Substance Abuse Counseling

Reduction, Not Only Abstinence: Meeting Patients in the “Gray Area” of Alcohol Use

Posted on by Joseph Gerard

drunk man drinking alcohol at table at night. Acceptable or in the gray area of alcohol use?

Most people whose drinking exceeds healthy limits will never walk into an addiction clinic. They are not dependent on alcohol, and they do not meet the criteria for a severe use disorder. Many are not looking for treatment at all. Their drinking is still not harmless, and a growing number of them know it. They sit in what clinicians and patients alike describe as a gray area: too much to ignore, not enough to resemble the treatment system as most people picture it.

The clinical term of art for this group is “unhealthy alcohol use.” The U.S. Preventive Services Task Force (USPSTF) defines it as a spectrum of behaviors that runs from risky drinking to alcohol use disorder. Risky or hazardous drinking means drinking above recommended limits, in a pattern that raises the risk of health consequences without meeting the criteria for an alcohol use disorder. An alcohol use disorder is a different matter: a medical condition in which a person struggles to stop or control drinking despite the consequences, and it can be mild, moderate, or severe.

The distinction shapes how care is organized. A person who drinks above the limits but has no disorder is unlikely to accept, or need, an abstinence-only pathway. A person with a severe disorder needs much more than a brief conversation. Between those poles lies a large, quiet group that the health system mostly misses.

Why this group is easy to miss

People who drink in the gray area rarely describe themselves as having a problem. Popular culture still draws a hard line between “alcoholics” and everyone else, and that framing can work against early change: when cutting back reads as an admission of a problem, reluctance to try tends to grow. Research documents a second barrier. A scoping review led by clinical psychologist Devin Banks found that Black people in substance use treatment feared being judged by employers, police, and others, and that this stigma can be a barrier to treatment.

Drinking to cope is also normalized. About two-thirds of adults in the United States report drinking in the past year, and nearly a quarter report binge drinking in the past month. When a drink is how someone marks the end of a workday, cutting back is less a medical decision than a social and personal one.

The scale of the harm justifies attention. Excessive alcohol use is one of the most common causes of premature death in the United States; the Task Force cites an estimated 88,000 alcohol-attributable deaths a year from 2006 to 2010, from acute causes such as injuries and from chronic conditions such as liver disease.

What the evidence supports

Screening for unhealthy alcohol use in primary care, followed by brief behavioral counseling for patients who screen positive, carries the Task Force’s Grade B recommendation for adults 18 and older, including pregnant women. The Task Force concluded with moderate certainty that the net benefit is moderate. For adolescents aged 12 to 17, the evidence remains insufficient to weigh benefits against harms.

The benefit is real but not dramatic, and the numbers are worth knowing. Pooled trial results behind the recommendation show that brief counseling reduced the odds that a patient would exceed recommended drinking limits by roughly 40 percent (odds ratio 0.60; 95% CI, 0.53 to 0.67), and lowered the odds of a heavy-use episode by about a third, with outcomes measured at 6 to 12 months. The Task Force also bounded the harms of screening and brief counseling as small to none.

Two details keep the picture honest. The interventions that worked varied in their components, administration, length, and number of interactions, and the Task Force could not identify which characteristics were clearly associated with better outcomes; the conversation matters more than any fixed script. Part of the case for reduction also rests on indirect evidence: epidemiologic studies link reductions in drinking with lower risks of illness and death, even though they cannot show that a brief conversation produced the change on its own.

External assessments point in the same direction. The World Health Organization (WHO) has concluded that no level of alcohol consumption is safe for health, that alcohol causes at least seven types of cancer, and that risks start from the first drop of any alcoholic drink; as one WHO official puts it, the less you drink, the safer it is. A reduction-focused conversation does not have to settle debates about safe levels. It only has to help someone move in the safer direction.

The service model that carries this into practice is SBIRT: screening, brief intervention, and referral to treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) describes SBIRT as a public health approach to delivering early intervention and treatment services in primary care centers, hospital emergency rooms, trauma centers, and other community settings: a quick screen assesses the severity of use, a brief intervention builds insight and motivation toward change, and a referral pathway connects people who need more to specialty care.

What this looks like in practice

Whatever your role, you are better positioned than you may think. Nurses notice patterns at intake. Case managers hear how the week actually went. Chaplains and counselors sit with the stress that drinking is often managing. None of these roles requires prescribing authority, and none requires a full clinical assessment to be useful.

Screening can be short. One- to three-item instruments such as the AUDIT-C and the single alcohol screening question have the best accuracy for detecting unhealthy alcohol use in adults, and the AUDIT-C takes a minute or two to administer.

When someone screens positive, the brief intervention is a conversation rather than a lecture. In SAMHSA’s description, it works by increasing a person’s insight and awareness about their substance use and their motivation toward change. Cutting back and stopping altogether are both defensible goals; the evidence behind reduction-focused care is what makes it reasonable to support someone who is not ready to quit. People can take smaller steps toward health even when they are not ready for permanent abstinence. For patients who want structured support between visits, patient-facing programs such as Sunnyside offer app-based tracking, coaching, and clinician-supervised options for those who want to reduce. Programs like this work alongside clinical care, not in place of it, and they are one option among many a patient can weigh.

Language does quiet work here. “Alcoholic” remains a stigmatizing term, and the sober curiosity framing works partly by setting the label aside: anyone can try cutting back, without having to define themselves as a problem drinker first. And when a cutback attempt fails, that failure is information: practitioners in this space treat it as a signal that a plan, a goal, or a support level needs adjusting, not as proof that the person cannot change.

When moderation is not the right goal

Reduction-focused care has a safety boundary, and it is not optional. Moderation is not an appropriate goal for someone with a physical dependence on alcohol. Withdrawal in that situation can be fatal, and patients who become nauseated, shaky, or otherwise unwell when they try to cut back need supervised medical withdrawal rather than a self-guided plan. Some of those patients might be better off seeking permanent abstinence, and others need formal treatment; the treatment navigator listed below exists for that handoff. The screening recommendation itself is written for people who are not already in evaluation or treatment for alcohol problems.

Pregnancy is its own case: alcohol use during pregnancy is one of the major preventable causes of birth defects and developmental disabilities, and brief counseling increased the likelihood that women remained abstinent from alcohol during pregnancy.

The takeaway for practice

The next step for any role in this work is a small one. Screen when you can, and let the screening become a conversation about goals rather than a verdict about drinking. Treat reduction as a legitimate goal for patients who are not ready for abstinence, and keep the safety boundary in view: withdrawal risk and pregnancy belong with clinicians, and a timely handoff is part of the care. That is the practice in its everyday form: a question, a conversation, a goal the patient chooses, and a clear line where clinical care takes over.

Resources to share with patients and clients

Two free NIAAA resources are worth knowing by name. Rethinking Drinking offers practical tools for adults who want to examine or cut back on their drinking, including strategies for cutting down and a free booklet. The NIAAA Alcohol Treatment Navigator is aimed at people who may need treatment for an alcohol use disorder; it focuses on evidence-based care, includes questions to ask a potential provider, and carries no commercial sponsorship.

 

Author’s Bio:

This article is brought to you by the expert content team at nexuse backlinks agency, specializing in digital marketing, SEO, and quality online resources

 

Please also review AIHCP’s Substance Abuse Practitioner Program and  CE courses to see if it meets your academic and professional goals.

Millions of Americans Struggle with Addiction So Here Is How Men Can Rebuild Their Lives in Recovery

Posted on by Joseph Gerard

Group psychotherapy for men with different problems and issuesWritten by Angela Rivera,

Getting through treatment is a major achievement. But if you’ve left a treatment program and are now thinking, “Okay, now what?”, you already understand the part that often gets far less attention: how to actually rebuild your life.

The need for actionable post-treatment support is enormous. According to the National Survey on Drug Use and Health, 44.6 million Americans had a substance use disorder in the previous year. That included 25.7 million people with alcohol use disorder and 26 million with a drug use disorder. About 7.1 million had both.

For men, it’s even harder. Men not only experience higher rates of several forms of substance use, but they are statistically more likely to end up in emergency departments or suffer fatal overdoses than women. Cultural expectations play a big role here, too. A man who has spent decades hearing that he should handle problems himself may find it especially difficult to admit that he needs help.

The good news is that recovery restores what addiction tends to take away: the ability to make deliberate choices about your time, health, relationships, work, and ultimately your future. You do not need to rebuild everything simultaneously, though. All you need is a practical place to start.

Treatment Ends But Recovery Keeps Going

The first weeks after treatment can be surprisingly uncomfortable. But understand one thing: this is normal and, in fact, to be expected.

Your schedule changes, you may sleep badly, and your appetite may be different. On top of that, you may have medical appointments, therapy, medication management, or lingering withdrawal-related symptoms to deal with. Then there are the less obvious problems: boredom, strained relationships, financial trouble, unemployment, and the sudden realization that a lot of your free time used to revolve around using.

None of these things mean that the treatment failed. They simply mean that treatment and long-term recovery solve different problems.

A person with opioid use disorder, for instance, may need ongoing medication treatment and monitoring after residential care. And someone recovering from alcohol use disorder may need continued counseling, medication, mutual-support groups, or some combination of these.

This is why your aftercare plan should come from your clinical team rather than a generic recovery checklist. Medication needs, mental health symptoms, sleep problems, and other medical concerns shouldn’t really be treated with a “wait and see” approach. They deserve professional attention.

Build a Day You Can Actually Repeat

How to make early recovery easier? Set a few daily goals you aim to hit every day.

For example, wake up at roughly the same time, eat regular meals, and take medications as prescribed. Go to work, school, treatment, or another productive activity. Exercise if you can, and attend your recovery support.

If this sounds too boring or simple, good. Boring routines have an advantage: they still work on a bad Tuesday.

Here’s another useful approach: create a “minimum day” for periods when motivation disappears. Meaning, decide in advance what you will do no matter how you feel.

That might mean getting out of bed, showering, eating breakfast, going to work, contacting your support person, and attending your scheduled meeting. This is flexible and personal, as some things may be more important to you than to others.

Get Specific About Stress

“Manage stress” may be reasonable advice, but it’s almost completely useless unless you define what stress looks like for you. So do that: what stresses you out the most?

Here are questions worth answering:

  • Do you become quick to anger?
  • Do you stop replying to texts and isolate yourself?
  • Do you start thinking about reaching out to old contacts?

Once you have your answer(s), map out your patterns using this sequence: Trigger → Warning Sign → Response

For example:

  • Argument with your partner → urge to leave and use → call your sponsor or therapist before leaving.
  • Paycheck arrives → thoughts about buying drugs → move money into essential expenses immediately.
  • Difficult day at work → isolation and irritability → eat, walk, shower, then contact someone.
  • Friday night → boredom and old drinking routines → make plans before Friday arrives.

