Opioid-type medications that have the potential to lead to addiction are only one way, and probably not the best way, to help manage chronic pain. So the best plan is to try all the alternatives first.

Non-medication interventions such as graded exercise programs, physical therapy, mindfulness meditation, yoga, tai-chi, and a form of psychotherapy called cognitive-behavioural therapy (CBT) all take some effort but often work very well. Acupuncture may benefit some people living with pain. Many medications that do not have addiction potential can also be helpful for chronic pain. These include anti-inflammatory medications like aspirin, ibuprofen, or naproxen; antidepressants like nortriptyline or duloxetine; or medications often used for seizures like gabapentin or pregabalin.

Suppose you or someone you know does require opioid pain medications to help manage chronic pain. In that case, it is reassuring to know that the majority of people who take these medications for chronic pain do not become addicted to them. However, anyone who takes these types of medications for more than a few weeks is likely to have some tolerance (less effect of the medication over time) and withdrawal symptoms if the medications are stopped abruptly.

Al-Anon and Alateen are widely available and free resources for family members. These organizations offer mutual help groups. Members do not give direction or advice to other members. Instead, they share their personal experiences and stories and invite other members to “take what they like and leave the rest” — that is, to determine for themselves what lesson they could apply to their own lives. The best place to learn how Al-Anon and Alateen work is at a meeting in your local community. Most professional treatment programs also offer family groups to help families support their loved ones struggling with addiction.

Yes. Overall, men are about one and a half to two times more likely to have a substance use disorder (SUD) than women. Data from the National Survey on Drug Use and Health indicate that in 2019, approximately 10.7% of males 12 years of age and older and 6.3% of females met the criteria for an SUD in the prior year. It is important to note, however, that when children 12 to 17 were examined apart from adults, the rates for boys and girls were much closer and even slightly higher for girls (5.7%) than for boys (4.8%).

Similarly, epidemiological research has found that among younger women and men in the U.S., the gender differences in rates of binge and heavy drinking are smaller than are seen for older adults. This suggests that women are essentially catching up to men in unsafe use of alcohol, and this has significant implications for their health and safety and that of their children, both unborn and born.

Children in families with a lot of drug or alcohol addiction among the members are at high risk. It is very clear from studies of twins that 50% of the risk for developing addiction is determined by genetics. Among identical twins who share all their genes, if one twin has an addiction, the other twin has a 50% chance of having it. Well, among fraternal twins who, just like any other siblings, share about half their genes, the other twin has about a 25% chance of having the disorder. The good news here is that half the risk for developing addiction is environmental, so effective interventions can probably prevent it in many genetically susceptible individuals.

We also know that, regardless of genetics, the earlier a child starts using substances, the higher the risk of later developing addiction. Children at high risk should be told of their risk at the earliest age when they can begin to understand the meaning, generally between ages 10 and 12, depending upon the child’s maturity.

If your son is using heroin, you are absolutely correct that he is in a life-threatening situation. The very best way to address this problem is to get him into medication treatment with one of the three medications that the FDA approves for the treatment of opioid use disorder (buprenorphine, methadone, or naltrexone). Treatment without medications does not work for most people. If you can contact a local addiction psychiatrist, that physician will know how to help you. If there is no doctor with that speciality in your area, at least take your son to his or your regular physician and ask for help arranging medication treatment with one of those medications.

In addition, there is an available antidote to heroin overdose, a medication called naloxone. It is used in emergency rooms to reverse an overdose and is increasingly being prescribed to patients with opioid use disorder and their family members. The naloxone doesn’t work if swallowed, so it must be given either in the nostrils or by injection. Since someone who has overdosed on heroin cannot give themself the naloxone, family members need to be trained to respond to an overdose and give the naloxone. The most important thing to do even before giving the naloxone is to call 911.