CHAPTER 5: TREATMENT AND RECOVERY

WHILE YOUR LOVED ONE IS IN TREATMENT

After years of dealing with a loved one who is on alcohol or drugs, many family members can be unclear as to how to handle them while they are in treatment. Over the next few pages, we have provided some rough suggestions on how to handle many different situations that might arise. These approaches can differ depending on the treatment type or the length of stay and these suggestions should only be used as a general guide. Any questions on how to deal with a specific situation can usually be answered by the treatment provider themselves. No matter what the modality of treatment, however, any effective treatment program should handle, at a minimum, the following 3 things:

1. Safely detox the client off of drugs and alcohol so that he is no longer experiencing any medical danger or physical withdrawal symptoms.
2. Help the client to learn and develop coping skills to face and deal with uncomfortable life situations, things and feelings in a healthy manner instead of “running away from them”.
3. Help the client to face and deal with past issues, take accountability and responsibility for any harms done and, if necessary, work towards making up the damage. 

During any stage in these processes of recovery, your loved one could be experiencing physical and/or emotional ups and downs. One day they may sound wonderful and the next day they are angry and bitter. Try and understand that an addict has lived a life of avoiding uncomfortable things and feelings, and now, without drugs or alcohol, he may be facing them sober for the first time in many years.

PHONE CALLS TO THE FACILITY: Due to HIPPA laws and client privacy, the treatment center (and any counselors they may have there) cannot give any information about a client, including whether or not they are even there. However, most treatment centers do have a confidentiality waiver list for family members wishing to discuss the progress of a client. Make sure that you encourage your loved one to place you on this list or else you will be deaf and blind to any progress or problems that may occur.

 PHONE CALLS TO YOUR LOVED ONE: Many treatment centers do not allow direct calls to clients within the facility, but instead provide payphones for the clients to use. Make sure that your loved one has a phone card so that he may make phone calls to you. If you do speak with them frequently, try not to focus on any negatives that may be going on at home.

For example, if they just received divorce papers, repeatedly speaking to them about it in early treatment might not be such a good idea. In addition, if you hear him begin to complain, try and understand. Acknowledge whatever positives you may hear, and try not to validate any negatives. Understand also that these calls are very rarely monitored, which means that in addition to you, your loved one may also be calling anyone else – even the negative people in their life.

MAIL AND PACKAGES: During this difficult time, it is encouraged that family members write letters of encouragement or ship packages while their loved one is in treatment. Most facilities will screen packages, but check with them and see if they restrict certain items such as food, books, hygiene products containing alcohol, etc. Remember that they may not have access to the local store, and the occasional letter or care package with an item or two is usually greatly appreciated.

 FINANCIAL ASSISTANCE: Sometimes we are asked by families as to whether or not they should provide any kind of financial assistance to their loved one while they are in treatment. Is that enabling? Not necessarily, as long as the amounts are limited. Agreeing to buy someone a car or pay all their debts completely just because they agreed to go to rehab is not healthy for a recovering addict. But paying some minor bills just to keep the house from going into foreclosure or the car from being repossessed would be acceptable. In addition, some families put small amounts of money into their loved one’s accounts at the treatment center, which allows them to go on outings or purchase small items.

Be conservative in this. Treatment should not be a day spa, vacation, or resort. Some programs suggest no more than $100.00 a month. If your loved one is in a half-way house or sober living environment where they are able to/required to work, a good suggestion is to only pay for the first month. If they are able to support themselves within treatment, they should. Providing more than you should for an addict, even in recovery, only takes away their responsibility and actively harms their recovery.

 VISITATION: Some treatment facilities allow visitation by family members or close friends. Although it is healthy for family members to take an active part in the recovery of their loved one, too much visitation can sometimes be counter-productive. The wife that visits her husband every single weekend during a 4-month treatment program without any accompanying marriage counseling may initially be doing more harm than good; because of this her husband wants to leave the facility for a period lasting several days after each of her visits. In addition to this, sometimes your loved one does not actually want to have visitors early on. Check with the, and see if they are comfortable having visitors. The last thing you want to have happen is your loved one to have any negative attention on you, or on them going home and leaving the facility.

