Saying “No” to your alcohol & or drug using brother or sister can be very difficult. It can make you feel overwhelmed, angry and scared. Here are a few tips to help you say “No” to your sibling.

“Please disease”.

People with the please disease also known as “people pleasers” find it difficult to say ‘No’ without feeling guilty or "bad." Instead they will say "Yes," even when deep down, they really want to say "No." The people pleaser feels a sense of responsibility towards everyone else and will also feel guilty when he or she actually finds the courage to say "No."

*Feeling responsible for everyone else — particularly your sibling or parent’s— is another common experience that sibling’s endure on a regular basis.

“Please disease” symptoms.

• Difficulty in saying ‘No’.
• Denying own needs. -Feeling guilty.
• Feeling obliged.
• Feeling responsible.
• Feeling less than others.
• Feeling resentful.
• Feeling angry.

* Over time the please disease takes over and you are often left feeling exhausted and resentful towards your sibling and parents. However the good news is...It is possible to learn how to stop being a people pleaser and start pleasing yourself. To do this one must start focusing on his/her own needs, while allowing others to take care of their own matters.

Learn how to put yourself first.

This is not an easy task especially if you have been trying to please everyone for a long time. Some tips on how to help put yourself first are:

1. Check your motivation.
   Before tending to your sibling’s needs think about what is motivating your behaviour. If it is not coming from a place of true desire and interest that benefits both you and your sibling, rethink any actions before taking them i.e. doing favors for your sibling.
2. Set healthy boundaries.
   If your sibling uses emotion to influence your behavior, it may be time to start setting healthy boundaries between you and your sibling. (To do this take a look at our ‘How to get through this’ fact sheet).
3. See others as capable.
   If sympathy motivates the way you behave and act towards your sibling then it is important to rise up to a place where caring for your sibling’s problems is balanced by seeing them as responsible for their behaviour and not you. This will lead to allowing others to care for themselves.

* Sibling’s offer support, solve problems and stand by their loved ones, no matter what; until they become so over burdened focusing on others that they become scattered, forgetful or ill from burn-out. This thenmakes them no good to others or themselves.

Why we find it hard to say “No” to our sibling.

Compassion is one reason siblings put others ahead of themselves, but when it becomes detrimental to their health there are usually additional factors such as:

1. Fear of conflict.
   You are afraid that your sibling may get angry if you say ‘No’ and that this may lead to an ugly confrontation or to negative consequences.
2. Feelings of guilt.
   You may be feeling responsible for your sibling or a sense of owing. You may even feel undeserving or less than your sibling? It is helpful to tune into these underlying messages and question their reality.
3. Keeping the peace.
   Sometimes when we become so overwhelmed by our sibling’s alcohol & or drug problem we get to a point where we find it easier to simply say ‘Yes’ rather than to say ‘No’ and put up with our sibling’s reaction.

Learn how to say “No” to your sibling.

Rather than avoid it altogether, it’s all about learning the right way to say ‘No’. Once you began to say ‘No’ to others, you’ll realise it’s probably not as bad as you thought.

1. Let me think about it first and I’ll get back to you.
   This is more like a “Maybe” than a straight out ‘No’. If you are interested in what your sibling is asking but you don’t want to say ‘Yes’ just yet you could use this. Sometimes we need time to think about what is being asked of us before making any decisions. Remember if your sibling is sincere about the request, he/she will be more than happy to wait a short while. Specify a date / time-range (say, in 1-2 weeks) where your sibling can expect a reply.
2. I’m not the best person to help with this. Why don’t you try...
   If your sibling is asking you for help with something you (i) can’t contribute much to (ii) don’t have the resources to help or (iii) is detrimental to your health or wellbeing it is a good idea to let your sibling know that you are not the best person to help them and if possible refer them to somewhere where they can get the appropriate help. (For suggestions on where to get help for your sibling see below).
3. No I can’t.
   The most direct way to say ‘No’ but the one we find the hardest to say. This is because we build up so many barriers in our mind about what saying ‘No’ means. These barriers are self-created and nearly always untrue. Don’t think so much about saying ‘No’ and just say it outright.

*Learning to say ‘No’ to requests that don’t meet your needs is difficult but once you do you’ll find how easy it actually is.

What saying “No” does mean.

It’s about how you say ‘No’, rather than the fact you’re saying ‘No’, that affects the outcome.

1. Saying ‘No’ is about
   Respecting and valuing your time and space.
2. Saying ‘No’ doesn’t mean.
   You’re doing anything wrong, after all, you to have priorities and needs, just like everyone else.

Why do you have trouble saying “No” to your sibling?

Here are some real life examples from siblings and their reasons why they find it hard to say ‘No’ to their alcohol/drug using sibling.

1. Sense of responsibility.
   “I feel responsible for my brother”.
2. Feeling Alone.
   “No one else in the family can help her, so I have to”.
3. Taking on responsibility.
   “I feel like I owe it to my parents to help my sibling because they can’t cope”.
4. Feelings of Fear.
   “I’m worried if I say ‘No’ my brother will become violent”.
5. Can’t take anymore.
   “I’m so tired of arguing that I end up just doing anything for my sibling to keep the peace”.

*When learning to say ‘No’, it’s important that we first understand what’s resisting us about it, this way we can start by making small changes...

Places where you can get help for your sibling.

Here is a list of services Australia wide that you can recommend to your sibling:

TurningPoint
Ph: (03) 8413 8413
(03) 8413 8413
Fax: (03) 9416 3420
info@turningpoint.org.au

Moreland Hall: Withdrawal Services
Community Residential Drug Withdrawal Unit
Address: 26 Jessie Street MORELAND 3058
Phone: (03) 9386 2876

Windana Society: Drug Withdrawal Unit
Address: 88 Alma Road, ST KILDA EAST 3183
Phone: (03) 9529 7955

Direct Line: 1800 888 236
24 hours Immediate counselling and support, including crisis intervention.

SANE Australia: (Mental health info and referral) 1800 688 382

Youth Substance Abuse Service: 1800 014 446

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Having a drug or alcohol using brother or sister can really affect you. It can make you feel overwhelmed, angry and scared. It can interfere with your family life, studies, work and friendships. Here are a few tips to help you get through this.

Don’t go through this alone.

