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Before scheduling an intervention, families almost always ask us, “How or what should I say to make my addicted loved one get treatment?”
Many questions asked are loaded and have many answers. An answer to these questions depends on the substance user and the family’s willingness to follow directions. The strategies used to communicate with an addict or alcoholic can change at any moment, and the more important question to ask is, “What can I do?”
It is essential to consider how, what, and when you say something to move a substance user toward accepting help. However, what is even more important is the family’s ability to follow through and change the behaviors that are currently fueling the substance user’s addiction and resentment. We are not implying that the family is at fault, but addiction is driven by much more than just physical and mental dependency on addictive substances.
Addiction is a problem of the following:
- Physical and psychological dependence
- A victim mentality
- Past experiences, whether real or perceived
These factors that drive addiction are a short list and don’t include common disorders observed in patients with a substance use disorder. Most substance users’ anger is directed towards the people who love them the most and who they feel are the cause of their problems – their family.
When the perceived problem (the family) faces the substance user and tries to communicate, the substance user and the family struggle to communicate effectively. The family is untrained and unaware of what is happening with the substance user. Substance users only hear what they want to hear and will argue or be resentful with every word spoken. Unless the family communicates how they will support or enable the addiction, the substance user is likely to resist other helpful suggestions.
The only help the addict or alcoholic is looking for is directly or indirectly supporting their addiction and lifestyle. So what do you say to make them quit? Next, we will share an experience to set the stage for what the substance user needs to hear, see, and feel at the intervention to start the change process.
What an addict or alcoholic needs to hear, see and feel to consider asking for or accepting help.
In 2005, we were part of an intervention for a 33-year-old substance user. The family had given up all hope and had reached a point where they accepted that one of their four children was just this way, and they would have to live with the nightmare.
The substance user’s mother had asked countless individuals to speak with her son in an attempt to talk sense into him. Those who spoke to him sometimes provided short-lived hope but never a sustained solution. The mother came to believe that nothing would work and her son would never change.
She thought that if he found the right job, met that special someone, or found the right mentor, that would turn him around. However, she and the rest of the family never considered that what they were doing and saying was making the situation worse. They had tried every form of communication possible and sent their loved one to treatment 19 different times, but each time he relapsed shortly after being discharged.
So, what was the problem?
After the mother and the rest of the family tried to convince the interventionist at every turn that the loved one would never go, the intervention took only 15 minutes before the loved one said yes.
How did this happen? How did the family spend ten years trying to come up with the right things to say, only to see the situation worsen? How did the interventionist convince the loved one to agree to treatment in less than 15 minutes?
As each family member read their letters, there were many long pauses filled with emotions and tears. When it was time for the father to read his letter, he said, “Dear loved one, you are my son, and I love you.”
His head dropped, and tears streamed down his face. He was unable to speak another word. As the substance user watched and started crying, he said, “Let’s go; I am ready.”
In disbelief, the family hugged, and the substance user left with the interventionist to head for treatment. On the way to treatment, the interventionist asked the substance user, “What made you say yes? I was ready for you to say no; your family told me you’d never go and that you would put up a fight. Your family almost didn’t do this intervention because they said you would never go.”
The substance user replied, “I broke him; I finally made him feel how he has made me feel my whole life. I never saw my father cry; that is all I needed to see, for him to be in pain over me. I felt I finally got his attention for the first time in my life.”
As the treatment journey continued, the interventionist continued to ask questions. The substance user revealed that he never thought his father cared about him. At times, he felt his father was emotionally abusive. He felt his father cared more about the other three children than the one spiraling out of control.
The substance user explained that his father was demanding towards him, and he always felt his father was not emotionally present. When the substance user started using drugs and alcohol, it got his father’s attention, the attention he felt he never fully received.
“The worse the substance user became, the more attention he stole from mom and dad. In turn, mom and dad neglected the other children and put all their energy into the substance user. It was the start of a dysfunctional family system.”
What you say to an addict or alcoholic is not nearly as effective as what you do.
The interventionist and the substance user continued to speak, and eventually, the substance user was delivered safely to detox. It may sound like a great ending with some valuable insights, but the story is far from over. After all, the family has been in this situation 19 times before; their loved one is now at a treatment center.
