Category Archives: Better Mousetrap

Helping addicts stay the course

8 ways leverage works to improve outcomes

Today’s topic could be called “Why We Love Leverage.” That’s because we use it for many purposes, including compliance with treatment recommendations, signing releases, and drug testing. As mentioned in past blogs, programs for substance-dependent physicians use leverage for similar purposes and achieve spectacular results when compared to other approaches.


To refresh: A high percentage of people who need treatment do not believe they need it and do not perceive themselves as having a problem with alcohol or drug use. Therefore, they are resistant to being forced into treatment. Adopting a leverage-based approach allows the family, working with their professional, to adopt a long-term strategy to address the addiction, including chipping away at the self-perception problem over many weeks, if not months. Continued pressure provides situations for the addict to develop insight into the disease over the stages of recovery.


Currently, no treatment center offers the medical board model to non-physicians, so we adapt and modify their model. Here’s why leverage is needed and how it works.

1. To help the addict complete the stages of recovery.

A recent article in a professional addiction journal discussed the developmental approach to recovery and the six stages to achieving stable remission[1]:

  • Transition – Recognition of Addiction
  • Stabilization – Recuperation
  • Early Recovery – Changing Addictive Thoughts, Feelings and Behaviors
  • Middle Recovery – Lifestyle Balance
  • Late Recovery – Family of Origin Issues
  • Maintenance – Growth and Development

In our experience, this is a two-to-five-year process, depending on the progression of the disease, severity of use, and co-occurring conditions (trauma, abuse, learning, mental health, etc.).


Leverage becomes especially important in the second stage.


Stage Two: Stabilization – Five Tasks to Facilitate[2]:

  1. Achieving recovery from withdrawal.
  2. Interrupting active preoccupation.
  3. Creating short-term social stabilization.
  4. Learning non-chemical stress management.
  5. Developing hope and motivation.

These stages take much longer than 28 days, which is why leverage needs to be maintained over many months – and also why relapse is so common: Addicts leave treatment without being stabilized. (By the way, did your loved one’s counselor ever tell you where s/he was in the recovery process? I think not!)

2. To allow time for converting external motivation to internal motivation to recover.

Therapeutic leverage to enter treatment and comply with post-treatment recommendations is needed because it is very difficult for people with substance dependence disorders to change harmful behaviors on their own.[3]


The goal is to maintain pressure until the person develops sufficient internal motivation to want to remain abstinent and active in a program of recovery on his/her own volition.


Internal motivation to recover is a much stronger indicator for success than external pressure. However, because the degree of internal motivation is measured by acts and attitude, rather than talk and intentions, it takes time for internal motivation to “kick in” and show itself – again, usually more than 28 days, especially after relapses.


To be effective, leverage must be used with sophistication and discretion and is much more a carrot-and-stick proposition than raw force. For the affluent, leverage comes from controlling money, participation in family businesses, access to family resources, and relationships. Leverage is most effective if senior family members, trustees, or others in positions of power support its use and are united when dealing with an addicted family member.

3. To obtain full releases of information.

One key element in recovery is open communication among the substance user, treatment center, and key players in the addict’s life. Substance dependence lives in secrecy, with the person often leading a double life and understating the amount and number of drugs, when caught. Insisting on being informed on treatment of your loved one’s disease is not only good practice but sends the message that your relationship is now different.


Leverage is an effective tool for encouraging an addict to sign releases. It is indeed more than ironic that so often families pay for treatment and then a wall of silence is erected based on confidentiality laws.


Affluent patients often will sign only partial releases and withhold information about post-treatment recommendations if the recommendations defy the patient’s wishes. One way to counteract game-playing by addicts regarding the scope of the release is to request the treatment provider to send a copy of the signed release to the professional hired by the family, who will understand any limitations in the document.

4. To encourage signing recovery contracts.

These contracts specify activities the addict will engage in when leaving treatment, such as counseling, drug testing, meeting attendance, etc. It usually includes a relapse plan and an agreement to sign releases of information for all therapists, who must be approved as addiction specialists. In exchange, the contract specifies expectations regarding support by the family or trustee for recovery activities and lifestyle.


