If a close friend or a family member is an addict, you’ve probably tried to help. But the road to recovery is bumpy, with unexpected twists and turns, and "It’s not simple or easy," says Mark Willenbring, MD, DLFAPA, director of the Alltyr Clinic in St. Paul, Minnesota. In fact, most people don’t achieve long-lasting sobriety on their first try. "It takes persistent effort over a long period of time."
Here, three experts offer their do’s and don’ts for persuading a loved one to get help.
Be Prepared
Have a plan for how you can help, suggests Scott Krakower, DO, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y. Your personal plan could involve giving the person money to pay for therapy, but deciding ahead of time to stop providing money if the person doesn't attend. It’s important to stick with your plan once you come up with it.
Show Support, But Set Limits
Getting clean takes time and it can be difficult to watch a loved one struggle to stay sober. If the person is making an effort to stick to the plan, you may continue to be supportive even if they relapse.
But you can (and should) set limits: For instance, you may want to limit contact with someone who isn't making an effort to get clean and sober, Krakower says. You don't have to hang up the phone on your loved one, but you can check caller ID and decline to take calls from someone you know is actively using. "In cases where the person is not even making an effort, don’t engage with them verbally," he advises.
Don’t Threaten
"Nobody likes to be threatened, and most people don’t respond well to this type of engagement," says Howard L. Forman, MD, medical director for Addiction Consultation Services at Montefiore Medical Center in New York City. So you may not want to say you'll take away the addict’s cell phone or make her move out.
Furthermore, "And what’s worse is that many people who go down the threatening route don’t follow through on their statements, which sends the message 'There’s no need to take what I say seriously,'" Forman warns.
Be Wary of a "Tough Love" Philosophy
"Tough love" is the approach in which an addict is left to "bottom out," in hopes that the experience—from wrecking a car and getting in a serious accident while high to losing one’s job, home, and/or marriage due to addiction—will be distressing enough to prompt a real commitment to sobriety. This method has limited effectiveness: "In the decades that 'tough love' has been espoused [promoted], addiction problems have only increased in prevalence," Forman says. "Love is an important element to helping people with addiction to recover." Still, balancing love with letting go can be tricky: "It’s a much more effective approach to let the person know that you are going to live your best life possible and that you are there to help them when they are ready to be helped."
Encourage Healthy Behaviors
While a tough love strategy isn't recommended, do save the bulk of the attention for when the person isn’t using, Willenbring advises: "We all like attention and we hate being ignored," he says. "What usually happens is that when the person is drinking, they get a lot of attention. When they get better and stops drinking, they get less attention." So turn this around completely: When the person isn’t drinking or using, tell them how much you appreciate them when they are clean and sober, Willenbring says. On the other hand, "When they are using, turn your back and walk away." Of course, if they need medical attention you will be there. But otherwise, there’s no need for you to get involved in the day-to-day routines.
Question Your Assumptions
You may think you know about substance abuse disorders, but much of what's commonly believed "may be based on myths," Willenbring says. For instnace, "The biggest myth is that a 12-step program [Alcoholics Anonymous is one example] is 100 percent effective if you do what you are told. The expectation that someone will get better the first time is absurd." In fact, he says, more than 90% of individuals will relapse, many more than once. "It takes five to ten years for an alcohol-dependent person to stop [drinking], and involves multiple recurrences," Willenbring says.
Educate Yourself About Addiction and the Brain
It can be very frustrating to watch a loved one struggle with substance abuse, that's why it can be so helpful to learn about how addiction works. "The brain is a flesh-and-blood organ that regulates the intake of intoxicants, and this is what gets broken in addiction," Willenbring says. "The brain loses the capacity to control intake in a reasonable way." The addict develops an intense preoccupation and desire for whatever he is addicted to, and has a diminished ability to resist it.
Be Realistic
Keep in mind that typically, sobriety happens in stages, characterized by longer periods of abstinence and shorter periods of recurrence, says Willenbring. When the person realizes that just because she can’t stop on the first try doesn’t mean she is a failure, she may be more motivated to keep at it, Willenbring explains.
Get Help—for Yourself
Loving an addict can be stressful, frustrating, and depressing. Finding a support group specifically geared towards loved ones of people with substance abuse issues, like Al Anon, can help, especially if you find yourself backsliding (for instance, giving money to a loved one who's actively using even though you decided you wouldn't), according to Krakower.
Alternatively, you might want to speak with a therapist. "You need to get reassurance that you are doing the right thing," in your relationship with an addict, he says. It’s very easy to backslide, so it’s important to find someone who can be supportive.
Don’t Take Recurrences Personally
"With a substance abuse disorder, change is hard and it takes a long time," Willenbring says. "So expect that people may lie about how they are doing, and don’t be hyper-vigilant and hyper-demanding."
Mark Willenbring, MD, reviewed this article.
Sources
Mark Willenbring, MD. Phone interview on March 16, 2016.
Scott I. Krakower, DO. Phone interview on March 10, 2016.
Howard L. Forman, MD. Email interview on March 18, 2016.