People can be far more understanding than you might think. Get advice and support from a trusted friend, family member, support group, psychologist or counsellor. You could also tr y posting something on the discussion board or join one of the online support groups. It’s also quite normal to call a support line, like the Family Drug Helpline to get ideas from other people who have been through similar experiences.

Take this one day at a time.

Tr y not to lump all of life’s events together, as this can make things feel even more overwhelming. Know that you are not alone. Strong emotions can seem overwhelming and frightening, but they will pass. Most people eventually learn to live with this situation. Cr ystal ballgazing and imagining a bleak future doesn’t achieve anything and can fill you with unhelpful despair. You can get through this and ever ything will probably work out.

Focus on your needs.

Look after yourself so you don’t get overwhelmed by ever ything. Take time out. Do things that you enjoy or have enjoyed in the past - coffee with a friend, going for a walk, hobbies, sport – anything that helps you relax or distract yourself. Tr y to keep to your normal routine.

Try not to blame anyone.

Blaming is unproductive. People use alcohol and drugs for many reasons. Analysing why this happened gets you nowhere. Understand that addiction is like a disease or a chronic illness. It can happen to anyone.

Dealing with conflict:

Talk about their behaviour, not the drugs.

If they’re doing something that’s bothering you, like anger outbursts, deal with the specific behaviour, not their drug use. You could try naming the specific problem or behaviour, and say it in terms of ‘you and I’ statements. For example, ‘when you lie to me all the time, I feel like I can’t trust you’.

Make sure they’re not running rings around you.

Be careful that they’re not manipulating you at all.

Set some rules with your brother or sister.

Try your best to work out what you’re not willing to do, like not lending money, and draw the line. Don’t do things for your brother or sister that they should be doing themselves. Setting boundaries will help them to develop a sense of responsibility and realise how unacceptable and inappropriate their behaviour is. Your family does not have to tread on eggshells. You can find a list of common boundaries at the end of this sheet. Making it easier for your brother or sister to keep using drugs or alcohol usually does not help them in any way.

If you feel unsafe, walk away.

It’s not worth sticking around when people are aggressive. Work things out when ever yone’s calmed down.

Many siblings experience drug and alcohol problems. You are definitely not alone.

For your support:

Family drug helpline – information, help and referral ser vice especially for families - 1300 660 068.

List of common boundaries/rules.

I won’t lie for you.
I won’t let you steal from me.
I won’t lend you money.
Don’t ask for unrepaid favours.
Don’t borrow things without asking.
Don’t yell at me.

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Dealing with a brother or sister’s alcohol or drug problem tends to be a continual process, which can be seen as a series of stages.

Stage One: Lack of Awareness of the Drug Use.

As a sibling you may:

• Sense that something is wrong.
• Notice unusual behaviour in your brother or sister.
• Feel concern, confusion, annoyance, self-doubt, suspicion.

Stage Two: Awareness of and Reacting to the Drug Use.

You may:

• Wonder who to talk to: do you keep it a secret from family and friends?
• Realise how much alcohol or how many drugs the person is using.
• Try to control the person’s behaviour.
• Try to fix the problem.
• Focus on the person using drugs at the expense of your own life.
• Seek help and information.
• Be overwhelmed by emotions. You may feel sorrow, anger, anxiety, guilt, hopelessness, powerlessness, shock and denial.

During this stage, tension and conflict may develop between family members. Some family members may step back from the situation.

Stage Three: Learning to Respond.

You may:

• Realise that you cannot solve your brother or sister ’s problem and that change takes time.
• Focus on ‘what is happening’ rather than ‘why it is happening’.
• Seek support for yourself.
• Build new ways of communicating with ever yone involved.
• Start thinking in a new way, adding in what you have learnt.
• Feel acceptance and understanding.

Stage Four: Reclaiming Your Life.

You may:

• Learn to set limits and boundaries.
• Get support when you need it.
• Stop thinking so much about the drug use.
• Learn better ways to deal with feelings; realise and accept that old emotions might come back.
• Get on with your own life.
• Support your brother or sister in their desire to change.
• Feel relief, hope, a sense of control, sad (but less intensely).

Stage Five: Back Flips.

A time of feeling worried again for a while, often when there’s a crisis.

You may:

• Try to fix the drug-use problem.
• Focus on the drug use.
• Forget to think about your own needs.
• Feel desperate, hopeless and discontented.
• You will usually return reasonably quickly to your previous stage.

Stage Six: The Long Haul.

You may:

• Continue to get on with your own life.
• Accept that it can take a long time for the person to gain control of their drug use.
• Help yourself feel more ‘normal’ by taking part in activities that you feel interested in and might help you sur vive.
• Feel more trusting of your brother or sister, less anger and fear, a degree of hope.

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Advice on how to deal with strong emotions:

• Worry / Anxiety
• Sadness / Grief
• Anger
• Feeling Alone / Social Embarrassment
• Jealousy
• Guilt

Worry/anxiety.

Sometimes you won’t know what to do, you’ll constantly worr y about your brother or sister and what might happen to them.

Helpful responses: – Tr y to think of ways to reduce the harm and risks associated with their drug or alcohol use. Have a read of some of the drug fact sheets for the specific drugs your brother or sister might be using.

Focus on one thing at a time, there’s no point lumping all of life’s events together, as this can make things feel even more overwhelming.

Get some advice from a parent, online counsellor, friend or psychologist. If you’re ever worried about your safety then you need to get away from the situation, and talk to someone whom you trust, like friends, teachers, your parents, or even the police.

Sadness/grief.

It’s common to feel sad when your brother or sister is using drugs. You could be neglected by your parents, and you might feel like you’ve lost your brother or sister.

Helpful responses: Talk to someone like an online counsellor, a friend, or call the Family Drug Helpline.

Post something on the discussion board, or just tr y writing stuff down. Regular exercise is as good as antidepressants at making you feel better. You could try going for a run, a walk or play sport. You could also do something you enjoy, or used to enjoy.

Try not to cr ystal ball gaze or imagine a bleak future. This doesn’t achieve anything and can fill you with unhelpful despair.

Remember that it’s okay to feel sad, ever yone does at times, it’s a natural part of life. The sadness will pass and you’ll probably learn a lot from this. Tr y not to focus on the negatives, remember what’s good about your life (you’re still alive!).

