Health

According to the "Substance Abuse Treatment and Family Therapy" guide, family therapy is a good resource for recovery for family members with drug and alcohol addictions.

How can family therapy help me?

• Your family's strengths and resources can help you find ways to live without alcohol and drug addiction.
• You and your family will be better able to deal with the impact of detoxification, the process of cleansing your body from an addiction.
• Your family will become more aware of their own needs and feel that they can express their needs safely.
• 
• The next generation in your family will be less likely to carry on your addiction.
• If you have lost custody of your children, you will be better able to overcome your addiction and reconnect with your family.

What should I know about family therapy?

• Make sure you find the right therapist or counselor and that you're upfront about why your family is going to therapy. Family therapists often don't screen for substance abuse, while substance abuse counselors need proper training and licensing to practice family therapy.
• If there is any physical or emotional abuse in the family, family counseling techniques are not an option, because family members must be protected.

Drug and alcohol abuse affects different family structures in different ways. These family structures are adapted from The Substance Abuse and Mental Health Services "Substance Abuse Treatment and Family Therapy" guide:

• You live alone or with a partner: Both of you need help. If one of you has an addiction and the other doesn't, you'll suffer from issues of co-dependence.
• You live with a spouse or partner and young children: Parents' problems effect children. Often, one parent has an addiction and the other protects the children or assumes more parental responsibilities. If both parents have addictions,
• the effect on children is worse. Your addiction is likely to pass down to your children.
• You have a step-family: Substance abuse impedes your step-family's integration and stability.
• You are older and have grown children: Family resources are needed to treat an older adult's substance abuse. Elder maltreatment may become an issue.
• You are younger and live with your family: The needs and concerns of siblings or other family members may get ignored because of crises caused by substance abuse. If you also have a parent who has a substance abuse problem, you're in danger of physical and/or emotional conflicts.

Drug and alcohol abuse not only affects you, but also your family. Addictions often create interpersonal problems for all family members.

1) Jealousy: You can grow jealous of your friends, your partner, other family members and other people in your life. Your partner may also be jealous and resentful of you.
2) Conflict with Partner: You may have arguments, get/give the "silent treatment" or grow apart by putting your addiction first.
3) Conflict with Children: You may argue with your children and they may disregard your authority or be afraid of you.
4) Conflict over Money: You may struggle economically because of losing your job, taking time off from your job, making poor financial choices or simply pouring your money into your addiction.
5) Emotional Trauma: You may create emotional hardships for your partner and/or your children by yelling, talking down, insulting or manipulating.
6) Violence: You may become violent or your family members may become violent with you, including slapping, hitting or smashing or throwing objects.
7) Cheating: You may become distant from your partner and seek satisfaction through pornography, Internet sex, prostitution or someone else in your life who you feel "understands" you.
8) Separation: Your behavior due to addiction may cause separation, divorce, and/or isolation from other family members, particularly children, either because they've been taken from you or because they don't want to be around you.
9) Patterns: Your life example will influence your partner, your children and other family members. There is a high likelihood that your children will become addicted to drugs or alcohol.
10) Health Risks: Drinking while pregnant can cause fetal alcohol syndrome -- damage to the baby's brain. Smoking in the household can cause health problems for family members from secondhand smoke, including lung cancer

Drug and alcohol abuse not only affects the abuser and his/her life, but also the lives of family members. When recovery begins, your whole family should be involved when possible. Family therapy is a good option for recovery with substance abuse.

The CAGE screening questionnaire is used to screen for alcohol abuse and dependence in adults. It is not used to diagnose the disease but only to indicate whether a problem may exist. If you answer "yes" to even 1 of the questions, you may have a problem with alcohol.

The CAGE questionnaire consists of four questions about your use of alcohol:¹

• Have you ever felt you ought to Cut down on your drinking or drug use?
• Do you get Annoyed at criticism of your drinking or drug use?
• Do you ever feel Guilty about your drinking or drug use?
• Do you ever take an Early-morning drink (eye-opener) or use drugs first thing in the morning ("a little hair of the dog that bit you") to get the day started or eliminate the "shakes"?

There is a strong connection between the use of drugs and alcohol and high-risk sexual behaviors. This increases a person's chance of getting sexually transmitted diseases (STDs), hepatitis C, and human immunodeficiency virus (HIV).

