If you love someone in addiction, this page is for you.

If you are reading this at 2 a.m. with a list of things you have not said out loud yet, you are not alone. The single most consistent thing we hear from families calling Roanoke Refuge is that they spent months or years quietly carrying the weight of someone else's addiction before they ever picked up a phone. This page is the page we wish those families had read the first night they started looking.

The guidance below is practical, evidence-based, and tied to the local Roanoke Valley resources that actually exist. It is not a substitute for a clinical conversation. It is a starting point for the questions that need answers before that conversation happens.

The four most common situations families bring to us are covered below:

• How to talk to a loved one about treatment.
• What to do if they refuse treatment.
• How to respond to an overdose.
• Where to find support for yourself.

After those sections, we list the local support groups, crisis lines, and emergency resources in the Roanoke region.

If This Is an Overdose Emergency Right Now

Naloxone is available at most pharmacies in Virginia without a prescription under a statewide standing order, and free naloxone is distributed through the Virginia Department of Health's REVIVE! program. Every family of a person with opioid use disorder should have naloxone in the house, and every adult in the household should know how to administer it.

Training is free, takes 30 minutes, and is offered through community health partners across the Roanoke Valley. The training also covers what to do after the reversal: the person will likely go into acute withdrawal, may be agitated, and will need follow-up medical care because naloxone wears off in 30 to 90 minutes while opioids can stay in the system longer.

After the immediate emergency is stabilized, the conversation about treatment becomes possible. A near-fatal overdose is often the inflection point that opens the door to care. The hospital social worker or the ED physician can make a referral; you can also call our admissions team directly while the person is still in the hospital and we will coordinate the transition into outpatient PHP or IOP from the discharge.

How to Use the Narcan Nasal Spray, Step by Step

If you have a Narcan (naloxone) kit at home, here is exactly how to use it on someone you suspect is overdosing on opioids. The signs to watch for are pinpoint pupils, slow or stopped breathing, blue or gray lips, and being unresponsive to a loud call of their name or a hard rub on the breastbone.

1. Call 911 first. Tell the dispatcher you suspect an opioid overdose and that you are about to give naloxone. Stay on the line if you can.
2. Tilt their head back and place them on their back if they are not already.
3. Hold the nasal spray with your thumb on the plunger and two fingers on either side of the nozzle. Insert the nozzle into one nostril until your fingers touch the bottom of the nose.
4. Press the plunger firmly all the way down to release the full dose. Each device is one dose. Do not test-spray it first.
5. Move them onto their side in the recovery position — one knee bent up, head supported on the lower arm. This keeps the airway clear if they vomit.
6. Wait two to three minutes and watch their breathing.
7. If they are not breathing normally after two to three minutes, give a second dose in the other nostril. Keep giving doses every two to three minutes until emergency services arrive if needed.
8. Stay with them until paramedics arrive. Do not leave them alone. Naloxone wears off in 30 to 90 minutes; opioids can stay in the system longer, and a second overdose is possible.

What to expect after the reversal: people who wake up from naloxone are often confused, agitated, and sometimes angry. This is the medication and the sudden opioid withdrawal, not them. They may try to leave. Encourage them to stay and let paramedics evaluate them. The risk of a second overdose in the hours after a reversal is real because the opioids are still active in the body.

How to Talk to a Loved One About Treatment

There is no script. Anyone who tells you there is one is selling something. What there is, instead, is a small number of principles that consistently make the conversation more likely to land. The principles come from decades of research on motivational interviewing, behavioral therapy, and family systems work. They are also things that most people in a high-conflict relationship with an addicted loved one have not been doing, often for understandable reasons.

The first principle is that the conversation works better when the person you love is sober. Confronting active intoxication is rarely productive and often dangerous. Pick a moment of relative calm.

The second is that the conversation is more likely to land when it leads with care and observation, not accusation and ultimatum. "I have noticed you have been drinking more in the evenings and I am worried about you" lands differently than "you are an alcoholic and I am done." Both may be true; only one keeps the door open.

The third principle is that you do not have to solve the whole problem in one conversation. The realistic outcome of a first conversation is not enrollment in treatment. It is a small shift in the person's willingness to consider that something needs to change. Motivational interviewing calls this "change talk." If your loved one ends the conversation having said even one sentence acknowledging the problem out loud, the conversation worked. Most families try to push much further in the first attempt and end up further apart.

The fourth principle, and the one most families have the hardest time accepting, is that you cannot force change. The CRAFT model (Community Reinforcement and Family Training), developed by Robert Meyers and colleagues at the University of New Mexico, has strong evidence for engaging treatment-reluctant family members without the confrontation-style intervention popularized on reality television.