If the person leaving treatment does not agree to the contract, the family can refuse to support him/her or provide minimal support, depending on their level of comfort.

5. To encourage long-term compliance with all treatment recommendations.

Failure to comply with treatment recommendations is the No. 1 cause of relapse. If a person had cancer and all they had to do to recover was follow treatment protocols, they would do so without fail.


Substance-dependent people – who also have a chronic disease where there outcome is death or disability – commonly ignore advice from professionals and go back to their old ways. Leverage encourages long-term compliance.

6. To require effective and comprehensive drug testing.

This should not even be up for discussion, given anyone’s history with an addict. Not only is it very wise to condition support and access to family resources on regular, observed, full-screen tests (because addicts lie), but testing helps keep loved ones on the path to recovery because they know they will be caught if they use.

7. To allow early intervention in the event of relapse.

When combined with drug testing and a written agreement as to what to do in the event of relapse, leverage provides for fast intervention before a relapse gets out of hand.


One problem with people who relapse is they can do so for some time before others become aware of it. Then, they deny it happened, and if proof exists, claim it was a one-time occasion. This is why drug testing is so important: It is undisputable data regarding use. And it allows for quick interceding before relapse becomes embedded.

8. To increase consequences of use to make the disease real.

One major block to recovery for affluent, substance-dependent people is that they suffer few external consequences from their use of drugs and alcohol. Research shows that the more consequences a person experiences, the more likely they are to take their disease seriously and take action to abstain and recover. For the affluent, a key challenge is figuring our how to recover without losing everything.

Making the disease more real

By using leverage to accomplish the goals in topics one through eight, we are in effect Creating Consequences™ by making the disease more real: Drug testing, recovery contracts, and treatment compliance create accountability and require action upon leaving treatment. Along with the written plan in the event of relapse, it means that if the addict returns home and takes it easy – does nothing much regarding further efforts at recovery – there will be consequences. The hard work begins after leaving treatment, and leverage provides the foundation to encourage continued progress towards stable recovery.


[1] Recovery From Addiction, A Developmental Model, Part One, It’s All in the Journey, Sept. 2008, p. 8.

[2] Ibid, p. 12.

[3] Satel, Sally, M.D. 2006. “For Addicts, Firm Hand Can Be the Best Medicine.” The New York Times, Aug.15.

A myth is that the addict must be motivated to quit – that, as it is often put, “You have to do it yourself.” Not so. Volumes of data attest to the power of coercion in shaping behavior. With a threat hanging over their heads, patients often test clean.

Goodman and Levy. Biopsychosocial Model Revisited. p. 3.

Chemically dependent patients, free of co-existing mental illness, with intact jobs and family, tended to do well in rehabilitation programs if families and employers applied therapeutic leverage and support.

Susan Merle Gordon. Relapse & Recovery: Behavioral Strategies for Change. Caron Found. Rept. 2003: p. 18.

Internal motivation is a more powerful predictor of recovery than external motivation. Moving from external motivation to internal motivation is a long process. Therefore it is critical for external pressure to continue until this transition is fully underway, if not complete. The failure to follow this advice is a major cause of relapse (paraphrased from report).

Chuck Rice. “Impaired Lawyers Overcome Denial, Stigma to Achieve Road to Recovery.” Hazelden Voice. Vol. 9, No. 2. Summer, 2004.

My experience with attorneys tells me that long-term outcomes are dramatically improved when lawyers can be monitored and when there is an accountability system with a fair amount of external support.

Alan I. Leshner, Former Director, National Institute on Drug Abuse. National Institute for Mental Health. Science and Technology. Spring, 2001: p. 2.

Treatment compliance is the biggest cause of relapses for all chronic illnesses, including asthma, diabetes, hypertension, and addiction.