Some groups of people are more likely than others to have problems related to alcohol or drug abuse. These groups include:

• Teenagers and young adults. Approximately one-half of all high school seniors in the U.S. admit to having used alcohol or an illegal drug. Substance abuse in this age group increases the risk of involvement in crime, high-risk sexual behavior, accidents, and injuries. Teens that use alcohol and drugs are more likely to have poor school performance and have higher dropout rates.
• Women.
  • Although women are less likely than men to abuse alcohol, they are more likely to have alcohol-related health problems, such as liver disease.
  • Women are more likely to have problems with prescription medicines. More than two-thirds of all tranquilizers are prescribed for women. Tranquilizers, sedatives, pain medicines, and amphetamines are abused most often by women.
  • Alcohol and drug abuse in women increases the risk of developing other health problems, such as osteoporosis or depression.
  • Women who abuse alcohol and drugs attempt suicide four times more frequently than nonabusers.
• Adults older than age 65. Drug abuse in this age group is a problem because of the high number of prescription medicines and the lack of coordination between health professionals. Signs of alcohol or drug abuse may be mistaken for other disease problems or simply overlooked as a symptom of "aging." Many older adults "self-medicate" with alcohol to help relieve sleep problems, depression, and other problems. Alcohol abuse is more common than drug abuse in older adults. Alcohol contributes to automobile accidents and other types of severe injury in this group of people.
• Low-income populations. Drug and alcohol abuse is a problem for many minorities, including disabled adults, the homeless, and minority populations.
• Babies. Drug and alcohol use during pregnancy can cause birth defects and increase the risk of infant mortality. Babies are more likely to have learning disabilities and social and behavioral problems when their mothers use alcohol or drugs during pregnancy. Babies with mothers who use alcohol are at risk for problems from fetal alcohol syndrome.
• Children. Studies show that children who are exposed to drug abuse in the home, especially methamphetamine, have higher rates of depression, anxiety, post-traumatic stress, anger, and alcohol and drug abuse. They also are more likely to have learning problems and do poorly in school.

Drug abuse includes the use of illegal drugs?such as marijuana, methamphetamines, cocaine, heroin, or other "street drugs"?and the abuse of legal prescription and nonprescription drugs. Some people use drugs to get a "high" or to relieve stress and emotional problems.

Drugs like ecstasy (MDMA), ketamine, GHB, Rohypnol, and LSD, which are known as "club drugs," may be found at all-night dances, raves, trances, or clubs. Club drug use accounts for increasing numbers of drug overdoses and emergency room visits. Inhalants like nitrous oxide may also be used at these clubs. Drugs come in different forms and can be used in different ways. They can be smoked, snorted, inhaled, taken as pills, put in liquids or food, put in the rectum or the vagina, or injected with a needle. Teens and young adults may be at risk for becoming victims of sexual assault or violent behavior in situations where these drugs are used.

Some nonprescription medicines, such as cold medicines that have dextromethorphan as an ingredient, are being abused by teens and young adults as a way to get a "high."

In the United States and Canada, approximately 40% of adults will use an illegal drug at some time during their lives. This does not include the use of alcohol or prescription medicines. Many people abuse more than one illegal substance at a time.

Drug dependence or addiction occurs when you develop a physical or emotional "need" for a drug. You are unable to control your use of a drug despite the negative impact it has on your life. You may not be aware that you have become dependent on a drug until you try to stop taking it. Drug withdrawal can cause uncomfortable and sometimes dangerous symptoms. The usual treatment is to gradually reduce the dose of the drug until you can completely stop using it.

Alcohol abuse causes over 100,000 deaths in the United States and Canada each year. It is the drug most commonly abused by children ages 12 to 17. Alcohol-related motor vehicle accidents are the leading cause of death in teenagers. People who drink alcohol are more likely to engage in high-risk sexual behavior, have poor grades or job performance, use tobacco products, and experiment with illegal drugs. Alcohol and drug use may be an unconscious attempt at self-treatment for another problem, such as depression.

You have an alcohol problem if your use of alcohol interferes with your health or daily living. You develop alcoholism if you physically or emotionally depend on alcohol to get you through your day.

Long-term heavy drinking damages the liver, nervous system, heart, and brain. It also can lead to high blood pressure, stomach problems, medicine interactions, sexual problems, osteoporosis, and cancer. Alcohol abuse can also lead to violence, accidents, social isolation, jail or prison time, and difficulties at work and home.

