Understanding Substance Use
You just found drugs in your teenager’s bedroom. Your sister has relapsed. Your partner arrived home drunk for the third time this week. In any of these scenarios, you are likely to feel frightened, worried, or angry. All of those would be understandable feelings. However, it is what we do next that can have a big impact on the person you care about and yourself.
Historically, we have been taught to use the tough love approach or begin scheduling a dramatic intervention. This often results in shame and judgment, even if that is not what was intended. Frequently, these approaches backfire or are just simply ineffective. Subsequently, there is often anger and resentment on both sides, which does not help anyone involved.
Sometimes the simplest answer is the right one. A conversation. A conversation in which the goal is not to change or instruct, but rather to understand.
In Chasing the Scream, Johann Hari discusses his own relationship with a family member with substance use. He speaks of how he worked to be more open, less shaming in his approach and states, “I didn’t threaten to sever the connection: I promised to deepen it.”
When to talk
Timing is often a key indicator of whether any conversation will be successful. Do not try to have this conversation when someone is clearly high or drunk, in withdrawal, or severely hungover. It is best when both of you are feeling stable both mentally and physically. Sometimes that might mean the conversation needs to wait a bit, but better to wait and have it go well. Make sure you are in a private, comfortable area and have adequate, undisturbed time to have the conversation.
Setting the tone
It has been drilled into our heads that drugs are bad, period. That mindset, while common and understandable, often creates a barrier to understanding. Try to withhold any judgment and focus on listening to them. Rather than being focused on a specific outcome, for example, “I’ll convince them to go to treatment” or “I need to try to make them see how this is hurting them”, let increasing understanding be the goal.
Strategies for good conversation
We often just talk without really thinking about it, especially around people we are comfortable with. However, by making a few adjustments, we can help increase the chances that this conversation will be successful.
1. Body language: a rigid, tight posture with arms crossed a furrowed brow do not necessarily invite people to talk about hard things. Try to relax your body, your face, and your mind.
2. Active listening: demonstrate you are hearing what the person says to you. Nod, use reflective statements, ask for clarification.
3. Open-ended questions: you want to minimize questions that result in yes or no answers. Questions that begin with who, what, when, where why, how, generally produce more in-depth answers and often sound less judgmental. For example, “how do you feel when you drink?” versus “are you drunk?”
4. Manage your reactions. You may not like what you hear and some of what you hear may be upsetting or confusing. Try to focus on taking it in and not getting angry or upset in the moment. Having a big reaction may shut down the conversation sooner than you wanted and decrease the likelihood of future talks.
Consider spending some time thinking about what you would like to know about their experience and how you might be able to ask some of your questions.
Questions and prompts that could be helpful
· What does it feel like when you are high/drunk?
· What do you like about cocaine (or whatever their substance is)?
· When do you most feel like you want to use?
· What downsides do you see to your use?
· How do you feel when you don’t use/drink?
· What steps are you taking to keep yourself safe?
· How are drugs/alcohol helping meet your needs?
· How can I support you through this?
· Your substance use frightens me, please help me understand it better.
· I know I got angry before, but I am ready to listen.
The end of the conversation
Whether or not it went well, thank them for sharing. It is not easy to talk to other people about substance use, so thank them for trying. Ask them if it would be okay to talk again later. If they did identify some help or support that they are ready for, make a plan to follow up. Invite them to come to you anytime if they want to talk again.
Taking care of yourself
If you can, plan to meet with a friend or family member soon after so you have a chance to process your feelings about the conversation. Give yourself some time and space to consider your own needs and determine what boundaries you need in place while supporting your loved one.
If you need your own support, Substance Use Therapy is available. Whatever you are facing, you do not have to face it alone.
“The opposite of addiction isn’t sobriety. It’s connection. It’s all I can offer. It’s all that will help him in the end. If you are alone, you cannot escape addiction. If you are loved, you have a chance.”
-Johann Hari, Chasing the Scream
Hari, Johann. (2015). Chasing the Scream: The First and Last Days of the War on Drugs. Bloomsbury Publishing.
O’Connor, P. (2021, May/June). Empathy Over Ambush. Psychology Today. 54(3), 34-35
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, gambling, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.