Family and friends often feel lost and alone when they discover that their loved one might have a drug or alcohol problem or suspect that they may be gambling excessively or engaged in various other potential addictions. In such cases, it is completely normal for family and friends to feel confused, worried, anxious or sad, among a host of other negative emotions. Navigating the problem can be an extreme challenge and finding solutions can be just as difficult. Know that you are not alone, and that help is available. This article contains some guidance to help you and your loved one get started with finding the fastest path to healing and recovery.
I Just Discovered That My Loved One Might Have a Problem With Alcohol (or Drugs, Gambling, or Another Addiction)
Sometimes we suspect that there might be an alcohol, drug or other such addiction problem, but we are not completely sure. Sometimes they may appear normal, while other times they appear far too inebriated. They may be functioning at their demanding job, but getting drunk every night, or perhaps they only binge drink on the weekends. They may only trade stocks and aren’t engaging in other forms of gambling such as sports betting or casino betting. Or perhaps they are occasionally taking too much of their prescription opioid or benzodiazepine medication, but they are prescribed. Whatever the case may be, we suspect something is awry, but may not be certain about the scope or severity of the issue. We may feel afraid to talk to our loved one about the problem, being fearful of their negative or defensive reaction or the impact it will have on our relationship with them.
Oftentimes our intuition is correct, especially when we are a parent, spouse or other close family member. Follow your gut. It is alright to let your loved one know that you love them and are concerned about their alcohol or drug use (or gambling, etc.). These conversations may be uncomfortable, but they are generally a good and healthy starting point. One does not have to be confrontational or reactive, but rather can be loving and supportive. That being said, individuals who have addictions often minimize their pain, deny their problem, or are otherwise unaware that their behavior is even problematic to begin with.
It is also important to know that addiction is not always black and white, and often can fall into a grey area. This is especially true of alcohol which is socially acceptable. However, oftentimes if you suspect there is a problem, it means there is a good chance there is a problem. Consider the ways that their alcohol use or other addiction has negatively impacted their life, and the life of those around them. Think in terms of mental health, physical health, spiritual health, financial health, their career/job, family and other relationships, sleep-hygiene, general hygiene, and other such life areas.
We have also written a blog on the subject titled, “How Do I Know If I Or A Loved One Has A Problem With Alcohol?,” which may help you further navigate the situation, and is applicable to other drugs such as opioids (like heroin, Oxycodone, or fentanyl), benzodiazepines (such as Xanax, Klonopin, or Ativan), amphetamines (such as Adderall or Vyvanse), marijuana, cocaine, or other drugs as well as process/behavioral addictions such as gambling, sex, porn, or other such addictions. You can find this article here: https://www.familyaddictionspecialist.com/blog/how-do-i-know-if-i-or-a-loved-one-has-a-problem-with-alcohol
My Loved One Denies They Have a Problem or Refuses to Get Treatment for Their Addiction
If you know that your loved one has a problem with alcohol or drugs, or gambling or another addiction, but refuses to get help, then a professional intervention may be beneficial and necessary. An intervention should only be carried out after at least few good faith attempts to speak directly with your loved one about your concern for them, and to request that they seek out professional help if they are unable to stop on their own. If your loved one denies their problem, is unable to stop on their own, or otherwise refuses treatment, this may be a good point to hire a professional interventionist.
It is a myth that interventions are confrontational or punitive. Although some models (Johnson Model) of intervention do involve a form of confrontation and consequence, they are primarily about love and concern. They are done to let the individual with the addiction know that you love them deeply but are worried about their behavior and the direct ways it is negatively impacting their life as well as your own and your relationship with them. You are asking them to receive help.
If they choose not to accept your offer of help, then Johnson Model practitioners encourages families to set firm boundaries. They encourage families to stop enabling their addicted loved one's behavior and set ground rules with them moving forward. These boundaries, often referred to as “bottom lines,” involve consequences that the addicted individual will face until they are ready to receive help. They must know that you are doing this to protect yourself because you cannot see them destroy their lives while you stand idly by, however, you are there for them when they are ready to choose the path of addiction recovery. Examples of bottom lines may include not giving them money, not paying their bills, not allowing them to live with you, not allowing them to be alone with a young child, not lying for them, not speaking with them or seeing them, or other such measures. Every individuals and families bottom lines are different and unique to them. The most important part of a bottom line is that you follow through with them.
