jueves, 22 de diciembre de 2016

What to Do If Your Adult Friend or Loved One Has a Problem with Drugs | National Institute on Drug Abuse (NIDA)

What to Do If Your Adult Friend or Loved One Has a Problem with Drugs | National Institute on Drug Abuse (NIDA)

12/20/2016 03:56 PM EST

Source: National Institute on Drug Abuse
Related MedlinePlus Page: Drug Abuse
SAMHSA Treatment Locator

How do I know if my adult friend or loved one has a substance abuse problem?

This page is filled with resources and information to help someone you care about who might have a drug* abuse problem. First, try to answer the questions below as honestly as possible. If the person is willing, you can include him or her in the discussion. (*"Drugs" is used here to refer to illicit drugs, prescription drugs, or alcohol.)
  1. Does the person take the drug in larger amounts or for longer than intended?
  2. Do they want to cut down or stop using the drug but can’t?
  3. Do they spend a lot of time getting, using, or recovering from  the drug?
  4. Do they have cravings and urges to use the drug?
  5. Are they unable to manage responsibilities at  work, home, or school because of drug use?
  6. Do they continue to use a drug, even when it causes problems in relationships?
  7. Do they give up important social, recreational, or work-related activities because of drug use?
  8. Do they use drugs again and again, even when it puts them in danger?
  9. Do they continue to use, even while knowing that a physical or mental problem could have been caused or made worse by the drug?
  10. Do they take more of the drug to get the wanted effect?
  11. Have they developed withdrawal symptoms, which can be relieved by taking more of the drug? (Some withdrawal symptoms can be obvious, but others can be more subtle—like irritability or nervousness.)
If the answer to some or all of these questions is yes, your friend or loved one might have a substance abuse problem. In the most severe cases, it is called an addiction. It can happen to people from all backgrounds, rich or poor, and it can happen at any age. See NIDA's video,  below.

Anyone Can Become Addicted to Drugs

Through scientific research, we now know more than ever about how drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.
If you think your adult friend or loved might be addicted, you cannot fix the problem by yourself, but there are some steps you can take. If the person is willing to explore the issue, refer him or her to this page: What to Do If You Have a Problem with Drugs: For Adults. Offer to walk the person through the information and to help access the resources.
If the person is initially not willing to be helped, you can read the information below to learn more about drug addiction and to see if there are resources or information that might convince him or her to seek help.

Why can't addicts stop using drugs on their own?

Repeated drug use changes the brain, including parts of the brain that give a person self-control. These and other changes can be seen clearly in brain imaging studies of people with a drug addiction. These brain changes explain why quitting is so difficult, even when an addicted person feels ready. NIDA has an excellent video, "Why Are Drugs So Hard to Quit?" (below)

Why Are Drugs So Hard to Quit?

If my friend or loved one asks for my help, where do I start?

If someone you care about has asked for help, he or she has taken an important first step. If that person is resistant to help, see if you can at least convince him or her to get an evaluation from a doctor.  
You can always take steps to locate an appropriate physician or health professional, and leave the information with your friend. You can call health professionals in advance to see if they are comfortable speaking with their patients about addiction. If not, ask for a referral to another doctor with more expertise in the area of addiction. There are 3,500 board-certified physicians who specialize in addiction in the United States.  The American Society of Addiction Medicine website has a Find a Physician feature on its home page. The American Academy of Addiction Psychiatry also has a Patient Referral Program.
Emphasize to your friend or loved one that it takes a lot of courage to seek help for a drug problem because there is a lot of hard work ahead. There is a great deal of scientific evidence that treatment works, and people recover every day. Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract the powerfully disruptive effects of drugs on the brain and behavior and to regain control of their lives. Like many diseases, it can take several attempts at treatment to find the right approach. But assure your friend or loved one that you will be supportive in his or her courageous effort.

My friend has considered treatment but is afraid of what others will think. What can I tell my friend?

Many employers, friends, and family members will be compassionate if they see a person is making a sincere effort to recover from a substance abuse problem. But you can also reassure your friend that laws protect the privacy of a person seeking drug treatment—or in fact, any medical treatment. Health care providers may not share information with anyone else without a patient’s permission. Some jobs may require a doctor's note saying an employee is being treated for a medical condition, but the nature of the condition need not be specified. For more information on how private medical information is protected by law, read the HHS information on Health Information Privacy (HIPAA).

If my friend or loved one refuses to cooperate, should we conduct an intervention?

Many people are compelled to enter treatment by the pressure of their family, friends, or a court system. However, there is no evidence that confrontational "interventions" like those familiar from TV programs are effective at convincing people they have a problem or motivating them to change. It is even possible for such confrontational encounters to escalate into violence or backfire in other ways. Instead, you should focus on creating incentives to at least get the person to a doctor. Often people will listen to professionals rather than have conversations with friends and family members, as the latter encounters can sometimes be driven by fear, accusations, and emotions.

Can I explore treatment centers even if my friend is not willing to go into treatment?