Symptoms of an alcohol problem include personality changes, blackouts, drinking more and more for the same "high," and denial of the problem. A person with an alcohol problem may gulp or sneak drinks, drink alone or early in the morning, and suffer from the shakes. He or she may also have family, school, or work problems or get in trouble with the law because of drinking.

The use of alcohol with medicines or illegal drugs may increase the effects of each.

Alcohol abuse patterns vary. Some people get drunk every day; others drink large amounts of alcohol at specific times, such as on the weekend. It is common for someone with an alcohol or drug problem to call in sick for work on Monday or Friday. He or she may complain of having a virus or the flu. Others may be sober for long periods and then go on a drinking binge that lasts for weeks or months.

Someone with alcohol dependence may suffer serious withdrawal symptoms, such as trembling, delusions, hallucinations, and sweating, if he or she stops drinking suddenly ("cold turkey"). Once alcohol dependence develops, it becomes very difficult to stop drinking without outside help. Medical detoxification may be needed.

The overuse or abuse of alcohol (alcoholism)
or other drugs is called substance abuse. It is common and costly.
It can cause or worsen many medical problems and can destroy families and lives.

The 12-step program guides your recovery from addictions, compulsions or any kind of behavioral issues you're having. Alcoholics Anonymous (AA) drafted the original 12-step program, but you can adapt the steps to any recovery plan.

Process
In the 12-step program, the process to recovery is seen as physical, mental and spiritual. In Native American pathways to healing, the process is also emotional. The overall process, according to the American Psychological Association, has six parts.

• Admitting that you can't control your addiction/compulsion.
• Acknowledging that a greater power can give you strength.
• Looking at your past mistakes with the help of a sponsor (someone who has experienced recovery).
• Accepting your mistakes and making amends.
• Learning to live a new life for yourself with your personal code of conduct.
• Helping other people who experience the same addictions/compulsions as you.

Steps

The 12-step program here has been adapted from the AA program to eliminate political, religious and gender bias. You can follow these steps in your own life.

1) I admit that I am powerless over my addiction or compulsion.
2) I believe in something greater than myself.
3) I have made the decision to turn my will and life toward something greater than myself.
4) I have looked at myself wholly and faced my past and present.
5) I have reflected on myself and shared these reflections with another person.
6) I am ready to accept change in my lifestyle and remove the addiction/compulsion from my life.
7) I have sought forgiveness from myself.
8) I have thought of people who I have harmed and am willing to make amends.
9) I have made amends with people who I have harmed when possible, except when it would cause them harm.
10) I am watchful of my actions and admit when I am wrong.
11) I regularly meditate and/or pray to become closer to true myself and/or a greater power.
12) I share my experience with others who are suffering from addictions/compulsions when they are receptive.

What is detox and rehab?

Detox describes the cleansing that happens to your body when you stop an addiction or compulsion. The best way to successfully detox is to join a Rehab program, which is usually done in a rehabilitation or treatment center.

What is rehab like?

• Your experience will vary from program to program, whether it's with a counselor in individual meetings a few times a week, a program with long meeting hours several times a week, or a live-in treatment center that has a rehab program and/or a medical detox center.
• At live-in treatment centers, you have a structured schedule that is prepared for you. Typically basic activities will include eating, going to lectures, discussing in group meetings, meeting counselors individually or reflecting on your addiction or compulsion.
• Some treatment centers are also medical detox centers, which are more like hospitals and provide services to help you in the detox process.

What are alternative rehab programs?

• There are some special programs that have high rates of success because of their unique perspectives and strategies for recovery.
• For example, Poundmaker's Lodge Treatment Centre, an addiction treatment centre near Edmonton, Alberta, treats people of all backgrounds using the cultural and spiritual beliefs of traditional First Nations peoples in combination with a 12-Step, abstinence-based recovery. Their treatment is holistic and focuses on the causes of addiction to empower you in recovery.

How long do I have to stay in rehab?

• Since there are many forms of rehab, you'll need to find a treatment program that works for you. The length of time varies.
• If your problem is less severe, you might be able to recover by seeking counseling a few times a week.
• If you have a moderate addiction or compulsion, you may need a program that is several hours long, several days a week.
• If you are dependent on your addiction or compulsion, you should stay at a live-in treatment center where you will be in a safe environment to undergo detox.
• In all cases, treatment should last at least one year. This doesn't mean you need to stay in a treatment center that long, just that you should keep in touch with treatment resources during that time.
• Overall, rehabilitation is a life-long process and meetings or group gatherings can be a helpful resource to keep you addiction or compulsion-free over time.

Does rehab really work?

• If you're dedicated to changing and you find a treatment that works for you, detox and rehab will get you through your physical withdrawal period.
• You should also develop coping skills during the program.
• Once you're past withdrawal, you should be able to practice these skills in your day-to-day life.
• Again, rehab can be a long process and you may need to try different treatment centers or types.

How do I find the right rehab center?

• Figure out where you want to be (local or distant) and look for programs, which you can easily do online. You can also join local or online support groups to get opinions about rehab centers.
• Look for success stories from people who went to the center. Contact them when you can and ask them questions.
• Visit the facility and ask questions. Good things to ask are: I f they're accredited (this is a form of certification), if they're registered with the government, or what about their program is right for you.
• Make sure it's not overcrowded so you're sure you'll get the help you need.

Whatever you decide works for you, make sure you walk into a rehab program willing and ready for change. You need to admit that you have an addiction to yourself and to others before you can take steps to recovery.

Naltrexone is available in pill form. Vivitrol is taken as a shot (injection) into a muscle (intramuscular) once a month.

What To Think About

You might develop liver damage if you have liver disease (such as hepatitis, cirrhosis, or liver failure) and take too much naltrexone.

This medicine will cause withdrawal symptoms if you are taking opioids drugs. If you have taken opioids in the past 7 to 10 days, talk to your doctor before taking naltrexone.

You might need to take naltrexone for several months to effectively prevent relapse.

Vivitrol, a once-a-month injection of this medicine, is approved by the U.S. Food and Drug Administration (FDA) to treat drinking problems. This form of naltrexone can be useful for people who have a hard time deciding whether to take the medicine each day.

The U.S. Food and Drug Administration (FDA) has issued an advisory about injectable forms of naltrexone. You may have a skin reaction at the injection site, the place where the shot is given. Call your doctor if you notice any skin change at the injection site, such as swelling, tenderness, redness, or pain, that does not improve or gets worse within 2 weeks.

Introduction

You can take steps today to stop drinking. Your first step might be to see your doctor, contact a support group, or set a date in the near future to stop. While some people can stop drinking on their own, others need medical help to manage the physical process of withdrawal.

If you think you have an addiction to alcohol, talk to your doctor about whether you need to withdraw from alcohol under medical supervision. Your doctor can give you medicine that will help you safely withdraw from alcohol. Other medicines might be prescribed later to help you stay sober. With a doctor's help, withdrawal from alcohol is safer.

Stopping alcohol use can:

• Prevent or reduce health problems that are made worse by alcohol use, such as liver damage.
• Prevent harm to your unborn baby if you are pregnant.
• Reduce related family concerns or relationship problems.
• Increase your ability to be productive at work, school, and home.
• Reduce legal problems that you might have as a result of misuse of alcohol.

More information about alcohol problems can be found in the topics Alcohol Abuse and Dependence, Alcohol and Drug Problems, and Teen Alcohol and Drug Abuse.

How It Works

Experts are still studying how this medicine works. It appears to reduce cravings for alcohol by helping balance brain chemicals called neurotransmitters. It also might reduce anxiety, mood swings, and sleep problems caused by alcohol withdrawal.¹

During pregnancy, everything you eat, drink, or take into your body affects you and your growing baby (fetus). Pregnant women often need to make changes to have a healthy pregnancy, such as eating better or exercising. But one of the most important things you can do when you are pregnant is to avoid alcohol and drugs.

Alcohol and drugs can cause problems for you during your pregnancy and when it is time for your baby to be born. They can also affect your baby both before and after he or she is born. They can:

• Affect your baby's size.
• Affect how your baby's heart, lungs, and brain work.
• Cause lifelong learning, emotional, and physical problems for your child.

Using alcohol and drugs like cocaine or meth is not safe for you or your baby.

The best time to stop using alcohol and drugs is before you get pregnant. But sometimes pregnancy is unexpected. Since drugs and alcohol can harm your baby in the first weeks of pregnancy, the sooner you can stop, the better.

