An estimated 2.1 million Americans are addicted to prescription opioid painkillers, and nearly 500,000 are addicted to heroin. Unintentional opiate overdoses have more than quadrupled since 1999.1
“2.1 million Americans are addicted to prescription opioid painkillers, and nearly 500,000 are addicted to heroin.”
The high prevalence of opiate abuse is largely due to the increased availability of prescription opioids in the past two decades. In 1991, roughly 76 million prescriptions were written for opioid pain relievers. By 2013, that number had jumped to around 207 million. The United States accounts for 81 percent of the world’s oxycodone use and almost 100 percent of its hydrocodone consumption.
If you have a loved one who is addicted to opiates, you know the feelings of fear, anger and helplessness that numerous families experience as they watch a loved one destroy his health, relationships and sense of well-being.
Whether your loved one has chosen to get the help he needs or is in denial or is ambivalent about his problem, you can help him overcome an opiate addiction. The more support he gets from you and other family members, the better his chances of enjoying long-term, successful recovery.
“The more support he gets from you and other family members, the better his chances of enjoying long-term, successful recovery.”
You won’t be able to help your loved one as effectively as you’d probably like unless you understand the nature of addiction and dependence and how opiates affect brain function, thought and behavior. This eBook is for you, and it explains eight vitally important things you need to understand in order to best help your loved one beat an addiction to heroin or prescription opiate painkillers.
Addiction and Dependence Are Not the Same Thing
The terms “addiction” and “dependence” are often used interchangeably, but they aren’t the same thing.
Characteristics of Addiction
Addiction is characterized by the inability to stop using a drug despite the negative consequences it’s causing in terms of health, relationship, financial and legal problems. Even though a person may want to quit, if they’re addicted, they’ll likely find that they can’t. It takes more than willpower and good intentions to overcome an addiction, which changes the structures and functions of the brain.2
“It takes more than willpower and good intentions to overcome an addiction, which changes the structures and functions of the brain.”
How Addiction Develops
Addiction develops as the result of dopamine flooding the nucleus accumbens, which is considered to be the brain’s pleasure center.3But it’s not the pleasure alone that leads to addiction. Dopamine is associated with learning and memory, and as this feel-good chemical interacts with glutamate, another neurotransmitter, these take over the brain’s learning process as it’s related to reward.
Normally, this system is concerned with linking activities of survival, such as sex and eating, to pleasure in order to ensure the proliferation of the human race. But when this system is repeatedly flooded with high levels of dopamine, the nerve cells in the nucleus accumbens and other areas of the brain begin to associate the pleasure derived from the drug of abuse with wanting it, and the result is a very strong motivation to seek it out. When this occurs, the abuse is no longer a choice, but a compulsion.
Characteristics of Dependence
Dependence, on the other hand, is the result of changes in brain structure and function that lead the brain to operate more “normally” when a drug is present than when it’s not. When the drug is withheld, withdrawal symptoms set in as the brain’s way of saying it needs the substance to function properly.
How Dependence Develops
Opiates produce a high level of tolerance very rapidly. This means that as the brain changes the way it functions in order to compensate for the presence of the drug, higher doses are needed to get the desired effects. With chronic abuse of opiates comes the likelihood that brain function will shift so that when the drug is present, the brain is functioning optimally, but when it’s not, its previous function rebounds and causes the nausea, abdominal cramps, cold sweats and body aches that characterize opiate withdrawal.
Dependence is treated through the detox process, while treating an addiction almost always requires various therapies that address the complex psychological issues behind the abuse and addiction.
Addiction is a Family Disease, and Everyone Needs Help Recovering
Addiction indelibly affects everyone in the family, often stressing the family system to the breaking point. It affects the stability of the home and finances and the family’s physical and mental health, and it puts the whole family under a great deal of stress.4
“Addiction indelibly affects everyone in the family, often stressing the family system to the breaking point.”
How Families Cope with Addiction
Through it all, family members develop unhealthy ways of thinking and behaving. They may manipulate or deny reality in an attempt to maintain order, and they may become co-dependent or engage in enabling behaviors that make it easier for the addicted family member to continue on his current trajectory of self-destruction.
For example, loved ones may focus all of their energy on the person with the addiction in an attempt to control the chaos, neglecting each other in the process. They may constantly walk on eggshells in an attempt to keep the addicted person happy, or they may cover for the addicted person, making excuses for him or taking care of his problems in order to protect him from the consequences of the addiction. These unhealthy behaviors often make the situation worse.
Therapy is Essential
Everyone in the family needs help recovering from a loved one’s addiction, whether or not he’s getting help, too. By working through the various complex issues surrounding the addiction and curbing enabling and codependent behaviors, family members can better support a loved one in recovery or improve the chances of helping him agree to treatment down the road.
“Everyone in the family needs help recovering from a loved one’s addiction, whether or not he’s getting help, too.”
Rebalancing the family dynamics and learning healthier ways of communicating will be essential for helping your loved one succeed in recovery. Just because he’s getting help doesn’t mean that other family members will automatically adjust their own harmful ways of thinking and behaving, and continuing old patterns of thought and behavior can contribute to a relapse of the addiction.
Individual therapy for each family member is essential for restoring function to the family and working through the fear, anger and resentment that’s built up over the course of the addiction. Therapy helps you restore your own mental health and clarity so that you can help your loved one in the most effective possible ways while improving your own quality of life and sense of well-being. Therapy can also help reduce the likelihood that younger family members will turn to substance abuse later on.
“Therapy helps you restore your own mental health and clarity so that you can help your loved one in the most effective possible ways while improving your own quality of life and sense of well-being.”
The More Support You Have, The More You Can Give
The National Council on Alcoholism and Drug Dependence points out the importance of a support group like Nar-Anon for helping you and other family members navigate the day-to-day reality of living with someone who is addicted to drugs, whether or not he’s in recovery.<sup(4,5) A support groups offers you a place to vent, find resources and get practical advice from other people who have been in your shoes or who are currently going through similar circumstances.
Joining a support group from the beginning will help you better support your loved one if he’s in recovery, and it can better help you lead him to choose treatment if he remains ambivalent to recovery or in denial that there’s a problem.
A High-Quality Treatment Program is Essential
Once your loved one is ready to enter treatment, choosing the right program is critical for success. A high-quality treatment program will use research-based therapies and adhere to the National Institute on Drug Abuse’s Principles of Effective Treatment, which outline the best-practices protocol for treating a drug addiction.6Particularly for an opiate addiction, an inpatient program is best, and a minimum stay of 90 days is ideal.
“Particularly for an opiate addiction, an inpatient program is best, and a minimum stay of 90 days is ideal.”
The first step in treating an addiction to opiates should be to put your loved one on medication for long-term maintenance of the addiction. Opiate addiction is associated with extremely uncomfortable withdrawal symptoms, including intense cravings that may linger for weeks or months.
Maintenance medications eradicate cravings and stave of withdrawal symptoms so that your loved one can focus on getting his life back together. When he’s ready, he’ll be weaned from the medications and be opiate-free.
“Maintenance medications eradicate cravings and stave of withdrawal symptoms so that your loved one can focus on getting his life back together.”
An article published in the Journal of Addictive Diseases points out that medication-assisted detox and behavioral therapy alone have very poor outcomes, with over 80 percent of addicted individuals returning to drug use.7 However, long-term maintenance with medications like methadone or buprenorphine are associated with a reduction in opiate use, decreased cravings, better social functioning and increased motivation in recovery.
Methadone is an opioid agonist, which means that it activates the opioid receptors in the brain. However, it affects the receptors gradually, and the effects of methadone are far weaker than those of other opiates. Because of its potential for abuse, methadone is dispensed daily at a special clinic.
Buprenorphine is a partial agonist, which means that while it activates opioid receptors, the effects aren’t as pronounced as those of other opioids, including methadone. Buprenorphine also has a ceiling effect, which means that higher doses won’t produce more intense effects. Because of this, buprenorphine doesn’t carry the high risk of abuse that methadone does, and it can therefore be prescribed by a physician and used at home.
Taking care of the physical aspects of dependence is the first step in treatment. The second step involves various treatment therapies that are used to help your loved one address the complex issues underlying the addiction.
Motivational interviewing will help him identify his own personal reasons for wanting to recover, while cognitive-behavioral therapy will help him identify and replace self-destructive ways of thinking and behaving. Psychoeducational classes will help him learn about his addiction, the mechanics of relapse and other information critical for successful recovery.
Through these and other therapies, your loved one will develop a toolbox of skills, strategies and techniques for coping with stress, cravings and other triggers. Therapy will take place in group and individual settings. A high-quality treatment program will also offer family therapy as part of the treatment protocol. Family therapy is essential for helping to restore healthy communication and function to the family system.
“Through these and other therapies, your loved one will develop a toolbox of skills, strategies and techniques for coping with stress, cravings and other triggers.”
If your loved one has a mental illness that co-occurs with his opiate addiction, a dual diagnosis program will be essential for helping him recover. Co-occurring disorders require integrated treatment so that the addiction is treated in the context of the mental illness, and vice versa. Treating only the addiction or only the mental illness will likely lead to relapse.
Aftercare is Critical to Success
Upon the completion of a treatment program, an aftercare plan will be individualized and set in place to help your loved one maintain the momentum and motivation gained in treatment as he transitions back home. The aftercare plan components will depend on your loved one’s unique needs and challenges.
Ongoing therapy and participation in a support group are almost always included in the aftercare plan. Therapy enables your loved one to continue working through his issues and gain skills related to successful, long-term abstinence. A support group offers him peer support, which is highly effective for increasing motivation and personal accountability as well as providing a social network of other non-users.
“Therapy enables your loved one to continue working through his issues and gain skills related to successful, long-term abstinence.”
The aftercare plan may also include time spent in a sober living facility to ease the transition from rehab back to regular life, and if your loved one has a dual diagnosis, it will include regular monitoring of the mental illness and any medications used to treat it. Vocational or educational rehab may be needed to help your loved one find and maintain employment or get back on track with his education.
Aftercare for the Family
Continuing to engage in family therapy and participate in your support group are also critical during the initial period of recovery after rehab. Treatment is only the beginning, and there’s still a long way to go. Healthy communication among family members is important for improving the chances of long-term recovery, and family therapy is crucial for restoring function to the household.
“Treatment is only the beginning, and there’s still a long way to go.”
Continuing to engage with your support system during this time will also be very useful for helping you support your loved one in early recovery, and it will help you maintain your own sense of well-being. Once he returns from treatment, your loved one will have to make a number of lifestyle changes, and understanding how these affect his recovery and learning how you can best support him will help ensure a smooth transition from addiction to sobriety.
Lifestyle Changes Help Improve Recovery Outcomes
Triggers are powerful things, and avoiding them or learning to effectively cope with them are central to long-term recovery. Perhaps the most powerful trigger is stress, and keeping stress under control in the weeks and months after treatment will be extremely important for helping to prevent a lapse or relapse. Staving off boredom and feelings of isolation will also be crucial for successful recovery.
“Triggers are powerful things, and avoiding them or learning to effectively cope with them are central to long-term recovery.”]
You can help your loved one by supporting or even initiating lifestyle changes that will help him navigate early recovery as effectively as possible. These include letting old friends who use fall away, adopting a healthy diet and exercising regularly.
Spending quality time together doing activities you enjoy will help your loved one find enjoyment in life and reduce feelings of isolation, and new traditions, such as taking a walk after dinner or spending Sunday doing the crossword over brunch, gives the family something to look forward to and fills the time with enjoyable and productive activities to help prevent boredom.
Relapse Isn’t the End of the World
A lapse is an instance of using drugs again after a period of abstinence. A lapse can lead to a relapse of the addiction, which is characterized by a return to compulsive drug use despite negative consequences. The relapse rates for addiction are similar to those of other chronic diseases like diabetes and cancer. Around 50 to 60 percent of people in recovery from an opiate addiction will relapse at least once.
“The relapse rates for addiction are similar to those of othis chronic diseases like diabetes and cancer.”
Relapse is an Opportunity
There was a time when relapse was considered a catastrophic event that meant treatment had failed. These days, lapse and relapse are considered a normal part of recovery, and they offer the opportunity to re-evaluate the recovery plan and develop missing skills that will help prevent another lapse or relapse and lead to long-term sobriety.8
There will be challenges and setbacks in treatment, and how you and your loved one handle these will help determine whether he moves on and continues navigating the path to long-term sobriety or gives up on recovery altogether. Viewing a lapse or relapse as a personal or moral failure is highly detrimental to someone in recovery, while viewing it as an opportunity to develop new skills can help ensure continued recovery.9
“Viewing a lapse or relapse as a personal or moral failure is highly detrimental to someone in recovery, while viewing it as an opportunity to develop new skills can help ensure continued recovery.”
Stages of Relapse
Relapse occurs in stages, and knowing the signs of each stage can help you recognize potential trouble ahead where your loved one may not be able to see it coming.
- Emotional relapse is the first stage, characterized by an increasing neglect of self-care, skipping meetings and feeling overwhelmed by negative emotions.
- Mental relapse is the second stage, during which your loved one may begin thinking about using again, reminiscing about or glamorizing past use and contacting old friends he used to use with. By the end of this stage, he’s planning a relapse around loved ones’ schedules.
- Physical relapse is the final stage, and this is where the lapse happens. Whether it leads to a relapse of the addiction depends on how swiftly your loved one gets help and the attitude with which he views the lapse.
Hope is the Foundation of Recovery
According to the Substance Abuse and Mental Health Services Administration, hope is the foundation of recovery.10 The belief that challenges can be overcome—and imparting that belief to your loved one when he feels hopeless—will help ensure that challenges are met head-on and that your loved one’s inherent values, strengths and talents come into play in overcoming setbacks.
Beating an opiate addiction isn’t easy, but it can be done, and it has been done. Your loved one can do it, too. Sobriety is a lifelong process of personal growth, and the work is never done. Your support as your loved one navigates his newfound sobriety will be absolutely essential for helping him get through rough spots and grow into his new identity as a sober person.
- Volkow, N. (2014, May 14). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse. Retrieved from http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse
- DrugFacts: Understanding Drug Abuse and Addiction. (2012, November). Retrieved from http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction
- How Addiction Hijacks the Brain. (2011, July 1). Retrieved from http://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain
- Family Disease. (2015, July). Retrieved from https://www.ncadd.org/family-friends/there-is-help/family-disease
- Resource: http://www.nar-anon.org/
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
- Bart, G. (2012). Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of Addictive Diseases, 31(3), 207-225. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22873183
- The Science of Drug Abuse and Addiction: The Basics. (2014, September). Retrieved from http://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics
- Melemis, S. (2015, September 3). Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine, 88(3), 325-332. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
- Recovery and Recovery Support. (2015, December). Retrieved from http://www.samhsa.gov/recovery