What does the research say about Intensive Outpatient and Day

Treatment working as well or better than residential treatment for alcohol and drug abuse and addiction:

“Treatment on an outpatient basis allows a more valid assessment of environmental, cognitive and emotional antecedents of drinking episodes and drinking urges on the part of the patient, and allows the patient to test new coping strategies while still within a supportive counseling relationship. These conditions would be expected to foster greater generalization of learning in treatment to the patient’s natural environment” (Annis, 1986, p. 183).

 

What are some of the different features of outpatient treatment which create better outcomes than in residential treatment setting?

  • Therapeutic and supportive relationships are not disrupted in outpatient treatment.
  • Therapeutic rapport with therapists, psychiatrists, prior sobriety supports and physicians are maintained.
  • Strengths and assets at work, home, recreation can be built upon during the course of outpatient treatment.

 

Isn’t learning new skills and avoiding drug and alcohol use at home more difficult than in a clean and supervised environment?

  • Rather than learning in a nice clean laboratory, apply the new skills directly into your life now. Outpatient treatment provides a much greater “take-home” advantage.

 

The benefits of getting sober at home actually enable newly sober people to

  • Practice new skills immediately in real-life situations;
  • Apply new discoveries, ideas and behavioral changes- practice improves retention;
  • As clients and families learn more effective coping, communication and relationship skills, they can “practice” these skills both in treatment and at home
  • Clients and families receive support and validation from each other while expanding their lasting sober supports in outpatient settings. Relationships can be maintained and won’t be disrupted at discharge as in residential treatment.

 

While you participate in an intensive outpatient or day treatment program for alcohol and drug abuse and addiction, what sober resources are found at home different from those in a residential program?

  • Outpatient treatment mobilizes available supports (family, therapist, psychiatrist, family doctor, and/or mutual support organizations) rather than creating temporary and artificial supports that will be removed once a residential experience ends.
  • Indigenous recovery supports are identified and activated during the course of outpatient treatment.
  • The transition from active outpatient treatment into social support and recovery maintenance is much less abrupt than with residential treatment. Social support gains are generalized into real life.
  • Clinical changes, recovery supportive resources, therapeutic and professional relationships are likely to be maintained.

 

Addiction creates casualties and long-lasting problems. How is this wreckage handled differently in an outpatient setting treating substance use disorders?

  • People coming to terms with an addiction often face mounting financial, vocational and domestic problems- “wreckage”.
  • Treatment should not add to those mounting bills, unnecessary absence from work and home.
  • Rehab should instead help move you into the solution- toward resolving the “wreckage” of your addiction.

 

Why is residential treatment so widely recognized as the way to get sober?

  • Residential treatment will produce better profit/ development margins for the business owner/ provider of care if critical business volumes can be achieved.
  • The higher operating costs, administrative time, and professional oversight of residential components draw decision-makers to focus on their residential treatment at the expense of their less complex and less lucrative outpatient services.
  • It is clear to the margin-oriented administrator that short-term financial gains will be best made from a residential model if only the beds can be filled.

 

Substance Use Disorder or Addiction

The words we use to describe alcoholism and drug addiction evolve with social, political and scientific change. Alcoholism and drug addiction have been the subject of huge social scorn and condemnation. People who cannot control their alcohol consumption and others who use other addictive drugs bring tragedy upon not only themselves, but also to their loved ones and society as a whole.

Eighty years ago as people began to recover for the first time, their stories became better understood. Medicine began to advocate for greater research as the biological causes of this “disease” were discovered. Prejudice, judgement and shame slowly subsided as solutions began to be uncovered; hope replaced disgrace.

Terms change as greater information is uncovered. Professionals from medicine, psychology, sociology, criminology, theology, etc. bring unique perspectives to the far reaching impacts of alcohol and drug abuse. The words we now describe “Substance Use Disorder” attempts to diminish stigma while capturing the essential characteristics of the disorder which includes a continuum of intensity and severity.

