Resources for Families Coping with Mental and Substance Use Disorders

Every family is unique, but all families share a bond that can be used to support one another during trying times.

While there is no one-size-fits-all solution for helping a family member who is drinking too much, using drugs, or dealing with a mental illness, research shows that family support can play a major role in helping a loved one with mental and substance use disorders.

When a family member is experiencing a mental or substance use disorder, it can affect more than just the person in need of recovery. Evidence has shown that some people have a genetic predisposition for developing mental and substance use disorders, and may be at greater risk based on environmental factors such as having grown up in a home affected by a family member’s mental health or history of substance use. Families should be open to the options of support groups or family therapy and counseling, which can improve treatment effectiveness by supporting the whole family.

It is also important to remember that the unique challenges that come from helping a loved one with a mental or substance use disorder can be taxing, so caregivers should take steps to prioritize their own health as well.

Family members may be more likely to notice when their loved ones are experiencing changes in mood or behavior. Being able to offer support, family members can connect those in need with treatment, resources, and services to begin and stay on their recovery journey.

For more information related to this article please visit: Resources for Families Coping with Mental and Substance Use Disorders | SAMHSA

Revised: May 7, 2020 Overview:

COVID-19 is a novel coronavirus spread by the respiratory route and contact with contaminated surfaces. It appears to be highly contagious and has a significant morbidity and mortality rate. Because these attributes are known and because this agent has been identified as responsible for a global pandemic, it is essential that behavioral healthcare facilities implement plans to protect patients and staff from infection to the greatest extent possible. The following are offered as considerations aimed at decreasing the likelihood of infection and viral transmission and providing for the behavioral health needs of patients.

There are many options for treating mental and substance use disorders which have an evidence base and/or are best practices. These include inpatient, outpatient and residential treatment options. Because of the substantial risk of coronavirus spread with congregation of individuals in a limited space such as in an inpatient or residential facility, SAMHSA is advising that outpatient treatment options, when clinically appropriate, be used to the greatest extent possible. Inpatient facilities and residential programs should be reserved for those for whom outpatient measures are not considered an adequate clinical option; i.e.: for those with mental disorders that are life threatening, (e.g.: the severely depressed suicidal person or persons with life threatening substance use disorders (e.g.: at high risk for overdose, complications from withdrawal). It is recommended that intensive outpatient treatment services be utilized whenever possible. Comprehensive long term residential treatment programs, where COVID related precautions can be implemented (social distancing, isolating, testing, etc.) remain a viable treatment option when clinically indicated.

CDC has released guidance on the expanded use of telehealth services. SAMHSA strongly recommends the use of telehealth and/or telephonic services to provide evaluation and treatment of patients. These resources can be used for initial evaluations including evaluations for consideration of the use of buprenorphine products to treat opioid use disorder. Further, these resources can be used to implement individual or group therapies such as evidence-based interventions including cognitive behavioral therapy for mental and/or substance use disorders.

For inpatient/residential programs that plan to remain open during the current COVID-19 related emergency; care should be taken to consider CDC guidance on precautions in admitting new patients, management of current residents who may have been exposed to or who are infected with COVID-19, and visitor policies.

For more information on this and similar articles, please visit: Coronavirus (COVID-19) | SAMHSA

Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.1,2 It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery.3 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.4 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects.

In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.4,5 Common names for illegally used fentanyl include Apache, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.

Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.8 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.

What are Opioids?

Opioids are a class of drugs naturally found in the opium poppy plant. Some opioids are made from the plant directly, and others, like fentanyl, are made by scientists in labs using the same chemical structure (semi-synthetic or synthetic).

How do people use fentanyl?

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.6

The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.7

Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose. To learn more about the mixture of fentanyl into other drugs, visit the Drug Enforcement Administration’s Drug Facts on fentanyl.

How does fentanyl affect the brain?

Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.8 After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug-seeking and drug use take over their lives.

Fentanyl’s effects include:

  • extreme happiness
  • drowsiness
  • nausea
  • confusion
  • constipation
  • sedation
  • problems breathing
  • unconsciousness

Can you overdose on fentanyl?

Yes, a person can overdose on fentanyl. An overdose occurs when a drug produces serious adverse effects and life-threatening symptoms. When people overdose on fentanyl, their breathing can slow or stop. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can lead to a coma and permanent brain damage, and even death.

How can a fentanyl overdose be treated?

