How to Talk with Someone About Getting Help with Addiction

If you’re concerned about someone’s drinking, use of drugs, spending, gambling and other behaviors that might qualify as addiction – using or doing that continues despite negative consequences – and want to talk with them about it, here’s a suggested to-do list based on my personal and professional knowledge and experience.

Truly inform yourself about addiction. What most people think they know about addiction is belief-based, not evidence-based. My suggestion is to start with information from NIDA, a division of the National Institute of Health. NIDA’s publications on the science of addiction meet these rigorous standards. If other sources you read don’t link to sources that also use these standards, I suggest distrusting them. What works and didn’t work for one person cannot be generalized as applicable to your person.

Helping requires negotiationSeparate the condition from the person. Addiction is identifiable at the molecular level as a brain abnormality. While the first drink or drug or action or subsequent ones may have been the person’s “fault,” once addiction occurs, brain changes can impair the person’s ability to use judgment, make decisions, and choose based on criteria – whether good or bad. The abilities to make plans and to follow through with them are impaired. The ability to learn from the error of one’s ways, to learn from punishment or reward, to be shown a fork in the road and implored to take this path or that path and to decide which is the most helpful – all impaired. The person looks like the person we know, but the brain no longer works the way it used to. Addiction presents a horrifying double bind. The individual’s very skills and abilities that help make them who they are – and are needed to stop doing something – are the very ones that are impaired.

“People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.”
– Nora D. Volkow, M.D, Director of the National Institute on Drug Abuse (NIDA), quoted in What We Take for Granted

Know what you’re asking the person to do without. People with addictions describe the experience of using or doing as a feeling of love, a sense of belonging, bliss, meeting an unmet need, oblivion, sacred space, the only way to be pain-free, relax, sleep, be around others, and many others. Many people with addictions have anxiety, depression and other mental health challenges, trauma symptoms, issues of temperament, physical pain, and debilitating sleep disturbances for which drinking, using or doing provides the only relief.  Pause to reflect deeply on what purposes you think using or doing serves in the person’s life. Suspend judgment. Imagine you are the person and use this simple cost-benefit analysis tool from SMART Recovery to get a sense of what it might be like for the person to give up drinking, using or doing. To deepen your insights, put the items you’ve listed, regardless of the section, in rank order.

Know what you’re offering as a replacement. When people with addiction stop drinking, using drugs, or engaging in an activity, many are thrown into an acute state experienced as mind-breaking, spirit-shattering, life-threatening distress. And, for many, for the rest of their lives, they have to do without something that met needs that nothing else can meet. Based on your best judgment of what needs the person has that are met by their use of alcohol, drugs, or activities, what is your plan to get their needs met if the substance or activity is removed?

Specifically, what’s your short-term plan to help the person deal with acute suffering? (This guide to getting health care for addictions may be helpful.) What’s your long-term plan to help the person handle the on-going whine of distress that could spike at any time? Relapse relates for alcoholism, for example, don’t drop significantly for 5 years. “Just stop” is not a plan. The person has tried that plan more times than you can ever know. Drinking, using and doing again, when a person is experiencing what feels unbearable, is not weakness, but mercy.

Your plan will depend upon your locale’s resources. Feel free to use this guide to getting help with addictions in the Blacksburg, Virginia area to customize your own plan. (If the person has an opioid addiction, more specifics are at the end of that guide, and here and here and here for myths about heroin.)

Ask: “What do you think would be helpful?” Once you understand that addiction is medical, not personal, i.e. neither about the person nor about you, and you’re savvy about your locale’s addictions treatment resources, you know what’s on offer. With goodwill, good intentions, a clear mind and calm heart, you can essentially enter a business negotiation. You want the person to buy some combination of addictions treatment products and services but which ones match this person’s needs and preferences? You have to ask to find out. Then you’ll have to discover whether or not what you’re offering is perceived as valuable enough for an exchange.

What we know isn’t helpful and we know doesn’t work: negative consequences.

Persistence in spite of negative consequences defines addiction. Therefore, negative consequences don’t arrest or cure addiction. Emotional punishment such as shouting or the silent treatment are akin to psychological abuse and are destructive to you and to your person. Physical punishment – including getting locked up in rehab or jail – can traumatize the person, which is already a pre-existing condition for many people with addictions.

Plan for yes. Plan for no. If the person says they want help, you better be able to act on that immediately, i.e. put them in the car and start driving. If you don’t know your locale’s resources and you don’t have things lined up, you’re going to put that person in a world of hurt. Any delays decrease chances for engagement in treatment. They’ll very likely have to return to what they were doing and their trust in you will be harmed. If the person doesn’t want help, this will require a terrible judgment call on your part. It’s time to use the cost-benefit analysis tool on your own dilemma. Just replace “using/doing” with “helping,” be sure to rank order what you list, and see what comes up for you.

“Love, evidence & respect.”
Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

Acknowledge the complexity of the situation. People with addiction continue to do what they do for reasons that make sense to them – even with impaired cognitive functioning –  and, with a little imagination and empathy, we can make sense of those reasons. Given that people with addictions, depending upon the substance or activity, may or may not experience dependence, given that addiction is classified as a brain disease, and given that the brain’s executive functioning is impaired by addiction, well, who would know how to talk with someone about addiction or would know what to say? By what criteria would we measure rightness or wrongness of a layperson’s – even a professional’s – attempt to broach the subject? For both parties, it’s a wicked, wicked problem.

When attempting to help people with addictions, I use the words of Maia Szalavitz for guidance – sometimes as prayer: “Love, evidence & respect.”

Photo by Zane Queijo

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