Even some over-the-counter and prescription medicines aren't safe to take when you're pregnant. Tell your doctor about all the drugs and supplements you take. He or she can help you decide what medicines are safe to take during pregnancy.

How do alcohol and drugs affect your pregnancy?

Substance	Possible effect on mother	Possible effect on fetus, newborn, and child
Alcohol	Lack of certain vitamins Miscarriage Stillbirth	Low birth weight Mental retardation Heart problems Learning and behavior problems Fetal alcohol syndrome
Cocaine	Seizures Hallucinations Fluid in the lungs (pulmonary edema) Breathing problems Heart problems Placenta abruptio Miscarriage Stillbirth	Low Apgar score Stroke Deformed reproductive or urinary organs Sudden infant death syndrome (SIDS)
Ecstasy	Effects not known	Long-term memory problems Learning problems
Heroin	Preeclampsia Bleeding in the third trimester Placenta abruptio Breech birth	Seizures Addiction, withdrawal symptoms after birth Breathing problems Small size at birth Physical and mental development problems
Inhalants	Life-threatening breathing problems Convulsions or seizures Coma	Low birth weight Problems with how bones form Learning problems
Marijuana	Preterm labor	Tremors Easily startled Cranky or fussy Learning problems Attention deficit hyperactivity disorder Depression Substance abuse Leukemia Certain types of cancer
Methamphetamine	Stroke Brain damage Miscarriage Placenta abruptio	Low birth weight Heart and lung problems
PCP/LSD	Confusion Delusions Hallucinations Risk of overdose	Withdrawal symptoms after birth Learning problems Emotional problems Behavior problems

What can you do to stop using alcohol or drugs?

You may already know that alcohol and drugs can harm you and your baby. But it can still be hard to stop. Changing your behaviors is not easy. Some people need treatment to help them quit using drugs or alcohol. Here are some things you can do:

Take the first step. Admitting that you need help can be hard. You may feel ashamed or have doubts about whether you can quit. But your treatment can be successful only if you make the choice to stay sober. Remember that many people have struggled with these same feelings and have recovered from substance abuse. Quitting now will help you and your baby.

Tell someone. If you can't stop drinking or using drugs on your own, tell someone that you need help. There are people and programs to help you. Your doctor is a good place to start. He or she can talk to you about treatment options. Your doctor may be able to give you medicines that can ease withdrawal symptoms. Or he or she may be able to find a hospital or clinic that you can go to for treatment.

You might also want to tell a friend or loved one. Having someone on your side that you know well, telling you that you can do this for yourself and your baby, is a very important part of recovery.

Make changes to your life. It can be hard to stop using alcohol or drugs when it has become a part of your life. You may need to make changes to your routine, like not being around certain people, or not going to places where you used to drink or use drugs. Ask friends and family to support your changes.

Consider counseling. Counseling helps you make changes in your life so you can stay sober. You learn to cope with tough emotions and make good choices. You may get counseling in a group or one-on-one.

Join a support group. Groups like Alcoholics Anonymous (AA) and Narcotics Anonymous were formed to help people who want to stop doing things that add no value to their lives. You may have more success quitting if you share your story, hear the stories of those who may be struggling and those who have successfully quit, and find someone to partner with.

Where can you find information and support?

If you're ready to quit drugs or alcohol, congratulations. You are taking an important step for your health and for your baby's health. Contact these organizations for information and help with quitting:

A blood alcohol test measures the amount of alcohol (ethanol) in your body.

Alcohol is quickly absorbed into the blood and can be measured within minutes of having an alcoholic drink. The amount of alcohol in the blood reaches its highest level about an hour after drinking. But food in the stomach may increase the amount of time it takes for the blood alcohol to reach its highest level. About 90% of alcohol is broken down in the liver.

The rest of it is passed out of the body in urine and your exhaled breath.

Alcohol has a noticeable effect on the body, even when consumed in small amounts. In large amounts, alcohol acts as a sedative and depresses the central nervous system.

A blood alcohol test is often used to find out whether you are legally drunk or intoxicated. If this test is being done for legal reasons, a consent form may be required, but refusing to take the test may have legal consequences.

A toxicology test checks blood or urine for the presence of drugs. In rare cases, stomach contents, sweat, or saliva may also be checked.

