As a result of this thinking, as well as other misconceptions, what is communicated to the struggling user is often inappropriate, if not counterproductive: misguided attempts to control use or narrow goals centered around the tangible effects (legal, medical, or occupational) of drug use. "Getting my life under control by getting my drinking under control" is a potentially dangerous fallacy. What is missing is an attention to emotional changes that distort thinking, and ultimately change relationships.

Terry Gorski, in Passages Through Recovery (1989), describes a "post acute withdrawal" phase, a time of emotional and behavioral changes that lingers twelve to eighteen months into a period of abstinence. Recovery programs refer to analogous concepts - "dry drunk" periods, or "white knuckling."

Long after the last drink has been taken, recovering addicts may have problems thinking clearly, be prone to irritability and conflict, sleep restlessly, feel vulnerable and even believe that they are going crazy.

Many addicts state that a primary goal in therapy is to regain the trust of their loved ones - parents and spouses who have become indignant towards their lying, secrecy, and manipulation. But they often become frustrated because they fail to recognize that the task of regaining trust is a reciprocal one. The mental and spiritual aspects of the disease create a negative relational cycle.

The user lies, the loved one colludes with the lie. The user pretends they are clean or blames their drug use on others; the loved one agrees to believe them. The addict says "let me handle it" or "I've got it under control" as a way of avoiding scrutiny; the loved ones back off. They subscribe to the myth that the addict can and will control their use.

This denial of reality leads users back into the cycle of use, and loved ones into despair. Provocative questions to addict clients often include: "Do you trust them enough to tell them the truth?"; "Do you trust them enough to allow for their questions?"- and especially for youth - "Do you trust them (your parents) enough to accept their limit-setting, to allow them to parent, and to allow yourself to be a kid?" The purpose is to reframe the task of regaining trust for users and their families, because the greater challenge is not that of users gaining the trust of would-be helpers, but, rather, that of helpers gaining the trust of users.

The following is a summary of important messages for substance users and families:

1. Mental and behavioral effects of drug use are not confined to an intoxication syndrome.
2. Risk-taking needs to be redefined in emotional terms; the courage to be honest and accept limitations replacing the false bravery of self-destructive behavior.
3. The "they like me better when I'm high" effect: When we confuse the negative effects of intoxication with those of withdrawal, we unwittingly reinforce drug use.
4. The development of maturity is arrested by regular drug use. This statement is not a value judgement about a person's selfhood but, rather, a truth about biological development.
5. The mental and emotional fallout of addiction continues long after usage stops.
6. The trust wound between substance users and their families is a mutual one.