Frequently Asked Questions in Drug and Alcohol
We know there are question you have. In this guide we have answered some of the most frequently asked question. This guide is not intended to be a complete course on addiction identification, treatment and recovery. Instead, we hope this guide will assist you as you make the decisions necessary to bring your loved ones to a path of wellness.
What are the signs and symptoms of substance use disorders?
Many resources are available to help families recognize symptoms of substance use and talk to their youth about substance use. The Partnership at Drugfree.org (www.drugfree.org) has a Parent Toolkit that provides guidance on recognizing symptoms of substance abuse and talking to youth about substance use at various ages.
What are the signs I should look for when I suspect drug use?
Youth can more easily hide substance use and illegal behaviors from caregivers who do not understand youth culture and language. Look for patterns or a number of changes in appearance, behavior, and attitude. Substance abuse may be a possibility if several of the following signs are present:
Less attention paid to dressing and grooming
Red and glassy eyes and frequent use of drops and breath mints
Decreased attendance and performance at school/work
Loss of interest in school, work, hobbies, and other activities
Newly developed secrecy: deceptive or sneaky behavior
Lying and stealing
Withdrawal from family and friends
Loss of appetite or unexplained weight loss
New friends and reluctance to introduce them
Mood or attitude that is getting worse
Lack of concern for the future
Becoming familiar with abbreviations in text messages can also help you recognize communication about drugs.
How serious is their drug use?
Although drug use is sometimes a onetime occurrence one use can lead to another. Individuals believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, this usually results in failure to achieve long-term abstinence. Studies have shown that long term drug use results in significant changes in brain function that persists long after the individual stops using drugs, changes in brain function may have behavioral consequences, including the compulsion to use drugs despite adverse consequences which is characteristic of the addiction.
What do I do first?
If you are concerned about a change in your child that suggests substance use or abuse, talk to him or her, seek advice and support, and take actions that address your concerns.
How do I talk to my child?
If you discover obvious signs of substance use, communicating with your youth, as calmly and rationally as possible, and acting to seek help are essential steps to take as soon as possible. Communication with your child is an intervention that is effective in influencing a youth’s behavior. Even though your youth may not tell you the truth, your conversation tells him or her that you are concerned and where you stand. Community Reinforcement and Family Training (CRAFT). CRAFT is an evidence-based program that trains parents on ways to communicate with their youth to help him or her enter substance use disorder treatment, to support youth behavior change after treatment, and to improve family functioning (see the Resources section).
What can I do if they will not be truthful about their drug use?
Most Individuals who are using drugs will not be truthful about their drug use. This is often called “denial” by the professional community. This aspect of the disease makes it very difficult to ascertain the exact length and depth on the individual’s addiction.
What happens if they continue to use?
According to the philosophy of Alcoholics Anonymous and Narcotics Anonymous, there are three outcomes for someone who is addicted to drugs - sobriety, prison or death. For most of us, there is a long road in between each of these. Some individuals may achieve sobriety for a short period of time only to resume using drugs again. Prison is often an outcome due to the person’s actions while actively using Illegal drugs and/or alcohol. Death related to substance abuse comes in a few different forms. Overdoses are one of the ways someone could die while using substances, auto accidents or individuals who are sober may return to using substances and when they do so try to use the same amount they were used to using, which can put their system into shock which results in death.
What can I do to help them / how can I fix this?
One of the best ways to help them is to get help for yourself so you can understand the disease of addiction. YOU don’t fix it. It can’t be FIXED. It’s a brain disease that currently has no cure. It can be managed with the proper care and willingness on the part of the ADDICT so they can regain control of their lives.
Am I enabling or helping?
People with substance use disorders are good manipulators of the emotions and behavior of those around them. Caregivers are enabling when they do something that their youth can and should do for themselves or give their youth something that they don’t need, such as money or possessions. They are helping when they do something that their youth cannot do for themselves. As caregivers grow and learn, they become better at recognizing when the things they do go beyond their absolute responsibility. Caregivers should learn skills to manage these types of situations as a part of family involvement in treatment.
What is crisis intervention?
Reaching out for help in a crisis, or before a crisis occurs, applies to the difficult and often life-threatening situations that surround alcohol or drug abuse, just as it does to other health concerns. Help should be obtained by seeking out appropriate and immediate crisis services. Crisis hotlines help in a crisis is available in states and communities through alcohol and drug crisis hotlines. Trained staff is available to help address the crisis and guide callers to services. In some states, youth hotlines are available to provide peer-to-peer guidance to youth.
Why is intervening quickly important?