There are other forms of intervention that are highly successful and not as punitive, and encourage more work on the family side in the way they interact with their loved one and teaching family members effective strategies to help their loved one change their behavior. This type of intervention is done by practitioners of the CRAFT Model of intervention. There are also interventions that involve formal family discussions with invitation and inclusion of their addicted loved one with focus on all family member's behaviors, not only the addicted loved one's, via the ARISE Model of intervention.
It is also incredibly important that family and friends of an addicted individual get their own support. This is true regardless of if the individual receives addiction treatment and enters recovery or if they remain in active addiction. Family and friends suffer just as much as the addicted individual, if not more. Receiving your own help will also model recovery behavior to the addicted individual and allow you to have your own healing journey. Search online for an addiction specialist who specializes in family dynamics and relationships, or search for a family program near you. Al-Anon and SMART Recovery also offer family support groups.
We wrote a blog on the subject of family support titled, “The Impact of Alcoholism and Addiction on Family, and How to Protect Yourself,” which can be found here: https://www.familyaddictionspecialist.com/blog/the-impact-of-alcoholism-and-addiction-on-family-and-how-to-protect-yourself
My Loved One Admits They Have an Addiction, but Is Not Ready to Receive Addiction Treatment
In such cases, a professional intervention may also be useful and necessary (please read the above section on interventions).
Depending on the severity of the addiction, some individuals are able to stop safely and successfully on their own without professional help. Be mindful that depending on the substance used, frequency of alcohol/drug use, duration of alcohol/drug use, and quantity of alcohol/drug use, some substances can be extremely dangerous to stop without medical treatment and can even be fatal. This is especially true of benzodiazepines such as Xanax, Klonopin or Ativan as well as for alcohol. It is also strongly suggested to have a medically supervised detox for opioids such as Oxycodone, fentanyl, and heroin. For more on substance abuse detox please see the below section “My loved one is ready to receive addiction treatment.”
Unsuccessful attempts to reduce or stop engaging in an addiction is a cornerstone of requiring professional help for their drug or alcohol use or other addictive behavior. Sometimes individuals can stop for days or weeks or even months at a time but then always end up relapsing. If they have tried to stop on their own but failed to sustain their recovery, it may be time to get professional help. Acknowledge their efforts and successes, but warmly point out to them that addiction is a disease that requires professional help, and that if they have had some success on their own then imagine what will be possible with some professional support and guidance.
My Loved One Is Ready to Receive Addiction Treatment – Navigating Treatment Options
As if it may not have been stressful enough to reach the point of your loved one being ready and willing to accept help for their addiction, this is just the beginning of their recovery journey. It is also one of the most important parts of their recovery journey, as it will help them build a foundation for moving forward with their lives. Finding the right type of treatment for your loved one can be very overwhelming and stressful in and of itself, but it is a fundamental part of the recovery process. Finding the right source of treatment that is a good fit for your loved one is critical in determining a successful outcome.
Oftentimes finding a treatment option for your loved one is done during a period of crisis and can be done in a rush. While we are not here to advocate or promote any one addiction treatment center or other addiction treatment professional, we are here to help you gain a better understanding of the various options available and when they might be appropriate for your loved one depending on a variety of factors, most importantly the severity of their addiction. If you are interested in direct treatment placement, we do offer consultations to help match your loved one with the right treatment setting to meet their unique needs, personality and demographics.
Medically Supervised Detoxification (or Detox)
Detox is often the first step to recovery for individuals with drug or alcohol addictions. As mentioned above, detox is often necessary for severe drug dependency, especially from substances such as alcohol, benzodiazepines, and opioids. Substance abuse detox is done on an inpatient basis, meaning the individual will be there during the day and spend overnights for a certain length of time. Some addiction professionals do offer outpatient detox if appropriate. The primary purpose of detox is to afford individuals the ability to withdraw from their substance under medical supervision to ensure safety and comfort with the help of short-term medications and support.
