If you are noticing problems in friend or family member’s work, health, family, finances, relationships, social functioning, legal issues, self-esteem or self-respect, you are not overreacting.

Continuing to use substances in spite of the fact that such behavior is causing problems, is a problem in and of itself. It shows that substance use has become more important than the problems it causes. Someone who is unwilling to discuss the issue or consider whether there might be a problem is a strong indicator that a problem exists.

Some actions you can take:

• Read about the signs and symptoms of substance use.
• Observe the person’s behavior closely over a period of days or weeks to understand what leads you to think there is a problem. This information will be good to have if you decide to talk with other family members about the situation, seek advice from a professional, or speak directly with the person. However, don’t feel you need an exhaustive picture of the problem before.
• Share your observations with other family members and friends to determine how they see the situation. If they agree there is a problem, figure out who will talk to the person about getting help.
• Contact a substance use professional, mental health professional, physician, employee assistance professional, guidance counselor, clergy or other helping professional to help you. Describe your family member’s substance use pattern to see whether the professional would deem it a problem. Provide details such as: type of alcohol or other drugs, how much the person is using, how often they are using, how long the pattern has continued, negative consequences, and the person’s response to discussions or confrontations about substance use.
• Ensure that you and other family members are safe from potential physical or emotional harm. If there is a threat or possibility of physical violence, you should develop a safety plan.

Waiting for people to ask for help is a risky strategy. Without help, family members can expect crises like arrests, medical emergencies, loss of job, public embarrassment, and even death.

Also, as untreated problems continue, family members develop their own issues. Partners of people who have substance use problems can suffer greatly.  Common symptoms include headaches, backaches, digestive problems, depression, anxiety, and panic attacks. Children of parents with substance use disorders can experience school behavior problems, poor academic performance, and are more likely to struggle with addiction themselves.

It is not easy to live with someone who is using mind-altering substances. Taking steps to begin treatment and recovery can be a painful process. However, it is the only path that holds promise for something better. As long as family members deny that there is a problem, the problem will progress along with suffering.

Start by getting help for yourself. Restore your own emotional stability and bring new direction and meaning to your life.  You will be better equipped to deflect crises and arguments and shift interactions with your struggling friend or family member. Getting help for yourself may seem counter-intuitive, but is crucial so you can effectively overcome the obstacles to wellness and recovery and better cope with the many problems that may emerge.

Some people find that when they seek help for themselves, the person struggling with addiction gets angry. This may be perhaps because the efforts represent a loss of control. Also, getting help signals that you are serious about changing the situation.

Some people threaten those seeking help to stop their efforts. Remain firm in your resolve to go forward and be aware of your personal safety.

It’s never too soon for you or for the person with an active addiction to seek help.

People often worry that initiating a discussion with the person with the problem will lead him or her to take drastic steps. They might make a scene in front of other family members, move out of the house, drop out of school, use more excessively, try to hide their problem, or retaliate against them or other family members. However, you might find the conversation to be a wonderfully productive experience. Perhaps the person simply hasn’t noticed behavioral changes or doesn’t realize that his or her substance use was or is causing a problem. And without change, the problems may become so severe that the same drastic outcomes could result.

Following a few guidelines will help you have a discussion:

• Don’t bring up the subject when the person is under the influence of alcohol or drugs. When people are inebriated, they are less able to understand logic and are more likely to be impatient, dismissive, angry, and blameful. Some people have poor impulse control and may act irrationally or violently if the subject is brought up while he or she is under the influence.
• Don’t be under the influence of substances yourself.
• Establish a time to talk when the two of you can have more than a few minutes alone. Your goal is to have a dialogue — a two-way conversation in which you can state your concerns and understand the person’s perception of the situation. Ask if you can set a time to speak in the next few days to discuss something on your mind. If the person responds by saying, “Now is fine,” tell them you’d prefer to set time aside and not be interrupted.
• When you meet, tell your family member or friend that you care for him or her. Emphasize that you wanted to have this conversation because you’re concerned for their well-being.
• List the behaviors you’ve observed, state that you are worried about the effect drinking or drug use is having and express concern about continued use.
• Create a two-way dialogue so the person doesn’t feel lectured or badgered and use open-ended questions.
• If the person states that there is definitely not a problem, ask to talk again at some point in the future. Your goal is not to convince the person that there is a problem, but to let them know that you believe there is one and that your belief is based on observable behaviors.
• Don’t try to speculate, explore motives, or judge. It can sidetrack you from the main point.
• Don’t expect a dramatic shift in thinking or behavior right away; this conversation may be the first time the person has thought about this problem.
• Keep in mind that there is no quick fix – prepare yourself for the long haul.

