U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Treatmentwww.samhsa.gov

AcknowledgmentsThis booklet was produced by Johnson, Bassin & Shaw, Inc.,under Contract No. 270-99-7072 with the Center for SubstanceAbuse Treatment (CSAT), Substance Abuse and Mental HealthServices Administration (SAMHSA), U.S. Department of Healthand Human Services (DHHS). Karl D. White, Ed.D., and AndreaKopstein, Ph.D., served as the Government Project Officers.

DisclaimerThe views and opinions contained in this publication do notnecessarily reflect the views or policies of CSAT, SAMHSA, orDHHS.

Public Domain NoticeAll material appearing in this booklet is in the public domainand may be reproduced or copied without permission fromSAMHSA. Citation of the source is appreciated. However, thispublication may not be reproduced or distributed for a feewithout specific, written authorization from the Office ofCommunications, SAMHSA, DHHS.

Copies of Publication and Electronic AccessThis booklet and other substance abuse treatment-related prod-ucts are available from SAMHSA’s National Clearinghouse forAlcohol and Drug Information (NCADI). To receive free copies ofSAMHSA products, call NCADI at 800-729-6686 or 800-487-4889TDD (for the hearing impaired) or visit www.ncadi.samhsa.gov.

Recommended CitationCenter for Substance Abuse Treatment. What Is SubstanceAbuse Treatment? A Booklet for Families. DHHS Publication No.(SMA) 04-3955. Rockville, MD: Substance Abuse and MentalHealth Services Administration, 2004.

Originating OfficePractice Improvement Branch, Division of ServicesImprovement, Center for Substance Abuse Treatment,Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.

DHHS Publication No. (SMA) 04-3955Printed 2004

What Is Substance AbuseTreatment?

A Booklet for Families

U.S. Department of Health and Human ServicesSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Treatment1 Choke Cherry RoadRockville, MD 20857

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CONTENTS

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

What Is Substance Abuse? . . . . . . . . . . . . . . . . . . . .2

What Is Substance Abuse Treatment? . . . . . . . . . . . .5

Just for You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

I’m Afraid It Won’t Work . . . . . . . . . . . . . . . . . . . . .22

Especially for Young People . . . . . . . . . . . . . . . . . .24

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

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INTRODUCTIONThis booklet is for you, the family mem-ber of a person dependent on alcohol ordrugs. Whether your family member isdependent on alcohol, cocaine, heroin,marijuana, prescription medications, orother drugs, his or her dependenceaffects you and your family, too.

This booklet answers questions oftenasked by families of people entering treat-ment. The “Resources” section, at theback of this booklet, lists a selection ofsources for more information and sup-port groups available to you during thisstressful time. Take advantage of thishelp, ask treatment providers questions,and talk with supportive friends or otherfamily members about your feelings.

Millions of Americans abuse or aredependent on alcohol or drugs. All ofthese people have families—so remem-ber, you are not alone. The fact that yourfamily member is in treatment is a goodsign and a big step in the right direction.People with alcohol or drug depen-dence problems can and do recover.

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W H AT I S S U B S TA N C EA B U S E ?Alcoholism and drug dependence andaddiction, known as substance use disor-ders, are complex problems. People withthese disorders once were thought to havea character defect or moral weakness;some people mistakenly still believe that.However, most scientists and medicalresearchers now consider dependence onalcohol or drugs to be a long-term illness,like asthma, hypertension (high bloodpressure), or diabetes. Most people whodrink alcohol drink very little, and manypeople can stop taking drugs without astruggle. However, some people developa substance use disorder—use of alcoholor drugs that is compulsive or dangerous(or both).

Why Do Some People Developa Problem but Others Don’t?

Substance use disorder is an illness thatcan affect anyone: rich or poor, male orfemale, employed or unemployed, youngor old, and any race or ethnicity. Nobodyknows for sure exactly what causes it, butthe chance of developing a substance usedisorder depends partly on genetics—biological traits passed down throughfamilies. A person’s environment, psycho-logical traits, and stress level also playmajor roles by contributing to the use ofalcohol or drugs. Researchers have foundthat using drugs for a long time changesthe brain in important, long-lasting ways.It is as if a switch in the brain turned onat some point. This point is different forevery person, but when this switch turns

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on, the person crosses aninvisible line and becomesdependent on the substance.People who start using drugsor alcohol early in life run agreater risk of crossing thisline and becoming depen-dent. These changes in thebrain remain long after a person stops using drugs ordrinking alcohol.

Even though your familymember has an illness, itdoes not excuse the bad

behavior that often accom-panies it. Your loved one is not at fault for having adisease, but he or she isresponsible for gettingtreatment.

What Are theSymptoms ofSubstance UseDisorders?

One of the most importantsigns of substance addictionor dependence is continueduse of drugs or alcoholdespite experiencing the serious negative consequencesof heavy drug or alcohol use.Often, a person will blameother people or circumstancesfor his or her problemsinstead of realizing that thedifficulties result from use ofdrugs or alcohol. For example,your partner may believe hewas fired from jobs becausehis bosses didn’t know how torun a business. Or yourdaughter may believe she gota ticket for driving under theinfluence of alcohol becausethe police were targeting her.Perhaps your loved one haseven blamed you. People withthis illness really may believethat they drink normally orthat “everyone” takes drugs.These false beliefs are calleddenial, and denial is part ofthe illness.

Q: My husband says that heis an addict. How can this bepossible when he still has agood job?

