HELPING SOMEONE WITH SUBSTANCE USE DISORDER
American Addiction Centers (AAC) recognizes that Substance Use Disorder — whether involving alcohol, prescription drugs, illicit drugs, or over-the-counter drugs — is a disease. Understanding this disease is your first step towards helping your loved on our yourself.
Substance Use & the Brain
Just like diabetes, heart disease, and other chronic conditions, addiction is an illness that requires treatment. According to the American Society of Addiction Medicine (ASAM), “addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry.”
Multiple areas of the brain are involved in the neurobiology of addiction. Addiction especially impacts the neurotransmission, how parts of the brain “talk” to one another, and the function of the brain’s reward system, also known as the mesolimbic dopamine pathway.
The effects of Substance Use Disorder on family and friends
Witnessing someone you care about battle a substance use disorder can be extremely distressing and take a heavy toll on your own mental and emotional well-being. Whether the drug abuser is a close friend, spouse, parent, child, or another family member, it’s easy for their addiction to take over your life. It can pile stress upon stress, test your patience, strain your bank balance, and leave you racked by feelings of guilt, shame, anger, fear, frustration, and sadness.
You may worry about where your loved one is at any given time, their risk of overdose, or the damage they’re doing to their health, future, and home life. You may be in debt from paying their living expenses, the cost of legal troubles resulting from their drug abuse, or from failed attempts at rehab and recovery. You may also be worn down by covering for your loved one at home or work, having to shoulder the responsibilities they neglect or being unable to devote more time to other family, friends, and interests in your life. As despairing as you may feel, you’re not alone in your struggle.
Whether the problem is with recreational drugs or prescription medications, drug abuse and addiction can affect people from all walks of life, wrecking families, tearing relationships apart, and destroying lives. But there is help available. While you can’t force someone to tackle their addiction, your love, support, and patience can play a vital part in their recovery. With these guidelines, you can learn to support your loved one’s efforts, set the necessary boundaries to preserve your own health and welfare, and find some stability for both yourself and your loved one.
Understanding your loved one’s substance abuse
People start using drugs for a lot of different reasons. Many turn to substances to cope with the emotional pain of a mental health problem, such as depression, anxiety, or PTSD. Known as self-medicating, some people may be aware they have a mental health issue but are unable to find healthier ways of coping, while others remain undiagnosed and use drugs to manage specific symptoms.
Other people turn to drugs to change how they feel, to fit in, or to alleviate boredom or dissatisfaction with their lives. Then there are those whose substance abuse develops from a doctor’s well-intentioned efforts to treat a medical condition. Of all the people prescribed opioids to relieve pain, for example, estimates suggest that more than a quarter will end up misusing the drug.
Whatever your loved one’s reason for starting, though, not everyone who uses drugs develops a problem. While the exact causes of addiction aren’t clear, genetics likely plays a role, along with environmental factors. While one person is able to use substances without detrimental effects, another finds even casual use quickly escalates into compulsion and addiction—a very dark hole from which they can feel powerless to emerge.
Recognizing drug abuse in a loved one
It’s not always easy to recognize if a loved one is abusing drugs. In teens, for example, drug abuse can often resemble normal adolescent moodiness. Furthermore, there’s no specific amount or frequency of use that indicates someone’s drug use has become a cause for concern. Whether your loved one is using every day or every month, it’s the adverse impact their drug abuse has on their life that indicates a problem.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), symptoms of a substance use disorder may include:
A desire or unsuccessful attempts to control, decrease, or stop substance use.
Continued substance use despite the problems it causes.
Cravings to use the substance.
Excessive time spent obtaining, using, or recovering from a substance.
Often use substance more than intended.
Ongoing need to increase use to achieve same effect.
Recurrent use of substance in risky situations.
Relationships negatively impacted by substance use.
Stopping or decreasing important activities because of the substance.
Substance interferes with fulfilling obligations.
Withdrawal symptoms if substance use is stopped.
How to talk to someone about their drug abuse
Starting a conversation with someone about their drug addiction is never easy, but it’s important you come from a place of compassion and understanding. Remember, no one sets out to become an addict. Drug abuse is often a misguided attempt to cope with painful issues or mental health problems. Stress tends to fuel addictive behavior, so criticizing, demeaning, or shaming them will only push your loved one away and may even encourage them to seek further comfort in substance abuse.
