What are some of the signs that we should be on the lookout for? How do we know when and if an intervention for our elderly loved ones is appropriate or necessary? Let’s look at this issue in a little more detail.

Clever Deception

We already know that our parents have a keen sense of privacy. They’re also pretty adept at keeping things secret that they don’t want others to know about, including us. It should come as no surprise, then, that our parents may cloak their growing abuse of alcohol and drugs, including prescription drugs and maintain an outward demeanor that everything is just fine.

Should there be slight glimmers of misuse of various substances, often our parents will cleverly cover it up by saying they’ve just got a bug or engaged in a little too much celebration. No big thing, they may say. There’s nothing for you to worry about.

That’s just about the time when your radar should sense that there might be more to the situation than your parents are letting on.

It isn’t that your parents want to lie to you, at least, not in most cases. But if they’ve become dependent upon drugs or alcohol, or any combination thereof, they may not be able to help themselves. Telling a falsehood becomes necessary in order for them to be able to continue their surreptitious consumption of drugs and/or alcohol undetected.

So, while we can forgive them their outright lies, this doesn’t mean that we should allow the situation to continue.

But how do we know if there really is a problem? Maybe it is true that they’re only drinking now and then, or took prescription medication in conjunction with alcohol only once. On the other hand, the problem may already be quite severe. In fact, only about 37 percent of substance abuse cases are recognized in people over the age of 60, compared with 60 percent among those under the age of 60.

The only way we can be less than clueless is to know and watch out for warning signs of drug or alcohol abuse.

Warning Signs of Prescription Drug Abuse in the Elderly

It’s easy to dismiss certain signs of prescription drug abuse in the elderly as just normal aging. Forgetfulness and irritability are two common behaviors that often go hand-in-hand with advancing years.

Here are some of the typical behaviors that are associated with drug abuse, including abuse of prescription medications. If any of them are present, it may be time to think about an intervention for your elderly loved ones.

• Changes in sleeping patterns – including sleeping too much or inability to sleep
• Changes in eating habits
• Poor personal hygiene
• Inability to concentrate
• Unexplained chronic pain
• Unsteady gait, tendency to fall frequently
• Lapses in memory
• Sadness, depression or irritability
• General loss of interest in life and activities that used to bring enjoyment
• Increased isolation from family and friends
• Has bottles of tranquilizers on hand and often takes the medication at the least sign of any disturbance

Before launching into a confrontation with your loved one, however, it’s a good idea to know a little more about what your elderly loved one may be dealing with. First of all, take an inventory of the prescription medication your loved one is taking.

Does your loved one take a drug that has addictive potential, such as benzodiazepine or opioid painkillers? These are drugs such as Valium, Xanax, Librium, OxyContin, Dilaudid, Demerol, Vicodin, Lorcet and others. If so, any deviation from taking it exactly as the doctor ordered, including how much to take, how often to take it and for how long, could be problematic.

What sometimes happens is that an elderly person doesn’t think he or she is getting the expected benefit from the medication and doubles up on the amount taken, or takes it more often than recommended. It’s also easy for older adults to forget that they’ve already taken the medication, if they don’t use a pill minder or organizer. And combinations of medications, perhaps prescribed by different doctors who aren’t kept informed of other medications your elderly loved one takes, can also be harmful. Interactions, side-effects and complications can ensue.

It might be time to accompany your elderly parent or loved one to the doctor and ask about the possibility of prescribing a safer alternative drug. This is especially important if your loved one has a past history of addiction.

Remember that it isn’t ever advisable for a patient to just stop taking a medication that the doctor prescribed for them. So, while you may be concerned about your older loved one’s misuse of a variety of prescription drugs, he or she may have become addicted to one or more of them. Quitting cold turkey is not only difficult, but can be extremely dangerous or even fatal. Withdrawal symptoms, such as seizures, for example, in the case of addiction to benzodiazepines, mean that safely detoxing from the drug needs to be carried out under the supervision of the doctor or a medical professional, often in an inpatient rehabilitation facility.

Warning Signs of Alcohol Abuse in the Elderly

Abuse of alcohol is dangerous for everyone, regardless of age. But it can be especially dangerous for older adults. Medical experts say that older adults usually need less alcohol to become intoxicated than individuals who are younger. An older person stays drunk longer due to the fact that the human body processes the alcohol more slowly with increasing age.

Older adults may have vision or hearing problems, or both. They may also have reaction times that are considerably slower than they once were. This means that use and misuse of alcohol can exacerbate these problems, causing more incidents of falls, alcohol-related vehicle crashes, as well as other types of accidents.

When an older adult mixes alcohol and prescription medications or over-the-counter (OTC) drugs, the results can be dangerous or even fatal. And the fact is that as adults get older, they are more likely to be prescribed multiple medications for a variety of medical conditions, everything from high cholesterol and high blood pressure levels, to diabetes, blood, lung or other illnesses.

Watch out for the following signs that may indicate alcohol abuse in your elderly loved one. Note that some of these warning signs are similar to or the same as those for prescription drug abuse.