Alternatives to leverage

Other models to encourage change when facing addiction


As anyone who has turned to the Web and typed in “addiction treatment” knows, there is an ever-growing number of options that promise a cure. These range from doing nothing, to medication management, to insight therapy. The wide variety of methods may puzzle the reader who wonders why there are no “best practices” or a commonly agreed-upon professional approach to treating addiction.


The reasons for this lack of standards are threefold:

  • Unlike other areas of medicine, claims for success are completely unregulated by the FDA, FRC, or health department. So it’s a buyer-beware, anything-goes market.
  • No established criteria exist for evaluating treating outcomes.
  • Most addicts do not want to stop and so go to treatment that lacks rigor or effective protocols, despite marketing claims to the contrary.

In fact, there is a best-practices model, and that’s the therapeutic leverage approach (modeled after the physicians’ program), which we described in last week’s blog.


That blog also briefly reviewed the accepted medical view that addiction is, in part, a disorder of the autonomic nervous system where the urge to use occurs at the unconscious, limbic level. That’s the “loss of control” addicts experience over how much and when to drink or take a pill. We also discussed the lack of motivation to seek help and remain treatment-compliant for the many months needed to achieve stable sobriety.


So in thinking about other approaches, consider how they address these hallmarks of addiction:

  • lack of control at the unconscious level, and
  • lack of perception and motivation to seek help and comply with treatment recommendations.

Then evaluate how each one manages these concerns in comparison to the leverage model.

Doing nothing

Waiting until the addict wants help

Many families prefer not to use coercion (leverage) because they fear a negative response from the addict or want recovery to be the addict’s “choice.” However, because the addict’s disease results in the compulsive and harmful use of alcohol or drugs (see above), you will be waiting a long time for this “choice.”


Here is what a leading authority has to say:


A myth is that the addict must be motivated to quit – that, as it is often put, “You have to do it yourself.” Not so. Volumes of data attest to the power of coercion in shaping behavior. With a threat hanging over their heads, patients often test clean.

Sally Satel, M.D. “For Addicts, Firm Hand Can Be the Best Medicine.” The New York Times, Aug. 15, 2006.


Even after explaining how we apply the physician model to other groups and their success rates, some parents are reluctant to use pressure, saying,


“My son/daughter will be so mad, s/he will never talk to us again.”


Anger and rejection are transitory threats made by the addict to preserve the status quo. A good counselor will help you manage these responses (and take some of the heat).


Without leverage, all the love in the world will not sustain recovery. (By the way, we do advise using leverage or the implied threat of leverage in a respectful and loving manner.) But doing nothing and waiting for a serious enough consequence is not an option. The risks are too great.


‘Letting go’

Common practice from Al-Anon, therapists, and counselors is to tell family members and their advisors to “let go” and not try to affect or “control” an addict’s use or recovery. This is not a successful recovery model because the addict is often suffering serious economic, emotional, and physical harm, with the attendant damage to family members, particularly children.


For the affluent, dangerous use can go on unabated, with few consequences, until late-stage alcoholism, overdoses, or nonstop use.


In our view, letting go or waiting for the addict to choose to enter treatment is, in fact, neglect because addiction – by definition – is loss of control over the decision to drink or drug.


Letting go does not honor autonomy because, at some point, the autonomic, unconscious part of the brain will override any vows to stop.


As one beneficiary said to me, “How come nobody tried to help me when they could see I was way out of control?”, after 20 years of hard use. 

Medication management

Craving-reduction medication

Naltrexone is an anti-craving drug designed to help alcoholics reduce their alcohol use and to prevent relapse. It can be helpful, but only as part of a comprehensive recovery program; it is not sufficient on its own to lead to stable recovery. If used, it needs to be combined with effective treatment.


Substituting one drug for another

Several well-advertised treatment programs substitute benzodiazepines (e.g., Xanax and Klonopin) for alcohol and hard drug use. These prescription medications are known as “alcohol in a pill” and users are simply swapping one addictive substance for another.


Similar considerations apply to “herbal remedies,” such as ayahuasca and rue seed, which are touted to cure addiction but affect the same areas of the brain as other hard drugs.


