Substance Use Disorders Treatment and Recovery

Summary

Some alternative treatments:

• Yoga
• Acupuncture
• Nutrition

Alcohol use disorder is progressive and can be deadly. Treatment includes both inpatient and outpatient programs, family counseling, and self-help meetings, such as Alcoholics Anonymous (AA). Over the years, many alternative treatment methods have been developed to help the overall health of the person and to work with existing therapies. For some people the results have been very good. But more research is needed.

What is alternative and complementary medicine?

It comes from years of home remedies and other professional disciplines. The focus of these methods is to aid changes that usher in good health and well-being. The Complementary Medical Association lists the eight tenets of this philosophy:

1. Good health is a state of emotional, mental, spiritual, and physical balance.
2. The mind and body are tied.
3. The body is able to heal itself.
4. Treating the root causes of a problem is more important than treating the symptoms.
5. Active self-help and health education are a major part of success.
6. Communication between the person with alcohol use disorder, medical doctor, and other health practitioners is needed.
7. Each person is an individual and must be treated as such.
8. Environmental and social influences can have a major effect on a person’s physical and emotional make-up.

What alternative methods can help with alcohol use disorder?

Yoga uses physical postures and controlled breathing to lengthen the spine and make it stronger, and increase its ability to bend with ease. It calms the mind, helps with focus, and develops patience. It can also lead to a greater sense of control when having cravings, trouble sleeping, being upset, etc. Regular practice is needed to get these good results.

Biofeedback is a scientific way of learning to lower tension. Practitioners use tools to give a person feedback right away about the level of tension in their body. People practicing it often say they gain psychological faith in themselves when they learn to control their emotions. It has been found to be useful in many aspects of treatment.

Massage can let tension go and help energy balance and flow. It can give deeper levels of relaxation and peace, and a greater sense of self.

Meditation includes many types. All work to quiet the mind and aid relaxation and mental clarity. It helps people focus and quiet negative thoughts that fill their mind and cause stress.

Acupuncture is a part of Asian medicine developed in China more than 2,500 years ago. It is the act of placing fine needles into specific points on the skin, which helps healing, cuts cravings for drinking, and eases withdrawal symptoms. It may also lower worry and sadness that lasts.

Spiritual practice can play a big role in recovery from addiction. For many people, gaining greater insight into their spiritual side helps them see their purpose in life. The founding rule of AA is that something greater than you (a higher power) can help heal and fix your life. Prayer and meditation is encouraged in AA.

Nutrition. Alcohol keeps your body from getting vital nutrients. Those who overuse it may not have the right amount of a number of vitamins and minerals. Your doctor may tell you to take vitamin supplements that can help cut cravings, control blood sugar fluctuations, and decrease stress from drinking.

Alcohol use disorder is a serious disease. Knowing the many care choices will add to the chances of recovery. If you are having a problem with drinking, talk with a trusted friend, doctor, or clergy member.

Resources

Al-Anon Family Groups
www.al-anon.alateen.org

Alcoholics Anonymous World Services, Inc. (AA)
Main site: www.aa.org
Online support groups: www.aa-intergroup.org

National Council on Alcoholism and Drug Dependence, Inc.
http://ncadd.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Drew Edwards, M.S., Ed.D.

©2012-2019 Carelon Behavioral Health

Reviewed by Enrique B. Olivares, M.D., Director of Addiction Services, Beacon Health Options

If you or a loved one is considering treatment for an alcohol use disorder, the following information may help.

Types of treatment

Inpatient and residential programs traditionally last three to eight weeks and provide highly structured treatment services, including group therapy, individual therapy and alcohol education. Professional staff are available around the clock to manage any acute medical and psychological problems.

Alternatively, some individuals receive short-term inpatient detoxification services before being transferred to an outpatient setting. Typically, outpatient programs offer the following services:

• Intensive outpatient programs (IOPs) provide alcohol education and group and individual therapy. IOPs typically engage the person with alcohol use disorder for two to three hours per day for up to five days per week and were developed as alternatives to inpatient programs.
• Day hospital programs, which allow the person with alcohol use disorder to participate in treatment during the day and maintain their family roles in the evening, offer similar programs as IOPs.
• Low-intensity outpatient services provide counseling sessions (group sessions, individual sessions, and—if necessary—family or couples therapy) once or twice per week. For many, low-intensity programs are intended as maintenance therapy after the person with alcohol use disorder has received initial inpatient or intensive outpatient treatment.

Components of quality treatment

• Medical management. Addressing the physical and psychiatric needs of people with alcohol use disorder is imperative. A skilled addictive disease physician or psychiatrist trained in addictions can properly diagnose alcohol use disorder and related psychiatric conditions and provide safe detoxification. 
• Alcoholics Anonymous (AA). Most mainstream inpatient and outpatient treatment programs encourage people with alcohol use disorder to attend AA meetings on a regular basis. It was, after all, a group of recovering peers that began the movement to consider alcohol use disorder a disease. AA offers an understanding and spiritual dimension that encourages forgiveness of self and others.
• Cognitive-behavioral therapy (CBT). This treatment strategy aims to change maladaptive thoughts and emotions such as craving for alcohol, depression, and anxiety. CBT helps the patient identify high-risk situations for relapse, learn, and rehearse strategies for coping with those situations, and recognize and cope with craving.
• Motivational enhancement therapy (MET). This method, which is based on the principles of motivational psychology, strives to motivate the client to use his own resources to set reasonable goals and make lifestyle changes. The counselor encourages the client to set goals, and attempts to maintain or increase the client’s motivation to initiate or to continue implementing change.

Which is best?

Research has found that the treatment forms outlined above produce roughly the same results. The key seems to lie in individualizing treatment to the particular needs of the patient or client.

Experienced substance use disorder professionals look at three dimensions to determine treatment intensity, duration, and form:

1. Severity of illness
2. Motivation of the patient
3. Level of social and family support

These three dimensions must be thoroughly evaluated before making a treatment recommendation. Individuals with severe alcohol use disorder will require medical detoxification. Similarly, those who also have medical or psychiatric conditions may require extended hospital care. However, the system does not always work according to these criteria. For instance, a young and relatively healthy adult who is poorly motivated and lives alone may need a residential program until support and motivation can be developed. 

If you are considering treatment for yourself or if you are trying to help a friend or family member, consider the three dimensions because participating in a level of treatment that is inadequate is a recipe for failure.

By Drew Edwards, M.S., Ed.D.

©2003-2021 Carelon Behavioral Health

Summary

Consider:

• Professional quality
• Organizational quality

Finding a good fit to help with a mental health or substance use issue can be hard. You have to consider accreditation, quality, cost, program philosophy, insurance, and more. Here are a few ideas to help you get started:

• Ask your doctor, a friend, or others you trust if they know of a program. Where would they take a loved one who needs the same care?
• Call expert organizations and your state and local health care groups. Ask for a list of member clinics and credentialed experts who can help.
• Check with your mental health insurance group on approved clinics. Your employee assistance program (EAP) can also help.

Professional quality

There are many types of people who can help:

• Psychiatrists are medical doctors who can give meds and talk therapy.
• Addiction medicine professionals are medical doctors who have training in the diagnosis and treatment of addictive disorders.
• Psychologists have a doctoral degree and can give one-on-one, group, and/or family therapy. They can also test and do other assessments as part of the review or treatment process.
• Other therapists often have a master’s degree in a related field. They can give assessments, one-on-one or group counseling, and discharge planning. This includes:
• Licensed clinical social workers (LCSW)
• Advance registered nurse practitioners (ARNP)
• Licensed mental health counselors (LMHC)

Check your state’s licensing board website or the National Practitioner Data Bank for more info. Find out:

• What is the program philosophy and treatment goals?
• What are the expertise and credentials of the staff? What is the level of experience of the medical or clinical director?
• Is there support for the family?

Organizational quality

Two of the most influential organizations that accredit and certify standards of quality for hospitals and mental health clinics are:

• The Joint Commission (also known as JCAHO)
• CARF International (formerly Commission on Accreditation of Rehabilitation Facilities)

Both are independent, not-for-profit groups that set the nation’s standards in health care. They each research and create professionally-based best practices. They also test the quality and compliance of health care centers.

With these groups in mind, ask:

• Is the center or program accredited? By what group(s)?
• Does it offer a full range of care needed for the diagnosis and treatment of a specific condition?
• How long has it been under its current management?
• Does it take your health plan?
• Are there extra costs for doctors, testing, etc.?
• What are the visitation rules?

It may sound like a lot of work, but more info will help you find the right path to recovery for you or your loved one.