Know that you are not alone. Most people eventually learn to live with this situation. Ever ything will probably work out.

Anger.

Many things can fill you with anger or even rage; your brother stealing your bike, your sister constantly asking for money, your parents being too easy on your sibling.

Helpful responses: Getting angr y is completely normal, and a natural response to frustrating situations.

It’s how you respond to the anger that matters.

Tr y walking away from a situation, deal with it later when you and ever yone else has had time to calm down. Go running, take it out on a punching bag, or play sport to help get rid of the anger.

Anger and blaming can really interfere in relationships. Have a look at the section called ‘dealing with conflict’ in the how to get through this fact sheet, for a few ideas on how to interact with your siblings.

Feeling alone/social embarrassment.

It can feel like you’re the only one going through this, that no one will understand, and that people will judge you for having these issues. You can feel like ever ything should be kept secret, even from other family members.

Helpful responses: It often helps to see that there are many other people going through similar issues to you.

Post something on the discussion board. Have a read of the sibling stories. Call the Family Drug Helpline (1800 888 236). Ever yone there has been through similar experiences.

Jealousy.

You can feel jealous if your parents continually focus all their time and attention on your brother or sister ’s problems.

Helpful responses: Tr y giving your parents the fact sheet your son or daughter is using drugs, what can you do?

You could talk to your parents about what you need.

Remember what you do have, rather than focusing on what you don’t have. Spend time around people who appreciate you for who you are.

Guilt.

You can feel guilty about a lot of things; breaching privacy, not being able to help, being the sibling who is ‘fine’. Even negative feelings, such as anger, jealousy and hostility towards your brother or sister and their problems can trigger feelings of shame. Helpful responses: Remember that feeling guilty does not mean that you are to blame.

Ask yourself who is actually responsible for the problem. If the problem is yours there are probably things you can do to make the situation better.

If the problem is someone else’s, let go of the problem and let them deal with it.

Remember that it is your sibling who has a problem and often they’re not thinking about you. Ask yourself if you’re tr ying to keep them from experiencing pain, hardship or discomfort? Sometimes this can be a valuable experience for them.

Often you can’t do a lot to help them, and the best thing is for you to get on with your own life.

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A number of checklists to help you with your sibling.

Preparing to talk to you brother or sister about their behaviour that affects you when there is also mental health issues.

1. You and your brother or sister are both sober and not drug affected.
2. You feel calm.
3. You have told your brother or sister that you want to chat with them and have made an agreed time.
4. You have privacy.
5. You are safe – you have told someone you can trust about the situation and what you are doing and you have that person around to call out to.
6. You are sure of what you want to say and how you want to say it.
7. You are sure about what you want (hope) to get out of the conversation – (be realistic: ‘fostering realistic hope’).
8. You have made a plan to stay focused.

Talking with your brother or sister.

1. Explain how you would like the conversation to go – taking turns talking and listening.
2. Prepare notes that include statements that begin with “I” (not “You”) and stay focused on what you need to change in your life (remember you don’t have to explain why, but if you want to you could try saying something like “because I feel like that would be better for me” or “easier for me.” Make sure your notes will not be offensive to your brother or sister; let them read them if they want to.
3. Be honest and clear.
4. Don’t feel guilty about saying what you need. Presume that your brother or sister doesn’t know that their behaviour is having a bad affect on you.
5. Don’t apologize unless you feel that you have done something wrong – you have a right to say what you need. After all, how else will they know if you don’t tell them?
6. Make sure you stick to your plan of listening to your brother or sister.
7. Try not to take the things they say personally, even if they use personal or confronting language.
8. Don’t respond straight away. Remember to be a STAR (say you need to think for a minute; read over your notes; draw on your note pad).
9. Clarify your brother or sister’s responses if you feel unclear about what they are saying.
10. Be clear about what you want or need.
11. Be prepared to negotiate (a little bit of compromise can go a long way).
12. Clarify the change that you have agreed, or not, agreed on.
13. Suggest (or ask your brother or sister for a suggestion) about what you will do if one of you breaks the agreement – try and agree on that to (lol) meaning unclear.
14. Thank them for listening and talking.

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It is not bad or uncommon to worry, feel ashamed, embarrassed and/or angry about what people say, or might say, or think about your brother or sister’s mental health problems and drug use and related “difficult behaviour”.

Stigma: “the shame or disgrace attached to something regarded as socially unacceptable”
(Encarta Dictionar y. Accessed 14, August 2009).

It is not bad or uncommon to worry, feel ashamed, embarrassed and/or angry about what people say, or might say, or think about your brother or sister’s mental health problems and drug use and related “difficult behaviour”. Difficult behaviour related to alcohol and drug use and/or mental health problems might include: totally ‘righting themselves off’ at social gatherings; being rude, awkward, violent, aggressive, paranoid, moody (best mates with you one minute and worst enemies the next); stealing from you or your friends; lying; keeping dangerous or obnoxious company; begging for money; living on the street; prostituting themselves and cutting/harming themselves.

• Living with public reactions to your brother or sister’s drug use and mental health problems can be really stressful, socially isolating and embarrassing.
• Medical diagnoses and the language of ‘professionals’ can be confusing, stigmatising and can put people off accessing help through services.

The development and delivery of the Sibling Online Support (SOS) service has drawn on the personal experiences of siblings of people living with mental health problems and drug use as well as research studies and a strong network of services.

Through our service delivery we aim to recognise the differences and complexities of people’s lives and encourage people to view their unique and independent experiences and perspectives as ‘experiential expertise’. In other words, siblings are the experts in relation to understanding the situations and events of their own lives and of their family context. This information is vital for developing appropriate support networks for individuals and/or families.

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To help your brother or sister you need to be in a solid position yourself, otherwise you could get drawn into the drama and problems. If your brother or sister is using drugs you have a much higher risk of ending up with your own drug or alcohol problems. Siblings’ relationships are often messy and unfriendly. To help your brother or sister you need to have a pretty good relationship. It is most often parents who help alcohol or drug users. Sometimes users don’t want help, and will get through on their own. To see if you’re ready to help your brother or sister, fill in the following checklist.

It is most often parents who help alcohol or drug users. Sometimes users don’t want help, and will get through on their own.

