How to Support a Loved One With an Addiction, Reported by an Addiction Psychotherapist
Written By: Carmen Schutz BA. MCP, RCC*
When we think of addiction, we think of the people we see on the street who are experiencing homelessness and deteriorating mental health issues. We think of people who are so deeply entrenched in the throes of addiction that we don’t stop to think that even those who appear to have it the most “together” may be struggling with substance misuse. These people can sometimes be those closest to us.
Approximately 21% or 6 million people in Canada will meet the criteria for addiction in their lifetime, with alcohol misuse being the most prominent substance of choice (Health Canada, 2002). With these statistics, we likely know someone struggling with substance misuse. But, it can be difficult to tell if someone is suffering from addiction - they may suffer silently. Let’s begin by breaking down what addiction is, how it happens, how you can spot it and how you can support someone you love on their road to recovery.
What Does it Mean to Meet the Criteria for Substance Use Disorders?
The Diagnostic Statistical Manual of Mental Disorders 5th Edition, or DSM-V for short, outlines the diagnostic criteria for Substance Use Disorders, where individuals can be placed in a category from mild to severe. Those who meet the DSM-V’s requirements are those that continue to use substances despite related problems, which can manifest in cognitive, behavioural or physiological manners. While the most prominent substance abused is alcohol, the DSM-V recognizes several other substances such as caffeine, opiates, inhalants and amphetamines. A full list of substances can be found here.
Why Do People Develop Addiction?
While this answer is rarely simple or singular, the stress-vulnerability model can shed some light on why some people end up developing an addiction. A person is at a higher risk of developing problems with substance misuse if they have a family history of misuse, if they live a highly stressful life, or if they are isolated and lack a social support system. While many people fit one or more of these criteria, most will not develop substance misuse issues. These should only be used as indicators of potential substance misuse.
Another reason that people develop an addiction is as a means to cope with the experience of trauma. Trauma is a subjective experience, and as a result, the degree to which we are affected by these events changes from person to person. Trauma can be anything from being bullied in your childhood, to sexual or physical abuse. Even if you were a witness to a traumatic experience, this can affect you just as much as being a victim of trauma.
What Are the Stages of Change and How Can I Help Someone in Each Stage?
In our counselling practise, we use stages of change to determine if someone is ready to enter a state of abstinence or ready to reduce the harm they are inflicting on themselves and others.
The stage of change a person is in will determine the course of treatment if there is any treatment, and how much groundwork we need to lay to help the person become successful in their goals.
Stage 1: Precontemplation “I don’t have a problem”
In this stage, people often lack awareness of their problems. They do not show any interest in quitting or reducing substance use and will often rationalize their use.
How to Support Recovery:
Try to raise awareness to your loved ones, express feelings of concern for their well-being.
Educate yourself about substance use, harm reduction, treatment, and recovery.
Provide information about the consequences of substance misuse in a non-threatening way for example “I have noticed that you’ve been using opiates a lot more and with the overdose crisis, you need to be safe when you are using. Opiate use is very dangerous right now and may result in death, do you carry Naloxone when you use? Do you use with friends or do you use alone?”
Things to Avoid:
Do not nag your loved one about their substance misuse, it will only result in them turning away from you and may not see you as supportive.
Do not attempt to control their substance use, this may only increase their use more.
Stage 2: Contemplation “I don’t know, but I might have a problem”
In this stage, your loved one may be aware of the problem but may feel ambivalent about reducing or abstaining from use.
How to Support Recovery:
Support your loved ones as they weigh out the pros and cons of substance use.
Encourage the person to speak to someone who may be in recovery.
Encourage the person to seek out counselling to help them decide what is right for them.
Things to Avoid:
Try not to push the person to implement change before they are ready. This is simply a stage where the person is looking at options, it does not mean that they will go through with any plans that you have for them.
People in this stage can spook easily and regress. Be gentle, and go at the persona’s pace rather than yours.
Stage 3: Preparation “I think I have a problem, but I’m not sure what to do about it”
In this stage, your loved one may begin making plans to change soon. They may begin seeking advice and information and forming a plan of action.
How to Support Recovery:
Help your loved one develop realistic goals and expectations of the future.
Support the person in considering what will need to change.
Support the person in getting the professional help they need.
Things to Avoid:
Avoid preparing for the person. I know we all want to help as much as we can, but they must take steps independently to get better on their own. They may be more likely to commit to abstinence or reduction if they put in the work to get there themselves.
Stage 4: Action “I have a problem and I want to change it. I know where to get help with this change if I need it!”
In this stage, your loved one will begin taking action. They may feel motivated by the plan and begin making small changes towards achieving their goal. However, relapses often occur throughout the first year of recovery. While relapses are a normal part of the process, the goal is to get back on track after a relapse.
How to Support Recovery:
Celebrate the little things! Positive reinforcement goes a long way, and the more they are celebrated for small things, the more likely they will be to continue.
Support them as they learn new ways of meeting their needs without substances
Be realistic about the speed of recovery. It takes a long time and there are many bumps in the road that can happen.
Things to Avoid:
Black and White thinking: recovery is an ongoing process. This is a time where your loved one needs to know it’s okay and it’s normal to have lapsed.
Do not shame the person if they lapse or relapse. Reduction of use is still something that helps the loved one, even if it's for a short period. Lapses and Relapses are an opportunity to learn about triggers and gaps in coping.
Stage 5: Maintenance “I have made the changes I need to make and I want help to maintain the changes”
In this stage, the person is continuing on their path to recovery and working on establishing new patterns.
How to Support Recovery:
Continue to celebrate and reinforce healthy behaviour.
Celebrate and reinforce progress towards achieving their goals
A Final Note…
While I hope this post proved useful in supporting a loved one in substance misuse, this is only an introduction to your role in supporting someone through recovery. I highly encourage those who have someone in their life who is experiencing addiction or supporting someone through recovery to reach out to a counsellor. The emotions you experience as a support system are valid and it can help to talk to a professional. Do your best to ensure that you take care of yourself as well through this process.