Motivate a family member or a friend to seek professional help to kick the substance use disorder, and maintain recovery by relapse prevention.

1. Help your family and friends get off
drugs and or alcohol.

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3. Table of Contents
 Introduction and definition of Addiction.
 Stages of Addiction.
 Physical, social, and other clues to addiction.
 Definition of the problem.
 What to do, and what not to do.
 5 A’s ( described later)
 Expectations of a solution.
 Resources, and creating a team.
 Stages of recovery as outlined by Prochaska.
 Treatment options.
 Recovery goals, and tools.
 Relapse prevention.
 Lifelong treatment.

4. Introduction: drug addiction is not a simple problem. It
is a very complex problem with many causes and
solutions
 No one sets out to be an addict/or an alcoholic- it is a journey.
 Sometimes it is a misguided attempt to deal with painful issues.
 Stress fuels addictive behaviors.
 There Is no fast or easy solution.
 You need a lot of planning, effort, and continued lifetime support.
 It is a complex problem with multiple causes and solutions.

5. Substance abuse is a common and
complex medical brain disease.
The life you save may be your own, or a
person that is very important to you.

6. Stages of Addiction
 Initiation-First time introduction to the drug or alcohol.
 Experimentation-trying the new found substance.
 Regular Use- it becomes a pattern with a need for a larger amount of the drug
by building up tolerance.
 Risky Use or Abuse-dangerous behavior drinking and driving.
 Dependence-the person gets sick if they do not use the drug.
 Addiction it is the person’s preoccupation in procuring, and using the drug in
equal or increased preference to daily food and nourishment.
 Crisis/ Treatment.

7. Prepare a plan.
 Educate yourself on the process of Addiction.
 Offer your support and help.
 Make an appeal for a change, and a better life.
 Meet the person at their stage of Addiction.
 Do not fund the use of drugs.

8. Problem identification: HOW TO TELL IF
THEY HAVE A PROBLEM.
 BEHAVIORAL CLUES.
 PHYSICAL CLUES.
 SOCIAL AND OTHER CLUES.

9. Behavioral clues: What to look for-
 Lies about the use of money.
 Drugs use or the use of beer in the morning to get through the day.
 Sudden changes in behavior or mood swings.
 Withdrawal from family members, family gatherings and social events, and other friendship groups.
 Carelessness about personal grooming.
 Loss of interest in, sports or other favorite activities such as hobbies.
 Neglect of responsibilities.
 Complains about drug use.
 Lies about using drugs.
 Brags about getting drunk or about drug exploits.
 Goes only to high volume liquor parties.

10. Behavioral clues continued:-
 Mood swings-jovial quickly turns into grouchy.
 Careless about personal hygiene.
 Unkempt appearance and /or out of season clothing.
 Irritability and agitation for no reason.
 Lack of motivation- depression.
 Neglect of regular duties and responsibilities.
 Neglect of self care- dental care ( one of the earliest and most consistent
clues)
 Socializing with drug abusers and alcoholics.
 See drugs as a solution instead of the problem.

11. Physical clues:-
 Pupils that are smaller or larger than normal.
 Looks different that usual.
 They may even have an unusual body odor.
 Sudden changes in weight; by either gaining or losing weight quickly.
 Disregard to harm caused by drugs. Continue use even after a drug- related injury.
 Sniffing frequently or a runny nose.
 Looking unkempt.
 Frequent nosebleeds.
 Shakes, tremors, incoherent or slurred speech, impaired or unstable coordination.
 Goes to the bathroom frequently.
 Sleeping problems ( sleepy during the day, and up most of the night).

12. Physical clues continued
 Nausea and vomiting.
 Bloody runny nose.
 Slurred speech.
 Poor coordination.
 Impaired balance.

13. Social clues:-
 Problems with relationships.
 Trouble at work or at school.
 Steals things from home or work to pay for drugs.
 Legal problems.
 Financial problems.
 Always asking to borrow money.
 Risky behavior for example; driving drunk, unprotected sex, using dirty
needles.
 They run their credit cards up.

14. OTHER CLUES:-
 The following items could also be a sign of addiction:
 Spoons and syringes.
 Small, resealable baggies that could be used to store drugs.
 Pipes, plastic bottles, or cans that have been pierced or tampered with.
 Burnt foil.
 Stuff missing, such as money, valuables or prescription medications.

15. More Clues
 Loss of interest in all the usual daily activities.
 Not attending school.
 Work problems.
 Hobbies ignored.
 Withdrawal from family and friends.
 Drug paraphernalia all around.

16. Other clues - Drug paraphernalia
 Look for drug paraphernalia.
 You may also be able to spot a loved one’s substance abuse through the new
or increased presence of drug paraphernalia.
 Paper wraps, small pieces of cling film, and tiny plastic bags are used to store
drugs.
 Rolling papers, pipes, bongs, or pierced plastic bottles or cans are often used
to smoke drugs.
 Burnt foil, spoons, and syringes may indicate heroin use.
 Those abusing prescription medications may be renewing their prescriptions
more frequently or have bottles of medications prescribed for someone else.

17. The first steps in your help is defining
the problem.
 Be positive in all your discussions.
 Tell them you are here to help.
 They do not perceive that there is a problem.
 It is your job to explain the problem to them.
 Once there is definition and acceptance of the problem, you can start
working on a solution.
 Discuss the negative effects of drug use.
 Outline the positive future goals of sobriety.
 Be realistic and do not use an emotional appeal.
 Do not threaten or bribe in any way.

18. After the problem is identified you want to
start looking for possible solutions: THINGS
YOU DO NOT WANT TO DO
DO NOT BE A HYPOCRITE- EVEN IF YOU ARE USING DRUGS YOURSELF EVEN IN
MODERATION
 No criticism.
 No nagging.
 Do not become an enabler either by giving money, or covering up.
 Do not guilt trip them.
 Restraint yourself from any preaching.
 Avoid any bribing.
 Avoid any threats.
 Refrain from bulling.

19. Thing you DO NOT want to DO
No accusations.
No arguments.
Do not demean them.
Do not threaten to punish them.
Do not expect immediate results.
Do not feel guilty for their bad behavior- It is not your fault.
No name calling or shaming.
Resist the feeling of giving them a lecture.
No ultimatums unless you plan to follow through.

20. The THINGS YOU NEED TO DO
 Realize that starting the conversation is never easy.
 Arrange to meet them in a quiet neutral location when the subject is sober
and not under the influence of any drugs- Definitely not a bar.
 Convey the message that you are concerned about them, their health and
safety.
 Persist with a positive message.
 Emphasize that you are worried about their safety and well being.
 Encourage treatment.(CHECK EVERYTHING before you start the discussion/s)
 Make a list of dangerous behaviors.
 Listen to them.
 Conversations may have to go on for several meetings over days or weeks.

21. THINGS TO DO CONTINUED
 Ask open-ended questions.
 Create a two way dialogue with no pressure.
 Offer a lot of information.
 It is crucial that you build trust with the individuals you are helping.
 Respect their privacy and be very supportive of their feelings.
 Deliver the message that you care about them, and want to get them help.
 Set limits to protect yourself from any violence.
 The conversation may have to go on for several days. Always get a
commitment for the next meeting.

22. REASONS THEY MAY WANT TO QUIT
 Emotional stability.
 Increased energy.
 Saving money is a very important reason.
 Physical and mental well being.
 An attempt to reduce or reverse damage to vital organs.
 Avoid an overdose or death.
 Better sleep patterns.
 Reconnect and improve relations with family and friends.

23. From the Agency for Healthcare
Research and Quality.
 5 A’s behavior change model:
 The 5 A’s Behavior Change Model has been adapted for self-management support improvement.
 The 5 A’s Behavior Change Model includes the following steps:
 Ask: Ask about behavioral health risk(s) and factors affecting choice of behavior change goals or methods
 Advise: Give clear, specific, and personalized behavior change advice, including information about personal
health harms and benefits
 Assess: Collaboratively select appropriate treatment goals and methods based on the beneficiary’s interest
in and willingness to change the behavior
 Assist: Using behavior change strategies (self-help and/or counseling), aid the beneficiary in achieving
agreed-upon goals by acquiring the skills, confidence, and social or environmental supports for behavior
change, supplemented with adjunctive medical treatments when appropriate
 Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance or support
and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment

24. What are the expectations for a Solution
 Be realistic- It may initially feel awkward to start the conversation.
 The person that you are helping may not be ready for a change.
 They may for afraid of the consequences in relation to their work.
 There is a societal stigma to substance abuse.
 They may be embarrassed and not ready to discuss their personal problems.
 The person may have a mental illness that needs to be addressed
concurrently with the abstinence from drugs.
 Be persistent and try to overcome the obstacles and overcome the barriers for
starting a treatment program.

25. You can lead a horse to water, but you
cannot make it drink.

26. How to handle possible emergencies
 The patient may be overwhelmed and lose consciousness.
 They may have a seizure.
 They me be in withdrawal- confused, trembling, or in delirium tremens (a
state of confusion due to alcoholism. Delirium tremens usually starts two to
five days after the last drink, and it could be fatal).
 They may threaten to commit suicide.
 Be prepared to call an ambulance.

