Amelia Sharp

Helping someone struggling with an alcohol use disorder (AUD) can be challenging. AUDs are chronic conditions characterized by an inability to control continued alcohol use despite the negative social and health consequences associated with their problematic drinking. Someone with an AUD might be in denial about their alcoholism or very resistant to pleas for them to get help. When this is the case, you may be left wondering how to move forward. 1 Often, substance abuse can affect an entire family unit and may also negatively impact close friends and coworkers. 2 It’s natural to be afraid for a loved one who continuously engages in maladaptive and potentially harmful behavior, such as alcohol abuse. With good intentions, loved ones of alcoholics may go to great lengths in an attempt to save the person they care about from the consequences of their substance use disorder (SUD) and end up enabling the addiction unwittingly.3 Unfortunately, you can’t control your loved one’s actions, but you can control your own behavior towards someone struggling with an AUD. In doing so, you might be able to help them see the need for and seek treatment for alcoholism.  Discouraging an Alcoholic from Drinking   Supporting the recovery of someone with an alcohol use disorder often includes ending any enabling of their addictive behavior and setting healthy boundaries for yourself.  While you may believe that making excuses for your loved one protects them in a way, to begin to help an alcoholic, it may be necessary to allow the consequences of their drinking behavior to come to light as you refrain from enabling their addiction.  Enabling Vs. Helping  Enabling often accommodates addictive behavior, rather than discouraging it or helping to stop it. Enabling someone with an AUD is not synonymous with helping them, and it can unintentionally communicate acceptance or otherwise downplay the serious consequences of a loved one’s behavior. One example of enabling may include repeatedly bailing a child or other family member out of jail, covering their court fees, and hiring and paying for lawyers.4 Enabling a loved one who is struggling with alcoholism may also involve:5 Making excuses for your loved one’s alcoholism.   Trying to “fix” your loved one.   Minimizing the situation.   Drinking with your loved one.   Justifying your loved one’s actions.  Suppressing your own feelings.  Taking over your loved one’s responsibilities.   Feeling superior to your loved one.   Lying for your loved one.    Unlike enabling, helping an alcoholic involves offering emotional support but not offering to be the fixer. You can continually communicate your concern and your love, while encouraging them to seek help for their disease.  You can also help the situation by helping yourself—setting clear boundaries (and sticking to them) and seeking help for yourself by attending support groups for families such as Al-Alon.  How Does Enabling Hurt Someone?  Without experiencing social, financial, or health-related consequences, an alcoholic may not fully recognize the pervasively negative consequences of their addiction. Enabling someone struggling with addiction prevents them from fully experiencing the repercussions of their actions. Therefore, someone abusing a drug, such as alcohol, may be less likely to make attempts to stop drinking if a loved one enables them.6 Enabling, in short, can prevent someone from learning the valuable lessons needed to save their life. Many people may think they are helping when they are actually enabling.  Quick Tips for Helping an Alcoholic:  Do:   Educate yourself on the potential symptoms and behavioral changes associated with alcohol use disorders  Set (and hold) clear personal boundaries.  Offer help, resources, and a listening ear for someone struggling with addiction.  Practice self-care and stress-reduction strategies to help yourself cope with your loved one’s addiction in healthy ways.  Don’t:   Protect your loved one from alcohol-related consequences.  Blame yourself for their addictive behavior.  Try to control their addictive behavior.  Deny the existence of an alcohol abuse issue.   Take your loved one’s actions personally.  What is a Personal Intervention?  If taking a step back isn’t enough to help someone struggling with alcohol abuse, it may be time for an informal discussion, also sometimes referred to as a “personal intervention”.7 Many people struggling with an AUD are in deep denial about their addiction, making it difficult to seek help.  