Helping with Co-occurring Disorders
Family role in supporting loved ones with co-occurring disorders is critical

The family role in supporting a loved one with co-occurring disorders is critical. Support can include many things – recognizing that there is a problem; motivating them to get help; navigating the treatment system; and helping them sustain progress in recovery. It can be a significant emotional time and financial commitment, but research shows that family involvement improves outcomes.

Encourage treatment participation

Encourage your loved one to keep appointments and participate in all aspects of their treatment plan. This may include therapy and medications as well as the development of life skills. If a case manager is involved, work closely with them to stay on the same page regarding treatment. You may also need to keep a calendar of appointments and ensure transportation is available.

Some families use positive reinforcement to improve the chances that their loved one will stick with a treatment plan. Hearing that their parent or other caregiver is proud of them or receiving a letter from home while in residential treatment to keep them motivated can be very meaningful. Some families offer incentives or rewards after participating in a counseling session or completing a program.

Provide emotional support and encouragement

Often, adolescents and young adults want to be “normal.” They may be aware of the stigma around addiction and mental health and, as a result, don’t want to have to deal with treatment or take medication. Listening to their concerns can go a long way toward encouraging them to enter treatment, in addition to simply letting them know that you care.

Some teens and young adults have been to multiple treatment programs and may feel that “nothing works.” You also may feel hopeless if they need treatment again. It can help you both to reflect on any part of their previous treatment that was useful (such as learning about mental health challenges, finding a therapist that they liked, feeling better for even a short period of time, learning a new coping skill, meeting someone in treatment that they could relate to, etc.). It helps to think about every treatment episode as an opportunity to build upon what was already learned.

Participate in family education

Many programs offer what is referred to as a psychoeducational group for families. These groups are provided so that families can learn more about mental health symptoms, signs of substance use, treatment options, medications and relapse warning signs. It’s also a place where families can process what has happened since the last session and get advice as to how to respond more effectively if needed.

A family weekend or four-day educational program is often offered in residential treatment settings. There are also designated times for visits and, in some cases, passes to spend family time off campus.

Attend individual and family counseling

Participate in individual and family counseling if offered, both with and without your loved one. These sessions can help you address your concerns, improve family connections and problem-solve with the support of a counselor in a safe environment. Skilled therapists can help you and your loved one learn how to relate to and communicate with each other to build a stronger relationship.

Assist with medication management

In addition to providing input to doctors when prescribing medications to your teen or young adult, you may need to fill prescriptions and, depending on their age, administer the medication. It can help to have notes with the name of the medicine, the prescribed dosage, and what you notice with respect to side effects and symptom reduction. If multiple medications are needed, consider purchasing a weekly pillbox from the pharmacy to organize pills rather than counting them out each day.

It isn’t uncommon for young people to be unhappy with their medications at first. This may mean that the medication they are taking has side effects they don’t like. It can also mean that the substances they were using did a better job — at least in the short-term — of addressing their anxiety, boredom or other reasons for use.

In either case, it can be helpful to discuss this with the treatment team to make adjustments if necessary. Visits with psychiatrists are often very brief — sometimes just 15 minutes — so make the most of the session by being prepared to discuss how the medication is working.

Key Takeaways

Encourage abstinence

Alcohol and other drugs can worsen mental health symptoms. Substances don’t mix well with medications either. The best course of action is to keep all substances out of your home. If you do keep alcohol or marijuana in the home for your personal use, keep it locked up along with any medications that can be misused. Also restrict access to household products that can be used as a substitute for alcohol (like hand sanitizers or vanilla extract), as well as products that can be sniffed or huffed (like keyboard dust cleaners).

Help establish structure and meaning

Co-occurring disorders can disrupt your loved one’s sense of purpose and disrupt their daily routine. Getting back to meaningful activities while in recovery can help motivate your child to manage their mental health and avoid substance use. Ask about and encourage involvement in school, work, volunteer activities, hobbies, sports and other interesting activities.

Your treatment team or counselor can help guide you and your loved one in creating a purposeful, structured day. A weekly planner can be helpful in setting up a schedule for when to wake up, do chores, attend school or work, participate in recreational activities, attend counseling, etc. This is not to suggest that every minute of every day must be scripted, but it can help to set expectations and identify gaps in your loved one’s schedule that can be filled with meaningful activities.

Obviously, it can be more difficult to do this with a young adult or adult. Having a conversation with them and encouraging a routine as opposed to telling them what they “should do” may be helpful. Suggest that they try a routine for a couple of weeks to see if it makes a difference in how they feel. Aside from structure, helping them develop life skills can be essential to their recovery.

Promote healthy social supports

Support groups can be a great way for your loved one to meet others who understand what they are going through as well as a potential source for resources. Encourage attendance at meetings for substance use such as 12-step (e.g., AA or NA) and SMART Recovery.

You can search for mental health peer support groups at association websites (e.g. Anxiety and Depression Association of America (ADAA), Depression and Bipolar Support Alliance (DBSA) or National Eating Disorder Association (NEDA). Dual Recovery Anonymous is a 12-step meeting specifically for people with co-occurring disorders. Many of these organizations have meetings that can also be attended online.

Your loved one may welcome your participation at a meeting or prefer to go alone or with a friend. (Some meetings are “closed,” which means they are only for people who are directly in need of support, not family members or friends). Take their lead, especially if they would prefer to attend without you being there. Every meeting is different, so if they don’t care for one, encourage them to try a different one.

One note of caution: Some participants at 12-step meetings believe that medications used to treat mental health and substance use are a crutch and unnecessary for “true recovery.” Despite overwhelming evidence that medications for opioid use disorder (MOUD) save lives, some NA meetings and other groups will limit the participation of anyone on MOUD. If this is the case, your loved one may be better served by attending a different support group.

You can also help your loved one find recreational activities that do not involve substances. Aside from support groups, many recovery centers host outings (such as flag football, 5K runs, coffee houses, movies, game nights, cooking classes, picnics, etc.) that may be of interest to your child. Many people with co-occurring disorders think they will never have fun again if they aren’t using substances, so helping them learn how to do this is an important part of recovery.

Join family support groups

Support groups for families geared toward a loved one’s substance use include Al-Anon, Nar-Anon, Families Anonymous and SMART Recovery for Friends and Family. In addition, many mental health associations provide supports to families as well. AA and Al-Anon as well as NA and Nar-Anon often host meetings at the same time and location. If the opportunity presents itself, it’s nice to connect with others afterwards over a cup of coffee or ice cream.

Foster coping skills

Help your loved one develop coping skills to deal with stress. Stressors can be major, such as an unexpected loss, moving, attending a new school or starting a new job. Sometimes they can be minor everyday annoyances or worries. Developing healthy skills, like taking deep breaths or learning to meditate, can help them avoid using substances to cope while relieving stress.

Be available as a sounding board to listen to your loved one if they want to talk about stressful experiences. It can help to ask questions like “What do you think you should do under the circumstances?” or “How do you think you will handle this if it happens again?” rather than jumping in with answers. While it may be tempting to try to solve problems for your loved one, it can lower their self-esteem and confidence. Support them as they learn to navigate issues in a healthier way.

Engage in self-care

Self-care is critical. Remember that if you fall apart, you won’t be able to help your child. Coping with your own stress by eating healthy meals, exercising, taking medications as prescribed, getting regular sleep, attending support group meetings, etc., can help you feel better. You will also be modeling a healthy lifestyle for your child. Engaging in mindfulness practices (like yoga, breathing exercises and meditation) can also be useful and can be done with your child or as a family.

Know the signs of relapse

Relapses and setbacks can be a part of recovery despite quality treatment and your child and family’s best efforts. Understanding your loved one’s triggers when it comes to mental health and substance use disorders is important to head off a relapse as well as to address one should it occur.

The symptoms of relapse are often different for mental health and substance use, so it may take some time to identify what to look for. The treatment team and your child can be helpful in figuring out what the early warning signs are and what to do if you spot them. Having a relapse prevention plan in place can help get your child back on track to well-being.

Hope that things can be better is very powerful. It can strengthen a person’s desire and determination to attend to their health and well-being. You can play a critical role in helping your loved one feel hopeful, that change is possible and that they can lead a wonderful, fulfilling life. For more co-occurring disorder resources, click here.