Where to start
The first contact is the family doctor or a specialist addiction service. Such services exist in almost every country under different names; they are free, ask for no prior diagnosis, and also see relatives on their own when the person concerned will not come. That point is often missed: you can seek help for somebody else.
Services aimed at young users are a category of their own: a few free, confidential appointments, no obligation to enter treatment, open to teenagers and to their parents. For a family it is by far the best door.
If the use goes hand in hand with sexual or relationship difficulties — low desire, erection problems, tension, silence — the page Who to see, and when says, symptom by symptom, which professional to turn to; the two steps are often taken together.
Treatments that have proved themselves
- Opioids: substitution treatment, methadone and buprenorphine, halves mortality. It is taken for a long time, sometimes years. Naloxone, the nasal-spray overdose antidote, should be wherever anyone uses opioids.
- Alcohol: medically supervised withdrawal — abrupt withdrawal can kill — then medicines that support abstinence or reduced drinking, behavioural therapy, mutual-aid groups.
- Tobacco: properly dosed nicotine replacement, stop-smoking medicines, telephone support. The combination more than doubles the chance of success compared with stopping unaided.
- Benzodiazepines: gradual reduction over months, never an abrupt stop.
- Stimulants, cannabis: no validated substitution treatment; effectiveness rests on cognitive behavioural therapy, motivational interviewing and treating what goes with it — depression, anxiety, attention disorder, the after-effects of trauma.
In every case, relapse is part of the ordinary course and does not cancel what has been gained. What predicts success is not the willpower declared at the start but staying in contact with a team.
Helplines and resources
United Kingdom — FRANK, 0300 123 6600, 24 hours. NHS stop smoking services;
Drinkline 0300 123 1110. Emergencies: 999 or 112.
Ireland — HSE drugs and alcohol helpline, 1800 459 459.
United States — SAMHSA National Helpline, 1-800-662-4357, 24 hours, free and
confidential. Emergencies: 911.
Canada — provincial helplines and 988 for mental health crisis.
Australia — National Alcohol and Other Drug Hotline, 1800 250 015.
New Zealand — Alcohol Drug Helpline, 0800 787 797.
The country pages give, for each country covered, the local services, the real cost of treatment, whether confidential access exists for minors, and the penalties that apply.
Reducing harm when stopping is not for today
Refusing to talk until the person stops protects nobody. A few principles genuinely reduce mortality: never use alone; do not mix, particularly depressants with each other — alcohol, benzodiazepines, opioids; start with a small amount when the product is new; never share injecting or inhaling equipment; get the product tested where a scheme exists; keep naloxone within reach if opioids are around; and call the ambulance straight away, saying what was taken.
Reporting
- An adverse effect or a poisoning: addiction and poisons monitoring schemes exist in most countries, and reporting is what makes a new danger visible.
- A suspect product: have it analysed rather than thrown away, where a collection scheme exists. That is how synthetic cannabinoids sold as e-liquids were identified.
- A seller or a website: police forces provide online reporting forms, and selling platforms have takedown procedures.
- A situation in a school: the nurse and the head have a protocol, and the approach is a health one before it is a disciplinary one.