get bucked off the horse; it’s what happens when you’re on the ground.