Discovering someone you love has a drug problem can generate feelings of shock, fear, and anger, especially if it’s your child or teen who’s using. These strong emotions can make communicating with a drug user even more challenging. So, it’s important to choose a time when you’re both calm, sober, and free of distractions to talk. Offer your help and support without being judgmental.
Don’t delay. You don’t have to wait for your loved one to hit rock bottom—to get arrested, lose their job, suffer a medical emergency, or publicly humiliate themselves—to speak out. The earlier an addiction is treated, the better.
Express your concerns honestly. Emphasize that you care for the person and are worried about their well-being. Offer specific examples of your loved one’s drug-related behavior that has made you concerned—and be honest about your own feelings.
Listen. Even when you don’t agree with the person, take the time to listen to what they have to say, without trying to argue or contradict them. The more your loved one feels heard, the more they’ll see you as supportive, someone they can confide in.
Offer them information about how they can address their drug problem—whether that’s calling a helpline, talking to a doctor or counselor, entering a treatment program, or going to a group meeting such as SMART Recovery, or a 12-step program like Narcotics Anonymous (NA).
Be prepared for denial. Your loved one may become defensive or angry and refuse to discuss their drug use. Many people feel a sense of shame when confronted by their behavior and will try to deny they have a problem. Don’t argue with them, just revisit the issue another time.
Avoid trying to lecture, threaten, bribe, or punish the person. Getting angry or making emotional appeals will likely only add to the user’s feelings of guilt and reinforce their compulsion to use.
Don’t expect a single conversation to fix the problem. This will likely be the first of many conversations you’ll need to have regarding your loved one’s drug use. There’s no quick fix to overcoming addiction. It may take several conversations for them to even acknowledge they have a problem, the first step on the road to recovery.
Staging an intervention
Staging an intervention tends to be a last-ditch effort to make someone realize they need treatment. However, many addicts can react angrily when confronted by a group or feel their loved ones are ganging up on them.
If you decide to stage a family meeting or intervention, it’s important everyone involved comes from the same place of compassion and understanding. This is not an excuse for people to vent their grievances about the addict’s behavior or make them feel bullied or ashamed. The problem is the disease of addiction, not the person in its grip.
Supporting a loved one’s addiction recovery
There’s no one-size-fits-all solution to overcoming an addiction to drugs, and it’s rarely a process that’s quick or straightforward. While you can support your loved one and encourage treatment, you can’t force them to change or control their decision-making. Letting your loved one assume responsibility for their behavior and choices is an important step on their road to sobriety.
Adjust your expectations. Everyone is different. Recovery for one person may mean total abstinence from drugs. For another, it could mean cutting back or staying mostly drug-free. Being too rigid in your expectations can lead to disappointment and a sense of failure, even if your loved one finds stability in their life again.
Encourage your loved one to seek help. While some people are able to quit drugs on their own, the more help and support a person has, the better their chances of success. Offer to sit with your loved one while they call a helpline or accompany them to a doctor’s appointment, counseling session, or peer support group meeting.
Ensure they address any co-occurring issues. The problems that triggered your loved one’s drug use in the first place will still be there once they get sober. If they turned to drugs to self-medicate a mental health problem such as anxiety or depression, they’ll need to find healthier ways of coping with these issues without resorting to substance abuse. To achieve long-term recovery, it’s vital they tackle both their addiction and their mental health issue at the same time.
Help plan for triggers and cravings. Your loved one will need to find ways to cope with drug cravings and triggers. You can help distract them with other activities or encourage them to learn how to ride out the urge, but ultimately, they have to be responsible for their own sobriety.
Encourage them to explore new interests. Quitting drugs can leave your loved one with a lot of extra time to fill. To help them avoid slipping back into old habits, encourage them to develop new interests—ones that don’t involve drugs but do add meaning to their life. Think volunteering, taking up a new sport or hobby, enrolling in a class, or spending time in nature hiking or camping, for example—anything that doesn’t generate a trigger to use.
Accept the likelihood of relapse. Despite your efforts and your loved one’s best intentions, the truth is that recovery often involves relapse. If that happens, encourage the person to recommit to getting clean and support them as they try again. Try to stay patient. Each relapse is an opportunity for your loved one to learn from their mistakes and find a new way forward.
