**What Is Substance Abuse Treatment?**

**A Booklet for Families**

**U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES**

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Acknowledgments

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

Disclaimer

The views and opinions contained in this publication do not necessarily
reflect the views or policies of CSAT, SAMHSA, or DHHS.

Public Domain Notice

All material appearing in this booklet is in the public domain and may
be reproduced or copied without permission from SAMHSA. Citation of the
source is appreciated. However, this publication may not be reproduced
or distributed for a fee without specific, written authorization from
the Office of Communications, SAMHSA, DHHS.

Copies of Publication and Electronic Access

This booklet and other substance abuse treatment-related products are
available from SAMHSA's National Clearinghouse for Alcohol and Drug
Information (NCADI). To receive free copies of SAMHSA products, call
NCADI at 800-729-6686 or 800-487-4889 TDD (for the hearing impaired) or
visit [www.ncadi.samhsa.gov](http://www.ncadi.samhsa.gov/). This
publication can be accessed electronically through
[www.kap.samhsa.gov](http://www.kap.samhsa.gov/).

Recommended Citation

Center for Substance Abuse Treatment. *What Is Substance Abuse
Treatment? A Booklet for Families*. DHHS Publication No. (SMA) 07-4126.
Rockville, MD: Substance Abuse and Mental Health Services
Administration, 2004, reprinted 2005, 2006, and 2007.

Originating Office

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

DHHS Publication No. (SMA) 07-4126

Printed 2004

Reprinted 2005, 2006, and 2007

What Is Substance Abuse Treatment?

A Booklet for Families

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

1 Choke Cherry Road

Rockville, MD 20857

CONTENTS

Introduction

What Is Substance Abuse?

What Is Substance Abuse Treatment?

Just for You

I'm Afraid It Won't Work

Especially for Young People

Glossary

Resources

INTRODUCTION

This booklet is for you, the family member of a person dependent on
alcohol or drugs. Whether your family member is dependent on alcohol,
cocaine, heroin, marijuana, prescription medications, or other drugs,
his or her dependence affects you and your family, too.

This booklet answers questions often asked by families of people
entering treatment. The "Resources" section, at the back of this
booklet, lists a selection of sources for more information and support
groups available to you during this stressful time. Take advantage of
this help, ask treatment providers questions, and talk with supportive
friends or other family members about your feelings.

Millions of Americans abuse or are dependent on alcohol or drugs. All of
these people have families---so remember, you are not alone. The fact
that your family member is in treatment is a good sign and a big step in
the right direction. **People with alcohol or drug dependence problems
can and do recover.**

WHAT IS SUBSTANCE ABUSE?

Alcoholism and drug dependence and addiction, known as *substance use
disorders*, are complex problems. People with these disorders once were
thought to have a character defect or moral weakness; some people
mistakenly still believe that. However, most scientists and medical
researchers now consider dependence on alcohol or drugs to be a
long-term illness, like asthma, hypertension (high blood pressure), or
diabetes. Most people who drink alcohol drink very little, and many
people can stop taking drugs without a struggle. However, some people
develop a *substance use disorder*---use of alcohol or drugs that is
compulsive or dangerous (or both).

Why Do Some People Develop a Problem but Others Don't?

Substance use disorder is an illness that can affect anyone: rich or
poor, male or female, employed or unemployed, young or old, and any race
or ethnicity. Nobody knows for sure exactly what causes it, but the
chance of developing a substance use disorder depends partly on
genetics---biological traits passed down through families. A person's
environment, psychological traits, and stress level also play major
roles by contributing to the use of alcohol or drugs. Researchers have
found that using drugs for a long time changes the brain in important,
long-lasting ways. It is as if a switch in the brain turned on at some
point. This point is different for every person, but when this switch
turns on, the person crosses an invisible line and becomes dependent on
the substance. People who start using drugs or alcohol early in life run
a greater risk of crossing this line and becoming dependent. These
changes in the brain remain long after a person stops using drugs or
drinking alcohol.

**Even though your family member has an illness, it does not excuse the
bad behavior that often accompanies it. Your loved one is not at fault
for having a disease, but he or she is responsible for getting
treatment.**

What Are the Symptoms of Substance Use Disorders?

One of the most important signs of substance addiction or dependence is
continued use of drugs or alcohol despite experiencing the serious
negative consequences of heavy drug or alcohol use. Often, a person will
blame other people or circumstances for his or her problems instead of
realizing that the difficulties result from use of drugs or alcohol. For
example, your partner may believe he was fired from jobs because his
bosses didn't know how to run a business. Or your daughter may believe
she got a ticket for driving under the influence of alcohol because the
police were targeting her. Perhaps your loved one has even blamed you.
People with this illness really may believe that they drink normally or
that "everyone" takes drugs. These false beliefs are called **denial,**
and denial is part of the illness.

Q: My husband says that he is an addict. How can this be possible when
he still has a good job?

A: Understanding how a person can be dependent on alcohol or drugs and
still keep a good job is difficult. The media often portray people with
substance use disorders as unemployed, unproductive, criminal, and
homeless. However, many people who are dependent on alcohol or drugs do
not fit this stereotype; they have jobs and live with their families.
The disease does tend to worsen over time. Eventually, your husband's
drug use may increase, and, with no help, he may begin to experience
more serious problems. The earlier your husband can get treatment, the
better chance he has of recovery.

