By Alex Shohet & Bernadine Fried, LMFT, Co-Founders of Red Door Life
The common belief that a person with substance abuse issues needs to "hit bottom" before they can get better is often an illusion. It is a common misconception that if there is enough pain, one will stop the behavior causing the pain. The problem with that analogy is that drugs, especially newer synthetics, are producing infinite amounts of pleasure, so they are experiencing life through a very different lens. The brain's dopamine and serotonin responses can mask the person's awareness of the true severity of their situation, making them perceive their substance use as a positive rather than a problem.
Waiting for a person to hit rock bottom is not an effective approach. The earlier intervention and treatment can begin, the better the chances of successful recovery. Treating substance abuse can be thought of similarly to treating cancer. If you catch it in the early stages and invest as much resources as possible in the beginning stages, you have a better chance of reducing the damage done to one’s life, brain, and body. As substance abuse progresses, the complexity and resources required to help the person increase dramatically. Proactively getting a support system in place early on is crucial.
A person’s substance abuse acuity level means how severe it is. Realistically evaluating the severity and stage of the person's substance abuse is crucial. Seeking professional guidance to help determine a loved one’s acuity level is critical in knowing what action to take. For someone who has newly begun abusing substances, peer support programs such as AA or NA and a sponsor or a standardized treatment program of 30, 60, or 90 days may be effective. For those with a severe acuity level, it can take a year or longer for the brain to heal its executive function. Executive function is the management system of the brain- a set of mental skills that include working memory, flexible thinking, impulse control, decision-making, and the ability to self-regulate emotions. With a higher acuity level, higher degrees of wrap-around care, multidisciplinary teams, and longer stays in treatment are necessary. The level of support and approach needed will vary significantly based on the acuity of the situation. Loved ones must adjust their expectations and strategies accordingly.
#4 THE IMPORTANCE OF CONNECTION
Maintaining a strong connection with the person struggling with substance abuse is critical. Even when family and loved ones cannot personally sustain that connection due to the painful circumstances that may arise, having a dedicated advocate or case manager to keep tabs and provide unconditional, consistent support can prevent the person from becoming disconnected and the disease from advancing. Disconnection is dangerous and can lead to overdose, suicide, and worsening unsafe conditions. Connection is life-saving and provides as much stability and safety as possible, a reminder that a brighter future exists, as well as a clear path to treatment when one is ready.
When a person is in denial about their substance abuse problem, the key is for loved ones or professionals to meet them where they are at, understand their perspective, and build trust and safety rather than trying to scare, threaten, or force them into treatment.
Understand that a person abusing substances may be looking at their substance use as positive in their life because it helps them transcend reality and pain. When you approach the situation with empathy and meet them where they're at, instead of trying to force your perspective on them, you can try to understand where they see the problems in their lives, or conversely the opportunities- and you can help them see where their substance use is impacting those areas or their bigger picture goals and affecting their future vision of themselves.
Employing empathy in translating between the different lenses through which the person abusing substances and their loved ones view the situation is important to dealing with the discrepancy in opinions on the situation, which can be frustrating and heartbreaking.
While professional treatment is ideal, it may not be accessible for everyone due to cost. Exploring free or low-cost peer support options like 12-step programs, faith-based recovery groups, virtual outpatient groups (IOP), online support groups, and other community-based resources can provide valuable support and connection for those struggling with substance abuse and also support their families. Getting peer-support as a family member or friend of someone struggling with substance abuse reduces the overwhelming aloneness and is critical in dealing with the confusion, pain, trauma, and burnout that arises.
It's an important practice for loved ones to listen to stories of others who have successfully navigated the recovery journey, in order to maintain hope. There are countless celebrities and members of recovery communities who have incredible stories of recovery, despite the odds being stacked against them- that seem like complete miracles. Anytime loved ones feel hopeless it is important to reconnect to these stories and have faith, remembering the human spirit can overcome incredible adversity.
# 8 SELF-CARE & PROFESSIONAL SUPPORT
Loved ones of those struggling with substance abuse must remember to take care of themselves and set boundaries. Trying to "save" someone can lead to burnout and mental health struggles. It can feel as if you are always having to bail your loved one out of dangerous and frightening situations, and that their problems have become your problems. Loved ones can feel held hostage in the sense that if they say No or set a boundary, their loved one could potentially end up in a dire situation. Seeking support is vital for loved ones’ well-being in helping manage their own stress, feelings, and trauma. Seeking professional help such as a therapist who specializes in substance abuse also helps loved ones make the decisions that are best for all involved. It is important to not feel guilt or shame when you need to take a break, or a step back and care of yourself. Practice self-compassion and know you are doing your best in an extremely difficult situation.
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