Resources

American Addiction Centers
https://americanaddictioncenters.org

CARF International
www.carf.org/home

National Practitioner Data Bank
www.npdb.hrsa.gov/

The Joint Commission
www.jointcommission.org

By Drew Edwards, M.S., Ed.D., and Andrea Rizzo, M.F.A.

©2005-2019 Carelon Behavioral Health

Reviewed by Rekha Rao, M.D., VP Medical Director, Beacon Health Options

Summary

• Mix of substance use disorders and mental health disorders
• Treatment should be well planned and client-centered

The term co-occurring disorders or COD means having at least one mental illness along with one or more substance use disorder. But there is nothing simple about having this condition. The two or more disorders will negatively impact each other. This requires that each disorder be treated separately but also at the same time. Recovery is not an easy process, but it is a goal that can be reached.

Types of COD

Substance use disorder can occur along with any mental illness. Some of the more common mental health issues linked with COD include:

• Depression
• Anxiety
• Schizophrenia
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Other disorders related to mood, anxiety, sleep, eating, and personality also often occur with COD.

Some common classes of substance use disorders include:

• Alcohol
• Nicotine
• Caffeine
• Cannabis
• Cocaine
• Amphetamines
• Sedatives
• Opioids

People with COD can have any mixture of substance use disorders and mental health disorders, but at least one of each.

Risks of COD

People with COD have certain higher risks than people with a single disorder. They also tend to be in poorer health and have a greater chance of relapse. Some of this is due to not taking or responding to treatment as well. The time and cost involved in this treatment is also higher.

Among these increased risks are:

• Violence
• Physical illness
• Psychosis
• Hospitalization
• Homelessness
• Unemployment
• Incarceration
• HIV/AIDS

Screening for COD

About half of all people with severe mental illnesses also have substance use disorders. The rate of people with substance use disorders who have mental illnesses is even higher. Despite these facts, screening for COD can be a challenge. A mental health service may not be able to spot substance use disorder. A substance use treatment center may not be able to spot mental illness. The screening process should decide whether or not the person needs to be further assessed. This assessment is then performed by a mental health doctor or other trained health care worker.

Treatment and recovery

Treatment for COD must target each disorder by itself and at the same time. This may occur in one setting or a number of settings. Treatment should be well planned and client-centered. This means the person with COD needs to be involved with all aspects of care. The type of care will depend on the types of substance use and mental disorders. It should also be tailored to the person’s unique needs and goals.

COD takes a toll on those who have it and on those around them. Coping skills must be taught to the individual as well as to her support group. Progress may be slow and sometimes hard to measure. The chance of relapse seems to always be right around the corner. Setbacks should be met with support rather than blame. The person will respond to praise much more than to guilt. Recovery is a long process that will require a group effort. It is not an easy task but it is well worth it.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2022 Carelon Behavioral Health

Summary

1. Learn more about addiction and recovery from others who have been there.
2. Get on a schedule as soon as possible. Include fun.
3. Talk to those you trust when you are craving or feeling bored.

Early recovery can be tough. Changing friends and finding new and healthy activities takes patience and planning. These qualities may not often be found in people who are actively overusing substances. Some of the biggest problems of early recovery can be cravings and boredom.

Cravings

The desire to use drugs or alcohol might be easily triggered by sights, sounds, smells, people, and certain places. This is called craving. Craving is not a weakness. Craving is the result of the effect of alcohol or drugs on your brain’s chemical balance. It’s a physical condition. The best way to understand craving is hunger. When we are really hungry and smell good food we have a physical reaction in our brain. Our mouths will actually water and our stomachs will growl. The desire to eat is very intense. The part of our brain, called the pleasure center, is where we experience a hunger or thirst for drugs or alcohol. So the trick is to avoid getting hungry by staying away from the things that trigger craving. This can be easier said than done.

For some, driving down a street where they used to buy drugs can cause an intense craving. Others report that certain movies or beer commercials tempt them. The most common mistake people in early recovery make is hanging out with people they used to drink or get high with. The pressure here can be too much. Physical craving, boredom, and social pressure to fit in and have a good time make it harder.

Boredom

It is often said that a person overusing substances organizes their life around drugs and alcohol. Getting drunk or using drugs become a high priority. This is because the brain has learned that good feelings now come from drugs or alcohol. Also getting high or drinking is perhaps the fastest way to change your mood. It seems to work every time. Other activities can seem boring. Even those things you used to enjoy. For example, Juan used to love skating and playing basketball. Once he began using marijuana on a regular basis these things were not as fun anymore. He became easily bored. So Juan gave them up. The high from the drugs had replaced the joy of real life activities.

Boredom can be a huge problem in early recovery. The brain has to learn how to feel good without drugs or alcohol again. This takes time. How long? It depends on many things. People addicted to cocaine report boredom and intense cravings for up to six months after they have quit; some even longer. Those who use marijuana might get bored very easily for several weeks to several months. It also depends on you and your willingness to recover.

Tips for dealing with craving and boredom

1. Learn more about addiction and recovery from others who have been there. A 12-step sponsor is one good choice. Recovery support specialists or recovery coaches are another option.
2. Get on a schedule as soon as possible. Include your recovery group plans and healthy social activities. Planning is a great tool to use against boredom and craving. Call friends and plan in advance. You can get through it knowing that you have some healthy activities to look forward to.
3. Try something new. Schedule something fun; include safe excitement in your recovery.
4. Talk to those you trust when you are craving or feeling bored. A sponsor, friend, or family member can walk you through the hard times. But they can’t read your mind. It is your responsibility to let others know when you need help.

By Drew Edwards, M.S., Ed.D.

©2010-2019 Carelon Behavioral Health

Reviewed by Diane Hopewell, Wellness Support Specialist, Beacon Health Options

“When I was drinking and doing drugs, I would sleep until noon and get high before I went to work at 3 p.m. After work I would meet my friends and party all night. When I first tried to quit the only thing that I changed was that I no longer used drugs or alcohol. I stayed out late and slept late. I was miserable and went back to drinking and drugging within three weeks.”

—Ricky, age 28

The life of someone with an addiction can sometimes center around whatever they are addicted to. Things that used to be important become less so. The early weeks of recovery can be very hard because lifestyle is a hard thing to change. Living a disciplined life can be the key to early recovery.

Three things that might help:

1. Set up non-negotiables.

Non-negotiables are things absolutely needed for your recovery. Things you must do each day, close to each day, or each week. They reflect your values and build your character. They include duties and commitments to family, work, health, etc. They can include: 12-step meetings or other support groups, daily reading or prayer, family dinners, parenting, or family duties, and going to church, synagogue, or other spiritual supports.

It helps to have them written down and talked about with someone you trust. They are called non-negotiables because they are things that you know you need to do every day to stay well and are clearly not based on how you feel each day. Mood changes are widely found in early recovery. You will have good days and bad days. But having a tough day can no longer be an excuse to avoid what you need to do for your recovery.

2. Set daily schedules and routines.
   
   Decide what time you will rise and go to bed each day. Make time for reading and quiet times as well as your daily 12-step or other recovery meetings. Your daily plan will include your non-negotiables. Less important activities must wait, but schedule them in and keep those appointments too.

Conflicts are a given, but caring for yourself must take priority. Know that being on a schedule does not mean you overload your life with activity. Downtime is a part of your self-care.

3. Build a circle of support.

It helps to have an inner circle of two to three others who can support you when things seem to be getting bad. These should be people you can call day or night. They should know you well enough to hold you accountable, support you, or just be with you during your dark hours. These are people you choose.

Friends, clergy, and 12-step sponsors may be part of your inner circle. Tell them that how you want to be accountable to them. Let them know how often you will be talking with them. Tell them the specific situations that are unsafe for you. It helps to let them ask you tough questions about your schedule, meetings, and relationships.

Creating order and accountability will help you stay on track when the emotions and stresses of early recovery run high. It can be hard at first. And the good feelings resulting from responsible living take time to regain. But unlike the passing highs of addiction, they can last a lifetime.

By Drew Edwards, M.S., Ed.D.

©2010-2022 Carelon Behavioral Health

Summary

• Teens with alcohol or substance use disorder will do better if they remain actively engaged in recovery.
• Help your teen learn healthy ways of coping with emotions.

Strep throat, chicken pox, or even a broken arm cause plenty of discomfort for children and worry for their parents. During times of acute illness, good parents attend to their children’s physical and emotional needs and provide an ample supply of love and comfort. As infections wane and bones mend, a child’s life quickly returns to normal.

Recovery from addiction to drugs or alcohol is not the same.