To see if you’re ready to help your brother or sister, fill in the following checklist.

Checklist.

• Does your sibling seem to want help?
• Is your sibling happy to talk to you (if they are older than you, they may not be keen on getting your advice)?
• Do you feel calm and relaxed around your brother or sister (can you talk to them without getting upset, anxious, or angr y round them)?
• Are you safe around your brother or sister?
• Do you feel they could manipulate you?
• Do you feel ready to help them (would it be better to look out for yourself first?)
• Do you have a few people you can rely on for support (some people say you need 5 supports in your life)?

Tick all the boxes? Here’s what you can do.

Make a few steps towards helping your brother or sister.

Have a read of ‘How to help your brother or sister ’ and ‘Stages of change; where is your brother or sister at?’ factsheets. Make sure you also have a look at the ‘How to get through this’ factsheet.

Missing some ticks? Here’s what can you do.

Look after yourself

before you try to help them. Take a look at our ‘how to get through this’ and ‘dealing with strong emotions’ fact sheets. You might need to take on the role of ‘spectator ’, as much as you can.

Give your parents a fact sheet:

‘Your son or daughter is using drugs, what can you do?’ and ‘stages of change: where is your brother or sister at?’ This will help give your parents a few ideas about how they can help your sibling and how they can help you.

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There are a wide variety of treatment options available for people dealing with addiction. Sometimes it’s hard to know where to go to get help. The following is a summary of some of the different types of treatment your brother or sister may be considering.

Before you begin, remember you can’t force your brother or sister to change or seek treatment.

It’s not up to you, and it will probably only work if they genuinely want treatment.

In-patient treatment.

• Lasts from a few weeks to more than 6 months.
• You don’t need to transport them to and from treatment.
• Provides around-the-clock super vision and professional help for managing your brother or sister ’s medical and mental health issues.
• Before your brother or sister is accepted to this type of highmaintenance treatment, various assessments must be conducted.
• Is appropriate for people who live in disruptive environments, have difficult work situations, are at risk of life threatening withdrawal symptoms, or require care for additional medical or mental health issues.

Residential programs.

• Your brother or sister lives at the clinic, which offers many treatment services.
• Often have phases of treatment with different expectations and activities during each phase e.g. during the first phase your brother or sister ’s contact with the family may be limited.
• In a later phase, your brother or sister may be able to start working again, going “home” to the facility ever y evening.
• They must also know and understand the program rules and expectations.

Partial hospitalisation or day treatment.

• Live at home whilst attending 4-8 hours of treatment per day.
• Programs usually last for at least 3 months and work best for people who have a stable, supportive home environment.

Outpatient program.

May range from counselling once or twice a week to a single all-day or evening program. Allows clients to keep up family and social relationships while receiving treatment. Typically costs less than inpatient treatment.

Intensive outpatient treatment.

• Requires a person to attend 9 to 20 hours of treatment activities per week.
• Can last from about two months to a year.
• Your brother or sister will do well in this type of program if he/she is willing to attend counselling sessions regularly, have supportive friends or family members, have a place to live, and have some form of transportation to get to treatment sessions.

Medication.

• Many programs use medications, like methadone or buprenorphine to help in the treatment process.
• Although no medications cure dependence on drugs or alcohol, some do help people stay abstinent and can be lifesaving.
• Visit for your brother or sister your GP to discuss the various options

What happens in a treatment program?

Assessment: assessment of your brother or sister ’s individual needs. Medical care: medical care typically includes screening and treatment for HIV/AIDS, hepatitis, tuberculosis, and women’s health issues.

A treatment plan: a plan is written to guide treatment. This includes your brother or sister ’s treatment goals..

Where to go from here.

If you want to discuss this with someone further, call DirectLine/ADIS on 1800 888 236 or Family Drug Help on 1300 660 068. They can hook you up with a few ser vices. You could also try seeing your GP.

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Advice for helping your brother or sister.

Talk to them:

Encourage your brother or sister to talk.

Listen with genuine interest, without being judgmental. Blaming, preaching or criticising your brother or sister can mess with the relationship, close down the lines of communication, and create conflict. Remember that ‘drug use’ does not necessarily mean ‘drug problem’.

Talk about their behaviour, not the drugs.

If they’re doing something that’s bothering you, like anger outbursts, deal with the specific behaviour, not their drug use. You could try naming the specific problem or behaviour, and say it in terms of ‘you and I’ statements. For example, ‘when you lie to me all the time, I feel like I can’t trust you’.

Choose your moment.

It is difficult to talk with your brother or sister if they are intoxicated, drug affected or when you are angr y or upset. Wait until they are sober and you feel ready.

Understand the drug.

Get the latest information on the drug they are using and its effects. This may help you to feel more prepared. Have a read of the drug-specific fact sheets on our website, or call ADIS or DirectLine for advice (1800 888 236). Be careful not to overreact or jump to conclusions though, as drug advice pages tend to give you the worst case scenario.

Remember you can’t ‘fix’ them.

Only your brother or sister can take steps to cut down or stop their drug or alcohol use. Sometimes they won’t want your help. If they don’t admit there’s a problem, and are not ready to get help, you can still look after yourself and others close to you. Realise that recover y may take time and many, many attempts before success. Even small steps are a positive sign.

Things that may help your brother or sister:

Recognise that they may need help.

You don’t have to deal with the issue within the family. Getting treatment for the person may help speed up the process of recovery.

Talk to your brother or sister about using drugs more safely.

Ask them about risks and safe use – what steps are they taking? For ideas on safer drug or alcohol use, see the drug specific fact sheets or call Family Drug Help.

Research the treatment options.

You could start with your GP. Treatment can include (1) counselling, (2) short-term private or public detox (where the person aims to get off the drug), (3) long term residential rehabilitation (where the person learns life skills and aims to get their life back on track), or (4) alternative drug therapy (like methadone). Remember, you cannot force someone into treatment, and treatment probably won’t work if your brother or sister is at all reluctant. Have a read of the ‘treatment’ fact sheet or call Direct Line or ADIS and they’ll help discuss the options with you (numbers at the end of this fact sheet).

Set some rules with your brother or sister.