A: Understanding how a person can be dependent onalcohol or drugs and stillkeep a good job is difficult.The media often portray people with substance usedisorders as unemployed,unproductive, criminal, andhomeless. However, manypeople who are dependenton alcohol or drugs do not fitthis stereotype; they havejobs and live with their fami-lies. The disease does tend toworsen over time. Eventually,your husband’s drug use mayincrease, and, with no help,he may begin to experiencemore serious problems. Theearlier your husband can gettreatment, the better chancehe has of recovery.

Other important symptoms ofsubstance use disorders include

Tolerance—A person willneed increasingly largeramounts of alcohol or drugsto get high.

Craving—A person will feela strong need, desire, orurge to use alcohol ordrugs, will use alcohol or a drug despite negative consequences, and will feelanxious and irritable if heor she can’t use them.Craving is a primary symptom of addiction.

Loss of control—A personoften will drink more alco-hol or take more drugs thanhe or she meant to, or mayuse alcohol or drugs at atime or place he or she hadnot planned. A person alsomay try to reduce or stopdrinking or using drugsmany times, but may fail.

Physical dependence orwithdrawal symptoms—In

some cases when alcohol or drug use is stopped, aperson may experience with-drawal symptoms from aphysical need for the sub-stance. Withdrawal symp-toms differ depending on thedrug, but they may includenausea, sweating, shakiness,and extreme anxiety. Theperson may try to relievethese symptoms by takingeither more of the same or asimilar substance.

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Q: My mother says there is nocure for this disease, so shedoesn’t need treatment. Isthat true?

A: Perhaps your mother doesnot understand the purposeof treatment. She is correctto some degree; a substanceuse disorder is often chronic—but it is treatable. This is alsotrue of many other long-termillnesses, such as diabetesand hypertension. Treatmentfor substance use disordersis designed to help peoplestop alcohol or drug use andremain sober and drug free.Recovery is a lifelong process.Staying in recovery is a difficult task, so your motherwill need to learn new waysof thinking, feeling, and acting. Treatment can helpyour mother accept, manage,and live with her illness.

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W H AT I S S U B S TA N C EA B U S E T R E AT M E N T ?

Who Provides Treatment?Many different kinds of professionals provide treatment for substance use disorders. In most treatment programs,the main caregivers are specially trainedindividuals certified or licensed as substance abuse treatment counselors.About half these counselors are peoplewho are in recovery themselves. Manyprograms have staff from several differentethnic or cultural groups.

Most treatment programs assign patientsto a treatment team of professionals.Depending on the type of treatment,teams can be made up of social workers,counselors, doctors, nurses, psychologists,psychiatrists, or other professionals.

What Will Happen First?

Everyone entering treatment receives aclinical assessment. A complete assess-ment of an individual is needed to helptreatment professionals offer the type oftreatment that best suits him or her. Theassessment also helps program coun-selors work with the person to design an effective treatment plan. Although clinical assessment continues throughouta person’s treatment, it starts at or justbefore a person’s admission to a treat-ment program. The counselor will beginby gathering information about the person, asking many questions such asthose about

Kinds, amount, and length of time ofsubstance or alcohol use

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Cultural issues around useof alcohol or drugs

Effects of drug or alcoholuse on the person’s life

Medical history

Current medical problemsor needs

Current medications(including pain medication)

Mental health issues orbehavioral problems

Family and social issues andneeds

Legal or financial problems

Educational backgroundand needs

Current living situation andenvironment

Employment history, stabili-ty, problems, and needs

School performance, prob-lems, and needs, if relevant

Previous treatment experi-ences or attempts to quitdrug or alcohol use.

The counselor may invite you,as a family member, to answerquestions and express yourown concerns as well. Be honest—this is not the time to cover up your loved one’sbehavior. The counselor needsto get a full picture of theproblem to plan and helpimplement the most effectivetreatment. It is particularlyimportant for the counselor to know whether your familymember has any serious med-ical problems or whether yoususpect that he or she mayhave an emotional problem.You may feel embarrassedanswering some of these questions or have difficultycompleting the interview, butremember: the counselor isthere to help you and yourloved one. The treatmentteam uses the informationgathered to recommend thebest type of treatment. No onetype of treatment is right foreveryone; to work, the treat-ment needs to meet your fam-ily member’s individual needs.

After the assessment, a coun-selor or case manager isassigned to your family mem-ber. The counselor works withthe person (and possibly hisor her family) to develop atreatment plan. This plan listsproblems, treatment goals, andways to meet those goals.

Based on the assessment, the counselor may refer yourfamily member to a physicianto decide whether he or she

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needs medical supervision tostop alcohol or drug use safely.

Medically supervised withdrawal (often calleddetoxification or detox) usesmedication to help peoplewithdraw from alcohol ordrugs. People who have beentaking large amounts of opioids(e.g., heroin, OxyContin7, orcodeine), barbiturates or sedatives (“downers”), painmedications, or alcohol—

either alone or together—mayneed medically monitored ormanaged withdrawal services.Sometimes, alcohol withdrawalcan be so severe that peoplehallucinate, have convulsions,or develop other dangerousconditions. Medication canhelp prevent or treat suchconditions. Anyone who hasonce had hallucinations orseizures from alcohol with-drawal or who has anotherserious illness or (in somecases) a mental disorder that could complicate detox-ification may need medicalsupervision to detoxify safely.Medically supervised with-drawal can take place on aregular medical ward of a hos-pital, in a specialized inpatientdetoxification unit, or on anoutpatient basis with closemedical supervision. Detoxifi-cation may take several daysto a week or more. Duringthat time, the person willreceive medical care and maybegin to receive educationabout his or her disease.

Q: My wife just started treatment. I called the pro-gram yesterday to ask thecounselor some questions.The counselor said that she“could not confirm or deny”that my wife was even there!What’s that about?