The one thing that is different this time is how quickly the substance user accepts help. It wasn’t what was said but rather what wasn’t said. It was the actions of the substance user’s father, not the words he spoke. The intervention with the family coming together was powerful. It was enough to bring the substance user to treatment, regardless of what was said.
However, within 24 hours of being in treatment, the substance user felt he had enough and left against medical and staff advice. He made a beeline back to his parents’ house, believing that his family would take him in, just as they had always done before.
“Addicts and alcoholics say no to an intervention or leave treatment for four reasons. They still choose to use drugs or alcohol, they believe the family isn’t strong enough to hold their boundaries and say no to them, they are not finished punishing their family, and all of the above.”
As the substance user banged on the front door, the mother called the interventionist. The interventionist instructed the mother not to let him in and to call the police. Shortly after, the police arrived, and the mother opened the garage door. She told her son to leave the property. The substance user was stunned, as the mother had never done that before.
The police gave the substance user two choices: leave the property or go to jail. The substance user chose to leave. It didn’t take long for the substance user to find a phone and plead his case, terrorizing his family. He stated how horrible the family was and how they went about this intervention the wrong way to anyone who picked up the phone. Any family member who answered the phone told the substance user they loved him and to go to treatment before hanging up.
However, there was one call that came next that changed everything. It was to the mother and father. As they listened to their son hurl insults and horrible things at them, they waited for their chance to speak. What they said next made the change that has kept their son sober to this day.
The mother and father said, “We’re no longer doing this; we have no tears left to cry. We have done everything we can, and you have made your decision. We know a lot more than we used to, and we accept your decision to be a drug addict and an alcoholic. Please accept our decision not to help you.” Within 24 hours, the substance user was back in treatment and never looked back.
The interventionist spoke with the substance user at his sober living house six months into his sobriety. He asked what had changed and why he had returned to treatment. The interventionist heard something he would never forget.
The substance user said, “I couldn’t hurt them anymore.” He said he got high one more time, and something was different; it just didn’t have the same effect as before. He realized that if he chose to continue using drugs and alcohol instead of accepting help, then he would have to do it on his own, with his own resources. He knew he couldn’t do this without his enabling family and felt their united strength. He realized it would never return to the way it was.
“It was not what was said; it was the actions his family took.”
The interventionist instructed the family on what to say at every turn, and it worked; it helped get their loved one to treatment. The reason their loved one returned and stayed in treatment resulted from what the family did. The family backed up their words with action and change.
Before the intervention, the family had tried holding boundaries and implementing tough love hundreds of times, but they never followed through. The substance user knew that and needed one last ditch effort to test them. The family followed through on their words with action, showing that what they said mattered, but what they did counted more.
We hope this story can help a family understand what needs to be said and done to help an addict or alcoholic quit. This story is true and unfolds precisely as you read it.
Although this may not be everyone’s story, there are common denominators:
- What you say matters, but what you do matters more.
- What you say may get them into treatment, but what you do keeps them in treatment.
- You do not have to wait for them to want help or to hit rock bottom.
- You can accept their decision to use drugs and alcohol and ask them to accept your decision not to help them use drugs and alcohol.
- It is okay to detach and say no.
- It is not okay to enable, which ultimately helps them stay sick.
- The family is often too close to their loved one and emotionally attached. As a result, they need professional guidance to find the right things to say at the right time.
- The acquired family roles have often had a hidden agenda that is not in the best interest of the substance user getting better.
- The substance user often says no to the intervention for several reasons. They may choose to continue using drugs or alcohol, they may believe the family isn’t strong enough to hold their boundaries and say no to them, they may not be finished punishing their family, or it may be a combination of all.
“It’s not about if they say no; it’s about what you do after they say no.”
Families often ask, “What should we say or do if our loved one refuses help?” That is a question that you should be asking yourself. It’s important for you to focus on the idea of setting boundaries and saying no to the addiction. The truth is, your loved one needs you more than they need the addiction.