Tr y your best to work out what you’re not willing to do, like lending money, and draw the line. Don’t do things for your brother or sister that they should be doing themselves. Setting boundaries will help them to develop a sense of responsibility and realise how unacceptable and inappropriate their behaviour is. Your family does not have to tread on eggshells. You can find a list of common boundaries at the end of this sheet. Making it easier for your brother or sister to keep using drugs or alcohol usually does not help them in any way.

Helpful phone numbers.

Directline/ADIS, Drug advice –1800 888 236. Family drug helpline, Support and Advice – 1300 660 068.

List of common boundaries/rules.

I won’t lie for you.
I won’t put up with you stealing from me.
I won’t lend you money.
Don’t threaten me.
Don’t ask for unrepaid favours, like driving to the bottle-shop.
Don’t borrow things without asking.
Don’t yell in the house.

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Having a brother or sister who smokes marijuana can be frustrating. It can make them boring and unmotivated. It can really get in the way of you and your sibling having a good relationship.

What are the immediate effects?

• Strong sense of well-being and happiness.
• Relaxation and feelings of euphoria.
• Anxiousness and paranoia.
• Poor attention and concentration.
• Increased heart rate.
• Dryness in mouth and throat.
• Altered sense of time and space.
• Reduced coordination.
• The ‘munchies’.

What are possible long term effects?

• Bronchitis, lung cancer and other respiratory diseases.
• Decreased motivation.
• Decreased concentration, memory and ability to learn new things.
• Decreased sex drive.
• Decreased sperm-count in men.
• Irregular menstrual cycles in women.
• Psychological effects, like paranoia.

It can also contribute to them developing schizophrenia if they are already vulnerable to getting the disorder.

How can you help your brother or sister?

• Have a read of the ‘how to help your brother or sister’ fact sheet.
• If motivation is a real problem, try to have a non-judgemental chat to them about what they think of the benefits and consequences of using marijuana.
• You could discuss things that they might like to do, other than smoking.
• If you need them to do things for you, set a few ground rules. Eg. ‘if you don’t clean up after yourself, I won’t drive you to buy snacks when you’ve got the munchies’.

Is marijuana addictive?

This issue is not fully understood. However, the following is known:

• Most people don’t become tolerant to the effects of marijuana unless they use large amounts over a long period of time.
• Withdrawal symptoms are unlikely to develop amongst occasional smokers of marijuana.
• Marijuana isn’t nearly as ‘physically’ addictive as drugs like heroin.
• Long-term users trying to quit may experience cravings, irritability, difficulty sleeping, and anxiety. They may also display increased aggression peaking about a week after last smoking marijuana.
• The ‘addictive’ aspect of marijuana may be mainly psychological. Marijuana users often say that using marijuana is like living in a cloud. It buffers them against things going on around them.

Is marijuana dangerous? Can my brother or sister overdose on it?

There is no record of any deaths being caused by marijuana. It’s almost clinically impossible to overdose.

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Alcohol can be really destructive. It can make your brother or sister aggressive, immature, moody and unpleasant to be around. Here’s a bit of information to help you deal with your brother or sister’s alcohol problem.

Some common problems with alcoholism.

• Craving - a strong need to drink.
• Loss of control - not being able to stop drinking once you’ve begun.
• Physical dependence - withdrawal symptoms, like nausea, sweating or shakiness after stopping drinking.
• Tolerance - the need to drink greater amounts of alcohol in order to get drunk.

Questions that might be going through your mind.

Does my brother or sister have a problem? Signs and symptoms of problematic use.

• Drinking is more important than their job, friends and family.
• They become angry when confronted about drinking.
• Daily or frequent alcohol consumption to function normally.
• Drinking secretly/alone.
• Finding excuses to drink.
• Poor eating habits.
• Difficulty stopping or reducing alcohol consumption.
• Memory loss, blackouts.
• Morning shakes or drinking early in the morning.
• Nausea, vomiting.
• Neglecting physical appearance.
• Violent episodes that occur when drinking.

How can you best deal with a person who’s drunk and confrontational?

When your sibling is intoxicated he/ she may be aggressive, violent and unpredictable. They can be completely unreasonable and immature. It’s not always easy to know how to handle these situations, especially when you’re the centre of their attention. If you do find yourself in this situation, it’s important to:

• Avoid getting into arguments – this may lead to confrontation (save sibling rivalry for when they’re sober!).
• Use non-threatening words & tone (avoid possibly offensive words like “drunk”).
• If you notice suicidal thoughts, take them seriously. Stay with your sibling, talk with them and, if necessary, call for emergency or the suicide help line 1300 651 251.
• Find an activity to distract them – television, a computer game, music etc.
• Offer non-alcoholic drinks and food. Keep an eye out for any late night, unsupervised cooking (you don’t want them to burn down the house!).
• Don’t argue or offer resistance to verbal assault, use “fogging techniques” – agreeing with the possibility of what the person is saying.
• Be mindful of your own safety – if it looks like the situation could get dangerous, just get away from your sibling to somewhere safe.

Long-term effects.

Alcohol can damage every organ and system in the body. It can also cause social and psychological problems.

Problems can include:

• poor diet.
• stomach problems.
• frequent infections.
• skin problems.
• liver and brain damage.
• damage to reproductive organs.
• memory loss/confusion.
• heart and blood disorders. depression.
• relationship problems.
• work problems.
• money or legal troubles.

Why won’t he/she stop drinking?

Your brother or sister could be:

Physically addicted – they might hate the withdrawal. Using it to deal with strong emotions and anxiety – in the short time. Using denial – they may not have much insight into their situation and may blame others for their situation, eg. saying “You’re driving me crazy!” Living a life built around alcohol – all their friends might drink as well.

What are the different types of treatment on offer?

Treatment may involve one or more of the following:

• Detoxification or ‘detox’ (removal of alcohol for 3-6 weeks).
• Seeing a psychologist or counsellor
• In-patient treatment.
• Medication.
• Self-help groups (e.g. alcoholics anonymous).
• Residential or outpatient programs.
• For a more in depth review on what these involve, refer to the ‘your sibling and treatment’ factsheet.

Are there any medications that can be prescribed for an alcoholic?

• Disulfiram – makes the user very sensitive to the negative effects of alcohol, so they are less likely to want to use it. They must already be wanting to cut down their use, as they can simply stop taking the drug in order to use alcohol again.
• Naltrexone – used in management of alcohol dependence.
• Acamprosate – helps maintain abstinence from alcohol.

What happens in self-help groups like alcoholics anonymous?

• Support and encouragement – to become or stay drug and alcohol free.
• Alcohol abstinence programs – like Alcoholics anonymous’ twelvestep programs.
• Regular meetings – every day or every week.

Can I support my sibling at a meeting?

Yes, non-alcoholics are welcome to attend ‘open speaker meetings’.

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Speed, and the much stronger ‘ice’, can make your brother or sister aggressive, unpredictable, erratic and sometimes even psychotic. It can be scary dealing with someone taking ice or speed. Here’s some information and tips about ice and speed to help you deal with your brother or sister. You could use this to help recognise if your brother or sister might be using ice or speed.

What happens the moment a person uses speed or ice?

Ice makes a person feel temporarily happy, excited and confident.

Ice is a stimulant. It speeds you up.

Your brother or sister may be more energetic, talkative, restless. They may have tremors and increased breathing and sweating. They may also itch, scratch and pick at their bodies.

Ice makes people very emotional.

It can make your brother or sister anxious and paranoid.

Ice can make people violent for no reason, irritable, aggressive and hostile.

Using ice can lead to psychosis.

They might believe they have special powers. They might see things that don’t exist, or have extreme jealousy. It might sometimes be hard to understand what your brother or sister is saying.

Ice can make it hard to sleep.

It can also lead to headaches, reduced appetite and nausea. Ice can lead to your brother or sister having work, relationship, money or legal problems.

Withdrawing or coming down off ice can be difficult.

As the effects of ice wear off, your brother or sister may get depressed, become tense, violent, exhausted and have huge mood swings. They might have restless sleep, and may be quite distressed. These symptoms can last for 1-3 months.

Ice is very addictive.

Ice users will focus more and more on how to obtain the pleasure and escape that the drug provides. This can become more important than all other aspects of their life. Ice changes the brain to make people crave the drug, and it can be very difficult to give up or cut down ice use.

There are many long-term effects of using ice.

These include heart disease, malnutrition, sleeping problems, depression and anxiety, brain damage, and contraction of viruses after sharing injecting equipment.

What to do if your brother or sister is using ice/speed?

If your brother or sister is violent or aggressive or you feel unsafe, get out of the situation and call the police if you have to.

Warn them against using ice. Compared to many other drugs, ice leads to more dangerous, unpredictable and damaging behaviour.

Communicate openly about how they can use ice in a safer way. They could:

Try a small taste or a small amount first to judge the strength of the mix when they buy a new batch of ice. This might also allow them to tell if it’s been cut with other substances idea to mix ice with other drugs. Alcohol and caffeine make you more dehydrated and overwork the liver. It’s also dangerous to rely on downers (eg. Valium or alcohol) to cope with the bad effects of ice or speed. This can lead to a ‘roller coaster ’ dependence on several different drugs. If they’re injecting, never share needles or injecting equipment and always use a clean needle for each shot. Use less. This isn’t entirely true – particularly for people who have been using a long time – they build a tolerance to the drug. Smaller amounts give about the sam e effect , but reduce the risk of addiction .

Take ice or speed orally. It’s safer than snorting, smoking or injecting, because the stomach is better at handling acidic substances than the lungs, veins and nose. You’re more likely to overdose from injecting. Try to carry condoms, as ice use can impair judgement and lead to unsafe sex.

Let them know about the treatment options.

Treatments include counselling, group therapy, withdrawal (detoxification) and medication. Residential, super vised/home withdrawal and “out-patient” programs are available. For advice you can call Family Drug Help, ADIS or DirectLine (numbers at the end of this sheet). Also, see the ‘treatment’ fact sheet.

Let them know about the risk of overdose.

Overdosing on speed or ice can lead to:

• psychosis.
• heart attack (very rare).
• death (very rare).

If they overdose:

If your brother or sister is not aggressive and you feel safe, call an ambulance or drive them to a hospital. If they are aggressive or you feel unsafe, call the police.

Helpful phone numbers.

Directline/ADIS, Drug advice –1800 888 236.
Family drug helpline, Support and Advice – 1300 660 068.

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Heroin can seem to take over people’s lives. They keep using even when it seems like the worst thing they could do. Their behaviour can affect you in a lot of different ways. Here’s a bit of information about heroin and a few tips to help you deal with your brother or sister.

What happens the moment a person uses heroin?

Heroin makes a person feel high and sedated.

Your brother or sister might feel a rush of intense pleasure. Soon this is replaced by a sense of contentment and relaxation that lasts about three hours. They will also experience drowsiness and confusion. They might sit in a half-conscious state called ‘nodding’.

Over time your brother or sister will probably need more of the drug to feel the same effects.

This obviously means they need more and more money to support their drug use. Eventually, no amount of the drug is enough to get a real high. The person may continue to use heroin, but mainly to delay withdrawal symptoms.

Heroin is very addictive.

A heroin user will focus more and more on how to obtain the pleasure and the escape that the drug provides. This can become more important than all other aspects of their life. Heroin changes the brain to make people crave the drug. It can be ver y difficult to give up or cut down heroin use.

Withdrawal symptoms happen when a person stops using heroin.

The symptoms are sometimes described as like having a very bad case of the flu and include:

• a craving for the drug.
• restlessness and shaking.
• cramps, muscle and bone pain.
• loss of appetite, vomiting and diarrhoea.
• tears and a runny nose.
• increased irritability.
• insomnia.
• depression.
• yawning.
• a cold sweat.

These withdrawal symptoms get stronger and usually peak around 2 to 4 days after the last heroin use. They usually wear off after 6 to 7 days, but some symptoms, like depression, anxiety, insomnia and a continued craving for the drug, can last for months and even years. Sudden withdrawal from heroin rarely causes death.

What are signs that your brother or sister may be using heroin?

• Constricted pupils.
• Sores on the body from injecting.
• Drowsiness and an inability to concentrate or think clearly.
• Items used to administer heroin left around the place including syringes, spoons, scales, coffee grinders, small plastic bags.
• Messy, unclean or poor physical appearance.
• Changes in behaviour (see below).

What behaviours are you likely to see if someone’s using heroin?