Other important symptoms of substance use disorders include

-   **Tolerance---**A person will need increasingly larger amounts of
    alcohol or drugs to get high.

-   **Craving---**A person will feel a strong need, desire, or urge to
    use alcohol or drugs, will use alcohol or a drug despite negative
    consequences, and will feel anxious and irritable if he or she can't
    use them. Craving is a primary symptom of *addiction*.

-   **Loss of control---**A person often will drink more alcohol or take
    more drugs than he or she meant to, or may use alcohol or drugs at a
    time or place he or she had not planned. A person also may try to
    reduce or stop drinking or using drugs many times, but may fail.

-   **Physical *dependence* or withdrawal symptoms---**In some cases
    when alcohol or drug use is stopped, a person may experience
    withdrawal symptoms from a physical need for the substance.
    Withdrawal symptoms differ depending on the drug, but they may
    include nausea, sweating, shakiness, and extreme anxiety. The person
    may try to relieve these symptoms by taking either more of the same
    or a similar substance.

Q: My mother says there is no cure for this disease, so she doesn't need
treatment. Is that true?

A: Perhaps your mother does not understand the purpose of treatment. She
is correct to some degree; a substance use disorder is often
chronic---but it is treatable. This is also true of many other long-term
illnesses, such as diabetes and hypertension. Treatment for substance
use disorders is designed to help people stop alcohol or drug use and
remain sober and drug free. Recovery is a lifelong process. Staying in
recovery is a difficult task, so your mother will need to learn new ways
of thinking, feeling, and acting. Treatment can help your mother accept,
manage, and live with her illness.

WHAT IS SUBSTANCE ABUSE TREATMENT?

Who Provides Treatment?

Many different kinds of professionals provide treatment for substance
use disorders. In most treatment programs, the main caregivers are
specially trained individuals certified or licensed as substance abuse
treatment counselors. About half these counselors are people who are in
recovery themselves. Many programs have staff from several different
ethnic or cultural groups.

Most treatment programs assign patients to 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 a clinical assessment. A complete
assessment of an individual is needed to help treatment professionals
offer the *type* of treatment that best suits him or her. The assessment
also helps program counselors work with the person to design an
effective treatment *plan*. Although clinical assessment continues
throughout a person's treatment, it starts at or just before a person's
admission to a treatment program. The counselor will begin by gathering
information about the person, asking many questions such as those about

-   Kinds, amount, and length of time of substance or alcohol use

```{=html}
<!-- -->
```
-   Cultural issues around use of alcohol or drugs

-   Effects of drug or alcohol use on the person's life

-   Medical history

-   Current medical problems or needs

-   Current medications (including pain medication)

-   Mental health issues or behavioral problems

-   Family and social issues and needs

-   Legal or financial problems

-   Educational background and needs

-   Current living situation and environment

-   Employment history, stability, problems, and needs

-   School performance, problems, and needs, if relevant

-   Previous treatment experiences or attempts to quit drug or alcohol
    use.

The counselor may invite you, as a family member, to answer questions
and express your own concerns as well. Be honest---this is not the time
to cover up your loved one's behavior. The counselor needs to get a full
picture of the problem to plan and help implement the most effective
treatment. It is particularly important for the counselor to know
whether your family member has any serious medical problems or whether
you suspect that he or she may have an emotional problem. You may feel
embarrassed answering some of these questions or have difficulty
completing the interview, but remember: the counselor is there to help
you and your loved one. The treatment team uses the information gathered
to recommend the best type of treatment. No one type of treatment is
right for everyone; to work, the treatment needs to meet your family
member's individual needs.

After the assessment, a counselor or case manager is assigned to your
family member. The counselor works with the person (and possibly his or
her family) to develop a **treatment plan.** This plan lists problems,
treatment goals, and ways to meet those goals.

Based on the assessment, the counselor may refer your family member to a
physician to decide whether he or she needs medical supervision to stop
alcohol or drug use safely.

**Medically supervised withdrawal** (often called detoxification or
detox) uses medication to help people withdraw from alcohol or drugs.
People who have been taking large amounts of opioids (e.g., heroin,
OxyContin7, or codeine), barbiturates or sedatives ("downers"), pain
medications, or alcohol---either alone or together---may need medically
monitored or managed withdrawal services. Sometimes, alcohol withdrawal
can be so severe that people hallucinate, have convulsions, or develop
other dangerous conditions. Medication can help prevent or treat such
conditions. Anyone who has once had hallucinations or seizures from
alcohol withdrawal or who has another serious illness or (in some cases)
a mental disorder that could complicate detoxification may need medical
supervision to detoxify safely. Medically supervised withdrawal can take
place on a regular medical ward of a hospital, in a specialized
inpatient detoxification unit, or on an outpatient basis with close
medical supervision. Detoxification may take several days to a week or
more. During that time, the person will receive medical care and may
begin to receive education about his or her disease.

Not everyone needs inpatient medically supervised detox. People with
mild withdrawal symptoms from alcohol or drugs and people using cocaine,
marijuana, opioids, or methamphetamine do not generally need to be
hospitalized for detoxification. However, they may need outpatient
medical care, a lot of support, and someone to ensure their well-being.

