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Mental Health Matters

Helping Addicted Loved Ones

By Ron Fagan, LMFT

Many of us have had friends or loved ones who we feel have alcohol or substance use problems, but despite our pleas, they are unwilling to acknowledge the problem, let alone do something about it. The most common explanation is that they are "in denial" and they have to "hit bottom" before they are willing to change. But there are things you can do to help people before they ruin their lives. Seeking help is influenced by psychological, social, and economic incentives and barriers.

Research shows that people trying to modify addictive behaviors typically move through a series of five stages from not feeling their substance use is a problem (precontemplation) to beginning to think about their problem (contemplation, preparation for change) to doing something to overcome their problem (action, change maintenance). Where they are in this cycle influences their willingness to change and how they will respond to different types of intervention. When confronted by loved ones, the courts, and/or employers about their use, most substance users are in one of the first two stages.1

Therefore, what can you do to help a friend or loved one who is at one of these early stages? People in the first two stages either truly do not feel they have a problem or, at best, are ambivalent about their situation. Even those who are at the third stage, are often only saying things like "I cannot go on like this," but can have little idea what they need to do to address their problems. Rather than trying to "break through the resistance" by confrontational tactics (such as getting the person to admit he/she/they are an addict) a positive, non accusatory approach may be a better place to start. One tactic psychologists and doctors use is called "motivational enhancement," which seeks to rev up a person's internal desire for change. A therapist might ask a person, for example, what benefits they would experience with reducing or eliminating their use.2

I have found that one of the best early strategies is to acknowledge with the person any ambivalence they may be feeling about their use. Remember it is very difficult for most people to give up something they know, no matter how distressing, to travel to an unknown place where they are being asked to give up some control. While you can give feedback about the negative consequences of their use for you and the people around them, if you only focus on the negative aspects of their use, most substance abusers will be equally adamant about the positive benefits.

Too often people communicate a double message to the substance abuser. They say: "you need to change," but at the same time they communicate, "but I am not very confident you can change." It is important for you to communicate to such persons that you sincerely believe they can make meaningful changes in their lives and you will help them in any way you can to remove any barriers to getting the help they need.

Your goal should be to gradually help the person shift their primary focus from the perceived benefits of use to more of the negative consequences of continued use. I have found that a very effective strategy is to discuss their life values and goals and how substance use may be compromising some of these aspirations. Sometimes they need to hear, "On one hand you say you do not have a problem in controlling your substance use, but on the other hand your use has had these negative consequences."

The person needs to get a consistent message that while you may need to do things to protect yourself and others from the negative consequences of their use, you care about them. Express to them that you are concerned, are willing to help in any way you can but ultimately it is their responsibility for deciding to make or not make changes.

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About the Author

Ron Fagan, PhD, MA, LMFT, was formerly a Professor of Sociology at Pepperdine University and currently a Llicensed Marriage and Family Therapist practicing in California. He has extensive experience and he has published numerous articles on substance abuse treatment. Dr. Fagan can be contacted at (310) 506-4818
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1Edie Weinstein, MSW, LSW on January 26, 2015 in Living Sober, Taking Care of Yourself