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10 Signs you Need Rehab

You’ve recently realized that your drug or alcohol use is increasing beyond what you once considered normal. Perhaps you’ve started going through more drugs than you used to, or you may have noticed that you tend to drink more than your friends when you all go out. While you may even be certain that you have a problem with addiction, you may still be unsure if you are in deep enough to require a trip to rehab.

The effects of drug and alcohol dependency can look a little bit different for everyone. While one person may experience severe physical withdrawal symptoms, others may have strong psychological cravings when they try to stop using on their own. In fact, just suspecting that you are in trouble signifies that you may already be grappling with a serious dependency. Now that you have started to question your drug or alcohol use, take a look at these 10 signs that you need rehab and ask yourself honestly if any apply to your situation.

You Feel the Need to Hide Your Substance Us.

Secretive behavior is a common sign that you know deep within your heart that you are misusing drugs or alcohol. You may have started out drinking alcohol openly in front of your loved ones, but now you feel the need to hide the bottles because you know that you drink more than the recommended daily amounts that are associated with moderate consumption.

Hiding substance use can take several different forms. You may hide the obvious physical evidence such as bottles, pipes, and lighters. Alternatively, you may begin to shift your finances around so that the people you live with cannot see how much money you are spending on your habit. You may also choose to do drugs or drink alone when others are not around to judge your behavior.

You Have Driven Your Car While Under the Influence

Driving under the influence has severe consequences that can ruin both your life and the lives of innocent people. While you may know that you should never get behind the wheel after you have been drinking or doing drugs, you may have made the choice to do so for a variety of reasons.

Severe substance use disorder could cause you to be high or drunk the majority of the day. If this is the case for you, then you may feel the need to drive just to accomplish your daily tasks. You may have also tried to drive to get more drugs or alcohol after you ran out during a session of use.

Denial is also a powerful force that could cause you to refuse to accept that you are out of control or over the normal limits for drinking. As a general rule, you should consider going to treatment if you have driven under the influence recently, even if you felt like you could still drive safely. The truth is that doing it again could cause you to have a severe accident or harm someone else.

You Get Withdrawal Symptoms

Your body develops a physical dependency on drugs and alcohol when you continue to use them over time. Withdrawal symptoms can occur within just a few hours after you stop using drugs or alcohol, or they can kick in within the first few days. Listen to your body for these common withdrawal symptoms that signify a need to go to rehab:

  • Nausea or vomiting
  • Body aches
  • Insomnia
  • Shaking
  • Irritability
  • Depression

In some cases, withdrawal symptoms can be severe enough to require immediate professional care. Even mild symptoms can be strong enough that you feel the need to return to your former habits just to get relief. Professional treatment programs offer services that can help you through the initial withdrawal process so that you have a stronger chance at making it to long-term recovery.

You Have Tried to Quit Before

You may have already reached the point that you decided to try to stop on your own. Unfortunately, trying to quit drugs or alcohol without professional help leaves the underlying reasons for your addiction unaddressed. For instance, you may have chosen to start drinking again after you had another fight with a family member. Alternatively, you may have turned back to taking prescription painkillers as a way to escape from the pain of past trauma. Going to rehab gives you immediate support for overcoming your personal challenges.

You should also know that having a relapse is not a sign of weakness. According to the National Institute on Drug Abuse, substance use disorder has similar rates for relapse as other health conditions that have a psychological component, such as hypertension.

It’s important to remember that the need for multiple treatments stays is not a sign of failure because it is part of the recovery process. You need to be willing to try again if you have tried to quit before in the past. You just get stronger every time you go to treatment.

You Have Hurt Yourself or Someone Else When You Were Drunk or High

The realization that you have hurt yourself or someone else while you were under the influence is unsettling. Sadly, drugs and alcohol affect your personality, and you may have done things that you would never do when you are sober. For instance, you may have gotten into a fight and hit someone without thinking.

Self-harm is another issue that can arise while you are using drugs or alcohol. Perhaps drinking made you feel worse about a problem that you were having and you had suicidal thoughts as a result. You may also have accidents such as falling down stairs that would not have happened if you were sober. Waking up with unexplained cuts, bruises or other injuries after a blackout is another sign that you need to seek professional help in a rehab program.

You Are Having Problems at School or Work

Eventually, drug and alcohol use affects how you perform at school or work. In recent days, you may have decided to stay home due to a hangover or withdrawal symptoms. You may also skip work or school so that you can engage in your substance use habits. Your boss, teachers or co-workers may have also begun to suspect that you have a problem with addiction, and you may have a history of poor performance that was never a problem until your substance use spiraled out of control.

Long-term use of drugs or alcohol may have even caused you to lose your job or quit school completely. Fortunately, getting help with your addiction allows you to regain the ability to return to work and school. Your counselors can even help you with the process of re-entering the workforce once you feel strong enough to take on more responsibilities.

You Have Been Arrested for Drug- or Drinking-Related Charges

Getting arrested is embarrassing and scary, and it may even dramatically alter your life. Every state has laws that regulate drugs and alcohol, and the consequences for breaking the law range from fines to jail time. You will also find that the consequences of repeating the same crime tend to get worse. If you have ever received a citation or been arrested for charges such as public intoxication, possession or driving under the influence, then you need to take this as a serious warning.

While you will still need to deal with your legal issues, going to rehab is a strong step in the right direction. Becoming sober helps you avoid turning into a repeat offender, and you may be able to use your time in rehab to demonstrate responsibility to the court. Everyone makes mistakes, but you don’t have to let a lapse in judgment destroy your future. Seek professional help to ensure that you can avoid continuing down a road of criminal activity.

Your Family and Friends Express Concern

The people who love you the most are often the first ones to speak out when they notice that you have a problem. While you may be tempted to brush off their fears, you should be aware that they may have waited for a while to finally bring the issue up.

Family members and friends sometimes stage interventions where they talk about how their loved one’s substance use affects their life. If you find yourself at an intervention, try not to get angry. Although listening to how your actions have hurt the people you love is upsetting, they are only trying to help you see that you need to go to rehab. Your loved ones may also start to set boundaries and consequences that go into effect if you continue to use drugs or alcohol.

It is painful to watch as your spouse moves out of the house or you realize that your loved ones will no longer support your habit financially. When you feel as though you have lost everyone who cares, however, try to remember that all is not truly lost. In fact, your family and friends are likely to be willing to return to your life once they know you are trying to get sober. Many rehab programs encourage family members to attend therapy sessions so that you can work on mending your relationships.

Your Substance Use Affects Your Health

Alcohol and drug use eventually take a toll on your health. While overdoses are the most obvious health consequence involved with addiction, others may be more subtle. For instance, liver disease is common among those who drink too much alcohol or misuse prescription drugs. Heart disease, diabetes, and respiratory illnesses are a few more potential health consequences that arise from substance use disorder.

Always be honest with your physician about the drugs and alcohol habits that you engage in on a regular basis. Remember that they are not there to judge you, but they can help you understand what normal behavior is. They can also help you know if a stay at a treatment center can help you regain control over your health.

You Want to Get Sober But Have No Idea Where to Start

The endless cycle of drug and alcohol use is exhausting, and you may already detest the negative effects that your lifestyle is having on your well-being and relationships. Yet, you may still be hesitant to try to quit simply because you don’t know what to do.

When you want to quit but don’t know where to start, it helps to know that you have already made one of the first steps toward sobriety. Realizing that you no longer want to continue with your current habits puts you in the right mindset for getting the most out of your treatment. With this decision already made, you can now begin moving forward by going to a rehab program where professional counselors can create a personalized treatment plan that you can follow.

The idea that you need to hit rock bottom before seeking help is a myth that can harm you in the long run. The truth is that you don’t have to lose everything to decide to go to treatment. Instead, you can make the choice today to get help with your addiction so that you can finally begin to enjoy the positive effects of life in recovery.

How do I Prepare for Rehab

Alcohol Awareness Week took place near the end of November, and many people who struggle with alcohol and other addictions are looking forward to a new year and a new life free from the harmful effects of these substances. You are likely interested in the possibility of checking into rehab because you read something about Alcohol Awareness Week or some similar campaign for drug use awareness, and that’s a fantastic life change you are considering.

Getting clean and sober will improve your life in a variety of ways. Your body will get healthier, particularly your heart and liver. Your thinking will improve as will your relationships. All of this will take time, consistency and hard work, but the results are definitely worth the effort. Over the long run, you might need to use several types of drug treatment options at different stages in your recovery.

How do you get ready for rehab? It’s a huge step in your life, and it’s not something that you just jump into in a heartbeat. You will be away at a facility for several weeks. If you have kids, pets, a home, and a job, then you have some things to get in order before walking into rehab. Here are six things you can do to prepare for rehab in the coming weeks.

  1. Submit FMLA Forms to Your Employer

If you are employed, you likely qualify for medical leave under the Family and Medical Leave Act for up to 12 weeks. This will ensure that you still have a job when you return from rehab, and having that job and income lined up will make your recovery a lot smoother.

However, you can’t just call up your employer one morning on your way to rehab and say, “I won’t be coming in today or for the next couple of months. I’ll be in rehab,” and then just hang up. That’s not fair to your employer. There is a process that you must go through to protect your job. Talk to your boss or contact your company’s human resources department so that you comply with the procedures and submit all of your paperwork ahead of time.

This might sound like a hassle, but holding onto your job while in rehab is actually a very important step in your recovery. Keeping yourself busy and productive upon discharge will be essential to keep you from slipping back into old behavior patterns. Having the structure and schedule that a job requires will be a big help to you in your recovery. Please don’t underestimate the value of this. Having a steady paycheck will also help you keep stress levels down, but even the act of going to work every day can play a big role.

Steady employment is healthy, positive and productive. Working hard at your job and taking pride in your work is good for you. It builds self-confidence. It makes you feel good about yourself, and that alone can be a great help in getting off drugs and alcohol and living a more positive, productive life.

  1. Make Arrangements for Your Kids and Pets

If you are a parent with young kids living with you, you’ll have to make arrangements for them. Your spouse or the children’s other parent will likely be able to care for them after work hours, but they might need to be in a daycare or an after-school program for part of the day.

You could also enlist the aid of a trusted family member such as a parent, sibling or in-law to come to stay at your home and care for your kids while you are away. This might be ideal as they can also bring in the mail, water the lawn and straighten up after themselves. If you have pets, they can take care of your pets, too.

If you don’t have anyone to come to help out at your home, you might need to have the kids stay with a family member or trusted friend at their home. If your treatment is taking place during the school year, you will need to coordinate a temporary transfer with the school district to enable your kids to continue their education in the school district in which they will be residing while you’re in rehab. This will take some time to arrange, so get started with the process as soon as possible.

If nobody will be staying at your home while you’re in rehab and you aren’t able to house your pets with a friend or family member, you’ll need to get either a pet sitter or a pet boarding service.

  1. Make Arrangements for Your Home, Vehicle, and Property

If possible, arrange for a trusted family member or friend to water your lawn and pick up the mail. If you receive newspaper delivery at your home, call up the newspaper and place your subscription on hold while you are away. It’s also a good idea to use a timer for your lights so that they will turn on and off every night.

The point of these tasks is to make it look like your home is occupied and all is normal. Thieves are more likely to target your home if they notice newspapers piling up in the driveway, see the lawn and plants dying or see that the lights are never on at night. Those are signs that nobody is home.

If you have a vehicle and live in an apartment or a condo complex, make sure that you are parked in your designated stall and that your registration and parking permit will not expire while you are gone. Allowing these to expire while you are in rehab might result in your vehicle being towed away. Arrange for these to be paid on time or even ahead of time and for the stickers to be placed on your vehicle for you.

It’s also a good idea to avoid tipping off all your friends on social media that your home will be empty for the next several weeks while you’re in rehab. Instead, just put up a status that says you are taking a break from social media for a while.

If you are single and your home will be vacant during your stay in rehab, take a little time to clean your home. When you walk back through that door after rehab, you don’t want to walk into a filthy, cluttered, disorganized environment. Empty the refrigerator of anything that is likely to spoil within the next 90 days. Straighten up the living room and make your bed. Do all of your laundry, too. Vacuum the floors and clean the bathroom.

Depending on how long you will be away, you may need to shut off your water either at the street or at your water heater.

This is also a good time to purge your home of every trace of your old lifestyle. Get rid of anything that makes you think about drugs and alcohol. Don’t just toss out any paraphernalia, drugs, and bottles. That’s a good place to start, but don’t stop there. Look through your closet and get rid of any clothes that remind you of people or past memories that you associate with drug or alcohol use. If an old band T-shirt reminds you of that concert where you got high or it makes you want to start drinking, then get rid of it.

Get rid of bottle openers, ashtrays, collector’s shot glasses and even CDs that have an emotional pull on you and will stir up feelings and desires for alcohol or drugs when you return from rehab. You have to understand and accept this.

If you’re serious about kicking your addiction, you will need to radically change your lifestyle: out with the old and in with the new. If you take these steps now before beginning rehab, you will greatly increase your chances of success when you return.

  1. Get Your Bills and Finances in Order

One mistake that will likely knock you off course is coming home from rehab to a pile of unpaid bills, disconnection notices, and late fees. These will increase your stress levels and cause unnecessary pressure from the start.

Call up your creditors to see if they can delay your monthly payments for a few months while you are at rehab. Many companies will be happy to work with you to keep your accounts in good standing, but you need to let them know ahead of time what is going on so that payment arrangements can be made.

For creditors that will not delay or minimize payments, you will likely need to set up automatic payments. This will work just fine if you have sufficient funds in your account to cover the payments. If that is a challenge, try to work with family members who are supportive of your rehab efforts to ensure that bills get paid.

  1. Bring What You Need and Leave the Rest at Home

You will need to bring some things with you to Rehab such as clothing and a few personal items. However, for the most part, you won’t need to pack up very much. Your rehab center will provide you with a list of the items you should bring along with a list of items that are prohibited. Do not try to sneak in any controlled substances or prohibited items with you into rehab as these will only make it harder for you to follow through. In some cases, they might even get you kicked out of rehab.

Commit to this process and only bring with you what you need. Many people have found keeping a diary or journal to be a huge help in the recovery process and for dealing with depression and other underlying issues that contribute to substance use.

If you are already in the practice of daily or occasional journaling, bring your journal with you. If not, go pick up a blank diary or spiral notebook for you to write in. Self-reflection and journaling might even be a required part of your rehab. Check with your facility representative to see if they have any specific tips regarding what to bring and what not to bring.

  1. Prepare Your Mind for the Journey Ahead

Getting clean from alcohol and substance addiction is a lifelong journey. It’s not just something that you can do for a few weeks and then find yourself permanently cured. This will be an ongoing process, so be realistic about the commitment that you are undertaking.

Everything is about to change. Your old lifestyle involved certain people, locations, activities, habits and thought patterns. If you want to experience permanent, life-changing results, you need to be willing to cut off from your old life and start over with building something fresh and new. It won’t happen overnight, and it might not happen without support and accountability to others. However, if you commit to making these changes and follow through, it will happen.

Begin thinking about your new life. Think more about prevention than willpower. Willpower and inner strength will not always be there, so it’s much better to prevent yourself from being in situations where temptation exists in the first place. This will mean engineering your environment so that willpower won’t even be necessary most of the time.

Be aware of the habits, locations, and people in your old life that trigger desires for substance use, and then avoid those situations and people. This is a difficult change, but it’s necessary for you to get well. Awareness and prevention go hand in hand. Being realistic about the journey ahead will go a long way toward securing your success.

In the end, your recovery is in your hands. There are many people who want to help you succeed from your family members, co-workers, and friends to health care professionals and social workers in your community. Ultimately, your success is your responsibility. You can make these changes stick by accepting personal responsibility for your life and by taking advantage of the assistance and resources that are available.

What is a PHP Program?

What is a PHP? A Partial Hospitalization Program (PHP) is a type of outpatient treatment program that has been found effective in treating addiction. These programs are designed to help people who can benefit from structured treatment but who do not need medical assistance or supervision 24 hours a day. PHP programs can be modified or customized to fit the requirements of the patient, and treatment can be delivered at varying care levels.

The treatment in this sort of program is intensively focused on the patient’s recovery, and it takes place in an environment that fosters the patient’s transition out of addiction and into a responsible, productive life. PHP programs are an alternative to residential or inpatient treatment options, and they may be more intense than other outpatient treatments.

What Is the PHP Treatment Model?

A Partial Hospitalization Program might make use of a number of different therapies to achieve its goals. Among the options commonly employed by these programs are:

Individual therapy

Addiction counselors or other health professionals consult with the patient to explore the triggers and causes of drug or alcohol use. The goals of this type of therapy are to address the patient’s denial and the underlying causes of the addiction so that they can focus on the recovery process.

Group therapy

Sessions in group therapy involve an addiction treatment counselor and a group of people who are recovering from addiction. The people in the group are encouraged to discuss emotions, experiences, coping mechanisms, aspirations and anything else that could be related to overcoming drug or alcohol addiction.

