Dr Gillian Tober, president of the Society for the Study of Addiction, and honorary consultant psychologist and clinical service manager at the Leeds Addiction Unit, answers questions about treating addiction.
When is it time to get help?
The sooner the better. Some people say you have to hit rock bottom before you’re ready to change, but the evidence shows that the earlier the intervention, the more successful it will be.
What can friends and family do?
Whether you're a relative, friend or an employer, as soon as you detect a problem relating to addiction you should tell the person that you've noticed a worsening pattern in their drinking, drug use, mood or physical health. If this is said in an accusing way, the person is likely to be defensive and will distance themselves. The more positive and constructive you are, the more likely it is that you will be able to help the addicted person and get them into treatment.
The evidence for the benefit of support from people close to the addict is so strong that many specialist services offer treatment that's based on recruiting a network of family and friends. It's important that the person with drug and alcohol problems is helped by people who are concerned, constructive and who don’t have problems themselves.
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Who should the person go to first?
A GP can refer an addicted person at any stage, not just when they're willing to stop. GPs can give advice about sensible drinking, and use their own surgery's resources, such as nurses or counsellors. GPs may also recommend national helplines, such as Samaritans, and support groups such as Alcoholics Anonymous and Narcotics Anonymous.
These groups enable many people to deal with their addiction. In addition, there are specialist NHS agencies, such as the Leeds Addiction Unit, that will see people, even if they’re not ready to stop. These units encourage people to talk about their addiction and try to change their motivation.
How is an addict treated?
Treatment is adapted to suit the individual. There are several treatments that are proven to work. These mainly combine talking therapies with medication. Cognitive behavioural treatments are typically used because they work very well with addiction problems.
Treatment usually starts with getting the person with the problem to think about how they want to change. It's important to avoid condemning them. They need to believe that they can do it, and that their life will be better as a result.
Professionals will discuss how the addicted person sees their life in the future, what obstacles they feel they face in changing, and what methods they think will help them to deal with those obstacles. Then they can identify the situations the addicted person will find difficult, and make plans to deal with those situations. Through this process, they can set the target, which is ultimately abstinence.
Once you’ve identified the target and what the person needs to do to reach it, you set up all the resources available. As well as treatment agencies, resources include family and friends who support change. You want people who won't encourage the person to "just have one drink because it won’t matter" but instead offer to take them to the cinema.
When people engage in dependent behaviour, their whole lifestyle revolves around using and obtaining the substance, and dealing with the after-effects. Therefore, changing that lifestyle is a very big step. Often the hardest part is not stopping the addiction but maintaining the change.
How do self-help groups and residential rehab work?
Some self-help groups are extremely useful because they provide a network, often in the absence of family and friends. Groups are very useful for giving support during aftercare.
Residential rehabilitation helps many people to overcome the initial phases of withdrawal and to start making lifestyle changes that will allow them to continue in recovery.
Do the self-help or home-based recovery programmes work?
Most definitely. People are more likely to find a way to recovery that suits them if there's a wide range of options available. People don't respond well when they feel they're being pushed into a corner. However, a self-help manual can rarely replace being with supportive people in a social setting that rewards abstinence or control.
Does recovery always have to mean abstinence?
For a minority of people with moderate drinking problems, a controlled drinking goal is possible. However, most people at treatment centres need to aim for abstinence. With heroin and cocaine, abstinence is the only option.
How does an addict guard against relapse?
Lots of ways. One would be removing or avoiding the triggers of addiction. Another might be making contact with new people who don't use drugs. That’s a big step to take, and some will advise the opposite, saying it's important to stick with people who are in recovery because they understand and can offer support. This is fine as long as they're supporting your abstinence rather than stimulating your addiction.
In the case of drug users, the people who recover successfully are the ones who change their drug-using surroundings. This can be very difficult, especially if their partner is a drug user (unless they change their habit too).
It's also important for recovering addicts to change their activities so that they have alternative ways of feeling rewarded, alternative ways of coping with feeling down or lonely and alternative ways of having a good time. Very often, people get into drug and alcohol addiction simply to relax and enjoy themselves, but then they lose control. When that happens, they have to find alternative ways to relax.