Yes. If you find centers that might appeal to your friend, either by their location or medical approach, it might encourage him or her to enter treatment.  
You can call this helpline and get some advice on how to proceed: 1-800-662-HELP (4357) (This service is supported by the U.S. Department of Health and Human Services.) You can also look for a treatment center online, which will allow you to search for a treatment center in your area and also give you information about the kind of addiction or patients it treats.

What should I look for in a treatment center?

Treatment approaches must be tailored to address each patient's drug abuse patterns and also other medical, psychiatric, and social problems. Some treatment centers offer outpatient treatment programs, which allow patients to continue to perform some daily responsibilities. However, many people do better in inpatient (residential) treatment. An addiction specialist can advise your friend or loved one about the most promising options.  
NIDA's Principles of Drug Addiction Treatment compiles 30 years of research into a set of general principles and frequently asked questions about effective treatment. Using these principles, NIDA has developed a booklet that outlines 5 questions you can ask when looking for a quality treatment program. You might want to have these materials on hand when you talk to treatment centers to help you ask the right questions.

My friend or loved one is afraid of being forced to stop using drugs and what will happen. Do treatment centers force people to stop taking drugs immediately?

People of all ages with substance use disorders live in fear of what will happen if their drugs are taken away. You can ensure the person you care about that professional treatment centers will keep him or her safe and as comfortable as possible if a detoxification process is needed.
Treatment is always individualized based on the person’s needs. However, if someone is using a drug upon admission to a treatment program, one of the first things needed is to help safely remove the drugs from his or her system (often referred to as "detox"). This is important, because drugs impair the mental abilities needed to engage with and stay in treatment.
When patients first stop using drugs, they can experience a variety of physical and emotional withdrawal symptoms, including depression, anxiety, and other mood disorders; restlessness, and sleeplessness. Remind your loved one that treatment centers are very experienced in helping patients get through this process and keeping them safe during it. Depending on your loved one's situation, there may also be medications to reduce these symptoms, which make it easier to stop using.

Who will be providing treatment?

There are different kinds of specialists who are involved in addiction care, including doctors, nurses, therapists, social workers, and others. In some treatment programs, different specialists work as a team to help patients recover from addiction.

What is treatment like?

Everyone entering treatment for a substance use disorder is unique. That is why the patient and the treatment staff work together to develop an individualized treatment plan. It may include some type of behavioral treatment ("talk therapy") designed to engage the patient in the treatment process, alter destructive attitudes and behaviors related to drug use, and increase healthy life skills. Behavioral treatment can also enhance the effectiveness of medications that might be available and help patients stay in treatment longer.
Treatment for substance use disorders can be delivered in many different settings using a variety of different approaches. You can read more about the different kinds of behavioral treatment options.

Do most treatment centers offer medication?

Some do, and that is a good question to ask them. Medications are currently available to treat addictions to alcohol, nicotine, and opioids (heroin and prescription pain relievers), and your loved one’s treatment team may recommend one of those medications. There are also medicines to treat mental health conditions (such as depression) that might be contributing to the addiction. In addition, medication is sometimes prescribed to help with the symptoms associated with drug withdrawal.
When medication is available, it can be combined with behavioral therapy to ensure success for most patients. Some treatment centers follow the philosophy that they should not treat a drug addiction with other drugs, but research shows that medication can help in many cases.

My friend was in rehab before but relapsed afterward. How do we know treatment will work this time?

This means your friend has already learned many of the skills needed to recover from addiction and should try it again.  The fear of relapse should not get in the way of trying treatment again. People being treated or recovering from addiction relapse about as often as do people with other chronic diseases, such as hypertension, diabetes, and asthma. Treatment of any chronic disease involves changing deeply imbedded behaviors, and relapse sometimes goes with the territory—it doesn’t mean treatment failed. A return to drug abuse indicates that treatment needs to be started again or adjusted, and your friend might benefit from a different treatment approach.

How can people find a treatment center they can afford?

If they have health insurance, it may cover substance abuse treatment services. Many insurance plans cover inpatient stays.  When setting up appointments with treatment centers, you can ask about payment options and what insurance plans they take. They can also advise you on potential low-cost options.
To find treatment—and to learn about payment options—try the Behavioral Health Treatment Services Locator provided by the Substance Abuse and Mental Health Services Administration. This free tool offers payment information for each of the treatment services listed, including information on sliding fee scales and payment assistance. Its "Frequently Asked Questions" section addresses cost of treatment.
You can also call the treatment helpline at 1-800-662-HELP (1-800-662-4357) or 1-800-487-4889 (TTY) to ask about treatment centers that offer low- or no-cost treatment.  You can also contact your state substance abuse agency—many states will help pay for substance abuse treatment.
Note that the new Mental Health Parity and Addiction Equity Act ensures that co-pays, deductibles, and visit limits are generally not more restrictive for mental health and substance abuse disorder benefits than they are for medical and surgical benefits. The Affordable Care Act builds on this law and requires coverage of mental health and substance use disorder services as one of ten essential health benefits categories.  Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations.  For more information on the Affordable Care Act you can call 1-800-318-2596 or go to https://www.healthcare.gov/ .
When you research payment options, be sure you are speaking to people familiar with the new rules (old websites and pamphlets will not necessarily be accurate).

I think my loved one takes drugs because he feels depressed—but he's depressed because drugs are overtaking his life. How do we know which problem came first?

It is very possible your loved one needs to find treatment for both depression and addiction. This is very common—it's called "comorbidity," "co-occurrence," or "dual diagnosis" when you have more than one health problem at the same time.  Encourage your loved one to discuss all symptoms and behaviors with the doctor.  There are many nonaddictive drugs that can help with depression or other mental health issues. Sometimes health care providers do not communicate with each other as well as they should, so you can be your loved one's advocate (with his permission) and make sure all of his health care providers know about all of the health issues that concern you. People who have co-occuring issues should be treated for all of them at the same time. For more information see our DrugFacts on comorbidity.
Note: if you know someone who is so depressed that he or she will do self-harm, there is a hotline that can help: The National Suicide Prevention Lifeline at  1-800-273-TALK (8255).  You are also welcome to call to discuss your friend’s symptoms and get advice on how to best handle the situation.

I am worried that my loved one is driving while using drugs.  What do I do?

If you share a vehicle, you should demand that your loved one see a physician before using the car again. This can be very inconvenient for both of you, but it is imperative that drug users not drive. Your loved one's life, yours, and others' could be at risk.
In many cases, you may not be able to control your loved one's ability to drive. You must tell him or her that the single most responsible thing to do is not drive while using drugs (including abusing prescription medications). All drugs can impair skills necessary for the safe operation of a vehicle, including motor skills, balance and coordination, perception, attention, reaction time, and judgment. Even small amounts of some drugs can have a measurable effect on driving ability.
Drugs also affect people's ability to tell if they are impaired—so you might have to make some difficult choices. If you believe your loved one is driving and impaired, you should consider calling law enforcement. This can be a difficult decision, but sometimes court intervention can actually help force a loved one to seek help.  For more see our DrugFacts on drugged driving.
If you are an employer and suspect an employee is using drugs, you should immediately suspend any driving privileges while you get it sorted out. You can contact this government helpline to find out more about workplace drug testing:
Drug-Free Workplace Helpline: 800-967-5752 (800-WORKPLACE) or HELPLINE@SAMHSA.HHS.GOV

How can my friend talk to others with similar problems?

Although they are not a substitute for treatment, self-help groups like 12-step programs can be a great source of support and encouragement while a person is engaged in treatment, and after. The most well-known self-help groups are those affiliated with Alcoholics Anonymous (AA)Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model.
Most drug addiction treatment programs encourage patients to participate in a self-help group during and after formal treatment. These groups can be particularly helpful during recovery, as they are a source of ongoing communal support and encouragement to stay drug free. Information on local meetings can be found on their websites. Support groups for family members of people with addictions, like Al-anon and Alateen, can also be helpful.
There are other groups in the private sector that can provide a lot of support. To find meetings in your area, contact local hospitals, treatment centers, or faith-based organizations. These organizations often coordinate support groups for substance abuse.

I am not sure what drugs my loved one is taking. Where can I find information on specific drugs and their health effects?

It is important to remember that people who struggle with addiction can have a lot of shame, fear, and anger, and do not always tell the truth about their drug use. You can focus instead on encouraging your loved one to see a doctor as a first step.
NIDA also has an Easy-to-Read website with information about many drugs.

If my friend does go into treatment, how can I offer support?

This is a great conversation to have with your friend's treatment provider. Different patients need different levels of support. If there are difficult dynamics in a family group or set of friends, the counselor may recommend little contact for a while. It is important to tell friends struggling with addiction that you admire their courage for tackling this medical problem directly through treatment and that as long as they stick with the treatment plan, you will offer encouragement and support. When residential treatment is over, your friend will have to re-enter the community and it will be a difficult time. There will be triggers everywhere that could promote a relapse—such as driving by places where the person once took drugs, or seeing friends who provided those drugs. You can encourage your friend to avoid these triggers, and you can make an effort to ask him or her what those triggers are. However, people addicted to drugs have to fight much of this struggle on their own, without the help and advice of friends, using the knowledge and skills learned in treatment. Offer as much love and support you can as long as your friend continues to follow the treatment plan.  If your he or she relapses, you should encourage additional treatment.

What if my friend wants to participate in research studies?

To read some general information about being a part of NIH research studies, see NIH Clinical Trials and You.
To search for a clinical trial that might be right for your friend or loved one, check out http://clinicaltrials.gov/.

Where can I find more information on treatment and recovery?

More information on what to expect in treatment and recovery is in our publication on the science behind addiction, called Drugs, Brains, and Behavior: The Science of Addiction, written by NIDA scientists based on many years of research.
You can also learn more at other NIH Institutes:

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