How to Help Someone Who Is Addicted

Social drinking can easily slide into problem drinking without fanfare, but there are signs that should raise red flags. Obviously, frequently appearing intoxicated should set off alarms. Drinking that starts early in the day or before social functions is a warning sign, as is hiding one’s drinking. Failing to meet obligations or sleeping through appointments is another serious sign, and such lapses may have repercussions such as problems at work or school. Alcohol use disorder also frequently manifests in problems of remembering or thinking. Questions about drinking may be met with anger, defensiveness, or denial.

Many teens experiment with alcohol. The vast majority of them do not become addicted. The Substance Abuse and Mental Health Services Administration (SAMHSA) describes a number of signs suggesting a child is abusing alcohol. They include:

• Mood changes including flare-ups of temper, irritability, and defensiveness
• School problems such as poor attendance, a significant drop in grades, disciplinary action
• Rebellion against family rules
• Changes in friendship patterns— switching friends, reluctance to bring new friends home
• A change in appearance, lack of involvement in former interests
• Alcohol presence: finding it in your child’s room or backpack or smelling alcohol on his or her breath
• Cognitive problems such as memory lapses and poor concentration
• Physical changes such as bloodshot eyes, constricted or dilated pupils, lack of coordination, or slurred speech.

Drug use becomes a problem when a person can no longer control use and the use interferes with functioning. Use is marked by shifts in behavior than can vary widely among individuals. Acute intoxication—slurred, slowed, or disjointed speech; perceptual disturbances; sudden mood shifts; disrupted thinking patterns; an “absent presence”—can be obvious. But other signs can be more subtle and develop over time. They include:

• Disinterest or difficulties in school or declining performance at work

• Changes in social patterns, sets of friends, or the onset of interpersonal problems

• Withdrawal from activities once enjoyed

• Secretiveness about activities and relationships

• Loss of energy or motivation

• Neglect of physical appearance and hygiene

• Lying about whereabouts

• Personality changes such as unpredictable displays of hostility, suspicion, or irritability, or rapid mood swings

• Stealing money or valuables to pay for drugs

• Becoming defensive or lashing out when questioned about drug use.

It is difficult for those addicted to see beyond the craving and momentary pleasures, to envision functioning without their drug, yet important for their future to have a powerful positive incentive to do so. Lectures and confrontational techniques are usually ineffective and often damage relationships that could be levers of change. What’s needed is an approach that is more collaborative than confrontational—reaching toward a goal everyone can be happy with.

Having a calm, respectful conversation about concerns—while setting boundaries about substance use, such as no alcohol or drugs are allowed in the house, not being allowed in the house when intoxicated——demonstrates caring. And such discussions could borrow the insights of motivational interviewing, a conversational technique that counselors use to help a person find and bolster their internal motivation to give up drug use and act on their deepest values and dreams for themselves. Easily adapted for everyday use, it’s an approach that respects a person’s struggles while inspiring them to make a change.

A noticeable drop in job performance. Long disappearances. Erratic behavior. Absences. Excuses. Disorganization. Frequent errors. These are signs that a colleague or supervisor might be using alcohol or drugs. Many opt to keep their concerns about a colleague quiet, lest the person lose his or her job. A better option is to have a talk with the coworker privately—but only if you keep the tone supportive and not at all confrontational. It should convey concern and the desire to help, while noting the changes in job performance. Be prepared, though, for the possibility that your colleague will dismiss your concern. Still, it’s important to let the person know you are receptive to talking any time.

The best option, however, depending on the industry and the size of the company, is to document the problematic behavior and bring the evidence to the attention of both your supervisor and the human resources department. Many companies have programs specifically designed to help such employees while protecting their job.

It’s important to remember that no one expects to get addicted. Forcing someone to admit to a problem is not the wisest way to encourage someone to stop using the problematic substance or behavior. Confrontation generally leads to defensiveness and denial. Instead, the goal is to quietly remove the many psychological barriers that keep a person from taking steps to overcome addiction. And then to help them find their own motivation to change.

A good start is to understand how addiction works, and that should encourage anyone to develop and display compassion for the loved one trapped in substance abuse. That approach acknowledges the loved one’s suffering, conveys caring and love and reduces the person’s shame—both lessening the need for denial and removing major obstacles to seeking treatment. A next step is to open the door to a calm, respectful conversation about your concerns and your loved one’s deep values and goals in life.

Of course, you have to find the right moment for the conversation, and it is definitely not when your loved one is high or hung over. Confine your concerns to what is observable—“You haven’t slept in days.” “You don’t answer calls from friends.” “You haven’t shown up at practice.” One conversation is not likely to turn things around, but that doesn’t mean it isn’t having an effect. Whatever you say, never call someone an “alcoholic” or addict.” It’s not just a stigmatizing put-down, it actually limits how people can see themselves. It conveys the expectation that they can never change. And makes people feel helpless.