27. THINGS YOU WANT TO DO
 Educate yourself about drug addiction.
 Be non-judgmental and a loving friend or relative.
 Offer unconditional support.
 Set realistic expectations.
 Investigate all available national, state, and local resources.
 Obtain counseling for yourself, and your friend or loved one.
 Do not worry about ruining your friendship. You may save their life.

28. RESOURCES
 Check finance and third party payers for insurance coverage.
 Check Employee Assistance Programs after admissions to a treatment facility.
 Investigate the availability of National online information and services.
 Check the SAMSHA ( Substance Abuse and Mental Health Administration) -Treatment locator
 Call the Treatment locator National Helpline ( 800 662-HELP)
 The State health department may help in locating community services.
 Check with the local or the County Health Department.
 Obtain support for the family physician, addiction specialist, treatment detox center etc.
 Locate a rehabilitation center before starting the discussion with your friend or relative.
 Before discharge locate a post detox recovery residence (halfway house or three-quarter
house).
 Try to stay focused, regardless of bumps or barriers in the road to recovery
 The social workers have a world of information.

29. CREATE A TEAM
 FAMILY OR FRIENDS
 PROFESSIONAL HELP
 PHYSICIANS
 FACILITY
 SOCIAL WORKER
 NURSE
 OTHERS FOR EXAMPLE TREATMENT FACILITY INTAKE PEOPLE

30. Stages of change as
outlined be Prochaska.
 PRECONTEMPLATION- not ready for any change, and not considering or planning any changes
 CONTEMPLATION- ambivalent about any changes, and is not committed to any changes with full
knowledge of the pros and cons of addiction
 PREPARATION- there is a realization of the existence of a problem and planning for recovery
 ACTION- first active steps the recovery process
 MAITENANCE-established new behaviors on a short term-basis, with the continued need of after
care in order to maintain long-term recovery
 RELAPSE- failure of recovery and restart the cycle

31. Possible Solutions/Treatment Options
Putting it together.
 Remember you cannot force people to go to a treatment facility.
 You may have to go to court to legally commit them for treatment.
 Your decision to help may have ambivalent feeling about getting involved.
 Step up and help your family and friends.
 Prearrange transportation.
 Make it easy for the addicted person.
 Do not delay until the hit “Rock Bottom”. (Rock Bottom is the end of the road where there is no lower
place to fall to. It is a desperate situation that makes one resolve to get well.)
 Set realistic short and long term goals.

32. If the desired effects are
not obtained:
Back to square one.
 Everything many not go as planned.
 There is no quick fix. Take small baby steps.
 It may take several conversations.
 BE PREPARED FOR DENIAL, DEFENSIVENESS, AND REFUSAL TO DISCUSS THE
PROBLEM
 The individual may be reluctant to receive your help.
 If things do not work out consider a group intervention.
 A COURT HEARING COMMITTING THE PERSON TO TREATMENT ESPECIALLY IF
THEY ARE VIOLENT, OR THREATEN TO HARM THEMSELVES OR OTHER.
 Do not hesitate to call law enforcement, if the situation gets violent or out of
control.

33. Post treatment – Relapse prevention.
(Relapse refers to returning to the use
of an addictive substance or behavior)
Determinants of Relapse ( recurrence) that should be avoided.
Stress.
People and places that remind the person of drug use.
Seeing the objects of addiction, for example paraphernalia.
Times of celebration, especially around holidays.

34. Make a plan in cooperation with the therapist
or the social worker to include:-
 Help them Identify and avoid specific triggers
 Help them set individual Recovery goals
 Help them define the Warning signs
 Provide them with Recovery tools
 Help them Define the course of action for situations that may come up

35. Help your friends or family members identify
and avoid triggers and how to deal with
them.
 They need to avoid Negative and challenging emotions.
 Locate an anger management class or group they can attend.
 Help them manage High stress situations.
 They need to avoid Loneliness.
 They need to balance work and pleasure in order to avoid getting tired or overworked.
 Introduce them to new friends. They need to associate with non-drug users.
 They need to end their relationship with drug using buddies.
 They should avoid or relinquish unhealthy romantic relationships.
 It is important that they learn coping mechanisms and be to handle anxiety causing occasions
such as a new job or a promotion.
 They should avoid attending celebrations especially the ones that involve drugs or alcohol.

36. Do not allow an alcoholic person to work
as a bartender or a waiter in a bar.
Likewise, do not allow a drug addicted
person to work in a pharmacy.
( Fox watching the hen house)

37. Recovery Ahead. Recovery Goals.

38. Recovery goals. ( Recovery is a process of
improved physical, psychological, and social
well-being after having suffered from a
substance-related condition.)
 Accountability.
 Quiet time and meditation.
 Strategies for healthy lifestyle.
 Attend meetings regularly.
 Healthy relationships.
 Achieve something of value in your recovery.