Family therapy

In this sort of therapy, members of the patient’s family, along with an addiction therapist, meet together to help the patient see the reality of the situation and to guide him or her to recovery. In some cases, a family member can be an enabling factor or even the cause of the addiction, but family therapy can provide a safe environment to address these issues.

History of Partial Hospitalization Programs

Partial Hospitalization Programs were originally developed in the 1960s with a focus on the treatment of mental illness. They were designed to help people who needed an intensive level of care but who would also benefit from being part of the community. It was also meant to help people who were struggling with mental disorders but who had safe, stable homes to return to the following treatment.

The Medicaid regulations changed in the 1980s, making Partial Hospitalization Programs more viable for health care and recovery centers. The number of partial hospitalization options nationwide increased significantly through the 1990s until restrictions were placed on them. Around that same time, the idea began to take hold that addiction was tied to mental and behavioral illness rather than being simply a question of willpower.

Partial Hospitalization Programs are still primarily designed to help individuals who have mental health issues, but there is significant overlap of this group with those who want to stop using substances or alcohol. The programs developed into a method of helping those people who want to overcome addiction without joining an inpatient program.

Who Can Benefit From a Partial Hospitalization Program?

Partial Hospitalization Programs are often recommended for people who have already gone through inpatient addiction treatment and who can benefit from transitional coaching as they reintegrate into the community. They are also recommended for people who need more structure and supervision than is available in traditional outpatient treatment programs.

On the other hand, a PHP might not be right for people who need constant monitoring or who do not have transportation or housing. Inpatient treatment may be a better option for people who:

  • Will be tempted to do drugs if they return to their homes and social circles
  • Are homeless
  • Are victims of domestic abuse or other violence
  • Have learning disabilities or structural brain issues and will not benefit from PHP therapy sessions
  • Require 24-hour medical supervision or care following an overdose
  • Might become dangerous due to withdrawal symptoms
  • Need a methadone treatment program
  • Lack community or family support

Primary Functions of Partial Hospitalization Programs

A taxonomy has been proposed for PHP options. Three primary functions of partial hospitalization treatment have been identified.

First, it is an alternative to more restrictive inpatient treatment. Second, it is a supplement to traditional vocational rehabilitation or outpatient treatment. As an outpatient supplement, a Partial Hospitalization Program can provide added intensity periodically throughout the treatment without requiring admission into the hospital or treatment center. Third, a Partial Hospitalization Program can provide an opportunity for functional maintenance while the patient remains part of the larger community.

Variations of Partial Hospitalization Programs

The ways in which medical appointments and therapy can be scheduled and structured might vary widely among different PHP options. They are often flexible enough to change with the needs of the patient. The number and structure of the therapy sessions required might range from as little as two hours each day for three days a week up to eight hours each day for five days a week.

Different Partial Hospitalization Programs might make use of many different types of mental health and other health care professionals. Among those who could be involved are:

  • Social workers
  • Occupational therapists
  • Recreational therapists
  • Psychiatrists
  • Psychologists
  • Nurses
  • Pharmacists
  • Peer support workers

Most Partial Hospitalization Programs require between four and five days of therapy each week, and each therapy session can range from four to eight hours. The day will have breaks scheduled in to break up intense therapy sessions. Typically, a minimum of 10 hours per week is required, and it is rare for patients to attend therapy sessions for more than 50 hours per week. On average, patients attend treatment for 20 hours a week.

PHP Versus Inpatient Treatment

Inpatient treatment for substance or alcohol abuse requires patients to live in a treatment facility 24 hours a day. Patients in this type of treatment program are separated from their previous lives. This means the patient has barriers between themselves and the outside world of influences, both positive and negative. The idea with an inpatient program is to provide a safe environment so that a patient can focus solely on sobriety and overcoming the issues that led to addiction.

Therapy sessions during inpatient treatment might make use of many of the same techniques and professionals that Partial Hospitalization Programs use. Typically, an inpatient program lasts at least 30 days, and some programs last as long as a year. The length of the program depends on a number of factors, including the patient’s specific plan of treatment, the severity of the patient’s addiction and the patient’s other obligations.

People who are in an inpatient addiction treatment program typically go through the phases of detoxification, hospitalization and residential treatment. All of these components take place while the patient lives at the treatment facility. A Partial Hospitalization Program, by contrast, allows the patient the freedom to move between the treatment facility and the outside community. In a partial hospitalization scenario, the patient shows up to the hospital at scheduled times for therapy and returns home after the session is over.

PHP Versus Outpatient Treatment

Outpatient treatment is a strong option for people who are dealing with substance or alcohol use but who do not meet the diagnostic criteria for inpatient or residential treatment. It can also be useful in providing continued support for patients after they’ve been discharged from an inpatient program.

This type of therapy is less costly than inpatient options and works well for people who have a solid support structure and other obligations outside of therapy. While they are less intensive than inpatient treatment options, many outpatient programs are effective because of their drug education components.

Partial Hospitalization Programs, by contrast, are a high-intensive treatment option. While outpatient addiction therapy might call for only weekly or biweekly sessions totaling less than eight hours of treatment, PHP options usually demand a minimum of 10 therapeutic hours per week.

The popularity of Partial Hospitalization Programs

Nationwide, Partial Hospitalization Programs have grown tremendously in popularity in recent years. This growth might be a reflection of certain benefits offered by partial hospitalization methods over other treatment options. According to the findings of a research study, 2.5 percent of non-disabled adults and 5.4 percent of disabled adults chose PHP options for treatment of addiction. The study covered a group of 32,037 people.

The authors of the study said the low percentages of people choosing PHPs might be due to a lack of public knowledge about the existence or effectiveness of these programs. As they are becoming more popular, though, PHPs are likely to draw increased attention from researchers and addiction patients alike. This sort of therapy has also shown promise in treating eating disorders.

PHP Benefits

A Partial Hospitalization Program can be the ideal way for a patient dealing with addiction to transition from inpatient treatment, which is the most intense and highest level of treatment, to outpatient treatment, where there is significantly less supervision and structure. Generally, PHPs are significantly more affordable than inpatient programs, which means more people can afford to get help.

All forms of addiction treatment were made more widely available to Americans by the Affordable Care Act, and insurance companies are more likely to approve payment for PHP options than they are for inpatient treatment. Because PHPs offer a longer treatment period at a reduced cost, insurance funds are likely to last longer for people in PHP treatment.

These programs also allow people who need addiction treatment but also have another home, work or family obligations to get treatment on terms that don’t demand all of their time or attention. The flexibility of PHPs and the reduced hours they require leave time for the patient to schedule and address other commitments. Participants in Partial Hospitalization Programs also have the chance to develop new or existing support communities with people who are not part of the treatment.


PHPs offer something of a middle ground between inpatient and outpatient addiction treatment options. They are typically utilized by people who have been hospitalized for substance use and who have been discharged following some level of treatment for addiction. They might be effective for people who:

  • Have a current diagnosis of a substance or an alcohol use disorder
  • Need regular monitoring by medical professionals but are stable enough to spend significant time without supervision
  • Are not at risk for self-harm
  • Are mental, physically and emotionally capable of going through several hours of intensive therapy at a time for several days each week
  • Have symptoms of detox that are moderate or mild and manageable without constant medical oversight
  • Are not currently capable of daily functioning but who have sufficient family and community support to avoid relapse

Partial Hospitalization Programs commonly offer detox support, but it is also common for patients to go through detox in an inpatient program and then join a PHP following inpatient treatment. Withdrawal symptoms only rarely rise to the level of threatening the life of the patient, but they can. Withdrawal from a severe addiction to alcohol or benzodiazepines can be life-threatening and may require 24-hour supervision to watch for heart attacks, seizures or other dangerous side effects until the patient has cleared the initial withdrawal period.

PHPs can be a good option for people who are tapering down their alcohol or substance use or who can make use of intensive therapy to alter their behaviors. These programs also act as an effective transition plan between inpatient and outpatient therapy options. People who believe they might benefit from addiction therapy should consider and discuss their options with medical professionals or trusted friends and family so that they can make an informed decision about the treatment option that may be the most effective for them.

What to do if an addict refuses treatment

Confronting the fact that a friend or a family member doesn’t really want to enter a recovery program in order to treat an addiction may leave you wondering what to do next. Just as treating an addiction is a process that needs to be very structured, it’s also important to take a structured approach to talk with anyone who might refuse treatment. More importantly, regardless of how an attempt to help them might turn out, you need to continue to be supportive to ensure that when the time comes for them to enter recovery, they’ll have people there to assist them.

Step 1: Acknowledge the Situation

When someone chooses to refuse treatment, it may raise some questions about whether they’re really an addict. People coping with drug or alcohol use disorders often can present very compelling arguments that they’re not in trouble. They may explain that they:

  • Only drink or get high to let off steam on the weekend
  • Insist that they’re highly functional
  • Are already cutting back their usage
  • Have fears they’ll lose their job if they are admitted to a treatment center
  • Need to be around to take care of their family
  • Will enter recovery after some big event, such as the holidays, a wedding, etc.
  • Won’t be able to afford rehab
  • Are worried about exposure to criminal charges

Rarely does a rational argument win out in these situations, so try to not dig in and make the discussion into a fight. The big thing is to recognize that you’re dealing with an addicted individual and you need to begin to take other steps to help them toward recovery. With the idea clearly framed, you’ll be able to confront other situations that might come up, such as if they beg you for money or need help making bail. This will ensure you don’t contribute more to the current problem.

Step 2: Learn More

Especially when dealing with an addict who refuses to seek help, it’s prudent to get educated about dealing with substance use disorders. You may also want to learn more about treating an overdose and obtain a supply of an antidote like Narcan if a loved one is using heroin or another opiate. It’s also wise to take a CPR course if you haven’t already been certified.

If you’re concerned that the person you care about is headed toward being charged with a crime, it’s also a good idea to talk with a drug law attorney. Conducting a consultation will give you a sense of how to address the situation if an addict is arrested. You can ask questions about things like the following:

  • Does your state offer any diversion programs?
  • Can someone charged with an offense still refuse treatment?

You’ll also want to get up to speed on the symptoms of different types of drugs, particularly if you’re not quite sure what the individual you’re dealing with is actually using. This is especially important to know if you’re worried that they’re engaged in mixed drug use, such as using cocaine to dial back the effects of heroin. Develop a written list of signs that your friend or family member is dealing with the misuse of specific drugs.

Step 3: Start Identifying What’s Going On

Having attained some degree of education about drugs and their symptoms, you should begin to figure out precisely what sort of situation your loved one is coping with. The first order of business is determining what drugs they’re actually using. Every drug has its own list of effects.

Someone who is using heroin, for example, might:

  • Seem out of it at times
  • Struggle to remember commitments
  • Withdraw from social life, especially interactions with non-users
  • Display medical issues, such as seizures or decreased breathing

On the flip side, a cocaine addict may be more likely to act:

  • Confrontational
  • Energetic
  • Twitchy
  • Violent
  • Panicky
  • Paranoid

You’ll also want to keep an eye for indicators that your loved one’s life is being disrupted by their misuse of alcohol or drugs. Regardless of the specific substance that might be abused, you may notice that they:

  • Aren’t grooming their hair as well as they used to
  • Haven’t bathed recently
  • Neglect to change their clothes
  • Try to hide their eyes by wearing sunglasses at inappropriate times
  • Disappear into the bathroom for unexplained reasons
  • Start forming friendships with people who use drugs

You may also begin to spot physical changes that are occurring, such as the phase that meth and cocaine users go through when they’re losing excess weight. As the addiction cycle continues, they’re likely to hit a point where they go from looking thin to downright scrawny.

By identifying the specific indications of a particular drug problem, you can start looking into treatment options tailored to the unique situation, such as dealing with someone who has a dual diagnosis. Even if they currently refuse treatment, it’s a good idea to have a recovery center in mind for when they come around. This will improve the chances they’ll get on board quickly during the period where they’re receptive to getting help.

Step 4: Get Them Medical Attention

Visiting a doctor and conducting a checkup may serve to give an addict a clearer picture of what they’re actually up against with a substance use disorder. This can frame the conversation in ways they might not have previously considered, such as learning about:

  • How much weight they’ve lost
  • Declines in motor skills
  • Diminished cognitive abilities
  • How their condition might continue to get worse
  • Toxicology reports
  • The effects of different drugs

It’s a good idea to give the doctor a heads-up about the situation before bringing an addict in for an exam. This will allow them to focus on a conversation that points your family member or friend toward recovery options. The experience may also provide better guidance regarding what specific drugs are being used.

Step 5: Stop Contributing to a Substance Use Problem

One of the more insidious aspects of addiction is that it compels people to seek money to fund their use. An addict may come straight out and ask for money, but they’ll often frame it as needing to cover rent or utility bills. Don’t assume that a presentation of bills is a legitimate reason for giving an addict money. It’s normal for a person with a substance use disorder to pay for drugs first, ask for money to cover bills and only then pay to keep the lights on. People with extreme addictions may be tempted to just buy more drugs.

An especially tricky aspect of this problem is that a user will often find ways around attempts to not contribute to their situation. You may try, for example, to directly buy something they need only to watch them turn around and sell it to convert into cash for drugs or alcohol. Friends and family often end up cutting addicts off completely in these situations.

It’s essential to make it known that you still care and that you’ll gladly help them if they need a ride to a recovery center. You don’t, however, want to put yourself in a situation where your finances are endangered because of their substance use disorder.

Step 6: Make a Clear Offer of Help

By this point, you should have collected a lot of information about the condition your loved one is in, what they’re using and which nearby treatment facilities are likely to offer suitable programs. At this stage, having acknowledged what the situation is and stopped contributing to it, you need to clearly state that you’re willing to help them get drug and alcohol counseling.

It’s normal for an addict to be emotional under such circumstances. You may be subjected to an outburst from them, or they might withdraw in the hope that non-engagement will kill the conversation. No matter what turn the discussion takes, you should:

  • Avoid being angry
  • Stay focused on the topic of recovery
  • Offer support
  • Refrain from being judgmental
  • Avoid escalating the situation with threats, such as saying you’ll call the police
  • Not use guilt
  • Remain encouraging

You should also try to avoid emotionally overcommitting to this moment. Many people with addiction issues don’t immediately jump in the car and go straight to rehab. With a little luck, they’ll understand, and you won’t eventually need to conduct a full-on intervention. You should, however, be prepared to provide steady friendship and support while they come to the conclusion themselves rather than being shocked if they refuse treatment. Knowing that you’ll be there to assist them in the process when the time comes will make it easier if they have a rock-bottom moment and decide to get help.

Step 7: Assess the Situation

Whether they refuse treatment or decide to go to rehab, you’ll need to assess where the situation stands. If they elect to go into recovery, you’ll need to make calls, set up an intake and provide transportation. Should they decide against entering rehab, you’ll need to start thinking about how to conduct an intervention.

Bear in mind that interventions don’t work the way they do on TV. A group of people don’t dramatically present an ultimatum and then watch as an addict emotionally caves. It’s often prudent to talk with a counselor at a treatment center, and it may be necessary to have a professional present to regulate the discussion during the intervention.

Step 8: Conducting an Intervention

Staging an intervention should take a couple weeks. You should be especially serious in thinking about who you invite to it. It’s critical that everyone who participates will be someone who can remain focused on the goal of directing the person to seek treatment. You don’t want to end up with people digging up old emotional wounds, screaming about unpaid debts and derailing the effort by providing anger or tears as conversational direction. If you have any doubts about the capacity of a potential participant to stay on point the entire time, do not include them.

Sort out everyone’s schedules to ensure they can be present. If possible, try to reserve a space that’s neutral, such as a conference room in a community center, in order to avoid reminders of emotional moments with the person you wish to help. You should also conduct a rehearsal in order to hear what everyone will say and place an emphasis on taking turns and staying on a defined script, even if your loved one tries to knock the intervention off course. Have contingencies in place in case the person decides to enter rehab right away, but be willing to accept that they may still refuse treatment.

Step 9: Following Through on Support

Helping someone get to a treatment center doesn’t mean your job is done. If they’re there on an outpatient basis, they may need rides back and forth. If they’re doing inpatient treatment, it will be helpful for visitors to come by regularly to check up on them. Someone should also be prepared to collect them when they’re done, and it’s important to have transportation for follow-up work, such as going to counseling sessions after completing treatment.

Recovery is a process, and it continues for years after the end of rehab. Don’t allow something that might feel like a major slip-up discourage you or your loved one, even if they’ve been clean for months. Remain supportive and keep a clear focus on what’s important: finding a path to a healthier and more stable life.

Difference Between Inpatient vs Outpatient Rehab

Generally speaking, there are two main types of treatment options when it comes to dealing with addiction recovery programs: inpatient rehab and outpatient rehab. In many ways, the two are similar in that they offer recovery programs that focus on the causes of addiction while offering tools to help people get out of it.

The differences between inpatient and outpatient programs lie in the intensity of the recovery program and the approaches taken. As the name suggests, an inpatient program requires staying at a facility for a period of time and working intensely with addiction counselors for extended periods each day. Outpatient programs, by contrast, deal with people on a part-time basis to help them overcome their addiction while they remain in society.

The Disease of Drug and Alcohol Addiction

According to the National Institute on Drug Abuse, addiction can be defined as “a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and changes in the brain, which can be long-lasting.” People with severe drug addiction can actually change the chemical and physical structure of their brain, leading to lasting problems with cognition, emotional control, and motor function. The effects on the rest of the body can be just as damaging, and depending on the drug in question, severe damage can be inflicted on the heart, lungs, kidney, liver, and other internal organs.

In addition to all the physical and mental problems that can develop from addiction, there are also the interpersonal ones. Oftentimes, addiction will put a heavy strain on relationships. This can include both personal relationships, such as those with family and loved ones, and professional relationships at work or school. The disease of addiction can destroy a person’s life in pretty much every way imaginable, which makes the importance of treatment and addiction recovery paramount.

Preparing for Inpatient Rehab

Inpatient programs can last anywhere from three weeks to 12 months depending on what the particular circumstances of a person’s addiction necessitate. Regardless of how much time is going to be spent in one of these residential treatment programs, preparations will need to be made ahead of time to ensure the transition is as seamless as possible. Here are some important items to keep in mind if you are preparing for long-term treatment:

  • If you are employed, then talking to your employer about your situation is necessary. The Americans with Disabilities Act (ADA) offers certain protections for those who are entering a long-term inpatient program, so you don’t need to fear being fired outright for seeking help.
  • Obviously, if you are a single parent or have a special living situation where you care for a parent or loved one, finding alternative arrangements is a necessity. In many cases, this help will come from family or friends who also want to see a successful recovery.
  • For those who rent an apartment or own a home, finding a way to keep the bills paid will also be a necessity. Monetary support can come in the way of private loans through a bank, grants through organizations like SAMHSA, family and friends, or Medicaid/Medicare.
  • An important thing that can easily get overlooked in all the craziness of preparing for inpatient treatment is finding out what sorts of personal items are allowed. Different facilities have different guidelines for what is and is not permissible for long-term patients, but everyday things such as clothes, jewelry, personal items, an alarm clock, and a personal journal will be fine.
  • Finally, after all the other preparations have been made, make sure there is reliable transportation both to and from the rehab center. While some people may be able to get rides from family or friends, there are others who may need to use a taxi or some form of public transportation. If the facility is located in another state, then securing airfare or a bus ticket may be necessary.

Entering Inpatient Rehab

For people who are suffering the worst effects of alcohol or drug addiction, an inpatient program might be the best way to go. These programs are held at clinics, rehab centers, and, occasionally, hospitals that provide 24/7 care as well as intensive recovery programs.

In most cases, when someone enters an inpatient rehab, they will have to undergo a detoxification period and medically managed withdrawal before they can begin the recovery process. This is when all traces of alcohol or drugs are removed from one’s system. For those who are entering an inpatient facility, the amount of a substance in their system may be high enough that there will be a physician monitoring the detoxification process to keep the patient safe. This is especially true in the case of alcohol, which can lead to severe withdrawal symptoms such as delirium tremens, hallucinations, accelerated heart rate, and seizures. During detoxification, medical physicians may prescribe medications to help alleviate symptoms of withdrawal.

The Treatment Process

Once the detoxification process is complete, the process of recovery can begin. Treatment plans can vary to some degree depending on where you stay, but, generally they are all well-structured programs designed to promote a healthy lifestyle while abstaining from drugs and/or alcohol. The day will begin with a healthy breakfast and morning treatment sessions. Some facilities offer yoga classes, meditation, and exercise programs to help relieve any stress and get ready for the day. An important part of the addiction-recovery process is to learn new healthy routines that you can take with you when you leave.

After breakfast, there will be a morning counseling session that can last until lunch. This is usually a group session with a treatment professional leading the discussion. The session will typically focus on the direction of treatment, long-term recovery, 12-step programs, and other similar topics. There is a lot that is misunderstood about the process of recovery, so the main point of these group sessions is to have everyone work together to come to a clear understanding of how it works. Part of this process also includes group discussions of triggers and behavioral patterns to help elucidate what they are and help avoid them in the future.

In the afternoon, there is more counseling, but this time, the process is one-on-one and will delve much deeper into individual issues. Here are some of the types of programs you may encounter:

  • Cognitive Behavioral Therapy (CBT) is a goal-oriented approach that uses the tools of psychotherapy to address problematic areas of a person’s life with the purpose of changing negative attitudes, thoughts, and behaviors. CBT is an excellent way of dealing with triggers and repetitive behaviors associated with alcohol and drug addiction. It is also effective for dealing with depression, anxiety, and relationship issues.
  • For some people, there are specific triggers that lead to substance use. These can include anger management, overwhelming stress, and grief over some type of loss. Specialized therapy sessions can help teach coping mechanisms for dealing with these feelings and provide tools for avoiding them whenever possible.
  • Family therapy is an important component because addiction is a disease that doesn’t just affect the person who is suffering from it. Families experience just as much grief and pain from addiction. Having sessions with everybody present can help the family as a whole along the process of healing while also providing the person who is addicted with extra resolve.
  • Alternative methods of therapy are often implemented alongside the above-mentioned programs. Some of these alternative methods include art or music therapy, equine therapy, exercise, and dance therapy.

The Importance of Family in Addiction Recovery

Even if someone is not engaged in family therapy while in an inpatient recovery program, they are still encouraged to have regular contact with family members during their stay. Whether it comes from a parent, child, sibling, or partner, the bonds of family can be an integral part of any recovery process.

Outpatient Rehab

Outpatient programs serve two purposes that are very similar. They are for people who need help with their addiction or substance use disorder but have not gotten to the point where they need an inpatient program. Outpatient rehab also serves as the next step for those who are exiting inpatient care. Depending on the level of treatment and care a person may need, there are a number of different programs that fall under the rubric of outpatient rehab to choose from. Here are the most common options:

  • Intensive outpatient treatment (IOP) provides a great service for those just starting the recovery process and for those who are transitioning from an inpatient program. IOP consists of both group counseling as well as one-on-one therapy sessions, and the program generally lasts anywhere from one to six months. During this time, attendees will take part in both group and individual counseling sessions multiple times a week. Each session will typically last between two and four hours.
  • Partial-hospitalization programs (PHP) offer a higher level of care and management than what is found in standard outpatient programs. In addition to counseling or therapy, addiction sufferers will also receive medical monitoring throughout the day. Generally, people in PHP will attend therapy sessions three to five times a week for four to six hours at a time.
  • Therapy and counseling is also available in less intense forms for people who are in the beginning stages of addiction or have a substance use disorder. These treatment options focus on what caused a person’s drinking or drug abuse in the first place and how to avoid falling into traps that can lead them further down the road into addiction. Counseling and therapy at this level are tailored to individual needs based on what both the patient and therapist/counselor feel are appropriate. The main form of treatment applied at this stage is CBT, but other treatment options are also available.

Inpatient vs Outpatient Care

If you are currently dealing with an addiction or substance use issue, you might be wondering which of these options listed above would work best for your situation. There are some general guidelines that counselors, therapists, and healthcare professionals use to determine if an inpatient or outpatient program is appropriate. Here are some guidelines to go by:

Inpatient Care Considerations

  • Inpatient programs are specifically designed to help people who are heavily addicted to substances and need to detox and go through withdrawal.
  • Since these facilities provide 24/7 care, there is always staff on hand to help addiction sufferers to cope with the initial stages of their sobriety.
  • Every aspect of an inpatient treatment program is highly organized and structured to support the ultimate goal of continued sobriety. This is important for long-term addicts who have built up their lifestyle around addiction. These programs work at both the interpersonal and intrapersonal levels.
  • There are doctors on hand to provide any medical assistant a patient might need. They can offer medications to assist with the recovery process and are available to assist in the rare event that an emergency arises.

Outpatient Care Considerations

  • Living at home during your treatment is far less expensive than being at a facility 24/7. This is true not only in terms of the specific cost of the program but also in terms of other costs incurred from loss of work, bills, and childcare.
  • If there is a positive network of family and friends available who are supportive, remaining at home can sometimes be a much better option. A positive support network at home is an important aspect of addiction recovery.
  • Depending on one’s level of addiction, an outpatient program might not be intensive enough. Those who have been using for a long time and are likely to go through withdrawal symptoms may want to opt for inpatient treatment.
  • Going to treatment once to a few times a week leaves much more time open for work, childcare, and all the other activities of life.

How to Choose the Right Rehab

Understanding that you have a problem is the first step in the right direction toward getting sober. Understanding that you can’t do it on your own is the next step. You will need to find the right rehabilitation center to continue on your road of recovery.

Discovering What You Need

choosing the right rehabA rehab facility isn’t a one-size-fits-all environment; you need to consider what you want in choosing a rehab. Some places don’t offer detox at their facility. You might have to do this at another facility before you go in. It might be easier to get all of your treatment at one center so that the staff is intimately familiar with your needs and you can get acquainted with everyone.

It’s wise to conduct searches, but keep in mind that there are a lot of rehab facilities out there with different specializations. Rehabilitation centers are required to be licensed, so look for that information. You can check your state to discover how facilities in your state are regulated.

You’ll need to read testimonials in addition to thinking about how long you’ll be in rehab, how long you think you need and any commitments you have outside of rehabilitation. If you have family, you might not be able to go far away. It all depends on your individual needs. However, because there are so many options available, you should be able to find one to fit your needs.

If you have an underlying mental condition, that will need to be addressed. You need to know if the rehab center you choose can treat this along with the addiction because these issues often tend to compound one another. Look for a rehab center that offers dual diagnosis if you need treatment for depression, anxiety or another mental disorder. It can be difficult to separate the two on your own. At times, there can be multiple conditions that need treatment, so don’t be afraid to ask questions to get the help you need.

You might consider taking a tour of the rehab center you’re interested in. Observe the staff and the people in the rehab center to get an overall idea of how it would be to stay there. If you don’t feel good about going there, listen to your gut feeling. You can visit other rehab centers to make an informed decision.

Truly Caring Rehab Centers

At the end of the day, you need a rehab center that focuses on your individual needs, and you need one with a staff that truly cares. You want to be overseen by specialists who will take time with you and who won’t be too eager to push you out their doors in an effort to label you as a “success” when you clearly need more guidance, counseling and treatment.

Physical Withdrawal

During and after a detox, the body goes through tremendous trauma. You need to be in a safe environment to detox because withdrawal can be extremely unpleasant when unsupervised. The facility overseeing your detox should be equipped with knowledgeable staff and carefully administered medication to keep you safe. Detox can last for up to three weeks or even longer in some cases.

Withdrawal symptoms range in severity. People can experience headaches, dizziness, heart palpitations, nausea, sweating, shakes, difficulty breathing and other symptoms. Severity and types of symptoms depend on how dependent a person is on drugs or alcohol. You might expect withdrawal from alcohol to be less severe, but it can be dangerous. Withdrawal from alcohol can cause a stroke, a heart attack, seizures, hallucinations and other severe symptoms. Rehab centers that are medically supervised will be able to make withdrawal symptoms less severe for you.

Psychological Withdrawal

Getting off of drugs and alcohol can mean a decrease in natural dopamine production. Dopamine is the feel-good hormone. Drugs and alcohol can cause an increase in abnormal dopamine production. Once you quit drugs and alcohol, it can take a while for your brain to relearn how to make dopamine naturally again.

You might suffer from depression, a lack of motivation, mood changes, stress, irritation or insomnia. It can take up to two years to produce dopamine naturally at normal levels, but these levels significantly increase in the beginning and taper off as time goes on. Just understand that it’s temporary, and the right kind of care will make this transition easier to go through. Rehab centers that have cognitive behavioral therapy and self-help groups can help with psychological withdrawal.

Emotional Needs

Becoming sober can be rough. When you see people who have come through the other side, you typically see smiles and indications that their life is on track. What you don’t see is the mess they went through. If you’re fortunate enough to talk to individuals in recovery or hear their stories, you’ll find there were days they wanted to give up, and things might have looked hopeless at some point in their recovery. This will help encourage you on tough days.

What you should know when you go to rehab is that there is a great deal of dysfunction that surrounds addiction. Many individuals who develop addictions grew up in dysfunctional families. People suffering with an addiction to drugs or alcohol usually have dysfunctional thinking and behaviors. Getting sober means dealing with dysfunctional thoughts and behaviors to live a free life. The right rehab center will help you to make sense of all of this.

Being sober also means facing painful emotions, regrets and more at times, but you don’t have the drugs and alcohol to distract you from these painful emotions. This is a good thing, but it doesn’t feel good at the time. You may feel like you want to run; you need a rehab center that can walk you through the painful times.

Success Stories

You need real life success stories to determine whether a rehab is likely to be beneficial. Any facility you go to should be able to tell you their success rates. However, you need to know what they consider to be a success.

You want to be able to walk out of rehab with a plan for attending meetings, understanding how daily life should look like and what to do when things get tough, and you should feel reasonably ready for the transition. It’s not to say that you won’t feel somewhat afraid, but you need to know how and where to get help.

A rehab center that does follow-up appointments with you can help you to transition back into daily life. Living sober is a different experience for each individual. Everything changes, including the friends you hang out with and emotions you feel for the first time in a long time; everything seems different because your perspective and awareness are different.

Consider referrals and word-of-mouth when you choose a rehab center. A rehab center’s reputation speaks volumes and will let you know whether it would be a place that could help you with your wants and needs.

Understand Your Part

Your “success” isn’t just based upon the rehab you go to. You need to be willing to do the work, which might mean facing some painful realities about yourself. You will need to listen to others pointing out things about yourself that you may not like. You will be faced with trying to express your emotions and thoughts in a healthy way. You might need to invite family members for therapy, so there is a lot to go through and experience.

It won’t be pleasant at first because you may have buried painful emotions for years. It can be overwhelming and confusing, but with time, it will become more manageable, and you will know what it feels like to live a free and healthy life. Just go into rehab with an open heart and an open mind. There are many people just like you to relate to. Keep that in mind and remember that the rehab center should help you along the way too.

You’ll need to know what your triggers are because you’ll need to avoid these after you leave rehab. Make sure that the rehab you choose will help you to identify these triggers and catch them before they take over. The rehab center you choose should give you tools on how to deal with your individual triggers so that you are less likely to relapse.


While location may not be as important as getting help, you still need to consider how the location of a rehab center will affect your life. Because of family and other commitments, you might need to pick something that is closer to home; however, don’t let this stop you from seeking the best rehab center according to your needs. Your sobriety is important. If you will be taking part in family therapy, the rehab center needs to be close enough for family to visit.


Rehab centers may cost a lot, but the truth is that an addiction is costly, and addiction costs far more than just money. Still, you need the best rehab center that fits into your budget. There are many ways to pay for rehab. You can see if your insurance will cover it and whether you can get help for a dual diagnosis. Talk with the rehab centers you are interested in to see what they recommend. The right rehab center will be able to assist you with different payment methods, so don’t be afraid to ask about your options.

Support After Rehab

When choosing rehab, you might want a program that continues to follow up with you and, at the very least, gives you a list of resources so that you have someone to call when you need support. You’ll want to attend some meetings, but you might have other issues come up that you need help with. The right rehab center should not leave you on your own to face everything. You need to do your part, but professionals are there to guide you. You might need to move out of your neighborhood or get help with other needs. You can’t face everything on your own.

Staying clean and sober after rehab can seem scary, but once you leave the facility, you will be better equipped to deal with your emotions, handle triggers and carry on living in a manageable way. It’s important that the rehab center you choose helps you through detox and recovery in a safe, caring and loving way and that you leave rehab with the ability to transition back into daily life. Recovery might seem hard, but professional help can make it possible to live a sober life.

Opioid Dependency Skyrockets Lately

From 2007 to 2014, health insurance claims for those with opioid dependency rose by over 3,200% according to a study conducted by Fair Health. This is to say that for every one person diagnosed with opioid dependency in 2007, there were over thirty within seven years. Robin Gelburd, president of Fair Health, said this study proved opioid dependency to be “in the general mainstream.”

The sharpest increase in opioid dependence occurred in 2011, the year that saw the most attention paid to the growing problem, between monitoring the amount of opioid prescribed by doctors and increasing the amount of opioid training given to doctors. Still, statistics show only about 20% of doctors following correct monitoring protocol. Another major issue concerning the opioid problem is the fact that one in five people prescribed opioid medication share it with a family member or friend.

We have an Opioid Epidemic

opioid-dependencyAndrew Kolodny, while not involved in the study, is the senior scientist for the Heller School for Social Policy and Management at Brandeis University. He spoke with NPR recently about the results, explaining how the dramatic increase of opioid abuse over such a short time period is the definition of an epidemic.

The number of medical services given to patients with opioid dependency in 2007 was approximately 217,000. This includes office visits and lab tests. The number in 2014 rose to seven million. That’s 800 medical services given to addicts per hour for an entire year. “A 3,000 percent increase is enormous,” said Kolodny. The evidence is in the numbers.

How did this happen so fast?

These dramatic increases come from somewhere. Experts such as Kolodny attribute it to doctors prescribing opioids at alarming rates. It turns out 99% of doctors prescribe more opioids than recommended by the Centers for Disease Control and Prevention. The recommendation for opioid-based painkiller prescription is three days’ worth or less per patient. Virtually all doctors prescribe them for 30 days or more. Perhaps this is fostering addiction.

It’s not just those with the prescription becoming addicted. As seen prior, family and friends of those with the pills receive them as well. In fact, half of those prescribed opioid-based painkillers who do not finish them do not discard them properly. This surely must be why two million Americans are addicted to opioids. Forty-four of these opioid addicts die from overdoses every single day.

Another viable explanation for the opioid epidemic is a phenomenon known as “doctor shopping.” This is when an individual in pain receives multiple prescriptions from multiple doctors, jumping from one to the next. If done rapidly, the painkillers can be dispensed before the authorities involved realize it.  Some people may do this to obtain drugs for themselves, whereas others may do it to obtain drugs for sale.

What’s being done?

Prescription monitoring programs for both doctors and patients are slowly but surely being put into place nationwide. Recently, leading insurance provider Aetna sent letters to those doctors found to have prescribed more than the average amount of opioids. These letters were essentially warnings to monitor the prescriptions more closely.

The Drug Enforcement Administration recently re-classified hydrocodone into a more restrictive category, making it harder to obtain. Also, most US states now allow patient monitoring, which includes a shared database of prescriptions given. This method has already been shown to be effective.

The number of opioid prescriptions given has quadrupled since 1999. Before the epidemic of opioid addiction ends, perhaps less opioids need to be handed out.

Parental Absence Leads to Pre-Adolescent Smoking & Drinking

According to a study published this month by researchers at University College London, children who experience the absence of a parent by age 7 have an increased risk of abusing both tobacco and alcohol in their pre-adolescence.  The researchers also concluded that engaging in such risky health behaviors as a pre-adolescent may severely impact a child’s health down the line, as well as increase the chances of developing a dependency on tobacco or alcohol.

While the link is clear between childhood hardship and substance abuse during adolescence and later years, a lack of research existed regarding childhood hardship and such risky behavior before adolescence, by age 11.

Adverse childhood experiences, or ACEs, are what psychologists use as an umbrella term for any traumatic events during childhood that have long-lasting, negative effects on overall well-being later in life. These can include, but are not limited to, the death of a parent, the incarceration of a parent, physical abuse, mental abuse, emotional abuse, or even parental divorce. Separate studies have shown that ACEs are directly linked to adolescent alcohol abuse, as well as to tobacco use during adolescence and adulthood. The alcohol-related study showed that “Adverse childhood experiences are strongly related to ever drinking alcohol and to alcohol initiation in early and mid-adolescence,” and the tobacco-related study showed that “Smoking was strongly associated with adverse childhood experiences.”

Details of the Study

The University College London collected data on 10,940 children who by age seven either had one or both parents die, or were separated from one or both parents. The subjects were a part of the larger Millenium Cohort Study, currently underway in the United Kingdom, which monitors 19,000 children for a wide range of behaviors.

According to the University College Londo  study, children who experienced the absence of a parent were over 80% more likely to use tobacco and were 46% more likely to use alcohol by age 11. Children who experienced the death of (as opposed to the separation from) a parent were less likely to have consumed alcohol, but among those who had consumed alcohol, were more likely to drink enough to be drunk. However you want to look at these statistics, the conclusion of the study is impossible to argue with: “Children who experience parental absence should be supported in early life in order to prevent smoking and alcohol initiation.”

In addition to parental absence increasing the risk for early substance abuse, the researchers came to two other important conclusions. Once pre-adolescent substance abuse occurs, the chances of adverse health effects and the chances of developing a substance dependency both go up. These conclusions are based on already-established evidence of these effects later in life.

Early smoking has been proven to increase the chances for lung cancer. Alcohol consumption prior to age 13 has been proven to increase the chances for alcohol dependence later in life. Why would it not be the same for pre-adolescents? The University College London researchers believe it is the same for them.

Attachment Theory (and how it applies)

Developed by John Bowlby and Mary Ainsworth, attachment theory essentially states that a child with an emotional and physical attachment to his or her caregivers can give that child “a sense of stability and security necessary to take risks, branch out, and grow and develop as a personality.” Working in reverse, this can also mean that without such an attachment, “a great deal of developmental energy is expended in the search for stability and security.” Basically, children without strong parental bonds tend to be more fearful, more anxious, and more susceptible to stress.

Children without such attachment to their caregivers may also be more susceptible to substance abuse, which is parallel with the University College London study. Some doctors firmly believe that parental absence is a ripe ground for addiction. This is exemplified by the work of Dr. Ondina Hatvany in the case of ‘Becky.’

Her name has been changed, but Becky is one of countless people without parental attachments who developed an early substance abuse problem. Hatvany says, “I believe that because Becky had not experienced the regulatory effect that secure attachment would have provided, she had to get creative. She had to find a substitute to help her regulate; alcohol became that substitute.”

Pre-Adolescent Tobacco Use

According to the Surgeon General, tobacco use is the leading cause of preventable death in the US. An astonishing 20% of all deaths, preventable or not, are caused by tobacco. Every day in America, nearly 4,000 people under age 18 smoke their first cigarette. More than four out of five everyday tobacco users begin using before graduating high school, and 99% of everyday tobacco users begin before age 25.

If discovering that one out of five tobacco users will die because of it doesn’t speak loudly enough, consider that tobacco-related injury and illness makes up 75% of all the money spent on healthcare in America. (This is well over a trillion dollars).

Cigars, cigarettes, electronic cigarettes, hookahs, vapor pens and chewing tobacco all hold the same risk. Nicotine is the active ingredient in all of these forms of tobacco use, which is known as one of the most addictive substances known to man. Nicotine reaches the brain within 10 seconds of consumption, and immediately releases adrenaline, creating pleasure and a buzz.


Cigar, cigarette and smokeless tobacco use among children has gone down, while electronic cigarette use has gone up. Still, these numbers are far too high.

According to Kids Health, children “might be drawn to smoking and chewing tobacco for any number of reasons — to look cool, act older, lose weight, seem tough, or feel independent.” The same logic applies to alcohol use, and furthermore, both tobacco use and alcohol use among children may be affected by the media. (This is discussed below, in the ‘Pre-Adolescent Substance Abuse and the Media section).

Pre-Adolescent Alcohol Use

Alcohol is the most prevalent substance abused worldwide. This fact is the same for full-grown adults as it is for pre-adolescents. A national survey revealed that the majority of people in the US who regularly abuse alcohol began doing so early on. In fact, 75% of high school seniors have been drunk. 25% of seniors had binge drank in the last week. Every single day, 8,000 American children try alcohol for the first time. Over 20% of children use alcohol by age 13.


However, alcohol affects children differently than it does adults. Psychologist Linda Spear of Binghamton University believes pre-adolescents and adolescents are more vulnerable to alcohol’s pleasurable effects than adults are. Also, she believes children are less apt to notice the sedative effects of alcohol, and therefore are more likely to drink until blacked out.

Spear’s theory is reinforced by a Canadian study performed by Éduc’alcool, which states that alcohol abuse is a form of thrill-seeking often used by young people. The pre-adolescent/adolescent brain is not fully developed, and consequences are not often fully considered at that age. According to Éduc’alcool, “Adolescents like intensity, excitement and arousal… Adolescence is a time when sex, drugs, very loud music and other high-stimulation experiences take on great appeal.” The study goes on to conclude that due to this combination of brain underdevelopment and desire for thrill, pre-adolescents and adolescents are much more susceptible to alcohol abuse than are teenagers and those older.

Risk of Bullying or Being Bullied

It is worth noting that according to a study published by the National Library of Medicine, both the perpetration of bullying and the victimization of being bullied increase for pre-adolescents who use alcohol. Over 175,000 Georgia students, from 6th to 12th grade, were studied to determine the link between early alcohol use and bullying/being bullied.

The results show that 24.4% of students studied reported bullying, as either perpetrator or victim, and of those students, nearly all had used alcohol in the last month. “Pre-teen alcohol use initiation was significantly associated with both bullying perpetration and victimization relative to non-drinkers,” concluded the researchers. Victims of bullies are up to nine times more likely to commit suicide, and bullies themselves have been shown to usually have some adverse health issues.


Pre-Adolescent Substance Abuse and the Media

Each year, the tobacco industry spends $3.6 billion on advertising, and the alcohol industry spends $2 billion. Although these amounts change, they are actually low-end estimates. (The American Academy of Pediatrics, or AAP, believes the number to be $25 billion for tobacco, alcohol and prescription drugs combined). Although both industries deny any advertising geared toward children, “research documents that cigarette and alcohol advertising and promotional campaigns are especially appealing and attractive to teenagers and children,” according to the American Public Health Association.

In 1991, when tobacco could still be advertised in the media, 93.6% of children could identify Joe Camel, the cartoon mascot for Camel cigarettes. Only 57.7% of adults were able to identify the mascot. (91.3% of six-year-olds were able to identify Joe Camel at the time, the same percentage of six-year-olds who were then able to identify Mickey Mouse).

The AAP published a study in 2010 regarding tobacco and alcohol advertising and its effect on children. According to the study, up to 30% of tobacco and alcohol use among children can be attributed to advertising. The most heavily advertised cigarette brands are the most popular, and the same goes for alcohol brands. Although tobacco ads have long been removed from television, it is estimated that children see up to 2,000 ads for alcohol annually.

Perhaps the most shocking fact regarding children and substance advertising has to do with the comparison between youth-oriented magazine ads and adult-oriented magazine ads. “Teen-oriented magazines contain 48% more advertising for beer, 20% more advertising for hard liquor, and 92% more advertising for sweet alcoholic drinks than do magazines aimed at adults of legal drinking age.”

In Conclusion

Not all families can stay together forever. Death occurs, divorces happen, and sometimes parents just don’t stick around. However, what can be prevented is the abuse of alcohol and tobacco by children. Obviously, not every seven year old who has an absent parent will abuse drugs. However, after seeing that these children are at greater risk than others to do so, education and intervention needs to happen at a young age.

“Early uptake of risky health behaviors is a feasible mechanism through which disparities in disease outcomes may emerge,” wrote one of the researchers in the University College London study. “Early life may be an important time to intervene in order to prevent the uptake of risky behaviors.”

Medication Assisted Treatment

Traditionally, drug and alcohol addiction treatment involves abstinence, behavioral therapy, and therapy. It does not traditionally involve other drugs. However, some traditions inevitably fade away, and in the case of drug and alcohol addiction treatment, the tradition is currently fading. Medication assisted treatment (MAT) combines the traditional method with the use of medications. MAT is most commonly applied to opioid addiction treatment, but has proven to be effective for alcohol addiction treatment as well.

The idea of including medicine in addiction treatment is not new. Methadone was developed in the 1930s and introduced to the US in 1947. Marketed initially as a kind of cure-all for anything painful, methadone was soon recognized as a powerful tool in addiction treatment. Methadone treatment is essentially drug replacement, except the addict will not feel high from methadone, only satisfied chemically. Combine this with traditional forms of addiction treatment, and you have MAT.


A History of Success

In 1994, the California Department of Alcohol and Drug Programs conducted a study on substance abuse treatment. The study mainly focused on the costs of treatment, however one of the findings of the study reads: “Patients in methadone maintenance showed the greatest reduction in intensity of heroin use, down by two-thirds, of any type of opioid addiction treatment studied.”

Methadone remains the most popular medication for opioid addiction treatment.  While effective, regarding MAT, some other less-addictive medications are also utilized:

  • Buprenorphine – Similarly to methadone, this is an opioid agonist, which means it blocks the effects of opioids in the brain. The user will not feel high, but will have their bodily craving of opioids taken care of. Buprenorphine is much less addictive than methadone, and has been proven to be nearly as effective, with fewer side effects.
  • Naltrexone – This is also an opioid agonist, but has proven to be effective in treating alcoholism as well. Regarding its use with alcoholism, because of the constant availability of alcohol, there is an injectable form of naltrexone called Vivitrol, which lasts for a month between injections.
  • Disulfiram – Approved by the FDA in 1951 and still effective today, this medication prevents alcohol breakdown in the liver, causing the user to vomit any and every time alcohol is consumed. The medication is rather effective for obvious reasons, but can be damaging to the esophagus (again for obvious reasons). Disulfiram is currently being studies as a possible treatment for cocaine addiction as well.
  • Acamprosate – Used primarily to combat alcoholism, this medication reduces the cravings for alcohol. It is a newer drug, (FDA approved in 2004), and is used similarly to Disulfiram, except acamprosate will not induce vomiting upon the consumption of alcohol.

The Harvard Medical School Study

Less than one year ago, the results of a long-term study on medication assisted treatment were published. Harvard Medical School, as well as McLean Hospital, led the study over the course of three and a half years. Buprenorphine was the medication applied, and the group consisted of over 650 opioid-based painkiller addicts. The results, according to Dr. Roger Weiss, one of the study’s conductors, “are cause for optimism,” and according to Dr. Jennifer Potter, the results “represent an important first step toward understanding the course of dependence on opioid pain relievers, and for identifying factors associated with longer-term recovery.”

After 18 months of MAT, here are some pertinent results from the study:

  • Over half of the patients (51.2%) reported abstinence after 18 months.
  • Nearly two-thirds (61.4%) of the patients reported abstinence after 42 months.
  • After 42 months, less than 10% of patients were scientifically diagnosable as dependent.
  • Patients not involved in MAT but rather in traditional treatment reported much less success.

With proper administration and regulation, medication assisted treatment proves to be more effective than non-medicated treatment. Steps are being taken in the right direction. More and more professionals every day are recognizing the benefits of MAT.

If you think Medication Assisted Treatment is for you, Call us to get into the best MAT Addiction Treatment Center Today!


Dual Diagnosis – Mental Illness and Addiction

dual-diagnosisAddiction to a substance is a disease that involves both mind and body. A mental illness occurs only in the mind but can affect the body as well. Even at first glance one can see the relationship between the two. It is similar to the square and the rectangle. All addictions are illnesses but not all illnesses are addictions. Evidence shows though that having a mental illness increases the likelihood of being addicted to a substance, and vice versa known as Dual Diagnosis.

In fact, those who have ever had a mental illness in their lives consume nearly 70% of all the alcohol bought, 84% of all cocaine, and 68% of all cigarettes. This is according to the National Bureau of Economic Research, an organization that tracks sales of all types. At any point, less than 25% of Americans have a diagnosable mental illness. While that still is a lot of people, it sheds light on just how many addictive substances those with mental illnesses consume.

Why the co-occurrence?

This question is much like the chicken and the egg. Does mental illness cause addiction or does addiction cause mental illness? Having both an addiction and a mental illness is known as having a dual diagnosis. Like many diagnoses, there is a wide range of intensity. Someone who develops depression as a result of being an alcoholic has a dual diagnosis, and so does someone who has schizophrenia and uses heroin as a self-medication. Obviously the two treatment plans would differ greatly, but nevertheless each person suffers from dual diagnosis.

Approximately 40% of those with a mental disorder also abuse substances. Mental disorders can arise from prolonged substance abuse, but self-medicating with drugs or alcohol in order to combat a mental illness happens as well.

One is a catalyst for the other.

According to Foundations Recovery Network, when dealing with dual diagnoses, “symptoms of one disorder trigger the other.” Though it may come off as harsh, they offer some examples of how addictions and mental illnesses can co-occur and catalyze each other. One example is how drug abuse increases the risk of being the victim of a violent crime, which itself can lead to PTSD or depression. Another example is how unprotected sex and/or sharing needles during drug use can lead to HIV or Hepatitis C, which in turn can (and probably will) cause severe depression and grief. Depression actually is very common in substance abusers, as many drugs actually cause it, i.e. alcohol, crystal meth and ecstasy.

The National Institute on Drug Abuse puts it well: “Both drug use disorders and other mental illnesses are caused by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.”

Treating a Dual Diagnosis

Because both addiction and mental illness are serious conditions, having a dual diagnosis requires careful attention. First, a detoxification is recommended, especially one that is inpatient. Due to the instability of dual diagnoses, a constantly monitored environment is probably best. Next, rehabilitation should occur. This would be therapy, group and solo discussion, exercise, diet… anything that assists in the process of cleaning up. After that would come medication, which must be carefully administered due to the nature of the issue.

Finally, the maintenance of sobriety and clean mental status is handled with self-help and support groups, along with strong willpower and determination. For detailed and in-depth information on dual diagnoses, including finding specific self-help and support groups, click here and visit Double Trouble in Recovery.