How do I get someone into rehab when they keep saying no? It is the question we hear most from families, usually after months or years of promises and one more chance. By the time a family calls us, they have talked, pleaded, threatened and paid the bills, and the addict or alcoholic is still using.
Getting someone into rehab is possible. In our experience, the majority of people accept help on the day of the intervention or shortly after. How it happens is usually different from what families expect, though. It rarely comes from finding the right words. It comes from the family changing what it does, so that continuing to use becomes less comfortable than getting help. In other words, the work starts with the family.
Why they will not go on their own
People enter treatment when they see a need for change. As long as using drugs or alcohol is more comfortable than stopping, the substance user has no reason to go. That comfort almost always comes from the people closest to them: a parent who covers the rent, or a spouse who calls work to say they are sick again.
This is what we mean by the family system. Each person in the family has adapted to the addiction, and each of those adaptations makes it a little easier for the substance user to keep going. Families rarely see this on their own because they are too close to it.
Waiting for rock bottom does not fix this. Everyone’s bottom is different, and no one can predict where it is. The better question is what the family is doing that keeps the bottom from arriving. We cover this in more detail in our post on the signs of hitting rock bottom in addiction.
Can you force an adult into rehab?
In most cases, no. An adult has the right to refuse treatment. Some states have laws that let a family member petition a court to order involuntary treatment for substance use, but the rules and the length of a hold differ from state to state, and some states have no such law at all. If you are considering it, speak with an attorney in the state where your loved one lives.
A court order can get someone through the door of a treatment center. It does nothing about the family system the person comes home to. A planned intervention gives the substance user the chance to say yes on their own, with the family’s boundaries already in place if they say no.
How to get someone into rehab, step by step
These are the steps we take with families. They work best in this order.
1. Get the family on the same page
One family member cannot do this alone, and a family that is split will be played against itself. The substance user goes to whoever still says yes. Before anyone talks to your loved one, the people involved need to agree that treatment is the goal and decide what each of them will stop doing if the answer is no. See our post on whether all family members should be involved in an intervention.
2. Stop making it comfortable to keep using
Look honestly at what you pay for, cover for or fix. Rent, phone bills, car insurance, bail money, explaining absences to an employer, cleaning up after a binge: each of these takes a consequence away from the substance user. You do not have to stop all of it overnight, and you should not do it in anger. The family does need to decide which of these it will stop, and then say so. Our post on how enabling behaviors hurt the whole family explains where to start.
3. Get a drug and alcohol assessment
An assessment tells you what level of care your loved one needs, whether that is medical detox, residential treatment, a partial hospitalization program or outpatient care. Most agencies that treat substance use disorder do the assessment at no cost and can consider the person for admission right after it. If there are mental disorder symptoms along with the drug or alcohol use, ask about dual diagnosis treatment so both are treated by the same team. Read what to expect from a drug and alcohol assessment.
4. Line up the treatment center before you talk to them
Have a bed reserved, insurance verified and travel arranged before the conversation happens. When someone says yes, that window can close within hours. If the family then needs three days to find a program, the substance user has three days to change their mind. Our guide on how to choose a treatment center for your loved one covers what to look for, including whether the program has a family program.
5. Bring in a professional interventionist
Do not start an intervention without a professional. Families who try it on their own tend to fall back into the roles they already play, and the conversation turns into an argument or an ultimatum. A professional interventionist prepares the family ahead of time and handles the objections in the room so the family does not have to. Read what an intervention is and how to do an intervention with a professional.
6. Expect the excuses
Most families hear the same objections. What about my job? Who will take care of my pets? I can quit on my own. I will go after the holidays. Some of these are real problems with real answers, such as job-protected leave under the Family and Medical Leave Act or a relative who agrees to take the dog. Most are ways to buy time. We have a full list of the common excuses addicts use to avoid treatment and how to answer them.
7. Decide what you will do if the answer is no
Before the conversation, each family member decides what they will do if the substance user refuses, and then follows through. Follow-through is what gives the next conversation weight. Success does not mean the substance user accepts help that day. Success means the family stopped taking part in the addiction and started its own recovery. Read what to do if they say no during a drug or alcohol intervention.
Getting an alcoholic into rehab
Alcohol needs one extra step. Withdrawal from heavy, daily drinking can cause seizures and delirium tremens, and it can be fatal, so an alcoholic should not quit cold turkey at home while waiting for treatment. Plan for medically supervised detox as the first stage of care. Our alcoholic intervention page explains how we plan for it with families.
After they say yes
Once your loved one is in treatment, the interventionist steps back. The best outcomes come from the treatment team and the treatment center’s family program, and the family’s job is to take part in that program and keep working on its own recovery. It is common for someone in early treatment to call home wanting to leave. Do not rescue them. Our post on what happens if a loved one leaves treatment against medical advice explains what to say when that call comes.
Talk to Family First Intervention
If you are trying to get someone into rehab and nothing has worked, call us at (877) 728-1122. We answer 24 hours a day, 7 days a week, and we work with families of adults in all 50 states and Washington, DC.