Teens with alcohol or substance use disorder must remain actively engaged in their recovery

Recovery is possible from the chronic disorders of drug and alcohol dependence, but it looks different from other illnesses. Some teens require prolonged treatment or multiple stints in treatment to achieve sustained abstinence and return to a productive and fulfilled life. But unlike recovery from strep throat, teens with alcohol or substance use disorder will do better if they remain actively engaged in their recovery in order to avoid a relapse. Like other chronic illnesses, this recovery process may be lifelong.  

Recovery from addictive disease may be wrought with many challenges. Some of these challenges facing teens in early recovery are different than those facing adults, particularly in the areas of emotional maturity and social life.

Social challenges

One of the diagnostic indicators of addiction is the extent to which one’s life becomes organized around using drugs or alcohol. For teens with alcohol or substance use disorder, there is almost always a well-defined sub-culture of friends, associates, parties, and rituals that becomes the center of their social life. Healthy activities that used to capture their imagination soon become secondary to the “party” culture.”

Helping teens find a new, drug-free social life is no small thing. It’s not as simple as plopping them back into healthy activities. They will need real friends, excitement, and purpose for their life. Unfortunately, many lack the social skills and emotional maturity to seek and sustain new friends. Parents must step in and blaze the trail.

Here are some tips to help you help your teen:

• If your child went through a treatment program, ask what after-care services are available for continued support. Ask for information about recovery in your community. Many treatment centers will assist in finding support groups.
• Check with your local Alcoholics Anonymous (http://aa.org) or Narcotics Anonymous (http://na.org) about local meetings. Local churches may also have faith-based recovery groups such as Celebrate Recovery (www.celebraterecovery.com/).
• Try to keep him active and engaged by planning fun family activities or weekend trips, or just hanging out with him.
• Acknowledge that recovery is difficult and sometimes “boring.” Ask how you can help today.
• Watch for healthy, drug- and alcohol-free teens or young adults and social events.
• No matter how bored she becomes do not lower the bar by letting her hang out with her old drug-using friends or go to parties where alcohol is available. Stand strong because the risk of giving in is too great.

Emotional challenges

Substance overuse hinders emotional development in teens. This is due to the psychoactive effects of drugs on the emotional center (limbic system) in the brain. All drugs of potential overuse change how this part of the brain functions. Teens learn that using drugs and alcohol are effective in changing their mood. When a teen is bored, smoking marijuana makes the time pass. When they feel depressed, alcohol or cocaine works wonders—for a while.

We become emotionally mature by experiencing all of our feelings and learning how to cope with them. It may take several years of sobriety for some teens to catch up emotionally, but it will happen. Helping your teen talk about his feelings and express them appropriately may not be easy. It will require patience and persistence and, most of all, a willingness to listen.

Here are some tips:

• Start a conversation by asking open-ended questions. Open-ended questions…
• Cannot be answered “yes” or “no”
• Allow your child to give spontaneous and honest answers—she should tell her story in her own words
• Usually begin with:
• “Tell me about…”
• “Describe…”
• “To what extent…”
• “What was that like?”
• “Help me understand…”
• Affirm his worth, courage and challenges. Affirming statements show your understanding and appreciation. For example:
• “I know how hard this is for you.”
• “You showed a lot of courage.”
• “You overcame a major obstacle last week.”
• “I am so glad you are home.”
• “You are doing great this week.”
• “No one does this perfectly.”
• “I am proud of you.”
• “I love you.”

Remember that recovery from addiction is a long walk that is best taken in the company of loving involved families.

By Drew Edwards, M.S., Ed.D.

©2008-2019 Carelon Behavioral Health

Reviewed by Trenda Hedges, C.R.S.S., C.P.R.S., Wellness & Recovery Program Manager, Beacon Health Options

Summary

• Empower your loved one whenever possible.
• Celebrate milestones in recovery together.
• Get help from others.

Recovery from addiction is both a wonderful thing and, at times, a difficult process for everyone involved. No one intuitively knows how to effectively deal with someone else’s addiction or recovery. Without adequate knowledge about addictive disease and its impact on relationships this turmoil can be overwhelming. 

As a result, families, friends, and co-workers might “tip toe” around the person with the problem in fear that they may cause him to get angry and relapse. This all-too common behavior is based on the faulty belief that we are somehow responsible for the mood and bad choices of another. The result—everyone stays sick. 

What is recovery?

Recovery from addictive disease—which includes alcohol and substance use disorders, compulsive gambling, and sexual addiction—is a process of learning, accepting, making responsible choices, and letting go of fear. 

For families, recovery begins when the decision is made to quit covering up, lying, or making excuses for the person with an addiction. In other words, you can choose to be responsible for yourself and your happiness and allow the other person to be responsible for her choices. If lecturing, worrying, rescuing, screaming, and losing sleep were effective, then every person with an addiction problem would be cured.  

Recovery is much more than stopping the addictive behavior. Some of the most miserable people are those who have stopped an addictive behavior but have not found an ounce of inner peace, forgiveness or joy. They just seem to stay angry. Recovery involves restoration of the body, mind, and relationships, and redemption of the spirit. The same can be said for the family members who have also been hurt by addiction.

How to help

How can those closest to someone with an addiction help him in recovery? First, admit that you do not have the power to cause someone to use drugs or gamble—but you do have some influence. Therefore, there are things that help, and things that do not. As trite as it may sound, you have to start with your own thinking and choices. 

Here are some suggestions for what helps and what does not:  

• Don’t take your loved one’s addiction, relapse, or even success personally. Remember—you did not cause it, and you cannot cure it. The hallmark of codependency is when the actions of another control how you feel or behave. Remember that those with an addiction choose their way toward happiness or toward relapse—so do you. 
• Acknowledge and affirm. Recovery can be difficult. In your own words, let your loved one know that you recognize how hard recovery can be. Affirm her good choices and tough decisions. 
• Empower whenever possible. For those with an addiction, early recovery seems like a long list of things they cannot do or things they must give up. Give your loved one choices about little things, such as where to go for dinner, or about how to handle kids and family life. Ask for his advice or opinion on things in your life. Be aware. This is harder than you think, especially for spouses who, out of necessity, may have spent years trying to control almost everything. 
• Celebrate milestones in recovery together. Let your loved one know that you are proud of her accomplishments. Thirty days, 90 days, and one year of sobriety are especially big markers. Plan accordingly. 
• Lose the drama. Creating emotional distance between you and the person’s “drama of the day” will keep you objective and healthy. When a problem or crisis arises, become a nonanxious presence and simply ask what he wants from you. Remember, never do for a person with an addiction problem what he is capable of doing for himself, even when it is hard. 
• Get help, support, and counsel from others. You can’t do this alone. Isolation from friends and extended family is a common occurrence in families overcoming addiction. Friends, clergy and counselors can help you remain balanced during difficult times because they can look at you more objectively than you can look at yourself. Self-help programs such as Al-Anon, Nar-Anon, and many faith-based programs offer excellent support for families. 
• Let go of worry. This is perhaps the most difficult hurdle for the loved ones of those with an addiction problem. In this sense, worry is connected to a false sense of control, when in fact, the opposite occurs. Worry keeps you preoccupied with things you cannot change and pulls your attention from other family members and responsibilities. 
• Be present and future oriented. Addiction brings out the worst in everyone. You cannot change the past. Seek forgiveness from others and forgive yourself—and move on. 

Recovery from addiction offers tremendous hope for a better future, but it is not easy. If you need more help, call the toll-free number on this site and speak with a professional.

By Drew Edwards, M.S., Ed.D.

©2006-2022 Carelon Behavioral Health

If a loved one needs help for a harmful behavior but refuses it, or denies a problem even exists, you can take action by planning an intervention.

At an intervention, family members, friends and concerned others join forces to engage a person about a problem behavior in a loving and non-confrontational way and invite the person to get help. It can reach people who refuse or are resistant to help for issues such as:

• Substance and alcohol use disorders
• Addictive or compulsive behaviors such as with gambling, sex, internet use, gaming or shopping
• Eating disorders

Planning is vital

A well-carried out intervention involves thoughtful planning and is best done before a crisis happens. These steps can help guide you:

• Mobilize a planning team. Ask a few close friends or family members to help you. Talk about the problem and set a goal. An example goal would be for your loved one to agree to enter a treatment program.
• Research help choices and make all needed arrangements before the intervention. Otherwise your loved one might change their mind before the arrangements are set. Think of every detail, from making reservations to deciding who will drive your loved one from the intervention to a care center.
• Set a time and place. Timing is especially important if your loved one has a drug problem. Pick a time when the person is most likely to be sober and clearheaded, such as after work or first thing in the morning. Choose a comfortable and private location where they would readily go, such as a friend or family member’s home. You also need to decide the approach you will take to get the person to the meeting. Some research suggests that asking a loved one to an intervention works as well if not better than a surprise intervention.
• Decide whom to invite. Participants should be important to or influential to your loved one and might include close friends and family members, a pastor or rabbi, coach, teacher, roommate or employer.
• Plan what to say. Many people find that writing a letter can help them organize their thoughts and make sure the message is delivered in a loving, caring and respectful way. The letter should express your love and concern and cite specific cases of how the behavior has caused problems for you and for your loved one. The letter should end with a request that your loved one get help and an expressed willingness to be involved. Try to anticipate how the person will react and be ready to respond to excuses, objections or attempts to bargain.
• Set consequences. Each participant should be ready to name a consequence should your loved one say no to the group’s terms.  Withholding financial help, restricting contact with children and ending a romantic relationship are some potential consequences.
• Organize the meeting and rehearse. Choose someone to act as a spokesperson for the group and facilitate the meeting. Make sure participants know the goal, how to plan and how much time they will have to speak. Decide seating and the order of speakers. Rehearsing the intervention is a good idea. This gives all participants a chance to hear all the letters and to make sure that the collective message is caring and consistent.

After the intervention

If the intervention is successful, you and others close to your loved one should play an active role in healing. This could involve making changes at home or work or finding a new set of friends to lower the chances of relapse. Family or one-on-one counseling can help you and others work through tough emotions and dysfunctional patterns that get in the way of family healing.

If the goals of the intervention are not met, the consequences must go into effect right away. In time, your loved one might make the choice to get help. But that is unlikely if you or others weaken and fail to stick to your plans for the long term. Look for ways to support and hold each other accountable, which can help keep up the group’s unity over time.

Involving a professional

Consult an interventionist, addiction specialist or other skilled counselor who can help plan and facilitate the intervention. Moreover, a professional can help family members learn better ways to communicate and look at the problem in the context of the family system. Friends and family may contribute to the problem and need to make changes themselves.

Final thoughts

Intervention involves risk. You risk ending a relationship with somebody you care deeply about in the hope that they will accept your offer of help. But doing nothing is also a risk. A successful intervention offers the chance for personal triumph over a harmful behavior and the chance to restore meaningful relationships.

By Christine Martin

©2013-2022 Carelon Behavioral Health

Summary

• Issues with co-workers vary.
• Plan response to inevitable questions.
• Build and use a support network.
• Acknowledge any hardships your addiction caused and make amends.

Jennifer, a 32-year-old, single graphic designer, is coming back to work after 30 days in a rehab center for addiction to cocaine and alcohol. She is petrified about returning to work, facing her boss, and answering questions from co-workers about where she has been for the last month.

She is not alone. Many employees believe that if they seek substance use disorder treatment they will face negative consequences from supervisors and co-workers when they return to work. Some fear discrimination, getting passed over for advancement, or losing their jobs. Most are just afraid of facing their friends and managers. Although laws protect a person’s confidentiality, most employees believe that once they seek treatment almost everyone at work will know about their problem. They wonder: “Who knows why I have been away and what have they been told?”

Early recovery from addiction is never easy, but it’s worth it. Learning to live without drugs or alcohol means reorganizing your life, restoring broken relationships, and earning back the trust and confidence of your employer and co-workers.

Talking with your employer

The transition back to work may seem scary but it is fairly straightforward. Here are some suggestions to ease the transition:

• Talk with your human resources department or your supervisor about return to work timelines, expectations, policies, or other concerns.
• Ask about any changes in job status or performance expectations.
• Discuss any follow-up counseling appointments, after care, or time off you will need for your recovery program.
• Make sure you understand what is expected of you and any requirements the organization has about long-term support.
• If your organization has an employee assistance program (EAP), make an appointment to discuss specific clinical issues or specific support you will need.
• Some organizations offer workplace peer support teams. These include employees who have gone through some training in order to assist co-workers who are in recovery or need on-site support and encouragement.

Co-worker issues vary

The transition back to day-to-day life with your co-workers is not so straightforward because there may be no clear-cut policies or guidelines to follow. The issues related to facing co-workers are somewhat dependent on:

• The nature of your job
• The specific culture of your department
• The specific relationships that were affected by your addiction

Some co-workers may harbor resentment about your performance, attitude, or absenteeism prior to treatment. Others may have enabled your addiction by covering for you at work or making excuses for you. The majority probably are just happy to have you back because they miss you and care about you.

Suggestions for dealing with co-workers

• Plan what you will tell your co-workers about your absence so that you are not caught unaware when they ask—because they will.
• For those you choose to confide in, try to meet individually and tell them how they can best support you; describe what is helpful and what is not.
• If you have close friends at work, talk with them about your recovery and let them be part of your support team.
• If your conduct at work caused hardship for your co-workers, acknowledge this fact and make amends accordingly.
• If your absence in treatment has caused more work or resentment with one or more of your team, ask to meet with them and talk it out.

If you feel overwhelmed and need additional help, speak with a mental health professional.

By Drew Edwards, M.S., Ed.D.

©2008-2022 Carelon Behavioral Health

Source: Hazelden Foundation. ﾓU.S. Employees Fear Job Loss if They Seek Drug, Alcohol Treatment.ﾔ Press release issued October 25, 2002.

Addiction can be a stubborn thing. For some, it is a chronic and long-term relapsing disease. There are many reasons for this. It is one of the only diseases in which its symptoms—overusing drugs or alcohol—actually make you feel good, if just for a short while. So good in fact, that in spite of serious consequences, the want to drink or use drugs seems overwhelming.

A word about craving

Relapse also involves craving. Craving a drug or alcoholic drink is widely found in early recovery. Craving is triggered by sights, sounds, smells, people, and places. Preventing relapse will require that you are honest about what things set off your craving. Telling those close to you about your triggers can help you avoid bad situations and lower your chance for relapse. Identifying your own triggers and telling others is a good way to start being responsible for your recovery. It also helps you learn about how this disease works for you.

Lucy’s story

Sometimes relapse starts with a little lie you tell to yourself. For example, Lucy used to go to happy hour with friends after work for a couple drinks. This escalated to coming home drunk many nights a week which caused tremendous stress on her marriage. When her husband threatened to leave her, Lucy entered a local outpatient treatment program.

She had been sober for three months and was feeling confident. Her husband was out-of-town on business the same day her co-workers invited her out to happy hour, telling her she could drink diet sodas and just enjoy herself. Lucy agreed. This was the first little lie she told herself. Lucy never planned to get drunk that night. But she put herself in a high-risk setting with drinking friends. After an hour of drinking diet soda and watching her friends laughing and getting drunk she became bored and angry that she could not join in the fun.

Lucy decided she could have one glass of wine; the second little lie. She sipped it slowly as if to prove to herself she could handle it. So she had one more, then another, and another. Soon she was very drunk and tried to drive home. Three blocks from her home, Lucy was arrested for DUI and spent the night in jail.

In truth, Lucy’s relapse began early that day when her co-workers asked her out and she agreed to go. Deep down she knew this was a bad idea, but with her husband gone she was even more vulnerable. In recovery groups they call it “stinking thinking.” Lucy was in the wrong place with the wrong people. Lucy could have chosen to go to a healthier place with people who support her recovery.

Relapse is a process, not an event

Relapse is provoked by many things. But you can take charge of where you go and who you are with. Changing your lifestyle can be very hard. If it were easy more people would succeed. It takes time to establish new friendships and recreational activities. Staying connected to others in recovery, is one way to strengthen your commitment.   If you’re not sure if an event is a good idea, politely decline the invite.

By Drew Edwards, M.S., Ed.D.

©2022 Carelon Behavioral Health

Summary

Any treatment problem requires:

• Time
• Effort
• Commitment

It is time. You need to do something about all the time and money you spend getting high, and instead spend it on living a full life. Your friends are pushing you into treatment, and so is your parent.

Now what happens?

Treatment for marijuana use varies with the characteristics of your use.

A professional, certified drug counselor can sort out what will work best for you. She will ask:

• When did you start smoking pot? If you started as a teenager, you may have a lot more work to do than if you started as an adult.
• How often do you smoke? If you smoke pot every day, you may be addicted. If you smoke less often, you might find it easier to change your patterns.
• When or why do you smoke? If you smoke to relax under stress, you need to find new ways to handle that stress. Cognitive-behavioral therapy—or talk therapy—can do that, along with the support of a 12-step program.
• How much do you use? If you have increased the amount you smoke over years and use a pipe to get the maximum amount of THC each time, you might experience more severe withdrawal when trying to stop.
• How has your use affected you? Has it ended relationships, jobs or your education? Are you 40 years old and still living in your parents’ house because you have lost your desire to support yourself?

