Caregiving in the Shadow of Addiction

How to navigate the emotional and practical tolls of caring for a loved one with a drug or alcohol addiction

Paul Wynn,

AARP

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Published March 04, 2026

a hand holding pills, someone drinking wine and two people embracing

AARP (Getty Images, 4)

If caring for a mother with dementia isn’t overwhelming enough, imagine also managing her addiction to illicit drugs. That’s the reality Karmen Howard faces, trying to protect her mother, Elaine, from the twin challenges of cognitive decline and drug abuse fueled by a manipulative boyfriend. The addiction took root later in Elaine’s life, emerging under the corrosive influence of a boyfriend, compoundeded by the challenges of her declining cognitive health.

Howard, 52, a medical student coordinator at Rush University Medical Center in Chicago, has spent much of her adult life caring for family members, but nothing tested her resilience like this latest chapter with her mother. Between arranging doctor’s appointments, managing medications and responding to her mother’s unpredictable behavior, Karmen shoulders the responsibilities with some help from one sister.

“I’m no longer just a daughter. I am my mom’s primary caregiver and bodyguard to protect her from a hostile boyfriend tempting her with drugs,” Howard says. “I was ready to support my mom through her cognitive decline, but wasn’t prepared for the added weight of her drug addiction on top of it.”

Beyond the private struggles of families like Howard’s lies a growing public health crisis: More than 7 million older adults battle a substance use disorder, including more than 60 percent or 4.4 million with an alcohol use disorder and 3.2 million with a substance use disorder, according to a 2024 report by the Substance Abuse and Mental Health Services Administration. Older adults may be more likely to experience depression, anxiety and memory issues from long-term substance and alcohol use. One study found that alcohol use disorders were the strongest modifiable risk factor for dementia, accounting for more than half of early-onset cases and tripling the risk of developing the disease among men and women.

“Substance use disorders aren’t just a problem for younger adults, they are rising among older Americans, and caregivers need to understand that addiction is a medical disease, not a moral failing,” says Dr. Melissa Weimer, associate professor of medicine at Yale School of Medicine and Public Health and medical director of the addiction program at Yale New Haven Hospital.

Breaking the stigma around addiction

Addiction remains one of the most stigmatized challenges families face, often hidden behind closed doors as shame and embarrassment shape not only how relatives talk about substance use, but whether they talk about it at all. For caregivers and parents of adult children, this silence can make it especially difficult to navigate how to offer support, set healthy boundaries and protect their own well-being while responding to addiction.

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“Addiction is a medical disease, but its symptoms are behaviors — not measured like cholesterol or glucose levels — which makes it harder for families and society to understand,” explains Weimer. “It’s often misinterpreted as a moral failing rather than a brain disorder. That misunderstanding fuels stigma and guilt.”

Caregivers often internalize blame, believing they somehow caused or failed to prevent the substance use, when in reality, addiction is a treatable medical condition. “Helping families understand what’s happening in the brain is often the first step in replacing shame with empathy,” says Dr. Denis Antoine II, director of Addiction Treatment Services at Johns Hopkins Bayview Medical Center.

The consequences of stigma go beyond emotional strain: Fear of judgment or blame keeps many families silent, cutting them off from support networks, treatment resources and even basic conversations that could help their loved one. “But silence shuts the door to support,” says Weimer. “Until families acknowledge what’s happening, there is no room for help. The first real step is stepping out of secrecy and talking about it openly, compassionately and without judgment.”

Caught between care and crisis

Susanne White, founder of Caregiver Warrior, spent a decade caring for her sister-in-law, who battled a long heroin addiction that ultimately led to cirrhosis of the liver, which forced White to get more involved with her health needs. The disease brought severe physical complications and chronic pain, compounded by the unpredictable and dangerous behaviors often associated with addiction. For White, caregiving included countless hours coordinating pain management care when the cirrhosis worsened, which led to anxiety and insomnia issues that needed special attention. She also walked an emotional tightrope, balancing compassion with constant vigilance to keep her sister-in-law safe while navigating the shame that surrounds addiction.

Central to White’s approach was embracing her support group’s guiding principle for families affected by addiction, the Three Cs: “I didn’t cause it, I can’t control it, and I can’t cure it.” These principles guided her through the frustration and heartbreak of watching someone she loved struggle with a disease she could not fix, as much as she wanted to.

Despite the challenges, White found moments of connection and acceptance throughout the journey until her sister-in-law passed away in 2016. “I learned that sometimes the best way to help is simply to be present, compassionate and supportive without trying to force change.”

Caregiving expert Pamela D. Wilson of Lakewood, Colorado, highlights the profound challenges families face when caring for loved ones with substance use disorders, particularly when compounded by conditions like dementia or brain injury. Drawing on years of experience as a court-appointed guardian, conservator, power of attorney and care manager, she notes that caregivers often feel powerless as they navigate crises without the legal authority to intervene effectively.

