The First 72 Hours: a family's checklist after an addiction crisis

1. Safety first

Before any conversation about feelings, blame, or treatment, make sure everyone is alive and out of immediate danger. That's the whole job for the first hours.

• If you can't wake them, treat it as an overdose.

  Call 911 first, give naloxone (Narcan) if you have it, and stay with them. Don't try to figure out what they took; that's the paramedics' job. From the overdose safety plan every family needs.

• Know the danger signs. "Sleeping it off" is not a plan.

  No response to a loud voice or a hard rub on the breastbone, slow or stopped breathing, blue or gray lips, a gurgling or snoring sound, vomiting while barely conscious, or a seizure: call 911. If they're unsteady but awake, keep them on their side and don't leave them alone. See what to do after a drinking episode.

• Let the ambulance come, even if they wake up furious.

  Naloxone wears off in 30 to 90 minutes, sometimes before the drugs do, so someone can slip back into an overdose after seeming fine. Let them be angry and alive.

• If anyone is threatened, or someone talks about suicide, call now.

  Call 911 for immediate danger, or call or text 988 for a suicide or mental health crisis. Get yourself and the kids somewhere safe. When violence or suicide is part of the picture, boundaries need to be planned with professional guidance (enabling vs supporting).

• Put naloxone where anyone in the house can reach it.

  At least two doses, not in a locked drawer, and everyone (teenagers included) knows where it is. It's sold over the counter, and it won't hurt someone who isn't overdosing. That's not enabling; it's a seatbelt.

• Don't make permanent decisions in a temporary crisis.

  No life-altering ultimatums, no packing bags at midnight. Get through the night, then think. From what to do in the first 24 hours after a relapse.

2. The first conversation

You don't need a perfect speech. You need one calm person, a few true sentences, and the discipline to stop talking.

• Wait until they're stable and coherent, not perfectly clear-headed.

  Not while they're intoxicated and not at 2 a.m., but don't wait for ideal conditions either. Usually that's within a day or two. A shaky, scared yes is still a yes.

• Decide who talks: one person, not a committee.

  The person with the least history of arguing with them is usually the right choice. From the 72 hours after the crisis.

• Say three things: what you saw, how it affected you, what you're going to do.

  "Last night you drove home after drinking. I was scared, and the kids saw it. I'm not covering for this anymore. I'm calling someone this week." The last sentence is about what you'll do, not what you demand.

• If there's a plan ready, keep it to eleven words.

  "I love you. There's a bed. I'll drive you right now." Make yes the easiest available option.

• Separate the person from the behavior.

  "I'm not done with you. I am done watching this run your life." Name it plainly, once, and then go to the next small step: "What's the one call you can make today?"

3. What not to do

Most of these feel like love in the moment. They close the door anyway.

• Don't recite the history.

  "This is the fourth time..." is true, and useless right now. Long speeches give people time to argue.

• Don't ask them to explain what happened.

  They don't know, and the question triggers defense.

• Don't negotiate a smaller version.

  "Maybe just outpatient" almost always becomes nothing.

• Don't clean up the mess.

  Calling the boss, paying for the tow, apologizing to the neighbors, telling the kids "Dad's just tired." Safety cleanup is different; the rest protects the addiction. Pick one and don't do it this time.

• Don't reach for shame.

  "I knew this would happen" echoes the voice in their head that says they'll never make it. You may feel it. Try not to say it. Accountability says "you can do the next thing better"; shame says "you are this."

• Don't mistake the calm for progress.

  Within a few days the fear fades, shame comes back, and the story becomes "a bad night, won't happen again." The calm after a crisis is the pause before the next one.

4. Gather information

Every one of these can happen while your loved one is still asleep, still in a holding cell, still on a monitor. You're not waiting on them. You're building the ramp.

• Write down what happened, with dates, while it's fresh.

  A few plain sentences: what you saw, what it cost, how it affected you. Memory bends toward hope, and addiction bends the truth. See why documenting a loved one's addiction matters.

• List what they use, their prescriptions, and their medical history.

  Include prior treatment and any withdrawal history. Alcohol and benzodiazepine withdrawal can be medically dangerous, and paramedics and treatment centers will ask.

• Get the money question answered.

  What insurance covers, what the deposit is, and what you're already paying every month (rent, phone, car, legal fees). Real numbers, not guesses.

• Find out what the bed situation is today, not next week.

  Ask about immediate admission, detox availability, and whether they'll take a direct transfer from the hospital or jail.

• Solve the logistics they'll use as excuses.

  The dog. The job. The car in the impound lot. The phone. Write them down and start solving them now.

• If they're in jail, use the time.

  Talk to their attorney about treatment as part of the outcome, find a facility that accepts a direct release, and get the plan in writing.

5. Line up support

You were never meant to carry this alone, and you can't be the calm person in the hallway on fumes.

• Call a professional before you call a family meeting.

  An interventionist or admissions team can tell you in ten minutes what options exist for your situation. The first call is a conversation, not a contract (the phone call you keep not making).

• Tell at least one person who can actually help.

  Another family member, a trusted friend, or a professional. Secrecy protects the addiction, not the family.

• Talk to the kids, honestly and simply.

  "Mom drank too much last night. It's not your fault, and you're safe." Kids can handle the truth. What hurts them is everyone pretending.

• Get support for yourself.

  Al-Anon, a therapist, or a family call like The Family Squares, a free Zoom every Monday night. You don't need the whole family on board to start (here's why).

6. Plan the next 72 hours

The families who use a window well had usually gotten ready before it showed up. If you're past the window, this is how you get ready for the next one.