A: Federal and State laws protect an individual’s priva-cy in treatment. Before the counselor can talk to anyone(including you) about yourwife’s treatment, the programmust first have her permis-sion, in writing. Even if thecounselor knows that youknow your wife is there, shestill can’t even say that yourwife is in the program untilyour wife signs a “release ofinformation” or “disclosureauthorization” form. You maywant to talk to your wife andbe sure she understands thatyou would like to be involvedin the treatment program.

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Not everyone needs inpatientmedically supervised detox.People with mild withdrawalsymptoms from alcohol ordrugs and people usingcocaine, marijuana, opioids,or methamphetamine do not generally need to be hospitalized for detoxification.However, they may need out-patient medical care, a lot ofsupport, and someone toensure their well-being.

Social detoxification canmeet this need. Sometimessocial detoxification centersare part of a residential treat-ment program; other timesthey are separate facilities.Social detoxification centersare not hospitals and seldomuse medication, but the person does stay there fromseveral days to 1 week. Thesocial detoxification staffincludes nurses and coun-selors. The staff watches eachperson’s medical conditionclosely, and counselors areavailable to help him or her

through the most difficult partof withdrawing from alcoholand drugs.

It is important to know thatdetoxification is not treat-ment; it is a first step that canprepare a person for treatment.

What Types ofTreatment ProgramsAre Available?

Several types of treatment programs are available:

Inpatient treatment

Residential programs

Partial hospitalization or day treatment

Outpatient and intensiveoutpatient programs

Methadone clinics (alsocalled opioid treatment programs).

Inpatient treatment, providedin special units of hospitals ormedical clinics, offers bothdetoxification and rehabilita-tion services. Several years ago,many hospital-based treatmentprograms existed. Today,because of changes in insur-ance coverage, inpatient treat-ment is no longer as commonas it used to be. People whohave a mental disorder or seri-ous medical problems as wellas a substance use disorder are

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the ones most likely to receiveinpatient treatment. Adoles-cents may also need the struc-ture of inpatient treatment tomake sure a full assessment oftheir substance use and mentaldisorders can be done.

Residential programs pro-vide a living environment withtreatment services. Severalmodels of residential treat-ment (such as the therapeu-tic community) exist, andtreatment in these programslasts from a month to a yearor more. The programs differin some ways, but they aresimilar in many ways.

Residential programs oftenhave phases of treatment, withdifferent expectations andactivities during each phase.For example, in the first phase,an adult’s contact with family,friends, and job may berestricted. An adolescent maybe able to have contact withhis or her parents but not withfriends or with school. Thisrestriction helps the personbecome part of the treatmentcommunity and adjust to thetreatment setting. In a laterphase, a person may be able to start working again, going“home” to the facility everyevening. If your loved one is ina residential treatment pro-gram, it is important that youknow and understand the pro-gram rules and expectations.

Often residential programslast long enough to offer general equivalency diploma(GED) preparation classes,training in job-seeking skills,and even career training. Inresidential programs for ado-lescents, the participantsattend school as a part of theprogram. Some residentialprograms are designed toenable women who needtreatment to bring their children with them. Theseprograms offer child care and parenting classes.

Residential programs are bestfor people who do not havestable living or employmentsituations and/or have limitedor no family support. Resi-dential treatment may helppeople with very serious substance use disorders whohave been unable to get andstay sober or drug free inother treatment.

Partial hospitalization orday treatment programs also

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may be provided in hospitalsor free-standing clinics. Inthese programs, the personattends treatment for 4 to 8hours per day but lives at

home. These programs usuallylast for at least 3 months andwork best for people whohave a stable, supportivehome environment.

Outpatient and intensiveoutpatient programs providetreatment at a program site,but the person lives elsewhere(usually at home). Outpatienttreatment is offered in a varietyof places: health clinics, com-munity mental health clinics,counselors’ offices, hospitalclinics, local health departmentoffices, or residential programswith outpatient clinics. Manymeet in the evenings and onweekends so participants cango to school or work. Out-patient treatment programshave different requirementsfor attendance. Some pro-grams require daily atten-dance; others meet only oneto three times per week.

Intensive outpatient treat-ment programs require a person to attend 9 to 20 hoursof treatment activities perweek. Outpatient programs lastfrom about 2 months to 1 year.

People who do best in an outpatient program are willingto attend counseling sessionsregularly, have supportivefriends or family members,have a place to live, and havesome form of transportationto get to treatment sessions

Q: My brother is in a residen-tial treatment program. Hesays he can leave the programat any time. Is this true?

A: Yes. Everyone has theoption of leaving. All alcoholand drug abuse treatment isvoluntary, although theremay be consequences forleaving if the person is intreatment, for example, aspart of probation or parole. Ifyour brother chooses to leaveand treatment has not beencompleted, the treatmentstaff may ask him to signpapers stating that he is leav-ing treatment against med-ical advice. The staff also willtry to find out why he wantsto leave early and will try toaddress any concerns he has.

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(some programs will providetransportation if needed).

Opioid treatment programs(OTPs), sometimes known as methadone clinics, offermedication-assisted outpatienttreatment for people who aredependent on opioid drugs(such as heroin, OxyContin,or vicodin). These programsuse a medication, such asmethadone or LAAM, to help a person not use illicit opi-oids. OTPs provide counselingand other services along withthe medication.

What ActuallyHappens inTreatment Programs?

Although treatment programsdiffer, the basic ingredients oftreatment are similar. Mostprograms include many or allelements presented below.

AssessmentAs we discussed earlier, alltreatment programs beginwith a clinical assessment of aperson’s individual treatmentneeds. This assessment helpsin the development of aneffective treatment plan.