The best time to help someone you love seek treatment is the moment you notice the person is having trouble controlling substance use. While treatment is possible at every stage of addiction severity and it is never easy, early action is the wisest course and spares everyone the significant harm, distress and disruption that may develop otherwise. There is a myth that people have to hit rock bottom—when their health, their livelihood, their relationships are destroyed—before they develop the motivation to change.

For most people, long before that, addiction becomes a trap that no longer provides the rewards it once did, and they are stuck in place, craving the very thing that tightens the trap. The fact is, people can be responsive to change if approached in an understanding and respectful way by concerned loved ones.

Experts agree that two of the most important tools for helping a loved one with an addiction problem are compassion and understanding that the very essence of addiction is increasingly dysregulated control over one’s behavior. Compassion acknowledges a person’s pain and conveys caring and love; it reduces the person’s shame, which removes a major obstacle to seeking help.

Armed with compassion, it is possible to hold a calm, respectful conversation with your loved one about your concerns. The same conversation can awaken or fortify the motivation for change by asking your loved one about his or her deepest values and dreams for life. It will likely take many more than one conversation. But that doesn’t mean the message is lost.

Another important tool is education about treatment possibilities. There are many routes to recovery, many types of treatment programs in many types of settings, and a discussion of recovery options can help your loved one find a pathway that is most in keeping with personal needs and goals.

Informing yourself about the array of treatment possibilities can be extremely useful in helping a loved one decide on an appropriate course of action when the desire for change arises or the need for help in putting a life back together is acknowledged. Residential, inpatient treatment programs—what’s known as “rehab”—are in the news when a celebrity has an addiction problem, but they are by no means the only form of treatment.

People embark on the road to recovery from addiction every day. Only a small proportion of people—from 5 to 10 percent—do it with the help of any type of clinical service or facility. Many people choose to free themselves of addiction through the support of peers, in self-help or mutual support groups. Many people choose to do it on their own. Just as there is no one pathway into addiction, there is no one pathway out of it.

If ultimatums—“Stop the drinking or I’m leaving and taking the kids.” “Straighten out or you’re fired.”—were all it took to get a person to stop harmful substance use, and they worked every time, this question would never arise. Ultimatums are not only alienating, they are no match for drug craving, an immediate, powerful force to continue use. Most often they are heard as hollow threats spoken in momentary anger, an expression of frustration.

Yet, if delivered in a calm, meaningful, and respectful way, they can spur change; the possibility of loss of a valuable relationship often does lead a person to embark on recovery. Studies show that many individuals entering addiction treatment programs have received an ultimatum stemming from either employment, legal, medical, or family sources. More men (and younger people of both sexes) act on ultimatums from a family member. Women (and older people) often act on a medical ultimatum.

The short answer to the dilemma of what to do when a person refuses to get help for an addiction problem is, never give up hope. Periodically, convey your concerns in a kind and respectful conversation and encourage your loved one to get help. Remember, however, that change is a long-term process, much of it occurring internally, and it can take time for the motivation for change to build to the point of taking noticeable action.

In the meantime, establish boundaries of acceptable behavior and consequences of unacceptable behavior inside the family. Educate yourself about addiction, how it changes people, and what treatment possibilities exist. And take care of yourself. Therapy for yourself can not only keep you sane and available to everyone else in the family but also provide guidance for helping your loved one.

It is a myth that the desperation of hitting rock bottom is the only way to get people to accept the need for change—or believe that they can. Too often, rock bottom is a point at which irreversible damage has occurred—careers, livelihoods, relationships derailed. The problem is that the myth of rock bottom sees people as hopeless, and seeing people as hopeless makes them feel hopeless about themselves. Addiction is not easy to overcome, but the first step on the road to recovery is awareness that it is a possibility.

Too often, efforts to help one troubled member of the family consume all the oxygen in the home. It’s challenging—but necessary for everyone’s well-being—to maintain family functions and routines as much as possible. It can also be helpful to explain to others in the household, in an age-appropriate way not overloaded with detail, that Dad or Sis is struggling with a problem.

It is always necessary in families to set boundaries, ground rules of behavior. But it is especially necessary in the case of addiction, both to preserve the continued development of the rest of the family and to let the struggling person know what is acceptable and what is not. Such expectations also let the loved one know they are welcome when standards are met.

Boundaries can be agreed upon in a conversation with the addicted loved one. They commonly include such rules as:

• No alcohol and other drugs allowed in the house

• Not allowed in the house when intoxicated

• No alcohol or other drug-using friends allowed in the house

• No personal communication when intoxicated (i.e., no calls, texts, etc.)

• No asking to borrow things (e.g. money, car, cell phone, etc.).