39. Meditation is defined as a mind and body
practice focused on interactions between the
brain, mind, body and behavior.

40. Recovery tools
 Ongoing therapy including group sessions, and twelve step meetings.
 Coping skill.
 Hobbies.
 Exercise.
 Balanced diet.
 Sober support network.
 Meditation- meditating is the opposite, the antithesis of addictive behavior
Deepak Chopra.
 Mindfulness- helps focus the mind on the present moment.
 Acceptance to come to terms with your history, recovery and a plan for the
future.

41. Warning signs that you need to watch
for and monitor
 There are many Red flags.
 Not going to meetings.
 False sense of control.
 Return to old behavior.
 Doubting the recovery process.
 Starting to isolate.
 Exposure to drugs or alcohol ( working in a bar).

42. MAKE A PLAN- RECOVERY SUPPORT IS A
LIFELONG PROCESS
 SHORT TERM GOALS 1-2 MONTHS
 INTERMEDIATE GOALS 3 MONTHS -1 YEAR
 LONG TERM GOALS 1-3 YEARS OR LONGER
 INCLUDE THE BENEFITS OF RECOVERY
 CONSEQUENCES OF RELAPSE- FAILING A DRUG SCREEN- CALLING IN SICK TO
WORK- MISSING MEETING, AND APPOINTMENTS.

43. Emergency planning: Rule #1 Do not sweat
the small stuff. Rule#2 Everything is small
stuff
 Times that you were not prepared for.
 Avoid panicking.
 Unexpected situations.
 Sudden urge to drink is common during times of stress.

44. Be Positive.
 Help them make a list of activities, that nurture a positive attitude. For
example think positively about the past, the present and the future, in order
to develop healthy attitudes.
 Provide assistance in creating a list of the names of people that can help
them over the phone during a craving. A friendly call goes a long way.
 Encourage them to attend meetings. Meetings create positive reinforcement.
 Help them make a list of cravings busters.

45. Help them devise a plan to get rid of
Negative Reinforcers.
 BEHAVIOURS THAT LEAD TO RELAPSE : MENTAL HEALTH ISSUES– PEOPLE
PLACES AND THINGS – GET RID OF ALL DRUG RELATED THINGS.
 PRIDE AND OVERCONFIDENCE. ( REMEMBER, PRIDE GOETH BEFORE THE FALL)
 PEOPLE AND PLACES, LINKED TO ADDICTIVE BEHAVIOURS THAT YOU WANT TO
AVOID.
 IDENTIFY AND AVOID TRIGGERS INCLUDING: ANGER, ANXIETY,
DEPRESSION,FATIGUE,STRESS AND PEER PRESSURE.
 WARNING SIGNS- SITUATIONS AND EVENTS

46. Ways to handle Cravings(physical, mental and
emotional). Craving creates urges that satisfy
a craving. Cravings last 10-20 minutes on the
average.
 Advise them to examine their thinking, about the benefits of stopping drugs.
 Help them learn distraction techniques. For example going for a walk, or taking the family dog for a walk.
 Advise them to eat sweet foods (not in excess especially for diabetic people).
 Encourage them to exercise.
 Help them De-Stress by enrolling in a stress reduction class or yoga.
 Make a list of 3-4 people they can talk with in times of doubt.
 The need to outsmart their cravings by practicing mindfulness. It is method of sensitive awareness that
allows the meditator to maintain a moment by moment awareness of thoughts, feelings, and bodily
sensations in their surrounding environment.
 Recommend Meditation.
 Suggest that they take a bath.
 Warn them that if they ignore their cravings, they might become grumpy and unhappy, and relapse to
ease the pain by using drugs or alcohol.

47. Ways to handle cravings
 Delay
 Distract
 Decide
 Determine
 Decide

48. Summary.
 Addiction is a common mind disease and process, with several stages.
 There are physical, social, behavioral, and other clues for identification of the
problem.
 Once the problem is defined a solution should be planned.
 There are things to do, and things that should not be done to help facilitate
resolution of the problem.
 Utilizing national, state, and local resources a team needs to be built.
 Once recovery is achieved the next step is relapse prevention.
 Addiction is a chronic relapsing lifetime illness.
 “Help them seek professional help for detox, and post recovery maintenance
treatment.
 The avoidance of triggers is the key to a long-lasting abstinence.

49. The future depends on what you do today.
GOOD LUCK.