What was once a hopeless condition viewed as sinful, weak, criminal, deviant, crazy is now viewed as a chronic, relapsing medical disease which has far reaching impact. Alcoholism and drug addiction became chemical abuse or dependent. Substance abuse and dependency is now considered substance abuse disorder. This new concept describes a continuum of symptoms from mild to severe, allowing each individual unique characteristics and consequences.

Recovery from Alcoholism and Drug Addiction- What is Recovery?

Ideas and words like “recovery”, “sobriety” and “clean and sober” make sense to people who have crossed the bridge from addiction to recovery, but people still suffering from the effects of the disease may not share that understanding. When a person trapped by their own need to drink or use chemicals arrives at the greater need to stop, they may be ready for recovery. Recovery starts with the realization that continuing to drink or use worsens existing problems and is a problem itself. At this point, the drink or drug creates negative consequences and a greater need to drink or use drugs next time.

Addiction (including alcoholism) is characterized by many signs and symptoms. One of the more telling signs is when someone encounters negative consequences from their substance use yet continues despite such consequences. Addiction (including alcoholism) is a psychiatric disorder and medical disease- it is chronic, progressive and relapsing with biological, emotional, cognitive, social and spiritual effects. (“Crazy” is when you take the same action but expect different results.)

Recovery starts with avoiding the first drink or drug… abstaining from addictive substances one day at a time. Once the chemical and its effects are physically absent and slowly become psychologically distanced, recovery can then become a process of learning, understanding, becoming increasingly aware, practicing new skills, and monitoring personal ideas, feelings and behaviors. The recovering person discovers an openness to learn and understand new ideas, and to practice new behaviors and skills. Change becomes possible in recovery.

New friends and acquaintances who are understand and support sobriety are gained- a new sober support network is introduced. People learn that the old secrets and isolation worsen feelings of loneliness and hopelessness. Expressing uncomfortable feelings and openly describing the sensation of craving decreases their intensity and builds behavioral practices of honesty and authenticity.

People who have encountered the same help strengthen each other’s sobriety through fellowship and service to each other. Giving back and becoming helpful to others strengthens recovery practices and builds self-esteem. Rather than the drunk or drugged fantasizing about fame and fortune, the recovering person gains self-esteem though estimable action.

In-Network HMO, EPO and PPO Covered Addiction Rehab

Working people and their families are often covered by affordable health care coverage offered through managed healthcare plans such as HMO’s (heath management organizations), EPO’s (exclusive provider organizations) and PPO’s (preferred provider organizations). The Affordable Care Act has resulted in healthcare exchanges such as “Covered California” where people can purchase affordable healthcare insurance which is priced according to their income.

HMO, EPO, and PPO insurance plans usually relegate behavioral healthcare coverage and management to behavioral healthcare departments or organizations. The reason that services provided by alcohol and drug rehabilitation and treatment centers are managed separately by behavioral health departments is that diagnoses, prognoses and progress cannot be measured through conventional biological markers or measurement tools. A specialist in behavioral health is required to determine the level and type of care needed for complex diseases such as alcoholism and drug addiction now referred to as “substance use disorders”.

Costs and personal restrictions are better contained when a professional who is financially independent from the provider oversees care and monitors costs. Treatment can become exorbitantly expensive when there exists no such oversight. For some people with wealth, rehab can be combined with an extended luxury vacation. Not everyone can or should afford luxury or lengthy treatment.

When you seek a provider contracted with your insurance healthcare plan, the coverage is much better and the services are closely monitored for quality and cost. Ethical business practices can also be enforced such as providing you and your family about the best estimate of cost before a contract is signed.

Providers who are “out-of-network” will often state that they accept insurance. Before signing contracts, take the following steps to protect yourself:

  • Ask the out of network provider if they will give you a written estimate of what the out-of-pocket cost will be after the insurance stops authorizing payment for treatment
  • Ask if they will provide you an itemized bill which they send to your insurance company, including the charges for urinalysis
  • Ask if the provider gets approved for all services rendered and ask how long the insurance company is likely to approve payment
  • Ask if they bill you the balance after the insurance company ceases to cover treatment and how much that total is likely to run.

