Former NBA player Lamar Odom has emerged from a coma after being found unconscious in a Nevada brothel, allegedly after several days of using cocaine and unregulated supplements that some call "herbal Viagra."
Odom's experience echoes the worst nightmares of the friends and family of people with drug addictions: a downward spiral, a medical crisis and even the possibility of death. And because people with addictions often deny their problems or avoid seeking treatment, loved ones can feel helpless.
But experts say that friends and family are among the greatest resources drug-addicted people have to help them recover. Convincing someone to seek treatment is often difficult, but it can be done in many cases — and friends and family don't have to wait for the person to hit rock bottom.
"The strongest thing that is helpful is having a system of care that can surround the person," said Dr. Kelly Clark, president of the American Society of Addiction Medicine (ASAM). Addiction is a chronic disease, which means it persists over a long period of time. In this way, it resembles other conditions, like diabetes, Clark told Live Science. And like people with diabetes, those who are trying to manage drug addiction require day-by-day support. [The Drug Talk: 7 New Tips for Today’s Parents]
"People don't do well managing their diabetes if their family has ice cream and cake every night," Clark said.
Barriers to care
The comparison of addiction to a chronic disease like diabetes is an important one, researchers say. One of the biggest barriers to care for people with addiction is the stigma of being labeled an "addict."
In fact, this stigma can even prevent people from getting science-based treatments, said Brendan Saloner, a health policy researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore. For example, the U.S. Food and Drug Administration has long approved methadone as a treatment to combat opioid addiction; regular methadone doses reduce cravings for drugs such as heroin and decrease the "high" from opioid drugs if a user does relapse.
However, methadone treatment itself is stigmatized, and 17 states prohibit Medicaid funds from being used to fund the treatment, Saloner said.
"There's resistance to methadone maintenance that, frankly, may have less to do with its clinical benefits than with other, cultural factors," he said.
Meanwhile, heroin overdose deaths have quadrupled in the United States over the past 10 years, while treatment rates for opioid addiction have remained stagnant, Saloner and his colleagues reported Oct. 13 in the Journal of the American Medical Association. Eighty percent of people in the U.S. who have an opioid addiction aren't getting treated — about the same percentage as a decade ago, Saloner said. (The actual number of people in treatment nearly doubled between 2004 and 2013, the researchers found, but the increase in people using opioids far outstripped the number of those in treatment.)
The cost of addiction treatments and spotty medical insurance can be another barrier to treatment, Saloner said. Patients and family members should make sure that the treatment they're considering is covered under their insurance plan. Just because a treatment facility says it takes insurance does not mean insurance will actually pay without preauthorization.
A concerned approach
For many families, though, the first hurdle is getting the person with the drug problem to seek help at all.
Denial is often a part of addiction, and people with an addiction are often terrified that they will lose control of their lives if they seek treatment. Myths about treatment centers exacerbate this problem, Clark said. For example, many people believe the only way to cure a drug addiction is to go to a rehab facility far away for a month and then come back "fixed."
"That's not what treatment is," Clark said. "That's a type of treatment that is useful for some people. But most people will get and stay sober in their communities."
Family and friends should know that they don't need to wait for a crisis to approach someone about their substance abuse; it's not true that a person needs to "hit rock bottom" in order to be motivated to find help, Clark said.
The National Institute on Drug Abuse has a list of questions to ask to determine whether a person might have a problem. For example, a person may have an addiction if they want to cut down on substance use, but can't, or if they spend a lot of time seeking and using the drug. Giving up relationships or struggling to keep up at work or school are other signs.
Despite the popularity of TV shows like "Intervention," a confrontational approach may backfire. A positive, nonaccusatory approach is the place to start, Clark said.
"The conversation is: 'I'm worried about you. These are the things I see that I'm worried about. I'm concerned you have this disease, but I know there is a treatment,'" she said. [Top 10 Stigmatized Health Disorders]
One tactic psychologists and doctors use is called "motivational enhancement," which seeks to rev up a person's internal desire for change. A therapist might ask a person, for example, what good comes of them drinking themselves into unconsciousness every night. The idea is to prompt the person to realize how unhelpful the addiction really is.
The challenge of recovery
The Partnership for Drug-Free Kids recommends approaching someone with a substance-abuse problem when they (and you) are sober, and have a stretch of time when you won't be interrupted. Emphasize your care and concern for the person, ask open-ended questions and avoid attacking or judging the person. If they deny a problem, focus on keeping the dialogue open.
"Your goal is not to convince the person that there is a problem, but to let them know that you believe there is one and that your belief is based on observable behaviors," according to the organization's website.
Families often struggle with whether to take a "tough love" approach (for example, kicking a relative who won't stop using drugs out of a home). The line between supporting someone and enabling them is not bright and clean, Clark said.
"Everyone has to deal with the disease in a way that's specific to them and their family situation," she said.
That's why it's crucial not to go it alone, she said. Groups such as Al-Anon, Alateen and SMART Recovery Family & Friends can help with the day-to-day struggle of a loved one's addiction. ASAM and the Substance Abuse and Mental Health Services Administration (SAMHSA) also have tools to use to find treatment centers and doctors. The process of recovery can be a long haul.
"People need to manage their disease one day at a time," Clark said. "They need to have a support system, an involvement in the community … The evidence shows that this is a chronic illness that needs ongoing treatment."