Personal interventions are a form of informal interventions and, in the right situation, may pose another promising solution to this denial. In relation to substance abuse, a personal intervention exists to “intervene” in someone’s addiction with the hope of that individual seeking immediate treatment help. Although the word “intervention” may seem daunting, these efforts towards mediation can mean something as simple as having a one-on-one conversation with your loved one.7 Although all interventions may seem the same, there are differences between interventions that are considered helpful and unhelpful. All interventions are considered a form of confrontation, and of course, some confrontations can be constructive while others may be considered unproductive by some. More helpful interventions on loved ones involved ones perceived as genuine that were delivered by trusted and respected individuals. Another common thread between helpful interventions includes the offerings of tangible solutions, such as clear steps to receiving professional mental health treatment.8 Well-conducted personal interventions may motivate some people struggling with substance abuse seek professional help for their addiction to alcohol. It is crucial that, if considering having a personal intervention with your loved one, that the discussion is well thought-out. A personal intervention shouldn’t feel like an attack on your loved one, but to address this person’s addiction and offer them help and resources. 7,8 There are plenty of intervention strategies that will help get you prepared for staging an intervention. No matter what, deciding what you’d like to convey to your loved one before approaching them is important. It may even be necessary for you to script your intervention before conducting it with your loved one.  During an intervention, Partnership for Drug-Free Kids highlights the importance of:7,9 Waiting until the struggling person is sober.  Staying calm.  Carving out an ample amount of time for the discussion.  Asking if it is a good time to talk. If the person says “okay”, then proceed.  Talking in a quiet, private area.  Emphasizing that this conversation is to express concern for your loved one and their self-destructive behaviors.   Preparing for your loved one to be receptive or defiant.   Telling the individual about the effects that his or her drinking has had on you and others.   Using specific examples of alcohol-fueled incidents, to point out the severity of their alcohol abuse.  Explaining that this discussion is not an attack, but instead an attempt to bring all the social and personal consequences of their addiction to their attention.  Preparing to have resources available if the person struggling with substance abuse decides that they want to go to rehab.   If necessary, setting boundaries and practice healthy detachment.   All in all, be genuine in your delivery and do your best to not take your loved one’s reaction to your conversation personally.    Seek Help from Healthcare Professionals  If your efforts to help convince someone of their need for rehabilitation services aren’t enough, it still isn’t time to give up on getting the individual to enter treatment. If you know of anyone else in the alcoholic’s life that has the kind of influence that may help, you should ask for that help. It can take a few discussions to get an alcoholic to see that the problem is serious and widespread.  When all else fails, approach a healthcare professional, such as a counselor or therapist, for advice. Someone with expertise in the treatment of an AUD may be able to help you approach a friend or loved one in need in a more effective manner, or may aid in your efforts to encourage treatment for them.10 When Your Loved One Agrees to Treatment  If you’ve held a conversation with your loved one and they are open to the idea of treatment, you’ll want to be certain they have the resources to quickly and easily find an alcohol treatment facility. It may be best to have a list of reputable treatment centers centers handy to make this person’s decision easier. While someone is seeking treatment for alcohol abuse, you can offer in-person support while they search for the right provider. Your loved one may be worried about issues such as the pain of detox or logistics like childcare when they attend treatment. Ideally, before approaching your loved one with treatment options, you’ve thought through some of these issues. You can present a list of medical detox programs that will help them through withdrawal and go over options for childcare with them—e.g., maybe you can help arrange for a family member to watch them during the treatment period.    How Long Does Alcohol Withdrawal Last?  If your loved one decides to seek treatment for their alcohol abuse, they may experience alcohol withdrawal symptoms at the start of the recovery period. In fact, fear of withdrawal may be one of the foremost concerns you may have to help address in order to get them to accept help. Understanding withdrawal, how long it will last, and the best ways to get treatment can help you address this fear with your loved one.   Depending on an individual’s level of alcohol dependence, acute alcohol withdrawal symptoms can begin within hours of the last drink and last for days.11 These symptoms tend to vary in severity based on factors such as how much and how frequently a person drank and their overall physical health. Certain alcohol withdrawal symptoms may be relatively mild, such as:12,13 Headache.  Insomnia.  Mild anxiety.  Stomach upset.  On the other hand those with severe alcohol dependence may also experience more severe symptoms shortly after they stop drinking, including:10 Confusion.  Agitation.  Fever.  Hypertension.  Alcohol withdrawal delirium (delirium tremens).   Due to the risk of severe or complicated alcohol withdrawal in some individuals, it may be necessary for those seeking recovery to be evaluated by a mental health professional. Next, they may need to be closely monitored by a team of medical professionals at a medical detox and alcohol withdrawal management program.   A medical detox program ensures the utmost safety during acute alcohol withdrawal, a time that can be very dangerous. Not only will medical detox give you peace of mind knowing you're in the hands of qualified medical staff, but it can help you through the discomfort and provide a starting point for further treatment. Resources Available for Loved Ones  While it’s ideal for your loved one to decide on their own to enter treatment, sometimes they need help in making the decision to take the first step. Family members can be a major influence toward nudging a loved one into treatment. It may take multiple attempts, but consistent encouragement and repeated discussions about treatment may pay off eventually. In the meantime, there are resources you can utilize to help you cope with your loved one’s addiction. These include: Al-anon: This resource helps loved ones and family members of alcoholics share their experiences, offer support to each other, and find hope for the future. Ala-Teen: This support resource for younger family members and loved ones of alcoholics is a part of the larger Al-Anon family groups. Co-Dependents Anonymous: This 12-step group helps members achieve healthy and loving relationships. Remember: prioritizing your mental and physical health is essential for healing from addiction. [accordion title="American Addiction Centers (AAC)"] Laguna Treatment Hospital Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks [/accordion][accordion title="Alcohol treatment near me"] Arizona California Colorado Florida Georiga Illinois Indiana Kentucky Maryland Massachusetts Michigan Mississippi Nevada New Jersey New York North Carolina Ohio Oklahoma Oregon Pennyslvania Rhode Island Tennessee Texas Washington Wisconsin [/accordion][accordion title="Insurance"] Aetna Blue Cross Blue Shield Cigna Humana Kaiser Permanente United Healthcare Veterans [/accordion][accordion title="Detoxification"] Alcohol detox Inpatient alcohol detox Outpatient alcohol detox [/accordion][accordion title="Rehab"] Alcohol rehab centers Alcohol rehab centers near me 28 day alcohol rehab 30 day alcohol rehab 60 day alcohol rehab 90 day alcohol rehab Choosing a rehab center Court-ordered rehab Dual diagnosis rehab Executive rehab Extended care rehab Free rehab High profile rehab Holistic rehab programs Paying for rehab Luxury rehab Mens rehab Nature based rehab Private rehab Residential Rehab State funded rehab Teen rehab Veterans rehab Womens rehab [/accordion] [accordion title="Helping someone you love"] Helping an Alcoholic Boyfriends Brothers Children Family members Fathers Friends Getting sober Girlfriends Grandparents Husbands Mothers Parents Partners Sisters Teens Wives [/accordion] [sources] [1] National Institute on Alcohol Abuse and Alcoholism (2020). Alcohol Use Disorder. [2] Substance Abuse and Mental Health Services Administration (2004). Substance Abuse Treatment and Family Therapy. [3] WA State Employee Program (2016). Codependency and Addiction. [4] Soc Work Public Health (2013). The Impact of Substance Use Disorders on Family and Children: From Theory to Practice. [5] University of Pennsylvania Health System (2003). Enabling Behaviors. [6] Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.  [7] Partnership for Drug-Free Kids. Intervention E-Book.  [8] J Psychoactive Drugs (2012). Substance Users' Perspectives on Helpful and Unhelpful Confrontation: Implications on Recovery. [9] Partnership to End Addiction (2014). Helping an Adult Family Member or Friend with a Drug or Alcohol Addiction. [10] American Family Physician (2004). Alcohol Withdrawal Syndrome. [11] National Institute on Alcohol Abuse and Alcoholism (2014). Treatment for Alcohol Problems: Finding and Getting Help. [12] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.  [13] National Institute on Alcohol Abuse and Alcoholism (2014). Alcohol Use Disorder. [14] National Institute on Drug Abuse (2018). Principles of Effective Treatment. [/sources] ...

Many local and state courts apply drug or alcohol treatment requirements to people convicted of crimes, after, or in lieu of, incarceration. Those who have committed minor crimes, and who are not repeat offenders, may be given the choice to attend court mandated rehab as an alternative to going to jail. Some prisons also offer treatment within the facility for inmates. What Is Drug Court? Drug courts, which prosecute and sentence those who have been accused of drug-related crimes, are a recent phenomenon. The first drug treatment court (DTC) was in Miami-Dade County, and it began hearing cases in 1989. The approach of the Miami-Dade DTC was based in the belief that addiction is a disease and that the associated criminal behaviors arise secondary to the disease. Therefore treatment, not punishment, is prioritized. The innovative way that this court dealt with drug-related offenses became the model for many future drug courts.1 The number of drug treatment courts rose quickly—by 1997 there were more than 300 in the U.S. and today there are more 3,000.1,2 Adult drug courts utilize many resources and services to help reduce drug or alcohol use and prevent further criminal problems for the individual. These include:2,3 Risk and needs assessments. Regular, respectful interaction between the participation and the judge. Monitoring and supervision. Treatment opportunities. Clear rewards (or penalties) for meeting (or not meeting) goals set by the court. Various rehabilitation services, including aftercare and relapse prevention resources. What Is Mandated Therapy? Mandated therapy refers to therapy required by the court. A drug court judge may impose a therapy requirement as a condition for avoidance of jail time or other penalties. How long the judge requires the participant to attend therapy and in which type of environment (inpatient or outpatient) will vary. Leaving court-mandated treatment early may result in penalties such as jail time. Those already incarcerated may be required to participate in therapy as a condition for parole or pretrial release.4,5 Does Court-Mandated Rehab Work? It is a common belief that treatment must be voluntary for it to work. However, the National Institute on Drug Abuse (NIDA) refutes this notion, saying that even sanctions by the courts (e.g., a requirement to enter rehab to avoid jail) can be as effective.4,6 Research backs this up. A large evaluation of adult drug courts by the National Institute of Justice (NIJ) found that:2 Drug court participants reported less criminal involvement and had fewer arrests than those with comparable offenses who didn’t participate in a drug court. Participation in drug court results in reduced substance use more often for participants than non-participants, and drug test results were less likely to come back positive among participants than non-participants. For drug court participants, the investment in treatment is more costly initially; however, the savings related to reduced involvement in the criminal justice system saved an average of $5,680 to $6,208 for each offender. One study found that, of 160 research participants who entered treatment due to court order, 45% completed the 6-month program. Many of the participants reported low motivation upon entering the program but were more likely to complete the program compared to those who entered treatment voluntarily. This further supports the idea that treatment does not have to be voluntary to work.6 Longer required treatment stays as mandated by the drug courts may offset the initial lack of motivation because it allows participants time to become more fully engaged in the program and to learn the tools to change their behaviors. Longer treatment stays result in better outcomes—and completing treatment is one of the best indicators of positive outcomes for participants—so mandated, extended treatment programs for drug court participants may be the best option for many offenders of drug-related crimes.4,6 When Does Court-Ordered Rehab Not Work? Incarceration may force abstinence onto an inmate, but the relapse risk is high for those who are released. Risk factors that individuals may face upon release from prison include: The stigma of having been to prison. Struggles finding a job and/or housing. Family reintegration challenges. The requirements around parole/monitoring. Without any real treatment or new coping skills, the individual—who may very well be returning to the same environment where they abused drugs or alcohol—may be very vulnerable to relapse in when returning to their normal lives. Using again may send them back jail, starting the cycle over again. In the most tragic instances, they may die. One study of inmates released from a WA prison found that in the first 2 weeks after release, the risk of death was 12 times higher than that of other state residents and that overdose was the leading cause of death. Treatment mandates imposed by drug courts can put a stop to the cycle of substance abuse, incarceration, and overdose.6,7 Does Insurance Cover Court-Ordered-Treatment for Addiction? Most insurance plans cover addiction treatment as it is an essential benefit, and this may include court-ordered rehab and/or therapy. However, it is not guaranteed that court-ordered rehab will be covered. For most insurance companies to cover your stay at an addiction treatment center or cover the costs of other therapeutic options, your condition must be deemed “medically necessary” by your insurance company.9 The best way to find out whether your insurance will cover a court-ordered treatment program or court-ordered therapy sessions is to contact your insurance company and inquire about your specific plan. You can also find out more about which insurance companies typically cover some form of substance abuse treatment at American Addiction Centers. Does Medicaid Pay for Court-Ordered Therapy? Medicaid is required to provide substance abuse and mental health treatment to their members.10 However, there is no definitive law declaring that state-funded Medicaid programs must cover court-mandated therapy and counseling.11 Depending on your state, at least some portion of court-ordered treatment (outpatient therapy, inpatient rehab, etc.) may be covered.11 Often, but not always, for someone’s counseling or other therapies to be covered by Medicaid, an in-network provider must deem their condition medically necessary. Then, the patient must go to a rehab that accepts Medicaid.12 Setting up Court-Ordered Treatment Typically, if you have been convicted by a drug court of an alcohol-related offense and ordered into treatment for an alcohol use disorder, the court will work with to help you arrange your treatment and to make sure you understand what is required of you.13 The first step is generally an assessment of your drinking to determine the severity of the problem, as well as treatment planning to set up an approach that is most likely to help you recover. Once in treatment, your care providers should also be in contact with the court to ensure that your treatment is aligned with the goals of the court and is meeting correctional supervision requirements. There should be ongoing communication and coordination between treatment providers and the courts, parole officers, and probation officers. Case managers may help to ensure you receive the necessary resources, such as aftercare and community services, to maintain abstinence and avoid relapse. How to Find Court-Ordered Alcohol Rehab Unlike voluntary treatment where you have the option to choose any rehab you can reasonably afford, mandated treatment is more limiting. The drug court will arrange for your treatment and outline all requirements around it. The drug court may give you a rehab or list of rehabs you have the option to attend. You can speak with your lawyer about any questions you have regarding appropriate treatment options that fit the requirements outlined by the court.13 Who Can Provide Court-Mandated Therapy? All in all, it is up to the particular provider to decide whether they’d like to accept court-ordered patients. Court services often offer referral lists of reputable therapists and treatment providers in your area.14 The National Institute on Drug Abuse recommends that court-mandated treatment utilize evidence-based interventions and treatment models. This includes approaches such as cognitive-behavioral and medication-assisted treatment.15 American Addiction Centers accepts court-ordered alcohol treatment patients. It’s normal to be worried about what to expect when you’re considering substance abuse treatment, but AAC’s caring team is here to help you through the entire process. We’ll walk you through each step and answer any questions you have about court-ordered treatment. Learn more about our court-ordered services at AAC.  [sources] United States Courts (2008). Federal Probation; A Journal of Correctional Philosophy and Practice. US Department of Justice (2020). Drug Courts. Bureau of Justice Assistance and the National Institute of Justice (2019). Seven Program Design Features: Adult Drug Court Principles, Research, and Practice. National Institute on Drug Abuse (2014). Is legally mandated treatment effective? US Department of Health and Human Services (2018). What are Drug Courts? Journal of Substance Abuse Treatment (2013). Does mandating offenders to treatment improve completion rates? National Institute on Drug Abuse (2018). Principles of Effective Treatment.  JAMA (2009). Treating drug abuse and addiction in the criminal justice system: improving public health and safety. Cigna Behavioral Health (2020). What is Covered FAQ. Healthcare.Gov (2020). Mental health and substance abuse coverage. Mental Illness Policy Org. (2014). Medicaid Policies for AOT. Utah Department of Health Medicaid (2020). Targeted Adult Medicaid Program. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer. Superior Court of California (2016). Tips for Choosing a Family Court Ordered Provider (Therapist) & Beginning Therapy. National Institute of Drug Abuse (2020). What treatment and other health services should be provided to drug abusers involved with the criminal justice system? [/sources] ...