To protect you and your family from unethical business practices or to avoid unnecessary costs and services, ask you insurance representative or therapist for their expert opinion.

If holiday or vacation drunkenness and drugging gets out of control, is this a sign of a real problem? What are the signs of alcoholism and drug addiction?

Imagine time off from work or other responsibilities such as a holiday or vacation. Is a drink or some form of drug automatically connected with relaxation? Do you anticipate what you will drink, smoke or use? Can you have a good time without getting high using some type of drink, substance or chemical? Reliance on chemically induced happiness might be replacing the natural good times.

When relief from pain or discomfort requires non-prescribed chemicals or if you simply have to have a drink, bump, snort, puff to set yourself into a better mood, you may have come to rely too heavily on those substances.

The DSM 5 (Diagnostic and Statistical Manual, 5th Edition- American Psychiatric Association) proposes the following as common signs of a substance use disorder, commonly called “addiction”. If you present three (3), the chances are high for having a substance use disorder/ addiction:

  • Failure to meet responsibilities/ obligations due to use
  • Risk and danger created when using
  • Continued use despite negative social and financial consequences
  • A need for more quantity of the substance to achieve the same high or state of relief
  • Symptoms of withdrawal (hangovers, lows, come-downs) when using stops or has been interrupted
  • Inability to control or decrease use
  • Taking a higher quantity than was originally intended
  • More time is spent getting and preparing to use the drink or drug
  • Recreational activities and events are substituted with drinking or using
  • Continued use despite adverse psychological or medical effects
  • Craving, hunger or a strong desire for the effect of the chemical.

Are recreational, leisure events with family or friends being sacrificed for opportunities to drink or get high? Does having a good time require drinking or using (partying)?

Recovery allows the addict to return to or pursue new healthy and natural highs. Being with friends and family or attending a sporting event or entertainment can become once again enjoyable. Simple pleasures slowly return. The color returns to a once gray world.

If you or a loved one miss the times where a vacation or holiday meant a good time to relax and enjoy friends and/or family, recovery is possible. There are many ways to start. Call a sober friend. Go to a 12-step meeting or mutual support group.  Carefully select or get a referral to call a treatment center. Schedule an appointment with an addiction specialist or therapist.

Life can be fun again. You can again enjoy time off without the drama created by the over use of alcohol or other drugs.

Drug and Alcohol Rehab while living at home: Intensive Outpatient and Day Treatment

Many people think that “drug and alcohol rehab” means moving into a treatment center, staying in their bed, eating their food and having a roommate. Moving away from your normal living circumstances might at times seem necessary to make the changes necessary to obtain sobriety or engage in a program of recovery. Research has not found that this level of care is necessary or more effective in most cases. (1)

Residential or inpatient care is usually necessary when medical detox is needed, or if environmental containment and supervision is required due to behavioral or psychiatric disorders. If a person is living with or adjacent to others with similar problems, it is important that another living environment is found. Getting sober around using others is unlikely.

The benefit of undergoing treatment in your normal environment is that you will immediately apply your new discoveries and changes into real world conditions. Rather than hoping that you can take home what is obtained in a protective living environment under the supervision and twenty-four hour care of professionals, at home you will learn how to apply the new skills directly into your life. You will also be able to bring in the early sobriety stresses, problems and “wreckage” to the program and to the group for real-world help.

People coming to terms with an addiction often face mounting financial, vocational and domestic problems- “wreckage”. Treatment should not add to those mounting bills, unnecessary absence from work and home. Rehab should instead help move you into the solution- toward resolving the “wreckage” of your addiction.

Most people undergoing treatment today do not have the resources to pay for the higher costs related to a residential level of care. Before committing, it is important to obtain a clear view of the costs involved with residential care and avoid relying upon general statement about the center billing the insurance and putting the rest on a payment plan. The rest could turn out to be the majority of the costs of a very expensive treatment encounter. Make sure that you are aware of what you are committing yourself and family.

