National statistics show that the majority of Americans who need substance abuse treatment do not get the kind of help they need. In 2013, approximately

17 million Americans met the criteria for alcohol abuse or dependence, while approximately 7 million had a problem with illicit drugs, according to the National Survey on Drug Use and Health,

yet only 4.1 million received specialized recovery services. Out of those who did not receive treatment, 40% reported that they did not go to rehab because they were not ready to stop drinking or using drugs.

It is not always easy for family members or friends to know when a loved one needs treatment. Many people drink casually or use drugs recreationally without suffering any serious effects. Knowing when someone has crossed the line from occasional, recreational use to abuse, dependence, or addiction may help prevent the negative consequences of substance abuse.

Casual Use vs. Problem Use

In order to detect the difference between casual substance use and abuse or addiction, it is helpful to know how addiction is defined. The National Institute on Drug Abuse states that addiction is a brain disease that can progress to disability, illness, or premature death. Unlike casual substance use, which is usually occasional and manageable, addiction is distinguished by the following symptoms:

  • A compulsion to abuse the substance of choice in spite of the harm that it does to the user’s health and quality of life
  • A failure to control how much of the substance the user consumes
  • Tolerance to the substance, or a need for more of the drug to become intoxicated
  • A pattern of repeated relapse after attempting to stop using the substance
  • Dramatic changes in mood or behavior associated with using the substance
  • Functional impairment on the job, at school, or in other daily activities
  • Relationship conflicts, financial difficulties, or legal problems arising from substance use
  • Feelings of remorse or self-loathing after using the substance
  • Physical and psychological withdrawal symptoms when the substance is suddenly discontinued

Casual users may indulge in a substance at parties or social events, yet they can stop after a drink or two without difficulty. They typically do not feel compelled to continue using the drug or to take it in response to emotional pain or stress. They do not crave the substance or feel driven to seek it out when it’s not available. When they can’t drink or take a drug, they rarely have the kind of side effects that characterize withdrawal. For an addicted user, suddenly stopping use of alcohol or drugs can cause uncomfortable and even dangerous side effects like the following:

  • Tremors
  • Anxiety
  • Sweating
  • Irritability
  • Restlessness
  • Nausea
  • Headaches
  • Muscle or bone pain
  • Runny nose
  • Watery eyes
  • Sleep disturbances
  • Appetite changes

A user who has developed a substance use disorder will almost always experience some degree of withdrawal if the person stops using, either because the drug is unobtainable or because the person has decided to quit. Medical detox programs offer clinical monitoring and interventions that can make the withdrawal process easier, safer, and more comfortable.

Identifying the Need for Treatment

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For the layperson who has little or no experience with substance abuse treatment, it can be difficult to know when someone needs to go to rehab. The most obvious sign is a consistent pattern of overuse of drugs or alcohol, with repeated failures to quit. According to the National Institute on Alcohol Abuse and Alcoholism, men who consume more than four drinks per day, or more than 14 drinks per week, and women who consume more than three drinks per day, or more than seven drinks per week, are at risk of developing alcoholism if they continue to drink without treatment. Listed below are several of the other common signs that it’s time for a drug or alcohol user to seek professional help:

  • Alcohol- or drug-related health problems, such as appetite changes, sleep disturbances, fatigue, weakness, chronic pain, digestive disorders, or dental problems
  • Poor performance at work or school, such as frequent absences and failure to meet commitments
  • Conflicts with a partner, children, or close friends concerning substance use
  • Episodes of anger or violent behavior
  • Unexplained changes in mood or affect
  • Persistent, delusional thoughts or paranoid beliefs
  • A loss of motor coordination, leading to frequent accidents or injuries
  • Legal problems, such as an arrest for drunk driving or drug possession
  • Persistent financial problems, resulting in the need to borrow or steal money
  • Frequent blackouts, or episodes of amnesia, after drinking or using
  • Lying or making excuses to hide the effects of one’s substance abuse

An individual who shows signs of suicidal thoughts or who expresses feelings of hopelessness or despair should have professional help immediately from a therapist, counselor, or healthcare practitioner. Substance abuse and depression often go hand in hand, and together they can increase the risk of high-risk behavior and suicide.

Many people continue to perform adequately at their jobs, maintain a home, and operate normally in other daily activities while they are addicted to drugs or alcohol. Such individuals, known as high-functioning addicts or functional alcoholics, are very adept at hiding their substance use from others or at recruiting family members or friends to help them hide their addiction. WebMD estimates that up to 20% of alcoholics are highly functional. Eventually, however, addiction causes serious impairment or disability in all areas of life.

Rehab vs. Self-Help

When confronted by the need for treatment — either by a loved one or by a serious life event, such as an accident, divorce, or arrest — addicts often wonder whether they can stop without professional help. In some cases, the self-help approach works. An alcoholic might recover by committing to daily 12-Step meetings; an addict might decide to quit “cold turkey” and succeed in remaining abstinent. But because relapse is a symptom of addiction, most people who abuse drugs or alcohol will go back to their destructive behaviors at some point, especially if they have no professional support system and have not acquired the coping skills they need to manage the stress of life.

Quitting without medical support can pose a threat to the individual’s health. Heavy drinkers, in particular, can experience dangerous side effects during withdrawal from alcohol. As alcohol clears the system, the brain becomes highly excitable without alcohol’s sedative effects. This acceleration in brain and nerve activity can cause the following withdrawal symptoms, which can be fatal if they are not treated immediately:

  • Tremors
  • Seizures
  • Agitation
  • Restlessness
  • Fever
  • High blood pressure
  • Increased heart rate
  • Confusion
  • Delirium


medical detox programWithdrawing from other substances, such as heroin, opioid pain relievers, meth, and cocaine, can also be dangerous. Although withdrawing from these drugs is usually not fatal, the symptoms of withdrawal can be extremely unpleasant. Heavy drug users often do not make it through the first few days of abstinence because of the pain and discomfort involved in this process.

In a medical detox program, clients are monitored by clinical staff while the alcohol and drugs clear their bodies. At this stage of recovery, the priority is to keep the client stable and comfortable. Once the client is stabilized, the person can be prepared to enter the next phase of treatment. Depending on the client’s history of substance use, co-occurring medical or psychiatric conditions, and motivation to remain abstinent, the next phase could be inpatient treatment, residential rehab, or an intensive outpatient program.

Inpatient and residential rehab programs offer several key advantages for their clients. In these structured environments, which offer 24-hour monitoring and support, clients can focus on their recovery with minimal distractions from the outside world. A daily schedule in rehab includes activities like individual therapy, support groups, 12-Step meetings, or recreational therapy. Breaks for quiet reflection or socialization are included. Contemporary residential treatment facilities offer comfortable accommodations, often with spa-like amenities and onsite fitness facilities.

Research studies consistently show that substance abuse treatment at a specialized facility can help the recovering addict or alcoholic remain abstinent after discharge. Treatment also increases rates of employment and decreases the risk of hospitalization and incarceration. For example, a study published in

the American Journal of Drug and Alcohol Abuse indicates that longer stays in residential treatment facilities produce the best outcomes for clients.

In this study, a group of clients in recovery were interviewed at six and 12 months after discharge from a residential rehab program. Out of this group, 68-71% of clients who had stayed in treatment for six months had remained abstinent, while success rates were lower for clients who had stayed for shorter periods of time.

Getting a Loved One into Treatment

For the addict or alcoholic, denial is a powerful barrier to recovery. In most cases, an individual who is addicted to drugs or alcohol will not voluntarily seek help. Instead, the person must be referred by a family member, a friend, a healthcare provider, an employer, or by the court system. If the individual does not respond to an honest, one-on-one discussion about the substance use, it may be necessary to hold an intervention, or a meeting to persuade the person that rehab is needed.

Interventions can be staged in different ways.

The most common strategy is to arrange a meeting of concerned people — such as the spouse, children, parents, employer, spiritual leader, or therapist — who get together to talk to the individual about the substance use.

The individual is usually not informed of the purpose of the meeting ahead of time, in order to avoid the possibility that the person will refuse to attend. At the meeting, all of the concerned parties may address the individual about how substance abuse has affected their lives. The individual is then presented with a treatment plan and given the option to enter rehab or face undesirable consequences, such as the loss of a job, a marital separation, or the loss of child custody.

Whether or not the individual agrees to enter treatment, the people involved should be prepared to follow through on the terms of the agreement; otherwise, the substance abuse is likely to continue. If carried out correctly, an intervention sends a signal that the individual’s loved ones, friends, and associates can no longer tolerate the effects of alcoholism or drug abuse, and that they have decided to take action in order to prevent further harm to themselves as well as the individual in question. Intervention specialists, or therapists with intensive training in this area, can provide valuable advice on how to conduct one of these meetings and may even participate in order to facilitate the transition to treatment.