People seeking treatment for marijuana also often use alcohol and other drugs, especially alcohol and cocaine. You will deal with all of your substance issues at the same time.

Also, most people who turn to marijuana or other drugs do so because they are looking for a way to deal with problems. Maybe they have anxiety, depression, obsessive-compulsive disorder or attention-deficit/hyperactivity disorder. Whatever it is, they know there is something not right with their life, and they self-medicate with something that makes them feel better. Drug treatment must go hand-in-hand with treatment for underlying problems.

Do not be surprised and do not be afraid if your search for drug treatment leads you to find out you have an underlying mental health problem. With help, you should be able to work toward a much better life.

Treatment options

1. Behavioral treatments. Talk out your problems with someone who can point you in a new direction.
2. Drug therapy. Prescribed medicine can reduce some of the anxiety that led to abuse.
3. Family therapy. It is usually not enough for one member of a family to change.
4. Residential treatment. Change the environment and change the habit.
5. Rehabilitation. Learn new ways to build self-esteem, handle stress and accept responsibility.
6. Group counseling. You can benefit from the experience of others.
7. Group support. Knowing you have a group behind you can help you make positive choices.
8. Recovery programs. Twelve-step programs, like Alcoholics Anonymous, have helped millions.

You may benefit from one, some or all of these options. All take time, effort and a commitment to change for the better.

“Therapy is a way of lining up one’s ducks in a row in a way that makes sense for you,” explains Joseph Lee, MD, in his book Recovering My Kid. “It helps [you] make peace with the past and gain hope for the future.”

“Everything comes crashing down when you give up whatever addictive substance you’ve been using to avoid problems,” says Tessina. You need treatment and recovery support to help you sort out all the stuff that addiction has left you unable to deal with, she adds.

You might ask yourself, what’s the big deal? It’s only marijuana, a natural plant that has been used by millions for centuries.

“But it is still a very powerful drug, and has been carefully grown to get stronger and stronger,” says Jenny Karstad, a drug counselor who oversees treatment at a mental health center. It is not sold as something to make you healthy, but as something to let you escape reality for a while.

Yes, but it has been decriminalized in my state and even used as medicine for some people who have terrible diseases.

“Just because marijuana use or medical marijuana use has been de-criminalized, doesn’t change the parameters or treatment of the addiction,” Tessina explains. “Being addicted has nothing to do with whether the substance is legal or illegal. Alcohol is legal, but one can still have alcohol use disorder.”

Will I go through withdrawal?

If you are physically addicted to the drug, yes, you will and it might be uncomfortable. but it might not be very noticeable.

If you break a leg and take painkillers for 2 weeks then stop, your legs might feel funny. A few days later, they are fine. You have gone through withdrawal without knowing it, says Jenny Karstad. “People who develop a drug dependency sometimes don’t realize they are dependent until they stop.”

If you stop using marijuana, you might get irritable or cranky, have stomach cramps or a little nausea. That will go away in a week or so. “If you use a drug long enough, you don’t know what normal is, after a while,” Karstad adds. “It can feel a little weird.”

If you are using other drugs or alcohol, your withdrawal may be more severe. A drug counselor will help you deal with it.

How will I keep sober after treatment?

Most people get help from a 12-step program like Alcoholics Anonymous or Marijuana Anonymous. There are programs for people of all ages. You can get a lot out of sharing your story, and learn from others. Also, it helps to know that you are not alone while you are learning to face life without marijuana.

Resources

Marijuana Anonymous
www.marijuana-anonymous.org/

Nar-Anon Family Groups
http://nar-anon.org/naranon/

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, M.D., Ph.D., M.P.H., VP Medical Director, Beacon Health Options

Summary

• Mindfulness is an awareness of what is going on right now.
• Stress is at the root of relapse for people in substance use disorder recovery.
• Mindfulness helps people reduce stress and manage triggers.

The No. 1 reason people use drugs and alcohol is to relax and to de-stress. Stress is also the No. 1 relapse trigger for those recovering from an addiction.

Here is why:

Life causes stress.→A person uses a substance to cope with stress and becomes addicted.→Her addiction causes problems.→She quits using the substance.→Life and recovery cause stress.→She uses a substance to de-stress…

We usually run “on autopilot,” not thinking about what we are doing. We rely on habits to make decisions. We do what we have done before even when it is not the best thing to do. What we need to do is stop the cycle and find other ways to cope with stress. Mindfulness can help.

About mindfulness

Mindfulness is the practice of being aware of the moment without judging. Mindfulness practices are actions that help us simply slow down and notice what is going on right now. They can give us time to consider our actions and choose our best response rather than reacting on autopilot.

Mindfulness can help relieve stress before it becomes a problem. Mindfulness practices have been scientifically proven to decrease stress and anxiety. This is true for everyone, not only those who deal with addiction.

Mindfulness techniques to try

Meditation is the most common activity. A basic meditation practice is sitting quietly and trying to quiet the mind. Thoughts and feelings might come up, but in meditation you simply notice them rather than react to them or judge them.

Other calm activities work, too. Examples are tai chi, yoga, walking, or biking. Over time, keeping a journal or diary can help you de-stress and think through your feelings and experiences.

Mindfulness practices can be used as you go through your day. Some useful on-the-go actions are breathing exercises, counting down from 10 to 1, or doing a quick mental scan of your body. Notice yourself, your environment, and the people around you before you move on.

Dealing with strong emotions

Strong emotions are relapse triggers. Emotions can feel too intense and uncomfortable. Many people who use substances use them to cover up strong emotions. Using helps them ignore the emotion or situations causing the emotions. This leads to problems that cause more stress.

A mindful reaction to a strong emotion is to focus on the present moment. Break out of autopilot and become aware of the present. Slow down and notice what you feel, before you react. Breathing exercises or counting backward can be useful for this.

Try not to judge your emotions. Take Erik, for example, who tends to be very negative. When he practices mindfulness he is able to examine his feelings. He asks, “What am I feeling? Will using drugs improve the situation? Is there a better course of action?”

People you used drugs with or situations and settings where you used can trigger the urge to use again. This is why experts say to avoid them. But this is not always possible. The situation may be at work. The people may be your relatives. The place may be your own home.

Relapse happens when you are unsure about your feelings or actions. You may want to use out of habit. You may think you can use just once. This is a big risk for people who are feeling better. It may also cause strong emotions and negative judgments. You may feel out of place or angry. You may even feel happy and want to celebrate. These feelings increase cravings. Mindfulness practices slow us down. They give us a chance to think about our response and any potential consequences before we react on autopilot.

Acceptance is a big part of substance use disorder recovery. When we are mindful, we notice without judging. We try to accept things we cannot control or change. This helps us make more logical decisions. Judging the present moment clouds that logic. It is not a problem-solving action.

Seeking professional help

Doctors and therapists use mindfulness in many types of therapy. Some examples are mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Mindfulness-based relapse prevention (MBRP) is a method used specifically with substance use disorder recovery. Another method used for substance use disorder recovery is acceptance and commitment therapy (ACT).

You do not need to address substance use alone. For further assistance and support, call the phone number listed on this site.

By Beth Landau

©2014-2021 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org; National Center for Complementary and Alternative Medicine, National Institutes of Health, http://nccam.nih.gov; Marcus, Marianne T. Zgierska, Aleksandra. “Mindfulness-Based Therapies for Substance Use Disorders: Part 1.” Substance Abuse. 2009 October-December; 309(4): 263; Vieten, C. Astin JA. Buscemi, R. Galloway, GP. “Development of an acceptance-based coping intervention for alcohol dependence relapse prevention.” Substance Abuse. 2010 April 31(2): 108-16.

•  Summary

• Ask for help.
• Focus on your kids.
• Seek mentors.
• Carve out time for yourself.

Single parenting is sometimes tough. Single parenting while recovering from drug or alcohol addiction can be overwhelming.

Going it alone as a single parent means that you routinely face emotional stress, fatigue, loneliness, boredom, and, sometimes, depression. In addition, many single parents struggle with emotions from things such as a messy divorce, untimely death of a spouse, debilitating guilt, or unhealthy past relationships. Finding the time and energy to focus on personal recovery might be very difficult but essential.

More than ¼ of American children live with one parent, and the majority of these children live with their mothers, according to the U.S. Bureau of the Census. Growing up in a single-parent home is a risk factor for substance use disorder and other mental health disorders. That’s why it is especially important for single parents to become actively engaged in their own recovery, so they can be actively engaged in the lives of their children.

