Does your loved one have an Alcohol problem?

1.  Do they lose time from work?

2.  Do they have difficulty sleeping?

3.  Do they drink alone?

4.  Do they keep a "stash" of alcohol hidden?

5.  Do they initially take a large gulp of alcohol (in order to get drunk/feel good)?

6.  Is your home life unhappy and are you experiencing relationship issues?

7.  Is drinking affecting his/her reputation?

8.  Do they feel a craving for a drink at a specific time daily?

9.  Do they only want to go to restaurants that serve alcohol?                               

10. Do they express remorse after they have gotten drunk?

11. Have they experienced complete loss of memory as a result of drinking?

12. Is drinking jeopardizing their job and creating financial difficulties:

Do they suffer from any of the following syptoms?:

1.  Shortness of breath

2.  Dry mouth

3.  Constricted (small) pupils

4.  Sudden changes in behavior or actions (mood swings)

5.  Disorientation

6.  Cycles of hyper alertness followed by suddenly nodding off

7. Droopy appearance, as if extremities are heavy

8. Lying or other deceptive behavior

9. Avoiding eye contact or distant field of vision

10. Substantial increases in time spent sleeping

11. Increase in slurred, garbled or incoherent speech

12. Sudden worsening of performance in school or work, including expulsion or loss of jobs

13. Decreasing attention to hygiene and physical appearance (weight loss, face breakouts)

14. Loss of motivation and apathy toward future goals

15. Withdrawal from friends and family, instead spending time with new friends

16. Lack of interest in hobbies and favorite activities

17. Repeatedly stealing or borrowing money from loved ones, or unexplained absence of valuables

18. Hostile behaviors toward loved ones, including blaming them for withdrawal or broken commitment

19. Regular comments indicating a decline in self-esteem or worsening body image

20. Wearing long pants or long sleeves to hide needle marks

More definitive warning signs of heroin abuse include possession of paraphernalia used to prepare, inject or consume heroin such as:

1. Needles or syringes not used for other medical purposes

2. Burned silver spoons

3. Aluminum foils or gum wrappers with burn marks

4. Missing shoelaces (used as a tie-off for injection sites)

5. Straws with burn marks

6. Small plastic or blue bags with white powdery residue

7. Water pipes or other pipe

8. Bottled water with a small amount of water missing and the cap lying next to it

 If you have answered yes to any of these questions there is a definite warning that your loved one may have a substance abuse issue.

 If you answered yes to any two, the chances are that there is a substance abuse issue.

If you answered yes to three or more, there is definitely a substance abuse issue.

1. Make them quit. You can stage an intervention, and you may be successful, but you cannot force someone with a substance abuse problem to quit.  Even in states that allow involuntary treatment, you can't make someone get sober.  "You can keep throwing money at them, telling them what to do and trying to lift them up but they have to commit to it," says Eve Goldberg, a mom who lost her 23 year old son, Isaac, to an opiate overdose in 2013, "I've learned you have to let go. You can't control them or the situation, and the sooner you accept your lack of control, the sooner they can face the natural consequences of their actions."

2. Do the work of recovery for them. Even if a loved one goes to drug rehab, you can't do the work of recovery for them and you can't prevent relapse.  Even if you see the signs you can't always do something about it." Addiction hijacks the brain, leading people to hide, lie and manipulate to maintain their drug abuse.  Isaac didn't want to die.  He wanted to get better.  But there is simply no logic to addiction.  You shouldn't babysit someone's recovery.  You can be a participant in their healing, but from arm's length."  For many, even those who ultimately maintain their recovery long-term, relapse is a common part of the process.  Like other chronic diseases, it's not unusual for those struggling with addiction to need multiple episodes of treatment.  "Someone can go to meetings, have a sponsor and be a poster child for AA but still relapse," says Bennett.  "It's a vicious cycle, and the person has to be willing to reach out for help to stop it."

3. Accept behavior that violates your boundaries. To avoid enabling, loved ones have to set boundaries.  And once you've laid out your boundaries, allowing them to be violated destroys your credibility and perpetuates your loved one's addiction.  "If you don't follow through with consequences when someone violates one of your boundaries, your word is like quicksand," says Bennett. "If you say what you mean and mean what you say, even if they're mad at first, they'll respect you in the long term."  Boundaries can be basic, for example, the person has to be clean and sober if they're in your home.  If the boundary is broken, Bennett recommends calmly saying, "We talked about this and this doesn't work for me" or "I love you but I can't go down this road anymore" and then following through with the consequence.  Holding firm to your boundaries may mean disengaging for a period of time, or indefinitely, she says. For some people struggling with addiction, experiencing the consequences of their drug use is the only way they'll recognize the seriousness of the problem and get help. As difficult as it is, you don't have the power to fix it.  Only they do."

1. Get educated.  You can't help fight an enemy you don't understand.  Learn about addiction, the signs, the treatments, the relapse triggers and talk to your loved ones about drugs and alcohol from an early age.  Of course, education is no guarantee of healthy choices, but it can be a powerful tool in preventing drug abuse and finding a way into recovery.  If your loved one goes into treatment, participate in any family programs that are offered.  The education and encouragement offered by a drug rehabilitation center can help you support your loved one and take care of your own needs at the same time.  Then continue to be a source of support and accountability post-treatment, when drug cravings and triggers heighten the relapse risk.  Bennett strongly recommends putting into place a family recovery contract when a loved one returns home from treatment or sober living.  She notes, "If the addict doesn't live at home, a recovery contract is important with fewer stipulations, but not imperative."

2. Take care of yourself. A critical lesson is to be good to yourself, regardless of whether the addict is doing well. You can't control another person, but you can make healthy decisions for yourself.  And you must in order to have any hope of being able to support and encourage your loved one.  For some people, groups like Al-Anon provide a safe place to get education and fellowship with others who are facing similar struggles. Others prefer seeing a therapist privately or joining a different type of support group.  Whatever your path looks like, "you have to keep putting one foot in front of the other, keep looking forward, not back.  "There's no way to make sense of it. There's no reason why my son should've died. Give yourself over to God."  There's a lot of pain and grief involved when you love someone with a substance abuse problem.  Your other family members and friends may not grieve in the same way as you and may have their own ideas about how to handle the situation.  For example, Eve started BIGVISION, an organization dedicated to helping young adults transition into sober life after rehab. Although her family had trouble understanding it at first, helping others suffering from the same illness that took away her son has been an integral part of her healing.    

3. Talk about it.  Talking about the problem can be healing both for the person trying to overcome addiction as well as their loved ones. A person with a drug problem may be reluctant to come to you and ask for help, but if you can tolerate the lies and manipulation, an open dialogue is your best chance to be there for them when they need you most.  "Work on building a good relationship, without judging or accusing," Eve suggests. "You have to step back, you can't be on top of them all the time, or thy won't trust that they can come to you."  For loved ones trying to take care of themselves, nothing is more toxic to your healing than shame. Eve had many friends who struggled with addiction in their family but were too ashamed to talk about it.  "We made a decision as a family to be up front about our struggles," she says. "the more you talk about it, the more you realize everyone has a story, everyone has been affected by addiction in some way."  For Eve, speaking her son's name and telling his story is one way to keep his memory alive. "I still cry when I tell Isaac's story, even two years later.  And I can see people's faces cringe when I talk about my dead child.  They don't know how to handle it, " she says. "But I can't worry about making them uncomfortable. He's still my son and I won't pretend he didn't exist."

The realities of addiction are painful. It's hard to hear that a loved one's life is at risk and you can't fix it.  But once you accept certain realities, you may discover that there's empowerment beyond the powerlessness. There are steps you can take to help yourself and your addicted loved one, and once you've taken those steps you can take solace in knowing you did all that you could in the face of a devastating disease. 

By Meghan Vivo