Medical CarePrograms in hospitals can provide this care on site. Otheroutpatient or residential pro-grams may have doctors and

nurses come to the programsite for a few days each week,or a person may be referred toother places for medical care.Medical care typically includesscreening and treatment forHIV/AIDS, hepatitis, tuberculo-sis, and women’s health issues.

A Treatment PlanThe treatment team, alongwith the person in treatment,develops a treatment planbased on the assessment. Atreatment plan is a writtenguide to treatment thatincludes the person’s goals,treatment activities designedto help him or her meet thosegoals, ways to tell whether agoal has been met, and atimeframe for meeting goals.The treatment plan helpsboth the person in treatmentand treatment program staffstay focused and on track.The treatment plan is adjust-ed over time to meet chang-ing needs and ensure that it stays relevant.

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Group and IndividualCounselingAt first, individual counselinggenerally focuses on motivatingthe person to stop using drugsor alcohol. Treatment thenshifts to helping the personstay drug and alcohol free.The counselor attempts tohelp the person

See the problem andbecome motivated to change

Change his or her behavior

Repair damaged relation-ships with family and friends

Build new friendships with people who don’t use alcohol or drugs

Create a recovery lifestyle.

Group counseling is differentin each program, but groupmembers usually support andtry to help one another copewith life without using drugsor alcohol. They share theirexperiences, talk about their

feelings and problems, andfind out that others have simi-lar problems. Groups also mayexplore spirituality and its rolein recovery.

Individual AssignmentsPeople in treatment may beasked to read certain things (or listen to audiotapes), tocomplete written assignments(or record them on audio-tapes), or to try new behaviors.

Education AboutSubstance Use DisordersPeople learn about the symp-toms and the effects of alcoholand drug use on their brainsand bodies. Education groupsuse videotapes or audiotapes,lectures, or activities to helppeople learn about their ill-ness and how to manage it.

Life Skills TrainingThis training can includelearning and practicingemployment skills, leisureactivities, social skills, commu-nication skills, anger manage-ment, stress management,goal setting, and money andtime management.

Testing for Alcohol orDrug UseProgram staff members regu-larly take urine samples frompeople for drug testing. Someprograms are starting to testsaliva instead of urine. Theyalso may use a BreathalyzerTM

to test people for alcohol use.

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Relapse PreventionTrainingRelapse prevention trainingteaches people how to identifytheir relapse triggers, how tocope with cravings, how todevelop plans for handlingstressful situations, and whatto do if they relapse. A triggeris anything that makes a personcrave a drug. Triggers often areconnected to the person’spast use, such as a person heor she used drugs with, a timeor place, drug use parapher-nalia (such as syringes, a pipe,or a bong), or a particular situation or emotion.

Orientation to Self-HelpGroupsParticipants in self-helpgroups support and encour-age one another to become orstay drug and alcohol free.Twelve-Step programs are per-haps the best known of theself-help groups. These pro-grams include AlcoholicsAnonymous (AA), NarcoticsAnonymous (NA), CocaineAnonymous, and MarijuanaAnonymous. Other self-helpgroups include SMART (SelfManagement and RecoveryTraining) Recovery7 andWomen for Sobriety.

Members themselves, nottreatment facilities, run self-help groups. In many places,self-help groups offer meet-ings for people with particularneeds. You may find special

meetings for young people;women; lesbian, gay, andbisexual people; newcomers;and those who need meetingsin languages other than

Q: What are these “sober life skills” my partner talksabout?

A: Sober life skills are thenew behaviors and ways ofliving that your partner willneed to work on. Before treat-ment, your partner spent agreat deal of time obtaining asubstance, using drugs ordrinking alcohol, and gettingover the substance’s effects.Most of his or her activitiescentered on drugs or alcohol.Most of his or her fun activi-ties included drinking alcoholor using drugs, and many ofyour partner’s friends used orabused substances, too. Forthese reasons, people recov-ering from substance use dis-orders need to learn a wholenew way to live and to makenew friends.

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English. Internet chat groupsand online meetings are alsoavailable for some groups.

Many treatment programs rec-ommend or require atten-dance at self-help groups. Byattending, many people makenew friends who help themstay in recovery. The numberof meetings required varies by treatment program; manyprograms require participantsto attend “90 meetings in 90days,” as AA and NA recom-mend. Some treatment pro-grams encourage people tofind a “sponsor,” that is,someone who has been in the group for a while and can offer personal supportand advice.

Self-help groups are veryimportant in most people’srecovery. It is important tounderstand, however, thatthese groups are not the sameas treatment.

There are self-help groups for family members, too, such

as Al-Anon and Alateen (seethe “Just for You” section ofthis booklet).

Treatment for MentalDisordersMany people with a substanceuse disorder also have emo-tional problems such asdepression, anxiety, or post-traumatic stress disorder.Adolescents in treatment alsomay have behavior problems,conduct disorder, or attentiondeficit/hyperactivity disorder.Treating both the substanceuse and mental disordersincreases the chances that theperson will recover. Somecounselors think peopleshould be alcohol and drugfree for at least 3 to 4 weeksbefore a treatment profession-al can identify emotional ill-ness correctly. The programmay provide mental healthcare, or it may refer a personto other sites for this care.Mental health care oftenincludes the use of medica-tions, such as antidepressants.

Family Education andCounseling ServicesThis education can help youunderstand the disease and itscauses, effects, and treatment.Programs provide this educa-tion in many ways: lectures,discussions, activities, andgroup meetings. Some pro-grams provide counseling forfamilies or couples.

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Family counseling is especiallycritical in treatment for ado-lescents. Parents need to beinvolved in treatment plan-ning and followup care deci-sions for the adolescent.Family members also need toparticipate as fully as possiblein the family counseling theprogram offers.

