Together Families Heal Resources

By: Dr. Delaney Smith
ADAMH Medical Director

As a family member or friend, it is important to understand that addiction is a chronic, relapsing disease. And just like any other medical condition, treatment is possible.

Start by Understanding

Understanding some of the science behind addiction starts with brain chemistry. Drugs or alcohol activate brain circuits that naturally exist to tell us what feels pleasurable or rewarding. However, drugs energize these circuits to a new level, creating a much stronger response than what results from the body’s naturally occurring neurotransmitters. This intense feeling of pleasure can drive the person to use drugs again and again.

When someone uses drugs for a prolonged period of time, the brain changes. First, tolerance develops, meaning it takes more of the drug to produce those same euphoric feelings. Further, the actual working structure of the brain shifts. Eventually the person becomes dependent and can no longer feel “normal” without the drug. They require it just to avoid the pain of withdrawal. At this point, the person makes pursuing their drug of choice their main daily purpose and as their obsessive need progresses, they often act in ways that would otherwise be out of character.

Stopping drug use does not immediately revert the brain to normal. Research suggests that the brain may require months or even years to reverse the structural and functional changes caused by drugs. It’s this reality that often causes relapses. While some people may be able to maintain their sobriety after receiving treatment the first time, many people require longer-term or repeated treatment.

As you try to better understand what your loved one is going through, learning more about addiction and hearing from others who have similar experiences can be tremendously helpful. You may also consider joining a support group.

Most importantly, know that you are not alone.

Additional Readings

Addict in the Family By: Beverly Conyers
Healing the Addicted Brain By: Harold C. Urschell, III, M.D.
Setting Boundaries with Your Adult Children By: Allison Bottke
The Addictive Personality: Understanding the Addictive Process and Compulsive Behavior By: Craig Nakken
The Enabler: When Helping Hurts the Ones You Love By: Angelyn Miller

When your loved one is nearing the end of inpatient treatment, life back in the community can be a difficult transition since there can be a lot of old reminders or triggers such as old friends, old hangouts and old behaviors that led them to using in the first place. Because of this, relapse can be a concern once a person completes treatment.

Supporting Life in Recovery

By: Carolyn Ireland, LSW, LCDC-III
Chief Executive Officer, the House of Hope

To address the fear of relapse, discharge planning is critically important. The Substance Abuse and Mental Health Service Administration (SAMHSA) identified four major dimensions that support life in recovery post treatment:

• Health
• Home
• Purpose
• Community

Health – Being connected to a primary care or a physical health. In our community, we have several clinics that understand the physical well-being of someone who is struggling with addiction.
Southeast Federally Qualified Healthcare Centers
PrimaryOne – The Alum Creek location is co-located in Maryhaven.

Home – One of the strongest indicators for long term recovery is safe and sober housing also known as Recovery Residences. Recovery Residences allow for people coming out of treatment a place to live with other peers who support each other as they adjust to their new found sobriety. According to research, following substance abuse treatment, individuals who live in a collaborative housing setting with community rules and responsibilities have their substance abuse treated more effectively than those not provided supportive housing.

Purpose – Whether it be getting a job, going back to school for GED or college or volunteering in the community is another critical component of long term recovery. Not only do these activities provide daily structure to the person in recovery, it also gives a sense of purpose and belonging. A common myth is that people who have criminal histories or addiction issues cannot find employment.

For help with employment, contact COVA.

Community – Once a person leaves treatment, the feeling of isolation and lack of support can be overwhelming. Connecting with other people in the community who have struggled with addiction is a vital step to long term recovery. A person who is new to recovery and surrounds themselves with people who are currently experiencing long term recovery has a greater chance for long term recovery than people who do not engage in a recovery community.

In today’s environment, navigating the healthcare system is complex. While there is no single set of answers, our goal is to give you some guidance and direction about questions to ask as you seek information for your family member in need of addiction treatment.

You Are Not Alone

By: Lori Criss, Associate Director, The Ohio Council of Behavioral Health & Family Services Providers and
Teresa Lampl, The Ohio Council of Behavioral Health & Family Services

Asking for Help

First and foremost, it is important to understand that a treatment provider will require your loved one to acknowledge they want help. If and when you make telephone calls on their behalf, you should expect the treatment provider to ask to speak to your family member directly.

Also, it is important to recognize that there are different types of need. While it may be tempting to tell the healthcare provider or your insurance provider that your loved one needs detox or inpatient treatment, an addictions treatment program is specifically qualified to work with your family member to determine what types of services are needed. You could consider saying something like, “My loved one has a problem with heroin. We need help.” From there, your treatment provider can ask questions to determine the level of care most appropriate for your family member and your insurance company will be able to answer if your loved one’s policy covers those services.

How to Handle a Crisis

If your loved one is currently high and a danger to themselves or others, it is a crisis. You should call 9-1-1 immediately. When you get to the hospital, you can ask for a social worker and assistance seeking addiction treatment.

How to Identify Treatment Options for your Loved One

1. Does the person needing treatment have health insurance (commercial or Medicaid)?
   ►YES
   • If your loved one has private insurance, you can work with the treatment provider and the insurance provider to see what services are covered, if the treatment provider is part of the insurance company’s network for those services, and what the patient’s financial responsibility is beyond the insurance coverage.
   • Insurance is obligated to cover addiction services the same way your loved one’s policy covers medical and surgical procedures. This is known as parity.
   • By federal law, consumers have access to their coverage. You can request it or it should be posted on the insurance carrier’s website. This is not fully enforced in Ohio and it may take some advocacy on your part. If you are not able to obtain information about coverage, you can file a complaint with the Ohio Department of Insurance.
   ►NO
   • Contact your local alcohol, drug and mental health services board: In Franklin County, the Alcohol, Drug and Mental Health (ADAMH) Board is the publicly funded behavioral health board. ADAMH contracts with more than 30 non-profit organizations.
   • You can call any of the providers directly and find out more about the services they offer. A list of suggested questions is below.
   • If you plan to self-pay, you can ask specifically about the cost of treatment. You may also consider asking about any required co-pays, no-show fees, or a sliding fee scale.

Questions for Possible Treatment Providers

• What insurance do you take?
  o Be clear about your loved one’s insurance company and plan name.
• Do you help coordinate the benefits with the insurance company or do we need to find out about coverage ourselves?
• Where are you located?
• What are your hours?
• When and how is treatment delivered? Will my family member have any limitations on their daily schedule or activities??
  o Can a person still work or participate in other activities during the course of treatment?
• How long does it take to get into treatment? What factors impact that time to access services?
• Are there groups you are known for working with? (i.e. women, men, children)
• What is your treatment philosophy? Is it patient-focused or family-focused? Do you offer family counseling or connect family members to information and services in other parts of the community? Do you help family members understand addiction and how to best support their loved ones during treatment and recovery?
• As a family member, I am ready for help. Is there help available for me? Is it covered by insurance?
• How do you define a good outcome? What do most people achieve as they participate in your program?
• If the provider does not offer the services your family member needs, ask for a referral. Who would you recommend I call?

Treatment and Recovery

Please remember that treatment is only part of a person’s recovery journey. Addiction is not a problem that comes up overnight, and recovery will take a long time, too. As you travel this journey with your loved one, you and your entire family can make changes to support their recovery. In addition to learning more about treatment options, you can learn more about addiction, support groups, safe environments including housing, how to handle a relapse and more. The more you understand, the better you can set realistic expectations about recovery for yourself and support your loved one over the long haul. This page is a good place for you to start to find information.

Remember you are not alone. There is hope.

Staying sober requires transformations in brain chemistry and processes as well as changing long-standing behaviors — which is why, unfortunately, relapse is possible. Relapses do not mean treatment failed. It does mean you should encourage your loved one to try again.

Understanding Withdrawal and Overdose

By: Michelle Maguire, PharmD, BCACP
Clinical Pharmacist at Southeast, Inc.

You can better understand the reasons for relapse by learning more about withdrawal. Withdrawal encompasses two stages: the time immediately following a person’s last drug use which may be several weeks and is marked with many physical symptoms, and; Post-Acute Withdrawal Syndrome (PAWS), encompassing as much as a two year period during which your loved will experience emotional and psychological symptoms. This normal process will take time and patience on everyone‘s part. To learn more, read this article: http://www.addictionsandrecovery.org/post-acute-withdrawal.htm

Opiate Overdose

Because opiate addiction has reached epidemic proportions, let’s look specifically at reasons for opiate overdoses, in addition to PAWS:

• Lower tolerance: After not using for a long period of time, such as during jail, a hospital stay or rehabilitation, some try to use the same amount of their drug of choice as was used previously, but their tolerance is lower.
• Mixing drugs: Mixing opiates with other opiates, with cocaine or speed, or with alcohol or benzodiazepines (Xanax®, Valium®, Klonopin®) increases the chances of overdose.
• Laced drugs: When buying drugs off the street, it is impossible to know what other substances may be mixed in the heroin. Deadlier drugs such as fentanyl are often added without the user or dealer’s knowledge.
• Using alone: Most overdoses happen over 1-3 hours, meaning that help could be offered if others were aware.
• Poor health: Poor physical or mental health adds to the risk of overdose. Common complicating factors include untreated COPD or asthma, infections, abscesses, and liver or kidney problems, as well as untreated mental illnesses, such as depression, bipolar disorder or schizophrenia.

Naloxone

Naloxone, also known as Narcan®, is the antidote for opiate overdose. When given as a nasal spray or as an injection, it reverses an opiate overdose in 2-5 minutes. It has been used in hospitals and emergency medical squads for decades, has no abuse potential, and is now available to families, friends and opiate users.

How does naloxone work?

An opiate “antagonist” or “blocker,” naloxone quickly blocks any opiates present in a person’s system. This allows the person to wake up from the overdose. It does, however, wears off in 30-90 minutes, so the person could re-overdose. That’s why you should immediately call 911 and transport the person to the emergency room as soon as possible.

Is naloxone safe?

Naloxone is a safe medicine with few side effects and no potential for abuse. It does cause immediate opiate withdrawal, but opiate withdrawal is not life-threatening. It will not affect anyone who has not used opiates.

Can anyone get naloxone to keep with them?

Yes, Ohio and many other states allow anyone to obtain naloxone and keep it in their home or on their person. Naloxone can be dispensed by a pharmacist, doctor or other clinic staff to people in close contact with those who use opiates.

How can I get my own naloxone kit?

Many pharmacies in Ohio naloxone without a prescription. Contact your physician or check the state board of pharmacy/s updated listings: http://pharmacy.ohio.gov/Licensing/NaloxonePharmacy.aspx . Or, go to your local Project Dawn site: http://www.healthy.ohio.gov/vipp/drug/ProjectDAWN.aspx.

Naloxone typically comes in a kit, which is a small bag with at least two doses of naloxone, needles or nasal sprays, a CPR shield, gloves, and detailed information.

How much does naloxone cost?

The pharmacy can bill your prescription insurance for your naloxone kit, even without a prescription. Or you can purchase your kit for $80-$200.

What if I don’t have any money or I don’t want to use my insurance? Where can I get naloxone for free?

ProjectDawn provides education and free naloxone. Their training teaches you to recognize the signs and symptoms of overdose, distinguish between different types of overdose, perform rescue breathing, alert emergency personnel and administer intranasal nalxone.

The signs and telltales that alert families someone may be using drugs:

Have you noticed some changes in your loved ones behavior that have caused you to question their behavior. You may find yourself asking, are they using drugs? Are they addicted to drugs or alcohol?

Signs of Using

What to look for & how to keep the conversation open

By: Vincent Sabino, MSW, LISW-S, LICDC-CS
ADAMH Alcohol and Other Drug Clinical Manager

It is important to understand that not everyone who uses a substance will become addicted and people can become addicted to a variety of substances. Not all substances that are addictive and can be misused are illegal. Some examples of substances include: alcohol, tobacco, paint, glue, marijuana, prescription pills, heroin and cocaine.

As a family member, if you are concerned your loved one may be using drugs, there are some physical signs and behaviors you may look for:

• Constricted or enlarged pupils
• Red or bloodshot eyes
• Drowsiness/excessive sleeping or overly alert/not sleeping
• Needle marks on arms or legs (possible infections)
• Change in moods
• Change in appearance
• Deceitful or secretive behavior

Keep in mind that different drugs can react differently in the body so symptoms may vary between the types of drugs and the person using them. For more information regarding the different signs and symptoms of drug use, visit this guide from drugfree.org.

Even if you do not suspect someone close to you may be using drugs or alcohol, it is important to learn more and have ongoing conversations with your family. Remember your words may make the difference. If you are considering talking to your loved one, consider the following:

• Be direct and calm
• Ask open-ended questions
• Do not punish
• Do not accuse
• Do not degrade
• Talk about treatment

See the full post via psychcentral for more details.

For complete answers to the following:

• What is a drug or alcohol Intervention?
• How do I know for sure if my teen is using?
• How should I prepare for a talk with my child?
• How do I make sure the talk is productive?
• What if my child needs outside help?

Please visit the Intervention eBook

Prevention & Education Resources

Prevention & Education Programs in Franklin County
Resources from National Institute on Drug Abuse for Parents