The goal is to recognize your own early warning signs. That way, you have more room to respond before a craving becomes a crisis.

Your Living Environment Matters Greatly

What happens if you complete treatment and return to an “unsafe” environment? A place where people drink heavily, or drugs are readily available, or where everyone expects you to behave exactly as you did before. Yes, you are technically sober, but your environment is not helping you remain sober.

This is why recovery housing can make sense for many men. It’s a structured living environment that not only promotes sobriety but usually also independent growth, too, making it particularly valuable for early recovery.

If you’ve been Googling what is sober living, you probably have a good reason to consider it. There are many options, but Design for Recovery, for example, operates men’s sober living programs built around structure, peer accountability, and practical independence. Its programs include house meetings, recovery meetings, employment support, life-skills development, and a 12-Step foundation.

It’s not the same thing as detox or residential clinical treatment, though. A sober living home should not be treated as a substitute for medical or psychiatric care when those services are needed. The distinction is important when you are choosing a program because you want to know exactly what the residence provides and what it does not.

So if you’re seriously considering it, ask specific questions regarding:

  • House rules,
  • Drug and alcohol testing,
  • Meetings,
  • Medication policies,
  • Staff availability,
  • Relapse procedures,
  • Employment expectations,
  • How residents transition toward independent living.

Rebuild Your Independence in Pieces

After addiction, “get your life together” can sound like a ridiculous assignment (because it is). But here’s how you can make it work: break it down.

Work

If you already have a job, simply focus on keeping it while you stabilize your recovery. If you have been unemployed, update your résumé and apply for a manageable number of positions each week.

Keep in mind, employment is not only about income. A job can give your week structure, restore confidence, and reconnect you with a sense of responsibility.

Money

List your fixed expenses, debts, income, and immediate obligations. Pay essential bills first. But avoid trying to erase every financial mistake at once. A simple budget that you actually follow will always be better than an ambitious spreadsheet that lasts four days.

There are also recovery programs that provide financial coaching. Look for one that helps with the basics of budgeting, debt planning, credit education, and preparation for financial independence as part of its support.

Relationships

Do not demand instant forgiveness from people you hurt while using. You can apologize and make amends where appropriate. But trust usually comes from repeated behavior, not a particularly convincing conversation.

So, give people time to see that your actions have changed. You also have permission to create distance from relationships that still revolve around substance use, even if those relationships have existed for years.

Do Not Try to Replace Addiction With Isolation

Some men respond to recovery by going completely inward. They stop seeing old friends, which can be sensible. But then they stop seeing almost everyone, which creates another problem.

Peer support can provide something family members and clinicians cannot always provide: contact with people who understand the practical reality of staying sober. SAMHSA identifies peer support as a recovery resource for a reason: it can help people stay engaged, build skills, and connect with community.

You don’t need twenty new friends. Start with two or three people you can contact when things are going badly.

And make the relationship reciprocal. Listen to other people. Show up when you say you will. Help with ordinary things. Recovery communities become useful partly because people stop being isolated individuals and start becoming dependable members of a group.

Take Care of the Physical Basics

Sleep, nutrition, movement, and medical care are not side projects. They’re essentials.

Substance use often coexists with untreated medical conditions, poor nutrition, dental problems, poor sleep, and mental health concerns. That’s why medical attention is important: your primary care clinician and/or behavioral health providers can help determine what needs attention rather than leaving you to guess.

Exercise is especially important. It can help create structure and improve overall health, but you do not need to turn yourself into a fitness fanatic. A daily walk counts, and so does lifting weights a few times a week if that is something you enjoy.

A Practical First-90-Day Plan

If you need something more concrete, start here.

Weeks 1–2: Stabilize

Follow your discharge and medication plan. Keep appointments. Fix your sleep schedule as much as possible. Remove alcohol and drugs from your immediate environment. Tell at least one trusted person what support you need.

Weeks 3–6: Add responsibility

Return to work or school if you can. Establish a regular exercise routine. Attend recovery meetings or other support consistently. Start addressing debts, paperwork, transportation, and other neglected practical problems.

Weeks 7–12: Expand your life

Strengthen sober friendships. Take on more responsibility at work or home. Revisit longer-term education or career goals. Start planning what independent living will look like if you are in structured housing.

Importantly, know that the timeline is flexible. If your clinical team recommends a slower pace, follow that plan.

Recovery Has to Become a Life, Not Just an Absence

Addiction can consume an enormous amount of time and attention. Once that space opens up, you have to decide what goes there.

Work. Friends. Family. Exercise. Education. More money in your bank account. A clean apartment. A weekend you remember. Plans for next year. In short, ordinary but ultimately fulfilling things. Which is why they matter.

If you take anything from this piece, take this: you do not have to become a completely different person to recover; you just need to develop routines, relationships, and coping skills that make substance use less central to your life. For some men, that happens with outpatient care and a strong support network. For others, a structured sober living environment provides the extra accountability needed to make the transition.

Either way, the work continues after treatment. And that is not a bad thing. Treatment can help you stop the cycle, but recovery gives you the chance to decide what comes next.

References

  1. Substance Abuse and Mental Health Services Administration (SAMHSA). 2025 National Survey on Drug Use and Health (NSDUH).
  2. SAMHSA — 2025 National Survey on Drug Use and Health
  3. National Institute on Drug Abuse (NIDA). Sex and Gender Differences in Substance Use.
  4. NIDA — Sex and Gender Differences in Substance Use
  5. Design for Recovery. Sober Living Programs.
  6. Design for Recovery — Sober Living Programs
  7. Substance Abuse and Mental Health Services Administration (SAMHSA). Peer Support Workers for Those in Recovery.
  8. SAMHSA — Peer Support Workers

 Author Bio

Angela Rivera is a health writer who specializes in addiction care, telehealth, and behavioral science. With a background in patient education and evidence based communication, they focus on making complex clinical topics clear and approachable. Their work highlights practical strategies people can use to navigate recovery with confidence and support.

 

 

Please also review AIHCP’s Substance Abuse Practitioner Program and  CE courses to see if it meets your academic and professional goals.

When family involvement helps and when it complicates addiction care: A clinical approach to boundaries

Posted on by Joseph Gerard

Members Of Support Group Sitting In Chairs Having Meeting

Written by Emily Carter,

Addiction rarely affects one person alone. Families often feel the strain early. Money problems may appear. Responsibilities may be missed. Crises at home can become frequent. Yet family support can also shape recovery. Family-based care can improve treatment engagement and family functioning. That makes family involvement clinically important. Still, more is not always better. Concern can become pressure. Support can become control. So, where is the balance? Family involvement helps when it supports recovery and respects patient choice. Safety matters. Privacy matters too. The goal is simple. Family participation should strengthen treatment, not take it over.

How can families support addiction treatment?

Families can make treatment easier. A relative may provide a ride. Another may help with childcare. These simple steps can remove barriers. Emotional support matters too. Recovery can feel stressful. It can also feel uncertain. A trusted person can reduce isolation. Family involvement can also improve communication around treatment. Research supports carefully structured family approaches for substance use disorders. Benefits may include reduced substance use and improved family functioning (Esteban et al., 2023). However, clinicians should still assess each situation individually. A supportive relationship can strengthen care. A highly conflicted relationship may have the opposite effect.

Family relationships may also feel tense during addiction. Some people may blame relatives or close friends. This can happen during conflict, shame, or denial. Understanding why addicts blame loved ones can help families understand this pattern. The goal is not to excuse harmful behavior. Instead, families can avoid turning every disagreement into a larger confrontation. Clinicians can also help relatives separate emotional reactions from treatment decisions.

Family roles may change throughout care. Early treatment may involve sharing important history. Families may also raise safety concerns. Later, their role may become less direct. They can support routines or encourage follow-up care. Discharge can create another shift. Relatives may help with transportation or home stability. However, they should not control every treatment decision.

Age also matters. Parents often play a larger role with adolescents. Younger patients may depend on adults for treatment access. Family-based interventions also have evidence among adolescents and young adults (Esteban et al., 2023). Adults usually have greater control over participation. They often decide which relatives or support people join their care.

How can families support recovery without enabling substance use?

Helping and enabling can look similar at first. The difference often comes down to accountability. Driving someone to treatment can support recovery. Paying repeated substance-related debts may do the opposite. It can reduce the impact of harmful choices. A similar problem may occur at work. A relative may repeatedly make excuses for missed shifts. That response may protect the person from consequences.

Giving unrestricted cash can also create risk. This is especially relevant when active substance use continues. However, withholding all support is not the answer either. Families can still provide help that supports treatment. They might assist with transportation or healthcare access. They can also offer emotional support. The important distinction involves what the help is reinforcing.

Support does not mean solving every problem. Families can encourage treatment without hiding serious consequences. They can show concern without accepting threatening behavior. They can also offer practical support without assuming full responsibility for recovery. Clear limits make that support healthier.

One useful approach is CRAFT. Community Reinforcement and Family Training works with concerned family members. It teaches communication and reinforcement strategies. It also focuses on encouraging treatment entry. A systematic review included 691 concerned significant others across 14 studies. CRAFT was twice as effective as comparison approaches for treatment entry (Archer et al., 2020). More intensive formats achieved particularly strong treatment-entry rates.

Should families stop helping completely? No. Useful support leaves room for responsibility. Enabling often develops from fear or repeated crises. Clinicians can address these patterns without blaming relatives. Specific examples are usually more useful than labels.

What do healthy boundaries look like during addiction recovery?

A boundary explains what someone will accept or refuse. It does not force another person to change. This distinction matters during addiction treatment. Family members may feel responsible for preventing substance use. In reality, they cannot control every decision.

A family may decide not to provide money for substances. They may also restrict access to household vehicles during intoxication. Threatening behavior can require another clear limit. These boundaries focus on safety rather than punishment. Other limits may focus on responsibility. A relative may stop making excuses to an employer. They may also refuse to hide repeated financial problems.

Good boundaries should be specific. They also need to be realistic. A rule has little value when nobody can maintain it. Consistency usually matters more than severity.

Clinicians need similar clarity. Families should know who may attend sessions. They should understand the purpose of their involvement. Respect for patient autonomy remains important throughout this process. Relatives can support treatment. However, they should not become informal therapists or investigators. Medication decisions should also remain within appropriate clinical care.

Clear boundaries protect several relationships at once. They support the patient-clinician relationship. They can also reduce confusion within the family. SAMHSA recommends defining family roles carefully during substance use disorder treatment (SAMHSA, 2020).

When can family involvement make treatment harder?

Family participation becomes difficult when the patient loses space to speak. One relative may answer every clinical question. Another may insist on joining every appointment. Constant monitoring can create similar problems. A patient who feels watched may become less open during care.

Treatment can also become harder when relatives challenge evidence-based recommendations. Someone may oppose medication for opioid use disorder. Another family member may define recovery only through complete abstinence. Such beliefs can conflict with individualized treatment planning. They may also create shame after recurrence.

