How to Help Someone Struggling with Substance Use Disorder

It has been said that coping with alcoholism is like boxing an invisible opponent. The same holds true for drug use. The behaviors and consequences associated with substance abuse disorders affect friends, family, and employers. 

How do you help someone struggling with drugs or alcohol while also taking care of yourself?

There is a path forward. How you intervene (or choose not to) may help or hinder the situation. 

When you observe ongoing changes in someone’s personality, mood, or behavior, the problem may be obvious. 

“However, some individuals are better at compensating or disguising maladaptive behavior, so they can appear to remain highly functional despite their drug or alcohol dependency,” says Spencer Eth, M.D., professor and director of the Addiction and Forensic Psychiatry Fellowship Programs at the University of Miami Health System. 

Familiarize yourself with the symptoms of a substance use disorder, then speak to a health care provider or mental health professional if you’re unsure how advanced the problem has become. 

“It is not always easy to decide what may be causing a perceived change in a person’s mood, relationships, or behavior,” he says. “In fact, many signs of impairment are non-specific and may be symptoms of medical or psychiatric illness.” 

To understand what constitutes alcoholism, take a look at the U.S. Guidelines for Drinking. Attending Al-Anon or Nar-Anon support groups may bring clarity to a confusing situation. 

Empathy or unconditional love may not be your default reaction when someone’s drinking or drug use negatively impacts your life. 

“It may help to consider that substance use disorders are classified as mental conditions, not failures of willpower or moral weakness. Some people may be genetically vulnerable to develop these disorders even at an early age,” says Dr. Eth. Others self-medicate with drugs or alcohol to relieve the distress of an untreated mental health issue, such as depression, anxiety, or PTSD.  

Using opioid medications to alleviate chronic and severe pain is another risk factor for a substance use disorder. 

A person raised by a parent with a mental health disorder or a drinking or drug problem may also be susceptible to having difficulty controlling drugs or alcohol use. 

In other words, they didn’t choose this – in a sense, their brains become reprogrammed to intensely crave alcohol or drugs despite the devastation caused by continued use. 

How to start a conversation about substance use disorders

Before speaking to someone about their dependency issues, review these guidelines on navigating difficult discussions from Felicia Gould, Ph.D., a clinical neuropsychologist at UHealth.

There are many ways to support someone trying to stay sober: 

• Suggest that they see a doctor for a physical exam to rule out underlying issues and to request a referral to mental health services 
• Educate yourself about addiction
• See a counselor separately or together, if appropriate
• Connect the person with treatment, services, and resources such as Alcoholics Anonymous or Narcotics Anonymous support groups, or the SAMHSA hotline, 1-800-662-4357, a national treatment referral and information hotline in English and Spanish
• Attend Al-Anon or Nar-Anon meetings

Treatment is imperative.

When a patient comes to Dr. Eth with substance use concerns, he starts a dialogue. 

“I speak to the patient about their current and past life experiences to better understand the context of drinking and drug habits. I elicit information about the impact of substance use on their health, relationships, and employment. Recent legal issues, such as an arrest for driving under the influence, can provide the external motivation to face the escalating adverse impact of substance use. The goal is to replace denial with a commitment to change behavior. Sadly, some patients have ‘bottomed out’ before seeking and accepting professional help.”   

If the patient acknowledges a problem, the next step is creating a treatment plan to help them change their behavior. 

“Professional care for substance use disorders may include a variety of medications and psychotherapies that have evidence-based value. The patient can receive care in different comprehensive programs and settings,” says Dr. Eth. 

When trying to be a supportive friend or partner, Dr. Eth urges you to remember that people with drug or alcohol problems are more likely to receive effective help from a professional counselor than a close friend or relative. 

“UHealth has mental health clinicians who can evaluate and diagnose substance use disorders and co-occurring psychiatric and medical conditions and offer expertise in delivering pharmacological and psychological treatments. That may start with acute detox and proceed with longer-term care that promotes a lifetime of recovery and relapse prevention in concert with community resources such as AA,” Dr. Eth says. 

How you interact with someone struggling with addiction depends on whether they’re a friend, partner, relative, or child. 

You may need to limit your time with a friend who refuses to acknowledge their problem. Let them know you’re there for them when they’re ready to seek help. It’s not easy to uninvite your uncle to holiday dinners, but if his drinking ruins the celebration yearly, it’s time to set boundaries. 

By doing so, Dr. Eth says you’re not rejecting your uncle as a person; you’re doing what is necessary to prevent the family and social consequences of disruptive behavior influenced by his substance use.

If your spouse asks you to cover for her behavior, it may be time to confront her with the consequences of her actions. Caveat: If those consequences injure anyone, you need to intervene – take the car keys, for example, before letting someone drive drunk.

Shaming, blaming, and bargaining are often ineffective and may worsen the situation. 

The same holds true for enabling or co-dependent behavior, such as making excuses for someone who doesn’t show up for work because they have a hangover.

Hypervigilance — pouring alcohol down the drain or counting the number of drinks consumed — is generally not helpful and exhausting. Arguing with someone in the throes of addiction can be a losing battle and could trigger a heated argument. 

“‘Tough love’ is easier said than done. It may be best to arrange to speak about the problem accompanied by close family members,” Dr. Eth says.

However, he also says, “Intervention can be counter-productive when individuals feel others are talking or plotting behind their back and trying to manipulate and control them. Professional guidance can be sought before taking this step.”

Put your own oxygen mask on first.

Helping someone recover from addiction can be physically, mentally, and financially draining. In some cases, it’s impossible if the person doesn’t want to change. It may demand so much of your energy you neglect your own needs. 

There are ways to cope: 

Ask for support. 

Seek help from others in similar circumstances in support groups such as Al-Anon or Nar-Anon, among church or temple friends, or in family therapy and counseling. Treating the whole family can improve the addict’s chances of staying sober. 

Make time for yourself. 

As difficult as it seems, try to maintain healthy habits. 

Exercise to let off steam, meditate, talk to a trusted friend, eat nutritious food, practice good sleep hygiene, and nurture your emotional resilience. 

Maintaining your health is important; so is holding on to hope. We can’t deny that substance use disorder exists, but we can reach out for help and urge others to do the same. 

If you or someone you care about struggles with substance use disorder, call 305-243-0214 and ask to make a virtual or in-person appointment with UHealth’s Psychiatry team.

Nancy Moreland is a regular contributor to UMiami Health News. She has written for major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: addiction, alcohol use disorders, Dr. Spencer Eth, drug addiction, mental illness, stopped drinkinng