After looking the other way for far too long, people and institutions in the United States are starting to face addiction. Respect for individuals in active addiction and resources to assist them into recovery are gradually becoming the norm.
Previous Addiction Medicine Updates have identified two core responsibilities, stated as calls to action, that most individuals in active addiction need to adopt in order to achieve lasting recovery. Keep Your Distance! advocates modifying routines and lifestyles to minimize the risk of resuming substance use. Ask for Help! advocates repairing and creating relationships based on honesty and mutual respect. The latest neuroscience, as well as decades of practical experience, support the relevance of these actions, which I call The Two Pillars of Recovery®.
But what about everyone else? What about all those who live with, care for, and work beside people in active addiction? What actions should family, friends, healthcare providers, and others adopt to help individuals in active addiction move into recovery?
First of all, be careful. Plenty of well-intentioned attempts to help people with addiction and those at risk for addiction have later been shown by science to actually work against the interests of the target groups.
For example, seeking to reduce teen substance use by emphasizing potential harm from drug use was ineffective and sometimes made use more likely. Likewise, putting patients in “the hot seat” and “breaking through their denial” during addiction treatment increased patients’ shame and their risk of relapse after treatment. Insisting that patients take, or not take, medication for addiction defeats individualized patient care and can compromise treatment outcomes.
On the other hand, research has repeatedly shown that individuals with addiction and individuals at risk for addiction respond well to empathy—to having their experiences and feelings recognized and accepted by others. Furthermore, when individuals in active addiction feel judged or criticized, they frequently react to this absence of acceptance with anger, and their resistance to healthy change increases.
It helps to understand that individuals in active addiction typically struggle with strong, conflicting emotions. Consider, for instance, that they may be even more disturbed by their addictive behavior than you are. They may feel ashamed and disgusted that their actions put substance use ahead of family and other relationships—or that their drive to use substances overpowers their drive for self-preservation. Accepting their anguish, rather than reminding them why they should have it, can bring you together.
Empathizing with individuals in active addiction, however, does not mean agreeing with them, particularly with regard to their behavior. Their priority in addiction, after all, is often to obtain and use more substance, not protect the interests of self and others.
It is possible, even essential, to feel and express acceptance toward those in active addiction while also holding them accountable for their behavior. For example, we might gently point out rationalizations that have contributed to their substance use. But our most powerful contribution will often be setting limits and delivering relevant consequences if those limits or expectations are not met.
Expectations and consequences need to be realistic. Individuals in active addiction cannot make meaningful commitments to ongoing abstinence. And even if they made those commitments, observers could not reliably know whether they were keeping them. However, clinicians can periodically confirm abstinence with urine toxicology tests. And family members or other observers can monitor and respond to whether or not individuals keep commitments such as seeing a counselor, entering a rehab, or attending a recovery group.
As for consequences, use what you have (family members have certain consequences at their disposal that judges in drug courts do not, and vice versa) and make sure they are specified in advance and relevant to the agreed-upon expectations.
Over time, when we hold people entering recovery accountable for behaving in ways that demonstrate respect for self and others, respectful behavior has a way of displacing the addictive behavior that dominated their lives.
A man in his twenties said, “There’s something funny going on with this recovery stuff. I’ve been at it about a year. It’s getting so sometimes I just open my mouth and the truth comes out.”
The NCADD Addiction Medicine Update provides NCADD Affiliates and the public with authoritative information and commentary on specific medical and scientific topics pertaining to addiction and recovery.