SUBSTANCE USE DISORDER
Imagine it’s your sister.
At twenty-four, Rebecca is already an avionics technician in the air force, hard-working, passionate, filled with integrity. At home she has a husband, two lab puppies, and a plant she calls Trudy. Life is amazing. She has an astounding future ahead – until cocaine sweeps her off her feet.
Over the next year she loses her career, house, puppies, and eventually her husband. Rebecca disappears soon after, only to be found panhandling near a gas station. She refuses to come home. You watch as she walks off and disappears again.
That was twenty years ago. Your sibling has had brief periods of abstinence. She’s cool when she’s off drugs: Kind, funny, and hopeful. She doesn’t know how to quit, but she always finds a job. She lives with Mom and Dad and doesn’t make waves. But abstinence doesn’t last. She’s not ready to quit. Every three months Rebecca loses control. She steals the credit card, disappears, uses, and resurfaces two weeks later in crisis, begging to come home. That’s twenty years of lost potential.
So what can you do to help your sister, if anything? That old belief comes into play: “You can’t help someone if they don’t want it.” Slap a big MAYBE on top of that. She might not be ready to take the full plunge into recovery, but there are things you can do. One important step is to familiarize yourself with treatment choices and other available resources/assistance. When she’s ready to quit, truly quit, you’ll have something vital to offer: Guidance.
This is a long article. I suggest you read it in more than one sitting, taking note of the resources that could be most helpful for your loved one, and gradually research each option. Investigate individual terms in a search engine or refer to the Substance Abuse Mental Health Services Administration for more information. Visit SAMHSA.gov/families or call the SAMHSA helpline 800 662 HELP to learn about treatment options.
It’s hard to focus on recovery when you’re homeless in the rain and have nowhere to go. It’s also hard to avoid drugs and learn basic life skills when surrounded by people who put you down all the time. To quit drugs and stay quit, a person needs a safe, supportive environment. For recovery, they need guidance.
We all need food and shelter. When a loved one is homeless, familiarize yourself with local resources. Search online or call the emergency room/local mental health care facility for a list. Churches often have assistance programs too. Resources might mean shelters, food pantries, clothing programs, and safe places to go during the day. Other helpful resources include low-cost or free transportation assistance, childcare, legal assistance, financial counseling, and vocational training (drug-free workplace programs). Once recovery is sustained and basic needs accounted for, consider discussing educational opportunities like completing a G.E.D. or earning a professional certificate (i.e., certified nurse assistant). Many people with long-term recovery become peer-support workers and use their experience to help others.
Shelters aren’t particularly conducive to gaining recovery, but there are other options, ranging from Oxford Houses with little supervision to inpatient settings where clients are monitored by professional staff. Often, a person in recovery will transition over time from the most supervised to the least. Here are some examples.
Oxford Houses. In this option, a group of people in recovery live together in a single setting. There’s no oversight except peer support. Residents control their own time and live their own lives. They must pay rent and attend 12-Step meetings. Oxford Houses are long-term.
Sober Living Homes. These are group homes where, like Oxford Houses, residents share a house. However, there’s typically a supervising figure, like a house manager, who provides house rules and some structure. These are long-term.
Long-term residential rehabilitation. Usually run by people in recovery (rather than professionals), residential rehabs are supervised settings that provide some onsite support like 12-Step meetings. They’re often connected to resources in the community, like support groups, motivational speakers, job-skills training, education, and employment opportunities. Residents are required to work. These typically entail a one-year commitment.
Transitional/Supported living. Transitional housing is a small-group living arrangement for people engaged in treatment. Residents share apartments at low or no cost. These are often run by treatment facilities. Other resources might include job assistance programs, transportation, and access to physical healthcare providers. The stay is long term and clients frequently graduate to their own apartments.
Therapeutic Community. This setting is similar to residential rehabilitation, but most services are onsite. Stay is usually one or more years. An unusual example is a farm program, where residents live in an isolated setting and care for the farm while working on their recovery.
Short-term residential rehabilitation. Here residents are monitored and supported by clinically-trained, licensed staff. Therapy and medication management are often done inhouse, as well as support and skill training groups. Residents focus on treatment and typically don’t work. These programs tend to have a specific duration, ranging from weeks to months. Sometimes this is covered by Medicaid.
Inpatient hospitalization. Hospitalization is reserved for people in danger of withdrawal from drugs, especially alcohol, benzodiazepines (like Xanax), or Opiates (like heroin). The stay is usually less than a week. This service is usually covered by insurance or Medicaid.
OTHER TREATMENT RESOURCES
Professional help and support groups are an important part of recovery, and most people trying to get past an addiction need this sort of assistance. While there are countless options out there, we list a few to start you off.
Partial Hospital. In partial hospital, individuals in early recovery attend a treatment program five days/week. Each day lasts 4-8 hours and includes groups and individual therapy, as well as medication management at times. Partial hospital lasts about three months. Clients live at home, not the hospital.
Intensive Outpatient. This branch of treatment is similar to partial hospital but less intense. Clients attend the program 2-3 times/week. Intensive outpatient may last for months or longer. Attendees live at home.
Medication-Assisted Treatment. Sometimes a client can’t stay clean, despite their best efforts. In this case, studies show that replacing the drug with a safer alternative helps them stay clean – or decreases the amount they use. This improves the quality of their lives. Safer alternatives include Methadone and Suboxone for heroin and Campral, Antabuse, and Revia for alcohol use disorders.
Outpatient Treatment. Here clients typically attend weekly or monthly appointments with a counselor, nurse, psychiatrist, or other professional. Some individuals require more support; this can include a case manager, home-visiting clinicians, peer-support workers, and other specialty care. Outpatient treatment happens at a mental health care facility; however, some people opt to see a provider through an online virtual clinic.
12-Step Programming and SMART Recovery. 12-Step is a peer-run organization found world-wide. Members attend meetings and go through different steps to best realize their recovery. They have a counterpart for families and friends, Al-Anon. An alternative group is SMART Recovery, another trusted source for helping families and their loved ones get past substance use.
You’re important to your loved one’s recovery. Even if they’re not ready to quit, there’s something you can do. Research phone numbers and websites. Pull it together. When they’re ready, discuss potential resources that might help them. Talk them through the options, who to call, which applications to complete, but don’t do the work for them. Show them how to do it, but leave the DOING up to them! It’s best they reach out for help themselves.
Kim Rosenthal, MD, is a board-certified psychiatrist with 20+ years of experience. Her website kimrosenthalmd.com features more than 130 articles about mental health and substance use disorders.