As mentioned above, many drug dealers mix the cheaper fentanyl with other drugs like heroin, cocaine, MDMA and methamphetamine to increase their profits, making it often difficult to know which drug is causing the overdose. Naloxone is a medicine that can treat a fentanyl overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs. But fentanyl is stronger than other opioid drugs like morphine and might require multiple doses of naloxone.

Because of this, if you suspect someone has overdosed, the most important step to take is to call 911 so he or she can receive immediate medical attention. Once medical personnel arrive, they will administer naloxone if they suspect an opioid drug is involved.

People who are given naloxone should be monitored for another two hours after the last dose of naloxone is given to make sure breathing does not slow or stop.

Some states have passed laws that allow pharmacists to dispense naloxone without a personal prescription. This allows friends, family, and others in the community to use the auto-injector or nasal spray versions of naloxone to save someone who is overdosing. People who are or know someone at risk for an opioid overdose can be trained on how to give naloxone and can carry it with them in case of an emergency.

Naloxone is available as an injectable (needle) solution, a hand-held auto-injector (EVZIO®), and a nasal spray (NARCAN® Nasal Spray).

Read more on our Naloxone webpage.

Can fentanyl use lead to addiction?

Yes. Fentanyl is addictive because of its potency. A person taking prescription fentanyl as instructed by a doctor can experience dependence, which is characterized by withdrawal symptoms when the drug is stopped. A person can be dependent on a substance without being addicted, but dependence can sometimes lead to addiction.

Addiction is the most severe form of a substance use disorder (SUD). SUDs are characterized by compulsive drug seeking and drug use that can be difficult to control, despite harmful consequences. When someone is addicted to drugs, they continue to use them even though they cause health problems or issues at work, school, or home. An SUD can range from mild to severe.

People addicted to fentanyl who stop using it can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms include:

  • muscle and bone pain
  • sleep problems
  • diarrhea and vomiting
  • cold flashes with goose bumps
  • uncontrollable leg movements
  • severe cravings

These symptoms can be extremely uncomfortable and are the reason many people find it so difficult to stop taking fentanyl. There are medicines being developed to help with the withdrawal process for fentanyl and other opioids. The FDA has approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms. Also, the NSS-2 Bridge device is a small electrical nerve stimulator placed behind the person’s ear, that can be used to try to ease symptoms for up to five days during the acute withdrawal phase. In December 2018, the FDA cleared a mobile medical application, reSET®, to help treat opioid use disorders. This application is a prescription cognitive behavioral therapy and should be used in conjunction with treatment that includes buprenorphine and contingency management.

How is fentanyl addiction treated?

Like other opioid addictions, medication with behavioral therapies has been shown to be effective in treating people with a fentanyl addiction.

Medications: Buprenorphine and methadone work by binding to the same opioid receptors in the brain as fentanyl, reducing cravings and withdrawal symptoms. Another medicine, naltrexone, blocks opioid receptors and prevents fentanyl from having an effect. People can discuss treatment options with their health provider.

Counseling: Behavioral therapies for addiction to opioids like fentanyl can help people modify their attitudes and behaviors related to drug use, increase healthy life skills, and help them stick with their medication. Some examples include:

  • cognitive behavioral therapy, which helps modify the patient’s drug use expectations and behaviors, and effectively manage triggers and stress
  • contingency management, which uses a voucher-based system giving patients “points” based on negative drug tests. They can use the points to earn items that encourage healthy living
  • Motivational interviewing, which is a patient-centered counseling style that addresses a patient’s mixed feelings to change

These behavioral treatment approaches have proven effective, especially when used along with medicines. Read more about drug addiction treatment in our Treatment Approaches for Drug Addiction DrugFacts.

Points to Remember

  • Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. In its prescription form it is prescribed for pain, but fentanyl is also made illegally.
  • Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths.
  • Illegal fentanyl is sold in the following forms: as a powder, dropped on blotter paper like small candies, in eye droppers or nasal sprays, or made into pills that look like real prescription opioids.
  • Illegal fentanyl is being mixed with other drugs, such as cocaine, heroin, methamphetamine, and MDMA. This is especially dangerous because people are often unaware that fentanyl has been added.
  • Fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. Its effects include extreme happiness, drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma, and death.
  • The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains it. They can underestimate the dose of opioids they are taking, resulting in overdose.
  • Naloxone is a medicine that can be given to a person to reverse a fentanyl overdose. Multiple naloxone doses might be necessary because of fentanyl’s potency.
  • Medication with behavioral therapies has been shown to be effective in treating people with an addiction to fentanyl and other opioids.