  • (1)”Subjects benefited equally from outpatient and residential aftercare, regardless of the severity of their drug/alcohol problem.” Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs. William M Burdon1, Jeff Dang2, Michael L Prendergast1, Nena P Messina1 and David Farabee 1, *Corresponding author: William M Burdon wburdon@ucla.edu, 1University of California, Los Angeles, Integrated Substance Abuse Program, Substance Abuse Treatment, Prevention, and Policy 2007, 2:16 doi:10.1186/1747-597X-2-16 
  • “Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.” The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects, JOHN W. FINNEY, ANNETTE C. HAHN, RUDOLF H. MOOS Article first published online: 24 JAN 2006 DOI: 10.1046/j.1360-0443.1996.911217733.x Addiction Volume 91, Issue 12, pages 1773–1796, December 1996 
  • “Greater service intensity and satisfaction were positively related to either treatment completion or longer treatment retention, which in turn was related to favorable treatment outcomes. Patients with greater problem severity received more services and were more likely to be satisfied with treatment. These patterns were similar for patients regardless of whether they were treated in outpatient drug-free programs or residential programs. The positive association between … greater levels of service intensity, satisfaction, and either treatment completion or retention-and treatment outcome strongly suggests that improvements in these key elements of the treatment process will improve treatment outcomes.” Relationship between drug treatment services, retention, and outcomes. Hser YI, Evans E, Huang D, Anglin DM. Neuropsychiatric Institute, University of California-Los Angeles, 1640 South Sepulveda Boulevard, Los Angeles, CA 90025, USA. yhser@ucla.edu 
  • National studies indicate significant reductions in recidivism following outpatient treatment Pre-treatment Post-treatment, Drug Abuse Reporting Program (DARP), National Treatment Improvement Evaluation Study (NTIES), Treatment Outcome Prospective Study (TOPS) 
  • Outpatient treatment of probationers leads to fewer arrests at 12 and 24-month follow-up (Lattimore et al., 2005) vs. untreated probationers 
  • High-risk probationers receiving outpatient treatment experience 10-20% reductions in recidivism (Petersilia & Turner, 1990, 1993) 
  • Reductions in probationer recidivism durable for 72 months after outpatient treatment (Krebs et al., 2009) 
  • Outpatient treatment more effective than residential treatment for drug-involved probationers (Krebs et al., 2009) and during reentry (Burdon et al., 2004) 
  • Greater benefits for the cost for outpatient treatment in non-offender samples (CALDATA, French et al., 2000, 2002) 
  • Aftercare services among drug-involved offenders can significantly reduce substance use and re-arrest (Butzin et al., 2006) 
  • Outpatient aftercare services can reduce likelihood of re-incarceration by 63% (Burdon et al., 2004) 
  • Aftercare services provide $4.4 – $9 return for every dollar invested (Roman & Chafing, 2006) 
  • “…(M)ore severe patients experienced better alcohol and drug outcomes following in-patient/residential treatment versus out-patient treatment; on the other hand, patients with lower baseline ASI drug severity had better drug outcomes following out-patient treatment than in-patient treatment. Treatment setting was unrelated to alcohol outcomes in patients with less severe ASI alcohol scores. Conclusions Results provide some support to the matching hypothesis that for patients who have higher levels of substance use severity at intake, treatment in in-patient/residential treatment settings is associated with better outcomes than out-patient treatment.” Day Hospital and Residential Addiction Treatment: Randomized and Nonrandomized Managed Care Clients; Jane Witbrodt, Jason Bond, and Lee Ann Kaskutas Alcohol Research Group, Constance Weisner, University of California, San Francisco, Gary Jaeger; Kaiser Foundation Hospital, David Pating, Kaiser San Francisco Medical Center, Charles Moore Sacramento Kaiser Permanente, Journal of Consulting and Clinical Psychology Copyright 2007 by the American Psychological Association, 2007, Vol. 75, No. 6, 947–95 
  • “Compared to those receiving no treatment, those receiving nonresidential treatment took longer to fail or recidivate. However, those receiving residential treatment did not differ from those who received no treatment in time to failure. In the treatment-only model, nonresidential treatment participants took longer to fail than their matched residential treatment counterparts.” The impact of residential and nonresidential drug treatment on recidivism among drug-involved probationers: A survival analysis. Krebs, C. P., Strom, K. J., Koetse, W. H., & Lattimore, P. K. (2009). Crime & Delinquency, 55, 442-471. 

HMO Covered Addiction Treatment

Twin Town Treatment Centers is a preferred and contracted, in-network addiction treatment program working with the members of over fifty HMO, EPO, PPO, EAP and managed care plans.

 

Question: Do HMO’s and other managed health plans cover treatment for drug addiction and alcoholism?

 

Answer: Yes! There are two federal laws which require that alcohol and drug treatment is covered at the same rate and under the same terms as other medical conditions.

 

Question: Will insurance cover all of the services offered or provided in treatment?

 

Answer: Your treatment program, if they are in-network or contracted with your insurance company to provide treatment is responsible to gain authorization for the intensity and duration of treatment. If your program or provider recommends services or treatment duration which is not covered, they are responsible for giving you this information and getting your informed consent to provide and bill you for such services or extended stay.

 

Question: How do I find a treatment program which my insurance plan will cover?

 

Answer: Go to your health plan website or call the 800 number for “Behavioral Health” or “Mental Health” providers. Your health plan will list professional, independent providers such as doctors and therapists, and will also list “facilities” which will include treatment programs for substance use disorder or addiction.

 

Question: What is the advantages of finding a contracted, in-network provider rather than “going out of network”?

 

Answer: Your insurance plan maintains strict cost and quality controls over its contracted providers, who are contractually obligated to render services which are sanctioned by government and accreditation agencies. Treatment rendered by a contracted provider is also covered at a substantially higher rate, with lower out-of-pocket expense than those provided out of network.

 

Question: Why do most treatment programs remain out-of-network if they can’t provide treatment and get paid by HMO and EPO plans?

 

Answer: The payment from PPO for out-of-network services are based on a percentage. If the marked-up retail rate is high enough, the out-of-network provider can bring in a profit significantly higher than those earned by in-network providers. The out-of-network provider is also able to bill you for services and lengths of stay without your expressed and informed consent.

Shore-Up Trust- The Foundation of Treatment and Recovery

David Lisonbee, CEO, Twin Town Treatment Centers

 

Though informing prospective patients and their families about prerequisite financial, emotional and time commitments and expenses prior to engaging in a course of treatment may seem inconvenient, counterproductive and potentially self-defeating, alternatives betray trust, which is the essential ingredient of any helpful relationship. To mislead and later to recant or to blame the third-party payer for untold costs is manipulative, dishonest and cowardly. For us in recovery, we long ago faced the need to curtail the practice of rationalization and duplicity so as to achieve and maintain sobriety. We also learned to practice these principals in all of our affairs.

 

Don’t fool yourself, staff and colleagues into believing that providing and billing for unnecessary services or length-of-treatment is justified. If you can’t provide meaningful and necessary services supported by ethical and legal utilization review and billing practices, find another model of rendering services or do something else for a living. When providers financially benefit from unnecessary tests (psychometric, urinalysis, DNA, etc.), experimental or unsubstantiated services (dietary, magnetic, electronic, digital, exotic) and extraordinary charges (out of network balance billing, PPO retail quotes outside of the community standard, etc.), your services and our profession loses credibility. You are also committing insurance fraud.

 

Paying or accepting fees for patient referrals creates a marketplace where human needs, human beings are being placed on the auction block. Auctions are a place for cars, art, real estate- putting someone and their insurance coverage up for bid through marketing and call-center processing destroys the very foundation of work. Rather than cherishing the humanity in each person in need, their vulnerabilities and financial assets are exploited. Such acts of exploitation corrupt any attempts at rendering help- trust is violated and people become as objects.