• Increased incidents of falls
• Inability to make it to the bathroom in time, a condition known as incontinence
• Increased headaches and/or dizziness
• Poor personal hygiene
• Changes in eating habits, for example, not eating enough or eating poorly
• Increased problems with money or finances
• Losing touch with or ignoring family and/or friends
• Thoughts of suicide
• Mood swings, frequently feeling sad or depressed
• Seems more hostile than usual or more resentful
• Loss of interest in activities that previously were enjoyable
• Difficulty in focusing and making decisions
• Worsening memory
• Feeling anxious most of the time
• Drinks alcohol despite warning labels on prescription drugs
• Often appears intoxicated, slightly tipsy, exhibits slurred speech
• Suffers from shakes and tremors
• Drinks in solitary, hidden from others
• Is drinking more than before
• Has drinking rituals, like drinking before, during or following meals, and is upset when this ritual is disturbed
• Suffers from alcohol-related health problems
• Often hides empty beer and liquor bottles or surreptitiously attempts to dispose of them
• Makes excuses to keep beer and liquor in the house
• Has the smell of liquor on his or her breath, attempts to disguise it with mouthwash or by chewing gum
• Falls asleep during conversations
• Calls you at odd hours or in the middle of the night

If any of the abovementioned warning signs are present, it doesn’t automatically mean that your elderly loved one is abusing alcohol. Some of these are warning signs that accompany other health problems that adults may have as they age. Some behavior changes are the result of stress, which may have prompted a sudden increase in alcohol consumption as a means of coping.

In addition, retirement, if recent, the loss of a spouse or other loved one, loss of the family home, and being recently diagnosed with a disease can all trigger substance abuse, whether that substance is alcohol or drugs or both.

Getting Help: Arranging for an Intervention

After careful analysis of the situation with your elderly loved ones, if you determine that there’s good reason to be concerned about drug or alcohol abuse, the first thing to do is to have a frank and loving conversation with your loved one about what you have observed.

This may not go as you had planned, however, due to the fact that your elderly parents may deny that a problem exists, promise to quit drinking and/or taking too many drugs, or ask you to mind your own business. You should not give up in the face of resistance, though, since the life of your loved one could depend on his or her getting professional help.

Maybe you will be able to convince your parent to see his or her doctor and you could accompany your loved one for the visit. This isn’t always practical and your parent may refuse to either go to the doctor or to allow you to come along. Again, it may be considered an invasion of privacy, a desire to remain independent, or a denial of any problem, or all of these.

What should you do if problems continue to exist and your elderly loved one refuses to get help to correct them? Consider an intervention by a professional.

Why not do the intervention yourself? For one thing, unless you’re a professional drug and alcohol interventionist, you aren’t properly equipped to handle the emotional aspects of the intervention. You may be swayed by tears and angry outbursts, feel a sense of shame or guilt about confronting your elderly loved one. Worst of all, you may back down and allow your loved one to continue behaving as before.

With a professional interventionist present, however, you can be assured that the meeting will take place according to evidence-based procedures. There will be a pre-meeting for family members and possibly close friends where everyone meets with the interventionist to go over what will take place during the actual intervention.

During the intervention itself, the interventionist’s sole purpose is to get your elderly loved one to acknowledge that his or her abuse is a problem and to accept and be willing to go into treatment. During the meeting, family members and close friends read aloud statements that they have prepared ahead of time, telling the loved one how his or her drug or alcohol abuse has impacted them, that they are here out of love for the individual and only want him or her to get the treatment they need.

It’s also critically important that your elderly loved one realize that there will be no more enabling of the drug or alcohol abuse by family members. Excuses will no longer be tolerated and there will be no further support unless and until the individual accepts treatment.

Once the individual agrees to go into treatment, the intervention is over. Arrangements for admission to a drug or alcohol rehab facility should already have been made and the interventionist often accompanies the individual directly to the facility. There’s no downtime, no delay to give the individual an opportunity to back out. This is striking while the iron is hot, so to speak.

When looking for a professional interventionist, search for one that is board registered and certified by the Association of Intervention Specialist Certification Board (AISCB).

Prognosis for Recovery

Look upon the professional intervention as an important part of the healing process from drug or alcohol addiction. It is true that older adults, over the age of 55, often take longer to recover, and they also often need greater support during treatment, but it is also true that their overall long-term recovery success rate is higher than any other age group.

Remember, age sometimes does have its benefits. While your elderly loved one may have been quick to dismiss that there was a problem with his or her alcohol abuse, once they enter treatment and commit to sobriety, they often embrace their new sober lifestyle with gusto.

Of course, one time in rehab for drug or alcohol abuse may not be sufficient to overcome chronic addiction. Your elderly loved one may relapse, requiring further counseling or treatment one or more times in a rehab facility or private counseling. This does not mean the original rehab was a failure. It only means that there may be more time required for your elderly loved one to understand the disease of addiction, learn more about how to recognize triggers and learn and practice coping strategies for dealing effectively with cravings and urges.

Participation in 12-Step groups such as Alcoholics Anonymous, Narcotics Anonymous or other self-help groups is also strongly encouraged following completion of drug and alcohol rehab.

With continued support and encouragement from family and peer support groups, your elderly loved one will have a much better chance of maintaining sobriety and living a more fulfilling life. Don’t shortchange your parents who may be in trouble with drugs and/or alcohol. The time to act is now if you believ

Loving a person who has experienced chronic relapse is difficult. It is all too easy to fall prey to the idea that your loved one will never overcome their addiction. The truth, however, is that overcoming addiction is a long-term prospect for everyone who has abused substances, especially for those addicted to cocaine, alcohol and certain other drugs. For them, studies have revealed that normal neural brain function may not return for a year or more. Since many primary drug rehab treatment programs last only about one month (and addiction has often been raging for years), the potential for relapse can be significant.