Perseverance is key

The Merriam-Webster Dictionary defines perseverance as “persisting in a state, enterprise, or undertaking in spite of counterinfluences, opposition, or discouragement.” That pretty much sums up the challenge facing single parents in early recovery. What are some of the “counterinfluences and opposition” single parents must address? Here is a partial list:

• Providing emotional and physical security for children
• Ea living
• Providing/preparing meals
• Helping with homework
• Talking with teachers
• Cleaning the house
• Paying the bills
• Handling the insurance, banking, taxes, shopping, etc.
• Car and home maintenance, repairs, etc.
• Taking kids to practice and extracurricular activities

How do single parents find time and energy to care for their children, meet their social and emotional needs, develop healthy relationships, and fully embrace their own recovery? The truth is that recovery from addictive disease, like most chronic illnesses, is hard, especially in the first year. Here are some suggestions to help you care for your child while enduring this difficult time:

• Ask for help. Getting to recovery meetings is essential, yet this is where many single parents compromise. They look at their schedule and their responsibilities and the first thing they cut back is their meetings. This may solve an immediate scheduling crisis but can also be the fast track back to drugs and alcohol.

It’s really hard to do this alone—so find people to help you. Let your trusted friends and family members know your needs and ask them for specific help. Carpooling and ride sharing to school and extracurricular activities will save you valuable hours (and gas) each week. Help with child care is trickier because you can’t have just anyone watching your kids. If you don’t have family to pitch in, ask around. Talk with neighbors and co-workers and see if they have ideas or know someone trustworthy. You don’t have to solve every problem yourself. Seek the wisdom of others.

• Focus on your kids. They are the most important responsibility you have. One of the best ways to have a close family and rebuild trust is to spend quality time together. Don’t be like most hurried, stressed-out families and try to squeeze in family time after everything else is done. Your kids need you now. Planning is one of your best weapons for battling overstressed lives. Get out the calendar and plan some time together. Going to movies, going to dinner or ice cream, or taking weekend getaways will speak volumes to your children about your priorities. Remember, things that get scheduled are more likely to get done.
• Seek mentors:
• Get a recovery sponsor to mentor you through your recovery. You find a sponsor by going to recovery meetings and meeting people.
• Create a small inner circle of supportive friends and family members who care about you and know your life well enough to ask tough questions, be there when you need them, and hold you accountable for your recovery and your responsibilities. This group could also include your pastor and friends from your church, synagogue, or other place of worship.
• Seek mentors for your kids. If you are a single dad with a daughter about to enter puberty you are going to need some female advice and help. Kids need same-sex mentors to guide them and model appropriate behavior. Extended family members, trusted friends, youth pastors, or Big Brothers or Big Sisters volunteers may be ideal.
• Shake off the guilt. Early recovery can be wrought with guilt and a lot of second-guessing. Recovering single parents frequently fight the feeling that their addiction, bad choices, divorce, etc. have ruined their kids for life. Sure, you made mistakes, but recovery means letting go of past mistakes and forgiving yourself. Talking with your sponsor, pastor, or a close friend is a good place to start. If feelings of guilt, shame, or depression persist, talk with a mental health professional, preferably one who is trained in addictions.
• Carve out time for yourself. This is very difficult for single parents who already feel guilty about not spending enough time with their kids. Everyone needs to be regularly refreshed and recharged. What works for you is different than what works for others. Find what refreshes you—reading, exercising, walking on the beach, visiting a friend, going to a movie or spiritual retreat. Plan and commit to time for yourself, because there will always be conflicts that compete for your time. Do it anyway. You will not be good for your kids if you are always stressed.

Early recovery seems like a paradox to single parents. On one hand, you can’t be a good parent and provider if you don’t spend more time with your kids and work hard to provide for them. On the other hand, you can’t stay in recovery if you don’t make it a priority by going to meetings and taking better care of yourself. The answer: Find what works for you.

By Drew Edwards, M.S., Ed.D.

©2008-2019 Carelon Behavioral Health

Reviewed by Trenda Hedges, C.R.S.S., C.P.R.S., Wellness & Recovery Program Manager, Beacon Health Options

• Summary

  • Wait at least one year before making any important decisions.
  • As the initial romantic high fades, you may look to other substances to substitute for this high.
  • Relationships can bring emotional stress.

  “Life has never been better since I gave up booze,” says John, who’s been clean and sober for five months. “I’ve been eating right and getting in shape. My job is going great. The only thing missing is someone to share in my success.”

  Life is full of ups and downs—no matter who you are. Although staying sober during the good times is easy for John, sooner or later things won’t go his way and the temptation to slip will be strong. Romance, even casual dating, during the earliest stage of recovery will further jeopardize his efforts to stay sober. In fact, Alcoholics Anonymous (AA) recommends waiting at least one year before making any important decisions—including whether or not to date.

  For one thing, the rush of excitement that you feel when you first meet someone you like can give you a false sense of confidence and fulfillment. In fact, this initial romantic high is biochemical and as its effects fade you may look to other substances to substitute for this high. Furthermore, relationships (no matter how good) bring emotional stress, and a simple disagreement or misunderstanding can threaten the fragile sobriety of a person who is newly recovering from alcohol use disorder.

  Honesty is the best policy

  “I’m crazy about this guy Jack at my office,” says Beth. “I want to ask him out. But, even though I’ve been sober for more than 3 years, I’m afraid that once he learns I’m recovering from alcohol use disorder, he’ll lose interest.”

  As Beth knows well, successful recovery is not possible without honesty—the same is true for successful relationships. People recovering from alcohol use disorder need to be up front from the beginning. In this example, after ordering an iced tea at dinner, Beth told Jack in a simple and matter-of-fact way that she was in recovery and couldn’t drink. Jack appreciated Beth’s honesty. After several months together, Beth felt comfortable enough to talk about her disease and recovery and to introduce Jack to her friends and life in AA.

  Even though Beth and Jack are no longer together, Beth has found that telling the truth has become easier over time. “I’ve learned that if telling the truth about my alcohol use disorder is a turnoff, I’d rather find out in the beginning than waste my time with someone who doesn’t want to understand.”

  Find new places to meet people

  “I’ve been sober for 18 months, and I’m ready to meet new people,” says Derik. “Meeting girls used to be no problem—after a few drinks, I thought I was really good-looking and charming. Although I like the person I’ve become, I’m hesitant to jump back into the singles scene.”

  Derik’s concern is valid, and at this stage of his recovery he would be wise to avoid places where drinking is the focus. Hobby clubs (such as book or hiking groups), the gym, church, classes (both academic and recreational), and volunteer groups are great places to develop friendships with people who share your interests.

  You also can meet new people through support groups such as AA, although dating a person with alcohol use disorder can have its pros and cons. It can be great to give and receive support from someone who’s been there. On the other hand, if one of you has a rocky recovery, a slip can jeopardize the success of the other’s sobriety.

  By Christine Martin

  ©2000-2019 Carelon Behavioral Health

  Source: The 13th Step: The High Risk of Romance in Early Recovery by John S. Baudhuin, MA. CompCare Publishers, 1991; The Joy of Being Sober by Jack Mumey. Contemporary Books, 1984; The Recovery Book by Al J. Mooney, MD, Arlene Eisenberg and Howard Eisenberg. Workman Publishing, 1992.

Summary

Recovery from addiction is hard but possible. The rewards are a well-balanced life, improved relationships, forgiveness, and even joy.

Drug and alcohol dependence are disorders of the body, mind, and spirit. Wellness is the other end of illness. Wellness is about taking care of all aspects of the human condition. It is also about how they are connected—body, mind, and spirit. Any condition that messes up one area throws our being out of balance. It can make us sick.

The truth is we are much more than the sum of our parts. Our mind, body, and spirit work together to make us who we are. But they also connect us to others, our environment and to our higher power.

Physical

Overuse of drugs and alcohol affect us in many different physical ways. They interfere with the immune system. They cause damage to vital organs such as the liver, pancreas, lungs, and the brain. The primary target of mood-altering drugs and alcohol is the brain. Our thinking and emotions are impaired as well. In other words, addiction is a brain disease.

Mind

An old commercial says, “A mind is a terrible thing to waste.” That is true. The best scientific evidence shows that teens who smoke marijuana are much more likely to develop a serious mental illness. This is compared to teens that do not use this drug. This was reported in Lancet, one of the most respected medical journals in the world. Other research shows that young people who use marijuana are three times more likely to drop out of school. This truth can no longer be ignored. If marijuana can wreak such havoc, imagine what crack, meth, or pills will do to your mind. It is simply devastating.

