By all accounts, many people encounter significant challenges to finding effective, evidence-based rehabilitation services for themselves or for their loved ones in need of addiction treatment.
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that, in the first quarter of 2018 alone, the program’s National Helpline received close to 69,000 calls per month (a slight increase from numbers reported in 2017). That same year, based on responses to their National Survey on Drug Use and Health (NSDUH), an estimated 21.2 million people (aged 12 or above) needed substance use treatment. Yet, despite the tremendous number of individuals who would benefit from treatment, and the tremendous demand for their treatment and referral information services, SAMHSA estimated in 2018 that only 3.7 million of the people who needed treatment received—meaning that as many as 83% of those who most need drug rehab won’t receive it.1
Work is still clearly needed to help bridge the gulf between the numbers of people who need treatment and the number who end up receiving it. Much has already been written about the challenges of identifying substance abuse issues in loved ones and guiding them towards appropriate treatment programs. However, this article will spotlight an issue that generally receives less attention: supporting family members and friends after they’ve completed rehab.
Planning for Post-Treatment Support
Completing a rehab program for drug or alcohol addiction is a tremendous milestone that every patient and their loved ones should be proud of. However, even the most successful treatment outcomes can’t be confused with cures. That’s because addiction doesn’t exist in black and white. It’s best thought of as a disease that must be managed on an ongoing basis—even when symptoms aren’t present.
According to Dr. Tom Doub, clinical psychologist and former Chief Clinical Officer at American Addiction Centers and Greenhouse Treatment Center, “Just like diabetes, addiction has to be managed every day, 24/7/365. Even people who have been in recovery for years can have a setback and relapse.” Extending the comparison further, imagine the experience of a newly-diagnosed diabetic. They may:
- Be angry or frustrated that they’re no longer able to enjoy the foods they used to or that they can no longer eat the way “normal” people do.
- Struggle to reorganize lifestyle habits, routines, and milestone celebrations, such as receiving an annual birthday cake or dinners out at a favorite restaurant, that revolved around food.
- Require trials of several different medications in order to find the option that best manages their symptoms.
- Become non-compliant if they feel the negative side-effects of treatment outweigh the advantages of controlling their diabetes.
Those suffering from substance addiction are no different. Following treatment, they may struggle to create new habits that don’t include drugs or alcohol. They may need to test different therapies or medications to find the best option. And, unfortunately, they may relapse, if the temptation of their addiction becomes too strong to ignore.
The Role of Compassion in Recovery
Because no two patients are alike, there is no universally appropriate post-treatment support approach that guarantees positive outcomes. Some patients benefit from a “tough love” approach, others thrive in a more comprehensive and supportive environment.
One thing we do know, however, is that addiction and shame are intimately connected. One study supporting this finding, carried out at the University of British Columbia, involved 100 men and women who had been sober fewer than six months. Researchers Jessica Tracy and Daniel Randles measured participants’ personality traits, levels of shame, and other emotions once at the start of the survey and then again, four months into their recovery.
At the study’s close, the team’s results, “showed that nonverbal behavioral displays of shame expressed while discussing past drinking strongly predicted (a) the tendency to relapse over the next 3 to 11 months, (b) the severity of that relapse, and (c) declines in health. All results held controlling for a range of potential confounders (e.g., alcohol dependence, health, personality). These findings suggest that shame about one’s problematic past may increase, rather than decrease, future occurrences of problem behaviors.”2
10 Tips for Creating a Compassionate Environment
Compassion—especially in the case of post-treatment support—is often easier said than done. Though hope and expectations at this point may be high, family members often still carry burdens of anger, shame, embarrassment, and other negative emotions in response to their loved one’s addiction.
To help create a more compassionate environment—even in the presence of these potential emotions—consider the following ten tips:
- Tip #1: Study the disease of addiction.
The more you understand about the biological nature of addiction and our current scientific understanding of it, the easier it will be to disassociate your loved one from their condition in order to treat them more compassionately.
- Tip #2: Continue attending family support groups with your loved one.
Addiction is never just about one person; it affects the entire family. For this reason, it’s important that families and other loved ones play an active role in post-rehab treatment and support. Family members should attend groups with their loved one and seek support for themselves in 12-step groups.
