Start by learning about mental health disorders, addiction, and integrated treatment. Integrated treatment addresses all co-occurring disorders at the same time. You can use different strategies to support a loved one's recovery.
Help your loved one follow all treatment recommendations
Integrated treatment for co-occurring disorders often includes a combination of different services that are tailored to each person's needs. A comprehensive treatment plan may include:
- pharmacological treatment
- individual and/or group therapy
- vocational rehabilitation
- family therapy
- case management
Your loved one may need support in following through with all of these. Following treatment recommendations may be difficult for some people with co-occurring disorders for a variety of reasons, such as:
- they may feel demoralized
- they may be unmotivated
- they may have trouble keeping track of appointments
- they may be skeptical about the value of certain services
- they may minimize or deny one or both disorders
You can support follow-through by
- helping your loved one remember to take all prescribed medications for one or both disorders
- listening to any concerns about medications -- such as their purpose, benefits, and side effects -- and helping address those concerns
- making sure appointments with treatment providers are kept
- working with the treatment team to stay informed and help address any issues related to medication
Encourage total abstinence from alcohol and other drugs
People with a mental health disorder are highly sensitive to the effects of drugs and alcohol. Even small amounts can make symptoms worse and trigger relapses. And the nature of addiction is such that people cannot successfully limit their use of drugs or alcohol, which makes "controlled" use impossible. Staying away from all alcohol and drug use is the safest, most practical choice for people with co-occurring disorders.
You can support abstinence by
- expressing the belief that abstinence is key to recovery
- helping your loved one avoid exposure to others' alcohol and drug use, including staying away from social situations where substance use is common and avoiding substance use with the family
- helping your loved one find and participate in sober recreational activities
- supporting your loved one in developing a social network of sober people who support abstinence
Help your loved one build good coping skills
Stress is an inevitable part of life. Rather than trying to avoid all stress, it is wise to develop strategies for managing it. Everyday life always has its minor stressors, but it can also include major stressors:
- unexpected losses
- starting or ending a close relationship
- beginning a new job
- handling an illness in oneself or another person
- resolving a personal conflict
Coping skills can also help people deal with these issues, and with persistent symptoms of mental health disorder, such as depression, anxiety, sleep problems, hallucinations, or cravings to use substances.
You can help a loved one cope with stress and avoid stress-induced relapses by
- being there to listen, talk, and help your loved one process stressful experiences
- reminding your loved one of the coping strategies for dealing with distressing symptoms or cravings
Reduce family friction and provide social support
High levels of conflict in close family relationships can be unpleasant for everyone. For people with co-occurring disorders, stress within the family can also contribute to relapses of the mental health disorder, the substance use disorder, or both. Social support, on the other hand, can reduce stress and facilitate coping, which makes everyone feel good.
You can reduce tension and be supportive by
- developing good communication skills that minimize tension and maximize constructive support
- being flexible and resourceful in the face of problems
- letting one another know how much you care
- spending positive time together that is rewarding for everyone
Encourage participation in peer support groups
People with co-occurring disorders can benefit from peer support organizations such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Some peer support groups are specifically for people with co-occurring disorders, such as Dual Recovery Anonymous (DRA).
Other groups address particular mental health disorders, such as the Depression and Bipolar Support Alliance, Obsessive Compulsive Anonymous, Social Phobics Anonymous, and Schizophrenics Anonymous. [links to all]
Encouraging a loved one to get involved in a peer support group is an important way of supporting his or her sobriety. You can facilitate peer support participation by
- going "meeting shopping" with your loved one: attend meetings of several local peer support groups to help find the right one(s) for him or her
- adjusting the family schedule to support regular participation in these meetings
- learning about the philosophy of the peer support groups(s) your loved one is joining, so you can support its language and concepts in daily life
Help your loved one create a sober peer network
Recovery from addiction means major lifestyle changes for your loved one, including choosing friends. Achieving and maintaining abstinence means less time spent with people who use alcohol or drugs, and more time with people who support sobriety. This takes time, but in the end, it results in better, more rewarding relationships.
You can help a loved one build a sober peer network by
- encouraging the person to reconnect with sober friends
- directly reconnecting with sober friends you share with your loved one
- asking about and discussing ways to meet potential sober friends
Know the signs of relapse
Mental health disorders and addiction are episodic; relapse of symptoms or of substance use can happen periodically. These relapses can disrupt not only your loved one's life but also the lives of other family members. Know the early warning signs, and have a plan for addressing them if they appear.
Awareness of "red flags" may take some care and thought. The warning signs of a substance use relapse are often different from the signs of a psychiatric relapse -- and those signs depend on the specific diagnosis. Moreover, each person's signs of relapse are unique.
You can help prevent relapses or minimize their severity by
- knowing your loved one's early warning signs of relapse
- monitoring your loved one to detect possible warning signs; keeping your eyes open and noticing changes
- developing a family plan in advance, together with the loved one, for responding to the signs of a possible relapse or an actual relapse
- involving other important people (such as treatment providers) in making a relapse prevention plan
Support your loved one's involvement in meaningful, structured activities
Everyone has a need for meaning and a sense of purpose in their lives. Work, school, parenting, community involvement, participating in a cause or charitable work -- these can provide a sense of purpose.
However, co-occurring disorders can disrupt involvement in such activities. Addiction or a mental health disorder may have become the center of your loved one's life. Regaining and developing these meaningful activities can help motivate your loved one to stay sober and manage his or her mental health disorder.>
You can support a loved one's involvement in meaningful activities by
- asking your loved one, "What kinds of activities have meaning for you? What roles would you like to take on in your life?"
- encouraging your loved one to pursue involvement in work, school, or other personally important roles right now -- not waiting until other problems are "solved"
- letting your loved one know that personally important and meaningful goals are achievable, despite the co-occurring disorders and any previous setbacks
Keep hope alive
Above all, family members play an invaluable role in helping their loved one keep hope alive. Change is possible.
Every person with co-occurring disorders is capable of living a worthwhile, stimulating, and rewarding life. Family members can offer support by firmly believing in their loved one's inherent capacity to get better and create the future life he or she wants. Such hope can be powerful medicine. It can fuel the person's efforts and determination to take control of life and enjoy its rewards.
These strategies are excerpts from a handout in the Family Program component of the Hazelden Co-occurring Disorders Program.