ORTC Articles

Should you try to intervene if someone you care about has a problem with alcohol or other drugs?

Now that you are beginning to enjoy the serenity and joy of being free of alcohol or other drugs, you may find yourself growing concerned about the drinking or drug problems of your friends or family members. You may feel a strong need to help, but how?

First, be cautious. In early recovery, it can be very tempting to try to help the people you care about who have addiction issues—but don’t do it if it means you may sacrifice your own sobriety. In early recovery, the best way to help a friend or family member is by establishing boundaries and remaining focused on your own recovery. There is a lot of power in a changed life, and if you continue to get healthy, you may find others wanting to get healthy too.

If you make an effort to hang around using friends or family members in order to influence them to get help, you may be putting yourself into situations where it is difficult to say no. Going to the bar where you hung out while using or sitting at home with someone you always drank with—these are choices that could set you on the road to relapse.

Once you have some more time in recovery and feel much more solid in your sobriety, you can begin to look at how to help others. When you are ready, it might make sense to do an intervention on others. If so, here is some general information on interventions that could be of help.

How should you intervene?

It is extremely painful to stand by and watch as someone’s life is destroyed. That’s the position family members and friends find themselves in when an addicted loved one denies having a problem with alcohol or other drugs. Until that person admits the need for help, there is usually little that can be done.

It is possible to try to intervene in an attempt to help the addicted person see the broad impact of his or her use. There are actually people who lead interventions on a paid or volunteer basis. Professionals who conduct formal intervention meetings for addicted people believe they can help families and friends hold up a mirror to their loved ones, convincing them to confront their problem before they hit rock bottom—before they lose their job, health, and family.

The power of an intervention comes from the participants’ expression of concern and compassion for the addict’s welfare. One technique is to have family members and friends write letters to the addict and then read them aloud at the intervention meeting. The letters allow family members and friends to express their feelings without threatening or blaming the addicted person.

A family member or friend might say, “I love you, and I care about you, but I’m concerned. These are the things I see happening to you.” Then each person ties his or her own feelings to the statements. They might give examples of times they were hurt by the addicted person. For instance, a child might write or say, “You went to my basketball game, and everybody knew you had been drinking; I was so embarrassed.”

Intervention should stress love and concern. It should not take a negative, confrontational approach. The person should not be beat up by the intervention. Here are some additional guidelines:

• Participants need to be educated about the disease of addiction prior to the intervention. Their words should be concise, be well rehearsed, and should accentuate the positive.
• Interventions should take place in neutral territory. Find a location that will not feel threatening to the addicted person.
• People invited to the intervention should include family members, close friends, and, when appropriate, employers or fellow employees.
• Limit the intervention to about sixty to ninety minutes. At longer sessions, anger may flare up and compassion tends to decline.
• Schedule a substance use evaluation to follow the meeting.

Most intervention subjects will agree to the evaluation, but of course that is not always the case. That doesn’t mean the intervention has failed. Interventions never fail, because family members and friends get help, and the sooner they get help, the sooner their loved one will. The process plants a seed for recovery in the addicted person’s mind. It teaches family members and friends about the disease of addiction, how they may be enabling the addicted loved one, and how support groups such as Al-Anon can help them care for themselves.

While recognizing the value of formal interventions in individual cases, it
is important for families to think carefully about whether the process is right for them. If you want to work with a professional interventionist, shop around for one you will be comfortable with and check references.

Interventions are most successful when the alcoholic or addict is already close to recognizing that a problem exists. If somebody is right on the edge, an intervention can nudge him or her into getting needed help.

What is cocaine?

Cocaine is a central nervous system stimulant. It is a fine, white powder processed from the leaves of coca plants grown in South America. It is typically snorted but can be injected. Cocaine can also be added to other drugs such as heroin (this combination is called a “speedball”).

What is crack?

Crack cocaine, crack, or rock is a solid, smokable form of cocaine. Crack is the street name given to the form of cocaine that has been processed to make a rock crystal, which, when heated, produces vapors that are smoked. The term “crack” refers to the crackling sound produced by the rock as it is heated. It produces an almost immediate high, and the fact that it is inexpensive to produce and buy makes it a popular alternative to the more expensive powder cocaine.

