Treatment and recovery for substance use disorder is a lifelong process, one that often takes a toll on the well-being of family members. For tips on peer support, we asked Adam Bisaga, MD, Ophelia’s Senior Medical Director, to share tips from his book, Overcoming Opioid Addiction.
1. Remember that opioid use disorder is just that…a disorder
While it may be easy to fall into the trap of perceiving addiction as selfish or as a “choice,” when you compare drug abuse against other disorders, the concept isn’t much different — and it’s important to remember that as your loved one begins to heal.
Believing that addiction is a disorder rather than a voluntary choice sometimes requires a leap of faith. Because people using opiates can remain rational in most other areas of their lives, it seems that their behavior around drugs is knowing and deliberate. With that, most families reject the reasoning that drug use has become involuntary and compulsory. They become angry rather than compassionate, accusatory rather than supportive. They initially reject the comparison to other medical disorders as well. Only over time do they begin to accept it, which becomes a relief for many families. But the evidence does not lie. Brain-imaging studies that evaluated the activity of areas of the brain involved in maintaining uncontrollable drug use show changes in function as compared to otherwise healthy brains. Thankfully, those brain changes resolve after a period of abstinence, which means that the brain can heal, damage is not permanent, and people can return to full health.
2. Understand the difference between outpatient + residential treatment centers
Residential programs have always been considered the gold standard when it comes to addiction treatment options. But they may not necessarily be better for a person with OUD, as those patients primarily need medical treatment. While they offer their residents a lot in terms of services and support for mental illness, it is difficult to predict who will benefit from residential versus outpatient treatment. When treating OUD with medications, which requires long-term follow-up, outpatient treatment usually makes more sense financially and logistically.
3. Know what questions to ask treatment providers
Such as:
- Do you prohibit the use of any medications? If yes, which medications?
- How long is the program?
- Is there a wait list?
- What does treatment cost?
- What are average out-of-pocket expenses after insurance?
- How do you help families use their health insurance to pay for treatment?
- What percentage of people are discharged on medications?
- What treatment do people usually go to after discharge? And how do you make sure they connect with that program?
- Do you follow up with the people after they leave the program?
- Is there an option to follow up with the primary therapist on the phone after discharge? Is it a scheduled or “as-needed” follow-up?
- What happens if a person struggles and wants to come back to treatment?
4. Know that your loved one’s recovery isn’t your full responsibility, but that you do play a large role
In early recovery, people need a lot of support, more than you might think necessary. Thinking and concentration can be foggy for a while, as the brain adjusts. Energy is low because a good night’s sleep is hard to come by, at least initially. A car, job, or money might be issues. Basic skills, from hygiene to job interviewing, might be lacking. All of this is because of a serious chronic illness. If your loved one suffered from a serious disorder other than addiction, how would you treat them? Would you help them learn to do new things? Drive them to appointments? Support them financially? Make sure they take their medication and stay in touch with their doctor? Help them apply for a job?
5. Consider medication-assisted treatment (MAT)
For individuals with OUD, rehab fails 90% of the time when not followed by medication to prevent relapse. (1) That’s where medical interventions come into play for someone recovering from opioid use disorder (OUD). With a FDA-approved medication prescribed by a health professional, your friend or family member can successfully stop using heroin or misusing prescription opioids while avoiding withdrawal symptoms from detox, (2) relieving cravings, (2) lowering the chances of relapse, (2) and reducing the chances of overdose death by 70-80%. (3) To learn more about this effective treatment plan (that’s an alternative to traditional 12-step programs), refer to our full guide on how to help an addiction without rehab.
6. Monitor medications
About 50% of people stop taking buprenorphine or XR-naltrexone after a while, and some do so because they feel they are back to “normal.” Many people question whether they need to keep taking it, especially when they feel so good. Yet they still have a chronic disorder, their brain is slowly healing, and they are exposed to stress and cravings, which leave them vulnerable to relapse. Getting off medication can make maintaining abstinence much more challenging. Here’s how you can help be their recovery partner:
- Be present when the medication is picked up from the pharmacy
- Help keep medication in a safe place
- Dispense it at scheduled times
- Supervise when medication is taken
- Accompany your loved ones for naltrexone or buprenorphine injections or implantation surgery
- Set clear expectations for taking medications in return for your support
- Clearly communicate benefits and rewards for taking medication and consequences for not taking it
7. Accept ambivalence as part of recovery
Ambivalence is normal. People in the grip of addiction are exposed to a lot of stressors and triggers which cause them to want to use. Sometimes your loved one will be motivated for abstinence; other days they will feel conflicted and exhibit addictive behaviors. Once you expect and accept this, you will find the seesaw characteristics of ambivalence much easier to deal with. Here’s how you can help:
- Ask questions about why your loved one is feeling unsure
- Ask about their reasons for change and their belief in the ability to change
- Emphasize their strengths, all the positive actions they have already taken
- Acknowledge that early recovery can be difficult
8. Create a contingency management plan (CMT)
A contingency management plan (CMT) is a written “contract” you can use to reward behaviors that are good for recovery and discourage behaviors that are not. It establishes expectations, sets limits, and outlines consequences. Guidelines and consequences are stated clearly and deliberately. Everyone in the household knows what is expected of them.
9. Have everyone in the household review their relationship with drugs and put use on hold
Drinking or smoking weed in front of the person in early recovery is a trigger. Having painkillers around is detrimental. In time, your loved one may not see alcohol as a trigger, but in the beginning they may. Here’s how you can help:
- Remove all drug paraphernalia from the home
- Remove all alcohol and other drugs from the home
- If you are prescribed painkillers, lock them up and do not take them in front of your loved one
- Avoid using all other drugs, including alcohol, in front of your loved one; set a new normal — a drug-free home
10. Get help for yourself
Addiction’s toll on a family gets worse before it gets better. Even when a loved one is progressive through the addiction recovery process, family members need help. Don’t underestimate how important self-care is for you and other family members. Reach out to others for support. Find a counselor, attend a family therapy support group for addiction, or attend Al-Anon or Nar-Anon groups. If you are unable to deal with an addicted family member, see whether you can get your loved one to see a therapist, who can keep the conversation open and provide professional help.
Interested in learning more?
Refer to the Substance Abuse and Mental Health Services Administration (SAMHSA) site for recovery support services as well as information on mental health and/or substance use disorders (both drug and alcohol addiction) for yourself or a loved one.
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