**Social detoxification** can meet this need. Sometimes social
detoxification centers are part of a residential treatment program;
other times they are separate facilities. Social detoxification centers
are not hospitals and seldom use medication, but the person does stay
there from several days to 1 week. The social detoxification staff
includes nurses and counselors. The staff watches each person's medical
condition closely, and counselors are available to help him or her
through the most difficult part of withdrawing from alcohol and drugs.

It is important to know that **detoxification is not treatment;** it is
a first step that can prepare a person for treatment.

Q: My wife just started treatment. I called the program yesterday to ask
the counselor 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 privacy in treatment.
Before the counselor can talk to anyone (including you) about your
wife's treatment, the program must first have her permission, *in
writing*. Even if the counselor knows that you know your wife is there,
she still can't even say that your wife is in the program until your
wife signs a "release of information" or "disclosure authorization"
form. You may want to talk to your wife and be sure she understands that
you would like to be involved in the treatment program.

What Types of Treatment Programs Are Available?

Several types of treatment programs are available:

-   Inpatient treatment

-   Residential programs

-   Partial hospitalization or day treatment

-   Outpatient and intensive outpatient programs

-   Methadone clinics (also called opioid treatment programs).

**Inpatient treatment,** provided in special units of hospitals or
medical clinics, offers both detoxification and rehabilitation services.
Several years ago, many hospital-based treatment programs existed.
Today, because of changes in insurance coverage, inpatient treatment is
no longer as common as it used to be. People who have a mental disorder
or serious medical problems as well as a substance use disorder are the
ones most likely to receive inpatient treatment. Adolescents may also
need the structure of inpatient treatment to make sure a full assessment
of their substance use and mental disorders can be done.

**Residential programs** provide a living environment with treatment
services. Several models of residential treatment (such as the
**therapeutic community**) exist, and treatment in these programs lasts
from a month to a year or more. The programs differ in some ways, but
they are similar in many ways.

Residential programs often have phases of treatment, with different
expectations and activities during each phase. For example, in the first
phase, an adult's contact with family, friends, and job may be
restricted. An adolescent may be able to have contact with his or her
parents but not with friends or with school. This restriction helps the
person become part of the treatment community and adjust to the
treatment setting. In a later phase, a person may be able to start
working again, going "home" to the facility every evening. If your loved
one is in a residential treatment program, it is important that you know
and understand the program rules and expectations.

Often residential programs last long enough to offer general equivalency
diploma (GED) preparation classes, training in job-seeking skills, and
even career training. In residential programs for adolescents, the
participants attend school as a part of the program. Some residential
programs are designed to enable women who need treatment to bring their
children with them. These programs offer child care and parenting
classes.

Residential programs are best for people who do not have stable living
or employment situations and/or have limited or no family support.
Residential treatment may help people with very serious substance use
disorders who have been unable to get and stay sober or drug free in
other treatment.

**Partial hospitalization or day treatment** programs also may be
provided in hospitals or free-standing clinics. In these programs, the
person attends treatment for 4 to 8 hours per day but lives at home.
These programs usually last for at least 3 months and work best for
people who have a stable, supportive home environment.

**Outpatient and intensive outpatient programs** provide treatment at a
program site, but the person lives elsewhere (usually at home).
Outpatient treatment is offered in a variety of places: health clinics,
community mental health clinics, counselors' offices, hospital clinics,
local health department offices, or residential programs with outpatient
clinics. Many meet in the evenings and on weekends so participants can
go to school or work. Outpatient treatment programs have different
requirements for attendance. Some programs require daily attendance;
others meet only one to three times per week.

**Intensive outpatient treatment** programs require a person to attend 9
to 20 hours of treatment activities per week. Outpatient programs last
from about 2 months to 1 year.

People who do best in an outpatient program are willing to attend
counseling sessions regularly, have supportive friends or family
members, have a place to live, and have some form of transportation to
get to treatment sessions (some programs will provide transportation if
needed).

**Opioid treatment programs (OTPs),** sometimes known as methadone
clinics, offer medication-assisted outpatient treatment for people who
are dependent on opioid drugs (such as heroin, OxyContin, or vicodin).
These programs use a medication, such as methadone or LAAM, to help a
person not use illicit opioids. OTPs provide counseling and other
services along with the medication.

Q: My brother is in a residential treatment program. He says he can
leave the program at any time. Is this true?

A: Yes. Everyone has the option of leaving. All alcohol and drug abuse
treatment is voluntary, although there may be consequences for leaving
if the person is in treatment, for example, as part of probation or
parole. If your brother chooses to leave and treatment has not been
completed, the treatment staff may ask him to sign papers stating that
he is leaving treatment against medical advice. The staff also will try
to find out why he wants to leave early and will try to address any
concerns he has.

What Actually Happens in Treatment Programs?

Although treatment programs differ, the basic ingredients of treatment
are similar. Most programs include many or all elements presented below.

Assessment

As we discussed earlier, all treatment programs begin with a clinical
assessment of a person's individual treatment needs. This assessment
helps in the development of an effective treatment plan.

Medical Care

Programs in hospitals can provide this care on site. Other outpatient or
residential programs may have doctors and nurses come to the program
site for a few days each week, or a person may be referred to other
places for medical care. Medical care typically includes screening and
treatment for HIV/AIDS, hepatitis, tuberculosis, and women's health
issues.