MedicationMany programs use medica-tions to help in the treatmentprocess. Although no medica-tions cure dependence ondrugs or alcohol, some dohelp people stay abstinent andcan be lifesaving.

Medication is the primaryfocus of some programs, suchas the medication-assistedOTPs discussed earlier.Methadone is a medicationthat prevents opioid with-drawal symptoms for about24 hours, so the person musttake it daily. Taken as direct-ed, it does not make a personhigh but allows him or her to function normally. In fact, methadone blocks the“high” a person gets from anopioid drug.

Some people stay on metha-done for only 6 months to 1 year and then gradually stop taking it; most of thesepeople relapse and begin touse opioids again. However,others stay on methadone for

long periods of time or for life,which is called methadonemaintenance treatment.People receiving this treatmentoften have good jobs and leadhappy, productive lives.

If your family member is taking medications for HIVinfection or AIDS or for anyother medical condition, it isimportant that OTP staff mem-bers know exactly what he orshe is taking. Mixing somemedications with methadoneor LAAM may mean that yourfamily member will need special medical supervision.

Buprenorphine is anothermedication that may be usedto treat opioid dependenceand is sometimes used byOTPs. Buprenorphine recentlywas approved for treatment byprimary care doctors in theiroffices. A doctor treating apatient with buprenorphinegenerally will provide or referthe patient for counseling, also.

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Disulfiram (Antabuse7) is a medication that causes a bad reaction if people drinkalcohol while taking it. Thereaction is flushing, nausea,vomiting, and anxiety. Becausepeople know the medicationwill make them very ill if theydrink alcohol, it helps themnot to drink it. Antabuse istaken daily.

Another medication, naltrex-one (ReVia7), reduces thecraving for alcohol. This med-ication can help keep peoplewho drink a small amount ofalcohol from drinking more ofit. Programs also sometimesuse naltrexone to treat heroinor other opioid dependencebecause it blocks the drug’seffects. It is important for people who use heroin to gothrough detox first, so theyare heroin free before startingto take naltrexone.

Because it is very difficult for aperson to detoxify from opi-oid drugs, many people don’tmake it that far; buprenor-phine is sometimes used tohelp people make that transi-tion. If a person does detoxifyfrom opioids and begins totake naltrexone, it still will notwork well for this purposeunless a person has a strongsocial support system, includ-ing someone who will makesure that he or she continuesto take the medication regu-larly. When an adolescent istaking naltrexone to treat opi-oid dependence, it is particu-larly important that parentsprovide strong support andsupervision.

Followup Care (AlsoCalled Continuing Care)Even when a person has suc-cessfully completed a treat-ment program, the danger of

Q: If substance use disorderis a disease, why aren’t theremedicines that will help?

A: There are medicines thatwill help, though only forsome addictions. No “magicpill” exists to cure substanceuse disorders, but medicinescan often be an importantpart of the treatment.Medications are used todetoxify a person, to preventhim or her from feeling highfrom taking drugs, to reducecravings, or to treat a per-son’s mental disorder.

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returning to alcohol or druguse (called a “slip” or relapse)remains. The longer a personstays in treatment, includingfollowup, the more likely heor she is to stay in recovery.Once a person has completedbasic treatment, a programwill offer a followup care pro-gram at the treatment facilityor will refer him or her toanother site. Most programsrecommend that a person stay in followup care for atleast 1 year. Adolescents oftenneed followup care for alonger period.

Followup care is veryimportant to successfultreatment. Once a person isback in his or her community,back in school, or back atwork, he or she will experi-ence many temptations andcravings for alcohol or drugs.In followup care, your familymember will meet periodicallywith a counselor or a group todetermine how he or she iscoping and to help him or her deal with the challenges of recovery.

For some people, particularlythose who have been in resi-dential treatment or prison-based programs, more inten-sive forms of followup caremay be helpful. Halfwayhouses or sober houses arealcohol- and drug-free placesto live for people coming from

a prison-based or residentialprogram. People usually stayfrom 3 months to 1 year, andcounseling is provided at thesite or at an outpatient facility.

Supportive living or transi-tional apartments providesmall group living arrange-ments for those who need asober and drug-free livingenvironment. The residentssupport one another, andinvolvement in outpatientcounseling and self-helpgroups is expected.

Why Does TreatmentTake So Long?

Substance use disorders affectevery part of a person’s life.For that reason, treatmentneeds to affect every part of aperson’s life as well.

Treatment involves more thanhelping someone stop drink-ing alcohol or using drugs.

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Actually, stopping alcohol useor drug use is just the begin-ning of the recovery process.Your family member will needto learn new ways to copewith daily life. He or she willneed to relearn how to dealwith stress, anger, or social sit-uations and how to have funwithout using drugs or drink-ing. Learning these new skillsis a lot of work.

Many people enter treatmentonly because of pressure fromthe legal system, employers,parents, spouses, or otherfamily members. The first stepin treatment then is to helpthem see that they do have aproblem and to become moti-vated to change for them-selves. This process oftentakes time.

Your family member also willneed time to understand andbegin to use the support of theself-help groups mentionedbefore. These groups will beimportant to his or her recov-ery for many years to come.

Remember: It can take a longtime for the disease to developand it is often chronic; there-fore, it can take a long time totreat it.

JUST FOR YOUNow that your family member is in treat-ment, things are starting to change. Someof the tension and turmoil that probablywere part of your life may be starting toease. But the first weeks of treatment arestressful. Each family member is adjustingto changes, starting to deal with past con-flicts, and establishing new routines. Amidall these changes, it is important that youtake good care of yourself—get enoughsleep, eat right, rest, exercise, and talk tosupportive friends and relatives. Yourchurch, mosque, synagogue, temple, orother spiritual organization also may be agood source of support.