 FAMILY THERAPY OR COUNSELING: Any time there is a strong emotional connection between the addict and a specific family member, some form of counseling/ therapy can be beneficial. Find out if the treatment center provides any family counseling as a part of their program. If they do, be sure to take advantage of it. If not, then seek some out on your own. The stronger the emotional connection you have with your loved one, the more damage you have probably suffered from them as a result of the addiction. Most major cities also have support groups such as Al-Anon for spouses; meetings can be located at the following website: www.al-anon.alateen.org.

WHAT IF THEY WANT TO LEAVE TREATMENT?

What if he leaves or wants to leave before completing the entire program? It is not uncommon for your loved one to want to leave at some point during the treatment process. Generally speaking, there are usually 3 “danger points” or stages to look for in any treatment modality:

1. THE WITHDRAWAL STAGE (0-7 DAYS) – Withdrawal, also known as “detox”, can be a very uncomfortable process. Physical pain, fatigue, or anxiety are some of the many symptoms that can be associated with withdrawing off of certain drugs. Opiates (Heroin, Methadone, Vicodin, or Oxycontin) usually have the most physically uncomfortable withdrawal symptoms. These include major aches, pains, anxiety, an inability to sleep for days, vomiting, and flu-like symptoms. Alcohol and Benzodiazepines (Xanax, Valium, Klonopin, etc.) can be the most dangerous and usually require a medically supervised detox. Cocaine, marijuana, LSD, or methamphetamine can be the safest withdrawal and commonly do not have any uncomfortable physical withdrawal symptoms associated. 

During this stage, it is not uncommon for a withdrawing addict to beg, promise, or threaten anything just to get back to their substance of choice. If your loved one expresses a desire to leave for any reason during this process, understand that this is usually just a desire to get back to old habits. The one thing that will definitely take away the major symptoms of almost any withdrawal are the actual drugs that your loved one is withdrawing from. Remain firm and do not give into the pleadings. While in detox, they are in a much safer place and they need to stay through this process. This is the first step towards true recovery.

1. THE HONEYMOON STAGE (7-21 DAYS) – During this stage of recovery, an addict can feel so good that they sincerely believe that they are done with treatment and do not need anything further. Although they may not even be finished with the program and the counselors recommend a further stay, they may insist on leaving. “I’m not as bad as these other people. I need to get back home to start working and be the good husband and father that I can be. I realize now how bad my drinking was and I’ll never go back there again. I feel awesome.”

Be very wary of this. They may sound extremely sincere and they probably truly believe that they will never use or drink again. However, understand that most longer-term programs are designed the way they are for a reason and if they leave before completing, they are going before they are truly well. It is not uncommon for many addicts to want to leave as they begin to face the uncomfortable underlying causes and conditions. Remain firm. They agreed to finish the program and it is there they should stay.

An independent study once suggested that 98% of all clients who left treatment early relapsed within the first 30 days of coming home. It is considerably easier to get your loved one to stay in treatment and finish the program than it is to get them to go back after leaving the program early, coming home, and relapsing. Some never return at all. A saying in recovery is, “you’ll never know if your loved one went to treatment for too long, but you’ll definitely know if he didn’t go long enough.”

1. THE WALL STAGE (21-90 DAYS) – Although your loved one has been safely detoxed at this point, they still are not fixed. They have not gotten into enough recovery to have developed effective coping skills to handle uncomfortable feelings and life situations. In addition, they no longer have drugs or alcohol to fall back on during these uncomfortable times. Typically, they become restless, irritable and discontented unless they can, once again, use those old familiar coping skills of before.

However, leaving a treatment program at this stage would seem ridiculous, so most addicts will try and justify a departure at this point. Getting extremely critical of the treatment center, the other clients, or the staff members themselves, you may hear your loved one make several disconcerting statements.

“The place isn’t clean enough. The food is terrible. The other clients are flirtatious towards me. No one here is my age. My roommate snores. The staff is mean to me. This program is a joke.”

What they are trying to do is come up with any excuse that you will agree with so that you will feel ok when they leave. If they can paint an ugly picture of the treatment facility or program then you will pull them out of it yourself. Understand that this is part of an addict’s diminished ability to face or deal with uncomfortable feelings or situations. Their first instinct is usually to run away. They just want you to agree with them when they do.

No matter which of the beginning stages of recovery your loved one is in, they may demonstrate a desire to leave treatment or quit the recovery process entirely. This is perfectly normal. Understand that when something feels emotionally uncomfortable during treatment, it is most likely something that they need to work on. It is sometimes said that the most difficult parts of treatment and recovery are the parts that benefit someone the most. Try your best to remain strong and draw a line in the sand. If they complete treatment, there is a definite possibility that they will recover and remain sober for the rest of their life. If they leave treatment, there is a good chance that this is just the beginning of the process of a relapse.

If they cannot handle being in a safe, nonthreatening, treatment environment, then what are the chances that they can handle life outside of a treatment center and still remain sober? Probably pretty slim. Remain firm and stay the course. It is always more important to fully complete a treatment program than to just simply arrive at their doorstep.

AFTER COMPLETING TREATMENT

Upon completion of the treatment program, it is not uncommon for the family of an addict to immediately go back to the fear and concern that they felt before treatment. What if it didn’t work? Do they need more treatment? How do we treat them? What if they use drugs or alcohol again?

Hopefully we can help to provide some general guidelines or answers to these questions: 

• DO THEY NEED MORE TREATMENT?

A common misconception among family members is that once the program is completed then the recovery is done. A general rule of thumb is the shorter or less intensive the primary treatment, the more intensive the aftercare needs to be.

For example, someone completing a relatively short-term 28-day inpatient treatment program would ideally enter into a 6-month half-way house or sober living residency afterwards. However, someone who completes a very intensive 6-month inpatient treatment facility might only need outpatient counseling or support groups to maintain their sobriety. Always remember that the longer time spent actively in treatment and recovery, the higher the long-term success rate. 

• HOW DO WE TREAT THEM?

A large part of recovery is taking full accountability and responsibility for one’s life. For an addict to go from the safe environment of a treatment center back to their home without a tested foundation in recovery can be a bit overwhelming at first. If they have no income source and no place to stay, then to simply say, “Too bad – take responsibility for your situation,” and expect them to be able to build a life up from the streets might be a bit unrealistic. However, to go back into full enabling mode and take over everything again with the best intentions is ill-advised as well. Just because someone finishes treatment does not earn them the right to a free house, car, or other undeserved opportunities. Try not to bribe or purchase someone’s recovery for them.

Sobriety has its own blessings for a recovering addict. Earning them is what increases their value. A general rule of thumb is to allow them to face the problems of their life. Helping them through guidance to overcome their problems is perfectly acceptable; however, do not solve their problems for them. If they need temporary assistance in the beginning and you feel comfortable helping them, then do so. On the other hand, if you still find yourself paying rent 45 days later and they still haven’t found a job, understand that you are probably enabling again and there is an increased chance that your loved one will relapse soon if both of you continue along this path. Their lack of productivity and personal responsibility, combined with your renewed enabling, are a definite recipe for relapse.

HANDLING A RELAPSE

 WHAT IF THEY USE DRUGS OR ALCOHOL AGAIN?

A relapse can be an emotionally trying situation for the family. It takes you right back to all the fears and frustrations you had before your loved one entered treatment. How you should deal with the relapse of your loved one depends more on their attitude about it and the actions they take afterwards than anything else. Believe it or not there is such a thing as a positive relapse as opposed to a negative one.

POSITIVE RELAPSE

If they exhibit most of the attitudes and demonstrate some of the actions listed below, then your loved one’s relapse could pave the way for stronger long-term sobriety.