Clinicians should pay attention to coercion. Family involvement should not become another form of control. The patient’s preferences remain important when consent rules allow choice. Some adults may want only limited family participation. Others may prefer a trusted friend or partner instead.

Safety deserves particular attention. Joint counseling may not be appropriate when violence is present. Coercive relationships can also make shared sessions unsafe. The same concern applies when retaliation is possible. SAMHSA advises careful assessment before using family-based treatment in situations involving violence (SAMHSA, 2020).

Past trauma can also shape participation. So can estrangement or longstanding conflict. Clinicians should explore these factors before assuming family involvement will improve care. Sometimes limited involvement is the safer clinical choice.

What can clinicians tell family members about addiction treatment?

Confidentiality often causes confusion. Relatives may want detailed updates because they are worried. Clinicians cannot always provide them. A useful distinction involves receiving information and disclosing information.

A family member may contact a clinician with an important concern. For example, they might report a suspected overdose. They might also describe a major behavioral change. Receiving that information does not automatically permit disclosure in return.

HIPAA may allow communication with people involved in care. However, disclosure generally depends on the circumstances. Patient agreement can also matter. Information shared should relate to the person’s involvement in care. Clinicians should not treat family participation as unlimited access to records.

Substance use disorder records can receive additional federal protection. These protections appear under 42 CFR Part 2. The 2024 final rule aligned some Part 2 requirements more closely with HIPAA. However, important protections remain. Compliance with the updated requirements was required by February 16, 2026 (HHS, 2026).

Clinicians should explain confidentiality early. Families should understand what can be discussed. They should also know what remains private. Clear expectations can prevent conflict later. They also support informed participation in treatment.

Does family therapy improve addiction treatment outcomes?

Family therapy can be useful, but it is not one treatment model. Different approaches serve different clinical situations. Some focus on communication and behavior within the household. Others focus on couples or adolescents. Broader addiction treatments may combine behavioral care with medication.

Research supports family-based approaches for substance use disorders. A systematic review examined recent family therapy research. It found benefits for substance use and family functioning (Esteban et al., 2023). A newer systematic review also examined randomized controlled trials. It included 15 trials. Eleven reported significant positive effects from family-based interventions. Those outcomes included reduced substance use or better family functioning.

Still, results vary. No single family model fits every patient. A couples-based approach may fit one adult. A youth-focused program may suit an adolescent better. CRAFT may be useful when a person resists treatment. Other families may need psychoeducation rather than formal family therapy.

Clinical selection matters. The approach should fit the patient’s needs. Relationship quality also matters. So does safety. Family therapy should support the treatment plan rather than compete with it.

How should families respond when relapse occurs?

Relapse can trigger strong reactions. Fear may become anger. Concern can turn into surveillance. Some relatives may threaten to withdraw all support. These responses are understandable. However, they may not improve treatment engagement.

A more useful response begins with reassessment. Continued substance use does not automatically mean treatment has failed. In many cases, relapse and recovery should be considered within the wider treatment process. A recurrence may show that part of the current plan needs adjustment.

Clinicians may reassess overdose risk. Medication may also require review. Treatment intensity can change when needed. Triggers and new stressors may deserve attention. The goal is to understand what changed before making the next clinical decision.

Families can support this process without taking control. They may encourage a return to treatment. They can help someone keep important appointments. They may also support prescribed medication. However, relatives cannot guarantee abstinence.

Family wellbeing deserves attention too. Addiction can place considerable psychological pressure on relatives. Research shows that interventions for affected family members can improve important wellbeing outcomes (McGovern et al., 2021). Families may need their own boundaries around finances and time. They should also protect their work and personal relationships.

Supporting recovery should not require constant monitoring. It should not make one relative responsible for every setback. Shared responsibility supports a healthier treatment environment.

How can clinicians decide the right level of family involvement?

There is no single correct level. Each case is different. The patient should have a meaningful voice. Clinicians can start by asking who the patient wants involved. They should also consider safety. A supportive relationship should not create fear or coercion.

Treatment goals offer another guide. Does the family member improve treatment participation? Do they provide useful collateral information? Does their presence support communication? These questions can help define an appropriate role.

The answer may change over time. A relative may help greatly during discharge. That does not mean they need every therapy session. Someone excluded during family conflict may become helpful later.

Family also does not always mean a blood relative. Some patients rely more on partners or close friends. Others may identify a caregiver as their main support person. Clinicians should focus on the relationship’s actual function.

Culture can also shape family roles. Some families expect shared healthcare decisions. Others place greater emphasis on individual privacy. Clinicians should explore these expectations rather than assume them.

Ultimately, family involvement helps when it strengthens care without taking over care. Good boundaries protect patient autonomy. They also support family well-being. Most importantly, they keep treatment focused on the patient’s clinical needs.

About the author

Emily Carter is a content writer with a focus on behavioral health, addiction treatment, recovery, and wellness. She creates clear, compassionate, and research-informed content designed to help readers better understand treatment options, mental health topics, and the recovery process. Her writing aims to make complex healthcare information more accessible while maintaining a respectful and supportive tone.

References

American Society of Addiction Medicine. (2024). Engagement and retention of nonabstinent patients in substance use treatment: Clinical considerations for addiction treatment providers. American Society of Addiction Medicine. https://www.asam.org/quality-care/clinical-recommendations/asam-clinical-considerations-for-engagement-and-retention-of-non-abstinent-patients-in-treatment

Archer, M., Harwood, H., Stevelink, S., Rafferty, L., & Greenberg, N. (2020). Community reinforcement and family training and rates of treatment entry: A systematic review. Addiction, 115(6), 1024–1037.

Esteban, J., Suárez-Relinque, C., & Jiménez, T. I. (2023). Effects of family therapy for substance abuse: A systematic review of recent research. Family Process, 62(1), 49–73.

McGovern, R., Smart, D., Alderson, H., Araújo-Soares, V., Brown, J., Buykx, P., Evans, V., Fleming, K., Hickman, M., Macleod, J., Meier, P., & Kaner, E. (2021). Psychosocial interventions for family members affected by an adult relative’s substance use. International Journal of Environmental Research and Public Health, 18(4). https://pubmed.ncbi.nlm.nih.gov/

Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment and family therapy (Treatment Improvement Protocol 39). U.S. Department of Health and Human Services.

U.S. Department of Health and Human Services, Office for Civil Rights. (2026). Fact sheet: 42 CFR Part 2 final rule. https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/fact-sheet-42-cfr-part-2-final-rule/index.html

 

 

 

Please also review AIHCP’s Substance Abuse Practitioner Program and  CE courses to see if it meets your academic and professional goals.

Managing Autonomic Instability During Acute Substance Withdrawal

Posted on by Joseph Gerard

Woman Having Counselling Session Substance Abuse Practitioners can help individuals understand their unique situation with addiction and the best ways to fight it. Please also review AIHCP's Substance Abuse Practitioner Training Program

Written by Charles Schubert

Abruptly stopping nervous system depressants can lead to a sudden and dangerous surge in sympathetic activity. This causes the heart rate to spike, blood pressure to rise sharply, and body temperature to climb to life-threatening levels. 

These changes happen fast. Can quickly become dangerous. That’s why managing acute withdrawal must be done under the care of trained professionals right away.

This guide breaks down the neurobiological mechanisms driving autonomic instability and outlines the clinical interventions essential to stabilize patients and prevent systemic collapse.

Neurobiological Mechanisms of Autonomic Hyperactivity

The central nervous system balances itself through inhibitory and excitatory neural stimuli. Inhibitory substances stimulate the inhibitory mechanism of the body but inhibit excitation in the brain. Natural inhibition neurotransmitters develop tolerance in the body as a result of prolonged use.

On the other hand, the brain secretes an increased amount of excitatory neurotransmitters in order to remain active. In the case of sudden cessation of drug use, this mechanism does not work because there are no inhibition neurotransmitters for the overactive neurons in the brain.

Neurotransmitter Imbalance and Receptors

This mechanism of physiological reaction is based on an imbalance between GABA and glutamate. The regular use of the drug causes desensitization of GABA receptors.

As a way of balancing out the constant inhibition, glutamate function is increased at NMDA receptor sites. Upon withdrawal of the depressant drug from the bloodstream, the glutamate receptors fire uncontrolled, causing excessive excitement in neurons.

Central Noradrenergic Outflow

The locus coeruleus serves as the primary noradrenergic nucleus in the brainstem, controlling systemic sympathetic tone. Under normal conditions, inhibitory receptors regulate local norepinephrine production.

During acute withdrawal, the abrupt loss of inhibition triggers uncontrolled neural firing. Several primary neurochemical shifts occur simultaneously during this rapid sympathetic surge:

  • Elevated catecholamine release throughout central pathways
  • Uninhibited signaling from the locus coeruleus
  • Heightened stimulation of arterial smooth muscle

This central surge spills over into the peripheral autonomic nervous system, causing severe stress that directly impacts cardiac tissue and metabolic function.

Regional Data on Sudden Cessation

According to research published by the National Center for Biotechnology Information, approximately 50% of individuals with alcohol dependence experience noticeable physical withdrawal symptoms when stopping consumption. Across major metro hubs in North Georgia and the greater Southeastern United States, clinical admissions for acute detoxification have increased significantly as regional healthcare systems expand community-based emergency intervention networks to handle rising demand in urban treatment centers.

Physiological Manifestations and Clinical Assessment

Autonomic hyperactivity affects multiple body systems at once as central inhibition breaks down. In high-acuity scenarios, clinicians closely monitor core physiological parameters to catch early markers of systemic overload.

The body shows clear physical signs when the autonomic nervous system becomes hyperactive:

  • Fast heart rate and high blood pressure
  • Heavy sweating and high body temperature
  • Muscle tremors and constant restlessness physical warning signs physical warning signs

Image Source: Gemini

Spotting these physical warning signs early helps medical teams change their care plans before patients feel very bad. Because managing these compounding shifts needs strict clinical oversight, putting patients in a structured detox placement in Atlanta gives them constant all‑day monitoring.

To deal with these instabilities safely, special clinical places, like Inner Voyage Recovery Center, watch vital signs all the time and use quick stabilization steps that help stop the body from being overloaded during early withdrawal.

Cardiovascular System Responses

The continuous exposure to catecholamines imposes immense stress on the cardiovascular system during withdrawal from stimulant abuse. Tachycardia causes decreased perfusion of the myocardium. In this case, the need for oxygen rises, while flow falls.

Vasoconstriction of systemic circulation vessels can lead to increased peripheral vascular resistance and ultimately raise systolic and diastolic blood pressure levels. The patient receiving treatment at the emergency departments in cities such as Atlanta may suffer from ACS, hypertensive crisis, and ventricular arrhythmias due to the presence of preexisting heart disease.