Drugs can be accidentally or deliberately swallowed, inhaled, injected, or absorbed through a skin surface or mucous membrane. These include prescription medicines, nonprescription medicine (such as aspirin or acetaminophen), vitamins, nutritional supplements, alcohol, and illegal drugs, such as cocaine and heroin.

A toxicology test may check for one specific drug or for up to 30 different drugs at once. Testing is often done on a urine sample instead of blood, because urine tests are usually easier to do than blood tests and many drugs show up in the urine. Also, traces of a drug may remain in urine for longer than in blood.

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The above information was "verified" as correct on the date at the end of each entry. Since American Self-Help Group Clearinghouse's database is extensive but staffing is limited and information for these organizations can change, it is not possible to keep every entry in American Self-Help Group Clearinghouse database completely current and accurate. Please check with the organizations listed for the most current information.

For additional information on self-help groups, please visit the American Self-Help Group Clearinghouse web site at http://www.mentalhelp.net/selfhelp

If you find information that is not current, please contact American Self-Help Group Clearinghouse at: admin@selfhelpgroups.org

Early Stage

How does the early stage work?

• The early stage is the hardest to detect, since it's mostly physical and unseen. Your body is developing a higher tolerance level to alcohol, which means you can drink more alcohol and still function.
• You don't appear to have any problems with performance at work, school, and/or social activities due to drinking.
• You probably aren't aware you're in this stage, because you can't easily tell what's happening to your body.

Am I in the early stage?

• Ask yourself: Where do you most often drink? Why do you drink? Does anyone notice anything different about you?
• If you most often drink in social situations but not for social reasons or drink to deal with stress or problems, but no one notices anything very different about your behavior, you are likely in the early stage of alcoholism.
• 

Middle Stage

How does the middle stage work?

• Here's where your ability to function in the early stage goes out the window. You're physically dependent but might not be aware of it yet.
• Your body suffers from withdrawal. You physically crave alcohol.
• You may have blackouts -- you continue to function but you can't remember what happened, because your brain either can't store memories or stores them improperly.
• Your work, school, and/or social activities are affected by drinking. You might miss work or school, perform poorly on tasks, or have behavioral issues with peers. You may also care less about your appearance and attitude.
• You can also remain stable and pleasant at work and school, but you hide how much you drink.

Am I in the middle stage?

• Ask yourself: Do I crave alcohol? Do I have tremors if I don't drink? Am I able to concentrate? How often do I make mistakes? How many day-to-day tasks do I finish? How often do I use sick leave? How much effort do I put into my appearance? How do I act with other people? How often do I drink? Do I have blackouts? Do I hide alcohol?
• If you feel a physical craving for alcohol or seem to put alcohol before your day-to-day activities, you may be in the middle stage of alcoholism. Sometimes it's hard to tell if you're in this or the early stage depending on your tolerance. You're also likely to deny you have a problem, which makes recovery difficult. You may justify drinking because of problems in your life.

End Stage

How does the end stage work?

• You experience physical, mental, and social suffering from drinking. You have lost control because you're obsessed with drinking. You may avoid friends, family and things you used to enjoy in order to drink.
• You are under threat of serious medical issues, including heart failure, fatty liver, hepatitis, cirrhosis of the liver, malnutrition, pancreatitis, respiratory infections, and even brain damage.
• You frequently blackout or pass out. Drinking alcohol may be one of the only ways you can fall asleep.
• If you stop drinking, you shake, which is caused by a nervous disorder. If you have hallucinations, you could have delirium tremens and seriously need medical help.
• You may be able to still hold a job, be pleasant with other people, and keep up your appearance, but you spend most of your energy and thoughts on drinking. You may also hide alcohol.

Am I in the end stage?

• Ask yourself: How often am I sick? Do I shake when I stop drinking? Do I put alcohol above friends, family, or other activities I enjoy? Do I hide alcohol? Where do I spend most of my time? Am I able to manage my work life and finances?
• If you are frequently ill, shake or have hallucinations if you stop drinking, or put alcohol first, you are likely in the end stage of alcoholism. You could be a functioning alcoholic--you have adapted alcoholism to your day-to-day life and will suffer long-term health issues. If you're still in denial, think seriously about what you can do to face your addiction.

Whichever stage you or someone you know may be in, many of the effects can be reversed over time with a healthy lifestyle, while others may be permanent. In any stage, you have a chance for recovery.