“The only one that should be worried about hearing the word no is the substance user. In our experience, families have a much more difficult time when the substance user says yes and accepts help than when they say no and refuse help.”
How does an Addict or Alcoholic Think?
Rather than delving into the complex medical and scientific explanations of how substance use affects the brain, we will explain the mindset of an addict or alcoholic in lay terms.
Drugs and alcohol take control of the brains of addicts and alcoholics. They shift their ability to differentiate right from wrong and begin to justify irrational behavior. They are in survival mode and prioritize obtaining and using substances as their number one task.
Addicts and alcoholics are always on edge, easily agitated, and discontent. They plan their entire days, events, gatherings, and tasks around obtaining the drugs or alcohol they need to get through anything. This way of thinking becomes an automatic first thought; from the moment they wake up to the moment they fall asleep, they are thinking of ways to obtain more of their substance.
Additionally, They are constantly rationalizing and making excuses for their destructive behavior. They plan dishonesty or manipulation when confronted and shift blame onto others. The addict or alcoholic cannot put others’ needs before their own and believe their problems are never caused by their actions but by the people around them.
It is a common misconception that these behaviors and thought patterns only occur while actively using drugs or alcohol. While abstinence can undoubtedly reduce these behaviors and thought patterns, they do not disappear entirely. Sobriety is when these behaviors and perceptions begin to change. The most significant mistake families make is thinking their loved one is better because they are in treatment or jail and away from drugs and alcohol.
The underlying causes of addiction do not disappear simply because the substance use stops. In our experience, the behaviors of substance users often worsen in the first 15-30 days of abstinence before they start to improve. The behaviors, resentments, experiences, traumas, and perceptions that fueled the addiction have not yet been addressed or changed. When a substance user is in treatment and not using drugs or alcohol, they may still display hateful and entitled behavior. Most resources during the intervention process are geared towards supporting the family after the intervention.
“Behaviors of concern don’t stop because the substance use has stopped. We spend more time and resources helping families after the intervention. The hardest time for families is when their loved one is in treatment, not when they have refused help.”
Substance users and their families can be more unstable during the early stages of recovery than during active addiction, which surprises many people, but it is true. This is one of the reasons why many addicts and alcoholics relapse after treatment.
When the focus is only on addressing substance use and not addressing the underlying causes and the family’s role in enabling the behaviors and substance use, it is unlikely to lead to a sustainable solution. The same patterns and behaviors will likely continue if a substance user returns to the same family and environment without addressing these underlying issues.
“Countless times we have heard a family or a substance user say they did an intervention before and it didn’t work, or they have been to treatment before, and it failed.”
Families, substance users, and many professionals in the mental health field do not fully understand addiction. Clinicians and psychologists may know about counseling but may not have extensive experience working with individuals struggling with addiction.
Many mental health professionals do not receive in-depth education on addiction during their graduate studies. While it would be beneficial for them to choose a degree focusing on addiction studies, science, and theory, many do not. Similarly, many doctors and psychiatrists may not receive sufficient education on addiction and counseling theories and practices during their medical education.
This lack of understanding can lead to a focus on treating symptoms rather than addressing the underlying causes of addiction. Families, professionals, and even substance users often aim to help the individual regain what they’ve lost before addressing the behaviors and perceptions that led to these losses. Others may quickly diagnose and prescribe medications without fully addressing the underlying causes. It is important to remember that treating symptoms alone will not address the root of the problem.
The cycle of addiction is a vicious one, which is why so many people repeatedly go in and out of treatment centers, therapy sessions, and appointments with mental health professionals. It is important to note that there is a significant difference between abstinence and true sobriety. Abstinence refers to refraining from using substances, but true sobriety involves addressing and changing the underlying factors and behaviors that led to substance use in the first place.
Abstinence alone is not enough to achieve sustainable recovery.
How does the family of the addict or alcoholic think?
The family of the substance user is often resistant to change for fear of the unknown outcome. Over time the family acquires maladaptive coping mechanisms to manage the stress of the chaos and drama. These coping mechanisms have become the new normal way of living. Family roles form to adapt as each family member struggles with the lack of attention that’s now primarily going to the substance user.
