How to Love an Addict
According to the Substance Abuse and Mental Health Services Administration, 2.5% of Americans are abusing or dependent on illicit drugs, 7% of Americans are abusing or dependent on Alcohol, and 28.5% of Americans are using tobacco products. Prescription drug abuse is a growing epidemic, and the addict is looking less and less like the bum on the side of the street and more and more like your neighborhood doctor. Or lawyer. Or teacher.
There are few people not affected by the harsh reality of addiction. Families are destroyed, lives are ruined, and people are left broken and lost. While this article speaks directly to addiction as it affects spouses, many of the concepts can be extended to other family and friends.
The Biology of Addiction
One thing that counselors deal with often in talking with families is the lack of available knowledge regarding how addiction actually works on the brain. While it is true that one makes the initial decision to have the first drink, or smoke the first joint, or snort the first line, there is a point where the decision to use becomes moot, and the brain takes over and is essentially functioning on “auto-pilot”.
While all drugs have their various mechanisms by which they enter the blood stream and begin to affect the brain, there is a basic chain of reaction. Alcohol and other drugs work by activating the reward centers of the brain, primarily an area known as the nucleus accumbens, and flood the reward centers with a powerful neurochemical called dopamine. Dopamine is released through many experiences, including sex and eating a good meal. Using substances tricks the brain into euphoric pleasure.
But most people know that not everyone who uses alcohol or other drugs becomes addicted, right? So what’s the difference? The difference is in how the brain responds to the dopamine flood, and that depends largely on the method of drug delivery (injecting, snorting, smoking, etc.), how the hippocampus codes the experience into memory, and the intensity of the conditioned response coded by the amygdala.
So the thing to remember is that addiction is heavily associated with not only the pleasure center of the brain, but also learning and memory. Drugs essentially “reprogram” the brain to respond a certain way to certain stimuli, or “triggers”. So a heroin addict may immediately want to use when they see a hypodermic needle. An alcoholic may want to drink every time they smoke a cigarette, or a smoker may want a cigarette every time they have a drink. This is why someone who hasn’t smoked in 10 years may find themselves craving a cigarette when they go through a stressful situation. The “programming” is still left there in the brain.
Furthermore, the longer someone uses a substance, the stronger the “programming”. Someone who has been alcohol dependent for one year will have a very different experience from someone who has been dependent for 20 years. In addition to the effects on the brain, many substances also require adaptation of the body. Alcohol, benzodiazepines and opiates come with powerful physical withdrawal symptoms such as shaking, vomiting, nausea and diarrhea, hot and cold sweats, hallucinations and even death. Combine those physical symptoms with powerful messages from the brain demanding more and more of the drug and you have someone trapped in a hopeless cycle of addiction.
Options for Recovery
There are options when it comes to recovery from addiction. The best option will depend on the type of drug used, the amount of time used and a host of psychological and biological factors of the individual. Here are some of the options available:
Self-help groups. Self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous have shown to be highly successful for those with a mild to moderate drug abuse or addiction problem. People who chose this form of recovery must be highly committed, with a stable support network. These groups are mostly effective for people who may be abusing substances, but who aren’t physically dependent on them. These groups are also helpful for people who are already doing some sort of medical treatment in addition to groups.
Outpatient Treatment. There are many different forms of outpatient treatment, depending mostly on the drug of choice. For those who do not need physical detoxification, individual and/or group counseling may be effective. Those addicted to opioids benefit many times from medication assisted (methadone) treatment. Intensive outpatient (greater than 9 hours per week) counseling and group therapy can be helpful for drugs that do not come with physical withdrawals, such as marijuana or cocaine. Outpatient treatment can be very successful, but there is still a large amount of freedom involved and the addict must be committed and must have a positive support network.
