How to Help a Loved One with Addiction: An Evidence-Informed Approach

Learn. 

Learn what constitutes an evidence-informed treatment plan for the medical condition of substance use disorder, popularly termed “addiction.” Acknowledge that debate rages, even among experts and researchers, about what addiction is and what effectively treats it. Discourse is, of course, necessary, but your loved one needs help now. Learn what the evidence suggests helps most people with substance use disorder, most of the time, better than other treatments, and better than no treatment.

Co-create solutions

Understand.

Learn enough about addiction to understand what people with the disorder experience, why their actions may not make sense, why abstinence is neither a cure nor a relief, and why they might not want treatment. Understand that substance use disorder occurs with multidimensional complexity and variability. Use terms related to addiction accurately.

In particular, understand that the neuroscience of addiction suggests that through compromising the brain’s basal ganglia, extended amygdala, and prefrontal cortex, addiction under-sensitizes people to pleasure, over-sensitizes them to pain, automates use of the substance to feel, not necessarily good, but normal, weakens decision-making abilities, magnifies emotional highs and lows and incapacitates the ability to regulate them, interferes with recognizing cause-and-effect relationships, and confounds the ability to make a plan and follow through with it.

“Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place.”
– Alan Marlatt, Ph.D., 2004

Encompass.

Be brave.  Beyond the medical condition of addiction which compels use, become aware of, seek, and acknowledge all the possible current conditions, risk factors, and pre-existing conditions – including trauma and mental illness – that might lead your loved one to find use of substances appealing, helpful, or meaningful. Without judgment, be open to discussing these with your loved one. What substances do for a person will need to be adequately replaced before a person can do without them. Expand and deepen your empathy and compassion for these conditions and reasons, and for the person who has them.

Love.

Offer love love, not tough love.

Co-create.

If your loved one is in an emergency state, dial 911 or get him or her to an ER.

If not, your loved one may be newly released from the hospital, newly released from treatment, or in need of urgent care.

Having grounded yourself in learning, understanding, compassion, and love, confer with your loved one about what next steps might be helpful. Although the situation might seem dire, co-decide on the smallest step that might make a slight improvement – perhaps finding an answer to a question through a phone call or a Google search – and do that. Don’t try to strategically build trust – be trustworthy.

This is subtle, but the goal of helping someone with substance use disorder isn’t to take over the person. The goal is to help the person be himself or herself and move towards health, in the increments that work for him or her, while having this condition.

Use the best of your heart, mind, knowledge, experience, wisdom, and presence, all together, all at once. The substance is perceived as needed to survive. The illness of addiction, the symptoms of co-occurring illnesses, and the impact of substances themselves can interfere with a person’s reasoning. Co-creating solutions with a person under such duress will take the very best of your full humanity.

Coordinate.

Serve as your loved one’s case manager and do what you can to make the components of the treatment plan happen. Make inquiries and appointments, make phone calls and follow-up phone calls, make copies of all documents, keep originals in a safe place, create a notebook of the copies, provide or find transportation, and accompany your loved one to as many appointments as possible, notebook of copies in hand.

Advocate.

Your loved one has a medical condition needing medical care, but society at large believes it is a moral and criminal problem needing redemption and punishment. Even your loved one may believe he or  she is a good person gone bad. Your natural inclination may be to walk away from care providers who hold these views. Since it’s a position held by the majority, doing so may leave you with no alternatives and no care. Instead, you may need to learn to skillfully and strategically advocate to procure the necessary treatment component from each individual or entity.

Insist on outcome-based treatment. If the treatment providers don’t have data that the treatment works – data that counts all the people who tried the treatment, not just the people who finished – ask them for the criteria used to decide which treatment protocols are offered. If a treatment isn’t known or proven to work, why would your loved one be required to do it? People mandated to treatment may have to attempt to make the best of what’s offered. You can convey, however, that you will be overseeing your loved one’s progress.

Commune.

Find others with loved ones with substance use disorders and connect with them in ways that are supportive, informative, and empowering. Community Reinforcement and Family Training (CRAFT) is an evidence-backed approach, developed first for alcoholism, and known since the 90s to foster engagement between people with substance use disorders and those who love them towards achieving treatment goals. Even if implementation of a CRAFT program is not possible in your area, finding others who value a CRAFT goal – “Minimize distress and increase positive lifestyles for all family members” – may be encouraging and strengthening.

“Love, evidence & respect.”
– Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

Recommended reading

Watercolor by Jesi Pace-Berkeley

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

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