A Treatment Plan

The treatment team, along with the person in treatment, develops a
treatment plan based on the assessment. A treatment plan is a written
guide to treatment that includes the person's goals, treatment
activities designed to help him or her meet those goals, ways to tell
whether a goal has been met, and a timeframe for meeting goals. The
treatment plan helps both the person in treatment and treatment program
staff stay focused and on track. The treatment plan is adjusted over
time to meet changing needs and ensure that it stays relevant.

Group and Individual Counseling

At first, individual counseling generally focuses on motivating the
person to stop using drugs or alcohol. Treatment then shifts to helping
the person stay drug and alcohol free. The counselor attempts to help
the person

-   See the problem and become motivated to change

-   Change his or her behavior

-   Repair damaged relationships with family and friends

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

-   Create a recovery lifestyle.

Group counseling is different in each program, but group members usually
support and try to help one another cope with life without using drugs
or alcohol. They share their experiences, talk about their feelings and
problems, and find out that others have similar problems. Groups also
may explore spirituality and its role in recovery.

Individual Assignments

People in treatment may be asked to read certain things (or listen to
audiotapes), to complete written assignments (or record them on
audiotapes), or to try new behaviors.

Education About Substance Use Disorders

People learn about the symptoms and the effects of alcohol and drug use
on their brains and bodies. Education groups use videotapes or
audiotapes, lectures, or activities to help people learn about their
illness and how to manage it.

Life Skills Training

This training can include learning and practicing employment skills,
leisure activities, social skills, communication skills, anger
management, stress management, goal setting, and money and time
management.

Testing for Alcohol or Drug Use

Program staff members regularly take urine samples from people for drug
testing. Some programs are starting to test saliva instead of urine.
They also may use a Breathalyzer™ to test people for alcohol use.

Relapse Prevention Training

Relapse prevention training teaches people how to identify their relapse
triggers, how to cope with cravings, how to develop plans for handling
stressful situations, and what to do if they relapse. A trigger is
anything that makes a person crave a drug. Triggers often are connected
to the person's past use, such as a person he or she used drugs with, a
time or place, drug use paraphernalia (such as syringes, a pipe, or a
bong), or a particular situation or emotion.

Orientation to Self-Help Groups

Participants in self-help groups support and encourage one another to
become or stay drug and alcohol free. Twelve-Step programs are perhaps
the best known of the self-help groups. These programs include
Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous,
and Marijuana Anonymous. Other self-help groups include SMART (Self
Management and Recovery Training) Recovery® and Women for Sobriety.

Members themselves, not treatment facilities, run self-help groups. In
many places, self-help groups offer meetings for people with particular
needs. You may find special meetings for young people; women; lesbian,
gay, and bisexual people; newcomers; and those who need meetings in
languages other than English. Internet chat groups and online meetings
are also available for some groups.

Many treatment programs recommend or require attendance at self-help
groups. By attending, many people make new friends who help them stay in
recovery. The number of meetings required varies by treatment program;
many programs require participants to attend "90 meetings in 90 days,"
as AA and NA recommend. Some treatment programs encourage people to find
a "sponsor," that is, someone who has been in the group for a while and
can offer personal support and advice.

Self-help groups are very important in most people's recovery. It is
important to understand, however, that these groups are *not* the same
as treatment.

There are self-help groups for family members, too, such as Al-Anon and
Alateen (see the "Just for You" section of this booklet).

Q: What are these "sober life skills" my partner talks about?

A: Sober life skills are the new behaviors and ways of living that your
partner will need to work on. Before treatment, your partner spent a
great deal of time obtaining a substance, using drugs or drinking
alcohol, and getting over the substance's effects. Most of his or her
activities centered on drugs or alcohol. Most of his or her fun
activities included drinking alcohol or using drugs, and many of your
partner's friends used or abused substances, too. For these reasons,
people recovering from substance use disorders need to learn a whole new
way to live and to make new friends.

Treatment for Mental Disorders

Many people with a substance use disorder also have emotional problems
such as depression, anxiety, or posttraumatic stress disorder.
Adolescents in treatment also may have behavior problems, conduct
disorder, or attention deficit/hyperactivity disorder. Treating both the
substance use and mental disorders increases the chances that the person
will recover. Some counselors think people should be alcohol and drug
free for at least 3 to 4 weeks before a treatment professional can
identify emotional illness correctly. The program may provide mental
health care, or it may refer a person to other sites for this care.
Mental health care often includes the use of medications, such as
antidepressants.

Family Education and Counseling Services

This education can help you understand the disease and its causes,
effects, and treatment. Programs provide this education in many ways:
lectures, discussions, activities, and group meetings. Some programs
provide counseling for families or couples. Family counseling is
especially critical in treatment for adolescents. Parents need to be
involved in treatment planning and followup care decisions for the
adolescent. Family members also need to participate as fully as possible
in the family counseling the program offers.

Medication

Many programs use medications to help in the treatment process. Although
no medications cure dependence on drugs or alcohol, some do help people
stay abstinent and can be lifesaving.

Medication is the primary focus of some programs, such as the
medication-assisted OTPs discussed earlier. Methadone is a medication
that prevents opioid withdrawal symptoms for about 24 hours, so the
person must take it daily. Taken as directed, it does not make a person
high but allows him or her to function normally. In fact, methadone
blocks the "high" a person gets from an opioid drug.