How to Avoid Chronic Relapse

Potential is not the same as pre-determined. Addicts can seek help in drug rehab and find long-term success without needing to fall into the cycle of chronic relapse. There are several key elements to sustained victory over addiction.

1. A long-term support network is crucial. This may include family, friends or a religious community, but the addict is most likely to succeed without relapse when surrounded by a group of caring individuals committed to supporting recovery.
2. Studies show that attending group therapy can make a vital difference in success versus repeated relapse. Groups like Alcoholics Anonymous, Narcotics Anonymous and other group therapy sessions provide an understanding environment with others who can share how they successfully overcame addiction. The person facing a difficult battle and many life changes needs hope. Group settings can provide much needed examples to give that hope.
3. Appropriate medical management can be important. Whether from a mental health professional, an addiction specialist or a family physician, the person’s chances of successful addiction recovery are boosted by having a health care professional monitor their progress. Especially following inpatient drug rehab, it will be key to not re-enter life as though a 30vday intervention has completely resolved the issue. When a trained pair of eyes is there, intervention can occur and relapse can be avoided.

Addiction experts agree that the single greatest factor in determining avoidance of chronic relapse is the willingness of the person to admit that their drug problem is too big for them to handle alone. Those who minimize their problem will likely be forced to deal with it again. It is a paradox that by confessing personal powerlessness, the person actually becomes empowered to overcome addiction. This is the basis for 12vstep methods; dependence on external help because of personal recognition that clench-fisted determination just isn’t enough.

What Chronic Relapse Means

Chronic relapse is a sign that the underlying root of addiction has not been sufficiently addressed; it doesn’t signal that the person is incurable. Just as a person who overeats or chain smokes is able to change their damaging behavior, so can a person dealing with substance addiction change their behavior.

Researchers worked with 1,700 participants through a federally funded trial called Project MATCH. This trial set out to compare three separate approaches in alcohol abuse treatment: cognitive behavioral therapy, motivational enhancement therapy and AA’s 12-Step approach. Participants were asked to follow one of the designated treatment protocols but were also permitted to attend Alcoholics Anonymous meetings if they so chose.

The researchers scheduled follow-up interviews at three months, nine months and 15 months after the conclusion of the Project MATCH trial. The follow-ups focused on five key indicators to measure and examine behavioral changes:

1. Participants were asked to describe both the frequency and intensity of any recent drinking.
2. Participants were asked to describe their involvement in the AA meetings along with current spiritual and/or religious habits.
3. The researchers used customized assessments to determine participants’ confidence about their ability to remain alcohol-abstinent even in social settings.
4. Participants were checked for symptoms of depression.
5. Participants were asked about current social connections and whether those tended to support or discourage their efforts to remain alcohol-abstinent.

A Social Support Network

The researchers discovered those critical factors which seem to contribute most strongly to the widespread successes for AA participants. The key element is that those involved with Alcoholics Anonymous develop a new social support network.

This new social support encourages the person in a couple of ways. First, the person struggling with alcoholism is brought into contact with more people who are supportive of their efforts to overcome alcohol addiction and spends less time with those who continue to drink and do not support efforts toward sobriety. Secondly, the person’s social network helps to build self-confidence in their ability to successfully face and manage social situations which require alcohol-abstinence.

The benefits of this new social support are key to the success of the Alcoholics Anonymous program, according to the study. Researchers examined the distinct mechanisms of AA and found that other elements which positively impact behavior are:

• Improved motivation toward making changes
• Confidence in personal ability to cope with challenges and maintain their path of recovery from alcohol addiction
• A reduction in depression
• An increase in personal spirituality

Alcoholics Anonymous is the most popular resource in the United States for people who are seeking to live sober. The program boasts high levels of short-term as well as long-term success. This study reinforces those success stories with data that show definite, positive behavioral changes flow from the improved social supports gained through following the 12-Step approach.

Some of us aren’t religious. Others of us are. Still others are somewhere in-between, believing in something but not participating in any organized religion. That’s okay. We don’t have to be religious in order to have faith. So, with that out of the way, let’s talk about how having faith helps in recovery.

No one knows what tomorrow may bring. There is no fortune-teller or sage or mystic that can read the future for us. Even if there were such an individual, we are possessed of free will. What we need to keep first and foremost in our minds is that tomorrow will evolve out of the actions we take today.

Note that we stress the word “actions,” for recovery is all about actions, not words. We can say we’ll do something but if we fail to act upon our words, then our words are hollow. We’re just kidding ourselves and others, but mostly we’re sabotaging our own recovery efforts.

Naturally, we’re a little frightened about tackling tough tasks. Maybe we’re afraid that we won’t succeed, or, on the other hand, we’re secretly afraid that we will and then we’ll be unable to deal with our resultant success. The unknown is always a little scary, but that’s part of the challenge, isn’t it? The goals we set for ourselves and the plans we put down in order to achieve them have to be a bit of a stretch for them to make a lasting impression. If it’s too easy, then maybe we’re not really giving it our all.

Maybe what we need is to have the faith in ourselves that we can do it. After all, there isn’t anything that’s an absolute given in life. Nothing is going to be handed to us on a silver platter, least of all our sobriety. Effective long-term recovery is something that we have to work at each and every day. If we slack off, if we only pay lip service to our sobriety, we’re doing ourselves injustice and we’re certainly not living up to our commitment.

What about when we have achieved a certain amount of success? We may feel that we don’t deserve any more, or that we’re leery of challenging ourselves too much for fear of failure. Again, that’s where faith comes in. We don’t know what tomorrow will bring, but we do know that it very much depends on what we do today. We should expect to be challenged. We should also have faith that we’ll be able to meet those challenges and recognize the opportunities that arise from them.

Talk with our sponsor about how faith helped him or her in recovery. If a goal that we’ve set for ourselves seems unattainable, how do we learn from that and keep on growing? Where do we summon the courage to keep on going or wisdom to be able to figure out what to do next? Our sponsor, our loved ones and friends can be invaluable in our quest to find faith in ourselves. Let’s not be afraid to ask for their help, but let’s also ask for our Higher Power, or the god as we know Him, to help show us the way. Be comforted that if we ask for such help, we will receive it. When we have faith, we will always be able to move forward in recovery.

Valerie J. Slaymaker, Ph.D., and Audrey A. Klein, Ph.D., focused on women ages 17 to 23. They compared the results of these 139 women with a sampling of 237 men that attended the same program during the same time period. The research showed that women were more successful than their male counterparts at following through with the Twelve Step program.

Young women make up a group that is understudied when it comes to substance abuse and treatment. Klein stated that women tend to suffer more neurological and physical abuse as a result of substance misuse. They are also more apt than men to have another mental disorder at the same time, according to an article in PR Newswire.

Overall, the research showed that attendance was the key to success in addiction recovery for these young women. This study was published in Alcoholism Treatment Quarterly magazine Issue 29.

How many times have we thought to ourselves that we’ll do this or that to get going with our recovery – tomorrow or sometime in the future? What’s wrong with working our recovery right now, today? The truth is that there’s no time like the present. Indeed, in recovery, the present is all we ever really have. That’s because we don’t live in the past or in the future. Right now is when we exist. The past is a memory and the future is not yet here. Action takes place in the present.

Thus, it stands to reason that we need to actively work our recovery in the present time. We may plan out our days in advance, and that’s an excellent strategy to keep us working our recovery, but it takes the present to be able to act.

By the same token, if we fail to act today, we are not likely to improve. Why? Very simply, we only make progress in recovery when we take the steps necessary to work on this or that aspect of our sobriety journey that we’ve identified as important – or that our counselor, therapist or sponsor has recommended we attend to.

Sometimes we fear that we don’t know what to do. Better look at that, however, because it’s just as likely that we’re kidding ourselves about something. We could very well be afraid to embark on a certain activity or action because we feel we lack the appropriate knowledge to do so. It’s also quite possible, even likely, that we’ve tried such an action before and did not succeed. That makes us doubly leering of engaging in the activity again.

But we should not allow such fear to dominate our thoughts or deter us from attempting to surmount a particular challenge or hurdle or overcome a certain obstacle. In fact, we will learn more from doing so than if we give up. Not only that, but we can’t move forward if we are unable to make sense of what didn’t work for us the last time we tried this or that approach.

It could also be that we’re uncertain what kind of improvements we should make. Maybe we’ve reached a certain plateau in our recovery and feel comfortable there. We’re not inclined to stretch ourselves at this point, preferring to remain at our comfort level. Why rock the boat, we may ask ourselves before answering that we’re just fine where we are. There’s a very good reason why we need to continue to challenge ourselves and move to the next step in our recovery journey. If we maintain a status quo, not moving forward and not moving backward, the very real danger is that we become complacent about our recovery. And when we take recovery for granted, guess what? The danger of relapse is right around the corner.

Fortunately for us, all we need to do is act today. Do something, even if it’s a small thing, to assist in our recovery efforts. It has to mean something to us. Whether it is a new meeting that we go to or the fact that we go out of our way to help a newcomer to the 12-step rooms feel welcome, it’s the action that we do – and continue to do – that will help us improve. Do this each and every day. Paraphrasing Anne Frank’s eloquent words, "Why wait when we can improve ourselves today?"

Know the Facts

Of course, a lot depends on what stage of the treatment plan your loved one is in when you hear those words. If it’s right after detoxification, just as the first phase of treatment is about to begin, you’ll have a pretty good idea of what’s going on. In fact, this is when most individuals in treatment for substance abuse try to get out of going any further.

It could also occur later on in treatment, when some of the painful issues are being confronted during therapy.But, to be sure, talk with your loved one’s primary counselor or therapist about the facts – and any recommendations for talking with your loved one about his or her desire to come home right now.

What You May Hear from Your Loved One

Here are some of the most common statements people make when they want to convince you to allow them to come home. While the words may be somewhat different, the underlying emotions and feelings they represent are similar. They’re all excuses or lies and are designed to make you feel guilty or sad or convinced there’s no problem – so that you’ll allow them to come home.

• I’m clean now, so I don’t need to be here anymore.
• I promise I won’t use drugs or alcohol again.
• I’ve learned my lesson.
• I won’t hang out with my using friends anymore.
• Why are you punishing me?
• You don’t love me. If you did, you wouldn’t make me stay here.
• I hate it here. The people are mean.
• I don’t have any privacy.
• I can’t sleep here.
• I don’t belong here with all these low-life alkies and stoners.
• How could you send me to this place?
• Isn’t it enough that you forced me to go through detox? What more do you want from me?
• You made me come here. It wasn’t my idea, but I went through it (detox). So now let me come home.
• Everybody’s blowing this all out of proportion. I hardly did any drugs at all, and now I’m stuck here.
• I got a bum rap. It wasn’t even my drugs. I don’t know whose they were, but someone stashed them in my things. I was drunk, but that’s it.
• I only did drugs one time and now I’m paying for it.
• My reputation is ruined being here. You’ve got to get me out.
• I have to get back to work or I’ll lose my job.
• If I don’t get back to school I won’t be able to graduate (or I’ll fail the semester, or some other excuse).

Understand What’s Really Going On

Before you can talk constructively with your loved one about his or her desire to come home, you need to understand what’s really going on. What are the underlying reasons prompting this request at this time? It may not always be so clear or easy to understand – but you need to try. Knowing what’s at stake will help you better frame what you say to your loved one.

Fear – Detoxification may have been pretty scary, especially if this is the first time your loved one has gone through the process. The younger the person is, the more likely this is to be the case. Some individuals try to cover up their fear with a false sense of bravado or may even state that detox was a piece of cake. Don’t buy it. Getting drugs or alcohol out of the system is just the first step in a long process of undoing the damage done by substance abuse. Fear of what’s going to happen next can also prompt your loved one to say anything in order to be permitted to come home. Acknowledge that it probably is pretty frightening, since this is all new territory. But stress that things will get better over time. Encourage your loved one to keep going forward and to learning what they can that will help them when they complete treatment and return home – clean and sober.

Resentment – If your loved one felt pressured or forced to go into treatment – perhaps as the result of a family intervention – underlying resentment may be the reason he or she is demanding to come home. You will hear a lot of accusations about the unfairness of your actions if this is the case. Even those who aren’t aware they’ve built up an extreme resentment may show traces of this emotion in what they say to you. It’s hard not to want to blame those closest to us when we have to go through something that’s as unpleasant as detoxification – and loss of personal freedom and privacy. Reiterate to your loved one that you only want what’s best for him or her. Abuse of drugs or alcohol changed their behavior into action that is harmful to themselves and others. Treatment is the only way to learn how to overcome all the accumulated resentment and underlying reasons to use.

Refusal to go forward – Depending on how entrenched your loved one’s problem with substance abuse is, or the particular type of substance he or she has been using and how long and how frequently, it may very well be the case that they simply refuse to go forward with treatment. They probably know that if they don’t commit to sticking with treatment, it’s going to faill. At this stage, they may want to go back to using, despite what you or anyone else says. If your loved one tells you they’re not going to do anything to get better, this is an ultimatum they’re giving you. Don’t let this sway you. While they may very well believe what they’re saying at this point, it’s the old drug-using behavior and mindset that’s talking. They don’t know how to function without using substances, and need to learn new behaviors in order to successfully cope. This is uncharted territory – and some people just don’t want to go there. What can you say to such refusal? You can acknowledge that you understand it may be tough, but that you are deferring to the advice of the professionals in charge of your loved one’s care. And that means that you support the continuing treatment the professionals recommend.

Intend to continue using – Again, depending on how long your loved one has been using or abusing substances, he or she may not be ready to accept help and commit to getting and staying clean. If you hear them say that they’re just going to go right back to using, this is a clear indication that they have made their mind up about the matter. That’s at least what they think at this point in time. This may change, or it may not. Some people need to go through treatment more than once before they fully commit to being clean and sober. The statement may also mean they’re trying to guilt-trip you or punish you for sending them to treatment. Don’t let statements that your loved one intends to continue using to give into the demand to come home. You should be firm, but loving, in your insistence that they remain in counseling.

Self-discoveries are too painful – Therapy involves examining a lot of fears, beliefs, and emotions that may have been long buried. Looking at the past and delving deeply into underlying causes or factors that may have contributed to substance abuse are often painful. For some individuals, particularly in the early phase of active treatment, it’s too painful. They just want it to stop. They’d rather go back to their comfort level of getting drunk or high as a coping mechanism. You need to recognize that it will probably get worse for them before it gets better. Probing the deeply-held secrets and fears is necessary in order to help your loved one recognize and identify how those things held him or her captive and allowed substance abuse to take firm hold. It’s the first step toward learning how to adopt healthier behaviors and live without the crutch of alcohol or drugs. You can acknowledge that learning things about yourself that you didn’t know before or didn’t want to face can be difficult and painful, but that the end result will be well worth the effort. Tell them that you are fully supportive of their commitment to get clean and sober – and that means that you want them to stay in treatment to get the maximum benefit out of it.

Physical and mental condition may be impacting healing – Some abusers of substances have deteriorated physically to the point where healing the body impacts their progress in overcoming dependence on substances. In other cases, substance abuse may have precipitated or exacerbated a mental health disorder that requires simultaneous treatment – and can take longer. Physical and mental health disorders take a tremendous toll on individuals suffering from substance abuse or dependence. You’re likely to hear mixed messages from your loved one if he or she has to also deal with physical or mental health problems in addition to substance abuse. What you need to recognize is that they are in the best place to get the help they need. They are not able to do it on their own – and you aren’t equipped to help them get better either. The best solution is to convince them to give it time, and to remain in treatment.

Insecurity and other issues – Very often those in treatment are so unsure of themselves that they don’t feel capable of overcoming their substance abuse problems. When they say they just want to come home, they may be hoping that by coming back to you, everything will go back to normal and they won’t feel as lost or unsure of themselves. Back in familiar surroundings may seem like a good idea, on the face of it, but if your loved one returns home too soon, he or she has no skills yet to cope with the triggers and temptations to use. Better for you to reassure your loved one and mention that it will get better soon. Again, reiterate that they need to give treatment time and stress that each day they are in treatment, they are making progress toward overcoming problems with substance abuse.

Get Family Treatment

Another way to better deal with your loved one’s repeated requests to come home is to get family treatment. This will not only help you understand what’s going on with your loved one, but it will also help you learn about the disease of addiction and what you can do to support and encourage his or her recovery. There may very well need to be changes in your own thoughts, beliefs, and attitudes as well as changes in your own behaviors. Without family therapy or counseling, which may be on an individual and/or group basis, once your loved one returns home, it’s a strong possibility that relapse is just a short time coming. That’s because it can’t go back to the same old, same old. If the home environment isn’t conducive to healing, if family members continue to drink or do drugs, for example, or stress levels and tensions remain high, your loved one may feel defeated and unable to withstand the temptations and urges to use.

On the positive side, undergoing family treatment or therapy at the same time as your loved one is in treatment is one of the best things you can do to help support and encourage his or her long-term recovery.

Join Family Support Groups

Another recommended step you can take is to join 12-step family support groups. It’s often frustrating and confusing for family members and others to know what to do in every situation once the loved one returns home from treatment. Even when the loved one is still in treatment, how do you know what to say to them during visiting times when they beg to come home?

The men and women in 12-step family support groups can provide that lifeline to you during those tough times. These are people who have loved ones or friends themselves who are trying to overcome problems with substance abuse. They’ve come together, as an adjunct or offshoot of 12-step groups like Alcoholics Anonymous, or Narcotics Anonymous, to name just two, to support each other and learn how to support and encourage their loved ones’ continuing efforts to remain sober.

The family group counterpart of Alcoholics Anonymous is Al-Anon/Alateen. Alateen is for younger members. Al-Anon/Alateen has been offering hope and strength for families and friends of problem drinkers for more than 55 years. By coming together and sharing their experiences of strength and hope, members together learn how to have a better life – whether or not the alcoholic continues drinking.

Narcotics Anonymous has a family counterpart group called Nar-Anon. This is a fellowship for those affected by someone else’s addiction. Like other family groups affiliate with 12-step groups, Nar-Anon is a 12-step program designed to help relatives and friends of addicts recover from the effects of living with an addicted relative or friend. They do so by sharing their experiences, hope, and strength.

Never Give Up

In the end, what you say specifically to your loved one who begs to come home from treatment will vary depending on circumstances, your own firmness and resolve, and your readiness to do what it takes to prepare the home for the eventual return following treatment. Use your own words, but keep what’s been mentioned here in the forefront of your mind. Recognize that this is a difficult situation for all concerned – but especially for your loved one in treatment.
It probably will be alternately frightening, demanding, painful, or uncomfortable for your loved one to go through all the phases of self-discovery, learning to identify and recognize triggers, learn healthier coping behaviors, and to begin to make constructive goals and craft a solid recovery plan. He or she will need a lot of love, encouragement, and support all through the process and going forward in recovery.

Recovery is a lifelong process. It isn’t something that just happens once and that’s it. Be prepared to be supportive of your loved one’s goal of ongoing recovery – and never give up. It may be the hardest thing you’ve had to do to wait and watch your loved one go through treatment – and not give in to the pleas to come home – but you need to summon the courage, resolve, and love to be able to see it through.

Give praise to your loved one for his or her efforts and progress in overcoming substance abuse – and say how much you love them. Remember that the family is one of your loved on’es two most important support networks, the other being his or her 12-step group.

As experts continue to study narcotics addiction and treatment programs, most agree that a sudden and complete removal of the drug is not an effective method to break the addiction. Instead, a gradual approach involving small doses of narcotics that are removed over time may be the best strateg, or the use of replacement therapy such as buprenorphine to ease withdrawal symptoms.

Narcotics, such as Morphine, OxyContin, and Percocet, are typically prescribed for pain and considered highly addictive because they give the user feelings of euphoria. The use of narcotics moves from medical to abusive when the patient’s relationships, home life and work life suffer, along with a compulsion to find and take narcotics – especially in increasing dosage amounts. The U.S. Substance Abuse and Mental Health Services reports that prescription narcotics are the second most widely abused drug in the nation, with well over 5 million people admitting to using the drugs for non-medical reasons.

Withdrawal from narcotics can be severe. Hallmark symptoms include anxiousness, aggressive moods or irritability, quickened breathing, increased saliva, nose congestion and body aches. Vomiting or stomach discomfort may also be present; as well as increased perspiration, a sense of disorientation, body tremors and dilated pupils. Physicians may need to observe the patient for additional problems connected with abusing narcotics, such as heart valve infections, skin infections, pneumonia or liver problems. Tests to monitor the severity of physical damage during withdrawal include EKG testing, X-rays of the chest, taking blood counts and blood toxicology work.

