HELPING LOVED ONES WITH DRINKING OR SUBSTANCE ABUSE PROBLEMS

by Ron Fagan, Ph.D.

Many of us have been in situations where we have friends or loved ones who we feel have drinking or other substance use problems. But despite our pleas, they are unwilling to even acknowledge the problem, let alone do something about it. The most commonly stated explanation is that they are "in denial" and they have to "hit bottom" before they will be willing to change. But there are things you can do to help people before they ruin their lives.

Help-seeking is influenced by psychological, social, and economic incentives and barriers. Research shows that people trying to modify addictive behaviors typically move through a series of five stages from not feeling their substance use is a problem (pre-contemplation) to beginning to think about their problem (contemplation, preparation for change) to doing something to overcome their problem (action, change maintenance). Where they are in this cycle influences their willingness to change and how they will respond to different types of intervention. When confronted by loved ones, the courts, and/or employers about their use, most substance users are in one of the first two stages.

What can you do to help a friend or loved one who is at one of these early stages?

People in the first two stages, either truly do not feel they have a problem or, at best, they are ambivalent about their situation. Even people who are at the third stage, often are only saying things like "I cannot go on like this," but they have little idea what they need to do to address their problems. Rather than trying to "break through the resistance" by confrontational tactics (such as getting the person to admit they are an addict), I recommend using a style that some have called "rolling with the resistance" as you try to help the person move through the stages of change. Going through all five stages is critical to making meaningful change.

I have found that one of the best early strategies is to discuss with the person any ambivalence they may be feeling about their use. Remember it is very difficult for most people to give up something they know, no matter how distressing, to travel to an unknown place where they are being asked to give up some control and put their life in the hands of others. While you can give them feedback about the negative consequences of their use for you and the people around them, if you only focus on the negative aspects of their use, most substance abuser will be equally adamant about the positive benefits. When you say: "You are an addict and you must get help," the likely counter response is: "I am not an addict and I don't need your help." People are more likely to take action to change when they perceive they have personally chosen to do so, not when they are told they have no other choice.

Too often people communicate a double message to the substance abuser. They say: "you need to change," but at the same time they communicate "but I am not very confident you can change." It is important for you to communicate to the person that you sincerely believe they can make meaningful changes in their lives and you will help them in any way you can to remove any barriers there may be to getting the help they need.

Your goal should be to gradually help the person shift their primary focus from the perceived benefits of their use to more of the negative consequences of their continued use. I have found that a very effective strategy is to discuss with the person their life values and goals and how their substance use may be compromising some of these aspirations. Statements like: "On the one hand you say you do not have a problem in controlling your substance use, but on the other hand your use has had these negative consequences" may help the person begin this process.

The person needs to get a consistent message that while you may need to do things to protect yourself and others from the negative consequences of their use, you care about them and these are the reasons you are concerned about their substance use. You are willing to help them in any way you can to see that they get the treatment they need, but ultimately it is their responsibility for deciding to make changes or not.

References:

Drews, T. (1998). Getting them sober. New York: Recovery Communications.

Johnson, S., Blanchard, K. (1998) Who moved my cheese. New York: Putnam.

Johnson, V. (1990). I'll quit tomorrow.

New York: Harpercollins. Knapp, C. (1997). Drinking: A love story. New York: Bantam Doubleday.

Miller, S., Rollnick, S. (2002). Motivational interviewing, Second Edition: Preparing People for Change. New York: Guilford.

Nakken, C., Twerski, A. (1999). Addictive thinking and the addictive personality. New York: Fine Communications.

Prochaska, J., DiClemente, C., Norcross, J. (1992). In search of how people change. American Psychologist, 47, 1102-1114.

Washton, A., Boundy, D., Boundy, D. (1998). Willpower's not enough. New York: Harpercollins.

Ron Fagan, Ph.D. is a Professor of Sociology at Pepperdine University and a licensed Marriage and Family Therapist practicing in California. He has extensive experience and he has published numerous articles in substance abuse treatment. He can be contacted at the Social Science Pepperdine University, 24255 Pacific Coast Highway, Malibu, CA 90263 and (310) 506-4818.

Originally published 01/14/03

Revised 8/20/08 by Marlene M. Maheu, Ph.D.

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