How to Talk to People About Their Alcohol or Drug Use

In movies and television, concerned friends and families often stage an intervention with a person who is drinking or using drugs in harmful ways. The hope is that the person, when confronted with people who love them and have their best interests in mind and heart, will make the decision on the spot to stop their use, get help in some form, and begin a new chapter of life. Many tears and hugs later, the person commits to a new way of living.

This is a bit of magical realism, a literary form that weds realistic depictions of the world and people with some magical elements. As an approach for helping someone with a substance use disorder, it may do more damage than good—especially when there are no professionals involved.

Most people know the second they walk into a space and see a certain combination of people that something is afoot and it is not going to be good. It doesn’t matter whether it is in person or a gallery of a video call. The people who are the objects of an intervention most often feel targeted or ambushed. Feeling judged, they often experience embarrassment and shame. They may feel especially vulnerable knowing that other people have been talking about them.

All of this contributes to people adopting a defensive and even defiant stance, which makes it far more difficult to hear and apprehend genuine expressions of concern from others. Those staging the intervention may also take offense or be hurt that their love and expressions of concern are not enough to effect change in someone else. The risk of hurts and harms on all sides is significant.

What are some other and more effective ways to express genuine concern to someone about their alcohol or other drug use? I first offer some suggestions for clearing a space for a productive conversation and then some open-ended questions. Framing questions well is crucial because they can be judgments in disguise. “You’re not wearing that, are you?” is a judgment in the form of a question. Those sorts of questions can drive a conversation right off a cliff.

1. Calibrate your expectations. You will not single-handedly in one conversation convert a person to a substance-free lifestyle. There may be no "eureka" moments.
2. Have a one-on-one conversation in a private setting. Staging an intervention with several people as the first move most likely will backfire.
3. Tell the person in advance or right off the bat what you want to discuss. Good friends and close family can always tell when someone is dancing around a topic.
4. Duration of quality conversation matters. Shorter is better to begin. Be prepared to back off if the dynamics are becoming adversarial, which may short-circuit the possibility of future conversations.
5. Draw from your own experience without making it be all about you. Don’t put yourself in the role of expert on someone else’s use or their life. Don’t tell someone, “You’re at rock bottom,” and avoid saying, “You should…” Make statements about your own observations; don’t engage in hearsay because that might feel like gossip.

Below are some generic questions that may serve as starting points for what may be a series of difficult conversations. A good question is one that is not easily and quickly answered in several words. Rather, it opens up the space for walking around and exploring a topic.

• What was your first experience of drinking or using? How did it make you feel and did you like it?
• Do you get pleasure from alcohol or drugs that is different from other pleasures?
• How do you see yourself and where does your alcohol or drug use fit into this picture?
• What are your hopes for your life? Do alcohol and drugs help you to realize them? If your hopes and dreams for life have faded, has your use played any part in that?
• Do you think people expect you to be certain ways and how does your alcohol or drug use intersect with those expectations?
• Do many people around you drink and use drugs so that you feel a certain pressure to join even if you really don’t want to do so?
• In U.S. culture, drug and alcohol use is equated with fun, happiness, success, glamour, etc. Does that seem true for you?
• Are you worried about your own alcohol or drug use?
• Are there things you need but are not getting? These may be of many sorts. Do alcohol or drugs help to meet those needs?
• Are there any downsides/bad consequences to your drinking or using drugs? Consequences can be physical and emotional.
• How do you feel when you are not drinking or using? Do you feel more like yourself? Less like yourself? And what is that self like? Do you like yourself?
• Do you ever lie about your use, use it secretly in private, or feel guilty about your use?
• Do you know people care about you and that you always have standing with them?
• Do you ever feel like you need alcohol or drugs rather than want them?
• Do you see changes in your own behaviors over time? If you do, what were some of the pivotal moments?
• Could anything else play the same role as alcohol or drugs in your life?

This is a partial list of questions to begin a dialogue. The manner in which questions are asked matters enormously. A series of them asked in a rapid-fire way may feel like an interrogation, which will only make a person defensive. Be patient and listen. Listen not just to what is said but what is left unsaid. Ask if you can have a further conversation. Extend an invitation for the person to reach out to you.

Facebook/LinkedIn image: fizkes/Shutterstock