Spiritual

Alcoholics Anonymous (AA) came long before there were fancy treatment centers. This group of people with alcohol use disorder believed they would fail without a relationship with a higher power. The early members of AA called it a disease of the spirit. What did they mean? Overuse of drugs and alcohol affect a person’s judgment. It often leads them to do things they regret. The feelings of shame, regret, and even resentment are said to damage the soul. That is why spiritual healing is an important part of recovery. Forgiving yourself and others is perhaps the hardest thing of all. You cannot do it alone. Letting go of the past and giving your problems to a higher power can be freeing for you. It’s a process that takes time.

Covering all the bases

Recovery is a team sport. You cannot do it alone. Many have tried and failed. Because this illness affects your body, mind, and spirit it will help to look at all areas of your life. A thorough physical exam with blood work can be done by a medical doctor. She may refer you to counseling or treatment if she feels it is necessary. Lastly, but most importantly, some people find that having a sponsor is helpful. A sponsor is a trusted person you can respect. It is a person who can relate with what you are going through firsthand. 

Recovery is hard, but possible. The rewards are a well-balanced life, improved relationships, forgiveness, and even joy.

By Drew Edwards, M.S., Ed.D.

©2010-2019 Carelon Behavioral Health

Reviewed by Diane Hopewell, Wellness Support Specialist, Beacon Health Options

Summary

• Drug and alcohol use is rising among older adults.
• They may misuse prescription drugs and alcohol.
• This is especially dangerous for this age group.

People may see drug use as a young person’s issue. But it is an issue for older adults, too. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) says it is “one of the fastest growing health problems facing the country.”

Substances

Alcohol is the most used and misused drug. Older adults may socialize with beer, wine, or cocktails. Happy hour is a common event in assisted living and retirement communities. SAMHSA advises no more than one drink a day. Some people should not drink at all.

Older adults use prescription drugs more than any other age group. Misuse of these drugs is growing. It can affect decision-making, create dependence, or cause other harm. Commonly misused drugs are:

• Opioid pain meds such as Vicodin®, OxyContin®, and Percocet®
• Benzodiazepine and anti-anxiety meds such as Ativan®, Valium®, and Xanax®
• Sleep meds such as Ambien® and Lunesta®

Medical marijuana is legal in some states. Older adults may use it to manage or treat health symptoms. There is no good estimate of how many people use illegal marijuana.

The same is true for illegal drugs, such as cocaine, methamphetamines, and heroin. In the past, it was thought that people stopped using substances as they aged. Recent hospital records show this may no longer be true. In fact, the National Study on Drug Use and Health shows that illegal drug use in people older than 50 has more than doubled between 2002 and 2013.

Who is at risk?

Drug use touches all ethnic and social groups. Men who have had drug issues in the past have the highest risk. Late onset issues are more common for women. People who deal with a long-term health problem, pain, trouble sleeping, or depression are also at risk.

Age-specific concerns

Older adults deal with a lot of loss. They may lose their sight or mobility. Their support networks shrink. Retirees may mourn their identity or financial security. They may miss their careers and work friends. Losing a spouse, a partner, or other loved ones can be painful. Older adults may use substances to self-medicate feelings of loneliness and loss.

As people age, drug use may have more consequences and risks. Bodies change with age. They lose muscle and body water. They digest and absorb things differently, often more slowly. Instead of leaving the body quickly, substances can build up to unsafe levels in the blood.

Also, older adults are more likely to deal with chronic health issues. Drugs and alcohol can make them worse. Common examples are:

• Diabetes
• Heart and liver issues
• Ulcers
• Cancer
• Sleep disorders
• Depression and anxiety

Drugs and alcohol do not mix well with medications. Some mixtures may not work well or may even be toxic. Examples include but are not limited to:

• Pain relievers
• Anti-inflammatory meds
• Heart and blood pressure meds
• Seizure meds
• Sleeping pills, tranquilizers, and sedatives
• Antidepressants
• Antibiotics
• Cold, flu, and allergy meds

It is vital for older adults to talk about their substance use with their doctors.

Signs of substance misuse in older adults

Drug misuse among older adults is not identified or reported enough:

• Clear signs like missing work or being drunk in public are not as common in older adults.
• Many people do not know substance use can be a problem for older adults.
• Loved ones may read signs of substance use as a normal part of aging.

Awareness is the key to identifying substance use and misuse among older adults. Symptoms to watch for include:

• Changes in appetite, personality, or behavior
• More health problems or confusion
• Decline in appearance or hygiene
• Unclear or slurred speech
• Anger or panic when asked about drug and alcohol use

Treatment

Treatment varies for older adults. The type and pace of care depend on a person’s situation. Experts advise a screening and intervention. This can include assessment, counseling, education, and goal setting. Professionals may offer referrals to medical and other services if needed.

Successful treatment plans are:

• Supportive and age specific
• Helpful in building support networks
• Focused on developing coping skills
• Run by qualified and skilled professionals
• Take place in individual or group settings

By Beth Landau

©2015-2021 Carelon Behavioral Health

Source: American Psychological Association’s “Elder Abuse and Neglect: A Search for Solutions.” (2012), www.apa.org/pi/aging/resources/guides/elder-abuse.aspx; Castle, Nicholas G., Ferguson-Rome, Jamie C., Handler, Steven M., Smith, Mary Lindsey, Wagner, Laura M. (2012) “Alcohol Misuse and Abuse Reported by Nurse Aides in Assisted Living.” Research on Aging. May 2012, 34: 321-336; Center for Substance Abuse Treatment. (2012) “Substance Abuse Among Older Adults.” Treatment Improvement Protocol (TIP) Series, No. 26. HHS Publication No. (SMA) 12-3918, www.ncbi.nlm.nih.gov/books/NBK64419/pdf/TOC.pdf; “Seniors and Alcohol.” (2015) West Virginia University School of Public Health, http://publichealth.hsc.wvu.edu/alcohol/effects-on-society/seniors-and-alcohol; Substance Abuse and Mental Health Services Administration. 2014. “Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.” NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, Md.: Substance Abuse and Mental Health Services Administration, 2014, www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf; Taylor, Matthew H. Grossberg, George T. (2012) “The Growing Problem of Illicit Substance Abuse in the Elderly: A Review.” Primary Care Companion for CNS Disorders. Vol. 14(4), PCC.11r01320; Wu, Li-Txy. Blazer, Dan G. (2011) “Illicit and Non-Medical Use Among Older Adults: A Review.” Journal of Aging Health, Vol. 23(3), 481-504.

Summary

• What is an accountability partner? 
• How to find the right person
• Informational links to recovery programs

Being held responsible in recovery is not optional. Needs for drugs, alcohol, gambling, and even sex are hard to get past. Recovery is seldom possible without help from others, but if so, the quality of recovery suffers greatly making relapse more likely. Living a life in recovery involves setting goals and changing behavior. An early step in the process is accepting the need to be held responsible.

What is an accountability partner?

This is a trusted person you respect and ask for help. You agree that he can hold you responsible for your choices, attitude, and behavior. He can relate first-hand to what you are going through.

The most common form is a sponsor. This person guides somebody new through the process. Twelve-step programs such as Alcoholics Anonymous stress a “one-on-one” relationship. This relationship shares experiences and is focused on working the Twelve Steps. A sponsor will share her past, strength and hope; what worked for her. She must be honest, reliable, and discreet. Having someone like this in your life will greatly increase your chance of success. 

The basics

The goal is simple. Meet often with your sponsor and let him guide you to find what works best for your personal recovery. Why? Recovery can be hard. Stress, cravings, and relationship problems are very common. Research also shows that depression and anxiety are also more common among people with addictions. Knowing someone has your back when you are feeling weak or alone is a great comfort.

A good sponsor will listen, challenge, and guide you to live a better and more disciplined life. He will not hesitate to call you out on your excuses and poor attitude.

You are allowing someone to see past the cover-up. This means talking about more than the weather or your favorite pastime. It means talking about the hard stuff. This can include cravings, triggers, problems in marriage and parenting, frustration, and boredom. Anything that steals your peace is fair game. 

Talking about your progress and failures to someone you respect is a great motivator. This is especially true on the bad days when some people don’t care enough about themselves to resist cravings. But they may care about what their sponsor will think. We just hate to let down the people we respect.

How to find the right person

One option is to attend support groups and 12-step meetings. Let others know that you want a sponsor. Usually someone will give you her number and arrange to meet with you. During this meeting you will decide if it seems like a good fit. Many accountability partners will agree to a temporary arrangement to see how things go. This gives both people the choice to stop meeting if it is not helping. This is common, so don’t be upset if it takes a few meetings to find the right person. It is worth it.