Inpatient (Residental) Treatment. Inpatient treatment requires patients to live at a treatment facility for an extended period of time that can range anywhere from 3-120 days, depending on the level of intensity of the program and the type of drug. Shows like Intervention and Celebrity Rehab have made these types of programs well-known. People with serious addictions that come with physical withdrawals and/or who suffer from co-occurring mental health issues such as Bipolar Disorder, Depression or personality disorders are appropriate for these types of programs. It is important to remember that it is vital to provide follow-up care to inpatient treatment programs. Many times, even when an individual is successful in a contained environment, they are set up for failure if they are released back into the “real world” with no substantial support.
Half-Way Houses. Half-way houses are a great form of secondary treatment to those recently released from inpatient treatment. Half-way houses are places where those in recent recovery can live with others in recovery and helps them learn the everyday skills they will need to function in the “real world”. Continued counseling and support services assure that these people learn how to cope with negative emotions and situations in healthy and productive ways.
There is no one form of treatment that works for every addicted person, and sometimes, finding the right path can take time. It is important to support your loved one through the entire process and to refrain from being a stumbling block for them.
How to Love an Addict
That brings me to the question at hand. What do you, as a family member, need to do to help your addicted loved one? How can you love someone who is causing you pain? How do you cope with your own pain and emotions surrounding the addiction?
- Seek understanding. Learn about your loved one’s drug of choice and how it works in the brain and in the body. The long and short of it is that most addicts can’t “just stop”. The more you know, the more benefit you will be.
- Have realistic expectations. Along the same line, keep your expectations realistic. Even if your loved one agrees to try to stop drinking, using or smoking, it doesn’t mean it will happen right away. And furthermore, sometimes, medications are necessary to help. The goal of recovery is to stop the addictive behaviors and to function normally. This may mean that your loved one doesn’t completely stop using anything at all.
- Understand that relapse is a part of recovery. Addiction is a RELAPSING disease. When a person goes into remission from cancer, it is expected that the cancer will return at some point. Addicts are expected to relapse at some point. The purpose of counseling and treatment is to put safeguards in place so that a single relapse does not turn back into full blown addiction. Be supportive WHEN your loved one relapses, and help them get back on track.
- Stop blaming them for getting addicted. The first use was their choice, yes. But even the greatest minds in science and medicine do not know exactly how people become addicted. It is a complicated and convoluted process that is largely out of one’s control once the chain of reaction is started. Focus on where you’re going to go from here rather than blaming your loved one for getting there in the first place.
- Support the addict’s decision for their own recovery path. I would be a rich woman if I could count the number of time someone dropped out of treatment because their family refused to support them being on methadone because it is “trading one drug for another”. This is an absolutely absurd assertion. If your loved goes from fiending on the street, stealing, lying, cheating, neglecting family and work and spending unsurmountable time looking for, using and recovering from a drug to being able to live a stable and productive life, they are in successful recovery, regardless of medications that may be stabilizing them. Support their recovery and the decisions they make regarding that recovery.
- Be a safe place for your loved one. Does every conversation you have about his or her addiction end in a fight? Do you approach them as if they are never going to be able to stay sober? Do you question and doubt everything they do or say? You should be a place of refuge, a place of unconditional positive regard. Build your loved one up. Be their biggest cheerleader. Don’t continue to tear them down and discourage them.
- Hold your family member accountable, with love. While you want to be supportive and encouraging, you should also hold your loved one accountable for their recovery in a loving way. If you have created an environment of support and trust, your loved one may come to you if they are struggling with cravings or a desire to engage in old behaviors. Be ready with a plan of action to suggest other ways to cope and to remind them of where they’ve come from and where they are trying to go.
- Engage in appropriate self-care. Loving an addict is hard work, with a high, high level of burn-out. You’re going to get frustrated, angry and hurt. You’re going to want to give up. You have to take care of yourself, and this will often times include counseling for yourself. Addiction is a disease that affects far more than just the addict–it affects the entire family. Remove yourself from the situation when you need to. Surround yourself with a strong support network (groups like Al-anon and Nar-anon can be helpful). You are the strength for yourself AND your loved one. Take care of yourself.
If you are committed to your loved one and your family, you can overcome an addiction. While recovery is ultimately the responsibility of the addict, it doesn’t mean you are helpless or than you can’t be a catalytic and supporting factor.