Learn More

For more information about fentanyl and other opioids, visit:

Find more information about the opioid reversal drug naloxone.


  1. Volpe DA, Tobin GAM, Mellon RD, et al. Uniform assessment and ranking of opioid Mu receptor binding constants for selected opioid drugs. Regul Toxicol Pharmacol. 2011;59(3):385-390. doi:10.1016/j.yrtph.2010.12.007
  2. Higashikawa Y, Suzuki S. Studies on 1-(2-phenethyl)-4-(N-propionylanilino)piperidine (fentanyl) and its related compounds. VI. Structure-analgesic activity relationship for fentanyl, methyl-substituted fentanyls and other analogues. Forensic Toxicol. 2008;26(1):1-5. doi:10.1007/s11419-007-0039-1
  3. Nelson L, Schwaner R. Transdermal fentanyl: Pharmacology and toxicology. J Med Toxicol. 2009;5(4):230-241. doi:10.1007/BF03178274
  4. Garnock-Jones KP. Fentanyl Buccal Soluble Film: A Review in Breakthrough Cancer Pain. Clin Drug Investig. 2016;36(5):413-419. doi:10.1007/s40261-016-0394-y
  5. Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration. Fentanyl Fact Sheet. March 2015.
  6. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776-789.
  7. Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration
  8. on. Acetyl fentanyl Fact Sheet. July 2015.
  9. Gutstein H, Akil H. Opioid Analgesics. In: Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill; 2006:547-590.

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

February 2019

I would like to express my gratitude and appreciation to Pathfinders and the amazing staff that makes it all possible. Pathfinders were there for me when I had no one else to turn to and in serious trouble. They provided me with not only a safe space and roof over my head but a healthy environment to get away from my old friends and my old lifestyle. I had knowledgeable people to talk to and down-to-earth counselors to give me great advice and make me feel like I was part of a family. As much as I tried, I could not break my old patterns on my own, but this was something different. Honestly, I was a little bit apprehensive at first and had a hard time admitting I was an alcoholic and a drug addict, and to sum it up.. helpless. I was introduced to the 12 steps and a sponsor who helped me understand and navigate these steps. I quickly adopted a new routine consisting of structure and punctuality. Not being a morning person, it was quite a change. I was waking up before the sunrise and doing my chores which was something I could never accomplish on my own. During our group sessions, we would plan our days from waking up to the time we went to sleep. This helped me tremendously. I was given just enough time and freedom to slowly readjust to normal life and before I knew it, I had a job and my family wanted me in their lives. Next thing I knew covid 19 hit the world like a ton of bricks. I lost my job, and the world was in chaos. People I knew who previously had their lives together were now alcoholically drinking and acting like the world was coming to an end. Thankfully, I had the tools I learned at Pathfinders and the people around me to keep me on the right track. During all of this, I was dealing with a serious court case. The pathfinder’s staff made sure to get my progress reports to the right people and always reassured me I was in good hands. It was not easy but I knew I had no other choice. I had to stay sober, and I could not let myself or anyone else down. I felt nothing but love and encouragement from the staff and my fellow pathfinders. Once completing the Pathfinder program, I easily transitioned to their onsite sober living facility. I recommend this program and the staff to anyone who wants to get sober and stay sober. Pathfinders are the real deal.

Colton S.

When I got to Pathfinders, I did not know what to expect. I had been to two rehabs in years past where the target client as LGBTQ, so I was a little timid and hesitant, but my spirit called me to Pathfinders, nonetheless. I was pleased to discover that the staff was very welcoming, open-minded and made me feel like I was part of their family/brotherhood. My experience there was different from the past treatment programs. The staff really took the time to not only show me sympathy but were very empathetic and understanding when it came to sensitive matters and when it came to my interests and my program. They pointed me in the right direction whenever I felt lost and lifted me up whenever I felt low. They were very open and receptive whenever I needed to express my feelings and they allowed me to process growing pains in a safe environment. Anytime I needed a shoulder to cry on…and there were plenty, someone was there to help me through it.

I thank my spirit guides every day for leading me to Pathfinders. If it were not for the staff and the brotherhood that they provide, I don’t think I’d be in the same state of mind. Anytime that I feel lost or alone, I know that I can call them and be greeted with love on the other end. Anytime I miss them, I know that I can stop by and be greeted with open arms. In my many years of feeling fearful of the unknown, I now know that it does not matter that I’m gay; I am considered a brother among brothers at Pathfinders and a brother among brothers in recovery.

Thank you, Pathfinders, for showing me another way.

Santi G.