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.

Recommended Citation

Center for Substance Abuse Treatment. What Is Substance

Abuse Treatment? A Booklet for Families. DHHS Publication No.

(SMA) 04-3955. Rockville, MD: Substance Abuse and Mental

Health Services Administration, 2004.

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) 04-3955

Printed 2004
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

iii

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

1

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.
2

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
3

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

Q Tolerance—A person will

need increasingly larger

amounts of alcohol or drugs

to get high.

Q 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. 

Q 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.

Q 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.

4

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.
5

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

Q Kinds, amount, and length of time of

substance or alcohol use
6

Q Cultural issues around use

of alcohol or drugs 

Q Effects of drug or alcohol

use on the person’s life

Q Medical history

Q Current medical problems

or needs

Q Current medications

(including pain medication)

Q Mental health issues or

behavioral problems

Q Family and social issues and

needs

Q Legal or financial problems

Q Educational background

and needs

Q Current living situation and

environment

Q Employment history, stability, problems, and needs

Q School performance, problems, and needs, if relevant

Q 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
7

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. 

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.
8

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.

What Types of

Treatment Programs

Are Available?

Several types of treatment 

programs are available:

Q Inpatient treatment

Q Residential programs

Q Partial hospitalization or 

day treatment

Q Outpatient and intensive

outpatient programs

Q 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
9

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
10

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

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.
11

(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. 

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.
12

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

Q See the problem and

become motivated to change

Q Change his or her behavior

Q Repair damaged relationships with family and friends

Q Build new friendships 

with people who don’t use 

alcohol or drugs

Q 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 BreathalyzerTM

to test people for alcohol use.
13

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) Recovery7 and

Women for Sobriety. 

Members themselves, not

treatment facilities, run selfhelp 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

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.
14

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). 

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. 
15

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. 
16

Disulfiram (Antabuse7) 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 (ReVia7), 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. 

Followup Care (Also

Called Continuing Care)

Even when a person has successfully completed a treatment program, the danger of

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.
17

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 prisonbased 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.
18

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 

19
20

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 CoDependents 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:

Q You are participating in

treatment for yourself, not

just for the sake of the person who used substances.

Q Your loved one’s recovery,

sobriety, or abstinence does

not depend on you.

Q Your family’s recovery does

not depend on the recovery

of the person who used

substances.

Q 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.
21

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.
22

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.
23

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.
24

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
25

to self-help groups such as AlAnon 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.
26

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.

27
28

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: 301-770-5800

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

SAMHSA’s Center for Substance

Abuse Prevention (CSAP)

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

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 

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

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30

Jewish Alcoholics,

Chemically Dependent

Persons and Significant

Others (JACS)

850 Seventh Avenue

New York, NY 10019

212-397-4197

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

National Association for

Children of Alcoholics

(NACoA)

11426 Rockville Pike

Suite 100

Rockville, MD 20852

888-554-COAS

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

National Association on

Alcohol, Drugs and

Disability (NAADD)

2165 Bunker Hill Drive 

San Mateo, CA 94402-3801 

650-578-8047
31

National Black

Alcoholism & Addictions

Council (NBAC)

5104 North Orange Blossom 

Trail, Suite 207

Orlando, FL 32810

407-532-2747

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

National Families in

Action (NFIA)

2957 Clairmont Road N.E.

Suite 150

Atlanta, GA 30329

404-248-9676

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

Secular Organizations

for Sobriety/Save Our

Selves (SOS)

Clearinghouse

4773 Hollywood Boulevard

Hollywood, CA 90027 

323-666-4295

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
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33
Place clinic sticker here

DHHS Publication No. (SMA) 04-3955

NCADI Publication No. BKD503

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration