UNDERSTANDING A LOVED ONE'S SUBSTANCE USE - A GUIDE FOR FAMILY AND FRIENDS OF PEOPLE STRUGGLING WITH ADDICTION

It can be extremely distressing to witness someone you care about deal with a substance use disorder. Inevitably, this leads to increased stress about your loved one but can also take a heavy toll on your own mental and emotional well-being. While your loved one may not be using every day, the adverse impact their drug abuse has on their life is the real indicator of whether there is a problem. If someone you know has a substance use disorder, understanding addiction and ways to support those suffering is an important step towards improving your relationships with your loved ones.

Addiction and drug misuse affect millions of people. Initially, people start using drugs for a variety of reasons. Some use drugs for their own pleasure, to change how they feel, to fit in, or alleviate feelings of boredom or dissatisfaction with their lives. Drugs activate and interact with the brain's reward system, causing people to feel good when they use them. With repeated use, the brain and body end up associating these positive feelings with the substance, leading to increased cravings and, oftentimes, physical dependence and addiction.

Many rely on substances to help relieve symptoms of mental disorders such as depression, anxiety, or post-traumatic stress disorder. These can be illicit drugs, legal substances, or indeed drugs that are prescribed by medical professionals, with specific instructions for use, used to treat particular concerns related to the disorder. This is also common for treating physical conditions such as pain and symptoms related to other illnesses.

Tolerance, dependence, addiction...

In terms of substance abuse, there are important distinctions to be made between the terms "tolerance", "dependence" and "addiction". Understanding these terms can help individuals provide the proper treatment to those struggling with substance use disorders.

Tolerance

Tolerance is the body's natural response to repeated drug use. When someone uses a substance over a long period, their body becomes used to it, and their brain becomes less reactive to the rewarding chemicals, bearing a smaller effect on the user. As such, individuals begin taking higher doses of the substance to get the same effect as they did before. Often, tolerance builds to a level that people need the substance just to get through the day.

Dependence

Drug dependence refers to feeling unable to function without the use of the substance. Dependence can be either physical or psychological and impacts many areas of someone's life. An individual might furthermore experience withdrawal symptoms when cutting back or stopping the drug.

Addiction

Addiction refers to the inability to control the use of drugs or alcohol. Those struggling with addiction may try to stop using the substance but will feel like they cannot stop despite experiencing negative consequences such as financial or interpersonal problems. Addicted individuals are often overcome with an intense desire to use and may go as far as engaging in risky behaviours to obtain the drug.

Addiction is not a lack of willpower

Drugs activate the brain's reward circuit by directly increasing the levels of dopamine, the 'feel good' hormone. Dopamine release influences memory and executive functioning, which encourages the person to repeat the experience that led to the positive feeling. With every use, this circuit becomes stronger, and the substance becomes more tempting, creating an addiction.

Brain imaging shows that in addicted individuals, areas of the brain related to judgement, decision-making, learning, memory, and behaviour undergo changes. A person who is addicted to a substance experiences cravings, causing their brain's executive centres to feel compelled to take any action necessary to get the drug to recreate the positive feelings that come with it. Individuals may, for example, interrupt parts of their day to buy or consume more of a drug, spend excessive amounts of money to obtain a drug or, as a result of its consumption, even steal from others or engage in other risky behaviours.

Why is addiction often considered a brain disease?

Prolonged substance use affects the brain and nervous system. One of the many processes involved in the transition from voluntary use to addiction includes changes in brain structure and brain function.

Individuals with addiction experience cravings for particular substances and feel the compulsion to use them despite harmful consequences. Compulsive behaviour is an urge to do something or behave a certain way against one's conscious wishes. The consumption of the drug becomes automatic as a response to the brain's desire to re-attain a positive feeling.

Some may say that addiction is a choice. No one chooses or wishes to become addicted. It happens to the body as a result of certain choices. While the initial exposure(s) to a substance may be a choice, the person loses control of their behaviour once the brain has undergone any changes.

Changes to the brain

An addicted person's inability to stop using drugs or alcohol is linked to deficits in brain functioning. Areas that are most affected are all involved with the brain's reward circuitry. Specific areas that are affected include:

• The basal ganglia play a role in the reward circuit of the brain and are responsible for the formation of habits (i.e., substance intake). As a substance over-stimulates the reward circuit, it adapts to the presence of the substance and decreases its sensitivity, making it difficult for the individual to feel pleasure from anything besides the substance.
• The amygdala is involved with feelings of stress and anxiety that are characteristic of substance withdrawal. With increased substance use, the reward circuit becomes increasingly sensitive to discomfort, leading the individual to consume in order to get temporary relief from the uncomfortable feeling.
• The prefrontal cortex plays a vital role in executive functioning. This comprises the ability to organise thoughts and activities, prioritise tasks, manage time, and make wise decisions. Disruptions to this circuitry reduce a person's impulse control, making it more difficult for them to avoid temptation.

Recognising the drug use of a loved one has crossed the line

It can be difficult to know when someone is using a drug. Users can be very good at concealing any signs of substance misuse. Unhealthy behaviours are often overlooked and attributed to stress if there is no other indication of drug abuse. Individuals living with someone who is using may be more likely to notice changes in their eating habits, routine, or personal hygiene and might even find drugs or drug paraphernalia in the house. Individuals not living together may be less aware of these changes and might fail to recognise certain signs. Possible indications of substance use disorders include:

• Physical health issues — Weight loss or gain, lack of energy and motivation.
• Neglected appearance — Lack of interest or effort in grooming.
• Changes in behaviour — Increased secrecy, changes in relationships with family and friends.
• Problems at school or work — Frequently missing school or work, disinterest in school or work, drop in performance.
• Financial problems — Inability to properly manage money, requests for money without reasonable explanation, stealing money or items from the home.

Family impact

Families can be greatly affected by a loved one's substance use disorder. Seeing relatives lose or gain weight, experience behavioural changes, and slowly become unrecognisable can be highly distressing. Addiction impacts families in many ways. Often families do not feel comfortable to speak about the issue. Family and close friends often also feel obliged to deal with the consequences of their loved one's actions while the addicted individual remains numb to their feelings and behaviours and their associated repercussions. This creates added stress in the household, which can lead to increased conflict between family members. What families often find hardest is watching someone they love turn into someone they don't know, and sometimes also someone they might fear.

Living with someone with a substance use disorder can be very challenging for the family. When one family member is addicted, the family as a whole can be impacted by financial hardships and strained relationships. Addicted individuals may lie to their family about their expenses or whereabouts and may steal or borrow money, without being able to reimburse their debt, from their family to support their addiction.

How to talk to someone about their drug abuse

Addiction can arise from a plethora of reasons. While some begin using to self-treat psychological issues like depression and anxiety, others turn to substance use to cope with stress. Finding the right way to approach an individual with a substance use disorder is important. Heavy confrontation can backfire, not only pushing them away but also encouraging them to continue using more covertly.

It is normal to feel a combination of emotions - angry, fearful, deceived, concerned – in light of discovering a loved one’s substance use disorder. It is important, however, to approach the situation with an organised and structured approach to promote the best outcome. Prepare yourself for reactions ranging from anger to denial, but don’t use their reaction as a reason to avoid the discussion. It’s important to stick to your initial point and not let them convince you that they don’t have a problem. Ultimately, this comes from a place of love and concern for them, and eventually, they will be able to see that.

Guidelines to help you have a discussion

When talking with a loved one about your concerns, it is important to choose the right time and space and communicate in a way that allows them to understand you. In order to start a discussion with your loved one, consider the following:

Be clear and upfront

Addiction can be a tricky topic for people to navigate. Be clear and straightforward with what you want to communicate. Don't hesitate to talk about your own feelings regarding the situation. You can tell them how much it hurts you to see them use substances and express your concerns for their safety and well-being. When speaking to them, use real examples of how their substance use disorder is impacting them and you. While this might upset them, it will be hard for them to disagree with your personal feelings and facts based on real instances where their behaviour has been problematic.

Be kind

While your goal is to bring attention to a problem, it is important to remember that addiction is a mental illness. Individuals don't choose to be addicted but are as a result of a variety of reasons. Don't scrutinise your loved one for their substance use disorder. Addiction is highly stigmatised, resulting in individuals worrying about receiving criticism, insults, or rejection. By accepting the person, even if you don't accept the behaviour, you are indicating to them that you are a safe and reliable person whom they can trust and go to for help. While you may not be equipped to help them deal with their substance use disorder, their trust is everything in allowing you to help them seek treatment and get the help they need.

Set healthy boundaries

As a friend or family member, it is important to provide support without enabling the behaviour. Oftentimes, families make excuses for a loved one that is suffering, concealing the addiction or providing financial support without truly addressing the problem. While you may think this is helping them, what this really does is enable the behaviour rather than help put an end to it.

Take action alongside them

By taking action with your loved one, you are showing solidarity and setting a good example for them. Individuals with addiction disorders can be scared to reach out for help or may lack the discipline to commit to attending meetings or therapy sessions. Action can involve attending support groups with them, starting individual and/or family therapy, or researching addiction to become a better advocate for your loved one.

Help them find support

Do some research on health care providers, treatment programmes and mental health services suited to your loved one's needs? While they may not be ready to commit to change, it doesn't mean you can't do preliminary preparations. Avoid discussing it too soon or pressuring them to enter formal treatment. They may feel ambushed, and you can lose their trust. Consider different treatment programnes suited to their needs. Some may benefit from residential treatment, while different forms of treatment may be more fitting for others.

Consult a substance use disorder professional

Consulting with an addiction specialist can assist with the preparation of the intervention for your problem. An addiction specialist takes into consideration their particular situation and suggests a suitable approach. An addiction professional can help families better understand what their loved one is experiencing, learn ways that they can support them, and can also help families prepare for an intervention. Sometimes interventions are carried out without intervention professionals, although expert assistance may be helpful.

Knowing when to intervene

In some cases, individuals will deny having a substance use problem, and a more formal discussion needs to be had. In this case, an intervention may be appropriate. An intervention is an organised meeting by family and friends and can involve a medical professional, alcohol and drug counsellor, interventionist, and other people important to the individual receiving the intervention. The intervention serves to illuminate to the individual the true consequences and fallout of their addiction and ask them to accept help and support. During the intervention, individuals:

1. Provide specific examples of destructive behaviours and their impact on the individual's life and their family and friends.
2. Presents a prearranged treatment plan with clear goals and treatment options.
3. Makes clear what each person will do if the individual refuses to accept treatment (i.e., stop supporting them financially).

Executing an intervention is no easy feat. With a long preparation process and commitment to support throughout treatment and recovery, individuals organising an intervention must be serious about their involvement.

Interventions usually follow a similar sequence of preparation, execution, and follow-up. The steps include:

• Planning. Preparing for an intervention can include anything from researching addiction, gathering information about your loved one's use and behaviours, and the formation of an intervention team. One of the most important parts of planning an intervention is to have everyone who is part of the intervention on the same page before actually intervening. As such, it is important to carefully create the intervention team. This usually includes four to six people who the individual loves, respects, or depends on. It is important not to include anyone who:

1. Has their own unmanaged mental disorders or substance use disorder
2. The individual dislikes
3. Might not be able to follow the agreed-upon plan and/or might sabotage the intervention.

• Individuals in the intervention team must work together to establish their goals for the intervention and discuss how each of them will play a role in getting their loved one to accept support. Often, individuals decide on specific boundaries that they will put in place if the individual does not wish to accept treatment options. The focus is really on expressing concern, love and a desire to support the person. It is not about blaming or shaming. Lots of preparation work takes place to help the intervention stay on track. Often interventions are very emotional for all participants.
• Hold the intervention. In some cases, it can be important to have a professional attend the intervention to help stay on track or if you believe your loved one might have a negative reaction.
• Follow up. An important part of any mental health treatment is follow-up. Once the individual has accepted and begun treatment, family members and close friends should stay engaged with the process and continue to show support for their recovery. This can be by attending self-help meetings with them or making changes in everyday living to help make it easier to avoid destructive behaviour. For example, if your loved one is struggling with alcohol addiction, consider eliminating all alcohol from the house to help lessen their temptation.
• Prepare for relapse. Relapse can be frustrating. However, it does not mean that recovery is impossible. Know that relapse is common for individuals recovering from substance use disorders. Educate yourself on what to do if relapse occurs in order to best help your loved one.

Supporting a loved one's addiction recovery

Addiction affects people in different ways. Understanding addiction as a mental illness is an important part of supporting a family member or close friend. While it is important for them to take responsibility for their actions, understanding why someone has turned to substance use can help you provide support. Trauma and other pre-existing mental health issues such as depression, anxiety, or stress can also play a role in a substance abuse disorder.

There is no single right method to overcome substance addiction. But research shows that those with a good support network of family and friends are more likely to have a successful recovery.

When one family member is struggling with addiction, the whole family can be affected. Alongside your loved one's treatment programme, you and your family could also consider partaking in family therapy sessions. A family counsellor can help facilitate conversations between family members and help create a safe environment for individuals to talk about family issues.

The benefits of taking action early

Intervening when a close friend or relative is abusing substances but not yet addicted can be crucial in preventing potentially life-threatening outcomes. By intervening early on, you can prevent the development of substance dependency and all the psychological and emotional problems associated with addiction. Early intervention can also help protect physical health by reducing the risk of developing critical conditions such as liver or heart disease.

Addiction moreover can interfere with every aspect of daily life. Health quality is merely one affected domain. The behavioural changes that people with addiction undergo also lead to interferences with relationships, school and work attendance and performance, as well as overall self-esteem. Early intervention can help prevent these disruptions to your loved one's life.

What does addiction treatment look like?

Addiction treatment typically begins with a medically managed detoxification to safely eliminate the abused substance from the body. While individuals likely experience uncomfortable withdrawal symptoms during this period, a team of medical professionals is there to support the individual throughout the process. For some addictions, such as opioid or alcohol addiction, medication-assisted treatment can be beneficial to help reduce the severity of the withdrawal from the substance.

Cognitive behavioural therapy (CBT) can help individuals recognise and avoid situations in which they are most likely to consume substances while also addressing problems, such as underlying depression, that contribute to their substance abuse.

Playing an active role in the recovery

Individuals in recovery can also work on themselves as part of their journey. While medical and psychotherapeutic treatment is essential in treating addiction, individuals can work to address different aspects of their lives that may be facilitating the addiction.

As loneliness and boredom can be triggers for relapse, working to develop a support system of friends and family can be of great benefit. Individuals can also join support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) to expand their sober support network.

The development of coping skills and stress management techniques with the help of a psychotherapist can also be a great tool for individuals in recovery. Substance abuse often serves as a coping mechanism for unpleasant emotions. Identifying healthier ways to cope, such as journaling, mindfulness, or physical exercise, is an essential part of the recovery process and relapse prevention.

Addiction thrives in the dark

Addiction is not a topic to shy away from. While we may feel that we are protecting our loved ones by concealing their addiction and its associated behaviours, we need to consider that in doing so, maybe the ones we're really protecting are ourselves. Addiction is a disease that requires professional treatment and aftercare with support from family members and friends for a successful recovery.

How do we treat addictions at The Kusnacht Practice?

At The Kusnacht Practice, we have developed our programme for the treatment of addictive disorders based on effective evidence-based interventions, alongside our experience and expertise in working with clients who have an addiction. We believe in having a person-centred approach to our work. We understand that the relationship with the client can help form the foundation for recovery. We work with the client in establishing goals, treatment plans and boundaries each step of the way.

The first steps of the programme will be with our dedicated Medical and Psychiatric Teams, who will work to ensure that all current and potential medical issues and any existing mental health issues are diagnosed and addressed. They will plan an appropriate detox regime and setting - ensuring the safety of the client and managing the withdrawal process. This important phase of cocaine use disorder treatment creates a safe platform for the other teams - psychiatry, psychotherapy and BIO-R® nutrition and lifestyle - to engage with and support the client.

It is important for families and loved ones to know that there is no quick fix. Often, residential treatment is one of the early phases of a much longer continuum of care. We will work with our clients and their families to establish an aftercare programme to help maintain the gains made in treatment and to navigate the potential ups and downs on the recovery journey.

Every person with a substance use disorder is unique. The Kusnacht Practice is equipped to treat addiction and substance use disorders and ensures health and care excellence. Our team of experts provide personalised treatment plans tailored to your individual needs and goals, with an array of therapies and treatments, including psychotherapeutic care, medical treatment and care, biomolecular restoration, and family systems therapy.

The Kusnacht Practice is renowned for its absolute, dedicated attention and precision, honesty, and transparency in a warm and empathetic environment for all. With the pure waters of Switzerland’s Lake Zurich lapping on its nearby shores and among nature and clean air, the treatment centre offers a holistic, 360-degree, mind, body and soul rebalancing and restoration approach. Its state-of-the-art facility combines Swiss standards of excellence, luxury and cutting-edge, innovative technology with world-renowned medical expertise, compassion, and sensitivity. Each patient is treated uniquely and privately in their own sumptuous, five-star residence and provided with the highest standards of professionalism, care, and discretion.

We have successfully treated many individuals. We will provide a safe, kind, and friendly environment where discretion and privacy are key. And our tranquil location and luxurious surroundings will help you relax and focus on your well-being, a place where we can concentrate on nothing more than improving your health and supporting you on a path of recovery.

Our experienced team of experts and professionals will seek to scratch beneath the surface to identify the roots of your issues. We wish to give you back control of your life and to learn coping strategies for a more content future - for you and your loved ones. Our treatment plans are unique and absolutely personalised, but simply opening up about your problem to a discreet professional is a big first step - alongside other therapies, naturally. We will organise everything for you with no detail overlooked.

Get in touch if a loved one is suffering from a substance use disorder or for more information on how we can help.