Co-Occurring Disorder Series: Understanding Depression and Substance Use Part 3: Helping Those We Love
In this final article on working with individuals with both substance use disorder (SUD) and major depressive disorder (MDD), I would like to take some time to talk about the often neglected part of treatment: helping the friends and family of the person in treatment. Sometimes helping the individual in treatment recovery is done by helping everyone get on the same page on ways to support, help, and tolerate said person. Sometimes their loved ones are really the people in need of the support. And sometimes it also requires change, which is the hardest part of this process.
To start with, I feel I need to lay down some ground rules for this process, or at least some clarifications, again, so that everyone is on the same page. To the friends and families I wish to say clearly: you are not responsible for your loved one’s substance use. Unless you were holding a gun to their head and telling them to use or die, you are not responsible. That does not mean that things were not done to encourage, aid, or ignore the person’s substance use; this can happen in the subtlest of ways, like calling in sick to work for them when they are hung over or loaning them money when they come to you for help. Looking at that behavior and changing it is one of the first things that will likely happen in treatment.
Next I want to again say very clearly that treatment is hard. Coming to terms with a co-occurring disorder can be very scary on many levels. There are many, many success stories about people turning their lives around, so it is not impossible by any means. But it is hard and that is where you come in. This is a team effort. Much like there are several different types of human service workers coming together to help an individual in a treatment program—like a therapist, psychiatrist, or social worker—the team needs your help as well. Your loved one needs your help as well, even though they may be right now the most unlovable.
One last thing to clarify is the need to know when to say when. This could be the hardest thing of all. I am not saying know when to give up on your loved one. No one wants to do that ever. But you need to have an honest discussion with yourself, other family, your loved one in treatment, or others who have been there before you, about the set boundaries of your support. You have to establish when it is time to say enough and withdraw support until such a time as the person in question is willing and able to be an active part of their treatment. You need to take care of yourself/yourselves first and foremost; without that, you can be no help to anyone else.
Steps to Take
First thing that is important is self-care, as I just said. What that looks like depends on what works best for each individual. Statistically, the more support a person has in his or her life, the greater the chances of positive outcomes, be it in treatment or in supporting someone in treatment (SAMHSA, 2016). So looking into therapy may be a good thing to explore, as well as finding a good counselor for both support and further understanding into what was healthy and helpful, and what was unhelpful. It may just be a place to go and scream in frustration once a month, but even that can help. The other thing that I encourage people to look into is al anon. Al anon, for those who have not heard of it, is the support group and self-help program for the friends and family members of addicts and those in an AA program. It is the program for loved ones to come together in a support group format to support and listen to each other, and to provide suggestions and experience to others going through similar situations. Much can come from listening to others who have “been there, done that,” so-to-speak and also from having a safe space to share concerns and frustrations. Now al anon groups, like AA groups, are all self-run, and each group is a little different based on personalities in there. This is important to note because if one group does not fit, there may be another group that fits for each person involved. Do not give up if there is a bad experience, but try another group if there is one available.
The next thing I encourage loved ones to do is take time to go with the person in treatment to meet their support persons (psychiatrist, therapist, etc.). Take the time to learn about the disorders with which they are dealing, the treatment plan, and the contingency plans for what to do when they feel relapse urges, because that is normal and it happens. Understand how to help support them during depressive cycles. Get to know this person and put a face to them. And do not be afraid to reach out to them should the need arise; there may be limits on what they can say, but there is nothing preventing you from telling them anything.
Lastly, learn. Learn what you can about these diseases. Learn what triggers a person to relapse, both for substances and for depressive episodes. Learn what the plans are for when your loved one struggles. And also, learn what limits you want to put in place with regards to your loved one’s behavior. No one’s life is going well when they enter into treatment, which is a given, and they may have burnt, or come close to burning, all the bridges they have. For the loved ones, I encourage you to learn what your limits are for what you will do and will not do to help out this person. Then set clear limits and consequences for if they are broken and communicate that clearly with the individual in treatment. If this feels too hard, it may be a good idea to talk to their therapist about it and secure help in doing so, which again says why you will want to talk with them. Lastly, stick to these limits. It will likely feel awful and be difficult, but sometimes that needs to happen before an individual at risk can take an active part in their own recovery.
I have talked extensively about people with co-occurring disorders, specifically SUD and MDD. While I will talk more at length about some other disorders, I do want to make one thing clear to everyone reading this: do not ever forget that they are people too, and when they are at their most unlovable is sometimes when they need love the most. Friends and family members suffer as well during these difficult times. Do not forget to care for yourselves.
Substance Abuse and Mental Health Administration. (2016). Recovery. Retrieved from https://www.samhsa.gov/find-help/recovery