Recovery is not just an adjustment for theperson in treatment—it also is an adjust-ment for you. For the past few years, youmay have assumed roles or taken care oftasks that were your loved one’s responsi-bilities. Now, as time passes, you and he orshe may need to learn new ways of relat-ing to each other and learn different waysof sharing activities and chores. If you arethe parent of an adolescent in treatment,you will need to be closely involved intreatment planning and treatment activi-ties. You may need to adjust your life andfamily relationships to allow for the extratime this involvement will take.

You may have many questions about howyour family member will behave in theseearly stages of recovery. Everyone acts dif-ferently. Some people are very happy tobe getting treatment at last; others suffera great deal while they adjust to a newlife and attempt to live it without alcoholand drugs. They may be sad, angry, orconfused. It is important for you to

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realize that these are normalreactions and to get supportfor yourself.

Al-Anon is the best-known andmost available resource forfamily members and friends ofalcoholics. Al-Anon was found-ed 50 years ago to provide sup-port for those living withsomeone with alcoholism.Alateen, for older children andadolescents, was foundedsomewhat later on. Today,many family members of peo-ple who use drugs also partici-pate in Al-Anon or Alateen.These meetings are free andavailable in most communities.

Your community also mayhave Nar-Anon meetings. Thisgroup was founded for fami-lies and friends of those usingdrugs. Other groups also maybe helpful, such as Co-Dependents Anonymous andAdult Children of Alcoholics.The treatment programshould be able to give youschedules of local meetings of all these groups, or you can

find contact information inthe “Resources” section of this booklet.

Many treatment professionalsconsider substance use disor-ders family diseases. To helpthe whole family recover andcope with the many changesgoing on, you may be asked totake part in treatment. Thisapproach may involve goingto a family education programor to counseling for familiesor couples.

It is important to rememberthe following points as youand your family memberrecover:

You are participating intreatment for yourself, notjust for the sake of the per-son who used substances.

Your loved one’s recovery,sobriety, or abstinence doesnot depend on you.

Your family’s recovery doesnot depend on the recoveryof the person who usedsubstances.

You did not cause your fam-ily member’s substance usedisorder. It is not your fault.

You still may have hurt feel-ings and anger from the pastthat need to be resolved. Youneed support to understandand deal with these feelings,and you need to support yourloved one’s efforts to get well.

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Remember: Help is alwaysthere for you, too. Ask the counselor for some suggestions, and check the “Resources” section of this booklet.

What if I Need HelpWith Basic LivingIssues?

You may need very practicalhelp while your family mem-ber is in treatment. If yourfamily member is the solefinancial provider and unableto work because he or she isin treatment, how will thebills get paid? If your familymember is the primary care-giver for children or an elder-ly adult, how will these needsbe met? The treatment pro-gram may be able to help youarrange disability leave orinsurance through your lovedone’s employer. Ask the

counselor about differenttypes of assistance that may be available to help you meetvarious needs. Most treatmentprograms work with othercommunity programs. Theseprograms may include foodpantries, clothing programs,transportation assistance,child care, adult day care,legal assistance, financialcounseling, and health careservices. Your family may beeligible for help from pro-grams that help those inrecovery.

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I’M AFRAID IT WON’TWORKTreatment is just the first step to recovery.During this process family memberssometimes have mixed feelings. You mayfeel exhausted, angry, relieved, worried,and afraid that, if this doesn’t work, nothing will. You may feel as if you arewalking on eggshells and that, if you dosomething wrong, you may cause yourloved one to relapse. It is important foryou to remember that you cannot cause arelapse—only the person who takes adrug or picks up a drink is responsiblefor that.

No one can predict whether your familymember will recover, or for how long,but many people who receive treatmentdo get better. The longer people stay intreatment the more likely they willremain drug and alcohol free. About halfthe people who complete treatment forthe first time continue to recover. Ofcourse, this means that about half willreturn to drinking alcohol and usingdrugs (called relapse) before they finallygive them up for good. Adolescents areeven more likely to use drugs or alcoholor both again. It is not uncommon for aperson to need to go through treatmentmore than one time. Often the personneeds to return to treatment quickly toprevent a slip or relapse from leading toa chronic problem.

It is important for you to understandthat relapse is often a part of the recov-ery process. Do not be discouraged ifyour family member uses alcohol or drugsagain. Many times relapses are short andthe person continues to recover.

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A treatment program mayinvolve you in relapse preven-tion planning and may helpyou learn what to do if yourfamily member relapses. Yourfamily member will benefit ifyou do not drink or use drugsaround him or her, especiallyin the first months after his orher treatment begins. Whenyou choose not to use drugsor alcohol, you help yourloved one avoid triggers. Asyou both begin to understandand accept the illness, the riskof relapse decreases. Thechanges in attitudes, behav-iors, and values that you bothare learning and practicingwill become part of your newrecovering lifestyle.

Q: My partner says a lot ofpeople in his group haverelapsed. What does thatmean?

A: Not all people in recoveryare able to stay sober. Whenthey cannot, it’s called relapse.Many people relapse a fewtimes. As with other chronic ill-nesses, such as diabetes orasthma, the symptoms cancome and go. Most treatmentprograms discuss relapseopenly and often. It is impor-tant that the person whorelapses return to treatmentright away, learn more abouthis or her relapse triggers, andimprove his or her copingskills. Returning quickly is asign of health (rather thansomething to be ashamed of)and a desire to begin workingtoward a life free of alcoholand drugs. It is important tounderstand the concept ofrelapse. It means that a per-son who had stopped drinkingalcohol or taking drugs for aperiod has started to drinkalcohol or use drugs again.Relapses may be very dis-heartening. However, a relapsedoes not mean that your fami-ly member will not recover.