Identifying problems with alcohol or drugs early reduces the chance that they will get worse. This can be hard to do when youth who are using substances do not want their families to know. Families may not believe that there is a problem but intervention can occur at any stage Intervening early can make the difference between experimentation and your child’s progression to more serious substances, abuse, and addiction. It can also mean interrupting a relapse after treatment before it gets worse. Early intervention has been proven to reduce deepening involvement with alcohol and other drugs and to prevent escalation to abuse and dependency.
What can I do if they will not accept treatment?
Most individuals need to hit a ‘bottom” before they are willing to accept the problems that drugs and/or alcohol are playing in their life. Some people never hit this bottom. Others encounter it after a bought of trouble with the law or other intervention.
Get HELP for yourself! You also need help and support. Go to an ALANON meeting and start asking the people there. They’re usually plugged into the recovery community. Start talking! This is nothing to be ashamed of and you’ll find a lot of people who are dealing with this.
What are the first steps to treatment?
Integrated screening and assessment of both mental health and substance use can determine the nature of your youth’s substance use problem, mental health conditions, and treatment needs. Treatment plans should be based on the results.
What is integrated screening and assessment? Integrated screening collects basic information to identify substance use problems and one or more co-occurring mental health conditions. Screening questions also may explore related service needs such as medical, trauma, and family supports. Screening may take 30 minutes. If evidence of substance use, mental health, or co-occurring disorders is found, an in-depth assessment is the next step. An in-depth, integrated assessment gives detailed information about the nature of both substance use disorders and mental health conditions and how each relates to the other. It is used to plan treatment and how services are delivered. Assessment should be conducted by a trained and licensed mental health or substance use disorder treatment professional. Diagnoses are determined by psychiatrists, clinical psychologists, and other qualified healthcare professionals. The assessment process may use a combination of assessment questionnaires; interviews with the youth and family members, friends, or others (with permission); review of medical and psychiatric records; physical examination; and laboratory tests. A thorough assessment may take several hours and may take place over several days during the early days in a treatment program. It cannot be done over the phone alone. Assessment may also occur over several days in a hospital setting to determine the nature of the substance use disorder and treatment needs.
What is a dual diagnosis?
Dual diagnosis is the term used when a person has a mood disorder such as depression or bipolar disorder (also known as manic depression) and a problem with alcohol or drugs. A person who has a dual diagnosis has two separate illnesses, and each illness needs its own treatment plan.
Do traumatic events affect substance abuse?
Childhood trauma has been linked to a range of mental, physical and social problems across the lifespan of an individual. Past or recent experience with traumatic events can increase a youth’s risk of substance abuse. Trauma can span a range of harm to ones body, mind, emotions, and spirit. Some events—such as sexual abuse, bullying, or the death of a parent—are widely accepted as causing trauma, but less obvious events may also be traumatic to a child.
What is trauma-informed assessment?
An integrated assessment of mental health and substance use problems should be trauma informed. A trauma-informed assessment asks questions about past or recent traumatic experiences (such as loss of a loved one, domestic violence, sexual abuse, witness to violence or crime, accidents, surgeries, and other traumatic events). A trauma-informed approach recognizes that revealing traumas may be difficult for the person.
Once you know that substance use disorder treatment is needed, figuring out which services are needed, where they are available, and how they can be obtained become critical steps in deciding how to proceed with seeking treatment. Issues that may affect access to services include:
Availability of services,
Nature of available services,
Whether services are available in the language that the youth or family members speak if other than English, and cost and source of payment.
Help from someone who is knowledgeable about treatment services and the process for obtaining these services makes it much easier to determine which services are best for your youth. Professionals such as mental health providers and pediatricians are one source of help. State-run substance abuse hotlines are another. Reputable helplines, such as those run by The Partnership at Drugfree.org, or websites that provide unbiased help can also help sort out treatment needs and services. Trained parent partners or peer support staff, or caregivers who have experience with seeking treatment for youth with substance use or co-occurring disorders, may be available in your community or state to help you make a plan.
Where do I start in order to locate treatment for my child?
When looking for treatment, call your counties single county authority or Drug and Alcohol commission which will be located in your telephone book.
What treatment options are available?
There are a number of treatment options. No one size fits all. You must find what works best for you and your family.
Outpatient Treatment - This is where you find a counselor, therapist, or doctor that will work with your child on the Substance use issues and have regular appointment until the treatment is complete.
Intensive Outpatient Treatment - With this level of treatment is more intense than outpatient services. More hours of service are provided per week and for longer periods of time. An IOP may be recommended for youth with multiple needs, including physical illnesses and mental health conditions. This may be the next step if a youth is not successful with outpatient services only.
Day treatment/partial hospitalizations - With these services, youth live at home and receive treatment at a facility four to eight hours per day. A more intensive, structured treatment experience, it is appropriate for treating more severe substance use disorders
Residential Treatment - Youth live at the residential program from one month to a year or more. Length of stay may depend on the program and the youth’s progress. Programs are usually divided into phases and should include a variety of effective treatment strategies, family involvement, and preparation for post treatment. Youth may at times have limited contact with outsiders, including family, except during family programming. To receive residential services, youth live at a treatment facility for a specified length of time. The residential treatment should be in a program that is specifically for youth or young adults and should not mix youth and adults. Residential treatment programs vary in length and cost. Youth in these programs generally have severe substance use disorders, have been unsuccessful in other types of treatment, or have complex treatment needs.
What is detox?
Detox is the sudden removal of alcohol or drugs from the system of a person who is physically dependent. Detox is short for detoxification, the process by which your body eliminates poisons or harmful substances, called toxins. When someone is physically dependent on addictive drugs or alcohol, they suffer uncomfortable, often dangerous side effects when they stop taking (withdraw from) the substance. The removal of the drug from the body can cause very adverse effects. A detox program is usually located within a drug rehab program or addiction treatment center and has as its main focus the management of drug withdrawal symptoms associated with the cessation of drug or alcohol use. Drug detox and alcohol detox programs are where the addiction recovery process begins.
Understanding what detox can do is an important step in the recovery process of beating addiction. Substance abuse detox is one of the early steps required to stop substance abuse and get your life back on track. Once the initial giant first step of seeking help is made, the next step will be detoxing. There are three immediate goals of detoxification:
To provide a safe withdrawal from the drug(s) of dependence and enable the patient to become drug free
To provide withdrawal that is humane and protects the patient's dignity
To prepare the patient for ongoing treatment of his or her dependence
What does evidence-based substance use disorder treatment mean?
Recognized evidence-based substance use disorder treatments—those that have been shown to work—are available and fall into (2) categories: those that focus on behavior (behavioral interventions) and those that use medication (medication treatment)
What does individual treatment and services mean?
Treatment plans and services should be individualized or customized to the results of the youth’s assessment. The treatment environment should be able to provide treatment specific to the characteristics of your youth.
What do I look for in a treatment provider?
As a consumer of treatment services for your youth, you have the right to know details about the organization and any conditions that may affect the quality of treatment and your relationship with the treatment provider. The treatment provider should be willing to share basic details about the history of the organization
How long will they be in treatment and can I see them there?
Length of time in treatment varies greatly, depending upon factors such as funding, duration of disease, length and number of past admissions, patient’s progress and participation, staff’s evaluation, etc. Visitation policies differ from facility to facility, but most include an initial period of “no-contact”, followed by limited visitation, possibly including an “orientation” or “family program” to educate loved ones in the process of addiction and recovery.
Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy is important; involvement of a family member in an individual’s treatment program can strengthen and extend the benefits of the program.
What to expect when a youth is in treatment:
In treatment, youth experience the adjustment of their bodies to the absence of drugs and alcohol. They learn about their substance use disorder and ways to change their behavior in relation to their disorder. They participate in structured activities individually, in groups, and with their peers in treatment. They may attend school, participate in support groups at the treatment location or in the community, and participate in activities with their families at structured times. They have an activity schedule and limited time to themselves. They share a room and have treatment homework, chores, and other responsibilities. As youth adjust to the absence of substances, their bodies will continue to want these substances. They may act out in ways to obtain drugs and try strategies that worked while they were using. They will try to manipulate staff and families with their needs. They may try to run away. These behaviors are part of the youths’ denial of their substance use disorder. Programs will work with youth to help them break through their denial. As youth adjust to treatment and the effects of withdrawal diminish, they can begin to take treatment seriously and change.
Limited communication. To help youth adjust and change, they may have limited contact with families and no contact with friends while in residential treatment. Families should expect that they will have no contact with the youth except at designated times, such as parent workshops and supervised phone calls or sessions that involve both family members and youth. Family members can reduce their anxiety about this separation by participating in self-help groups during this time.
Screening of belongings, mail, or packages. Youth will have restrictions on what they bring with them and what they can receive by mail. The treatment program should thoroughly screen what is brought to treatment and the content of any mail received so that drugs and other prohibited items are not brought into the facility.
What is the family’s role in treatment?
Caregivers and families must prepare to be in the best position possible to support ongoing sobriety during and after treatment. Families should learn about substance use disorders, begin to understand that substance use disorder is a lifelong illness that is not cured during treatment, participate in family activities, and attend Al-Anon, FA, Nar-Anon, or other family support meetings. Caregivers should have an active role in treatment and continuing care planning. They should make sure that mental health services are not neglected and that mental health staff are present and involved in treatment. If a program cannot address the youth’s needs adequately, decisions may need to be made to move the youth to a different program. Keep in mind that caregivers and families may have developed a distorted view of their youth’s needs and experience while dealing with their addicted youth.
What is “Quality of Services”?
The quality of treatment depends on the type of available services, staff training and supervision, and the alignment of the treatment plan with the youth’s needs. When caregivers seek co-occurring treatment services, they need to determine the following:
Is an integrated mental health and substance use disorder treatment approach used?
How are mental health services provided?
Are evidence-based treatment approaches used and with whom?
Are staff trained and certified in evidence-based treatments and co-occurring treatment?
Are licensing and accreditation of the treatment program current (see below)?
Are services available that will address the youth’s needs?
Even though a program may tell you that its staff use specific approaches, the quality or frequency with which these approaches are used may be limited.
Substance use disorder treatment staff often are not trained or certified in mental health services. Mental health staff often are not trained or certified in substance use disorder treatment. This may mean that youth with co-occurring disorders do not receive the services they need or that their unique circumstances are not appropriately addressed.
Caregivers may be afraid to contact their insurance companies about a youth’s substance use problems. They may worry about treatment as a part of their youth’s medical history. If your youth has insurance coverage, accessing these resources is essential. Familiarize yourself with the policy, review information on the insurance provider’s website, and call to discuss coverage. These steps will help you figure out what services are covered, how much time (e.g., number of sessions, length of stay) is covered, what you can afford, and what other resources you may need to support treatment.
What is Act 106?
Act 106 of 1989 requires most group health insurance policies drafted in the state of Pennsylvania, including Health Maintenance Organizations (HMO's), to include these mandated minimum benefits for treatment of alcohol and drug addiction. All treatment services must be provided in a program licensed by the Pennsylvania Department of Health specifically to provide alcohol and other drug treatment. A client advocate is available to help you, free of charge, with getting treatment through your insurance company. Call PRO-ACT's Act 106 Client Advocate at 1-800-221-6333. Minimum Benefits under Act 106: Up to 7 day’s detoxification per year - 28 days per lifetime (Includes hospital or non-hospital residential detoxification) "Detoxification" is a safe way to withdraw from alcohol or other drugs. "Residential" means you stay there all day and overnight.
Minimum of 30 days non-hospital residential rehabilitation per year - 90 days per lifetime
Minimum of 30 full session visits of outpatient or equal partial hospitalization visits (sometimes called Intensive Outpatient) per year - 120 total visits per lifetime
What questions do I ask treatment providers?
How long have the treatment providers existed?
How are they accredited and licensed?
Is there special accreditation or licensing for serving youth and young adults?
What is their reputation?
Have there been any complaints against them?
Are they in good standing financially?
Is their accreditation up to date?
How long have they served youth?
Have they ever had a youth die during treatment?
What about after treatment?
What were the circumstances?
What happens after treatment?
Detoxification and treatment are just the beginning of lifelong management of a substance use disorder. As with other chronic diseases, such as diabetes, people who have substance use disorders must learn how to stay healthy over the long term as they live with their disease. They must apply what they learned in treatment to their everyday lives. In the treatment of chronic diseases, self-management means doing the things needed to stay healthy.
Both the individuals receiving treatment and their families often want to believe that after treatment, they will be able to live their lives without concern about substance abuse again. This is a form of denial. A substance use disorder is a chronic disease. The addiction recovery process takes time and develops over time. The needs of people in recovery in the early stages will differ from what they will need in later stages. A good continuing care plan addresses support at home, in school, and in the community and by medical professionals, as needed, for mental health and physical health concerns to support recovery.
Questions to consider for return home after treatment:
Have I and my family learned new skills to support recovery?
Does the environment at home support sobriety?
Does the environment at school support sobriety? Does the school or school system have a recovery support program or recovery school?
Are 12-step meetings nearby for the youth to attend?
Are 12-step meetings nearby for my family to attend? Have family members been attending 12-step or other support groups?
Which mental health professional will manage mental health needs and medications? Is this person knowledgeable about addiction?
What is relapse?
Relapse refers to the return to using substances after a period of sobriety achieved in treatment or out of treatment. Relapse is a part of the learning process in recovery. The brief use of a substance again (sometimes called a slip) or the prolonged return to substance use (relapse) can help youth understand triggers and the danger of substance use for them. A relapse is not the end of the world, but it can create considerable challenges. Having good recovery supports in place and using these supports to get back to recovery quickly will limit the length and severity of the relapse. For youth with mental health conditions, ongoing treatment and monitoring of these conditions is needed so that their symptoms do not trigger relapse. A youth’s own efforts to control troubling mental health symptoms can lead to substance use post-treatment. Integrated mental health and substance use disorder services post-treatment mean that youth are more likely to have the tools they need to address their mental health needs effectively.
Are the professionals always correct? Should we always defer to their judgment?
No one knows for sure what forms of treatment are the best for the individual. Professionals, however, have the benefit of extensive training and experience. The best case scenario is when professionals, addicts, and family can work as a team.