Depending on the individual, the substance they are detoxing from and the severity of their substance abuse, detox generally lasts anywhere from 1 to 7 days. Hospitals have detox units, and many inpatient drug and alcohol treatment centers have a detox unit as well. There are also other facilities that specialize solely in drug and alcohol detox. Oftentimes after detox individuals will begin inpatient treatment, also commonly referred to as “rehab.”
Inpatient Addiction Treatment (Inpatient Substance Abuse Rehabilitation or Rehab)
Inpatient treatment is probably what most people think of when they think of treatment for drug and alcohol abuse. Inpatient treatment is done in an inpatient center, meaning the individual spends the daytime engaged in the therapeutic program that the treatment center offers and stays there overnight. Inpatient treatment commonly lasts for 28 days (1 month), but there are also shorter-term options as well as longer-term options (commonly including 60-day, 90-day, 6-month or 1-year programs).
Drug and alcohol rehabs differ greatly between one another, and choosing the right rehab for your loved one is extremely crucial. The most important indicator of treatment is the types of treatment being offered. More specifically, it is important to find out what the therapeutic approach is of the treatment center you are interested in. Some common approaches are Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Dialectical Behavioral Therapy (DBT), and Rational Emotive Behavior Therapy (REBT), among others. Some may also offer specialty therapies such as Art Therapy or Equine Therapy. Deciding which approach is best for your loved one may take some time and research.
Some facilities incorporate 12-step facilitation, while some are faith-based. There are also wilderness programs available. Many facilities also incorporate a family program to help engage family members in the treatment process. While the vast majority of treatment centers are abstinence based (meaning the end goal is complete abstinence as opposed to harm reduction), there are also moderation management programs (meaning the end goal may be moderation). There may also be specialty wellness or spiritual services such as fitness, nutrition, yoga, tai-chi, meditation, acupuncture, and other such programs. Some treatment centers allow for computer and phone access in order to continue working remotely while in treatment, while others do not allow it in order to ensure their clients are focused on treatment.
It is also important to inquire if a treatment center specializes in any particular area. While the vast majority of treatment centers now specialize in treating co-occurring disorders, that is, addiction in addition to another mental health diagnosis such as depression or anxiety, some also specialize in treating certain issues or certain demographics. For example, there are treatment options that specialize in treating addicted individuals with severe trauma. There are also treatment centers that cater to particular populations such as young adults, individuals of particular faiths, certain genders, or LGBTQ, as well as other specificities. There are many other considerations such as the size of the treatment center (some may be smaller and more intimate with 4 to 8 patients while others may be large with over 100 patients), the credentials of their staff, the location, the amenities, their after-care program, the type of client they cater to, and various other considerations.
Many individuals believe that their loved one can attend inpatient treatment for a month or more, come out, and then be cured. This is a myth. Inpatient treatment is just the beginning of their road to recovery. Unfortunately, 40 to 60% of individuals relapse within their first 30 days of leaving an inpatient treatment center, and up to 85% relapse within the first year. When they get out of inpatient treatment and return to their home environment and have access to drugs or alcohol, that is when the real work begins. Outpatient treatment or working with an addiction specialist and mutual help groups are a good support for individuals after leaving inpatient treatment. The first year of recovery is a critical time to continue to build their foundation for long-lasting sustainable success.
Residential Treatment Center
Residential Treatment Centers (RTC's) are sometimes synonymous with inpatient treatment, or rehab. Alternatively, the terms is sometimes used for long-term treatment that is usually 3 to 12 month minimum stays. Like a 30 day rehab, these are facilities where the patient lives, offering a variety of structured programs and therapies.
Outpatient Addiction Treatment (Outpatient Addiction Rehabilitation or Outpatient Rehab)
Outpatient addiction treatment, commonly referred to as just “outpatient,” offers addiction therapy on an outpatient basis. This means the individual attends treatment during the day for group therapy, individual therapy, or psychiatrist appointments (usually a combination of all three) and then goes about their day and sleeps at home. Depending on the treatment provider and the service being attended, outpatient treatment is often 60-90 minutes per day, 1 to 5 days per week. Outpatient treatment, like inpatient treatment, offers various treatment approaches, may specialize in treating certain individuals, and may cater to particular populations. Drug and alcohol screen monitoring is usually used to help with accountability, either via urinalysis, mouth swab, or breathalyzer.