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ESPECIALLY FORYOUNG PEOPLEYou may be having difficulty handlingsome of your concerns about living witha person who abuses alcohol or drugs.Whether this person is your mom, dad,grandparent, brother, or sister, it isimportant that you talk about your prob-lems, fears, and concerns with peoplewho are understanding and sympathetic.

You may feel that you caused your familymember’s substance use disorder or thatit is somehow your fault. You may thinkthat if you had behaved better, done bet-ter in school, or been different in someway your mom or dad or the person youcare about would not drink so muchalcohol or take drugs. You did not in anyway cause their disease. No one evercauses another person’s substance usedisorder. It is nobody’s fault that some-one you care about has become ill.

Your family member may have embar-rassed you in front of friends, teachers, oranother person. You may have stoppedbringing friends home or stopped tellingyour parents about school activities. Nowthat your relative is in treatment, his orher behavior should improve.

You may have lived with fighting andstress, and you may have been abused orwitnessed other kinds of violence. Youmay feel very angry and sad because ofthese experiences. Now you can talkabout this and other feelings with yourfamily or the staff at the treatment pro-gram. It will be important for you toshare your thoughts and feelings aboutwhat has happened. You may want to go

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to self-help groups such as Al-Anon or Alateen. Some youngpeople find these meetings to be helpful. These groupstalk about the three C’s: Youdidn’t Cause it, you can’tControl it, and you can’t Cureit. Remembering the three C’scan help.

It is important to know thatsubstance use disorders runin families. People who have ablood relative with a sub-stance use disorder are aboutfour times more likely todevelop the same disorder

than those who do not. Thismeans that you may haveinherited a tendency to devel-op a problem yourself, andyou should be careful aboutdrinking alcohol or takingdrugs. This information ismeant to educate you, not toscare you.

The situation at home willprobably improve becauseyour relative is in treatment.Like treatment for people withother illnesses, treatment forsubstance use disorders ishelpful, but not everyoneknows or believes it is. A greatdeal of stigma and shame arestill associated with substanceuse disorders. What and howmuch you tell your friends orteachers is your decision andyour family’s. You may justwant to say something like,“My mom is ill, but she willget better and come homesoon. Thank you for asking.”

You may choose to help educate some of your closefriends about your relative’sillness and his or her progressin treatment. Or, you maydecide not to share thisinformation with them. It’syour choice.

Remember, you didn’t createthis problem, but you canplay an important role inhelping everyone heal. Hangin there.

Q: My father is the one whodrinks too much alcohol. Whydo the counselors want totalk to me?

A: Treatment professionalsknow that substance use disorders affect the wholefamily. It makes sense, then,to offer help to the wholefamily. Some programs offerfamily education, and othersinvolve the family or couplesin counseling sessions. It’shard to grow up with a parentwho uses alcohol or drugs. Itcan be helpful if you learnmore about the disease andthe effect it has had on your family and on you. Talking tosomeone who understandssubstance use disorders canmake a big difference for you.

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GLOSSARYDenialThe thought process in which a persondoes not believe he or she has a problem,despite strong evidence to the contrary. Itis a way of protecting oneself from painfulthoughts or feelings.

Detoxification (or “detox”)A process that helps the body rid itself ofsubstances while the symptoms of with-drawal are treated. It is often a first step ina substance abuse treatment program.

Followup careAlso called continuing care. Treatment thatis prescribed after completion of inpatientor outpatient treatment. It can be partici-pation in individual or group counseling,regular contact with a counselor, or otheractivities designed to help people stay inrecovery.

Halfway house/sober houseA place to live for people recovering fromsubstance use disorders. Usually severalpeople in recovery live together with limit-ed or no supervision by a counselor.

Inpatient treatmentTreatment in a setting that is connected toa hospital or a hospital-type setting wherea person stays for a few days or weeks.

Outpatient treatmentTreatment provided at a facility. The services vary but do not include overnightaccommodation. Sometimes it is pre-scribed after inpatient treatment.

RelapseA recurrence of symptoms of a diseaseafter a period of improvement; that is, aperson in recovery drinks or uses drugsagain after a period of abstinence.

Relapse preventionAny strategy or activity thathelps keep a person in recov-ery from drinking alcohol orusing drugs again. It mayinclude developing new cop-ing responses; changingbeliefs and expectations; andchanging personal habits,lifestyles, and schedules.

Residential treatmentTreatment in a setting in whichboth staff and peers can helpwith treatment. It providesmore structure and moreintensive services than out-patient treatment. Participantslive in the treatment facility.Residential treatment is longterm, typically lasting from 1month to more than 1 year.

Self-help/12-Step groups Support groups consisting ofpeople in recovery that offer asafe place where recoveringpeople share their experi-ences, strengths, and hopes.AA’s 12 Steps help the mem-bers recover from addiction,addictive behavior, and emo-tional suffering. These groupsare free and are not support-ed by any particular treatmentprogram.

Supportive livingAlso called transitional apart-ments. A setting in which the

skills and attitudes needed forindependent living can belearned, practiced, and sup-ported. It provides a bridgebetween supervised care andindependent living.

Therapeutic communityLong-term residential treatment that focuses onbehavioral change and per-sonal responsibility in allareas of a person’s life, notjust substance use.

Treatment planA plan that provides a blueprint for treatment. Itdescribes the problems beingaddressed, the treatment’sgoals, and the specific stepsthat both the treatment pro-fessionals and the person intreatment will take.

