A reporter wrote in and asked Dr. Hurd: Basically, my third part in this series focuses on care — and that's a broad topic. The goal here is that somebody who might be going through addiction reads this, gets sound advice and goes about seeking treatment. If not the actual patient, I hope that a friend or loved one can read the series, identify a problem and help that person get the help he or she needs.
What I'm looking for from you is advice. Where do people turn? What frame of mind should somebody get them into before getting treatment? What can family members and friends do to offer their support? What aftercare should somebody seek after getting initial treatment? And, basically, what things am I missing in trying to help these people?

Dr. Hurd replies: Check out Rational Recovery, online. (www.Rational.org) It's a tough but honest and, I think, ultimately better approach to all addiction than AA or rehab programs. I agree with Rational Recovery that addiction isn't a disease, but behavior. It's behavior that people engaging in often feel conflicted about and wish they could change.

The best thing loved ones can do is believe in the person ("You're better than this!") and care enough about them to want them to change. Nobody can force somebody to stop addictive behavior, at least not permanently. In order to stop an addiction, a person has to want to stop it. (This is true of any internal or behavioral change, in fact.) Some people benefit from support groups, and others don't; some benefit from counseling and frankly others don't; some go cold turkey and it works the first time, while others take years and still others never stop, sadly. There are as many stories to addiction as there are individual stories about anything, and there is no one-size fits all solution.

I encourage people to think of an "addictive voice" within them (not just my idea, but also from Rational Recovery), or as having an "addictive self" or "rational self" (choose whatever term you wish instead of rational). I encourage them to accept that both parts of them exist, and while realizing that one side is wrong and the other right, they all make up the self and one has to love one's whole self, even if there's a battle going on inside there. I encourage loved ones to look at it this way as well. Not everyone has an addiction (or maybe some do, but don't realize it), but just about everyone can relate to being conflicted or unsure inside about something important. The addicted person is like this all the time, and it's complicated by the physiological impact of the prolonged substance abuse (when that's what it is).

Tough love is a bit of a cliché, but it's still the right idea. The tough part is telling loved ones (and oneself) that "You can control what you choose to do, even if it's not easy." The love part is, "While I won't make excuses for you, I'll recognize this is a genuine conflict for you, and so long as I see you making a sincere effort I'll stand by you." Treatment programs don't always help the individual, but they can still help the family, because they're a way of proving that a sincere effort is being made. Also, an addict can never give up on himself. In the end, you're all you've got -- and while its valuable to have others, you have to stick by yourself and forgive yourself no matter how many times you mess up. Each time you relapse or mess up, it's always possible for that to be your last, no matter what you believe.

For the person struggling with the problem, the best thing I can say is: Own it. Talking to another person, including a counselor or support group, is a way of owning it. We own things by naming them aloud. They're true whether we say them aloud or not, but somehow saying them makes them feel more true. This is the opposite of denial and all other things considered psychologically unhealthy. It's a tired cliché to say, "Get help." To a lot of people, this means being yelled at or put down. That's not help. You can be held responsible for your unhealthy choices without being put down. If a choice you're making, like an addiction, really is bad for you, then you're already paying the price for suffering for it. No helper -- therapist, group, organization -- is going to rescue or save you. You can only save yourself, but saving yourself doesn't mean you can't talk to anybody about it. It's not the talking itself that helps you overcome the problem, but naming it aloud and treating it as real, rather than pretending it doesn't really exist. Just as making mountains out of molehills creates unnecessary anxiety, the same is true when you minimize a big problem -- like a serious addiction -- and pretend it's small when it's actually big, and getting bigger all the time.

With something like prescription drug abuse, start with your medical doctor and work outward, from there. You might or might not need a hospital stay for medical reasons, and your doctor will assess this. Tell the truth and make sure it's the whole truth about the drugs you take. That's the only way sound decisions can be made, by you or others you're depending on. The truth does set you free, especially with something like this. Most people can't afford expensive rehab, frankly, and it's not widely available in many areas. Some find AA/NA helpful and I want to emphasize Rational Recovery as an alternative, something that can be done in conjunction with an individual therapist. These would need to be forms of after care whether there was hospital/rehab or not. That's where a lot of people go wrong. They have their hospital stay or rehab, but lose interest in follow up. But the real test of stopping an addiction is when you're no longer in a controlled type of setting. In the end, you're the only person with yourself 24/7, and while you don't ever have to be totally alone on the issue, you are the only one who will stop it. Abstinence is a daily task and it will be on your daily "to do" list for as long as you live, if you're an addict.