Disruption in Thermoregulation and Metabolism

Elevated sympathetic discharge changes the temperature regulation set point in the hypothalamus, causing an inability to dissipate the internal body heat. Overproduction of sweat compensates for core cooling; however, rapid fluid loss immediately causes volume depletion.

Such a condition results in high metabolic rate, which increases the utilization of glycogen stores and proteolysis. If not controlled in high-humidity zones, hyperthermia will increase oxygen consumption in vital organs, lowering the threshold for brain excitation.

Standardized Assessment Tools

Clinical teams depend on clinically validated scores to continuously assess any physiologic changes. The Clinical Institute Withdrawal Assessment for Alcohol scale is used for assessment of pulse rate, anxiety, and trembling. 

The Clinical Opiate Withdrawal Scale measures pulse rate, pupil size, and joint pains. Lastly, there are benzodiazepine scales that assess motor instability and abrupt sensory shifts.

Medical Management and Clinical Interventions

Image Source: Gemini

Controlling autonomic instability requires stabilizing central neurotransmitters while softening peripheral sympathetic overload.

Clinicians use several core medical strategies to keep patients safe during detox.

  • Vital sign tracking with continuous monitoring equipment
  • Targeted medications to calm the central nervous system
  • Intravenous fluids to restore hydration and key electrolytes
  • Low sensory lighting to reduce external stress triggers

These combined interventions reduce physical discomfort and prevent dangerous shifts in blood pressure or rate. Continuous observation ensures that dangerous spikes in vital signs are caught immediately.

Pharmacological GABA-A Receptor Modulation

There is currently no pharmacological therapy other than agonism of GABA-A receptors that can counter the condition of central hyperarousal due to alcohol or sedative drug withdrawal. Long-acting benzodiazepines enable smooth and constant inhibition of CNS activity.

Through normalization of inhibitory function, they enable reduction in central noradrenergic firing in the locus coeruleus. This, in turn, ensures less stress on the cardiovascular system, a lack of muscle tremors, and virtually eliminates seizure risk.

Targeted Adrenergic Receptor Blockade

In situations where there is a lack of satisfactory control of autonomic symptoms by benzodiazepines, adrenergic-selective medications are also administered. Alpha-2 agonists achieve their effect by means of blocking presynaptic receptors within the brain in order to prevent excess release of norepinephrine.

In addition, clinicians may prescribe cardioselective beta-blockers for the management of chronic tachycardia and severe muscle tremors. These medications can help to ensure hemodynamic stability without producing excessive central sedation.

Hydration and Metabolic Functions

Dehydration happens when the body loses too much water and important minerals. A high metabolic rate makes this loss happen quickly. When someone gets IV hydration, it helps bring the body’s fluids to normal levels. This keeps the kidneys working and helps maintain steady blood pressure.

Magnesium and potassium need to be replenished to prevent any heart rhythm abnormalities due to high adrenaline levels. Thiamine should be administered in large doses to support carbohydrate metabolism.

Severe Complications of Unmanaged Withdrawal

The inability to manage autonomic hyperactivity can result in severe health complications. Generalized tonic-clonic seizures occur in many patients, where the brain continues to be out of control and overexcited.

According to statistics from the Substance Abuse and Mental Health Services Administration, up to 10% of patients undergoing severe withdrawal go through an abrupt autonomic crisis that needs immediate medical assistance. The local health departments report that timely admission into local detoxification centers in North Georgia significantly reduces overcrowding in the ER because of withdrawal complications.

Left untreated, patients may progress to severe confusion, high fever, and sudden circulatory failure. Furthermore, severe muscle agitation combined with extreme body heat can damage the kidneys and cause total organ collapse.

Delirium Tremens Pathophysiology

Delirium tremens is referred to as the most serious manifestation of an autonomic crisis. The signs that characterize the condition include confusion, hallucinations, be it visual or auditory, intense trembling, and unstable blood pressure. Dehydration and a high metabolic rate result in fast loss of bodily fluids and electrolytes. The process of IV hydration restores the fluid content of the body to its normal state, ensuring renal perfusion and stable blood pressure.

The reason for these symptoms is that the body releases hormones. This can cause blood pressure, a fast heart rate and a higher body temperature. Delirium tremens needs medical help. If not treated a person could die from problems, with the blood system or the breathing system.

Seizure Mechanisms and Excitotoxicity

Seizures associated with withdrawal manifest as acute generalized seizures resulting from excessive firing of glutamate neurons. The prolonged absence of GABAergic inhibition permits rapid propagation of electrical impulses in the cerebral cortical circuitry.

Each seizure increases cerebral oxygen use and cellular calcium uptake, resulting in cellular damage. It is important to prevent the occurrence of seizures to protect brain function.

Acute Kidney Injury and Rhabdomyolysis

Continuous motor agitation, muscle stiffness, and excessive heat production result in extensive breakdown of skeletal muscles. The breakdown of muscles results in the leakage of high amounts of myoglobin and potassium into the bloodstream.

High levels of myoglobin in the blood lead to clogging of the renal tubules, resulting in acute tubular necrosis. This eventually leads to the development of kidney failure.

Clinical Protocols for Long-Term Stabilization

Comprehensive treatment plans extend beyond immediate crisis management to ensure full physical recovery. Medical teams follow systematic protocols to guide patients safely through every phase of detox.

  • Tapering medication dosages gradually to prevent rebound symptoms
  • Reevaluating neurological function daily using standardized clinical criteria
  • Transitioning patients directly into structured residential or outpatient programs

Establishing these clinical steps minimizes physiological stress while preparing individuals for ongoing therapeutic care.

Clinical Protocol Standards for Managing Autonomic Instability

Proper withdrawal from drugs or alcohol requires regular supervision from the clinicians in order to manage such risks effectively. Clinician supervision enables continuous monitoring of vital signs, along with appropriate medication and treatment to prevent life-threatening complications.

Treatment centers provide an environment essential for managing complications and stabilizing patients according to their individual needs. Consulting the admission specialists at medically managed detoxification centers can help you make the right decision for recovery.

 

About the Author

Charles Schubert is a freelance marketer and SEO copywriter. He specializes in medical and wellness content. He has experience researching complex neurobiological mechanisms and healthcare protocols. Charles turns medical science into easy-to-understand practical resources. These resources help patients, families, and healthcare professionals make decisions.

 

References 

Bharadwaj, B., & Kattimani, S. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial Psychiatry Journal, 22(2), 100–104. https://doi.org/10.4103/0972-6748.132914

 

Romach, M. K., & Sellers, E. M. (1991). Management of the alcohol withdrawal syndrome. Annual Review of Medicine, 42(1), 323–340. https://www.annualreviews.org 

Please also review AIHCP’s Substance Abuse Practitioner Program and  CE courses to see if it meets your academic and professional goals.

DSM-V-TR & Substance Abuse Disorders and Eating Disorders

Posted on by Mark Moran

Addiction is a powerful thing.  Addiction is a habitual need to keep doing something despite negative outcomes for the taste of a positive reinforcer.   Ironically addiction can be almost anything in excess in life.  It can pertain to an action, such as gambling, gaming, or even sex and sexual acts.  Usually addiction is correlated with substances, food, or drugs.  In this blog, we will focus on substance abuse disorders and eating disorders described in the DSM-V-TR and review diagnosis and etiology of these disorders.

Please also review AIHCP’s Substance Abuse Practitioner Certification Program.

Substance Abuse

Substance abuse is a big problem affecting millions of people. Please also review AIHCP’s Substance Abuse Practitioner Program

Substance use is the involvement and partaking of a particular substance.  Substance use within itself does not entail a disorder.  It can lead to a dangerous outcome or a lesson learned due to a onetime DUI or fine, or severe hangover to never be repeated.  In this case, substance abuse occurred, but a disorder was not existent (Barlow, et al., 2023).   Substance abuse is usually associated with substance intoxication in which the levels of the substance exceed safe and social norms of it.  Obviously some substances within moderation are legal, while other substances are illegal even in moderation.  Unfortunately, substance abuse even once can be a life altering choice when it harms oneself or others.

Substance Abuse Disorders

The DSM-V-TR lists 10 separate classes of substances and drugs with subcategories.  Within these categories include, alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants and tobacco (2022).  In addition the disorders include the behavioral and psychological craving of the substance, intoxication of the substance and the withdraw of the substance (DSM-V-TR, 2022).

Addiction in general to these substances involves a general and universal footprint that transects the various substances.  Within this general diagnostic criteria, the DSM-V-TR lays out these guidelines for a Substance Abuse Disorder

A.  A problematic pattern that leads to significant impairment with at least 2 of the following occurring within a 12 month period.

  1. substance is ingested in larger amounts that intended
  2. unsuccessful efforts to control or limit intake
  3. great deal of time and energy to obtain substance
  4. cravings or strong desires or urges to use substance
  5. recurrent uses of substance resulting in failure to fulfill obligations at home, work or school
  6. continued use despite negative personal, legal and social issues
  7. reduction of occupational or recreational activities in place of substance use
  8. recurrent use in hazardous situations
  9. continued use of substance despite knowledge of the physical and physiological problem
  10. presence of tolerance
  11. presence of withdrawal

The disorder can be specified as mild if 2 or 3 symptoms are present, moderate if 4 to 5 symptoms and severe if 6 or more symptoms present (DSM-V-T, 2022).

This presents the basic blueprint for all addiction with substances.  Intoxication or withdrawal differ from substance to substance.  For purposes of brevity, we will just review a few substances and encourage those with particular interests to review particular substances in the DSM-V-TR.

Alcohol Intoxication 

With recent ingestion of alcohol (depressant), clinical problematic behavioral and psychological changes include inappropriate sexual or aggressive behavior, mood lability,  and impaired judgement.  Physical symptoms include one or more of the following, slurred speech, incoordination, unsteady gait, nystagmus, poor attention and poor memory,  and stupor or coma (DSM-V-TR).

Alcohol Withdrawal

Alcohol addiction is very common and can exist at numerous levels

Two or more of the following issues develop after cessation of heavy and prolonged drinking.  Autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient visual, tactile or auditory illusions, psychomotor agitation, anxiety and generalized tonic-clonic seizures (DSM-V-TR, 2022).

Cannabis Intoxication

With recent ingestion of cannabis, clinical problematic behavioral and psychological changes include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, and social withdrawal.   Two or more of the following symptoms can manifest including conjunctival injection, increased appetite, dry mouth and tachycardia (DSM-V-TR, 2022)

Cannabis Withdrawal 

Three or more of the following issues develop after 1 week of heavy or prolonged use of cannabis.  They can include irritability, anger or aggression, nervousness or anxiety, sleep difficulty, decreased appetite, restlessness, depressed mood, or at least one physical symptom of abdominal pain, tremors, sweating, fever, chills or headaches (DSM-V-TR, 2022).