The most significant challenge professionals face in working with family members of substance users is making the family aware of what they are doing and why. It’s far more difficult for a family to let professionals help them than it is to help the addict or alcoholic.
The fear isn’t in helping their loved one; it’s what will happen to them if the situation changes. Some reading this may laugh or even roll their eyes, but it’s true. Addiction is the only fatal problem where families hesitate to help the patient. In reality, the patient is the family. If the family cannot change, the substance user has little chance of changing.
Families ask many questions during our consultations. Very rarely are the questions about the substance user. Many appear to be about the substance user, and they are all circled about what will happen to them if the substance user gets help or declines help. The thought of trying to help their loved one escapes many in exchange for holding onto the fear of change.
Interventions are most difficult when the substance user accepts help at the intervention, not when they decline. How is that possible? It’s possible because there’s less to change when the substance user says no. Everything changes when the substance user says yes.
The hardest part for families is the silence and immediate disappearance of the chaos and drama thought to be coming from the substance user. Families quickly realize, after the intervention, that when their loved one is sitting quietly in treatment, they are more uncomfortable than they were before, but how?
Families are familiar with things; they need time to adapt to the significant changes. Family roles need to shift back to normal, and families need to address their problems once buried behind the substance users’ issues as a diversion. Families can resist these theories all they would like, and it doesn’t change that they are true.
Before breaking down some of the ways specific family members think, we will use an analogy. Imagine a person is incarcerated for a very long period, and at first, they’re uncomfortable. After a while, they adapt to the situation. After ten or twenty years, it’s all they know. They always state how they can’t wait to get out of prison and talk about their plans when they do. The day comes when they are eligible for release. Some become angry and even sabotage themselves by getting in trouble and losing their chance of freedom, but why?
First of all, their anger comes from fear. The fear is making it on the outside. They have acquired coping skills and survival skills in prison. They’re afraid of whether or not they’ll make it on the outside. Seem like a farfetched analogy? We think not.
If this were farfetched, why do so many families choose inaction as a solution? We should never have to talk anyone into doing something for a family member who needs help for a potentially fatal problem. Sadly, this is required all day, every day.
Calling an interventionist for help is not like the routine of calling a doctor for your child’s medical concerns. Imagine if you called your child’s pediatrician and said, “I think my child needs medical attention. Before I make an appointment, I’ll need you to have the doctor and nurses on the phone with my entire family. We need you to convince us to help our child and bring them to see you.”
That’s what it’s like daily as an interventionist when calls come in. No family is ever on the same page, nor is every family in agreement their loved one needs help when they do. The excuses and the questions that come out are all about the fear of what will happen to them if their loved one goes to treatment.
It’s similar to not calling 911 for an accident inside your house. You are more concerned about what the neighbors will think with all of the police, firefighters, and first responders outside your front door. I know this all sounds bizarre, and this is what families challenge us with every day. Let’s look at how some of the family members of a substance user think.
The primary enabler fears the intervention. Suppose the substance user accepts help and goes to treatment. In that case, we’ll have removed their purpose and role of being needed in the relationship. If I do this intervention and they get better, what does that say about me? Am I okay with them getting better somewhere else? The enabler is stripped instantly from the codependent relationship with the addict and alcoholic, and that’s hard for them. They’re not wrong; this is just how it works.
The martyr fears what will happen to them if their loved one is gone. They have acquired being a victim and are more concerned about what will happen to them while their spouse is in treatment than their spouse getting better. You can always tell who they are on the call or at the intervention. They will be screaming for help and telling everyone how they are miserable. They will do this while shooting down, making excuses, and poking holes in every solution.
A hero has dealt with the substance user and the lack of attention from the primary enabler. As a result, they have become a perfectionist. The hero thinks if the substance user gets better, what happens to them? The hero either has to smash the idea of intervention entirely or has to be in complete control of the intervention. If something goes wrong with any part of the intervention in the eyes of the hero, they will be sure to blast the family with I told you so, and we shouldn’t have done this.
“He who dares not offend cannot be honest.”
