What Is Substance Abuse Treatment?

AcknowledgmentsThis publication was prepared for the Substance Abuse andMental Health Services Administration (SAMHSA) by theKnowledge Application Program (KAP), a Joint Venture of TheCDM Group, Inc., and JBS International, Inc., under contractnumber 270-99-7072, with SAMHSA, U.S. Department of Healthand Human Services (HHS). Karl D. White, Ed.D., and AndreaKopstein, Ph.D., served as the Government Project Officers.DisclaimerThe views, opinions, and content of this publication are thoseof the authors and do not necessarily reflect the views, opinions,or policies of SAMHSA or HHS.Public Domain NoticeAll materials appearing in this publication except those takenfrom copyrighted sources are in the public domain and maybe reproduced or copied without permission from SAMHSA orthe authors. Citation of the source is appreciated. However,this publication may not be reproduced or distributed for afee without the specific, written authorization of the Office ofCommunications, SAMHSA, HHS.Electronic Access and Printed CopiesThis publication may be ordered or downloaded fromSAMHSA’s Publications Ordering Web page at http://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7(1-877-726-4727) (English and Español).Recommended CitationCenter for Substance Abuse Treatment. What Is SubstanceAbuse Treatment? A Booklet for Families. HHS Publication No.(SMA) 14-4126. Rockville, MD: Substance Abuse and MentalHealth Services Administration, 2004.Originating OfficeQuality Improvement and Workforce Development Branch,Division of Services Improvement, Center for Substance AbuseTreatment, Substance Abuse and Mental Health ServicesAdministration, 1 Choke Cherry Road, Rockville, MD 20857.HHS Publication No. (SMA) 14-4126First Printed 2004Revised 2005, 2006, 2007, 2008, 2010, 2011, 2013, and 2014

What Is Substance AbuseTreatment?A Booklet for FamiliesU.S. Department of Health and Human ServicesSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Treatment1 Choke Cherry RoadRockville, MD 20857

CONTENTSIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1What Is Substance Abuse? . . . . . . . . . . . . . . . . . . . . . 2What Is Substance Abuse Treatment? . . . . . . . . . . . . 5Just for You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19I’m Afraid It Won’t Work . . . . . . . . . . . . . . . . . . . . 22Especially for Young People . . . . . . . . . . . . . . . . . . 24Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28iii

INTRODUCTIONThis booklet is for you, the family member of a person dependent on alcohol ordrugs. Whether your family member isdependent on alcohol, cocaine, heroin,marijuana, prescription medications,or other drugs, his or her dependenceaffects you and your family, too.This booklet answers questions oftenasked by families of people entering treatment. The “Resources” section, at theback of this booklet, lists a selection ofsources for more information and support groups available to you during thisstressful time. Take advantage of thishelp, ask treatment providers questions,and talk with supportive friends or otherfamily members about your feelings.Millions of Americans abuse or aredependent on alcohol or drugs. All ofthese people have families—so remember, you are not alone. The fact that yourfamily member is in treatment is a goodsign and a big step in the right direction.People with alcohol or drug dependence problems can and do recover.1

WHAT IS SUBSTANCEABUSE?Alcoholism and drug dependence andaddiction, known as substance use disorders, are complex problems. People withthese disorders once were thought to havea character defect or moral weakness;some people mistakenly still believe that.However, most scientists and medicalresearchers now consider dependence onalcohol or drugs to be a long-term illness,like asthma, hypertension (high bloodpressure), or diabetes. Most people whodrink alcohol drink very little, and manypeople can stop taking drugs without astruggle. However, some people developa substance use disorder—use of alcoholor drugs that is compulsive or dangerous(or both).Why Do Some People Developa Problem but Others Don’t?Substance use disorder is an illness thatcan affect anyone: rich or poor, male orfemale, employed or unemployed, youngor old, and any race or ethnicity. Nobodyknows for sure exactly what causes it, butthe chance of developing a substance usedisorder depends partly on genetics—biological traits passed down throughfamilies. A person’s environment, psychological traits, and stress level also playmajor roles by contributing to the use ofalcohol or drugs. Researchers have foundthat using drugs for a long time changesthe brain in important, long-lasting ways.It is as if a switch in the brain turned onat some point. This point is different forevery person, but when this switch turns2

