Why did I turn my attention to friends and families of drug users after so many years of focusing just on the users—and on helping them navigate their relationships with people who were often not supportive? I realized that I was getting a lot of calls from concerned friends and family members who had tried Al Anon and other self-help groups and needed something more and/or different. They wanted to be supportive and helpful, but were confused about the best ways to do that. They were also suffering emotionally from years of anxiety, fear, anger, and general bewilderment about why their loved one couldn’t quit using. They didn’t just need tools and strategies, they needed the attention of a person who could help them manage their feelings and the hair-raising situations that they were dealing with. They, too, needed a harm reduction approach.

Ten years ago, I decided to start a support group for family and friends of people who were having trouble with drugs. Anyone could join. This first group ran for 5 years. I learned a lot from them and decided that it was important to reach more people. I have since offered dozens of family consultations and written several articles about the dilemmas facing people who love people who love drugs.

HRTC News Fall 2015

There are two broad categories of people who call us for help. In one group are those who just found out about a loved ones’ problems with alcohol or drugs. They tend to be frightened, angry or anxious. They want information and options now. Another group are those who have been dealing with a drug-using loved one for a long time. Nothing seems to have helped. They are beyond stressed, full of despair, and all but ready to give up. They are also suffering their own traumatic reactions to repeated crises and losses such that, even if their loved one is doing well, they continue to react as if a crisis were brewing, looking for clues, not sleeping, and waiting for disaster to strike. These are people whose loved one may have had many failed attempts at treatment— detoxes, 28-day rehabs, or 12 Step programs. Or their loved one may have been refusing treatment for years. They have watched as disasters and near-misses have taken their toll, and they have tried many strategies to contain the chaos.

It’s not like they haven’t reached out before. They have been counseled about what to believe, what to do, and what not to do by self-help books and groups, therapists, intervention specialists, and residential treatment programs. The “rules” go something like this:

  • Don’t enable them
  • Don’t protect them
  • Don’t trust them

If you do, you are codependent. Codependency is often spoken about as a parallel disease to the disease of addiction. So now everyone has a label! Families and friends have been told that their loved one’s got to go to rehab, that 12 Step programs are necessary, and that they must demand and enforce abstinence. If that fails, then the only recourse is to do an Intervention and force them into a residential program. Tough love is the only way.

But These Things Just Don’t Work. Words like addiction, alcoholic, and addict lack useful meaning. They lump all people who use drugs together. They are words of prejudice and stigma that don’t describe the nuances and complexities of their loved ones. Interventions and other forms of coercion don’t generally work—they are inimical to the growth of motivation, they usually cause intense trauma to the individual, and they often rupture relationships with friends and families.

Rehab (or what I like to call The “miracle of 28 days”) is not realistic. We know that rehab programs are a revolving door – and they are very expensive. Most people relapse within 3 months after completing treatment. And then you’re told that they need to come back for another round of the same treatment because you didn’t “get it” the first time.

While 12 step programs are free, easy to find, and welcoming, there are serious shortcomings. They tell families that if only their loved one will attend meetings and work the steps they will recover. But, only 20% of people with alcohol and drug problems go to meetings in any given year, most don’t stay, and most who do stay don’t remain abstinent after a year. Repeated analyses of data from AA show that about 5% of people with drug problems in the U.S. “recover” through 12-step groups.

Why Traditional Treatment and 12 Step Doesn’t Work for Most People: These one-size fits all models only work for people who buy into them. The rest won’t or can’t – they resist – which is their way of saying “this doesn’t work for me. I have ideas of what’s wrong but I need to explore what to do in my own way.”

An Annual National Survey found that almost half of people with drug problems don’t seek treatment because they aren’t ready to quit- but they DO recognize that they have a problem. Many researchers have found that a lot of people get better without treatment, on their own- but not necessarily by themselves. They get better with the help of books and the support of loved ones.

Bring in Harm Reduction

Harm reduction is any strategy that reduces drug-related harm to the individual, their family, or the community.

Harm reduction was developed as an alternative to one-size-fits-all treatment. Harm reduction uses motivational strategies, not coercion. It is flexible enough to accommodate a wide variety of individuals and goals. It recognizes that the idea of powerlessness doesn’t appeal to most people; rather, feeling powerful is essential to lasting change.

Harm Reduction Tips for Family and Friends:

Tough love is neither- and it feels awful to everyone involved.

Hitting Bottom is not Motivating- it’s dangerous and demoralizing.

Promises Only Cause Problems- the cycle of hope and despair is caused by demanding promises for change that are repeatedly not met.

There are no rules except the ones you make- You get to decide how to love. If paying a person’s rent to prevent them being homeless and drug dependent helps you sleep at night, do it!

You cannot enable drug use- (unless you are supplying them…) You can only enable love, support, and survival.

Base your actions on your values– Loyalty, understanding, compassion, generosity, and humility (there but for the grace of god go I) are the values of altruism and heroism. When it comes to drug users, however, these values are mistaken for codependency!

Base your actions on what you can tolerate– Small changes in yourself can lead to larger steps.

You have triggers too- You’ve been traumatized and will overreact at times

Any limits you set are about you– Set limits based on what you need, not what you think will make them change!

You and your loved one may have very different goals– They just might not be able to tell you for fear of judgment or punishment

Patt Denning, PhD