These comments are not to offend, and they are honest. The clinical explanations of these family members are much more complex, and this is the layman’s version. Please remember that none of these family members are wrong in how they feel, think, and act. Although none of what they do helps the family or the substance user, even worsening the situation sometimes, they don’t know any other way.
The roles and the behaviors they have acquired are by default. Chances are high that if not for the addiction in the family, behaviors in these specific family members would not be coming out. We may sound harsh in explaining how families think. Families need to understand how they feel, act, react, and behave, as it dramatically impacts whether or not the substance user quits using drugs and alcohol.
What do you say to someone who is an addict or alcoholic?
How do you speak to someone with a false sense of perception to help them quit or see the need to change? The substance user is often incapable of owning the problems that come their way. Everything that goes wrong, in their mind, is the result of some other person, place, or thing.
Almost all misdirected blame is thrown at the family who loves them the most. So, how would the perceived problem effectively communicate with someone who is angry and resentful towards them? The answer is it’s difficult, and you need a third-party mediator to help and a strategically written and effective letter to start productive communication.
A third-party mediator can better understand the substance user. Emotional detachment from the professional is more effective than an emotionally attached family member who is perceived as the cause of the problems. The letter your interventionist will help you with brings the substance user to a place of listening.
“Some people are reading this saying, ‘this is not our loved one; they love us very much.’ That may be true that they love you very much. Somewhere, somehow your loved one using substances has anger and resentments directly or indirectly at one or multiple members of your family, contributing to the addiction.”
Addiction creates unhealthy family roles. The anger of the substance user is towards multiple family members. The wrath of the other family members, who are usually unaware of this, is with the primary enablers.
As a result of this family dysfunction, what you say, and who says it when you try to speak to your loved one makes a significant impact on the substance user. There’s a proper way to communicate and effective strategies for who should be doing most of the communication. As we have stated several times, what you say matters; what you do matters more.
There are evidence-based communication skills that interventionists and clinicians can utilize to help the substance user see the need to change. Much of this depends on the substance user’s location and how and what you say matters in moving them toward accepting help.
Suppose your loved one is in complete denial, which is very rare. In that case, there are different strategies you would use in place of a process used when someone is aware of their problem. Very few people are in denial of having a problem. That denial almost always comes from denying the need to do something about it.
Motivational Interviewing is a conversation between two people that seeks to motivate one of the people in the conversation to change. Among many goals, Motivation Interviewing aims to move the person needing help from sustained talk to change talk.
The more that people talk about staying the same, the less they talk about change. Motivational interviewing is not something a family can just put into practice to get their loved one to quit using drugs or alcohol. MI seeks to address the five dimensions of motivation: Desire, Ability, Reasons, Need, and Commitment.
The MI strategies used to help with this are called OARS:
- O – Open-Ended Questions: Questions designed to get the person talking. Start questions with words like Tell, How, What, Why, Could, etc. When you use a closed-ended question, you often receive short answers.
- A – Affirmations: Acknowledging the person’s strengths and accomplishments. It’s essential to distinguish this from validating all behavior. An important part of MI also addresses the discrepancies in the person’s story.
- R – Reflective Listening: Expresses to the person that you are listening to them.
- S – Summaries: This is part of reflective listening. When the person shares information, being able to summarize and link the information back to the other person is helpful. It builds trust with the person you speak with and makes them comfortable.
Reading through all the information, you can see the pattern and the goal. The substance user has to see the need to change, whether it’s the actions or words you take or speak. All of the greatest motivational interviewing in the world by itself is no match for a change in the environment.
Many great clinicians, interventionists, and other substance use and mental disorder professionals have helped many people. The strategy helps people arrive at treatment centers utilizing MI, which is often a short-lived accomplishment. Suppose the environment and the family system remain the same. Using motivational interviewing and changing the environment and family system achieves far more excellent results than when only one of these strategies is used alone.
What not to say to someone who is an addict or alcoholic?
What not to say is just as important as who should not be saying anything. Very few family members can effectively communicate with the substance user. Furthermore, many family members who want to speak with the substance user come from an unhealthy and flooded state of mind.
Depending on what family role is doing the talking, the agenda or motive will be selfish. Most people would disagree with that, and it’s true.
The hero role has the plan to help the substance user to receive validation for themselves. Enablers have an agenda. The agenda is to feel a need in the relationship and a purpose as part of the outcome. The martyr is afraid for the substance user to go away, fearing what will happen to them.
So what’s the point?
The question is, “What shouldn’t I say to someone who is an addict or an alcoholic?” Suppose you’re the family directly affected by the addict or alcoholic. In that case, you shouldn’t say anything without consulting a professional.
The addict and the alcoholic are angry, resentful, and full of blame, not to mention they feel like victims. Most of them believe they think this way because of the very same people who may be trying to speak to them.
Imagine you are angry at someone and believe they are the cause of your problems, only to hear them say, “You know what you need to do,” or “You know what you should do?”
Most of the time, when the family tries to speak to the addict or alcoholic, they are left with broken promises and false hope. They may even feel it was a productive conversation for a short window of time. That is until they realize they have been lied to again.
Rarely is a family able to talk their loved one into quitting. Even if the family could do that like a trained professional using motivational techniques, what would happen in a week, month, or year? What to say and what not to say is essential.
Likewise, knowing what to do and what not to do is important. A family member trying to talk to their loved one using drugs or alcohol is like pouring water on a conference table. The water rolls off, and no liquid is absorbed. Has just talking to them worked yet for those reading this and rolling their eyes?
What is required is an unbiased, emotionally detached, trained professional to mediate between the addict or alcoholic, the conflict, and the family who has suffered.
Here are some things to avoid and what not to say to an addict or an alcoholic:
- Try to avoid overloading on closed-ended questions. Using them when appropriate is okay, but they can backfire if not done by a trained professional.
- Avoid telling the substance user what they need to do or what they should do.
- Do not focus on drug or alcohol use. That isn’t your problem right now. Focus on the behaviors. The substance user may be able to deny alcohol and drug use, but they cannot restrict their behaviors or actions.
- Do not throw their past in their face. They already know they have done wrong. As soon as you reference past wrongs, all they will do is flip the script and somehow make it your fault for what happened.
- Do not let the hero, the martyr, or the enabler do the talking. All three roles are incapable of an unselfish conversation with the substance user. They don’t or won’t even realize the discussion will be all about them and not the addict or the alcoholic.
- If you must bring up certain instances of concern, do not go back in time beyond 3 – 6 months. They will immediately call you out and say it was long ago.
- Never validate any positive things that occurred while they were intoxicated.
You probably wouldn’t want to represent yourself in court, so please avoid portraying yourself during a DIY intervention. The addict and the alcoholic are too bright and manipulative for your family. If the substance user were to accept help, it would most likely be short-lived. It’s required for the family not to change themselves and the environment where the substance user is comfortable.
How do I have a successful intervention for my loved one?
Following professional advice and guidance, you have a successful intervention. There’s no other time in life when something this important would lead a family to believe they can fix the problem themselves. Whether a court case, a medical decision, a financial concern, etc., people seek help from people who know better.
Addiction is the only fatal problem that people try to fix themselves. Most of this comes from what we said about the hidden agendas of specific family roles. Families act out their family roles in the chaos and drama as much as they do in the solution.
As part of our intervention process, we help you understand how to communicate effectively with your loved one. We do this during the intervention process and after the intervention. The family will have far more significant challenges after the intervention than before and during it.
To have a successful intervention is to surrender to professionals. What you expect your loved one to do, is get help, and you have to too. Most of the time, families have to do that first. If your loved one puts as much effort into their recovery as yours, they will receive the same results you have up until now.
We wish addiction were a victimless crime where it only affected the substance user, but it’s not. The family has been through just as much, if not more, than the addict or alcoholic. To think the substance user is the only one who has to change is incorrect. To believe that the only problem was drugs or alcohol is also not accurate.
The problem is the behaviors and thinking on both the part of the substance user and the family. A successful intervention comes from families surrendering to this belief and bringing in a professional to guide them. In doing so, the family will learn how to care for themselves and to communicate more effectively with the addict or alcoholic, whether they are sober or not.