on, the person crosses aninvisible line and becomesdependent on the substance.People who start using drugsor alcohol early in life run agreater risk of crossing thisline and becoming dependent. These changes in thebrain remain long after aperson stops using drugs ordrinking alcohol.behavior that often accompanies it. Your loved oneis not at fault for havinga disease, but he or sheis responsible for gettingtreatment.What Are theSymptoms ofSubstance UseDisorders?Even though your familymember has an illness, itdoes not excuse the badOne of the most importantsigns of substance addictionor dependence is continueduse of drugs or alcoholdespite experiencing theserious negative consequencesof heavy drug or alcohol use.Often, a person will blameother people or circumstancesfor his or her problemsinstead of realizing that thedifficulties result from use ofdrugs or alcohol. For example,your partner may believe hewas fired from jobs becausehis bosses didn’t know how torun a business. Or yourdaughter may believe she gota ticket for driving under theinfluence of alcohol becausethe police were targeting her.Perhaps your loved one haseven blamed you. People withthis illness really may believethat they drink normally orthat “everyone” takes drugs.These false beliefs are calleddenial, and denial is part ofthe illness.Q: My husband says that heis an addict. How can this bepossible when he still has agood job?A: Understanding how aperson can be dependenton alcohol or drugs and stillkeep a good job is difficult.The media often portraypeople with substance usedisorders as unemployed,unproductive, criminal, andhomeless. However, manypeople who are dependenton alcohol or drugs do notfit this stereotype; they havejobs and live with their families. The disease does tend toworsen over time. Eventually,your husband’s drug use mayincrease, and, with no help,he may begin to experiencemore serious problems. Theearlier your husband can gettreatment, the better chancehe has of recovery.3

Physical dependence orwithdrawal symptoms—Insome cases when alcohol ordrug use is stopped, a personmay experience withdrawalsymptoms from a physicalneed for the substance.Withdrawal symptoms differ depending on the drug,but they may include nausea,sweating, shakiness, andextreme anxiety. The personmay try to relieve these symptoms by taking either more ofthe same or a similar substance.Other important symptoms ofsubstance use disorders include Tolerance—A person willneed increasingly largeramounts of alcohol or drugsto get high. Craving—A person will feela strong need, desire, or urgeto use alcohol or drugs, willuse alcohol ora drug despite negativeconsequences, and will feelanxious and irritable if heor she can’t use them.Craving is a primarysymptom of addiction. Loss of control—A personoften will drink more alcoholor take more drugs than heor she meant to, or may usealcohol or drugs at a timeor place he or she had notplanned. A person also maytry to reduce or stop drinkingor using drugs many times,but may fail.4Q: My mother says there is nocure for this disease, so shedoesn’t need treatment. Isthat true?A: Perhaps your mother doesnot understand the purposeof treatment. She is correctto some degree; a substanceuse disorder is often chronic—but it is treatable. This is alsotrue of many other long-termillnesses, such as diabetesand hypertension. Treatmentfor substance use disordersis designed to help peoplestop alcohol or drug use andremain sober and drug free.Recovery is a lifelong process.Staying in recovery is adifficult task, so your motherwill need to learn new waysof thinking, feeling, andacting. Treatment can helpyour mother accept, manage,and live with her illness.

WHAT IS SUBSTANCEABUSE TREATMENT?Who Provides Treatment?Many different kinds of professionalsprovide treatment for substance usedisorders. In most treatment programs,the main caregivers are specially trainedindividuals certified or licensed assubstance abuse treatment counselors.About half these counselors are peoplewho are in recovery themselves. Manyprograms have staff from several differentethnic or cultural groups.Most treatment programs assign patientsto 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 aclinical assessment. A complete assessment of an individual is needed to helptreatment professionals offer the type oftreatment that best suits him or her. Theassessment also helps program counselors work with the person to designan effective treatment plan. Althoughclinical assessment continues throughouta person’s treatment, it starts at or justbefore a person’s admission to a treatment program. The counselor will beginby gathering information about theperson, asking many questions such asthose about Kinds, amount, and length of time ofsubstance or alcohol use5

The counselor may invite you,as a family member, to answerquestions and express yourown concerns as well. Behonest—this is not the timeto cover up your loved one’sbehavior. The counselorneeds to get a full picture ofthe problem to plan and helpimplement the most effectivetreatment. It is particularlyimportant for the counselorto know whether your familymember has any serious medical problems or whether yoususpect that he or she mayhave an emotional problem.You may feel embarrassedanswering some of thesequestions or have difficultycompleting the interview, butremember: the counselor isthere to help you and yourloved one. The treatmentteam uses the informationgathered to recommend thebest type of treatment. No onetype of treatment is right foreveryone; to work, the treatment needs to meet your family member’s individual needs. Cultural issues around useof alcohol or drugs Effects of drug or alcoholuse on the person’s life Medical history Current medical problemsor needs Current medications(including pain medication) Mental health issues orbehavioral problems Family and social issues andneeds Legal or financial problemsAfter the assessment, a counselor or case manager isassigned to your family member. The counselor works withthe person (and possibly hisor her family) to develop atreatment plan. This plan listsproblems, treatment goals, andways to meet those goals. Educational background andneeds Current living situation andenvironment Employment history, stability, problems, and needs School performance, problems, and needs, if relevantBased on the assessment,the counselor may refer yourfamily member to a physicianto decide whether he or she Previous treatment experiences or attempts to quitdrug or alcohol use.6