• Lying to friends and family members.
• Inability to keep commitments and long unexplained absences.
• Mood swings and strong emotions.
• Money troubles, including unpaid loans or stealing.
• Drop in work or school performance and inability to hold down a job.
• Loss of interest in all activities other than obtaining and using heroin.
• Not caring about the consequences of their actions.
• Not seeming to take into account the injury, pain, or loss their behaviour causes others.
• Behaving in compulsive, selfdestructive and irresponsible ways.

What should you tell your brother or sister to help them?

Tr y a small taste first to judge the strength of the mix when buying a new quantity of heroin.

Be ver y careful if they haven’t been using for some time or are using in an unfamiliar place. Their body’s tolerance to heroin will be lower than normal and they are more likely to overdose. Never use heroin alone. They should make sure there is a friend to watch them, even if the friend is also using. Heroin should not be mixed with other drugs, particularly depressants like alcohol and benzos (eg. Valium). This is a major cause of overdose. Even a stimulant like cocaine with heroin (a “speed ball”) is bad news. The cocaine wears off quickly, then the central ner vous system is depressed while the heroin is still active. Never share needles or injecting equipment and always use a clean needle for each shot.

Make sure the equipment and space in which they are using is clean. Filters can help to remove bacteria, and lessens the risk of infections.

How to tell if your brother or sister may be overdosing.

Signs of a heroin overdose include:

• Shallow or difficult breathing.
• Pinpoint pupils, blank eyes or eyes rolled back in the head.
• Clammy skin.
• Convulsions.
• Cannot be woken.
• Pale skin.
• Vomiting.

What to do if they are overdosing. Call 000. Don’t delay because you think you or your brother or sister might get into trouble. Ambulance officers ver y rarely involve the police. Tr y to wake the person if they are unconscious and keep them awake. Lay them on their side and make sure that their mouth and throat is clear. Gently tilt their head back so their tongue does not block the airway. Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonar y resuscitation (CPR), unless you know how to administer it yourself. Provide the ambulance officers with as much information as you can: how much heroin was taken, how long ago, and any pre-existing medical conditions.

Treatment options.

Methadone.

A safer substitute for heroin. It helps reduces the impact that heroin has on the lives of people who are dependent, by reducing the harm associated with injecting an expensive illicit drug of unknown strength and purity.

Buprenorphine.

Can help treat heroin dependence by preventing withdrawal symptoms and by blocking the effects of heroin (so using heroin will not provide the “high” that would normally be expected).

Naltrexone

Naltrexone works by blocking the pain-killing and euphoric effects of heroin. It can help because the person is aware that they cannot achieve a “high” from using heroin.

Ultra Rapid Opiate Detox (UROD).

UROD is a quick method of withdrawing or detoxifying from heroin. It involves high doses of naltrexone given over a 48-hour period or less along with heavy sedation. By the end of the process, the patient should be physically withdrawn from opiates. UROD is currently under trial in Australia.

Questions and answers.

Q. Why would your brother or sister inject heroin?

A. Injection produces more of a rush, and is more cost-effective.

Q. Isn’t heroin a less dangerous drug if you snort or smoke it instead of injecting it?

A. No. Heroin is heroin. There is no safe way of ingesting it. You can still die from an overdose or become addicted by snorting or smoking it. Smoking heroin is sometimes thought to be more addictive, but using heroin in any form is always addictive.

Helpful phone numbers.

Directline/ADIS, Drug advice –1800 888 236.
Family drug helpline, Support and Advice – 1300 660 068.

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Drug use affects our:

• physiological state.
• mood and, in turn,
• relationships.
• work and financial security.
• self-esteem and mental health – or ability to feel good about ourselves and life and act in ways to better our life space.
• behaviour, and
• physical health.

If you look it at like this it is not hard to see how long-term drug and alcohol use and mental illness often result in people having a range of health care needs. Unfortunately there are no ‘one stop shops’ – ser vices to meet all our healthcare needs with all knowing, all available, health care providers. As a result people often utilise a range of ser vices to meet their various health needs.

Everyone needs support when they experience difficult situations in their life and it is no different for you and/or your brother or sister when their healthcare is intense and/or complicated. Some siblings take on the role of helper – helping their brother or sister to deal with their healthcare needs.

Helping your brother or sister access ser vices can be time-consuming, confusing and draining. There may be many different ser vices to juggle, your brother or sister ’s mental health issues and alcohol and other drug use may affect their ability to communicate clearly and/or their ability to be organised in relation to their health care needs, appointment times and information.

It is a big job trying to help someone help themselves and it is a good idea to encourage your brother or sister to do handle their own health care as much as possible.

Health care providers generally support this approach (maintaining an individual’s autonomy – their right to make decisions about how to handle their own health care needs).

Helping your brother or sister organise their health care may include:

• encouraging them to be aware of the kind of information they need to know and ser vices they could ask for help; keep track of appointments, medication, treatment plans, dates/ times, things to do and ask about.
• recording their progress and concerns and information from various health care professionals: general practitioner, psychologist, psychiatrist, councillor and rehabilitation ser vices.

Hospital health care providers may be a little easier to keep track of and contact.

• In hospital you (or your brother or sister) can request that a social worker be assigned to your brother or sister.
• The social worker does case work: s/he identifies your brother or sister ’s healthcare needs and links them with the appropriate ser vices. This relieves you, or your brother or sister, of the stress of contacting health care professionals and keeping track of ever ything.
• You or your brother or sister can ask the social worker for notes. Having information about your brother or sister ’s healthcare needs before and after hospital will help family members (and hopefully professionals) advocate for appropriate care options, both in and out of hospital, such as rehabilitation, considering the likelihood of relapse and their ability to care for themselves.

If you or your brother or sister is finding it difficult to make decisions or understand their healthcare options talk with someone – telephone Family Drug Help (FDH) and ask for the Sibling Online Support ser vice (SOS) – 9573 1756. FDH can give you information and support about how to handle situations like this.

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A big part of helping your brother or sister with his or her addiction is educating yourself about the disease. A good start is to check out some of our factsheets or alternatively, check back here for updates on the latest AOD (alcohol and drug) research.

