Helping a family member with addiction

You do not need a diagnosis to pick up the phone. What you can do is notice the pattern a clinician asks about.

Substance use disorder is diagnosed against the DSM-5-TR criteria published by the American Psychiatric Association. Eleven items cover the last twelve months, grouped into loss of control, harm that has not changed the use, use in physically dangerous situations, and the physical signs of tolerance and withdrawal. Two or three met is mild, six or more is severe.

From the outside: consequences arrive and nothing changes. Promises to cut down are sincere and do not hold. The day starts with a drink, or a dose, to steady things. Hours go into obtaining it and recovering from it, and money stops adding up. Someone who cared about their work or their kids behaves as though none of it registers.

Loss of control and the damage that fails to stop the use carry the diagnostic weight. Amount consumed is one input among several.

Pick a time when they are sober and neither of you is late for something. A conversation held with someone intoxicated will not be remembered.

Say what you saw, recently and specifically. "You passed out in the car on Sunday and the kids saw you" lands where "you have a problem" does not. Describe your own worry. Leave their character out of it. Make one request, small and concrete: an assessment, or a phone call you sit through with them. Then listen, even when what comes back is defensive or untrue. You are trying to leave the conversation possible to have again next week.

What backfires: an ultimatum you will not carry out, since the first unenforced one teaches that none of them are real; an inventory of everything they have done since 2019; an argument about whether they are an alcoholic, which is settled at an assessment; and shame, which does not reduce the use.

Protecting someone from consequences, paying the fine or replacing the phone again, is a different thing from keeping them alive. Carrying naloxone belongs in the second category.

You cannot make someone else stop using, and you cannot make them want to. What you decide is what you do: whether you keep paying, what you say, whether you stay in the house, and what the rules are for your children.

Motivation moves, though. Someone who says no in March takes the appointment in July, usually after something specific happens, and they call the place the family already found. People do enter treatment after a relative keeps asking, though it does not work on your schedule.

Put your own support in place before the crisis. Al-Anon and Nar-Anon are free and meet across central and southwest Ohio. SMART Recovery runs Family and Friends meetings. Children in the house need a grown-up to talk to who is not you.

The intervention most people picture comes from a model developed in the 1970s: friends and relatives assemble and read prepared statements to someone brought in without warning. The surprise can end contact with someone who is already ashamed.

Clinical practice has moved toward training the family instead. One of these, Community Reinforcement and Family Training or CRAFT, has a clinician coach relatives on how to communicate, how to stop cushioning the use, how to respond to a sober stretch, and when to raise treatment so that it lands. Trials have found CRAFT gets more reluctant people into treatment than confrontational intervention does.

Hiring an interventionist is a real option in a largely unregulated field. Ask about the license, the model they work from, who pays them, and whether they have a financial relationship with the facility they intend to recommend.

Most families need none of this. A calm conversation from one person they trust, followed by a phone call somebody has already researched, does the work more often than a staged event.

Expect it. Refusal is the usual first answer and rarely the final one.

Keep the offer alive instead of repeating the argument. Tell them what you will do when they are ready, and where the number is. The offer does not expire. Then leave it alone, because raising it daily turns the subject into background noise.

Decide what you will fund and what you will not. Say it once, then hold it.

Call admissions yourself while you wait. A family member can ask how the assessment works and what happens if withdrawal needs more supervision than an outpatient program can give. Asking commits nobody to anything, and the window, when it opens, is usually short.

Ohio has a probate court route through which a family member can petition for someone with a substance use disorder to be assessed and ordered into treatment. A separate emergency route, run through hospitals and law enforcement, applies to a person who is an immediate danger because of mental illness.

This page will not walk you through either one. Who may file and what a court wants in evidence are answered at county level, and the answers change. Talk to an attorney, or call the probate court in the county where the person lives.

Two practical points first. A court order does not create a treatment place, so a program still has to exist and be clinically appropriate. And treatment entered under pressure is not wasted, since the National Institute on Drug Abuse states that treatment does not have to be voluntary to work. It is still a serious step to take against a relative, and it can cost you the relationship.

Withdrawal from alcohol and from benzodiazepines can kill, so somebody drinking heavily every day, or taking alprazolam or clonazepam regularly, should not stop abruptly at home. Seizures and delirium are the risks and they need medical supervision. If they are talking about quitting cold this weekend, get them assessed first. Leora's ambulatory detox covers mild to moderate withdrawal only. A nurse practitioner and a registered nurse assess everyone who comes in for detox, and not everyone is a candidate. Where the assessment points to a hospital, the person being assessed is told so.

Keep your own medications locked away, including anything controlled. Store firearms outside the house, or locked with the ammunition separate, since suicide risk rises alongside heavy substance use. If there are children at home, tell one trusted person outside the house what is going on, so somebody can collect them if a night goes badly.

Violence changes the sequence, and your safety comes before any treatment plan. If anyone is talking about suicide, call or text 988 for the Suicide and Crisis Lifeline.

If opioids are anywhere in this, keep naloxone in the house and know how to use it. Counterfeit pills sold as oxycodone or Xanax often contain fentanyl, so this applies even when nobody involved thinks of themselves as a heroin user.

Naloxone reverses an opioid overdose and does nothing otherwise, so giving it to someone who took something else does no harm. In Ohio, pharmacies can supply it without a prescription from your own doctor, and many county health departments and Project DAWN sites give it out free. Nasal spray is the form pharmacies and health departments hand out, and it needs no training to use. Get more than one.

An overdose looks like breathing that has gone slow or stopped, blue or gray lips, skin that is cold and clammy, and a person who cannot be woken by shouting or by a hard knuckle rub on the breastbone. Snoring or gurgling in somebody you cannot rouse is not sleep.

Call 911 first. Give the naloxone, and breathe for them if they are not breathing. Give a second dose after two or three minutes if nothing has changed. Stay until help arrives, because naloxone wears off within about an hour and fentanyl can outlast it. Call anyway. Getting them breathing is what matters in that moment. Naloxone only works if somebody else is there to give it.

Family therapy is a scheduled session with a licensed clinician and the people the client chooses to bring. It deals with what happens at home: how a partner responds after a bad group session, or what the household does if there is a return to use.

The client decides whether it happens. Nobody is scheduled into a session because a relative called to ask for one.

The same principle governs information. Substance use records here are covered by federal privacy law, so staff cannot confirm that someone is a client or discuss their care unless that person has signed a release that covers you.

Ask the clinician whether a relative who lives far away can join remotely. A clinician sometimes recommends waiting, usually because of violence at home, abuse that has not been dealt with, a relative who arrives intoxicated, or a legal matter an attorney wants settled first.

You can call before they are ready. Both facilities welcome walk-ins.

Have this ready if you can:

• what they are using, roughly how much, and when they last used
• how long it has been going on, and what happened during any previous withdrawal or treatment
• current prescriptions, including anything psychiatric, and any medical conditions
• whether there is somewhere stable and substance free for them to sleep
• how they would get to Columbus or Dayton five days a week, if the assessment lands on a partial hospitalization program, which runs during the day with the client sleeping at home

Say plainly what worries you, including any reason to think withdrawal will be dangerous, and any talk of suicide. It changes what admissions does with the call.

To the assessment they bring photo ID, their insurance card, a current medication list, and a discharge plan if they are coming from another program. Leora accepts all major commercial insurance and Medicaid, and their insurance provider can say what the plan covers.

The Columbus facility is at 5432 N High St and the Dayton facility at 948 Patterson Rd. Call (614) 665-8878. If the person is outside Ohio, the SAMHSA national helpline is 1-800-662-4357.

• American Psychiatric Association, DSM-5-TR criteria for substance use disorders
• National Institute on Drug Abuse, principles of effective treatment
• Substance Abuse and Mental Health Services Administration, TIP 39 on family therapy, and the opioid overdose prevention toolkit