Intensive Outpatient Program (IOP)
Outpatient treatment centers also offer IOP, which is a more intensive model of outpatient where individual will often be in treatment during the day for commonly anywhere from 3 to 5 hours per day, 2 to 5 days per week.
Partial Hospitalization Program or Partial-Day Program
These programs are similar to IOP in that they involve receiving comprehensive treatment services (and medical monitoring if needed) during the day for an intensive period of time, often from 4 to 6 hours per day, 3 to 5 days per week. The individual then returns to their home and goes about their day-to-day lives when not in their program.
Sober Living (also known as Sober Home or Recovery Home)
Sober Living Homes are exactly what they sound like, a home where individuals live where they are expected to maintain sobriety. Sober homes are not treatment, they are support. The vast majority of sober homes do not offer addiction treatment or therapy services, but some do offer Recovery Coaches (Sober Coaches) and/or Recovery Companions (Sober Companions) as well as case management and alcohol and drug screen monitoring.
Sober Homes will commonly house approximately 6 to 10 recovering individuals living in a home, although some may have more or fewer residents. The majority of sober homes are not co-ed (for obvious reasons). Sober Homes also usually have a live-in house manager or 24-hour staff on-site for supervision and support who is usually a person in long-term recovery. Sober homes often encourage or require individuals to either be in school or working, or otherwise looking for work or applying to school. Additionally, they often encourage or require individuals to be in some form of recovery treatment, therapy, or attending mutual help groups. Residents of sober homes are otherwise free to go about their day-to-day lives without supervision.
Sober homes sometimes offer additional amenities such as an in-home gym or membership to a local gym, a fully stocked kitchen, house chef, sober and safe transportation, and other such amenities.
Addiction Specialist such as an Addiction Psychiatrist or Addiction Therapist or other such Mental Health Professional Specializing in Addiction (Licensed Mental Health Counselor aka LMHC or Licensed Clinical Social Worker aka LCSW)
Addiction specialists come in many different forms such as a psychiatrist, psychologist, therapist or other such mental health professional that specializes in treating individuals with addictions. These individuals are master level or doctoral level professionals who have gone through extensive schooling, internship/externship experience, and work experience, as well as passed state licensure, working field hours, and other requirements. Such individuals work within treatment settings such as inpatient or outpatient treatment, but many also have their own private practice. Oftentimes individuals prefer to work with an addiction specialist instead of going to a treatment center due to increased privacy, increased personability, and sometimes greater quality of care.
While psychiatrists can prescribe medication, other such mental health professionals cannot. Psychiatrists are often focused on medication management as opposed to regular talk therapy and relapse prevention skills. As such, individuals who need medication will often work with a therapist in tandem with a psychiatrist for medication management if and when needed
Recovery Coach, Sober Coach or Addiction Recovery Coach
Recovery Coaches are different than therapists in that, while therapists tend to be more focused on addressing and processing the past or addressing present mental health concerns, coaches are more focused on attaining goals and providing accountability and support to reach them. Coaches do not require any state or federal licensure or any educational or examination requirements, while therapists go through extensive schooling and other state requirements as mentioned above. Most coaches will have some type of coaching certification, although there are no industry standards. Recovery coaches are often a person in long-term recovery who have personal experience in helping other individuals reach their sobriety goals.
Recovery Companion or Sober Companion
Recovery Companions serve to travel with a person new to recovery in order to safeguard their sobriety. Companions can accompany a newly sober person to a recovery meeting such as Alcoholics Anonymous, to the gym, to a social event, travel with them on vacation, or simply spend the day with them in their home. Companions can be hired on an hourly basis or 24/7 live-in basis. Recovery companions, like coaches, do not require any state or federal licensure or require any specific training, although some do receive certification. They are often a person in long-term recovery with experience in helping others maintain sobriety.