Suboxone is given as an alternative to opioids, such as OxyContin, because it results in a lesser high and stays in the body longer. Similarly, methadone is prescribed as a substitute for heroin. The problem is that users are just as dependent on the substitute drugs and will usually return to their former drugs when available. Another huge concern is that there is a large resale market for the substitute drugs because prescriptions are loosely monitored.


Anti-use medication

Drugs such as Antabuse have been used since 1951 to help people stop drinking by making you sick to your stomach if you have a drink. If you know you can’t drink, then you won’t think about drinking as much. This is an example of an external control designed to remain in place until the person develops sufficient internal motivation to achieve recovery. The problem is that many people on Anatabuse stop taking it or drink while on it and never reach the next phase.

Insight-based therapy vs. stopping the addiction first

Some therapists and treatment centers believe the addict needs to resolve the underlying conditions (i.e., the mental health, social, or other factors) leading to addiction before recovery can take place.


This belief is completely incorrect, not supported by research, and views addiction as a disease secondary to the underlying issues.


Addiction is a primary disease that needs to be addressed first, in that the addict needs to be detoxified and in the first stages of recovery before delving into the “drivers of addiction.”


I know addicts who see their psychiatrists two or three times a week for years and never stop using drugs. (Nothing better than an addict with money to keep on paying for therapy!) Addicts will give 100 reasons why it’s hard for them to stop and claim that if they can just get them resolved or gain more insight, the problem will be solved. This is all part of their smokescreen to keep on using.

Moderation management

This approach is designed to help people reduce their drinking (or drugging) to a manageable level where they are no longer binging. The goal is to still enjoy a beverage or a pill without the hangover or negative impact on work or relationships and to socialize without the stigma of being a non-drinker or – God forbid – an alcoholic.


If a person truly has a substance use disorder and the attendant brain change, it’s nearly impossible to exercise the control needed to maintain reduced use. This means at some point, there will be a return to prior use levels and that can be very dangerous, depending on when and where it happens.


Let’s face it: People drink to get a buzz on. So it’s no fun only to have a drink a day. (Or maybe it is, depending on the size of the drink.) Many “restrictors” are unpleasant to be around because their bodies “thirst” for that next drink, and the amount of willpower needed to stop at one makes them angry and bitter (i.e., “Why did God take away the only pleasure I had in life?”).

Assessment/evaluation model

This model is based on the idea that there is unsettling conduct, behaviors, or emotions on the part of the loved one, but uncertainty as to what may be the cause. So the person of concern is asked to obtain an evaluation or assessment – either outpatient or inpatient – to get a better picture of what is going on. Great idea, but your loved one has to agree, and then there is the debate about the type of evaluation, where it should be held, and who will be sent the results.


This segues into another phenomena: the addict who goes to treatment intending to stay awhile and then being “discharged” before completion, either due to disruptive behavior or leaving AMA. The addict is changing the attitude of his/her parents by ostensibly complying with their wishes but really is only going through the motions, with no intention of doing the internal, emotional work that recovery requires.

Drug testing

The success of all of these models is dependent on addicts being truthful about their use. As addicts lie, the only way to know what drugs are being taken is through drug testing with a competent service. Most users these days are taking multiple drugs but may only admit to one or two less-serious ones – alcohol and pot, for example – when they are also on benzos and ecstasy. Drug testing is a change technique in that it provides information about what is really going on, so the family and the user are on the same page. Also, drug testing, when combined with these various models, should lead to better results – either showing the need to intensify efforts or move to a more leveraged approach.

None as successful as leverage

None of these strategies is as successful as the leverage-based physicians model. Without the help of family and friends, the addict will continue to suffer as the disease progresses.


For families, the options are not leverage or choice – they are leverage or neglect.


Your addict needs encouragement to seek help, and this requires working with a qualified counselor to strategize and create a plan to address and manage the disease over the long term.


Our next blog will detail the benefits and fine points of using leverage.