The Health Report: Research into Addiction 17^th August:

Audio and transcript can be found at:

http://www.abc.net.au/rn/healthreport/stories/2009/2653827.htm

Looks at identifying the kinds of people who are more likely than others to become addicted to substances; whether they be legal or illegal, and explores new ways to help people come off their drugs. Because some of the old ways could be doing more harm than good. All this from a person who leads one of the world's foremost drug research groups, Barry Everitt.

Shortened version of the most recent research into addictive behaviour, by Barry Everitt

- summarised from the full transcript, taken from todays Helath Report (21-June-2010), accessed at: http://www.abc.net.au/rn/healthreport/stories/2010/2929643.htm#transcript

A resent study of addictive behaviour (based on rats - not humans), using cocain and heroine.

This link provides a radio transcript that you can either listen to or read. It details the latest research in understanding addiction and behavioural characteristics and draws away from the idea 'that 'addicts' are weak willed people who just need to say no.' And draws attention to a compulsive behavioural trait that %20 of people appear to both have and develop through drug use and learned behaviour over time.

‘Barry Everitt: That's right, it's complex. I think the notion is that there are vulnerable individuals who when they take drugs will be led down a path of behavioural and cognitive change that they have no control over, there's an interaction between their genetic therefore brain makeup and the effects that the drug has but at some point individuals, most individuals do recognise that the drug taking is damaging them and they want to stop so you have this volition to stop. It's whether you can actually bring that to play and gain control over your own behaviour. And I think this does hark back to why I think the drug addiction field is being so ignored ... addicts are [though of as] just people who show a weak will and all they need to do is say no. And the fact is by their makeup it's hard to say no, because they don't say no, say for example they are impulsive their brain is sitting waiting for these drug induced chemical effects to usurp the control that they had in the first place. And so that cycle goes on and it's very difficult to resist.’

The elemet of compulsivity as it is understood in relation to this study of behaviour and drug use is the
ongoing seeking of the drug even when it is not present and regardless of adverse social affects.

Adverse social affects for people includes loss of job, family, friends. For people who display compulsive behaviour these adverse affects cannot deter the individual enough to make them stop using drugs. They may want to stop but their learned behaviour and responses are two strong, coupled with impaired 'reversal learning' (evident in cocain addicts) - reversal learning can be understood as the process by which you give a person a situation in which a certain 'thing'/stimulus (in this case cocain or heroine) and link it with a reward (the eurphoic feeling of a drug induced state) - the relationship between the stimulus (cocain) and reward (euphoria) is probebalistic, in that the stimulus may not always result in a reward, but does so more often than not. Then you reverse the contingency - so that a stimulus that didn't produce a reward now does and the timulus that did now doesn't - the impairment of reversal learning is charchterised by 'perceveration of the wrong response choice which could be seen as a kiind of compultion in behavioural type.' Barry Everitt 21st June 2010.

People who both have and develop compulsive behaviour would most benefit from abstinence (rather than harm minimisation appraoches to managing addiction), as any drug use or even associated stimuli (such as needles, or rolled up bank notes) can (and do) act as prompts to retrive memories and renact compulsive behaviour linked to drug use and learned expectations of rewards.

Unlearning compulsive behaviour - Everitt goes on to talk abou this concept and posiblities for treatement that are not far away - if you want to read more ... follow the link provided bellow


http://www.abc.net.au/rn/healthreport/stories/2010/2929643.htm#transcript

Drugs in the family: The impact on parents and siblings, Marina Barnard (2005)

http://www.jrf.org.uk/sites/files/jrf/1859353207.pdf

If you’re feeling worried, anxious, stigmatised, helpless, shameful, embarrassed or guilty over your brother/sister’s problem, you’re not alone. All of these aforementioned feelings were identified as being most problematic amongst 20 siblings whom were interviewed in this Scottish qualitative study. The following is a short summary of each:

Worry and Anxiety: Worry and anxiety mostly tended to revolve around their siblings health and well-being (particularly when they were using drugs away from home) and over the possibility of them overdosing. Siblings who had a good relationship with their parents also experienced additional anxiety over their parents’ ability to cope.

Helplessness: Feeling powerless of their position as a sibling to alter things. Many siblings felt like helpless spectators in the unfolding drama of their brother’s or sister’s lives.

Shame and embarrassment: Siblings found it particularly embarrassing to see their brother or sister in public under the influence of drugs or begging in the streets. In public there was a tendency to slip out of sight to avoid being publicly humiliated by their sibling. Additional feelings of shame were triggered by drug using siblings who neglected their personal appearance and hygiene.

Stigma: Universal reluctance amongst siblings to publicly acknowledge that a family member had a drug problem.

Having a brother or sister on drugs also tended to put a strain one’s relationship. Many felt a lack of connection with drug-taking sibling – as though drug using sibling is uninterested in them. Continued drug use was also seen as causing greatest damage to their sibling relationship – some saw that it could create a permanent wedge between them.

Drug Use: Siblings had an elevated likelihood of developing drug problems themselves. Particularly where younger brothers and sisters are routinely exposed to drugs there is the chance that they will develop a curiosity as to their effects and that this might encourage experimentation.

Sibling peer support group for young people with a sibling using drugs: A pilot study, Elizabeth Gregg, John W. Toumbourou, 2003

Gregg, M.E., & Toumbourou, J.W. (2003). Sibling peer support group for young people with a sibling using drugs: A pilot study, Journal of Psychoactive Drugs, 35, 3, 311.

Siblings of young people are at particular risk for drug abuse and other health compromising behaviours. This research, an evaluation of two pilot peer support groups, indicated positive benefits for group members, who reported feeling better informed, more supported, and having a reduced sense of isolation. Parents reported that their adolescent attending the group demonstrated improved communication with, greater understanding and tolerance of, the family member using drugs.

The impact of illicit drug use on non-using siblings in the Vietnamese community, Ruth Webber, 2003.

Webber, R. (2003). The impact of illicit drug use on non-using siblings in the Vietnamese community, Australian Journal of Social Issues, 38, 2, 229-245.

This paper examines the ways in which Vietnamese young people are affected by a sibling's illicit drug use (2). The aim is to explore the changing reactions of Vietnamese young people and parents and the changing strategies they employ as they seek to cope with the situation. The focus is on the siblings' reactions and experiences as the family system changes and adapts.