• Appears truly remorseful.
• Calls the original treatment center for suggestions
• Realizes they do not have the control they once thought.
• Demonstrates an understanding of the magnitude of the relapse.
• Has a good awareness of how the relapse affected loved ones.
• Sincerely desires to figure out why they relapsed.
• Increased willingness to apply recovery principles in life.
• Interested in taking measures to prevent a repeat of relapse.
• Open or receptive to suggestions.
• Talks to a counselor or a sponsor.
• Gets into a support group, increases AA meetings, etc.
• Willingness to increase treatment, including therapy, outpatient or even back to inpatient.

HOW TO HANDLE A POSITIVE RELAPSE

If you feel that your loved one primarily fits into the majority of the criteria listed in the above section then they may potentially be in a position to grow and improve in recovery. They should not necessarily be treated very harshly. Continue to support them emotionally and if they need help getting to a support system or in getting some further treatment, by all means do. However, if they need help paying the bills because their recent relapse has left them broke, do not offer assistance. Allow them to feel the negative consequences of their decision, but continue to be emotionally supportive. Look for actions and not words. Any addict can speak of the regrets of a relapse but without taking the proper actions to prevent it, it will only lead to another relapse.

Continue to be loving, but be very cautious and wary.

HANDLING A RELAPSE

NEGATIVE RELAPSE

If your loved one is not remorseful, or they demonstrate some of the following attitudes/ actions, this is considered a negative relapse. In a negative relapse, situations must be dealt with differently than in a positive relapse.

• Does not seem to care or lashes out at you.
• Only remorseful “that they got caught.”
• Says, “It’s only alcohol and not [my drug of choice].”
• Thinks that they have it under control.
• Has no understanding of the magnitude of the relapse or how it affects you.
• Demonstrates no desire for further treatment or support groups.
• Just sits around the house with an apathetic approach instead of proactively seeking solutions.
• Has no clear-cut plan to prevent future relapse.
• Does not call anyone positive for help.
• Hangs out with old friends as a support group.
• Lies to cover up the relapse or continued drug or alcohol use.

HOW TO HANDLE A NEGATIVE RELAPSE

If it appears that your loved one demonstrates a lot of the attitudes and actions on the negative relapse list, then you must take a different approach than if it was a positive relapse. If their actions, or inactions, demonstrate a lack of willingness to maintain sobriety, then you must assume that your loved one has made a choice to continue to use drugs or alcohol. At this point, all enabling must end and it is suggested that you go to full bottom line or tough love mode in order to prevent things from going back to where they were. We often suggest to families that they keep the bottom- line letter or the tough-love boundaries they wrote during the intervention just in case.

A danger for family members is to fall back on the old behaviors by bailing someone out of a relapse without allowing them to feel the consequences of it. The justification is that “it’s only their first mistake.” Be wary of this way of thinking. For it was this exact mindset that set you down this path during the beginning of their drug or alcohol use. If your loved one does not feel the consequences of the relapse, then they will never change. This trying period can be a test for you that, should you remain firm, could be the springboard into eventual long-term recovery. When in doubt, always run things by all the other members of the intervention team that you formed in the beginning.

Sometimes family members feel that because the intervention is over, there is no need to bother us with questions. We do not believe that there is such a thing when it comes to saving a loved one and their family from the darkness of addiction.

As mentioned in the beginning of this handbook, we do not feel that the intervention process is truly over until your loved one attains at least one year of continuous sobriety. Our staff is always available for questions, comments, or help.

UNLIMITED SUPPORT

After retaining our services, we are on-hand at any time to help you during the intervention as well as for any post-intervention consultation. This includes further treatment, recovery solutions, handling bottom line phases, and even in the event of a relapse months or years after the intervention itself. As long as a family is willing to listen and heed our suggestions, our services are meant to be given.

 However, we do not intend to continually enable the enabler. Everyone makes mistakes and we fault no one, but if a family time-and- again refuses to apply the principles that we have laid down for them, then there is little we can do. For example, if the wife of an addict continually calls us every week after repeatedly refusing to set a boundary with her husband and is solely looking for sympathy instead of a solution, then we may use discretion and limit our phone consultations.

 We can give all the suggestions in the world, but it is up to you to take the advice. We are here to help you to take that advice as best we can. Sometimes families just need a reassuring voice on the darkest nights to light the way home.