CRAFT focuses on rewarding sobriety, removing unintentional reinforcement of substance use, taking care of the family member's own wellbeing, and waiting for windows of openness to introduce treatment. It is not fast. It is not dramatic. It works.

If you want a clinical conversation about how to apply CRAFT principles to your specific situation, our admissions team can talk through it with you. The conversation does not commit your loved one to anything. It is for you.

You Can Come In Alone First

One of the most common things we hear from family members is some version of: I want to call, but my loved one is not ready. The honest answer is that you do not need their permission, their knowledge, or their participation to reach out. The first conversation with our admissions team is for you — about what you are facing, what your options are, and what the most useful next step might be given the specific situation you are sitting in tonight.

You can come in for a clinical conversation alone. You can ask all of your questions without anyone you love finding out you called. We do not contact the person you are asking about unless you ask us to. We will not enroll them in treatment without their consent. The conversation between you and our team is confidential under HIPAA and 42 CFR Part 2.

Many families work with our team for weeks or months on the family side of the problem — using approaches like CRAFT, working through how to talk to their loved one, planning for the conversation that might invite treatment — before the person in addiction ever speaks to us directly. That is a normal path. Some loved ones never call us. Their family member did the work, the conversation shifted at home, and the person eventually walked into treatment somewhere on their own.

What to Do If They Refuse Treatment

The most common starting point for the families who call us is exactly this: the person they love does not want help. Some version of this is true for most calls.

The first thing to know is that refusal is not the end of the road, and refusal today is not refusal forever. The neurobiology of active addiction makes acknowledging the problem genuinely harder, which is part of why the disease persists. The second thing to know is that there are evidence-based approaches that change the trajectory without forcing the issue.

The CRAFT framework, mentioned above, is the most researched of these. Other approaches include:

• Motivational interviewing applied in family settings.
• Professionally facilitated family meetings that are not confrontational interventions.
• Individual coaching for the family member on how to interact differently.

The common thread is that the family changes its behavior first, and the person with the substance use disorder responds to the new context over time. In published studies, CRAFT engages roughly two-thirds of treatment-reluctant family members into treatment within six months, compared to under 30 percent for Al-Anon-based or Johnson-model approaches (Meyers et al., longitudinal CRAFT outcome research).

Two things to avoid:

• Ultimatums you cannot enforce ("if you do not go to treatment, I am leaving" when you are not actually prepared to leave).
• The dramatic surprise-confrontation intervention. The clinical community has largely moved away from the Johnson-model surprise intervention except in narrow circumstances.

Both can backfire and often do. The exceptions exist but they are not the default first move.

One small but high-leverage practical move: when a window of openness appears — a moment after a near-miss, a quiet morning after a bad night, a hospitalization — have the call to our admissions team ready. The window may be small. If you have already verified insurance and know the next-day schedule, the friction between "I think I am ready" and "I am sitting in front of an intake clinician" can be measured in hours, not weeks.

How to Take Care of Yourself

This is the section families skip and the section that most matters for long-term outcomes. Family members of people in active addiction develop their own clinical pictures of anxiety, depression, secondary trauma, and burnout at rates well above the general population. The phrase "you cannot pour from an empty cup" is a cliché, but the underlying clinical reality is documented in the family-systems literature for decades. Your own wellbeing is not a luxury or a distraction from helping them. It is the precondition for being able to help them.

The practical menu of self-care for the family member of a person with addiction includes:

• Peer support through Al-Anon or Nar-Anon.
• Individual therapy with a clinician trained in addiction family systems.
• Family therapy with the addicted loved one when appropriate.
• Education about the disease (NIDA, SAMHSA, and the books listed in the resources blog).
• Practical boundaries about what you will and will not do (lend money, lie to employers, provide transportation to a using context).

Boundaries are not punishment. They are the way the family environment stops accidentally reinforcing the substance use.

Family therapy sessions are built into our PHP and IOP programs so that the family system gets clinical attention alongside the client's recovery work. That is not the same as individual support for the family member, which is also clinically appropriate and often the right starting point regardless of whether the addicted loved one ever enters treatment.

Local Support Groups for Families

The Roanoke Valley has a substantial network of family support resources. The list below is a starting point; meeting times and locations change frequently, so the meeting-finder URLs are the source of truth for current information.

Local Crisis and Emergency Resources

These are the numbers and locations to have handy. If the situation is acute, start at the top of this list.

Common Family Questions

The most common questions we hear from family members during admissions calls are answered in the FAQ below. If your specific question is not there, calling our admissions team is the next step. The conversation is confidential and obligates nothing.