Some people stay on methadone for only 6 months to 1 year and then
gradually stop taking it; most of these people relapse and begin to use
opioids again. However, others stay on methadone for long periods of
time or for life, which is called **methadone maintenance treatment.**
People receiving this treatment often have good jobs and lead happy,
productive lives.

If your family member is taking medications for HIV infection or AIDS or
for any other medical condition, it is important that OTP staff members
know exactly what he or she is taking. Mixing some medications with
methadone or LAAM may mean that your family member will need special
medical supervision.

Buprenorphine is another medication that may be used to treat opioid
dependence and is sometimes used by OTPs. Buprenorphine recently was
approved for treatment by primary care doctors in their offices. A
doctor treating a patient with buprenorphine generally will provide or
refer the patient for counseling, also.

**Disulfiram (Antabuse**7**)** is a medication that causes a bad
reaction if people drink alcohol while taking it. The reaction is
flushing, nausea, vomiting, and anxiety. Because people know the
medication will make them very ill if they drink alcohol, it helps them
not to drink it. Antabuse is taken daily.

Another medication, **naltrexone (ReVia**7**)**, reduces the craving for
alcohol. This medication can help keep people who drink a small amount
of alcohol from drinking more of it. Programs also sometimes use
naltrexone to treat heroin or other opioid dependence because it blocks
the drug's effects. It is important for people who use heroin to go
through detox first, so they are heroin free before starting to take
naltrexone.

Because it is very difficult for a person to detoxify from opioid drugs,
many people don't make it that far; buprenorphine is sometimes used to
help people make that transition. If a person does detoxify from opioids
and begins to take naltrexone, it still will not work well for this
purpose unless a person has a strong social support system, including
someone who will make sure that he or she continues to take the
medication regularly. When an adolescent is taking naltrexone to treat
opioid dependence, it is particularly important that parents provide
strong support and supervision.

Q: If substance use disorder is a disease, why aren't there medicines
that will help?

A: There are medicines that will help, though only for some addictions.
No "magic pill" exists to cure substance use disorders, but medicines
can often be an important part of the treatment. Medications are used to
detoxify a person, to prevent him or her from feeling high from taking
drugs, to reduce cravings, or to treat a person's mental disorder.

Followup Care (Also Called Continuing Care)

Even when a person has successfully completed a treatment program, the
danger of returning to alcohol or drug use (called a "slip" or relapse)
remains. The longer a person stays in treatment, including followup, the
more likely he or she is to stay in recovery. Once a person has
completed basic treatment, a program will offer a followup care program
at the treatment facility or will refer him or her to another site. Most
programs recommend that a person stay in followup care for at least 1
year. Adolescents often need followup care for a longer period.

**Followup care is very important to successful treatment.** Once a
person is back in his or her community, back in school, or back at work,
he or she will experience many temptations and cravings for alcohol or
drugs. In followup care, your family member will meet periodically with
a counselor or a group to determine how he or she is coping and to help
him or her deal with the challenges of recovery.

For some people, particularly those who have been in residential
treatment or prison-based programs, more intensive forms of followup
care may be helpful. **Halfway houses or sober houses** are alcohol- and
drug-free places to live for people coming from a prison-based or
residential program. People usually stay from 3 months to 1 year, and
counseling is provided at the site or at an outpatient facility.

**Supportive living or transitional apartments** provide small group
living arrangements for those who need a sober and drug-free living
environment. The residents support one another, and involvement in
outpatient counseling and self-help groups is expected.

Why Does Treatment Take So Long?

Substance use disorders affect every part of a person's life. For that
reason, treatment needs to affect every part of a person's life as well.

Treatment involves more than helping someone stop drinking alcohol or
using drugs.

Actually, *stopping* alcohol use or drug use is just the beginning of
the recovery process. Your family member will need to learn new ways to
cope with daily life. He or she will need to relearn how to deal with
stress, anger, or social situations and how to have fun without using
drugs or drinking. Learning these new skills is a lot of work.

Many people enter treatment only because of pressure from the legal
system, employers, parents, spouses, or other family members. The first
step in treatment then is to help them see that they do have a problem
and to become motivated to change for themselves. This process often
takes time.

Your family member also will need time to understand and begin to use
the support of the self-help groups mentioned before. These groups will
be important to his or her recovery for many years to come.

Remember: It can take a long time for the disease to develop and it is
often chronic; therefore, it can take a long time to treat it.

JUST FOR YOU

Now that your family member is in treatment, things are starting to
change. Some of the tension and turmoil that probably were part of your
life may be starting to ease. But the first weeks of treatment are
stressful. Each family member is adjusting to changes, starting to deal
with past conflicts, and establishing new routines. Amid all these
changes, it is important that you take good care of yourself---get
enough sleep, eat right, rest, exercise, and talk to supportive friends
and relatives. Your church, mosque, synagogue, temple, or other
spiritual organization also may be a good source of support.

Recovery is not just an adjustment for the person in treatment---it also
is an adjustment for you. For the past few years, you may have assumed
roles or taken care of tasks that were your loved one's
responsibilities. Now, as time passes, you and he or she may need to
learn new ways of relating to each other and learn different ways of
sharing activities and chores. If you are the parent of an adolescent in
treatment, you will need to be closely involved in treatment planning
and treatment activities. You may need to adjust your life and family
relationships to allow for the extra time this involvement will take.

You may have many questions about how your family member will behave in
these early stages of recovery. Everyone acts differently. Some people
are very happy to be getting treatment at last; others suffer a great
deal while they adjust to a new life and attempt to live it without
alcohol and drugs. They may be sad, angry, or confused. It is important
for you to realize that these are normal reactions and to get support
for yourself.

Al-Anon is the best-known and most available resource for family members
and friends of alcoholics. Al-Anon was founded 50 years ago to provide
support for those living with someone with alcoholism. Alateen, for
older children and adolescents, was founded somewhat later on. Today,
many family members of people who use drugs also participate in Al-Anon
or Alateen. These meetings are free and available in most communities.

Your community also may have Nar-Anon meetings. This group was founded
for families and friends of those using drugs. Other groups also may be
helpful, such as Co-Dependents Anonymous and Adult Children of
Alcoholics. The treatment program should be able to give you schedules
of local meetings of all these groups, or you can find contact
information in the "Resources" section of this booklet.

Many treatment professionals consider substance use disorders family
diseases. To help the whole family recover and cope with the many
changes going on, you may be asked to take part in treatment. This
approach may involve going to a family education program or to
counseling for families or couples.

It is important to remember the following points as you and your family
member recover:

-   You are participating in treatment for **yourself,** not just for
    the sake of the person who used substances.

-   Your loved one's recovery, sobriety, or abstinence does not depend
    on you.

-   Your family's recovery does not depend on the recovery of the person
    who used substances.

-   You did not cause your family member's substance use disorder. It is
    not your fault.

You still may have hurt feelings and anger from the past that need to be
resolved. You need support to understand and deal with these feelings,
and you need to support your loved one's efforts to get well.

Remember: Help is always there for you, too. Ask the counselor for some
suggestions, and check the "Resources" section of this booklet.

What if I Need Help With Basic Living Issues?

You may need very practical help while your family member is in
treatment. If your family member is the sole financial provider and
unable to work because he or she is in treatment, how will the bills get
paid? If your family member is the primary caregiver for children or an
elderly adult, how will these needs be met? The treatment program may be
able to help you arrange disability leave or insurance through your
loved one's employer. Ask the counselor about different types of
assistance that may be available to help you meet various needs. Most
treatment programs work with other community programs. These programs
may include food pantries, clothing programs, transportation assistance,
child care, adult day care, legal assistance, financial counseling, and
health care services. Your family may be eligible for help from programs
that help those in recovery.

I'M AFRAID IT WON'T WORK

Treatment is just the first step to recovery. During this process family
members sometimes have mixed feelings. You may feel exhausted, angry,
relieved, worried, and afraid that, if this doesn't work, nothing will.
You may feel as if you are walking on eggshells and that, if you do
something wrong, you may cause your loved one to relapse. It is
important for you to remember that you cannot cause a relapse---only the
person who takes a drug or picks up a drink is responsible for that.

No one can predict whether your family member will recover, or for how
long, but many people who receive treatment do get better. The longer
people stay in treatment the more likely they will remain drug and
alcohol free. About half the people who complete treatment for the first
time continue to recover. Of course, this means that about half will
return to drinking alcohol and using drugs (called relapse) before they
finally give them up for good. Adolescents are even more likely to use
drugs or alcohol or both again. It is not uncommon for a person to need
to go through treatment more than one time. Often the person needs to
return to treatment quickly to prevent a slip or relapse from leading to
a chronic problem.

**It is important for you to understand that relapse is often a part of
the recovery process.** Do not be discouraged if your family member uses
alcohol or drugs again. Many times relapses are short and the person
continues to recover.

A treatment program may involve you in relapse prevention planning and
may help you learn what to do if your family member relapses. Your
family member will benefit if you do not drink or use drugs around him
or her, especially in the first months after his or her treatment
begins. When you choose not to use drugs or alcohol, you help your loved
one avoid triggers. As you both begin to understand and accept the
illness, the risk of relapse decreases. The changes in attitudes,
behaviors, and values that you both are learning and practicing will
become part of your new recovering lifestyle.

Q: My partner says a lot of people in his group have relapsed. What does
that mean?

A: Not all people in recovery are able to stay sober. When they cannot,
it's called relapse. Many people relapse a few times. As with other
chronic illnesses, such as diabetes or asthma, the symptoms can come and
go. Most treatment programs discuss relapse openly and often. It is
important that the person who relapses return to treatment right away,
learn more about his or her relapse triggers, and improve his or her
coping skills. Returning quickly is a sign of health (rather than
something to be ashamed of) and a desire to begin working toward a life
free of alcohol and drugs. It is important to understand the concept of
relapse. It means that a person who had stopped drinking alcohol or
taking drugs for a period has started to drink alcohol or use drugs
again. Relapses may be very disheartening. However, a relapse does not
mean that your family member will not recover.

ESPECIALLY FOR YOUNG PEOPLE

You may be having difficulty handling some of your concerns about living
with a person who abuses alcohol or drugs. Whether this person is your
mom, dad, grandparent, brother, or sister, it is important that you talk
about your problems, fears, and concerns with people who are
understanding and sympathetic.

You may feel that you caused your family member's substance use disorder
or that it is somehow your fault. You may think that if you had behaved
better, done better in school, or been different in some way your mom or
dad or the person you care about would not drink so much alcohol or take
drugs. *You did not in any way cause their disease*. No one ever causes
another person's substance use disorder. It is nobody's fault that
someone you care about has become ill.

Your family member may have embarrassed you in front of friends,
teachers, or another person. You may have stopped bringing friends home
or stopped telling your parents about school activities. Now that your
relative is in treatment, his or her behavior should improve.

You may have lived with fighting and stress, and you may have been
abused or witnessed other kinds of violence. You may feel very angry and
sad because of these experiences. Now you can talk about this and other
feelings with your family or the staff at the treatment program.

It will be important for you to share your thoughts and feelings about
what has happened. You may want to go to self-help groups such as
Al-Anon or Alateen. Some young people find these meetings to be helpful.
These groups talk about the three C's: You didn't Cause it, you can't
Control it, and you can't Cure it. Remembering the three C's can help.

It is important to know that substance use disorders run in families.
People who have a blood relative with a substance use disorder are about
four times more likely to develop the same disorder than those who do
not. This means that you may have inherited a tendency to develop a
problem yourself, and you should be careful about drinking alcohol or
taking drugs. This information is meant to educate you, not to scare
you.

The situation at home will probably improve because your relative is in
treatment. Like treatment for people with other illnesses, treatment for
substance use disorders is helpful, but not everyone knows or believes
it is. A great deal of stigma and shame are still associated with
substance use disorders. What and how much you tell your friends or
teachers is your decision and your family's. You may just want to say
something like, "My mom is ill, but she will get better and come home
soon. Thank you for asking."

You may choose to help educate some of your close friends about your
relative's illness and his or her progress in treatment. Or, you may
decide not to share this information with them. It's your choice.

Remember, you didn't create this problem, but you **can** play an
important role in helping everyone heal. Hang in there.

Q: My father is the one who drinks too much alcohol. Why do the
counselors want to talk to me?

A: Treatment professionals know that substance use disorders affect the
whole family. It makes sense, then, to offer help to the whole family.
Some programs offer family education, and others involve the family or
couples in counseling sessions. It's hard to grow up with a parent who
uses alcohol or drugs. It can be helpful if you learn more about the
disease and the effect it has had on your family and on you. Talking to
someone who understands substance use disorders can make a big
difference for you.

GLOSSARY

Denial

The thought process in which a person does not believe he or she has a
problem, despite strong evidence to the contrary. It is a way of
protecting oneself from painful thoughts or feelings.

Detoxification (or "detox")

A process that helps the body rid itself of substances while the
symptoms of withdrawal are treated. It is often a first step in a
substance abuse treatment program.

Followup care

Also called continuing care. Treatment that is prescribed after
completion of inpatient or outpatient treatment. It can be participation
in individual or group counseling, regular contact with a counselor, or
other activities designed to help people stay in recovery.

Halfway house/sober house

A place to live for people recovering from substance use disorders.
Usually several people in recovery live together with limited or no
supervision by a counselor.

Inpatient treatment

Treatment in a setting that is connected to a hospital or a
hospital-type setting where a person stays for a few days or weeks.

Outpatient treatment

Treatment provided at a facility. The services vary but do not include
overnight accommodation. Sometimes it is prescribed after inpatient
treatment.

Relapse

A recurrence of symptoms of a disease after a period of improvement;
that is, a person in recovery drinks or uses drugs again after a period
of abstinence.

Relapse prevention

Any strategy or activity that helps keep a person in recovery from
drinking alcohol or using drugs again. It may include developing new
coping responses; changing beliefs and expectations; and changing
personal habits, lifestyles, and schedules.

Residential treatment

Treatment in a setting in which both staff and peers can help with
treatment. It provides more structure and more intensive services than
outpatient treatment. Participants live in the treatment facility.
Residential treatment is long term, typically lasting from 1 month to
more than 1 year.

Self-help/12-Step groups

Support groups consisting of people in recovery that offer a safe place
where recovering people share their experiences, strengths, and hopes.
AA's 12 Steps help the members recover from addiction, addictive
behavior, and emotional suffering. These groups are free and are not
supported by any particular treatment program.

Supportive living

Also called transitional apartments. A setting in which the skills and
attitudes needed for independent living can be learned, practiced, and
supported. It provides a bridge between supervised care and independent
living.

Therapeutic community

Long-term residential treatment that focuses on behavioral change and
personal responsibility in all areas of a person's life, not just
substance use.

Treatment plan

A plan that provides a blueprint for treatment. It describes the
problems being addressed, the treatment's goals, and the specific steps
that both the treatment professionals and the person in treatment will
take.

Treatment team

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

Trigger

Any event, place, thing, smell, idea, emotion, or person that sets off a
craving to drink alcohol or use drugs.

RESOURCES

Federal Government Resources

Substance Abuse and Mental Health Services Administration's (SAMHSA's)
Substance Abuse Treatment Facility Locator

www.findtreatment.samhsa.gov/facilitylocatordoc.htm

SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI)

*SAMHSA's NCADI offers thousands of publications (most of them are free)
and runs a 24-hour helpline (English and Spanish) for SAMHSA. Helpline
operators can answer questions about substance use disorders, suggest
written resources, and make treatment referrals using the national
Substance Abuse Treatment Facility Locator.*

11420 Rockville Pike

Rockville, MD 20852

Helpline: 800-729-6686

Local number: 240-221-4017

TDD: 800-487-4889

www.ncadi.samhsa.gov

SAMHSA's National Mental Health Information Center

800-789-2647

TDD: 866-889-2647

www.mentalhealth.samhsa.gov

SAMHSA's Center for Substance Abuse Treatment (CSAT)

[www.csat.samhsa.gov](http://www.csat.samhsa.gov/)

SAMHSA's Center for Substance Abuse Prevention (CSAP)

[www.csap.samhsa.gov](http://www.csap.samhsa.gov/)

Other Resources

*The following is a sampling, not a complete list, of available
resources. Inclusion on this list does not imply endorsement by SAMHSA.*

Most State and local governments have an office on substance abuse
issues that can be an excellent resource. There also may be an office of
the Council on Alcoholism and Drug Dependence in your area; consult your
local telephone book.

Adult Children of Alcoholics

World Service Organization, Inc.

P.O. Box 3216

Torrance, CA 90510

310-534-1815

[www.adultchildren.org](http://www.adultchildren.org/)

Al-Anon Family Group Headquarters, Inc. (Al-Anon and Alateen)

1600 Corporate Landing Parkway

Virginia Beach, VA 23454-5617

888-4AL-ANON (meeting information line)

www.al-anon.alateen.org

Spanish Web site: www.al-anon.org/alaspan.html

Alcoholics Anonymous

P.O. Box 459

Grand Central Station

New York, NY 10163

212-870-3400

www.aa.org

Cocaine Anonymous World Services (CAWSO)

3740 Overland Avenue, Suite C

Los Angeles, CA 90034

310-559-5833

[www.ca.org](http://www.ca.org/)

Co-Dependents Anonymous (CoDA®)

P.O. Box 33577

Phoenix, AZ 85037-3577

602-277-7991

www.codependents.org

Dual Recovery Anonymous (DRA) Central Service Office

P.O. Box 8107

Prairie Village, KS 66208

877-883-2332

www.draonline.org

Jewish Alcoholics, Chemically Dependent Persons and Significant Others
(JACS)

850 Seventh Avenue

New York, NY 10019

212-397-4197

[www.jacsweb.org](http://www.jacsweb.org/)

Join Together

One Appleton Street

Fourth Floor

Boston, MA 02116-5223

617-437-1500

www.jointogether.org

Marijuana Anonymous World Services

P.O. Box 2912

Van Nuys, CA 91404

800-766-6779

www.marijuanaanonymous.org

Nar-Anon

22527 Crenshaw Boulevard

Suite 200 B

Torrance, CA 90505

310-547-5800

Narcotics Anonymous World Services Office

P.O. Box 9999

Van Nuys, CA 91409

818-773-9999

www.na.org

National Asian Pacific American Families Against Substance Abuse
(NAPAFASA)

340 East Second Street

Suite 409

Los Angeles, CA 90012

213-625-5795

[www.napafasa.org](http://www.napafasa.org/)

National Association for Children of Alcoholics (NACoA)

11426 Rockville Pike

Suite 100

Rockville, MD 20852

888-554-COAS

[www.nacoa.org](http://www.nacoa.org/)

National Association for Native American Children of Alcoholics
(NANACOA)

c/o White Bison, Inc.

6145 Lehman Drive, Suite 200

Colorado Springs, CO 80918

719-548-1000

[www.whitebison.org/nanacoa](http://www.whitebison.org/nanacoa)

National Association on Alcohol, Drugs and Disability (NAADD)

2165 Bunker Hill Drive

San Mateo, CA 94402-3801

650-578-8047

National Black Alcoholism & Addictions Council (NBAC)

5104 North Orange Blossom

Trail, Suite 207

Orlando, FL 32810

407-532-2747

[www.nbacinc.org](http://www.nbacinc.org/)

National Clearinghouse on Families and Youth (NCFY)

P.O. Box 13505

Silver Spring, MD 20911-3505

301-608-8098

[www.ncfy.com](http://www.ncfy.com/)

National Families in Action (NFIA)

2957 Clairmont Road N.E.

Suite 150

Atlanta, GA 30329

404-248-9676

[www.nationalfamilies.org](http://www.nationalfamilies.org/)

Nicotine Anonymous

419 Main Street, PMB 370

Huntington Beach, CA 92648

415-750-0328

www.nicotine-anonymous.org

Parents, Families and Friends of Lesbians and Gays (PFLAG)

1726 M Street, N.W.

Suite 400

Washington, DC 20036

202-467-8180

[www.pflag.org](http://www.pflag.org/)

Secular Organizations for Sobriety/Save Our Selves (SOS) Clearinghouse

4773 Hollywood Boulevard

Hollywood, CA 90027

323-666-4295

[www.secularsobriety.org](http://www.secularsobriety.org/)

SMART Recovery

7537 Mentor Avenue

Suite #306

Mentor, Ohio 44060

440-951-5357

www.smartrecovery.org

Su Familia: The National Hispanic Family Health Helpline

866-SuFamilia (783-2645)

Women for Sobriety, Inc.

P.O. Box 618

Quakertown, PA 18951-0618

215-536-8026

[www.womenforsobriety.org](http://www.womenforsobriety.org/)

DHHS Publication No. (SMA) 07-4126

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration