Disease of Addiction

• The Disease Model of Addiction

  Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine.

  Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioral, environmental and biological factors. Genetic risks factors account for about half of the likelihood that an individual will develop addiction.

  Addiction involves changes in the functioning of the brain and body. These changes may be brought on by risky substance use or may pre-exist.

  The consequences of untreated addiction often include other physical and mental health disorders that require medical attention. If left untreated over time, addiction becomes more severe, disabling and life threatening.

  
  HOW SUBSTANCE USE CHANGES THE BRAIN
  

  People feel pleasure when basic needs such as hunger, thirst and sex are satisfied. In most cases, these feelings of pleasure are caused by the release of certain chemicals in the brain. Most addictive substances cause the brain to release high levels of these same chemicals that are associated with pleasure or reward.

  Over time, continued release of these chemicals causes changes in the brain systems involved in reward, motivation and memory. When these changes occur, a person may need the substance to feel normal. The individual may also experience intense desires or cravings for the addictive substance and will continue to use it despite the harmful or dangerous consequences. The person will also prefer the drug to other healthy pleasures and may lose interest in normal life activities. In the most chronic form of the disease, addiction can cause a person to stop caring about their own or other’s well-being or survival.

  These changes in the brain can remain for a long time, even after the person stops using substances. It is believed that these changes may leave those with addiction vulnerable to physical and environmental cues that they associate with substance use, also known as triggers, which can increase their risk of relapse.

  
  IS ADDICTION A CHRONIC DISEASE?
  

  A chronic disease is a long-lasting condition that can be controlled but not cured.

  About 25-50% of people with a substance use problem appear to have a severe, chronic disorder. For them, addiction is a progressive, relapsing disease that requires intensive treatments and continuing aftercare, monitoring and family or peer support to manage their recovery. The good news is that even the most severe, chronic form of the disorder can be manageable and reversible, usually with long term treatment and continued monitoring and support for recovery.

  
  WHY IS WILL POWER OFTEN NOT ENOUGH?
  

  The initial and early decisions to use substances reflect a person’s free or conscious choice. However, once the brain has been changed by addiction, that choice or willpower becomes impaired. Perhaps the most defining symptom of addiction is a loss of control over substance use.

  
  ARE PEOPLE WITH ADDICTION RESPONSIBLE FOR THEIR ACTIONS?
  

  People with addiction should not be blamed for suffering from the disease. All people make choices about whether to use substances. However, people do not choose how their brain and body respond to drugs and alcohol, which is why people with addiction cannot control their use while others can. People with addiction can still stop using – it’s just much harder than it is for someone who has not become addicted. People with addiction are responsible for seeking treatment and maintaining recovery. Often they need the help and support of family, friends and peers to stay in treatment and increase their chances of survival and recovery.

  
  WHY SOME PEOPLE SAY ADDICTION IS NOT A DISEASE
  

  Some people think addiction cannot be a disease because it is caused by the individual’s choice to use drugs or alcohol. While the first use (or early stage use) may be by choice, once the brain has been changed by addiction, most experts believe that the person loses control of their behavior.

  Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.

  Others argue that addiction is not a disease because some people with addiction get better without treatment. People with a mild substance use disorder may recover with little or no treatment. People with the most serious form of addiction usually need intensive treatment followed by lifelong management of the disease. However, some people with severe addiction stop drinking or using drugs without treatment, usually after experiencing a serious family, social, occupational, physical, or spiritual crisis. Others achieve sobriety by attending self-help (12-step or AA) meetings without receiving much, if any, professional treatment. Because we do not understand why some people are able to stop on their own or through self-help meetings at certain points in their life, people with addiction should always seek treatment.

  References

  CASA Columbia (2012) Addiction medicine: Closing the gap between science and practice. https://www.centeronaddiction.org/what-addiction/addiction-disease

• Early Warning Signs

  One of the most challenging aspects of addiction is that it is a progressive disease. Early warning signs can go unnoticed until well into unhealthy patterns of use. Behavioral signs of substance use are often the first observable signs of addiction. Those actively using substances may start to display dramatic changes in behaviors, habits, and priorities.

  
  

  Common Behavioral Signs of Substance Dependence and Addiction
  Problems at work or school	Increased absence, chronically late, poor performance
  Disrupted sleep patterns	Sleeping more, sleeping less
  High-risk behaviors	Criminal activity, legal problems
  Defensiveness	Changing subject when asked about substance use, resistance to feedback
  Different priorities	Loss of interest in activities and hobbies, missing important engagements
  Heightened secrecy	Increased desire for privacy, dishonest about whereabouts
  Suspicious excuses	Elaborate excuses, outright lying
  Personality transformation	Shifts in mood, attitude
  Physical appearance	Significant weight loss, weight gain
  Drastic relationship changes	Abandonment of long-time peer groups, increased conflict, socially isolating
  Drastic relationship changes	Abandonment of long-time peer groups, increased conflict, socially isolating
  Financial problems	Spending more money than usual, unexplained need for money, requesting to borrow money
  Emotional disruption	Sudden mood swings, irritability, angry outbursts
  Constant illness	Frequent flu-like symptoms, unexplained injuries
  Social media behavior	Posting very different messages, odd language, login at irregular times
  Decline of personal hygiene	Unhealthy or unclean skin, hair, teeth, and nails

• Treating Addiction

  These 13 principles of effective drug addiction treatment were developed based on three decades of scientific research. Research shows that treatment can help drug-addicted individuals stop drug use, avoid relapse and successfully recover their lives.

  1. Addiction is a complex, but treatable, disease that affects brain function and behavior.
  2. No single treatment is appropriate for everyone.
  3. Treatment needs to be readily available.
  4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
  5. Remaining in treatment for an adequate period of time is critical.
  6. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
  7. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.
  8. Many drug-addicted individuals also have other mental disorders.
  9. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
  10. Treatment does not need to be voluntary to be effective.
  11. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
  12. Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

  Source: National Institute on Drug Abuse. These principles are detailed in NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide.

• Medication Assisted Treatment

  Different types of medications may be useful at different stages of treatment to help a patient treat withdrawal symptoms, stay in treatment, and prevent relapse. Individual treatment plans will vary.

  Some of the goals of medication in the treatment of addictions include:

  • Abstinence (or reduction) of compulsive use
  • Treat or prevent withdrawal symptoms
  • Reduce urges/cravings
  • Diminish “the high” making it less worthwhile
  • Minimize relapse time/intensity
  • Treat co-morbid disorders
  • Stabilize to enhance counseling therapy

  
  

  This section provides an overview of the medications and therapies that comprise MAT. Several medications have been found effective in treating addiction to opioids, alcohol, and nicotine in adults. There are currently no FDA-approved medications to treat addiction to cannabis, cocaine, or methamphetamine.

  Some of the most commonly used medication assisted treatments are listed below:

  Naltrexone (Vivitrol®) is approved for the prevention of relapse in patients following a complete detoxification from opioids/alcohol. It acts by blocking the brain’s opioid receptors; preventing opioid drugs/alcohol from acting on them and thus blocking the euphoria the user would normally feel. This medication is approved and recommended to be used in conjunction with outpatient counseling treatment.

  Buprenorphine (Suboxone®) reduces or eliminates opioid withdrawal symptoms, including drug cravings, without producing the euphoria or dangerous side effects of heroin and other opioids. It does this by both activating and blocking opioid receptors in the brain.

  Methadone prevents opioid withdrawal symptoms and reduces cravings by activating opioid receptors in the brain. It is available through specially licensed methadone treatment programs.

  Disulfiram (Antabuse®) inhibits an enzyme involved in the metabolism of alcohol, causing an unpleasant reaction (i.e. flushing, nausea, and heart palpitations) is alcohol is consumed after taking the medication.

  Acamprosate (Campral®) reduces symptoms of protracted withdrawal (i.e., insomnia, anxiety, restlessness, and dysphoria) by normalizing brain systems disrupted by chronic alcohol consumption in adults. It is thought to be more effective in patients with severe alcohol use disorders.

  In addition to the above medications for substance use disorder treatment, Naloxone is a medication used to prevent opioid overdose deaths. Naloxone binds to the opioid receptors and can rapidly reverse or block the effects of other opioids. In doing so, Naloxone can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of opioid overdose.

  
  

• Approved Medications for Opioid Use Disorder

  Approved Medications for Opioid Use Disorder
  Prescribing Considerations	Buprenorphine (Suboxone®, Subutex®)	Extended-Release Buprenorphine (Sublocade®)	Extended-Release Injectable Naltrexone (Vivitrol®)	Methadone (Methadose®, Dolophine®)
  Frequency of Administration	Daily	Monthly	Monthly	Daily
  Route of Administration	Oral tablet or film is dissolved under the tongue. Can be taken at a physician’s office or at home	Subcutaneous injection by a certified healthcare professional	Intramuscular Injection in the gluteal muscle by healthcare professional	Oral (liquid) consumption, usually witnessed at an Opioid Treatment Program (OTP)
  Restrictions of Prescribing/ Dispensing	Only licensed physicians who are DEA registered and either work at an OTP or have obtained a waiver to prescribe	Healthcare settings and pharmacies that are certified in the Risk Evaluation and Mitigation Strategy (REMS) program	Any individual who is licensed to prescribe medicine (physician, physician assistant, nurse practitioner) may prescribe and order administration by qualified staff	Only licensed physicians who are DEA registered and who work at an OTP can order methadone for dispensing
  Additional Requirements	Physician must complete limited special training to qualify for the DEA prescribing waiver; any pharmacy can fill the prescriptions	Requirement of stabilization on daily oral buprenorphine medication for 7+ days prior to induction; only certified providers may administer	Requirement of 7-14 days without any opioid or opioid containing medication prior to induction; any pharmacy can fill the prescription	For opioid dependence treatment purposes, methadone can only be purchased by and dispensed at certified OTPs or hospitals

  Adapted from SAMHSA.gov

• Stigma of Medication Therapies

  Are people really "drug-free" if they take a medication? Aren't they just substituting one drug for another? We believe there are important distinctions. While some people choose to use alcohol, marijuana or illegal drugs, nobody chooses to have a substance use disorder. Alcoholism and other drug addiction is a disease that wreaks havoc in the parts of the brain involved in making choices and controlling behavior. There’s no weakness, laziness, or lack of moral character involved when your mind and body tell you that taking a drug is as urgent as taking your next breath. People who are committed to treatment and recovery learn that there are many differences between substances used to get high and medications used to get well. The chart below lists examples of these differences.

  Drug*	Medication
  The motivation to use a drug is a brain reward (euphoria, or getting high).	The motivation to use medication is to prevent and treat an illness.
  The pattern of using drugs is marked by dosages and methods of administration— such as injection or smoking—that create spikes and slumps in the drug's concentration in a person's blood. The dosage escalates and the drug is administered more frequently.	The pattern of using medication is marked by dosages, dosing schedules, and methods of administration that produce steady concentrations of the drug in a person's blood.
  Drug use is characterized by self-monitoring, a progressive loss of control, and secrecy and dishonesty.	Control and monitoring of medication is maintained via open, honest communication with physicians and family members.
  The net effect of drug use is a progressive deterioration in the quality of life.	The net effect of medication use is a progressive improvement in the quality of life.
  Drug use (other than alcohol use by adults) often involves breaking the law.	Medication is taken within laws that govern its manufacture, sale, possession, and use.
  Drug use often occurs within a drug-saturated social network.	Medication use occurs within a pro-recovery social network.

• Family and 3 C’s

  You didn't cause the addiction. It is not your fault your loved one is addicted to drugs. Repeat that to yourself: “It is not my fault”. Despite what you have come to believe, you did not drive that person to use drugs. Maybe the drug user has suggested you are the cause of the problem. Don’t believe it. The person using substances is highly resistant to taking responsibility and happy to put the blame on you. Remember too that you make the situation worse by taking responsibility when you should not. Think about it: if you are to blame, then that means the person is free to use drugs without any feelings of responsibility. Your love or lack of it can no more compel someone to abuse drugs than to become diabetic. You are powerless over the disease of addiction – this is the first thing to remember.

  You can't control the addiction. Unless the person using substances wants to give up drugs, your attempts at controlling the situation will be futile. Under pressure, the individual may ease off for a while, but they are bound to relapse. It’s only when the individual makes the decision that they want to stop because they have had enough self-imposed misery that recovery can begin.

  You can't cure the addiction. Unless you are a doctor, you likely will accept that you cannot cure diseases. In the same way, if your loved one is addicted to substances, accept that you cannot make them well. Clinging to the belief that you can cure the addiction worsens the situation. You make it harder for the person who uses substances to get well, because you make yourself the agent of recovery. But it’s the individual substance user alone who can make the decision to stop using drugs. Take that decision away from them and you diminish their power to find their way out of addiction. As with any illness, the sick person must first accept they suffer from a disease before they will do anything to address it. Unless you as a family member is clear on this point, you will cause yourself much heartache and frustration in fruitless attempts to force the individual using substances to get well.

• Effective Strategies

  Accepting that your loved one is suffering from a disease, here are some of the things you can do to improve the situation:

  • Learn about the disease of addiction. This will raise your awareness of the nature of the disease your loved one is suffering and help you come to terms with it. The disease of addiction affects the body, the mind, and the spirit. In dealing with a loved one who uses substances, ask yourself how would you treat them if they were suffering from another kind of illness like heart disease or cancer.
  
  
  • There is a saying in family Fellowships: “Don’t get angry at the addict, but at the disease.” Even though their behavior may be causing you worry, try not to get angry or take it personally. When the disease has progressed, the substance user is no longer choosing to use drugs, they are compelled. They don't even know why they continue using substances despite the devastating consequences.
  
  
  • Do not enable them. You may think you are showing your love for them when you make up excuses for their behavior or cover up their mistakes. But ultimately what you are doing is making it easy for them to stay in denial and continue with their addiction.
  
  
  • You can help someone dependent on substances by letting them take responsibility for their life. You need to exercise tough love, which means having the courage to allow them to deal with the fallout of their addiction. If they have been arrested, resist the impulse to bail them out or hire a lawyer. They got themselves into trouble and they can get themselves out. Individuals dependent on substances are much more likely to face up to their problem when they have suffered the consequences of it.
  
  
  • Set boundaries on what is acceptable and what is not around the house. Setting boundaries is not about punishing or shaming them. Rules and expectations for behavior are for the greater health and good of the family – and, ultimately, for the person dependent on substances too. Be firm and be consistent. A simple and reasonable rule is that the individual is never allowed to use drugs in the home. You may decide that you will stop providing money to the them. Maybe you will go as far as to bar them from the home when they are under the influence. Whatever rules you make, it is important that you be ready to enforce them consistently. To do otherwise is to invite confusion and conflict for the household, which is what you are aiming to avoid.
  
  
  • If you want to provide financial support, buy the goods and services they need instead of giving them money that they will most probably use to buy drugs.
  
  
  • For the good of everyone, create an environment in the home that is safe and stable. They will benefit from a household free of undue stress and turmoil. Naturally, if there are prescribed drugs in the home that might tempt the person, they should be kept hidden away.
  
  
  • Support them in activities that will encourage them to become sober. This might mean that you will attend a fellowship meeting with them to ease their anxiety. You will want to be welcoming to their new friends who are in recovery. Keep in mind that getting free of drugs is the absolute best thing they can do for themselves, so anything you can do to facilitate the effort is helpful. Don’t overdo it, though. You want to resist jumping in and trying to orchestrate their recovery. That would never work.
  
  
  • If they have entered recovery, allow them the time and respect to process their new way of life. Recovering from drugs has its ups and downs. Do not suddenly expect or pressure them to change overnight and become the perfect family member. Have patience and respect for their recovery process. Remember they did not become addicted overnight, and they will not recover overnight.
  
  
• Tips to Avoid Enabling

  Below are some suggestions on ways to stop enabling your loved one:

  • Don’t do anything for them that they can do for themselves.
  • Don't assume responsibility for their duties.
  • Don’t give them money that enables them to buy drugs.
  • Do not pay their bills, fines, rent, or food expenses.
  • Don’t repay their loans or money they have borrowed to buy drugs from friends or dealers.
  • Don’t lie, cover up or minimize their addiction or the consequences of it.
  • Don't make up excuses for them or justify their abusive behavior.
  • Don't allow them to use drugs in the home or to come home under the influence.
  • Don’t give them anything that they may sell to get drugs.
  • Don't make threats, but set boundaries to what behaviors you find acceptable -- and don’t back down on them.
  • Question your motives in wanting to rescue or save them. Ask yourself whether your help will likely push them in the direction of recovery or to continued use of drugs.
  • Finally, don't punish yourself or feel guilty if you have ended up helping them avoid the consequences of their addiction. Enabling usually comes from a place of love and good intentions and it takes time to learn the difference between helping and enabling.

  
  

  Drawing the line between enabling your substance dependent loved one and offering them reasonable help can be difficult. In trying to determine if an action on your part falls into one category or the other, one question to ask yourself is this: are you doing something for the substance user that they are capable of doing for themselves? If you are doing for them what they should be doing for themselves, that very likely means your behavior is enabling. When we enable, when we do for them what they can – and should – do for themselves, we send two messages: that the person is not capable of helping themselves and that someone else is going to do it for them. Both messages, obviously, are untrue and both are destructive to the chances that they will get their life together. For instance, the individual has run out of money and so you pay for their cell phone bill. That’s enabling. They should be paying that bill themselves. Yes, it is going to cause them inconvenience, and them not having a phone may cause you anxiety too, but you are doing them no favor when you help in these ways. You need to ask yourself whether your effort – whatever it may be -- is going to help them confront their addiction or whether it is helping them avoid it. As heart wrenching as it may be to allow them to experience the dark places they land themselves in, this is what they need if they are ever to confront their disease. Though it may seem like the hardest thing in the world, the best thing you can do may be to do nothing – meanwhile, allowing them to reach a place where they will want to do something for themselves.

• Suggestions to Manage Your Own Life

  Below are some suggestions on ways to stop enabling your loved one:

  • You can win peace of mind if you accept you are powerless over the disease of addiction. Give up all your fruitless attempts at trying to convince the addict to change or trying to force them to behave as you wish. Remember you cannot force someone to change if they are in denial and are unwilling.
  
  
  • Letting go does not mean that we let a substance dependent loved one run haphazardly over our lives. Just the opposite is true. When we finally come to terms with the truth that addiction is a disease, and that we are powerless to stop them from using drugs, we gain clarity. We know what to expect from them and what we must demand of them. We can focus on what is best for ourselves and best for the family. We stop bargaining and arguing with them. We stop feeling guilty. Though we know we cannot cure them, we do demand that the person using substances follow the rules we set down for the good of the household. We don’t let them bring drugs into the house; we don’t allow their actively using friend into the home either; we don’t bankroll them; we don’t cover for them at the job; we don’t bail them out of jail. We stop babying them, we stop enabling him.
  
  
  • Avoid blaming yourself for your loved one’s addiction. Guilt will overwhelm us if we are not careful – while clouding our thinking, and making us ineffective. Believing that somehow we are to blame for another’s addiction leads us to become enablers, to do things for them that only serve to prolong their addiction.
  
  
  • Accept your limitations. The alternative is exhaustion, frustration, anger, and despair. Despite how much you may love your substance dependent family member and want to help them, you do not have the power to stop their addiction. Knowing what you can do and what you can’t is key to your recovery. Practicing this principle of humility will help you come to terms with your family’s predicament.
  
  
  • It is time to let them take responsibility, time to let them make whatever choices they want – and then to live with the results of those choices. Of course, we protect ourselves and the family from any bad choices they may make. We insist they respect our rights to a harmonious household. Meanwhile, we respect them as an adult free to choose their path in life, even if it is clear that the chosen path will lead them to misery. When you allow them to live their life as they want, you are freer to take responsibility and choose to improve the quality of your own life.
  
  
  • Arguing or trying to reason with someone under the influence of drugs is pointless. Doing so will only frustrate you. If there is something you need to say to the person using substances in the family, wait for a time when they have not been using.
  
  
  • Do not get angry or confrontational with them. This simply increases their feelings of guilt and the sense they are under siege – which adds to their excuses to use drugs again. In any case, remember that arguing with an someone who is addicted almost always leave you feeling miserable. The yelling, the threats, the insults all add to the insane dynamic in families marked by addiction. Remember too that they have their drugs to escape to, whereas you don’t.
  
  
  • Schedule time for activities that bring you pleasure and that provide a break from the toxic environment created by the addiction. Living with an active substance user is exhausting and frustrating, so you need to take care of yourself. Making time for yourself will better equip you to deal with stress.
  
  

Caregiver Support

• HEROES Friends and Family Support Group
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  UTHEALTH THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER
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  Addiction is a chronic and progressive brain disease impacted by biological, psychological, and social influences. Understanding addiction and learning skills to manage is important for supporting friends or family in long-term recovery.

  This weekly group is to provide support and informational services to family and friends of loved ones living with substance use disorder. The group is facilitated by experienced staff familiar with the processes of recovery.

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• Family Support Staff Bios
  

  Andrea J Yatsco, PhD, CADC, LCDC is a certified and licensed addiction counselor and currently employed as the Program Manager for the Houston ER Opioid Engagement System (HEROES) program at UT Health. She received her PhD in Criminal Justice from Sam Houston State. Her undergraduate work at University of Arizona included a major in psychology and a minor in sociology that focused on learning how to understand both individual dynamics and social relationships. Dr. Yatsco has counseled adult incarcerated populations, and worked with families and juvenile offenders. She is a previous adjunct professor of Becker College, teaching curriculum in the undergraduate forensic psychology concentration and developing grant funded substance education courses on family dynamics of addiction and adolescent risk factors.

  
  
  

  

  Christine R. Bakos-Block, PhD, LCSW is currently a postdoc fellow with the Houston ER Opioid Engagement System (HEROES). She received her PhD in social work from the University of Houston where she serves as a clinical adjunct professor. Christine has worked in the behavioral health field for over 7 years and also has a part-time private psychotherapy practice.

  
  

Other Resources

• Local Support Group

  Al-Anon Family Groups
  http://www.houstonalanon.org

  Nar-Anon Family Groups
  https://www.nar-anon.org

  Opioid Support Group for Family or Loved Ones
  1st Thursday of the month, 6-7pm, all are welcome
  The Council on Recovery
  303 Jackson Hill St
  Houston, TX 77007
  (713) 942-4100
  https://www.councilonrecovery.org/

  Parents of Adolescents/Adults in Recovery (PAR)
  The Hope & Healing Center
  717 Sage Road
  Houston, TX 77056
  (713) 871-1004, ext. 570
  https://hopeandhealingcenter.org/

  Faith Based Pathway to Peace Recovery Ministries
  Concerns Persons Group for Families and Loved Ones
  Thursdays @7p.m.
  CCCC Clear Lake campus
  16743 Diana Lane
  Houston, TX 77062
  (832) 287-9299
  For more information contact: Jennifer Ellis ([email protected])

• Counseling and Other Services

  (Many services listed are low cost or offer sliding scale based on income)

  Center for Recovering Families
  The Council on Recovery
  303 Jackson Hill St
  Houston, TX 77007
  (713) 914-0556
  https://www.councilonrecovery.org/treatment-programs/
  

  Houston Galveston Institute
  Multiple Locations
  713-526-8390
  www.talkhgi.org

  Fuller Life Family Therapy Institute
  4545 Bissonnet St, #289
  Houston, 77401
  855-245-5433
  

  Krist Samaritan
  17555 El Camino Real
  Houston, 77058
  281-480-7554
  http://www.samaritanhouston.org

  Shield Bearer
  Multiple locations:
  281-894-7222
  http://www.shieldbearer.org

  Center for Creative Resources
  816 Hawthorne St
  Houston, 77006
  713-461-7599
  

  Catholic Charities
  Multiple locations
  713-874-6590
  http://www.catholiccharities.org/

  Family Services of Greater Houston
  4625 Lillian
  Houston, 77007
  713-861-4849
  https://www.familyhouston.org

• Helpful Literature on Family Recovery
  • The Language of Letting Go: Melody Beattie
  • Codependent No More: Melody Beattie
  • Beyond Codependency: Melody Beattie
  • Codependent's Guide to the Twelve Steps: Melody Beattie
  • Straight Talk from Claudia Black: What Recovering Parents Should Tell Their
  • Kids about Drugs and Alcohol: Claudia Black
  • Setting Boundaries with Your Adult Children: Alison Bottke
  • The Alcoholic Family in Recovery: Stephanie Brown and Virginia Lewis A Gentle
  • Path Through the Twelve Steps: Patrick Carnes Codependence and the Power of Detachment:
  • Karen Casey
  • Boundaries: Dr. Henry Cloud and Dr. John Townsend
  • Boundaries in Marriage: Dr. Henry Cloud and Dr. John Townsend
  • Addict in the Family: Beverly Conyers
  • Everything Changes: Beverly Conyers
  • Facing Shame: Families in Recovery: Merle Fossum and Marilyn Mason
  • A Guide for Adult Children of Alcoholics: Herbert Gravitz and Julie Bowden
  • Hold Me Tight: Seven Conversations for a Lifetime of Love: Dr. Sue Johnson
  • The Dance of Intimacy: Harriet Lerner, Ph.D.
  • Chalk Talk on Alcohol: Joseph Martin
  • Addiction and Grace: Gerald May
  • Facing Codependence: What It Is, Where It Comes From, How It Sabotages Our Lives: Pia Mellody
  The Intimacy Factor: The Ground Rules for Overcoming the Obstacles to Truth, Respect, and
  • Lasting Love: Pia Mellody
  • Facing Love Addiction: Giving Yourself the Power to Change the Way You Love: Pia Mellody.
  • Breaking Free: A Recovery Workbook For Facing Codependence: Pia Mellody and Andrea Miller
  • The Enabler: When Helping Hurts the One You Love: Angelyn Miller
  • Family Recovery: Growing Beyond Addiction: Merlene Miller and Terence T. Gorski
  • The Addictive Personality: Craig Nakken
  • Reclaim Your Family From Addiction: Craig Nakken
  • Don’t Let Your Kids Kill You: Charles Rubin
  • How Can I Forgive You?: Janis Abrams Spring
  • Addictive Thinking: Abraham Twerski
  • Why Don’t They Just Quit?: Joe Herzanek
  • Beyond Addiction: Jeffrey Foote, Carrie Wilkens, and Nicole Kosanke, with Stephanie Higgs

  
  

  Check out the “recovery” section of bookstores or www.amazon.com, hazelden.com and www.al-anon.alteen.org. Search under key words such as “recovery”, “codependency”, “family recovery”, “addiction”, etc.

• Other Information
  NIDA Science of Addiction PDF
  
  Post-Acute Withdrawal PDF
  
  Letter from an addict