When addicts say no

Using therapeutic leverage to encourage change and promote recovery


When alcohol and drugs assume a life of their own and begin to influence and, at times, take control of the behavior of the user, family members and advisors wonder how best to respond. The simple answer might be, “Why not ask them to stop?”


But anyone familiar with a substance user knows this request is very likely to be ignored or objected to (sometimes vehemently). The concerned person who is rebuffed or too afraid to ask the question faces three major challenges:


  • Understanding what is going on in your loved one’s brain.
  • Lack of motivation to change his/her behavior.
  • In the face of resistance, deciding on the most effective option to encourage the addict to seek help and be successful in recovery.


This blog will briefly discuss these challenges with an emphasis on why we much prefer “therapeutic leverage” to encourage addicts to seek help, versus other commonly-used approaches. As one parent wrote about her young adult child:


And the truth is without mom and dad forcing change, as some point either the law will force change, or tragically life will.[i]


This the stone cold truth – it is reality in world of addiction. And the purpose here and in the next few blogs is to talk about leverage and compare it to other, less-effective approaches.

Understanding the disease concept.

The first thing those dealing with a substance user need to remember is this:

  • It’s not your loved that is rebuffing you, it’s the disease.

With brain scans, we now understand addiction as an “automatism” – a disorder of the central nervous system partially located in the limbic system – the fight-or-flight area of the so-called primitive brain, which tells itself “I need this substance to survive.”


The intensity of the reaction to any request to stop is directly related to the limbic system’s commitment to the drug or drink.


This commitment to use can be for several hours a day, on weekends only, or two-to-three days a month. It’s not the frequency of use – it’s what happens as result that matters.


In order for the limbic system to become less reactive, an addict must abstain from mood-altering substances and learn new responses to the desire to use. This means in discussing change strategies, the idea is to look at the model(s) that provides the best opportunity to achieve abstinence in the long run. (If you, the reader, do not buy into the disease concept, you have an obligation to present credible alternative scientific evidence to support your view.)

Lack of awareness on the part of the addict.

One major hurdle is what we call the “self-perception” problem. A high percentage of people who need treatment do not believe they need it. They do not perceive themselves as having a problem with alcohol or drug use and are resistant to being told they need help or to seeking treatment. For example:


Of the young adults who needed but did not receive substance use treatment in a specialty facility in the past year, 96 percent did not perceive a need for treatment. Of the 4 percent of the young adults who did perceive the need for treatment, less than one-third made an attempt to get treatment.


This holds true even if there is a crisis that outside observers consider to be overwhelming dependence on alcohol or drugs: DUI, low grades or dismissal from school, car accidents, failed relationships, or a consistent pattern of binge drinking.


The addict’s inability to see the need to change is one of the core conditions that an effective approach to encourage the person to seek help must take into account. Addicts are not merely in denial, they are delusional because of lack of awareness regarding behavior or attitudes. Therefore, any change strategy must focus on chipping away at the self-perception problem – the delusion that the addict is fine as-is and you are the problem.


This can take weeks and continues on even after entering treatment. For example, merely because someone agrees to seek help does not mean they fully understand what they need to do to recover – the “learning process” is ongoing. Addictions are different from other illnesses in that the degree of effort is greater for recovery, and it requires a unyielding determination to remain abstinent no matter what.

Choosing a change model.

While there are a number of different approaches used in the treatment field, we firmly believe in the leverage model used by medical boards for substance-dependent physicians because its results are spectacular when compared to other approaches. Let’s look at the numbers:


“The research showed that 78 percent of 904 doctors in the studied programs completed an average of 7.2 years of monitoring without relapse. …

Those are just over-the-top numbers for a chronic, progressive disease that kills people.” – Dr. David Carr, Director, Mississippi Physicians Health Program


Seventy-eight percent rate of continuous abstinence at seven years!


These results are much better than those for other programs. (And the data is reliable because it is based on regular drug testing overseen by medical boards, rather than self-reporting or very small, restrictive samples, as is the case for success rates reported by other programs.)


One reason for their very good outcomes is that medical boards use the license to practice medicine as leverage or pressure to assure that physicians comply with treatment recommendations, including post-treatment plans and reliable drug testing for two or more years.


“A skeptical argument often goes that physicians are a special case because the threat of losing a lucrative profession they have worked so long to pursue gives them extra motivation to stay sober.


But Carr believes most everyone has something similar in their life that they value, and that is what the treatment system must identify and tap into.


The plumber has a good job and doesn’t want to lose it,’ he says. ‘Or he’s got a great wife.’


Carr says the field needs to analyze what it is providing to groups such as physicians and airline pilots but not to others. Then it can determine how to overcome barriers to a more widespread application of a treatment model that is based on accountability.”


Our goal, then is to identify and tap into what the addict values and does not want to lose.


Finding and using leverage points.

Parents, family leaders, trustees, and business owners need to find pressure points to encourage their addicts to enter treatment and comply with post-treatment recommendations, via either explicit or non-explicit leverage.


  • Explicit leverage includes using continued employment, access to funds, and professional licenses as incentives for compliance.
  • Examples of non-explicit leverage include requests to seek help, embarrassing social incidents, and school or employment failure.


Non-explicit leverage is far less effective because it does not provide enough pressure for the addict to engage in recovery activities long enough to sustain stable abstinence.


Using leverage to encourage compliance with treatment recommendations over many months helps make the disease “real.” People with few external consequences – especially those with wealth, status, and power, who are immune to the Average Joe’s “rock bottom” – begin to recognize they do have a problem, particularly when there is accountability and drug testing.


Why leverage works

The primary goal of applying leverage is to modify behavior by encouraging the addict to seek effective treatment and follow post-treatment recommendations. The pilot and physician model is, in essence, forced behavior modification in which the addict is required to engage in recovery activities until they internalize the desire to remain sober.


Internal motivation is a more powerful predictor of recovery than external motivation. Moving from external motivation to internal motivation is a long process. Therefore it is critical for external pressure to continue until this transition is fully underway, if not complete. The failure to follow this advice is a major cause of relapse. (Paraphrased from report.)

Susan Merle Gordon. Relapse and Recovery: Behavioral Strategies for Change. Caron Foundation Report. 2003: p. 18.


As noted in a New York Times article, “The Secret of Effective Motivation,” internal reasons for remaining sober are far more conducive to success. Therefore helping people focus on the meaning and impact of their new life without drugs or alcohol is one of the primary goals of treatment, beginning with initial detoxification and continuing on as a life-long process. We cannot stress enough how important it is to maintain pressure until the addict is motivated to recover for the sake of recovery, and not for the benefits of doing so – or the punishments for failing.


Leverage is a strategy to obtain compliance – it is not treatment.

Leverage is not treatment. It is a technique to get the addict to enter treatment and stay in recovery. So you have to find treatment centers who support your use of leverage and has an abstinence-, 12-step-based program that respects and treats the individual clinical needs of your loved ones.


In upcoming blogs, we’ll discuss other aspects of leverage as well as other approaches to treatment and recovery and why we believe these fall short of the therapeutic leverage model.


[i] Lynn Benson, Star Tribune 8.6.11

Return to reality – Now what?

Smoothing the transition from treatment to daily life

For almost all families, 28 days in treatment passes far too quickly. It seems like you’ve just breathed a sigh of relief that your loved one is safely stashed away, and bang! It’s discharge day!


Now the hard work of recovery begins.


Contrary to popular belief, 28-day inpatient treatment at a center is not a cure for addiction. In fact, it’s only the beginning of the hard work of recovery. The hardest work – and the biggest barrier to sustained sobriety – is in transitioning back to daily life. Many recovering addicts and the people who love them forget this fact – or have never been told – and assume that life will return to the way it was “pre-problem,” now that the problem is “fixed.”


But the worst thing you can do is act like nothing has happened. Addiction is powerful. It changes – and damages – important relationships. But recovery is equally as powerful in its capacity to transform individuals.  Life, as you once knew it, is over. Everyone involved must be prepared to support post-treatment recovery and rebuild relationships.


Let’s look at some of the questions and challenges our clients and their loved ones raised with us, when adjusting to the “new normal” life after treatment.

For the addict

What to say to people who know they went to rehab.

  • Anxiety and discomfort about facing their loved ones now that their chemical dependency is out in the open.
  • Not knowing how much to disclose and whom to disclose it to. There is a tendency to overshare because part of treatment is talking to peers about using behavior.

What to say to people who thought they were on vacation.

  • Anxiety and discomfort about facing their loved ones if the reason for their absence was not fully disclosed to everyone. In treatment, the addict is taught they have a disease, but almost all people have shame over both their inability to control their use and conduct while using.

Concern about being judged, stigmatized, and labeled.

  • This is real, which is why attending support groups is important because everyone there has the same problem. Support groups offer a concrete way the person in recovery can rebuild self-esteem.

An unrealistic expectation that they can immediately repair past damage to relationships.

  • A good therapist, recovery coach, or sponsor is needed for advice.

Is there a support system in place before your loved returns from treatment?


An unhealthy desire to hit the ground running and to prove themselves.

  • This common problem can easily lead to relapse.
  • Setting up a schedule is a good way to prevent work from becoming the new “ism.”

Concern about social and work functions that involve alcohol.

  • Support is needed to skip all non-essential functions and to take a non-drinking partner if attendance is required.

Are you prepared to refrain from drinking in front of your loved one and taking the alcohol out of your house?


Embarrassment about needing to prioritize recovery.  

  • These feelings reflect the addict’s shame. Be a positive supporter of putting recovery first.

For the addict’s friends and loved ones

Confusion about how to support the individual.

  • Ask! This is an ongoing and evolving concern that is often best talked out with a skilled addiction counselor or recovery coach.

Uncertainty about trusting them.

  • One advantage of regular drug testing is that it increases the confidence level for family members and helps deter use.

Who is going to “bell this cat”?  Will the treatment center, your addiction specialist, or you initiate this conversation?


Lingering emotional wounds or unprocessed resentments from past behavior.

  • These are not going to simply evaporate through superficial “forgiveness sessions” at a family program.
  • Wait for stable recovery to take hold before bringing these up with your loved one (preferably with a counselor present).

Reservations about including them in social functions where alcohol may be served.

  • Brain scans show environmental “cues” can trigger urges, so this concern is valid.
  • Why take unnecessary risks? Options are to give a pass, suggest you all go to an alternative activity, or if it’s a must-attend, you refrain from drinking as well.

Lack of education/understanding addiction as a disease concept.

  • You don’t know it all after a few days at the family program.
  • Ongoing education about the disease is a high priority to avoid mismatching expectations and reality.

Unrealistic expectations that the individual is cured.

  • You need a good grounding in the stages of recovery; this takes many months.

Yes, there are different markers for progress, do you know what they are and what level your loved one is at when leaving inpatient?


Concern about how to cope in the event of a relapse.

  • This should be addressed during inpatient treatment.

Is there a written relapse plan in place?

Picture this!

Remember seeing the ad where the high school kid with cancer has a bald head and all her friends shave off their hair to show solidarity? Well, keep that image in mind. We are all in this together.

Plan ahead!

A common theme is that this transition can be smoothed with thorough preparation and planning. Having a solid, workable, well-informed, and practical plan in place before someone returns from treatment can substantially increase the likelihood of successful reintegration.


The plan should address the needs and challenges of both the family and friends and the returning individual, keeping in mind that mismatched expectations are common but avoidable through clear and open communication of the issues faced by both parties.

Professional help

Above all, find a qualified addiction specialist for support – someone you can call with questions and can help you prepare a recovery plan and contract.


For additional information on putting a plan in place for post-treatment recovery, see the following articles:

Case Management for Families Dealing with Addiction Recovery: Dual-Track Method

Financial Managers and Dysfunctional Clients