Substance-use disorder is one of the most widespread afflictions in the United States, with an estimated 49 million Americans battling addiction to drugs or alcohol. Yet the subject remains rife with shame and stigma as well as with conflicting narratives around how to think and talk about it, let alone how to treat it. So while most of us know someone struggling with addiction, we may have no idea how to effectively address it.
This was the case for Laurie Healy.
Healy’s brother Brian struggled with alcohol and opioid addiction for decades. She tried to be supportive but was unsure about how much to get involved. Like many of us, she’d absorbed cultural narratives around “tough love” and letting people “hit rock bottom,” and she wondered whether too much compassion might be the wrong approach.
Although she never stopped caring about Brian, Healy maintained some distance from her brother — and from the rest of her family too. “We were all very siloed,” she reflects. “We never collectively acknowledged what a toll his addiction was taking on us.”
Then Brian died by accidental overdose in 2017. It was devastating, of course, but Healy found that learning about addiction helped her process the grief. It also showed her that she wasn’t alone in feeling confused and overwhelmed. With so many addiction treatment programs and protocols and surprisingly few spaces for loved ones to find their own support, it was no wonder Healy and her family struggled to navigate the experience.
Inspired to provide others with the guidance she never had, Healy became a certified peer recovery specialist and ARISE interventionist, and she established a consulting company offering recovery coaching and education to families affected by addiction.
She’s also now the family recovery director of a women’s recovery residence, The Lion House Brownstone, in St. Paul, Minn. “The biggest reason I do this work is to help families overcome the shame and stigma my own family struggled with for years,” she says. “There is a better way, and that path includes love, compassion, and understanding.”
“There is a better way, and that path includes love, compassion, and understanding.”
Healy is certified in the Community Reinforcement and Family Training (CRAFT) approach, which promotes healthy communication and positive reinforcement as an alternative to distancing from a loved one struggling with substance use.
If you’re unsure how to support someone struggling with addiction, consider the following suggestions, which incorporate core CRAFT principles, Healy’s experience, and the latest research on effective substance-use treatment and recovery.
Know Your Involvement Matters
Family and friends can have an enormous impact on the recovery process, in part because the majority of individuals who struggle with substance use never undergo formal treatment.
“That means families are the first responders,” Healy explains.
This is especially true when the person is under the age of 18 — but it can be more difficult when the person suffering from addiction is an adult.
Those closest to someone with a substance-use issue are not only more likely to notice what’s happening, but they may be the best equipped to provide the encouragement and motivation that ultimately spur change: A study published in the Journal of Research in Health Sciences found that family factors are a common motivation for individuals seeking treatment.
Don’t Wait to Intervene
The long-held axiom “wait until they hit rock bottom” is ineffective — and it can be downright dangerous.
Early intervention reduces the likelihood of severe or permanent damage to health, finances, and relationships. It also increases the likelihood of change: Substance-use problems are likely more treatable when addressed before they get too serious.
The long-held axiom “wait until they hit rock bottom” is ineffective — and it can be downright dangerous.
Early intervention can take many forms, from an honest conversation to formal chemical-dependency treatment. Discerning what intervention is most appropriate can be tricky: If the person struggling with addiction is an adult, their loved ones may have to accept the limits of their influence while weighing the risk of harm against the risk of driving the individual further away.
Early intervention can also save lives, especially given the risk of overdose inherent in drugs like fentanyl. As Healy puts it, “‘Rock bottom’ can be death.”
Kindness Trumps Tough Love
It’s normal to feel hurt by and angry with someone battling addiction, as well as to feel a wider range of emotions, including sadness, worry, compassion, and fear. It can be tempting to berate, belittle, or draw a hard line — especially if you aren’t tending to your own needs (more on this later).
But here’s the thing: People generally don’t like being told what to do, yelled at, insulted, or threatened. Such approaches tend to breed animosity more than change. So as hard as it may be at times, try to take a deep breath, lower your voice, and truly listen. Ask questions (“How did you feel about what happened last night?”), validate emotions (“I hear you that anxiety can be overwhelming sometimes”), and focus on exploring options rather than making demands. (When we pay attention to the words we use and the way we use them, we improve the odds of strengthening and deepening our relationships. See “Compassionate Communication” for more.)
Use the Right Reinforcers
Rather than relying on punitive responses, such as threats, stonewalling, or withholding affection, Healy encourages her clients to let loved ones experience natural consequences — which can range from a hangover to a job demotion — for their behavior, while allowing that this may not be realistic if those consequences cause undue stress for other members of the family.
It’s also important to reward good behavior, whether that’s a homemade dinner to celebrate dry January or a simple “Thank you for taking my concerns seriously.”
Less effective are ultimatums such as “If you don’t go to treatment, I’m cutting you out of my life.” Research suggests that collaborative interventions like CRAFT are more effective at motivating individuals with substance-use issues to seek treatment.
Remember That Recovery Is a Long and Winding Path
Change tends to be a gradual process, replete with false starts, backslides, and second guesses.
Meet your loved one where they are in that process by acknowledging their ambivalence (“I hear you that you’re still unsure about treatment”), exploring the pros and cons of change, and remaining patient through setbacks.
This is especially important when it comes to relapse, a common phenomenon. Instead of treating it as a return to square one, remember that the insights, coping skills, and other resources accrued prior to a relapse don’t simply disappear.
What’s more, failure begets knowledge. For example, your loved one may learn that they need to avoid certain people, places, or things that still trigger an urge to use.
Prioritize Self-Care
Hope, despair, desperation, and rage are only a handful of the emotions you may be confronting if your loved one has a substance-use issue. Coping with these feelings while also striving to practice patience and compassion is no easy feat, so prioritizing your own well-being is essential.
Make time for exercise, rest, social connection, and whatever else keeps your cup full. Not only do you deserve it, but you’ll also be more likely to bring your best self to hard conversations. “When families first come to me, they tend to be highly emotionally dysregulated and have often been disregarding their physical, emotional, and financial well-being,” says Healy. “It’s important to get everyone feeling balanced and grounded before we start learning any techniques.”
Know That You Get to Have Limits
Remember, compassion does not negate the right to set boundaries. Consider what you are and aren’t willing to tolerate — and know that those limits may shift over time.
Know, too, that there are instances when physical or psychological safety necessitate firmer boundaries. For example, if a loved one is engaging in dangerous or violent behavior, you may need to establish physical distance or involve a third party.
If the situation doesn’t require an immediate response, consider contacting mental-health-crisis services if one is available where you live. In an emergency, however, calling 911 is the best choice.
Don’t Walk Through it Alone
“When a loved one is battling cancer, people show up at your doorstep with flowers and casseroles,” Healy says. “Not so when your loved one is dealing with addiction.”
Stigma remains no matter how common addiction is, yet retreating into secrecy and isolation helps no one. That’s why Healy coaches her clients to join supportive communities. “It’s so important to know you’re not alone,” she maintains. “There is power in connecting with others.”
There are several organizations that offer support for you as you support someone struggling with addiction:
- Al-Anon and Alateen are long-standing options for family members, with meetings held all over the world and on virtual platforms.
- Helping Families Help is a directory of CRAFT-certified resources, support groups, and providers.
- SMART Recovery offers in-person and online support groups for friends and family.