In past decades, a commonly used drug administered to help patients with narcotic withdrawal has been methadone hydrochloride, a type of man-made opiate. The drug has been employed because methods for recovery that remove narcotics all together, such as acupuncture, have not been shown effective in breaking the cycle of narcotics addiction. Other treatment plans substitute narcotics for another kind of opioid, such as heroin, and then gradually reduce the opioid dosage.

The non-narcotic drug clonidine hypochloride has also been used. Treatment begins with an experimental dosage to test for adverse reactions, and if none are found, an increase in the dose is administered. In research cases, patients were shown to have greatly reduced symptoms of narcotic withdrawal when prescribed clonidine. Non-narcotic drug treatment also provides the added benefit of preventing patients from attending detoxification on the premise of receiving a steady supply of narcotics. The process may also be quicker than other methods of detoxification.

Narcotic withdrawal can be overwhelming and very painful to the patient, family and friends, especially in the beginning stages – but for most addicts, the outlook is positive if appropriate treatment is pursued. As research continues into the growing problem of narcotics addiction, detoxification programs involving a combination of medical drug treatment with group counseling may be the most effective path to recovery.
 

Woods is part of the 6 to 8 percent of the population (about 18 to 24 million Americans) believed to be sex addicts, according to the National Council on Sexual Addiction Compulsivity. This figure does not account for individuals who do not seek treatment. Sex addicts describe themselves as being incapable of stopping their actions, preoccupied with sex, and compulsive to various sexual acts such as masturbation, voyeurism, pornography, Internet sex, multiple partners, anonymous sex, solicitation of prostitute or escort services, sexual seduction, and varying degrees of these activities.

Many critics oppose the concept of sexual addiction. A large group of the medical professional field rejects the theory, and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) only categorizes sex addiction as a “Sexual Disorders Not Otherwise Specified.” The DSM-IV defines sex addiction as “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used” and involves “compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.”

A basic human need and necessary for survival, a person’s sexual instinct is natural and innate; many psychologists and psychiatrists find the idea of sex as an addiction controversial since it potentially dismisses the fundamental impulse of human sexuality as a disease similar to alcoholism or chemical dependence. Variations of the term being introduced to the psychology field include “sex compulsivity,” “sex and love addiction,” “sexual addiction,” “sexual dependence,” or “hypersexuality.” Opponents consider the acceptance of sex addiction as a medical condition as providing an excuse for improper behavior for which society is normally held accountable. By diagnosing it, individuals can shift responsibility off themselves and plead that the diagnosis as the cause of their misconduct. Was Woods manipulating his fame, fortune, power, and accessibility to many of life’s luxuries—or is he legitimately suffering from an addictive disorder? Most medical professionals consider hypersexuality an underlying symptom for a more serious behavioral condition, such as manic depression or obsessive-compulsive disorder. Sex can be a way for these individuals to cope with fear of intimacy or solitude, reduce stress, and escape from problems.

The idea of sex addiction as an independent condition came about during the mid-1970s but became popularized in 1983 by Dr. Patrick Carnes in his book, Out of the Shadows: Understanding Sexual Addiction, in which Carnes first recognized the destructive behavior called sex addiction. Sexual addiction is classified as an obsessive-compulsive disorder, or excessive sexual behavior disorder, characterized by despair and severe distress involving the individual’s sexual acts and compulsions. “Consequences may be relational, emotional, physical, financial, legal, occupational, social, and spiritual in nature” writes Brenda Schaeffer, D.Min., M.A.L.P., C.A.S., in her book Is It Love or Is It Addiction? “In the process, a physical dependency on the bio-chemical or mood-altering experiences of arousal, satiation, and fantasy occurs. There is usually marked tolerance and continued involvement in spite of negative consequences. And, like other addictions, sexual addiction becomes an unconscious habit, a compulsive ritual that is no longer a choice, and a psychological and biological attachment to the stimulus that provides the pleasure. Withdrawal symptoms occur when the sexual stimulus is removed, and preoccupation begins to interfere with life.”

Although little research has been conducted on abnormal sexual activity, some recent studies have helped chip away at the complex, unofficial diagnosis. Sex has been found to release dopamine within the brain and create a temporary sense of euphoria like intoxication. Unhealthy sexual behavior is being considered as affecting an individual similar to a chemical dependency. When stimulated, sex addicts display a loss of activity in the top frontal lobe of the brain where reasoning, emotions, judgment, and voluntary cognitive function are controlled. Signs of sex addiction include: inability to stop sexual acts or thoughts; preoccupation; using sex as a coping mechanism, escape, or fix; mood changes; increasing tolerance and need to seek more stimulation; a developing routine; negative consequences; risks involving family, occupational, and social relationships; destructive behavior; maintaining a secret life; suppressing sexual trauma; feelings of shame or guilt; and sexualizing in inappropriate settings. A sex addict normally does not recognize the negative consequences of their sexual behavior and pursuits, which can include: depression; anxiety; loss of self-respect; loss of self-esteem; stress; loss of concentration and productivity; suicidal thoughts; comorbid substance abuse addictions; illness; risk of HIV, AIDS, and unwanted pregnancies; objectifying others or feeling objectified; violence to self and others such as molestation, assault, rape, or scandal; betrayal; engaging in illegal activities; and inappropriate physical or sexual behavior that is out of context or out of character.

