Is my loved one addicted?
The best way to tell if a person is addicted is to determine whether or not the use of the substance in question (or the behavior like gambling or sex) is harming him in any way. That is, does the person's use of cocaine, for instance, harm him physically, damage his relationships, impair his school or work performance? The potential for damage, especially in the case of a dangerous substance like cocaine, should be considered also. Of course, the person who is not yet addicted but using a particular substance or showing a particular pattern of behavior may have problems which can be addressed by you or a professional.
Can I handle this myself?
The first thing to do is to try to handle it! If you have not spoken with your loved one about your concerns, go ahead and speak with him or her about your concerns. It may be that he or she thought the problem was hidden from everyone else, and your bringing it up will be enough to get him or her to accept some help. If she does not address the problem after you have spoken about your concerns, he or she will probably need professional assistance.
What kind of therapist should my loved one go to?
The therapist's philosophy is less important than his or her training and experience with addiction. Even the best-trained therapist who does not have this training and experience will likely be unable to help your loved one. See the section on this website entitled "How to Find an Addiction Clinician" for specific recommendations.
Is inpatient treatment or outpatient treatment better?
Inpatient treatment (where the addict lives in the facility) is most useful when the addict has been unable to stop outside of a facility, has an active psychiatric problem, is suicidal, or has a living environment which promotes substance use. Outpatient treatment (where the addict returns home every day) is best for all other situations.
My general preference is to use outpatient treatment except in those situations where it has not worked or appears very unlikely to work. This is because the addict's skills in avoiding substance use are best solidified when he has the actual day-to-day stresses to practice on when he returns home, unless, as I noted above, those stresses provoke actual relapses!
Does my loved one need detoxification?
That depends on the substance used and the addict's reaction to stopping the substance. For alcohol and other central nervous system depressants like Xanax, a medical detoxification program is necessary if the addict shows physical signs of withdrawal like tremors, changed thinking, or fluctuating blood pressure of pulse. Since withdrawal from these substances is very dangerous, the addict should at the very least be examined by a doctor.
Withdrawal from heroin, Oxycontin, and other opiates, by contrast, is usually not dangerous although it is extremely uncomfortable. Excellent strategies exist for minimizing this discomfort exist. Withdrawal from cocaine, marijuana, and other substances can be treated symptomatically, but has no specific treatment strategies.
After keeping the addict physically safe, the most important aspect of detoxification is as a method to get the addict into actual treatment for the addiction. Detoxification should be a bridge to the ongoing treatment to help the addict stop and stay stopped.
What should I do if the addict denies he has a problem?
First, remember that denial is very common when an addiction is brought to light!
Of course, your belief that the person has an addiction problem may be incorrect, and you should look again at the problems you see, and perhaps check out your perceptions with others or with a professional.
But if the person has a problem and is in denial, the best attitude for you to take is the respectful disagreement of "Creative Engagement." That is, you do not need to immediately bring the addict over to your perspective with a logical argument, since that clearly will not work. Rather, you should find ways to make sure you are on the same side as the addict, and trying to find ways to make his or her life better. This may involve gently suggesting that the alcohol use may be affecting his relationships, or asking him to at least get an evaluation to humor you. Other tacks are to ask the person in question to tell you what would constitute a problem, or to challenge the person to stop using for a certain period of time.
In my experience, it is almost always best to stay engaged with the addicted person rather than to deliver ultimatums or cut off contact if the person does not do what you think he or she should.
Do medications help with addiction?
Many medications do help with addiction, and more are being developed all the time. Research on each of these medications has shown however, that they work best when they are combined with other treatment methods such as peer-led support groups like Alcoholics Anonymous and psychotherapeutic methods like relapse-prevention therapy.
What if my loved one switches to a less-dangerous substance?
If a heroin user switches to, for instance, alcohol, he or she is at risk for addictive use of the new substance. Switching to another substance, even a less dangerous one, is not a good strategy although it may sometimes be an intermediate step in the addict's recovery.
Alcoholics Anonymous or other peer-led support groups necessary for recovery from addiction?
Peer led support groups are often tremendously valuable in dealing with an addiction, and I recommend that every addict use this widely available modality, However, each addict finds his or her own way into recovery, and some find their way without using peer-led support groups.
What if my loved one agrees to cut down on his use of the abused substance?
Your first response to this should be "Great!" Cutting down is certainly a step in the right direction. However, merely cutting down is unlikely to solve the addiction problem, so you should continue to promote the idea that much more will need to be done, and that abstinence from the abused substance is an important goal.
Is addiction a disease?
This is a trick question!
Entering into a debate on this question takes up time and energy from helping your loved one, although I agree that there are valid philosophical, financial and medical bases for disagreement.
My own perspective is that addiction is enough like a disease that we should treat it as one.
Where can I find a therapist who is trained and knowledgeable in the treatment of addiction?
See section "Finding an addiction clinician" in the Links section of this site.
Where can I find an inpatient or outpatient treatment facility?
See the section on this web page entitled "Finding an addiction treatment facility."
What if I'm worried that the addict will kill him or herself?
If you are worried about an immediate threat to the life of an addict, you should call 911 immediately.
In the more common scenario, in which an addict's continued use threatens his or her well-being, you should get professional help in determining how forceful you need to be in getting professional help to the addict.