Listen for “Change Talk”

So, how does a willingness to get help reveal itself? It usually comes in the form of “change talk.” Change talk is any time your loved one voices a concern over the way things are, or expresses a desire to improve his or her life in some way. Do any of these examples of change talk sound familiar?

“I’m really feeling depressed that I don’t have a decent job.”

“I think I really upset Jack [a friend] last night when he thought I had one too many.”

“I want to move out and have my own place.”

“I wonder if I should go back to school.”

When a loved one expresses change talk, take notice and help him or her connect the dots. Compassionately explain how their substance use is related to their concerns in the present and their hopes for a better future.

Consider the following contrasting dialogues between a parent (P) and young adult (YA) who is struggling with substance use, can’t get a job and wants to be independent.

YA: I really want to move out and have my own place.

P: How many times have I heard that? You need to get a decent job.

YA: Yeah, I know, but no one’s hiring.

P: You mean no one is hiring that doesn’t want a drug screen. When are you going to figure out that employers don’t want stoners? If you’d only get your act together and stop smoking, your life would be so much better. You know, you really ought to go to rehab.

YA: That’s ridiculous! It’s not that bad.

P: Not that bad? You’re stoned right now. You’d better figure it out pretty soon because your father isn’t going to put up with you not contributing and you’re going to find yourself out on your ear.

YA: I have to go. There’s no point in talking to you about anything.

 
Now consider the following exchange which begins with very similar change talk.

YA: I really want to move out and have my own place.

P: I know you’ve wanted your own place for quite some time. What do you think is holding you back?

YA: I can’t get a decent job that pays enough.

P: What have employers told you when you’ve applied?

YA: They all want drug screens. That’s BS in my opinion. I mean why should they care that I smoke some weed and do a little cocaine now and then.

P: So, you want a good job and your goal is to move out, but your drug use is getting in the way.

YA: Yeah, that about sums it up.

P: What are your thoughts about getting a consultation to see what kind of help might be available to cut back, or quit for at least a while so that you can get a better job?

YA: I don’t know… maybe.

P: Why don’t you think about it and let’s talk about it again in a day or so.

YA: Ok.

What can we take away from these conversations?

There are several key differences to note. The second exchange remains a respectful conversation without becoming confrontational by using techniques like open-ended questions that lead the young adult to reach his or her own conclusions. The parent likely knows that drug use is at the root of their child’s unemployment, but draws it out of him or her without belittling or judgment.

And the timing of this kind of conversation is important. While it’s useful to let a loved one’s change talk open the door to this type of conversation, it’s counterproductive to do so when they’re under the influence, racing out the door, overly tired or might otherwise feel interrupted.

Note that in the second conversation, the parent suggests “getting a consultation” rather than demanding, “You have to get treatment” or “You have to go to rehab.” Treatment comes in a range of options and it’s helpful for your loved one to have some degree of input and choice. This could be at the level of treatment (for example, your loved one may agree to attend an intensive outpatient program, but won’t agree to residential treatment) or within a treatment level (for example offering that a loved one could make a choice to attend ABC outpatient program or XYZ outpatient program.)

In addition, even though abstinence may be the ultimate goal, it can also be effective to suggest that a loved one consider treatment in order to “cut back” on substance use. Once in treatment, they’ll have an opportunity to examine whether they can moderate and still meet personal goals.

Incentives and Leverage

Some parents choose to use incentives or leverage to get their teen or young adult into treatment. An incentive ties treatment to something a loved one wants. For instance, “If you complete treatment and remain abstinent, we will help you with a deposit for a halfway house or apartment.”

Leverage usually involves taking something of value away. For example: “If you don’t go to treatment, we won’t cover any more of your expenses like tuition or rent.” Sometimes leverage takes the form of disclosing substance use to someone of significance including a probation officer, coach or significant other. Choosing to use leverage in this way should be done as a last resort and with caution, as often loved ones will react defiantly, and the situation could get worse. It helps to present any leverage in a loving way and to give your teen or young adult a week or two to think about it before going through with whatever you’ve decided.

A conversation using leverage might begin as follows:

“I continue to be concerned about your substance use and would like you to seek a consultation on how to manage your substance use (or go to counseling, an intensive outpatient program, residential treatment, etc…) I know this is something you’ve been opposed to in the past, but the current situation is difficult for all of us and I’d like you to reconsider. If you choose not to seek treatment, I will not pay for college this upcoming semester (or you will have to find alternate housing, lose privileges for the car, etc…) I’d like you to think about it and let me know what you decide by the end of next week.”

 
This is in contrast to “I’m sick and tired of your substance use so either go to treatment or you won’t not see a nickel from me for college. What’s it going to be?”

Interventions

Intervening — that is, stepping in and speaking up — is a vital first step in taking action to address a loved one’s substance use. However, media and pop culture have popularized the notion of an intervention as a scenario in which family and friends gather around a loved one to share the impact of the loved one’s substance misuse, usually followed by an ultimatum: go to treatment or else. The “or else” can include cutting the loved one off financially, asking him or her to leave the home and cutting off all communication unless the loved one agrees to treatment. The success rate of this style of intervention is lower than using other evidence-based approaches like Community Reinforcement and Family Training (CRAFT), and claims to the contrary are generally limited to getting someone into treatment, with no measures related to the successful completion of treatment.

Hurry Up, Now Wait

Helping a loved one reach the point of being willing and ready to engage in treatment is an important milestone. In some areas, however, there are extensive waitlists for treatment services. We understand the frustration and added challenges this can cause. If you find yourself in this situation, consider calling your state’s Department of Human Services and your state’s Department of Mental Health & Addiction Services to see if they can direct you to treatment programs that could be helpful. Recovery centers, Angel Programs connected to law enforcement and word-of-mouth at 12-step and support group meetings can also provide suggestions as to where to get treatment more quickly. In some cases, simply being persistent and calling a facility on a daily basis can help your loved one move up on the waitlist.