Medically Assisted Treatment (MAT)
Medically Assisted Treatment has become the standard in addiction treatment and is commonly used to assist individuals to maintain their sobriety in inpatient and outpatient settings, as well as through working with a psychiatrist. MAT is exactly what it sounds like, medication that will help the individual maintain their sobriety by serving to help reduce cravings, cause adverse effects of substances when used, or block substances from having the desired effect. MAT is especially common for alcohol through the use of medications such as Naltrexone (commonly prescribed as Vivitrol), Acamprosate (Campral), Disulfiram (Antabuse), as well as with opioids through the use of Buprenorphine (commonly prescribed as Suboxone which also contains the opioid blocker Naloxone) or Naltrexone (Vivitrol). Methadone is also a form of MAT that individuals may be more familiar with, but is no longer commonly used by addiction professionals for new patients due to its addictive nature and long-term use.
MAT usually coincides with behavioral counseling and therapies in addition to the medication, with the end-goal to have the person be completely abstinent from their drug of choice, as well as their assisted medication that helps them maintain sobriety in the short-term. Depending on the individual and the prescriber, MAT is commonly used in the short-term from 2-4 weeks up to 6-12 months, and sometimes on a longer-term basis when needed.
Mutual Help Groups
Mutual help groups such as Alcoholics Anonymous, Narcotics Anonymous, Refuge Recovery, Women for Sobriety or SMART Recovery are not addiction treatment, they are additional support. They are not led by professionals such as mental health clinicians, psychiatrists or other types of addiction therapists, but rather by other fellows in recovery from addiction. Some groups such as SMART Recovery do require a trained leader to run its groups, while groups such as Alcoholics Anonymous are simply run by voted on members in its groups. Mutual help groups are free on a donation basis, and can be found via doing an online search for meetings in your area with the designated group you are interested in attending.
Oftentimes individuals in early recovery will attend both professional treatment as well as mutual help groups in order to safeguard their recovery. That being said, it is possible for some lower risk individuals without severe addictions to get sober in mutual help groups without the aid of professional help. Individuals often continue attending mutual help groups for their long-term recovery, some for a lifetime.
Further guidance
For further information, you may also want to read our blog titled “A Guide to the Different Pathways of Addiction Recovery” which can be found here: https://www.familyaddictionspecialist.com/blog/a-guide-to-the-different-pathways-of-addiction-recovery
I Know My Options, but This Is Overwhelming
You’re not alone. This is why there are professionals to help guide you. A good starting point is also to decide if you want to use health insurance, or if you prefer or are willing to pay out of pocket. If you choose to use health insurance, this limits your options to the providers that accept your particular insurance. In such cases, it may be helpful to call your insurance company and ask them for a list of providers who accept your insurance. It may also be helpful to call the Substance Abuse and Mental Health Service Administration (SAMHSA) at 1-800-662-4357 to ask for guidance.
If you are willing to pay for treatment you have more options. In such cases, it is often recommended to start with a provider who does consultations and treatment placement. Consultations consist of an assessment to better understand the unique needs of the individual, their substance abuse problem and history, mental health issues, and other important information in order to help place the individual in the appropriate level of care with a well-aligned provider.
You may also do an online search for addiction professionals in your area and do your own research to find an appropriate match. For example, if you live in Manhattan you can do an online search for Addiction Treatment in Manhattan, Addiction Therapist in New York City, Alcohol Rehab Upper East Side, or Best Addiction Help in NYC. Be mindful of paid advertisements or providers that generate at top of list, as it does not necessarily mean they are the best selection. It will take visiting many websites, doing a lot of research, and reaching out to several treatment providers to ask your specific questions and to find a good fit. Most are very helpful and will be happy to answer your questions. Don’t settle for the first or easiest option, as this is a fundamental decision in determining long-term success. It is well worth the investment in your time and energy.
For more information on addiction treatment, therapy and mental health, sober coaching, sober companions, addiction psychiatry, consultation and addiction treatment placement, or to inquire about our private concierge therapy services and/or our teletherapy services (online therapy/virtual therapy) in New York City please contact our undisclosed therapy office location in the Upper East Side of NYC today at (929) 220-2912.
