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Don’t Wait for Rock Bottom

Most families don’t know what to do or where to turn when someone they love is struggling with substance use. I’ve been there too — worried about family or friends, worried that any misstep could make the problem worse or further distance a loved one.

After tense conversations and the exhaustion of constant worry, many families are left standing still, hoping that their loved one hits “rock bottom” quickly, and not too hard.

For decades, this idea of rock bottom has been a theme in our field, where families are told that their loved one needs to feel “ready” to seek treatment in order for it to work. But this idea isn’t based on science, and we can’t afford to wait. Addiction is a progressive disease that if left untreated, tends to get worse.

Research has shown that treatment works just as well for patients who are compelled to start by outside forces as it does for those who are self-motivated to enter treatment, and that the sooner you intervene, the better the outcomes. Imagine if we waited until stage four to begin treating cancer? Addiction should be treated with the same urgency because the heartbreaking reality is that too often for this disease, rock bottom is death.

Addressing addiction like a disease instead of as a moral failing requires shifts in practice as well as understanding. We must revise our outdated ways of thinking about this condition to better align with the medical discoveries about what addiction does to the brain, and how it is most effectively addressed.

Addiction impacts the limbic system, which is responsible for our basic survival instincts, and the prefrontal cortex, which regulates decision-making and impulse control. Addiction hijacks the brain, making it believe that the primary need for survival is the drug. Because of these changes to the brain, it can be very difficult for somebody suffering from a substance-use disorder to engage in treatment, no matter how much they might want to find recovery.

Start with affection

But how do you start that conversation with your loved one about treatment? Dr. Mark Gold, a renowned addiction psychiatrist and professor at the Washington University School of Medicine, suggests the following: “Start with affection, such as, ‘You’re one of the most important people in my life,’ which helps reassure the person,” he said.

“Talk about how you are afraid of losing them, that their relationship to the drug is getting stronger and stronger,” Dr. Gold continued. “Add how their behavior has challenged your relationship. Then cite specific behaviors that you are concerned about, such as episodes of impaired driving, arrests, missed work or other changes. Then suggest or even insist that they undergo an assessment, which helps determine the severity of their substance-use disorder and assists in the creation of a treatment and recovery plan.”

When you’re worried about a loved one, it can feel like you’re drowning. It’s important not just for the individual struggling with substance use to get help, but for the whole family to be wrapped up in love and support. “Reach out,” shared my friend Doug Griffin from New Hampshire, who lost his daughter to a heroin overdose. “There are so many people right next door who are dealing with addiction too, and so much support we can give each other.”

If you or someone you love is struggling, call the Addiction Resource Center at 833-301-HELP (4357) for free, confidential support.

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