Treatment teamA team of professionals (e.g.,clinical supervisor, counselor,therapist, and physician)responsible for treating a person and helping his or her family.

TriggerAny event, place, thing, smell,idea, emotion, or person thatsets off a craving to drinkalcohol or use drugs.

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RESOURCES

Federal GovernmentResourcesSubstance Abuse and MentalHealth Services Administration’s (SAMHSA’s) Substance AbuseTreatment Facility Locatorwww.findtreatment.samhsa.gov/facilitylocatordoc.htm

SAMHSA’s National Clearinghousefor Alcohol and Drug Information(NCADI)SAMHSA’s NCADI offers thousands of publications (most of them are free) andruns a 24-hour helpline (English andSpanish) for SAMHSA. Helpline operatorscan answer questions about substanceuse disorders, suggest written resources,and make treatment referrals using thenational Substance Abuse TreatmentFacility Locator.

11420 Rockville PikeRockville, MD 20852Helpline: 800-729-6686Local number: 301-770-5800TDD: 800-487-4889www.ncadi.samhsa.gov

SAMHSA’s National Mental HealthInformation Center 800-789-2647TDD: 866-889-2647www.mentalhealth.samhsa.gov

SAMHSA’s Center for SubstanceAbuse Treatment (CSAT)www.csat.samhsa.gov

SAMHSA’s Center for SubstanceAbuse Prevention (CSAP)www.csap.samhsa.gov

Other ResourcesThe following is a sampling,not a complete list, of avail-able resources. Inclusion onthis list does not implyendorsement by SAMHSA.

Most State and local govern-ments have an office on substance abuse issues thatcan be an excellent resource.There also may be an office ofthe Council on Alcoholismand Drug Dependence in your area; consult your localtelephone book.

Adult Children ofAlcoholicsWorld Service Organization,

Inc.P.O. Box 3216Torrance, CA 90510310-534-1815www.adultchildren.org

Al-Anon Family GroupHeadquarters, Inc.(Al-Anon and Alateen)1600 Corporate Landing

ParkwayVirginia Beach, VA 23454-5617888-4AL-ANON (meeting

information line)www.al-anon.alateen.orgSpanish Web site: www.al-anon.org/alaspan.html

Alcoholics AnonymousP.O. Box 459Grand Central StationNew York, NY 10163212-870-3400www.aa.org

Cocaine AnonymousWorld Services (CAWSO)3740 Overland Avenue, Suite CLos Angeles, CA 90034310-559-5833www.ca.org

Co-DependentsAnonymous (CoDA®)P.O. Box 33577Phoenix, AZ 85037-3577602-277-7991www.codependents.org

Dual RecoveryAnonymous (DRA)Central Service OfficeP.O. Box 8107Prairie Village, KS 66208877-883-2332www.draonline.org

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Jewish Alcoholics,Chemically DependentPersons and SignificantOthers (JACS)850 Seventh AvenueNew York, NY 10019212-397-4197www.jacsweb.org

Join TogetherOne Appleton Street Fourth FloorBoston, MA 02116-5223617-437-1500www.jointogether.org

Marijuana AnonymousWorld ServicesP.O. Box 2912Van Nuys, CA 91404800-766-6779www.marijuana-anonymous.org

Nar-Anon22527 Crenshaw BoulevardSuite 200 BTorrance, CA 90505310-547-5800

Narcotics AnonymousWorld Services OfficeP.O. Box 9999Van Nuys, CA 91409818-773-9999www.na.org

National Asian PacificAmerican FamiliesAgainst SubstanceAbuse (NAPAFASA)340 East Second StreetSuite 409Los Angeles, CA 90012213-625-5795www.napafasa.org

National Association forChildren of Alcoholics(NACoA)11426 Rockville PikeSuite 100Rockville, MD 20852888-554-COASwww.nacoa.org

National Association forNative AmericanChildren of Alcoholics(NANACOA)c/o White Bison, Inc.6145 Lehman Drive, Suite 200Colorado Springs, CO 80918719-548-1000www.whitebison.org/nanacoa

National Association onAlcohol, Drugs andDisability (NAADD)2165 Bunker Hill Drive San Mateo, CA 94402-3801 650-578-8047

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National BlackAlcoholism & AddictionsCouncil (NBAC)5104 North Orange Blossom

Trail, Suite 207Orlando, FL 32810407-532-2747www.nbacinc.org

National Clearinghouseon Families and Youth(NCFY)P.O. Box 13505 Silver Spring, MD 20911-3505301-608-8098www.ncfy.com

National Families inAction (NFIA)2957 Clairmont Road N.E.Suite 150Atlanta, GA 30329404-248-9676www.nationalfamilies.org

Nicotine Anonymous419 Main Street, PMB 370Huntington Beach, CA 92648415-750-0328www.nicotine-anonymous.org

Parents, Families andFriends of Lesbians andGays (PFLAG)1726 M Street, N.W.Suite 400Washington, DC 20036202-467-8180www.pflag.org

Secular Organizationsfor Sobriety/Save OurSelves (SOS)Clearinghouse4773 Hollywood BoulevardHollywood, CA 90027 323-666-4295www.secularsobriety.org

SMART Recovery7537 Mentor AvenueSuite #306Mentor, Ohio 44060 440-951-5357www.smartrecovery.org

Su Familia: The NationalHispanic Family HealthHelpline866-SuFamilia (783-2645)

Women for Sobriety, Inc.P.O. Box 618Quakertown, PA 18951-0618215-536-8026www.womenforsobriety.org

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Place clinic sticker here

DHHS Publication No. (SMA) 04-3955NCADI Publication No. BKD503

U.S. Department of Health and Human ServicesSubstance Abuse and Mental Health Services Administration