If someone you love is struggling with an addiction to an opioid painkiller like fentanyl, oxycodone or hydrocodone, the idea of simply sitting by and watching them abuse these powerful painkillers may seem intolerable. It’s natural to want to help and you may feel everything from overwhelming anxiety and fear for their life to serious anger that they can’t just “sober up.” Maybe you’ve also pleaded with the person to go to rehab. Or perhaps you prefer to turn a blind eye, wanting to avoid a confrontation and hoping things will improve.
Often, the first reaction is to accuse the person of being addicted. “This almost always results in the person becoming defensive and can create a situation where they become resistant to help,” says Michael Frost, MD, medical director of Eagleville Hospital and president/medical director of The Frost Medical Group.
Part of the resistance, understandably, might be because while the person may consider him or herself to be dependent on painkillers, they might not agree with your assessment that they are addicted to them. And that is an important distinction, albeit one a physician is best-qualified to make. Not everyone who takes painkillers will develop an addiction (dependence and addiction affect different parts of the brain, says the National Institute on Drug Abuse) and your loved one could very well be dealing with an opioid dependence. (A brief definition of addiction is the continued use of a substance in spite of negative consequences. Dependence, on the other hand, occurs when the body comes to rely on a substance to function.) Regardless of which your friend or family member is experiencing, you should still be concerned, since in some people dependence will progress to addiction.
So what are some helpful ways you can support a loved one struggling with an opioid addiction? Below are specific tips according to the stage your loved one is at, whether they’re:
- currently using opioid painkillers;
- in rehab/treatment for opioid addiction;
- or newly sober
Ways to help someone who is currently abusing opioid painkillers:
- Show your concern for the person’s well-being without being judgmental. “Displaying an open willingness to help a loved one without trying to dictate the course of action is often received much more positively,” says Dr. Frost.
- Show empathy and compassion in the same way you’d show it to someone suffering from any other chronic illness. Telling the person what to do is often not as effective as showing them that you are on their team and are prepared to assist them in getting help for their addiction. “Phrases such as ‘you need to…’ and ‘why aren’t you doing…?’ are usually met with resistance and animosity, whereas communicating from a personal perspective with phrases like, ‘I would feel better if you did…’ and ‘I’d like to help you do…’ may make it easier for the person to accept the help being offered,” Frost explains.
- Create a structured, stable environment. Establishing basic expectations of behavior along with simple, predictable routines around the home help to reduce stress and limit the chaos that can encourage addictive behaviors.
- If you’re not sure if the person is addicted, seek out an assessment with a licensed addiction treatment specialist. “A professional and impartial evaluation can usually determine if a loved one is suffering from opioid addiction or if another problem may be responsible for behaviors or symptoms that are being displayed,” notes Frost.
- Keep track of your loved one’s medications and refills so you and they know what they’re taking and how much should be taken and when.
- Be aware of overdose. Ask your loved one’s doctor whether a prescription for naloxone (brand name: Narcan), a medication used to counter the effects of an opioid overdose, is appropriate. Because naloxone can’t be self-administered, you may need to learn how to give it to your loved one in an emergency. For guidance on how to administer naloxone if you suspect an overdose, visit the North Carolina Harm Reduction Coalition’s website.
Ways to help someone who’s in rehab or treatment:
“When a loved one starts receiving treatment at an inpatient facility for opioid addiction, there are several ways to be supportive,” says Frost. These can include:
- Communicating regularly with the treatment facility staff (e.g., therapist, doctor, case manager). This enables you to stay updated on the progress of treatment as well as contribute to treatment planning and help with arrangements for when your friend or family member is discharged.
- Attending family sessions with the person you love. This shows your support and can start or renew a pattern of positive communication.
- As your loved one prepares to leave the rehab facility, making sure the next steps in treatment are in place can make a vital difference. “Helping to facilitate the person getting to outpatient counseling and one of the various medically-assisted therapies, such as buprenorphine, methadone or naltrexone, can lend stability and reduce the likelihood of relapse following discharge from a rehab facility,” Frost explains.
Ways to help someone newly sober from opioid addiction:
In early recovery, “the most useful first step is to determine what form of support the person needs,” says Frost. “Oftentimes, family members will try to give what they consider support when in reality their loved one would benefit from something different. Simply asking the question, ‘What is the best way you think I can help you right now?’ can start a conversation to establish what form of support the person needs.” Here are some other ways to offer your support:
- Avoid open-ended or vague forms of help in favor of more concrete support. For example, rather than giving the person cash to pay their phone bill, have them bring the phone bill to you so it can be reviewed and paid without the chance for the money to be spent on substances.
- Encourage the person to continue with treatment, including medication (if appropriate) and counseling. “Also, becoming familiar with and participating where possible in the various forms of treatment that a loved one is getting can help the person feel understood and encouraged,” says Frost.
- As noted above, one of the most important things you can do to help your loved is to understand the risks of overdose. Keep alcohol out of the house, at any stage of addiction. The risk of an overdose climbs greatly when any amount of opioid (which includes heroin) is mixed with alcohol and/or benzodiazepines, especially in someone who has detoxed from opioids. Also, if a loved one has detoxed from opioids and they take even a small amount of the drug, it could prove fatal. The reason is because their brain has adjusted to not having the drug in the body. This is actually the period when the risk of overdose is greatest because your loved one is vulnerable to dying from a much lower dose of opioids than they took when they were using regularly.
August 20, 2015 correction: Dr. Frost’s title was corrected.