Dr. Doub shares, “The best thing families can do is connect to a local Al-Anon group to find others experiencing the same journey. People in early recovery, just like all of us, need love, support, and structure. The Al-Anon peer group is crucial to providing appropriate supports while setting appropriate limits.”
- Tip #3: Be present without judgment.
Learn to sit with uncomfortable topics in order to give your loved one the space needed to express negative feelings regarding addiction and recovery without feeling judged.
- Tip #4: Remove disease triggers.
Think of a dieter who tries to lose weight with a cupboard full of sweets. Help minimize temptation for your loved one by removing drugs and alcohol from the home in order to create a substance-free environment post-treatment.
Additionally, consider eliminating your own recreational substance use (or at least stopping the usage of substances around your loved one) to further reduce potential triggers.
- Tip #5: Identify and remove expressions of contempt.
Anger is an understandable response to a loved one’s addiction, yet, as we learned above, shame does more harm than good when supporting recovery. Look for actions like eye-rolling or sarcastic responses—whether conscious or subconscious—and work on releasing the anger driving them and replacing them with more supportive actions.
If necessary, consider seeking out therapy on your own to release your anger. Doing so gives you the space to explore and express your own emotional responses in a healthy way.
- Tip #6: Encourage healthy behaviors.
Ensure your loved one has access to healthy food, and encourage them to exercise with you, as appropriate. Some evidence suggests that strength training and cardiovascular exercise can support substance abuse treatment by replacing the pleasurable sensations of drug or alcohol use with “natural highs.”
Possible opportunities for supporting your loved one include:
- Stocking their kitchen with healthy groceries.
- Suggesting healthier options when deciding where to dine out together.
- Inviting them out for a walk.
- Taking part in a sport or other activity they enjoyed before addiction.
- Accompanying them to the gym.
Extend these healthy behaviors to yourself as well. It isn’t selfish to practice self-care. By prioritizing your own health and well-being by eating well, exercising, and getting sufficient rest, you’ll be better able to provide your loved one the support they need in recovery.
- Tip #7: Create healthy boundaries for yourself.
Even after treatment, loving someone who has struggled with addiction can be demanding. They may feel scared about the potential for relapse, embarrassed over their actions during addiction, or even angry over the effort required to maintain sobriety. These and other negative emotions can cause patients to lash out or to engage in manipulative or destructive behaviors.
The impulse to help someone we love is understandable. However, family members must learn to set healthy boundaries, rather than enable these dysfunctional behaviors. Counselors and support programs can be useful resources for identifying codependent tendencies and learning to set healthy boundaries.
- Tip #8: Watch for warning signs of relapse.
Though many families want to believe rehab is a cure, the potential always exists that those struggling with addiction may relapse.
In her memoir, Everything is Horrible and Wonderful, author Stephanie Wittels Wachs describes her family’s reaction to the news that her brother—comedy writer Harris Wittels—had returned to rehab following a relapse of his heroin addiction. “Harris had already gone to rehab,” she writes. “He had already gotten sober. The problem was solved six months ago. Why were we back at the problem? Why had the problem gotten worse?”3
Her reaction is both understandable and common. According to Dr. Doub, “Families should be especially vigilant during times of exceptional personal or job stress, presence of triggers for their alcohol or drug use, or connections to old friends or places associated with their previous addiction.”
Pay attention to signs that indicate your loved one’s sobriety is slipping so that you can take loving, proactive action.
- Tip #9: Stay positive.
Praise your loved one’s decision to seek treatment and stay sober, rather than focusing on your negative memories associated with their addiction.
- Tip #10: Be patient
Above all, be patient with your loved one. Addiction is a complex disease; treating it takes time.
As Dr. Doub explains, “Addiction takes over the brain and compels people to behave in ways that don’t reflect their core values or who they really are. Fortunately, when substances are removed, much of that will be resolved but it often takes time (sometimes years) for the brain to fully recover. Don’t be surprised to see glimpses of your loved one only to lose ground, but stick with them through the setbacks while the brain recovers.”
- Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
- Randles, D., & Tracy, J. L. (2013). Nonverbal Displays of Shame Predict Relapse and Declining Health in Recovering Alcoholics. Clinical Psychological Science, 1(2), 149–155.
- Wachs, S. W. (2018). Everything is horrible and wonderful: A tragicomic memoir of genius, heroin, love, and loss. Naperville, IL: Sourcebooks.