Counseling for Friends & Family of Addicts
Understanding drug use and addiction is essential to understanding recovery. Many people don’t understand why or how others become addicted. They may mistakenly think addicts and alcoholics lack moral principles. Or, that recovery from addiction is simply a matter of willpower. In reality, chemical dependency is a complex disease. Quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction.
What is addiction?
Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to use drugs or alcohol is voluntary. But repeated use can lead to brain changes that challenge an addicted person’s self-control. These brain changes can be persistent, which is why drug addiction is considered a “relapsing” disease. People in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.
It’s common for a person to relapse, but relapse doesn’t mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.
What happens to the brain when a person takes drugs?
Most drugs affect the brain’s “reward circuit,” causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.
As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.
Research looking to understand drug use and addiction shows the long-term use also causes:
Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.
The impact of addiction on the family
Few in the addict’s life are unaffected by their addiction. Family members often respond in various ways depending on their proximity to the addict and their understanding of the disease of addiction. Those who love an addict will often try to protect them from the consequences of their choices. This actually makes sense, as a loved one, observing them, knows they are irrational and wants to save them from the ramifications they will surely regret one day. However, standing between them and the logical consequences of their choices will keep them sick. In a nutshell, stop running interference for the addict (bailing them out, paying their fines, calling their boss, lying for them, and giving them money – for starters). Get back into your life, and start your recovery (yes, if you have been in an addicted system you need to recover). Go to Al-Anon or Nar-Anon or any support group for families of addicts in your community. There are plenty out there. You need to see, and know, and believe that you are not alone in this. There is power in numbers. This is too heavy to carry alone; you need friends who get it.
The importance of setting boundaries
Setting healthy boundaries with your addicted family member is essential to protecting yourself. Boundaries can also be the impetus for an addict to finally seek treatment. Boundaries tell others what behaviors we are willing and unwilling to accept. Family members ask me all the time, “How do I set boundaries with my loved one?” I have four rules for setting healthy boundaries:
- The boundary must be clear and definable. Boundaries are like lines on a football field. You need to be able to explain to the other person what behavior is “in bounds” versus “out of bounds”. It’s unfair to them if they aren’t sure what behavior is acceptable and what is not.
- The addict must be informed of the boundary. These are frequently uncomfortable conversations. Addicts, in the midst of active addiction, do not like to have limits placed on their behaviors. However, this is not about them. It is about protecting you from their behavior.
- There must be a consequence for violating your boundary. Think about this one carefully!
- If you are unwilling or unable to do Step 3, don’t bother with Steps 1 or 2! The first time you allow the individual to cross your boundary without enforcing your consequence, you have just given the message that your boundaries mean nothing
How should I help my family member?
Ultimately, your family member must make the decision for themselves that they are ready to stop using drugs and alcohol. Family members can offer support by helping to research and schedule treatment or counseling. Do not enable, set firm boundaries, and establish a united front. Take care of yourself. Attend Al-Anon or Nar-Anon meetings. While I hope that every person with a substance use disorder finds recovery, the sad truth is that not all will. However, family members still need to have their own recovery that is independent of their loved one. Family members frequently benefit from individual counseling, too.
As an addiction counselor, I will address the symptoms of your loved one’s addiction and the related areas of impaired functioning, and together we’ll structure the time and content of their ongoing recovery.
I believe that there are many paths to successful recovery that will work with the goals and desires of your loved one, and ensure they can make the life changes they want to make.