Local churches are also a good place to look. Many have recovery groups in the building. You can talk with a pastor about who they might suggest as a sponsor. Also many pastors and religious leaders are used to dealing with people who have addictions. They can be an excellent source of support. Don’t forget—it’s hard to do this alone.

By Drew Edwards, M.S., Ed.D.

©2010-2019 Carelon Behavioral Health

Reviewed by Diane Hopewell, Wellness Support Specialist, Beacon Health Options

Summary

• Getting to 12-step meetings and spending time with a sponsor can be essential.
• Focus on your kids.
• Ask for forgiveness whenever needed.

Parenting can be tough. It can be even harder while recovering from substance or alcohol use disorders. In early recovery it is normal to feel stress, fatigue, and mood swings. Many parents carry emotional challenges from things such as a strained marriage or divorce. Severe guilt or just feeling like a bad parent is also common. Finding the time and energy to focus on personal recovery while raising children is not easy. 

Tips for parents

• Getting to 12-step meetings and spending time with a sponsor can be essential. But this is where many parents first compromise. They look at their busy schedule and the first thing they cut back is their meetings. This may solve an immediate time crunch but it can also be a fast track to relapse. Of course your kids are most important, but if you’re not sober you can’t be a good parent.
• Work on your marriage. A good marriage is one of the best ways to have healthy kids. If you need counseling get it. Many religious organizations offer therapy for couples.
• If you are not married, avoid new relationships. This may only confuse your kids and hurt your recovery.
• Focus on your kids. They are the biggest responsibility you have. One of the best ways to have a close family and rebuild trust is to spend quality time together. Don’t be like most stressed out families and try to create family time after everything else is done. Your kids need you now. Planning is one of your best weapons for battling a busy life. Get out the calendar and plan some time together. Going to movies, dinner, or ice cream, and weekend getaways will speak volumes to your children about your priorities. Things that get scheduled get done.
• Answer their questions about your addiction. But do so in an age-appropriate way. Let them know in your words that addiction is an illness like diabetes. And that you intend to follow your treatment and do whatever it takes to get well. If they have fears or develop any issues of concern, suggest they talk with a professional and encourage them through that process.
• Shake off the guilt. Early recovery can be full of guilt and shame. Parents in recovery often feel that their bad choices have ruined their kids for life. Sure, mistakes are made, but recovery means letting go of the past and forgiving yourself. Talking with your sponsor, pastor, or a close friend is a good place to start. If feelings of guilt, shame, or depression persist, talk with someone who is trained in addictions.
• Ask for forgiveness whenever needed. If you have neglected or hurt your child, apologize and ask her to forgive you. Forgiveness is a sign of a healthy family.
• Take time for yourself. This is very difficult for busy parents who already feel guilty about not spending enough time with their kids. The point here is that everyone needs to be regularly refreshed and recharged. What works for you is different than what works for others. You need to find what refreshes you. Reading, exercise, walking on the beach, visiting a friend, going to a movie, or spiritual retreat. Plan these times in advance because there are always conflicts that will compete for your time. Do it anyway. De-stressing will help you be a better parent. 

Recovery, like parenting, seems overwhelming at first. On one hand, you can’t be a good parent if you don’t spend time with your kids. On the other hand, you must work hard to provide for them. It will be very hard to stay sober if you don’t make your recovery a priority by taking better care of yourself. The answer is to work on your recovery one day at a time.

By Drew Edwards, M.S., Ed.D.

©2010-2019 Carelon Behavioral Health

Reviewed by Diane Hopewell, Wellness Support Specialist, Beacon Health Options

Summary

How to win back trust:

• Stop using drugs or alcohol.
• Be honest.
• Give it time.

Maybe the saddest part of addictive disease is that those closest to the person with the addiction get hurt the most. It’s hard to watch someone you care about self-destruct. You can feel helpless and out of control. Fear, anger, and overwhelming grief are typical emotions among these families and friends. Loved ones try to control the impossible. Or they try to stop caring. The relationships are damaged either way.

Winning trust back

Those who have been hurt as a result of addiction find it nearly impossible to trust again. Lying, broken promises, financial ruin, shame, and immoral behavior cause deep wounds. Early recovery restores hope but gaining trust back is not so easy. It requires three things:

1. Stop using drugs or alcohol and change your lifestyle.
2. Complete painstaking honesty is needed. Become the person who you say you are. Actions speak louder than words.
3. The third is time. How much time? As long as it takes.

Trust is not the same as love or forgiveness. These are three different things. You can love and forgive someone without trusting them. But those who want to restore their family life must work hard to earn trust. Love and forgiveness are a choice. We can choose to love and forgive a recovering family member. Trust takes honesty and good choices. All this can be accomplished through sustained recovery and time.

Forgiveness

Forgiveness is at the core of healthy families. It is not a psychological problem. It is a spiritual issue. Forgiveness is a determined change of heart by those who have been hurt. It doesn’t mean you weren’t hurt. It means not letting hurt steal your peace and your future. Not forgiving and bitterness will only make you sick.

Forgiving may not come naturally. In fact, it can be very hard. It may be the only thing that releases families from their shame and restores the possibility of trust and intimacy. Twelve-step recovery programs like Alcoholics Anonymous stress the importance of making amends to those who were hurt and seeking forgiveness. Faith-based organizations like churches and synagogues know the power of forgiveness too. Talking with a person of faith can be very helpful.

Taking down the wall, one brick at a time

Restoring a broken relationship is like trying to take down a large brick wall. No matter how hard you try, it won’t come down all at once. Be patient. The recovery process allows you to remove only one brick each day. Over time, there is a hole in the wall large enough to talk through without shouting. After a while the opening is large enough for a hand to reach through and offer a loving touch. And one day, trust can be restored.

Remember that alcohol and drug use disorders can happen to anyone. It causes people to make bad choices. It also causes them to engage in hurtful and destructive behavior. Some days it feels overwhelming and like there is no hope, but there is. Unconditional love, trust, and forgiveness are keys to healthy family life. Don’t give up. A loving family is worth the fight.

By Drew Edwards, M.S., Ed.D.

©2010-2019 Carelon Behavioral Health

Reviewed by Diane Hopewell, Wellness Support Specialist, Beacon Health Options

Summary

• Let go of things you cannot change.
• Much of life is out of control.

For every ailment under the sun
There is a remedy, or there is none;
If there be one, try to find it;
If there be none, never mind it.

—William W. Bartley, Stanford University

At times life is just plain hard and full of surprises and disappointments. There is something about us that expects life to be fair and for the most part, good. Yet bad things do happen to good people. When they do, it creates worry, and worry can create the false idea that we should take more control over life. When these efforts fail, we feel more out of control.

Letting go of things we cannot change

When a loved one gets sick there are certain things you can do to help, some things can make the situation worse and others don’t make any difference at all. The outcome of an illness is not up to you. This is especially true when dealing with addictions or mental illnesses. We tell families, “You didn’t cause it, and you can’t cure it.” Yet loved ones often feel that if their spouse or child develops an addiction or a mental illness, it is their fault. As a result, they try to change things they cannot change. In other words, they become overly involved and controlling. This is primarily caused by fear of losing their loved one. It is exhausting. Some refer to this thinking and behavior as codependent.

The main problem of trying to change things that you cannot control is this. When things go bad, you feel responsible. For example, when a teen with depression has a bad day, his mother may feel that it is her fault. The fact is everyone has bad days. Teens who have depression have them more often but that is the nature of the disease. No one can control that any more than the symptoms of cancer. But you can ask if there is anything you can do to help. We must learn to let go of what we cannot change and focus on what we can.

Much of life is out of control

Twelve-step programs like Alcoholics Anonymous (AA) remind their members that much of life is out of control but getting drunk is never the answer. “Let go, let God” they say. When bad things happen, change what you can, but recognize the things you cannot change. This philosophy is summed up nicely in the Serenity Prayer, which is said at every AA meeting: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

It is common to second guess and blame ourselves when a child has depression or a spouse develops an addiction. Keep in mind that mental illnesses and addictions are caused by numerous and largely unknown factors. Blaming yourself or trying to control symptoms or the outcome will not change a thing, and may even make matters worse. The best way to help is to stay in the present, ask how you can help and pray for their recovery. Let them know how much you love them and take it one day at a time. Then let tomorrow take care of itself.

By Drew Edwards, M.S., Ed.D.

©2010-2019 Carelon Behavioral Health