If the problem has only occurred over a short period of time or has not reached a severe stage, it is possible that the adult you care about could successfully cut back on the use of alcohol or other drugs. If the person has not tried cutting back, you could suggest this strategy as a first step. Some people in the risky stages of substance use, or even in the early stage of addiction, are able to cut back and consistently use only minimal amounts in the future.

You may find, though — as many do — that people who can cut back are the exception, not the rule. Many people try to cut down and discover that they can’t, or that they can only cut back for a few days or a few weeks before resuming heavy or excessive use. Trying to cut down and failing may help the person realize that the problem is more extensive than once thought.

You may also find that the person is able to stop completely. But many struggling with addiction have tried this strategy and couldn’t stop or remain abstinent for a significant amount of time. Ideally, the person should be assessed by a professional who can determine the best course of action depending on the severity of the problem and the person’s medical, psychological, and social history. If you sense the person is willing to consider that there is a problem, suggest that an evaluation or a consultation with a trusted medical or mental health professional. (This suggestion may be too threatening for some people during a first conversation of this kind.)

To talk with others struggling with similar issues, consider SMART Recovery Friends & Family, which offer science-based, secular support group meeting (both online and in-person) to help those who are affected by drug, alcohol, or other addictions. Al-Aanon, a Twelve-Step organization, is also a positive way to provide help family members struggling with an alcohol problem. Meetings are widely available and free of charge.

Although you probably want the substance use to stop as soon as possible, immediate abstinence from  certain drugs has certain risks including withdrawal symptoms and serious medical consequences. Many people need to be admitted to a detoxification center to help them physically withdraw.

Even if detoxification is not necessary, a formal, structured treatment program is vital for sustained abstinence. A health care professional or substance use counselor can help you and the person in need assess your options.

To encourage the person to stop, you might want to tell them ways you would be willing to help make it easier – for example, going to counseling together or providing transportation or childcare.

Friends and family members may feel that they constantly express concerns about a loved one’s substance use but never see any changes. You may have reached this point after weeks or months of giving lectures, making threats, ignoring behaviors, accepting promises of change, giving second chances, or imposing consequences.

Experts recommend developing and repeating a consistent, positive message: “We care about you and we want you to get help.” Define substance use as a problem for you and others who care about the person. Avoid blaming, arguing, and reproaching, and expect denial, distortion, avoidance, rationalization, and intellectualization of the problem.

Perhaps a friend, another family member, doctor, clergy, boss, co-worker, or other significant person in their life might be able to have an effective discussion. Or maybe the person with the substance use disorder would respond to activities you can do together, such as reviewing brochures or videos, meeting with a professional, or going to a self-help SMART Recovery or Twelve Step meeting.

DOs and DON’Ts

As you continue to try to talk to the person in need of help, please remember these important details:

• Don’t try to talk when either one of you is under the influence.
• Do protect yourself and others around you from physical harm.
• Do call police if there is violence.
• Do set limits that will protect your home, finances, and relationships and stick to those limits.

And if you are at your wits’ end, you might consider a formal intervention.

Mention the word “treatment” in relation to substance use and many people think of long-term residential facilities or detox. In fact, treatment includes both of these options — and a variety of others.

Treatment addresses the individual’s physical, psychological, emotional, and social conditions. Sustained reduction in alcohol or other drug use and sustained increases in personal health and social function are the primary goals.

The type of treatment is based on the severity of the problem. For risky people with an active addiction, treatment can be as simple as a screening and a brief intervention. For people exhibiting signs of dependence or addiction, a screening will probably lead to a referral for more intense level of care.

All treatment starts with a screening, which is a series of questions about the amount and frequency of alcohol or other drug use and the consequences it may be causing. Screening can be done by many types of professionals, including a physician in a hospital or an office, a nurse, a clinical social worker, or a licensed substance abuse counselor.

After a screening, some people may need a brief intervention, usually done by a health professional. During a brief intervention, people receive feedback on their substance use based on the screening results. Frequently, people are asked to cut back or stop their use. If they are ready to cut down, the health care professional will work with them to set a goal based on lower consumption. They may also be encouraged to reflect on why they use and how their lives will change by lowering their use. People who want to stop substance use will most likely be referred for additional evaluation or treatment.

To help someone you know who you think may have a substance use problem, you first need to get them screened. Your best bet is to talk to your own physician or employee assistance professional about referring you to someone who can help, such as a licensed substance abuse counselor or family therapist.

You may think that you need to choose just the right program for your family member and if you don’t, treatment will fail. But experts believe that any number of programs can lead to success – if the person is willing to accept help from others and invest energy in working on recovery. A physician or another health care professional can also help you choose where someone should go for treatment.

To find a treatment program, visit SAMHSA’s Behavioral Health Treatment Services Locator.