Wilson’s own work spans more than 25 years managing complex addiction cases that families rarely discuss publicly. Many involved older adults with co-occurring conditions such as brain injuries, dementia or mental illness layered on top of substance use disorders. She recalls clients with alcohol-related dementia who could not remember having a drink 10 minutes earlier but continued to seek more, and others whose addictions led to repeated hospitalizations, falls or jail stays. In cases where she had legal authority, Wilson could limit access by moving clients into secured assisted living or coordinating care with hospitals to manage withdrawal.

“Families frequently find themselves caught in a cycle of rescue and crisis — retrieving loved ones from jail, hospitals or dangerous situations — usually without the tools to intervene productively,” Wilson says.

Wilson emphasizes the emotional toll this takes, with caregivers grappling with guilt, frustration and helplessness, especially when repeated rehabilitation efforts fail. She encourages families to recognize the limits of their control, reminding them that recovery ultimately rests with the individual struggling with addiction.

Howard has sought emotional support through biweekly therapy sessions to process her feelings, manage guilt and address the lasting emotional effects of her mother’s illness. “I didn’t think I needed therapy,” she says, “but I realized it’s affected me and my work.”

“Caring for a loved one with addiction is emotionally draining, unpredictable and full of setbacks,” says Wilson. “Finding the balance between offering support and protecting oneself is essential.”

Caregiver’s guide to supportive action

Experts stress that caregivers need structure, boundaries and access to resources to navigate this challenging journey. Here are key ways caregivers can support themselves and their loved ones struggling with addictive behaviors.

Boundary setting. Wilson stresses the importance of setting firm boundaries by clearly defining what they will and will not do. “Though emotionally difficult, this protects the caregiver’s well-being.” She also notes that legal tools like guardianship or conservatorship can provide structured oversight, enabling interventions such as limiting access to alcohol or drugs in controlled settings. Wilson adds that in some cases, stepping back and resisting the urge to constantly rescue a loved one may even prompt them to seek help, though it is never an easy choice.

Be supportive without enabling. Addiction experts say supporting a loved one with addiction requires a careful balance: offering help without reinforcing the very behaviors that fuel the disease. That can mean guiding someone toward treatment, encouraging adherence to prescribed medications or focusing on harm-reduction strategies such as making sure they stay hydrated, eat regularly or have safe transportation rather than driving while impaired, says Weimer. Caregivers must weigh their own safety and emotional capacity, avoiding repeated bailouts — from financial rescues to crisis cleanups — that can unintentionally enable continued substance use, Wilson adds. “You can offer care, safety and access to treatment, but you can’t control their choices. That’s where many caregivers get stuck and experience frustration.”

Accepting and understanding relapse. For many caregivers, seeing a loved one relapse can feel like a devastating setback. Experts caution, however, that relapse is often a normal part of the recovery journey, not a sign of incompetence or failure. “Recovery isn’t just about stopping substance use,” says Antoine. “It’s about rebuilding social connections, restoring routines and creating meaningful engagement in daily life.” Wilson acknowledges the frustration caregivers feel when family members relapse after multiple rehab attempts: “I’ve had families who have paid for loved ones to go multiple times into addiction programs, and they go in, and they come out and they go back to the drugs. It happens in the best of families.” That’s why Wilson says that caregivers must acknowledge that they cannot control the behavior, but offer safe, supportive environments and unconditional love.

Safer places to heal: For some individuals with substance use challenges, safe housing or specialized facilities can be a lifeline. Wilson highlights assisted living communities and programs designed to accommodate residents with addiction, often enforcing strict rules to limit access to alcohol or drugs, providing structured routines and offering staff trained to spot early signs of relapse. While these measures cannot fully stop substance use, they reduce risks such as alcohol-related injuries, falls or complications from conditions like dementia. For caregivers, placing a loved one in a supportive, monitored environment can provide peace of mind, prevent crises and create a setting where recovery-focused interventions, such as counseling, medical oversight or harm-reduction strategies, are more effective.

Crisis response. Emergencies can happen anytime, whether during a hospital visit, a sudden health crisis or at home. Call 911 for any medical emergency. One lifesaving tool for families concerned about opioid risk is naloxone, also known as Narcan. This medication can quickly reverse the effects of an opioid overdose, including heroin, prescription painkillers and fentanyl. It acts fast and is safe to use. “If a loved one may be at risk, having naloxone on hand can make the difference between life and death,” says Weimer. Some pharmacies provide free naloxone kits or make them available over-the-counter for purchase; ask your local pharmacist about availability and instructions.

Support for caregivers. Caregivers can take proactive steps to protect their own well-being. Howard joined a caregiver support group through Rush University, which offers monthly teleconferences and occasional lunch meetings. There are also support groups available through national programs like Al-Anon and Nar-Anon, that allow caregivers to share experiences, learn practical strategies and put relapses into perspective. “Engaging with these groups helps maintain resilience, reduce burnout and make connections with other families facing the same challenges,” says Wilson.

Caregivers can also leverage legal and community resources. Contacting Adult Protective Services, exploring Medicaid-supported treatment or housing programs can provide crucial support when complete recovery isn’t immediate. For treatment guidance and additional resources, caregivers can reach out to:

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Paul Wynn, a veteran health care writer, has spent over a decade immersed in the caregiving community , both as a family caregiver and as a journalist covering caregiving issues for national publications.