 

Treatment should be based on the elemental principal of effective therapy: TRUST. Building trust requires that our actions are always trustworthy. Respecting the people who ask us for help includes recommending services which are accessible, affordable and appropriate to their needs. Call centers and referral fees diminish patient identity and places patient need below financial incentive.

People with opioid dependence in recovery show ‘re-regulation’ of reward systems

Within a few months after drug withdrawal, patients in recovery from dependence on prescription pain medications may show signs that the body’s natural reward systems are normalizing, reports a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study by Scott C. Bunce, PhD, of Penn State University College of Medicine, Hershey, and colleagues provides evidence of “physiological re-regulation” of disrupted brain and hormonal responses to pleasurable stimuli – both drug- and nondrug-related.

Signs of Reward System Disruption After Drug Withdrawal…

The pilot study included two groups of seven patients in residential treatment for dependence on opioid pain medications. One group had recently gone through medically assisted opioid withdrawal–within the past one to two weeks. The other group was in extended care, and had been drug-free for two to three months. A group of normal controls were studied for comparison.

The researchers performed several tests to assess changes in the “brain reward system” during early recovery. After drug withdrawal, many people with opioid dependence have “persistent changes in the reward and memory circuits”–they may experience heightened “rewards” or “pleasure” in response to drugs and related stimuli, but greatly reduced responses to naturally pleasurable stimuli (such as good food, or friendship).

Dr Bunce explains, “This is thought to occur because opiates are potent stimulators of the brain’s reward system; over time, the brain adapts to the high level of stimulation provided by opiates, and naturally rewarding stimuli can’t measure up.” Such dysregulation of the natural reward system may contribute to the high risk of relapse during recovery.

The test results showed several significant differences in the reward system between groups. A test of startle reflexes showed that patients with recent drug withdrawal had reduced pleasure responses to “natural reward” stimuli–for example, pictures of appetizing foods or people having fun.

In brain activity studies, patients with recent drug withdrawal showed heightened responses to drug-related cues, such as pictures of pills. In the extended-care patients, these increased responses to drug cues — in a region of the brain called the prefrontal cortex, involved in attention and self-control — were significantly reduced.

…May Lead to New Objective Measures of Recovery

Patients who had recently withdrawn from opiates also had high levels of the stress hormone cortisol (adrenaline). In the patients who had been drug-free for a few months, cortisol levels were somewhat reduced, although not quite as low as in healthy controls. The recently withdrawn group also had pronounced sleep disturbances, while sleep in the extended care group was similar to controls.

All of these changes — brain and hormonal responses to drug cues and natural rewards, as well as sleep disturbances — were correlated with abstinence time. The more days since the patient used drugs, the lower the abnormal responses.

The study supports past research showing dysregulation of the reward system during early recovery from opioid dependence. It also provides evidence that these responses may become re-regulated during several weeks in residential treatment — a period of “clinically documented” abstinence from opioids.

That’s a potentially important step forward in addiction medicine research, Dr Bunce believes. “It shows that if the patient remains in treatment and off drugs for several months, the body’s natural reward systems may have the capacity to return toward normal, making it easier for them to remain drug-free outside the treatment setting.” With further study, tests of the natural reward system might provide useful, objective markers of recovery — clinical tests that help to evaluate how the patient’s recovery is proceeding.

Such tests might help in managing the difficult problem of prescription opioid dependence — an ongoing epidemic associated with a high risk of relapse after drug withdrawal. Dr Bunce and colleagues are conducting a follow-up study, funded by the National Institute on Drug Abuse, to determine whether measures of the brain’s reward system, sleep and the stress response system indicate the capacity for re-regulation and the patient’s risk of relapse during recovery.

Helping an Addicted Loved One

David Lisonbee, twintowntreatmentcenters.com

How do you help arrest a loved one’s decent down the destructive path of alcoholism and addiction? Is this the best time to address these problems? Can you pretend that everything is fine and that everyone is happy? Are you motivated by a benevolent care for your family or is self-defense or evening the playing field the goal? Are you acting from a place of concern and love, or are you reacting from the fear and pain of past injuries?