Opioid Intoxication

Common Opioids- Heroin, hydrocodone, oxycodone, fentanyl (Barlow, et al, 2022)

With recent ingestion of opioids, clinical problematic behavioral and psychological changes include initial euphoria followed by apathy, dysphoria, psychomotor agitation, retardation and impaired judgement.   Pupillary restriction can occur.  In addition drowsiness, or coma, slurred speech and impairment to attention and memory (DSM-V-TR, 2022).

Opioid Withdrawal

Three or more of the following issues develop after cessation of heavy or prolonged opioid use.  These include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea (tears or runny nose), pupillary dilation, sweating, diarrhea, yawning, fever or insomnia (DSM-V-TR, 2022).

Stimulant Intoxication

Common Stimulants- Amphetamines ( crystalized-Methamphetamine), (Adderral), Cocaine (Crack in crystal form) (Barlow, et al, 2022)

With recent ingestion of stimulants, clinical behavioral and psychological include euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, and impaired judgment.  Two or more symptoms include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, nausea or vomiting, weight loss, psycho motor agitation, muscular weakness, respiratory depression, chest pain, confusion, seizures or coma (DSM-V-TR, 2022).

Stimulant Withdrawl

Two or more of the following issues develop after cessation or reduction of prolonged amphetamine use that include fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation (DSM-V-TR, 2022).

Tobacco Withdrawal

Tobacco withdrawal can occur after daily use for at least several weeks and with abrupt cessation include irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood and insomnia (DSM-V-TR, 2022).

Hallucinogen Intoxication

Common Hallucinogen- Phencyclidine or Angel Dust, LCD or Acid (Barlow, et al., 2023).

With recent ingestion of hallucinogens clinical behavioral and psychological changes include belligerence, impulsiveness, unpredictability, psychomotor agitation,  and impaired judgement.  Symptoms include two or more of the following within an hour such as vertical or horizontal nystagmus, hypertension, numbness, ataxia (Uncoordinated motor movement, dysarthria (impaired speech), muscle rigidity, seizures or coma, hyperacusis (hearing). (DSM-V-TR, 2022).

Eating Disorders

Eating disorders stem from anxiety, body dysmorphia, depression and low self esteem and sometimes even control

Substance misuse can also include how one eats and what one consumes.  In ways, it can become a impulse and compulsion as well due to anxiety, or poor self concept that leads individuals to eat certain ways or binge eat, or to starve oneself or attempt to control one’s weight through purging.  These disorders are very dangerous to overall nutrition and health but also have deep psychological issues.  Among the numerous eating disorders listed by the DSM-V-TR, there are Pica or the eating of nonnutritive or nonfood substances, rumination disorders,  binge eating, as well as the most common Anorexia Nervosa and Bulimia Nervosa disorders.  These disorders usually are tied to control issues, anxiety, low-self esteem, and body dysmorphia (Barlow, et al. 2022).

In regards to the BSM-V-TR,  Anorexia Nervosa meets these diagnostic criteria

A. Restriction of energy intake leading to significant body weight loss.

B. Intense fear of gaining weight or becoming fat and behavior that interferes with weight gain

C. Lack of recognition of the severe loss of weight.

Specifiers include restrictive type in which one has not binge ate or purged within the last 3 months but has severely dieted, exercised or fasted.  The second specifier is binge-eating/purging type in which the person within the last 3 months has self induced vomiting or utilized laxatives, diuretics or enemas (DSM-V-TR, 2022).  Based on one’s weight loss determines mild, moderate, severe or extreme.

Bulimia Nervosa

The DSM-V-TR points out that diagnosis of Bulimia does not occur exclusively during episodes of anorexia nervosa.  In addition, many individuals with bulimia do are average weight and do not appear thin or weakly (Barlow, et al., 2022).  The DSM-V-TR lists these criteria:

A. Recurrent episodes of binge eating which include eating within a certain 2 hour period of time of an amount of food that is larger than most individuals would eat and a sense of lack of control during that period

B. Recurrent and inappropriate measures to prevent weight gain through self-induced vomiting, laxatives, diuretics or other medications and excessive measures.

C. These behavior occur at least on average at least once a week for a three month period

D. Self evaluation of the body is unduly founded regarding shape and weight

Specifiers can include mild, moderate, severe or extreme (DSM-V-TR, 2022).

Binge Eating

Binge eating leads to guilt and disgust

Binge eating is recurrent episodes of eating large quantities of food to find some type of reduction of anxiety or comfort.  These recurrent binges are defined by the DSM-V-TR within the following parameters.

A.  Eating in a discrete period of time within a 2 hour period of an amount of food larger than what would be consider appropriate with a sense of lack of control.

B.  The binge eating is associated with three or more of the following feelings

  1. eating more rapid than normal
  2. eating until uncomfortably full
  3. eating large amounts when not hungry
  4. eating alone because embarrassed for others to see the amount consumed
  5. feeling disgusted, depressed and guilty with oneself after consuming the meal

C. Marked distress regarding binge eating is present

D. The binge eating occurs once a week for three months

E. The binge eating is not associating with Bulimia or Anorexia

The specifiers include mild, moderate, severe and extreme (DSM-V-TR, 2022)

The Problem and Etiology of Addiction

Addiction is not only psychological and behavioral but also genetically and biologically based. Please also review AIHCP’s Substance Abuse Practitioner Certification

Addiction looks for quick fixes.  It looks for pleasure in place of happiness.  The dopamine high is sought at the expense of the serotonin stability of life.  Many are looking to escape life’s problems and maladaptively cope via escapism.  This coincides also with more than stressors and problems but also comorbidity with other mental disorders such as depression and anxiety (McRay, et al., 2016).   In addition, addiction is many times tied to impulse control disorders as well (Barlow, et. al, 2023).

In addition, the activation of genetic and biological markers are passed down from generation to generation.  Individuals can face more than merely a psychological and mental addiction but also develop a physical addiction and disease.  Obviously some substances are more objectively addictive, but for some, genetic predispositions play a key role in whether someone can become addicted to a certain substance (Barlow, et al., 2023).

One reality is addiction is not always about substances, albeit the DSM-V-TR only lists gambling as a disorder, but addiction can take the form of many things if one considers actions to be repeated for purpose of positive reinforcement but with negative consequences.  All three qualities must be present for an addiction.  Hence, one can include activities that exceed moderation and in some way become harmful.  This could include gaming, pornography, or any type of obsession that takes away from quality of life.  Balance and temperance are key factors in maintaining healthy outlooks on things we do in life.

Addiction Treatment

Addiction treatment depends on a person’s willingness and the level of addiction itself.  For many it is a life long cross that involves will power, peer support, avoidance of the substance and its occasions, as well as developing better coping strategies for stressors, as well as anxiety and depression.  For some, it also involves finding deeper meaning in life and finding a spiritual anchor.  AA utilizes a spiritual based plan that holds one accountable to a higher power (Barlow, et al., 2023).

Depending on the depth of the disorder also plays a large role.  Abuse of a substance is different than a disorder itself.  Disorders can be mild, moderate or severe and the level of chemical dependency is subjective upon individuals.  Also, the nature of the substance plays a large.  Substances such as nicotine and opiates are far more addictive than other substances.  Some individuals may require medical treatment during the detox phase and require in patient care at a addiction facility.  Others may require gradual reduction and doses to avoid withdrawal under medical guidance.   Others with less severe conditions may just need intensive out patient care and psychoeducation, but others may require more peer support, as well as psychotherapy that includes CBT, motivational interviewing or even contingency management (rewards for sobriety).  Others may require medications to curb cravings (Naltrexone for drinking) or even cause nausea or discomfort in drinking (Disulfiram)

AA and the emphasis on spiritual meaning and finding something more than addiction is possible.  Many spiritual traditions see addiction as more than merely a physiological problem but also a spiritual one that involves bad sinful habits and sometimes even forms of spiritual oppression.  The practice of virtue over vice is essential in creating a healthy spiritual balance.  The virtue of temperance is key in implementing a long term solution against the vice of immoderation and addiction.  Understanding addiction in all its forms, just not substances, is an important aspect of spirituality and finding a healthy spiritual life.

Conclusion

Whether addiction is a substance or a practice, it involves maladaptive coping to face life and issues.  It involves a habitual need to engage or indulge oneself in something that has negative consequences for the small price of brief positive reinforcers.  For some addiction is mental and behavioral, but for others it can be inherited and activated.  It is important to never allow something to become so powerful over oneself as to destroy everything in one’s life.  Addiction is not fast, it is insidious and slowly seduces and entraps the victim but individuals can escape it with a strong will and peer support.  Finding meaning in something greater than oneself is key to overcoming habitual vice and addiction.

Please also review AIHCP’s Substance Abuse Practitioner Program and see if it meets your academic and professional goals.

Additional Blogs

12 Steps of AA Video blog: Access here

Dopamine and Serotonin in Addiction Process:  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Addiction and Substance Abuse Disorders. APA. Access here

Drug Addiction.  Mayo Clinic.  Access here

Substance Use Disorder (SUD). Cleveland Clinic.  Access here

Hartney, E. (2026). “DSM 5 Criteria for Substance Use Disorders”. VeryWellMind.  Access here

Withdrawal Symptoms: Clinical Red Flags for Healthcare Professionals

Posted on by Joseph Gerard

Meeting the needs of all populations.

Written by Agwalogu Bob,

Someone who decides to stop substance abuse is making a monumental choice for a good life. But this choice comes with the price of withdrawal symptoms, and, as every clinician knows, it’s rarely the same for everyone.

One patient may go through it with nothing worse than sweaty palms and a bad mood. Another may end up in the ICU. Take alcohol, for example. The National Library of Medicine notes that while about 50% of alcohol dependent people experience withdrawal, only a few experience true medical emergencies.

This is why recognizing withdrawal symptoms early enough should be one of the key skills healthcare frontline workers should learn.

The good news? Most withdrawal cases are manageable with appropriate monitoring and treatment. The challenge is recognizing the ones likely to lead to a medical emergency. 

Read on as we discuss the clinical red flags of withdrawal symptoms that every healthcare practitioner should know.

Why Some Withdrawal Symptoms Become Medical Emergencies

As we’ve already established, withdrawal isn’t the same for everyone. So, why do some withdrawal symptoms become medical emergencies while others are just mild?

The substance is the biggest factor. Withdrawal from alcohol and benzodiazepines can be very difficult. When a person starts withdrawing from these substances, they can experience seizures and delirium tremens (DTs). 

Opioid withdrawal, on the other hand, is rarely fatal. However, it can cause incredible pain and misery. Patients also tend to vomit a lot, which can cause dehydration and other serious issues.

Other factors that can also determine the severity of the withdrawal include:

  • Duration of substance use disorder (SUD)
  • Age of the patient
  • Overall health
  • Previous withdrawal complications
  • Coexisting medical conditions

Clinical Tip. Do not rely 100% on what a patient tells you, as they often downplay the problem because of shame. This can lead to cognitive bias if you don’t do proper verification. Cognitive bias accounts for up to 65% of diagnostic errors in primary care settings.

Common Withdrawal Symptoms vs. Clinical Red Flags

Withdrawal comes with symptoms, even though it looks different for different people. Here are some common examples clinicians should know.

Common Withdrawal Symptoms

Common symptoms of substance use withdrawal basically show that the body is recalibrating after prolonged substance use.

They include:

  • Anxiety and irritability
  • Restlessness
  • Sweating
  • Nausea
  • Mild tremors
  • Poor sleep
  • Increased heart rate

These symptoms will surely make the patient uncomfortable, but they’re usually not dangerous. If they get worse, or too many appear at the same time, however, it may indicate something more serious.

Clinical Red Flags

These symptoms are also part of the substance use withdrawal process, but they tend to be more severe. These red flag symptoms mean that the patient’s body is starting to destabilize.

Some of these symptoms include:

  • Seizures
  • Hallucinations
  • Severe confusion or delirium
  • Persistent vomiting with dehydration
  • Extremely high blood pressure or rapid heart rate
  • Chest pain
  • Difficulty breathing
  • High fever
  • Loss of consciousness
  • Suicidal thoughts or severe agitation
  • Delirium tremens (DTs) 

Keep an eye out for these red flags, as each one can quickly become life-threatening. Delirium tremens, in particular, have a high mortality rate of about 20%.

Clinical Tip: Multiple red flag symptoms occurring together means emergency. Immediately refer the patient to emergency services or inpatient care.

Withdrawal Symptoms Assessment for Healthcare Professionals

Many of the symptoms of substance use withdrawal can be mistaken for mental health conditions. This is because both conditions disrupt the same neurotransmitters in the brain.

Dr. Mark Horowitz, a Clinical Research Fellow in the NHS, sums it up perfectly: 

“Withdrawal is commonly confused with other conditions, even misdiagnosed as mental health concerns. This often leads to an inappropriate reinstatement of the medication causing the withdrawal.”

So, how do you tell exactly what you’re looking at?

Consider the following checks:

  • Mental health checks
  • A thorough substance use history, including timing of last use
  • Vital signs that you track over time and not just in one appointment
  • Medication review, including any current medications the patient is taking
  • Input from family or caregivers (They’re often the first to notice behavioral changes)

But the checklist above might not be enough on its own. Use screening tools like CIWA-Ar for alcohol withdrawal and COWS for opioids to complement the results of your physical examination.

When to Refer for Medically Supervised Withdrawal

One of the biggest decisions you’ll make with a substance use patient is deciding when to refer the person for medically supervised withdrawal. 

You should make this recommendation if:

  • Symptoms that worsen despite treatment
  • The patient develops seizures, hallucinations, or DT
  • Vomiting or diarrhea causes dehydration
  • The patient has a history of complicated withdrawal
  • The patient has medical or psychiatric conditions
  • The patient is pregnant or old
  • There’s no reliable support system for the patient

The good news? There are hundreds of centers that offer medically supervised withdrawals, also known as detox, all over the country.

In California, that might mean referring a patient to a safe medical detox in Orange County, since the area offers many options. Figure out which medically supervised detox centers in your area actually take referrals and have a good reputation.

South Shores Detox notes that detoxing can be a tough process, both physically and emotionally. But that doesn’t mean you should wait until a patient is crashing out before making the call.

Bottom line? Get them to the right level of care while you still have control of the situation.

Supporting High-Risk Patients Beyond Withdrawal

We’ve already discussed the red flags that may lead to an emergency. But some patients actually happen to have a higher risk of developing those complications.

These patients usually meet the following criteria:

  • Previous withdrawal seizures
  • Previous delirium tremens
  • Heavy daily alcohol use
  • Benzodiazepine dependence
  • Polysubstance use
  • Pregnancy
  • Older age
  • Liver disease
  • Cardiovascular disease
  • Serious mental illness

For these patients, safely managing withdrawal is only the first step. Once that has been safely completed, the focus will then shift to long-term recovery.

This can happen through counseling, behavioral therapy, medication-assisted treatment, and ongoing follow-up care.

The goal is to create a care coordination plan that addresses the whole person. It’s also to prevent a relapse. More than 60% of people recovering from SUD relapse within twelve months, so it’s important that this stage is handled properly.

FAQs

Which withdrawal symptoms should prompt immediate emergency evaluation?

Any symptom suggesting a threat to life demands immediate emergency evaluation. Examples include seizures, hallucinations, severe confusion, chest pain, difficulty breathing, or an altered level of consciousness.

Which substances are most likely to cause life-threatening withdrawal symptoms?

Withdrawal from alcohol and benzodiazepines can be life-threatening. This is due to the risk of seizures and delirium tremens, which can cause severe cardiovascular and neurological issues.

Can withdrawal symptoms become worse after the first day?

Yes. Alcohol withdrawal symptoms can definitely escalate after the first day. In fact, delirium tremens (DTs) typically starts 48 to 72 hours after the last drink.

Withdrawal Symptoms: Key Points to Remember

Key Clinical Takeaway What to Remember
Withdrawal Varies Most cases are mild, but there are some withdrawal that can become life-threatening
Know the Red Flags Seizures, hallucinations, delirium, chest pain, dehydration, and so on require urgent medical evaluation
Assess Thoroughly Don’t rely on history alone. Verify findings using screening tools
Escalate Early Refer patients for medically supervised withdrawal when outpatient care is no longer ideal
Think Beyond Detox Long-term success depends on follow-up care, proper support, and relapse prevention

Wrapping Up

Substance use disorder is a big problem all over the world, and for someone to decide that enough is enough, that’s a big deal.

Of course, deciding to quit often means facing withdrawal symptoms that can be either mildly uncomfortable or life-threatening. Knowing the different symptoms to look out for to ensure proper medical intervention early is the key to long-term recovery. 

Hopefully, this article has shown you how to identify those symptoms so that you can respond with confidence.

 

Author Bio

Agwalogu Bob believes great content doesn’t just inform; it resonates and then sticks. For over eight years, he’s been helping agencies across four continents craft just that kind of content: sharp, engaging cut-through-the-noise copy across SaaS, finance, tech, health, and lifestyle.

When he’s not putting pen to paper, you’ll likely find him scouring the internet for funny memes.

Connect with him on LinkedIn or Medium.

 

Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Why Most Teens Don’t Receive SUD Treatment and How We Can Fix It

Posted on by Joseph Gerard

Teenage girl sitting on the ground next to a brick wall. Written by Marchelle Abrahams

The wonder years are meant to be a time of discovery. Finding out who you really are. Making new friends. Falling in love and experiencing your first heartbreak.

And yet, kids aren’t doing childhood like they’re supposed to. The U.S. is currently in the throes of a teen mental health crisis. The National Institute of Health claims that one in five teens is diagnosed with a mental health or behavioral condition. 

Anxiety. Depression. Academic pressure. The list includes the “best of” attractions that feed on the next generation. Most are vulnerable and scared. With little else to turn to, they experiment with substances. 

The Child Mind Institute found that over 60% of teens who use substances also have a co-occurring mental health disorder. That percentage is shockingly high. 

Psychiatrist Dr. Sarper Taskiran at the institute says that generally, almost half of kids with mental health disorders, if not treated, will end up with a substance use disorder (SUD).

Opioids, an Overlooked Issue

A study published in Health Affairs, in September last year, shed light on another problematic issue. It indicated that only one in three kids with past-year OUD received treatment.

And, in a national 2023 survey, 1.3% of kids between the ages of 12 and 17 reported an OUD. It might not sound like much, but the Prison Policy Initiative puts it into perspective. That percentage represents about 342,000 children, more than the total population of Newark, New Jersey.

Substance use is a serious issue among young people. But experts agree that the treatment protocols are failing them. So, how can counselors like you fix what’s broken? We’ll explain below.

 

Making Treatment More Accessible

The lack of access to SUD treatment will always be a moot point. The same Health Affairs study found that fewer than one in four treatment facilities offered programs specifically designed for adolescents. 

Most families can’t afford private treatment facilities, which is why health insurance can be a lifeline. To make the experience less scary for families, research adolescent treatment centers that accept insurance. 

Depending on the policy, a teen rehab that accepts insurance may cover some or all of the cost of teen addiction treatment. Contact adolescent rehabs covered by insurance directly to verify benefits and understand what’s covered. Artemis Adolescent Healing Center explains that teenage brains are still developing, requiring specialized care.

 

A Holistic Approach

Traditionally, law enforcement visits a school and teaches the Drug Abuse Resistance Education (D.A.R.E.) program. The message is complete abstinence. Don’t do drugs. 

This approach doesn’t work. It’s largely ineffective. It’s outdated. And guess what? One study in the American Journal of Public Health even suggested that kids who completed D.A.R.E. were more likely to take drugs.

“We know that the ‘Just Say No’ campaign doesn’t work. It’s based in pure risks, and that doesn’t resonate with teens.” developmental psychologist Bonnie Halpern-Felsher, PhD.

Psychologists suggest using a different method. Instead of preaching not to use substances, acknowledge that some are still going to try it. And help them avoid the worst consequences, says the American Psychological Association (APA).

It might seem unconventional and taboo, but incorporating principles of harm reduction could be a solution.

 

Respecting Autonomy

Harm reduction therapy incorporates respect for autonomy, ambivalence, and lived experience, Barry Lessin tells FilterMag.

Lessin is the co-author of Harm Reduction Approaches With Adolescents Who Use Substances. He agrees that traditional treatment methods lean heavily on abstinence, compliance, and diagnosis. Never mind understanding context and relationship. 

Harm reduction therapy centers on safety, collaboration, and small and incremental change. Counselors can build trust by reducing harm in the real world. You can have boundaries about adolescent substance use, and still meet young people where they are.

Harm reduction therapy respects that process by giving teens a sense of agency and supporting healthy identity development.

 

It Starts in the Classroom

The adage still applies: One size does not fit all. That’s why schools are combining harm reduction with traditional prevention. 

Many experts trust this process. NGOs and various civic organizations offer free resources for counselors and schools. Stanford’s Halpern-Felsher REACH Lab has free, evidence-based programs.

Honest discussions must start somewhere. In the home. At school. Encourage teachers and parents to have these discussions. If they fear their kid has a substance use problem, asking for help is not a shame.

 

FAQs

Why are adolescents with mental health conditions at greater risk for substance use disorders? 

Mental health challenges and substance use mostly go hand in hand. According to the Child Mind Institute, more than 60% of teens who use substances also have a co-occurring mental health disorder. 

Why is specialized addiction treatment important for teens? 

Their brains are still developing, particularly in areas related to decision-making, impulse control, and emotional regulation. Teen-focused treatment programs are designed to address these unique developmental and mental health needs.

What is harm reduction, and how does it differ from abstinence-only approaches? 

Harm reduction acknowledges that some teens may experiment with substances and focuses on reducing the risks associated with that behavior.

How can families find more affordable adolescent addiction treatment?

Many treatment centers accept health insurance, which may cover some or all treatment costs depending on the policy.

 

Key Statistics on Teen Mental Health and Substance Use 

Statistic Finding Source
Teens diagnosed with a mental health or behavioral condition  1 in 5 adolescents  National Institutes of Health (NIH) 
Teens who use substances and also have a mental health disorder  More than 60%  Child Mind Institute 
Adolescents with past-year opioid use disorder (OUD) who received treatment  Approximately 1 in 3  Health Affairs
Treatment facilities offering adolescent-tailored substance use programs  Less than 23%  Health Affairs

 

Where To From Here?

Accessing treatment is one part of the problem. Then there’s the stigma, the lack of available resources, and the thinking that teen drug use is framed as “experimenting”.

Fixing the crisis requires going back to the drawing board and reworking outdated methods. Integrating screening into schools, improving family education, and expanding access to teen-specific mental healthcare.

And it all starts with you. Counselors are aptly tuned into the chaotic daily lives of teens. It’s your superpower. Use it. 

 

Author bio

Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks. 

Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Substance Use and Mental Health: What Every Healthcare Professional Should Know

Posted on by Joseph Gerard

Attractive desperate alcoholic man . depressed addict isolated in front of whiskey glass drunk and wasted in dramatic expression suffering alcoholism and alcohol addiction problem

Written by Agwalogu Bob,

If you work in primary care, the ER, or really any part of general medicine, you’ve probably met patients with co-occurring disorders.

It could be a patient with crushing anxiety who drinks a bottle of wine a night to take the edge off. It could also be the young adult with back pain who’s become increasingly dependent on their opioid prescription. 

It definitely isn’t a niche issue anymore. In fact, recent data from SAMHSA revealed that out of 61.5 million adults with mental challenges in 2024, 34.5% also had substance use disorder. Out of this number, more than 41% didn’t get the treatment they needed for either. 

For some of the patients who fell in the crack, chances are the clinician they met didn’t know what to look for. That’s exactly what the guide is for. Read on as we discuss co-occurring disorders, why they happen, and most importantly, what you can actually do to help.

What is a Co-Occurring Disorder?

A co-occurring disorder is when someone has a substance use disorder and a mental health condition together at the same time. 

You might also hear it called a dual diagnosis. We already gave two examples in the introduction: someone with social anxiety taking alcohol for confidence, and someone with PTSD abusing sleeping pills. As of 2024, approximately 7% to 8% of U.S. adults suffer from co-occurring mental illness and substance use disorder, according to Statista.

4 Things Healthcare Professionals Should Know About Co-Occurring Disorders

Now that we know what co-occurring disorders are and how prevalent they are, let’s look at four truths every healthcare practitioner should know about this condition.

Substance Use and Mental Illness are Bidirectional

Substance use disorder and mental illness have a two-way relationship.

On one side, there’s self-medication. This could be a person with PTSD who uses opioids or sleeping pills just so they can forget.

The second direction is substance use itself, actually causing or worsening psychiatric symptoms. People who consume alcohol heavily, for example, can also suffer severe depressive episodes. 

In fact, research shows that 50% of the adults who misuse substances are also likely to suffer from one form of mental illness or another.

So, how do you know if what you’re looking at is a co-occurring disorder? Some common examples include:

  • Depression and alcohol use
  • Anxiety disorders with benzodiazepine misuse
  • PTSD with opioid use
  • Bipolar disorder with stimulant misuse

The problem? Diagnosing these issues in a single fifteen-minute consultation is almost impossible. You have to see the pattern over time before you can confidently determine the problem and decide on a proper treatment plan.

Integrated Treatment is the Most Effective

It can be tempting to want to treat co-occurring disorders as isolated cases. Most people do this. In fact, the medical system has historically walked separate paths, and treating in isolation has always been the model.

The truth, however, is that when addiction and mental illness are handled as separate cases, a lot of patients will fall through the cracks. The result? Increased risk of relapse. This is why integrated care is the most effective option.

Rather than addressing each condition separately, a single team handles the treatment programs for co-occurring disorders. In practice, that means:

  • One coordinated care team for mental health and addiction
  • Shared treatment goals
  • Better communication between providers
  • Fewer gaps in care
  • More personalized treatment
  • Better long-term outcomes

And it really works, too. A 2025 BMC Nursing literature review found that integrated, patient-centred care that combines psychosocial and pharmacological approaches is the most effective way to treat dual diagnosis. It consistently performs better than fragmented care.

Diagnosis is Highly Complex

Another thing healthcare teams should know about comorbid disorders is that diagnosis can be really complex. Why? Because symptoms tend to mask or overlap.

The quote below by the Mental Health Academy sums this up perfectly. 

“Co-occurring mental health disorders are not the exception – they’re the reality for many clients. And they often present one of the most challenging landscapes for assessment and intervention.” – Mental Health Academy via LinkedIn.

Let’s look at some examples of this overlap using the table below:

 

Substance-Related Presentation Can Mimic or Mask
Alcohol or benzodiazepine withdrawal Primary anxiety disorder (tremor, racing heart, panic)
Stimulant intoxication or withdrawal Bipolar mania or hypomania (elevated mood, agitation, grandiosity)
Chronic alcohol use Major depressive disorder (low mood, poor sleep, low energy)
Opioid withdrawal Generalized anxiety or panic disorder (restlessness, GI upset, insomnia)
Cannabis-induced psychosis Primary psychotic disorder (schizophrenia spectrum)
Stimulant-induced psychosis Acute primary psychosis
Untreated PTSD hyperarousal Stimulant intoxication or withdrawal

 

As we’ve already established, you have to see these patterns over time before you can determine what exactly is happening. 

Take Bipolar Affective Disorders, for example. According to Icarus Behavioral Health, if a doctor misses the hypomanic episodes, they can inaccurately diagnose the person with depression alone. Even worse, they can mistake it for just withdrawal from certain substances.

This is why watching for patterns is important. When symptoms only show up alongside substance use and clear up after a period of abstinence, they’re more likely to be substance-induced. 

But when they persist even after complete abstinence, then you’re looking at a primary psychiatric disorder.

Recovery is a Long-Term Process

Finally, it’s important to understand that recovery doesn’t happen overnight. It takes time, structure, and consistency. 

It’s also important to note that relapses do happen, but this doesn’t mean that the treatment failed. It could simply mean that the plan needs a bit of adjustment.

The biggest part of recovery? What happens after? Transitioning from structured care back to everyday life is a vulnerable point for many patients. Many of them end up getting readmitted within the first 30 days after discharge, especially when there’s no strong system in place.

This is why there should be a proper hand-off, which should actually feel like a continuation of care.

This means:

  • Clear follow-up appointments before discharge
  • Direct connection to outpatient or community services
  • Medication continuity where needed
  • Warm handoff, not just a referral slip

When these steps are in place, there’s a stronger chance of full recovery.

FAQs

How many people have co-occurring health conditions?

The number of people with these conditions differs based on the study you’re looking at. However, SAMHSA estimates that more than 34% of the 61.5 million people with mental challenges also struggle with substance use disorder.

 

Should substance use or mental health symptoms be treated first?

Neither should necessarily come first. Co-occurring disorders should be handled together using an integrated care model. Treating them separately may mean incomplete recovery and relapse.

 

How can clinicians determine whether a patient has a co-occurring disorder or not?

Clinicians can determine whether it’s a co-occurring disorder or not by looking at patterns. Probably the best giveaway is symptom persistence. If symptoms continue during the period a person is abstaining from substance use, then it may suggest an underlying mental health condition.

Co-Occurring Disorders: Final Thoughts

Co-occurring disorders are common, complex, and frequently missed. But they don’t have to be. By understanding the bi-directional relationship, embracing integrated treatment, and knowing symptoms that overlap, healthcare practitioners can make a real difference in patient outcomes.

Hopefully, this article has helped bring some clarity to a topic that often feels more complicated in practice than it looks on paper.

 

Author Bio

Agwalogu Bob believes great content doesn’t just inform, it resonates, and then sticks. For over eight years, he’s been helping agencies across four continents craft just that kind of content: sharp, engaging cut-through-the-noise copy across SaaS, finance, tech, health, and lifestyle.

When he’s not putting pen to paper, you’ll likely find him scouring the internet for funny memes.

Connect with him on LinkedIn or Medium.

 

Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Why Patients Feel Taken Advantage of in Rehab, and How to Change That 

Posted on by Joseph Gerard

Victims of bullying need external supports to help them cope through the abuse of bullying and shaming

Written by Marchelle Abrahams,

For decades, addiction was treated as a criminal problem. And then research suggested that we view it as a medical condition and address it as such.

This understanding is now helping rehab centers take a more holistic approach in treating millions of people with a substance use disorder (SUD). But the divide remains.

Even with all the evidence pointing towards addiction as a moral failing, many experts believe that SUDs and crime are inextricably connected. Add physician and author Dr. Gabor Maté’s unshakable views as a coping mechanism for unresolved trauma, and the discourse becomes deafening.

It doesn’t matter which hypothesis you subscribe to: criminal, medical or trauma. The question is how you treat it. Rehabs are at the center of this paradigm. And treatment is an industry too.

A Broken System?

Talk to enough people in recovery, and a common thread emerges: one where patients feel misled, pressured, or exploited.

This isn’t a reputational issue. It’s a clinical one. As a rehab counselor, you know that when trust diminishes, outcomes suffer. Dropout rates rise. Relapse risk increases.

Oftentimes, patients feel taken advantage of in treatment centers. So, what can you do to fix it?

 

The Trust Gap: Where It Starts 

A study published in the National Institutes of Health sought to identify barriers to optimal inpatient rehabilitation outcomes among patients with spatial neglect (SN). 

It was determined that specific needs, such as family support, training, and treatment engagement, were strong predictors of recovery outcomes. However, engagement depends heavily on trust. And trust is what many patients say is missing.

Across forums like Reddit, a recurring theme appears: “I don’t know who to trust.” That uncertainty influences every interaction from intake to discharge.

One Redditor posted a desperate plea to find a real treatment program that wasn’t “predatory.” The responses ranged from empathy to helpful advice to join a program that offers CBT, trauma work, and relapse prevention.

 

Lack of Transparency Around Costs and Insurance 

Patients regularly enter treatment without understanding what their insurance will cover. Or what they’ll owe out of pocket.

Unexpected bills can put them back, psychologically. Cases involving lawsuits reinforce this perception. 

Case Study

A 32-year-old patient enters a residential program believing her insurance covers 30 days. She’s discharged after 10 due to coverage limits. She receives a bill for the remaining balance. The patient leaves feeling misled, even if the provider followed policy.

The Fix

  • Walk through insurance coverage line-by-line before admission.
  • Provide written cost estimates (and update them as needed).
  • Assign a financial liaison patients can reach.

Transparency upfront reduces resentment later. It’s that simple.

 

Forced or Coerced Treatment 

In some states, civil commitment laws allow individuals to be placed in treatment without consent. 

In Idaho, for instance, only a peace officer or qualifying members of medical staff can initiate an emergency evaluation, per Idaho Code 66-326. The Treatment Advocacy Center (TAC) recommends that family members directly file an emergency court order for court-ordered treatment.

Case Study

A young adult in Ada County is admitted under family pressure. They feel stripped of autonomy and resist participation. Even after transitioning to voluntary care, they remain disengaged. 

The Fix

Icarus Wellness and Recovery advises counselors to use involuntary commitment laws as a guideline to obtain court-approved treatment providers.

 

Patient Brokering and Questionable Referrals 

Patient brokering, where individuals are referred to specific facilities in exchange for financial incentives, has become a major concern. 

Families report being steered toward programs that benefit the referrer rather than the patient.

Case Study

A parent seeking help for their son is contacted by multiple “advisors.” Each pushes a different facility, sometimes in another state. The son cycles through programs without improvement. The family later learns those referrals were financially motivated. 

The Fix

  • Be transparent about referral relationships.
  • Avoid commission-based referral structures.
  • Focus on clinical fit over bed availability.

Patients can sense when they’re being “placed” instead of helped. Counselors should make clinical reasoning visible.

 

General Treatment Plans 

Patients report feeling like they’re being pushed through a system rather than treated as individuals. 

Standardized approaches don’t work for everyone.

Case Study

Two patients with different trauma histories receive identical treatment schedules. One engages. The other shuts down.

The Fix

  • Tailor treatment plans to individual histories and goals.
  • Adjust pacing and modalities based on response.
  • Involve patients in treatment decisions.

Personalization now becomes a requirement for buy-in.

 

Poor Communication from Staff 

Confusion around rules. Expectations and progress. When these aren’t communicated to them, patients get stressed and anxious. And that leads to mistrust.

Patient satisfaction impacts recovery outcomes, patient adherence, and the facility’s reputation. 

Case Study

A patient violates a rule they didn’t fully understand and faces consequences. They interpret this as unfair treatment instead of a misunderstanding. 

The Fix

  • Set clear expectations from day one.
  • Repeat key information regularly.
  • Encourage questions without judgment.

Clarity builds safety, which builds trust.

 

The ‘Revolving Door’ Experience 

Some patients cycle through multiple programs without lasting results. 

The New York Times recently reviewed a book by investigative reporter Shoshana Walter on systemic issues in parts of the rehab industry, including profit-driven practices.

Case Study

A patient attends three facilities in two years. Each promises a fresh start. None address underlying trauma. The patient begins to believe rehab itself is the problem. 

The Fix

  • Concentrate on continuity of care beyond discharge.
  • Build realistic expectations about recovery timelines.
  • Address root causes, not symptoms.

Recovery isn’t a 30-day event. Treating it like one sets patients up for failure.

 

FAQs

1. Why do patients distrust rehab programs?

Many patients report unclear costs, inconsistent communication, and feeling like decisions are made for them rather than with them.

2. Does forced rehab work?

It can stabilize individuals in the short-term, but long-term success improves when patients transition to voluntary, engaged participation.

3. How can counselors improve patient engagement?

By involving patients in decisions, setting expectations, and showing measurable progress throughout treatment.

4. What is patient brokering, and why is it harmful?

Patient brokering involves referrals driven by financial incentives rather than clinical need, which can lead to poor treatment matches and repeated relapse cycles.

 

Key Facts at a Glance

Insight Source
Treatment engagement is a key predictor of recovery success  NIH (2021)
Patient satisfaction improves with better communication  Net Health
Patient brokering continues to impact treatment quality  Partnership to End Addiction 
Outcome tracking improves care effectiveness  NIH (2024)

 

What Counselors Can Do Differently

Fixing these issues starts with small changes.

Be transparent, even when the truth is uncomfortable. Treat patients as partners, not participants. Prioritize long-term outcomes over short-term metrics. Build trust intentionally, not passively.

Patients don’t expect perfection. They expect honesty.

Author Bio:

Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.

 

 

Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Why Military Families Struggle to Find Addiction Counselors

Posted on by Joseph Gerard

While many only correlate PTSD with veterans it can also affect survivors of abuse or other traumatic experiences

Written by Marchelle Abrahams

Karie Fugett will never forget that morning in November 2008 when she found her husband lying next to her. Suffocating on his own vomit, he turned purple.

Frantically, she performed CPR. When the paramedics arrived, they injected him with naloxone into the heart. Cleve Fugett survived that day. Four years later, he wasn’t as lucky. 

The veteran developed a dependence on prescription opioids after sustaining injuries during his deployment in Iraq. He later died from a fentanyl overdose while at an inpatient facility for veterans with PTSD.

Karie says Cleve died afraid of losing his military status. For thousands of military personnel, the shame of addiction weighs heavily on them. And so, Karie wrote a book, Alive Day, detailing the hardships her husband endured. 

Today, she remains actively involved in desperately finding a solution to the U.S. fentanyl crisis. Her 2025 opinion piece for The Guardian is grounded in facts and research, pleading with the government to do more for military families.

 

Trauma and Shame are Major Barriers to Seeking Help

Cleve Fugett should have received addiction counseling when he became dependent on prescription opioids. 

Instead, his doctors switched him to something new. It went from Dilaudid to Percocet, then methadone, OxyContin, and eventually fentanyl. The main reason vets don’t enter treatment facilities is the fear of losing their rank. 

“Until the military publicly ensures no veteran’s job, rank, or benefits will be taken away for substance abuse, service members and veterans will continue dying from overdoses.” – Karie Fugett via Vox.

 

Limited Access

Those who choose professional help may find themselves hitting a wall.

On paper, coverage exists. Programs are listed. Resources are available. In practice, families struggle to find a qualified counselor who understands their needs and takes their insurance.

In a treatment setting, this shows up as missed referrals, delayed admissions, and patients arriving after months of trying to get help. 

As a counselor, you need to understand where the breakdown happens when working with military-connected clients.

 

The Demand Is Higher Than Many Realize 

Military personnel face increased risks when it comes to substance use and co-occurring mental health conditions.

Exposure to trauma. Repeated deployments. Chronic stress and reintegration challenges. They all play a role. 

Research shows strong links between PTSD, depression, and substance use disorders (SUDs) in veteran populations, according to Psychology Today. Citing figures from the 2024 National Survey on Drug Use and Health, the publication claims that 7.5% of veterans reported heavy alcohol use compared to 6.5% of non-vets. 

There’s also the issue of identity. Substance use is tied to ongoing struggles around purpose, belonging, and transition back to civilian life. The National Council for Mental Wellbeing says that without a clear mission and support network they once relied on, many experience uncertainty and isolation.

These are not simple cases. They require specialized, often long-term care.

 

Coverage Doesn’t Equal Care

From the outside, it looks like military families have options. In reality, finding programs that take TRICARE in-network has its limitations.

TRICARE in-network treatment programs cover a wide range of services, including outpatient counseling, inpatient care, and substance use treatment.

Coverage is only one piece of the puzzle.

A shrinking pool of providers, longer wait times, and limited access to specialized addiction care are some of the problems encountered. TricareRehabs.com suggests families consult a private placement service that provides information on addiction treatment programs that accept TRICARE.

 

Why Providers Opt Out

For counselors, the decision to accept or reject insurance is rarely personal. It’s practical. 

Low Reimbursement Rates 

One of the biggest concerns is compensation.

Therapists report that reimbursement rates can be substantially lower than other insurance plans, sometimes below Medicaid levels. Over time, that becomes unsustainable.

Administrative Burden 

The paperwork is another major issue.

Providers describe increased documentation requirements, ongoing compliance checks, and time-consuming claims processes. In some cases, clinicians are required to submit detailed notes after every session.

That time comes out of clinical work.

A Reddit discussion among therapists highlights the administrative demands. They can outweigh the benefits of participation, pushing providers toward private pay or out-of-network models.

Payment Delays and Uncertainty 

Even when services are provided, payment is not always predictable.

Delayed reimbursements and claim denials create cash flow issues, particularly for smaller practices. For counselors, that uncertainty is enough to step away from insurance panels altogether.

Clinical Complexity Requires Specialized Care 

Not every provider is equipped to work with military populations. 

Emerging Treatments 

We’re seeing newer approaches to trauma and addiction treatment, including psychedelic-assisted therapy. 

Some veterans are seeking these treatments for PTSD and related conditions outside traditional systems.

Gaps in Continuity of Care 

The challenges don’t stop when a patient enters treatment.

Continuity of care is fragmented. Transitions between detox, inpatient, outpatient, and community support are not always smooth.

The National Institutes of Health’s research on substance use treatment systems shows the need for coordinated care across levels of treatment. Unless addressed, these gaps can lead to relapse or disengagement.

 

Moving Toward Better Access 

Understanding the “why” helps counselors set realistic expectations, advocate more effectively, and design treatment plans that account for system-level barriers. 

There is no single fix. Yet a few steps can make a difference:

  • Building referral networks that include TRICARE-approved rehab centers
  • Strengthening case management and care coordination
  • Expanding trauma-informed and culturally competent care
  • Supporting policy efforts that address reimbursement and access

Awareness is a starting point. When counselors understand the barriers their patients face before they walk through the door, they are better positioned to respond.

 

FAQs

1. Why don’t more counselors and rehab centers accept TRICARE?

Low reimbursement rates, administrative burden, and payment delays make participation difficult for many providers.

2. Are military clients more complex clinically?

Many present with co-occurring conditions such as PTSD and substance use, which require specialized, integrated care.

3. Does stigma still affect military families seeking treatment?

Yes. Concerns about confidentiality, career impact, and judgment can delay help-seeking.

4. What can rehab counselors do to improve access?

Strengthening referral networks, improving care coordination, and using trauma-informed approaches can help.

 

Key Facts

 

Fact Source
7.5% of veterans reported heavy alcohol use compared to 6.5% of non-vets 2024 National Survey on Drug Use and Health
Coordinated care improves outcomes in substance use treatment systems  PMC (2023)
TRICARE covers a wide range of mental health services, but provider participation varies  TRICARE Newsroom
Veterans experience higher rates of co-occurring PTSD and substance use disorders  Psychology Today (2024)

 

Recognizing the Obstacles

Military families are not struggling to find addiction counselors because they lack coverage. They are struggling because coverage does not guarantee access.

Between provider shortages, administrative barriers, clinical complexity, and stigma, the path to care becomes harder than it should be.

As a counselor in a treatment setting, recognizing these obstacles is helpful and necessary. It shapes how patients enter treatment, engage, and recover.

 

Author bio

Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial-up sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks. 

Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification