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Making Recovery from Addiction a Shared Journey

Including loved ones in the recovery process may lead to better outcomes.

Key points

  • When a person has cancer, loved ones are often involved in the person's treatment. With substance use disorder, loved ones are often left out.
  • Traditional opaque models of treatment for substance use disorder may be unsatisfying to loved ones and unlikely to enhance sustained recovery.
  • Loved ones should be involved in conversations about treatment options as well as likely outcomes and discuss goals when someone exits treatment.

Imagine that you recently learned that a loved one was diagnosed with a potentially terminal illness, like cancer. Your first reaction would most likely be anxiety, followed by a natural inclination to want to know more, as well as how you might be able to help. This scenario, of course, is perfectly natural and normal. Unfortunately, it is not the experience that many people report having when the potentially terminal diagnosis is addiction.

Treatment for Addiction Tends to Be an Opaque Process

Loved ones of those who find themselves caught up in the throes of a substance use disorder, for example with alcohol or opioids, are typically very anxious about the problem while it is untreated (and possibly worsening) and will usually report that they experience some degree of relief if and when the substance abuser makes the decision to enter treatment of one kind or another. But that is where the analogy to cancer treatment typically ends. While cancer treatment tends to be more transparent to loved ones, and even engages them as collaborators in many ways, substance abuse treatment tends to be an opaque process in which loved ones have little insight and often find themselves left out in the eventual outcome. When a loved one has cancer, family and friends are often enlisted in ways such as attending doctor's meetings and taking notes, discussing treatment options and their likely outcomes, accompanying the patient to treatments, helping to build a support network of fellow survivors, and so on.

Not so with addiction treatment. A more common scenario reported by loves ones goes something like this: “Take care of yourself and leave the treatment process to us, and recovery to the substance abuser.” Needless to say, this can be immensely frustrating to loved ones who are, in truth, stakeholders in recovery as much as the substance abuser.

The time has come to change the above scenario and to move both treatment of and recovery from a substance use disorder to a more collaborative process. It will likely be more successful, as in cancer treatment, when it is approached as a shared journey that includes the patient and other stakeholders in his or her life.[i]

Substance Abuse in the Time of COVID

Researchers and clinicians have reported a significant increase in both mental health and substance abuse diagnoses since the advent of the COVID pandemic—a trend that unfortunately continues to this day. According to the Centers for Disease Control and Prevention, as of June 2020, 13 percent of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19.[1] Although the pandemic itself is not the only source of the current substance abuse crisis, the reality is that more and more families are finding themselves confronted by an alcohol, opioid, or prescription drug abuse problem in a family member. For this substantial portion of our population, the traditional opaque treatment model is neither satisfying nor likely to enhance the prospects of sustained recovery.

What is more likely to work is to approach treatment and post-treatment recovery as a shared journey that includes the patient and loved ones who are stakeholders in the outcome. This post will describe some of the elements of such a collaboration.

Recovery as a Shared Journey

Recovery begins when the substance abuser takes that first step in engaging in treatment. That may be residential rehab, intensive outpatient treatment, or simple weekly outpatient treatment—and here is where the first critical step needs to be confronted in a frank way. Just as some individuals who are told that their diagnosis is cancer (or diabetes, emphysema, or heart disease) may refuse to accept that reality, so it is for the substance abuser. He or she may simply deny that the problem is there, or try to minimize its consequences for them and their family. She or he may “talk the talk” and say that they are addicted and need to abstain from all substance use, while privately holding on to some belief that they can control or “moderate” their use: “A couple of cocktails on the weekend can’t hurt,” or “Just a little painkiller helps me get through the day.”

As a first step, loved ones as stakeholders have a right to know exactly what “treatment” for the substance abuse problem looks like. When a loved one is diagnosed with cancer, family members typically are included in discussions of treatment options (chemotherapy, radiation, surgery, etc.) and what the likely outcomes associated with each option are. So it should be with substance abuse treatment.

The fact is that substance abuse treatment is currently an unregulated industry, and that while there are generally accepted treatments for most medical problems, that is not the case when it comes to substance abuse. The result is that not all substance abuse treatment programs (on the inside) are the same. Loved ones, as well as the person with substance use disorder seeking help, need to know this and therefore take time to inquire about just what the “treatment” program looks like. Some programs, for example, offer treatment that may include hot tubs and horseback riding that appear to appeal to people as vacations more than treatment. Fortunately, there are what are called “evidence-based” treatments for substance abuse disorders that have been tested and are supported by sound research.[2] Loved ones as well as the substance abuser can spend a little time reviewing these options and then inquiring with a prospective treatment program about their use of such treatments. And while in treatment, the person with substance use disorder should share their experiences with being involved in such evidence-based treatments.

Supporting Loved Ones as They Enter and Leave Treatment

Loved ones who are stakeholders in recovery also do well to engage the substance abuser at the time she or her both enters and leaves treatment about what he or she truly believes about the substance abuse problem, and what the solution should be. It is common knowledge that the risk of relapse following rehab is high. With that reality in mind, if the newly sober person and his or her loved ones are not on the same page in this regard, the chances of success are significantly reduced, as research has shown that, for a severe substance abuse problem, choosing abstinence as a goal (as opposed to moderation or “controlled use”) leads to better outcomes.[3]

Loved ones need to be informed of research like this when they engage the newly sober person in this discussion of what they truly believe and therefore what their real goal should be. No use pursuing different goals based on different beliefs about what the real solution is. An honest dialogue at this early juncture can make the difference between recovery as a collaborative effort among stakeholders and a risky venture.

With this as a starting point, treatment and recovery move from being an opaque process in which loved ones play little to no role (other than being bystanders) toward being co-equal stakeholders. Needless to say, the responsibility for recovery rests mainly on the shoulders of the substance abuser; but in a collaborative approach, the journey to recovery stands to be more successful due to a common commitment and shared involvement.

References

Nowinski, J. Recovery After Rehab: A Guide for the Newly Sober and Their Loved Ones. Rowman & Littlefield, 2021.

Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.

https://novarecoverycenter.com/treatment/evidence-based-addiction-treat…

Bujarski, S., O’Malley, S. O., Lunny, K., & Ray, L. A. (2013). The effects of drinking goal on treatment outcome for alcoholism. Journal of Consulting and Clinical Psychology, 81 (1) 13-22.

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