First take a look at yourself. Gauge your readiness for the task. Evaluate the present likelihood of success. Be realistic since all of these motives, both constructive and destructive are likely and legitimate.

I hope that this note provides you some helpful thoughts and strategies. It is normal to resent the very person you are striving so hard to help. Their behavior has harmed you and others for a very long time. Your anger, fear, and anxiety stem from constant anticipation of threat from the person who needs your help. You may have once relied upon for help yourself. Now they cannot be trusted. They have become unpredictable and unreliable. Repeated traumas have reinforced beliefs, ideas, feelings and behaviors that push your emotions out of control. You must protect yourself before becoming useful to anyone.

Even though the causes of addiction are innate and biological, continued regression versus recovery boils down to personal choice. The practicing addict is immersed in a world of immediate rewards and the avoidance of pain and emotional turmoil. Their reactions to you are constantly colored by their psychological and physical relationship with a chemical. That chemical has become centered and all-important in their life.

You can blame yourself. You can blame them. You can blame the chemical. Blame simply magnifies pain- your pain, their pain, our pain.

Set ground-rules or boundaries for yourself and keep them. If you react out of resentment or pain, you have become ineffective or destructive. Stop yourself and retreat.

Remember that you can only control your behavior. When you attempt to control others including addicts, you are acting to increase your pain, anger, resentment and fear. You set yourself up for failure. The futility of your actions result in worsening results. Stop!

Aggravating old problems and creating new ones does not improve the situation for anyone though this may feel natural at this point in your relationship.

Denial and rationalization are defenses which serve to maintain the status quo. Change is uncomfortable and creates fear, fear of the unknown. Accepting the reality of a situation is first stage of recovery. You must accept that you may lose your addicted loved one before you set out to help them. They must somehow arrive at the reality of their problem. Arousing their defenses defeats the purpose and blocks progress.

Rather than entangling the person’s drug or alcohol use/ inebriation, conduct any and all conversations while they are sober. During the holidays or weekends, these conversations will necessarily be made well before events and usually early in the day.

Draw a line in the sand that if the person drinks or uses, you will not associate with them during their use or while they appear under the influence. If you find them using or under the influence at your place, ask them to leave. If you are elsewhere, you leave. Make the agreement simple and hold to it.

When the loved one wants to engage or reengage in a relationship with you, set the expectation that they have to be sober and doing something to maintain that sobriety. Don’t step into the trap of accepting quick-fixes and temporary reprieves. If your loved one comes to realize that their relationship with you is important, they will allow you to hold onto your expectations.

Raising your voice, making threats, recalling shaming events are likely to arouse defensiveness in the addict and motivate even more chemical use. The chemical is used to avoid such situations and the emotions encountered from them. Set ground-rules about what you will tolerate and hold to them. Place accountability and responsibility back on the addicted loved one. Parenting creates childish behavior. Anger creates fights. Guilt creates shame.

Rather than submitting to the well-known and self-defeating habit of looking to blame, notice what is happening inside, and remember the routine and its consequences. Realize that your insides don’t feel well and seek more constructive remedies. Step away from the situation, go to an Alanon/ Coda meeting, talk with someone, write it down, change your focus, listen to different ways of viewing or thinking about the situation, but take action for yourself. Do what is uncomfortable- take the long-term solution. Take care of yourself and your loved one will do what they need to do.

Balancing work, home, leisure, recreation and physical exercise are essential toward maintaining resilience and to build energy from which action can be taken. Isolation, boredom, fatigue, frustration, anger are often results of encountering addiction in a loved-one. Realize when stress becomes greater than stress reducing activities. Seek social support, exercise, meditation, healthy diet, supportive social relationships, spiritual practices, rest…

Find a mutual support group, a treatment center, a professional therapist or an interventionist. Accepting the help of another contains potent medicine. Collaboration creates unity and connection. Addiction is the lonely disease for all effected.