Setting healthy boundaries
When someone you love has a substance use disorder, it’s easy to fall into the trap of shielding them from the consequences of their addiction. Referred to as “enabling”, you may cover up for the person, take over their responsibilities, put their feelings before your own or other family members’, rearrange your life to accommodate their addiction, or provide financial assistance when they’re unable to pay bills or get into legal trouble because of their drug use.
While it may seem that you’re being supportive, enabling your loved one will only help maintain their addiction—and damage your own health and well-being along the way. Of course, it can be extremely hard to say “no” to someone you love, especially if it’s your child, but protecting the person from the consequences of their drug abuse often means you’re removing the motivation for them to seek help and change.
To better help someone with a substance use addiction, it’s often necessary to hold them accountable for their actions by establishing limits or boundaries for what is and isn’t acceptable behavior. Without boundaries, your loved one never has to face the consequences of their actions—and you’ll eventually feel burned out from all the attempts to cover up, excuse, or compensate for their behavior.
Establishing boundaries for a loved one abusing drugs could include:
Not allowing drug use, drug paraphernalia, or other drug users in the home.
Not covering up for them if they miss work or school, not lying to get them out of trouble, or not taking over any responsibilities they’ve neglected.
Requiring they pay their share of rent and other bills on time.
Refusing to give them money to pay off debts or cover legal expenses if they’re arrested.
Insisting that they always treat you with respect, even when high.
How to set boundaries—and stick to them
Talk to your loved one about boundaries at a time when you’re both calm and not under the influence of drugs. Clearly outline what behavior you will and will not tolerate and what the consequences will be if they break your rules.
Follow through. It’s almost inevitable that someone with an addiction will test any limits you set, so be prepared to follow through. If you don’t enforce the consequences you’ve outlined, your loved one will know the boundaries are worthless and their destructive behavior will continue.
Remind yourself why you’re doing this. No one wants to see someone they care about suffer, but a meaningful, respectful relationship cannot exist without boundaries. Having to face the negative consequences of their behavior could be the impetus your loved one needs to get clean.
Establishing financial boundaries
In addition to the heavy emotional costs, money problems can also mount for families of drug abusers. Heavy drug use can be expensive, as can the cost of rehab and resolving legal problems stemming from your loved one’s drug dependency. It’s not uncommon for spouses to lose their homes bankrolling their loved one’s addiction, parents to empty their retirement accounts bailing their child out of debt, or for other family members to max out their credit cards paying for costly rehab programs.
That doesn’t make cutting off your loved one any easier. When setting financial boundaries, it’s important to consider how far you’re willing go. For example, are you willing to see your loved one spend time in jail instead of covering their legal fees? Are you willing to see them evicted or living on the street instead of paying their living expenses?
While setting boundaries won’t cure your loved one of their drug addiction or guarantee they seek help, neither will spending money. If your loved one chooses not to address their addiction, it won’t matter how much money you spend trying to change that. Ultimately, all you can control is how well you look after your own health and welfare.
Taking care of yourself
Your loved one’s recovery from substance use disorder can be a long process and the negative impact on your own health, outlook, and well-being can multiply over time. It’s important you maintain a balance in your life to avoid burnout from all the stress and frustration that comes from helping someone get clean.
Find support. Expressing what you’re going through can be very cathartic, so look for support from trusted friends and family, or a peer support group for family members of drug addicts. Talking to others who are facing similar challenges can help you find comfort, reassurance, and new ways of coping.
Manage stress. The stress of witnessing someone you love battle addiction can take a heavy toll. You can reduce your stress levels by eating right, exercising regularly, sleeping well, and practicing relaxation techniques. Since stress levels can escalate when quitting drugs, you can even encourage your loved one to do the same.
Practice acceptance. At some point, you’ve probably asked yourself “Why me?” or even blamed yourself for your loved one’s struggle with addiction. But dwelling on circumstances outside your control will only sap your energy and damage your mood. Instead of searching for someone to blame or asking questions with no easy answers, learning to accept the things you can’t change can help you focus on the things that you do have control over.
Maintain other interests and relationships. It’s easy for your loved one’s battle with addiction to become all-consuming. But you’ll find it easier to cope with a difficult situation when other areas of your life are rewarding. Set aside time in your day to pursue activities and relationships that bring you joy—and try to keep up with work, hobbies, and social plans.