According to the Sexual Recovery Institute, “sex” is the most commonly searched topic on the Internet. Around 25 million Americans visit pornographic websites between 1 to 10 hours per week. Approximately 40% of those with sex compulsivity with Internet pornography are now women. Schaeffer also states that around 83% of sex addicts have a comorbid substance abuse addiction or behavioral disorder; 70% have thoughts of suicide; 60% have experienced financial troubles or failure; and 58% have engaged in illegal acts to foster their sexual compulsions. Another concern for classifying sex addiction as an official disorder is that the diagnosis might assist sexual predators and rapists in a court of law. Not all sex addicts are sex offenders, and vice versa. Approximately 55% of sex offenders are considered to be sex addicts. The problem is more serious when involving child sex offenders, whose compulsions are believed to never be prevented unless kept behind bars. Around 70% of child sex offenders have a sex addiction. The Society for the Advancement of Sexual Health (www.sash.net) assists those struggling with a sex addiction by providing multiple resources, information, and guidance on how to manage their compulsive behavior.

Dr. Markel writes that Dr. Lambert had years of experience taking care of thousands of alcoholics at Bellevue Hospital’s infamous “drunk ward,” which is where he experimented with the belladonna cure. He obtained the recipe from a layman named Charles B. Towns, who claimed to have learned about it from a country doctor.

In 1901, Towns opened a substance abuse hospital in New York City; he needed Dr. Lambert because he lacked a medical degree, and Dr. Lambert needed Mr. Towns because he had relatively little to offer his patients in terms of an effective treatment.

The Towns Hospital attracted the wealthiest alcoholics and addicts, who paid exorbitant fees for a treatment that “successfully and completely removes the poison from the system and obliterates all craving for drugs and alcohol.”

Perhaps the most famous patient of the Towns Hospital was William Griffith Wilson, better known as Bill W., or the co-founder of Alcoholics Anonymous. In the early 1930s, Wilson was consuming more than two quarts of rotgut whiskey daily, a definite health risk according to Dr. Lambert, who found that consumers of cheap or bootlegged alcohol were far more prone to seizures, delirium tremens, and brain damage than those who drank expensive liquor.

Dr. Markel writes that between 1933 and 1934, at his wife’s urging and on his wealthy brother-in-law’s dime, Wilson was admitted to Towns four times. The cost upon admission was up to $350 (about $5,610 today) for a four- to five-day stay. Although Wilson made some progress in temporarily abstaining, he relapsed after each of the first three hospitalizations. It was around this time that he reunited with a drinking buddy named Ebby Thacher, who told Wilson that he had quit drinking and was now a member of the Oxford Group, a church-based association devoted to living on a higher spiritual plane guided by Christianity.

On Dec. 7, 1934, Thacher took Wilson to the Calvary Mission on East 23rd Street and Second Avenue, where the most drunken of New York’s Depression-era down-and-outers went to be fed and, hopefully, “saved.”

A few days later, Wilson drunkenly returned to the Towns Hospital, where Dr. William D. Silkworth sedated him with chloral hydrate and paraldehyde, two agents guaranteed to help an agitated drunk to sleep. This was especially important because the medical staff members had to wake patients every hour for at least two days to take the various pills, cathartics, and tinctures of the belladonna regime.

Dr. Markel writes that on the second or third day of his treatment, Wilson had a spiritual awakening. Earlier that evening, Thacher had visited and tried to persuade Wilson to turn himself over to the care of a Christian deity who would liberate him from the ravages of alcohol. Hours later, Wilson cried out: “I’ll do anything! Anything at all! If there be a God, let him show himself!” He then reportedly witnessed a blinding light and felt an ecstatic sense of freedom and peace. When Wilson told Dr. Silkworth about the event, the physician responded: “Something has happened to you I don’t understand. But you had better hang on to it.”

This experience ultimately led Wilson to abstain from alcohol for the remaining 36 years of his life and to co-create the novel program whereby one alcoholic helps another through a commitment to absolute honesty and a belief that a higher power can help one achieve sobriety, what we now know as Alcoholics Anonymous.

Long before Towns touted his cure for alcoholism, belladonna (as well as henbane) was known to cause hallucinations. The hallucinations brought on by alcoholic delirium tremens tend to be a transmogrification of things the alcoholic is actually seeing or experiencing into a realm of sheer terror. Other hallucinations associated with alcohol withdrawal, or alcoholic hallucinosis, tend to be brief and involve hearing accusatory or threatening voices. Belladonna hallucinations, however, are typically based on recent discussions the person had but become far more fantastic. Many times, these visions appear to fulfill the wishes one might have had during the inspiring experience.

Several decades after his 1909 announcement, Dr. Lambert took great pains to distance himself from belladonna. Although he found the detoxification process to be useful in the short run, Dr. Lambert became discouraged by its toxicity, its propensity to induce hallucinations, and the fact that many of those he treated at Bellevue relapsed and returned for subsequent treatment. Something more was needed, he declared, and that task fell to Bill Wilson and an alcoholic physician from Ohio named Bob Smith, who created Alcoholics Anonymous in 1935.

Dr. Markel asks: Were Bill Wilson’s spiritual awakening and influential sobriety the products of a belladonna hallucination shortly after his discussions with his friend Ebby Thacher? Could they have been incited by his alcohol withdrawal symptoms? Or did something else happen to him that science cannot explain? In the end, millions of people who have benefited from Alcoholics Anonymous and similar 12-step programs around the world would say that such pharmacological, physical, or spiritual parsing hardly matters.