What are the physical consequences of cocaine use?

Cocaine is a stimulant. Its effects can last from 5 to 10 minutes when smoked, or 15 to 30 minutes or longer when snorted, depending on how much is taken, as well as differences in body types and chemistry. Cocaine can lead to a num- ber of health issues, but most notably it can raise heart rate and blood pressure, leading to heart attack or stroke. Most cocaine-related deaths are a result of cardiac arrest. Cocaine users who inject the drug can also be exposed to HIV, hepatitis C, and other blood-borne illnesses.

The American Psychiatric Association (APA) uses the term “stimulant use disorder” to define a pattern of stimulant use that leads to significant physical, interpersonal, medical, or work problems. Stimulant use disorder is rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with stimulant use disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Those with stimulant use disorder should receive treatment, and those who identify themselves as addicts often find the skills and support to stay sober through peer support groups like Narcotics Anonymous.

Addiction is considered a brain-based disease characterized by abnormal drug-seeking behavior that leads to impaired control over one’s drug use.

Addiction means a person will continue using alcohol or other drugs despite the harm it does to their health, family, work or school, and relationships. An addict may experience withdrawal symptoms (physical pain, fatigue, depression, trouble sleeping, irritability) if he or she stops using, and may need to keep using just to feel normal. “Curing” addiction is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, addiction is considered a chronic disease which is beyond one’s control and fatal if left untreated.

How does cocaine use affect a co-occurring mental health disorder?

Co-occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co-occurring disorders should be part of any good assessment or treatment plan.

Cocaine can affect the same neurochemicals that researchers believe to be abnormal in bipolar disorder. Thus, the use of cocaine may trigger an earlier onset of bipolar disorder in people who are vulnerable to the disorder. It’s also possible that cocaine use could re-create depression or mania in people with bipolar disorder.

Chronic cocaine use can also worsen major depressive disorder, which can lead to increased use. As people with major depressive disorder use cocaine, they move from feeling euphoric to depressed and then, very often, paranoid.

Ritalin is a stimulant medication prescribed for people with ADHD. People using Ritalin should avoid any form of cocaine, because its abuse can lead to stimulant overdoses leading to heart problems, strokes, hyperthermia (elevated body temperature), and convulsions. Abuse of both cocaine and alcohol compounds the danger, increasing the risk of overdose, especially if the person is already using Ritalin.

How does cocaine use affect the brain?

When a person uses cocaine, there is an immediate rush of the neurotransmitter dopamine, which the brain’s neurochemical circuits perceive as pleasurable and rewarding. Because cocaine disappears from the brain quickly, chemical messages urge the user to repeat the experience as soon as possible. Thus, the user develops cravings for the drug.

As the user uses more and more, this causes a change in the brain’s reward system requiring more and more of the drug to achieve the same effect. This is called tolerance, and is one sign of a substance use disorder, or addiction. As the user requires more cocaine just to feel normal, this can lead to increasingly damaging behaviors.

Any form or amount of cocaine can do lots of damage to the body because it targets the brain and central nervous system.

Is addiction to cocaine treatable?

Yes. Treatment usually involves detoxification and outpatient or residential therapy. While no medications have been proven to reduce cocaine cravings, stimulant addiction has been effectively treated with a combination of methods such as motivational interviewing and experiential learning. The Matrix Model is a treatment model backed by more than thirty years of research. It was developed in California in the 1980s, when cocaine addiction was at record-high levels.

Addiction won’t go away, like a cold or the flu. It is a chronic disease, meaning you have it all your life. However, by staying sober and getting ongoing support, recovering people can live normal, healthy, productive lives.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

National Institute on Drug Abuse (NIDA)

This government organization is dedicated to addiction research and education. Through its website you can access up-to-date publications about many different drugs of abuse as well as emerging trends.

Matrix Institute on Addiction

Learn about the Matrix Model of treatment for substance use disorders at the website for the Matrix Institute.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is part of the U.S. Department of Health and Human Services. Its mis- sion is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness.

How can you manage your caregiving role while still maintaining your sobriety?

Being a caregiver of an elderly parent or disabled loved one is never easy. It can be even harder if you are trying to be a caregiver while in recovery. The stress of taking care of another’s needs may be so great at times, it can lead to the desire to drink or use. If not dealt with in healthy ways, caregiving can be a dangerous role that could lead to relapse.

More than fifty million Americans care for a chronically ill, aged, or dis- abled loved one. Deborah, a recovering alcoholic, will be celebrating her birthday on Sunday. She plans to invite her aging mother for dinner because Deborah would feel guilty if she didn’t. But the truth is that Deborah would like to celebrate with her young children and be spared her mother’s litany of ailments and complaints.

“I love her,” says Deborah, “but my mother feels so sorry for herself that it’s hard to be around her a lot. I try to do everything I can for her. I’m constantly taking her to doctors. I have her over for dinner twice a week. I take her shop- ping. But I have a job and a husband, and my children need me. Plus I have my own health problems. It just gets to be too much.”

Love, a sense of commitment, or guilt may thrust you into a caregiving situation. Some take on the caregiving role willingly, others reluctantly. In either case, caregiving can disrupt family life, strain resources, and create emotional chaos. Deborah will need to take extra care of herself and keep working a strong AA program to avoid relapse.

Studies show that family caregivers are more likely than non-caregivers to experience strokes, heart attacks, depression, and anxiety. The stress and isolation brought on by caregiving may lead to feelings of anger, resentment, and grief. Caregivers are also at increased risk for unhealthy behaviors such as overeating and substance use disorders; those recovering from addictions may be at greater risk for relapse. As a recovering person, it can be particularly difficult if you are caring for a parent that never really cared for you while you were growing up.

While many caregiving situations may develop into an unmanageable bur- den, that doesn’t need to be the case. Caregiving can be a positive experience, one that brings families together during a difficult time. The Twelve Steps can help caregivers let go of the burden of caring for another. Caregivers can find serenity when they come to trust a power greater than themselves with the outcome.

Bob, a recovering addict whose mother died recently, relied on the Serenity Prayer when his mother’s health declined and she alternated between demanding his help and resisting it. “I used to worry about her falling, and sometimes I would get angry when she treated me like I was still nine years old,” he said. “But then I figured, what’s the point? I can’t change her.”

The Serenity Prayer helped Bob deal with his powerlessness: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Bob set some boundaries for himself. He learned how to say no without feeling guilty, and he practiced detachment with love. Detachment means respecting the other person’s right to make choices. It is remembering that you cannot control anyone else’s feelings, thoughts, or behavior, and that you are not responsible for them.

Detachment is a delicate matter for caregivers, who must step in when the relative can’t make sound decisions. Assuming the role of parenting your parent can be highly stressful. Detachment means taking care of yourself. Bob saw to it that his mother got good care, but he didn’t let her chronic condition trap him in a life of despair. Between visits, he found ways to relax and enjoy himself.

What resources are available to help you
in your caregiving role?

Caregivers seeking support and guidance may contact Children of Aging Parents, a national nonprofit resource and referral organization on caregiving for the elderly.

Other resources include the National Family Caregivers Association, the Family Caregiver Alliance, and the National Family Caregiver Support Program.

What is blaming?

As long as we blame others for things that happened in the past, we can’t accept our part of the responsibility, and therefore no growth or change can occur.

Blaming others enables us to hold on to anger and resentments and to avoid having to change ourselves. It’s the way we shrug off responsibility for challenges in our lives. It’s easier for us to believe that other people, places, and things make us angry, than to take responsibility for our part in the situation.

If you have blamed others for what’s happened in your life, you have kept yourself from looking inward and choosing what you could do to change things. The guilt trips you laid on your spouse, parents, children, friends, and co-workers did nothing to really change the sadness, anger, and frustration you were feeling. All blaming did was to turn your fear of those emotions and direct it outward toward others.

When you blame other people for what happens in your life, you give your power to those people, because your feelings become the responsibility of someone else.

Many of us blame others because it allows us to operate from a morally superior position. In your life do you notice that you always have to be “right” while someone else has to be “wrong”? Do you dominate others because you fear that you will be dominated? Do you usually have ideas about how things should turn out? Have you already decided that the outcome you have in mind is the “good” outcome and that others’ ideas are “bad” or “wrong”? If the answer is yes, then you need to work on blaming and controlling behaviors.

How can you stop blaming?

The only way to get out of this trap is to stop blaming. Begin by refusing to let yourself turn your anger and fear outward. Don’t blame, accuse, or point fingers at others for your own frustrations and longings. Working to let go of blaming will take lots of discipline, effort, and practice, because years of old habits are hard to break. But once you start to identify your blaming behaviors, it will be easier for you to take a deep breath, to be present in the moment, and to realize that most of the complaints you have are in the past. They don’t need to hold you back from what you can achieve now.

Before you can truly accept that you are powerless against the disease of addiction, you need to remove blame from your thoughts, actions, attitudes, and communications. You can then look inward instead of outward for solutions. You can be responsible for your relationships with your friends and loved ones and with your Higher Power.

Recovery action Step

Let go of blaming others and start looking inward to take responsibility for your life. Start by using “I” instead of “you” or “we” when you share your thoughts, feelings, and intentions.

1. Write down a brief description of times you blamed others for things that happened in your life.
2. Looking inward, take responsibility for your own role in what happened. Write down what you could have done to accept and come to peace with the situation, or what positive action you could have taken to change it.
3. Let your sponsor, recovery support group, friends, and family know that you are working to stop blaming others. Ask them to respectfully let you know when you fall back into blaming.

What is abuse?

Abuse is the use—or threat of using—physical, sexual, or verbal behavior to coerce another to do something. The abuser generally wants to degrade or humiliate, or to gain or maintain a sense of power or control. Abusive behaviors may include subtle or covert harm as well as life-threatening acts of violence.  These behaviors create an imbalance of power and control within a relationship or family.  There are several kinds of abuse—physical, sexual, and emotional—and each kind can take many different forms. Our society is so tolerant of abusive behavior that we often do not even recognize it as such.

What is physical abuse?

Physical abuse is any forceful nonconsensual physical behavior. It includes but is not limited to situations where a person is

• pushed, shoved, or hit
• held down, tied, or otherwise physically restrained from leaving
• targeted with a thrown object
• locked out of the home
• abandoned in a dangerous place
• denied basic physical needs such as eating or sleeping
• choked or burned
• threatened or abused with a weapon

Note that many of the above may not result in physical injury. The degree of injury is not what determines that an action is abusive. It is the behavior itself and the atmosphere of intimidation that defines abuse.

What is sexual abuse?

Sexual abuse is any nonconsensual sexual act or behavior. It is not just rape. It demeans and humiliates, making one feel shameful and exposed, particularly with regard to one’s sexuality. It includes but is not limited to situations where a person is:

• demeaned by remarks about body or body parts
• berated about sexual history, possibly including being blamed for being sexually abused or raped as a child
• called degrading sexual names
• treated as a sex object
• forced to beg for sexual attention
• forced to watch or have sex with others or pose for sexual photographs or pornography
• forced to engage in sex (rape)
• forced to do sadistic sexual acts

What is emotional abuse?

Emotional abuse is any verbal or nonverbal message given in order to threaten, intimidate, and degrade. It includes but is not limited to situations where a person:

• is belittled by name-calling
• feels frightened by another’s looks, actions, or gestures
• is treated like a servant
• feels controlled by the abuser, who monitors one’s activities and plans, conversations, and reading choices
• has concerns that are not taken seriously
• feels threatened
• is made to feel mentally unbalanced

Recovery Action Step

Can you relate to these three types of abuse? Write down a time in your life when you experienced emotional abuse. Some people were emotionally abused as children when they were called names on the playground and weren’t allowed to play with other children. Discuss the answers with your therapist, sponsor, or recovery support group.

What is post-traumatic stress disorder?

It doesn’t matter what type of abuse you’ve experienced, every type has a cost. That cost depends on the severity of the abuse. Many people suffer from post-traumatic stress disorder (PTSD), a debilitating condition that can develop after exposure to a terrifying event. PTSD affects both men and women. The event causing it may be something that threatened the person’s life or that of someone close to him or her.

Traumatic events that can trigger PTSD include violent personal assault such as rape or mugging, natural or human-caused disasters, accidents, or military combat. Whatever the source of the problem, some people with PTSD suffer from chronic memories of the trauma in the form of nightmares and disturbing flashbacks.

Other symptoms of PTSD include sleeping problems, feeling detached or numb, being easily startled, losing interest in things once enjoyed, and having trouble feeling affectionate. Irritability or aggressive behavior may result.  Reminders of the trauma may be very distressing and can lead to avoiding certain places or situations that bring back those memories. Anniversaries of the traumatic event may also be very difficult.

Many people have PTSD, especially those who have spent time in war zones.  PTSD is diagnosed only if the symptoms last more than a month. In those who develop it, symptoms usually begin within three months of the trauma. The length of the illness varies. Some people recover within six months; others show symptoms that last much longer. Occasionally PTSD does not show up until years after the traumatic event. If you suspect that you suffer from PTSD, it is best to see a mental health professional, psychologist, or licensed professional counselor for an accurate diagnosis.

What kinds of treatment are available?

Although PTSD is a mental health disorder, it can be treated with medical and behavioral interventions. Like others with mental health disorders, people with PTSD are highly likely to experience alcohol or drug use problems.

Cognitive-behavioral therapy, group therapy, and individual psychotherapy have been found to be effective treatments for PTSD. Studies have also shown that medications can help ease the symptoms of depression and anxiety. It is important to discuss medication options with a professional knowledgeable about substance use disorders because some medications can be addictive.

Where can you get help?

National Domestic Violence Hotline

The National Domestic Violence Hotline offers crisis intervention, information about domestic violence, and referrals to local service providers to victims of domestic violence and those calling on their behalf. Hotline advocates and volunteers have access to translators in 139 languages. They also offer resource materials on violence issues.

National Center for Post-Traumatic Stress Disorder (PTSD)

The National Center for PTSD was created to advance the clinical care and social welfare of America’s veterans through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders. This website is an educational resource concerning PTSD and other enduring consequences of traumatic stress.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA offers a wealth of information on all mental health topics.

MaleSurvivor

This organization is for men who have been victims of childhood sexual abuse and rape. They offer a newsletter, a search tool to find licensed therapists by state, and professional articles on abuse.

Rape, Abuse & Incest National Network (RAINN)

This organization helps survivors of rape, incest, and childhood sexual abuse find counseling. It operates a twenty-four- hour toll-free helpline that connects people with rape crisis counselors in their area.

Survivors of Incest Anonymous

This is a Twelve Step group for survivors of incest and other childhood sexual abuse.

How does joy affect recovery?

While in active addiction, some of us pretended to be happy for long enough that we forgot what real joy felt like. We used alcohol and other drugs to self-medicate ourselves against emotional pain, and in the process gradually found ourselves also incapable of feeling other emotions, such as happiness, joy, and peace.

In early recovery, many of the emotions flooding into your life may seem painful. Remember that your capacity for joy, serenity, and peace will grow as you gain more experience in recovery.

Like happiness, joy is often an elusive emotion. But if you actively work the Twelve Steps, pursue a meaningful relationship with your Higher Power, and make time to deepen relationships with others, you’ll witness more joy in your daily life.

How will you experience freedom in recovery?

As you progress in your recovery you will feel a renewed sense of freedom and happiness from letting go of dishonesty, unresolved anger, and controlling behaviors. There is a great freedom and liberation in letting go of the lies, blame, and resentments that we used to justify our addictive behavior.

You may also begin to experience the world through awakened senses. Earlier, your senses of touch, smell, hearing, taste, and sight may have been diminished by the disease of addiction. As time passes and you remain abstinent, you will likely notice a renewal of these senses.

Others experience freedom on a less physical level. Sometimes serenity is experienced in spiritual insights that you missed when you were focused on your addiction.

Surrendering to your Higher Power brings freedom from the weight of trying to fix a problem (addiction) that you can’t fix on your own. The more you let go and let your Higher Power take control of your life, your choices, and your thinking, the greater freedom you will experience.

Most people in recovery also experience greater freedom after they have completed a thorough and honest personal inventory, share that inventory with another person, and then take steps to make amends to those they have hurt. Doing these things as part of your Twelve Step program will help you find freedom.