If one of your friends needed help solving a business problem, or was sick, or needed help watching the kids, no doubt you'd lend a hand; but when a friend shows signs of abusing alcohol or other drugs, sometimes it's hard to know what to do or say. Addiction is more than just a "problem" it's a medically proven disease, just like diabetes, cancer, and heart disease. And it's just as life-threatening if left untreated. While the symptoms of these other diseases are mostly physical, people with alcoholism and drug problems experience emotional and social symptoms as well, often hurting their friends, families, jeopardizing their jobs, or harming themselves. It's hard to be a friend to someone abusing alcohol or other drugs, yet this is the time when your friend needs you most. By following the suggestions offered here, you may be saving your friend's life. How to sort out your confusion about a friend's substance abuse When deciding whether to speak up to your friend, you may have some reservations, such as the following: "It's none of my business how much my friend drinks or gets high. I wouldn't want anyone telling me what to do." Think about it this way: Suppose you were in a restaurant and someone at a nearby table was having a heart attack. If you knew CPR, you'd perform it right away, wouldn't you? Or if you didn't, you'd at least try to get help. You'd do everything you could for a total stranger. Addressing a friend's substance abuse is just as critical. Many hospitalizations are due to the abuse of alcohol and other drugs. And addiction is a leading cause of death in America. So, when you talk to your friend about drinking or drug use, you may be literally saving a life, as well as helping your friend get that life back together again. "I don't want to risk ruining our friendship." Most people feel this way and are surprised to find out that the opposite happens. Often people who abuse alcohol or drugs are secretly hoping someone will talk to them honestly about their problem. "My friend drinks a lot, but at least there are no drugs." Though legal, alcohol is a drug, and for someone with the disease of addiction, it is just as devastating as illegal drugs. In fact, many health officials believe it is the most abused drug in America. Also, for an alcoholic, it doesn't matter if the drink of choice is "light" beer, wine or scotch; any alcohol will cause trouble. "How do I make sure I say the right thing? I don't want my friend to get angry, or to feel hurt." It's never easy to talk about something as sensitive and personal as drinking or drug use. And when you do, you'll probably put your friend on the spot or cause hurt pride. Your friend may even become angry. But focus on the behavior and consequences, not the person. "I'm sure my friend's family would say something if it were that bad. I'm only a friend." If your friend's drinking or drug use has gone on for some time, family members may not have noticed that it's gotten worse or they may have learned to ignore it to protect themselves. One of the tragedies of alcoholism and drug abuse is the incredible adjustments family members make to cope with this disease. Also, your friend may be hiding drinking or drug use from family members. Or drinking or drug use may be an accepted way of life in the family, so no one thinks there is a problem. As you can see, sometimes families are the least able to offer help. As a friend, you may have far greater impact—especially since most people prefer to confide in a friend when they have a problem. How to tell if your friend has a problem with alcohol or other drugs Addiction is a confusing disease. Contrary to popular myth, your friend doesn't have to drink or use drugs every day to be addicted. Someone with the disease may still have a good job, home and bank account and be a good spouse, parent, or friend. Different people react to alcohol and drugs in different ways. One may get loud and funny while another gets quieter than usual. Some are able to drink and use drugs in large quantities and act normally, while others experience acute personality changes after even a small amount of alcohol or drugs. Remember, it's not how much your friend drinks or uses drugs, but what the effect is. If your friend is having problems related to alcohol or other drugs, he or she needs help. And your friend does not have to show all or even most of the symptoms to be in trouble. Nor does your friend have to be a daily drinker or drug user to need help. Many alcoholics and addicts follow a pattern of binges on weekends or several times a month. If your friend shows these symptoms but doesn't seem to drink or use very much, he or she may be drinking or using in secret or may be "cross-addicted" to both alcohol and prescription or illegal drugs. You may see the drinking, but not the drug use. There may be abuse or addiction if your friend: Has been drinking or using drugs more than usual, even if usage has increased slowly over the years Periodically "goes on the wagon" or switches from liquor to beer or from cocaine to another drug Only goes to parties or places where alcohol or drugs are available Has a personality change when under the influence of alcohol or other drugs Drives after drinking or reacts angrily when you ask for the car keys Sniffs constantly, has frequent colds, or makes many trips to the bathroom Calls late at night but doesn't remember the conversation the next day Brags about drinking and drug exploits or, if you don't approve, is secretive or withdrawn Has trouble on the job or loses time from work Has problems at home Spends more time with friends who drink and less time with you Has a couple of drinks before you even get together or doesn't show up on time or at all Complains about other people or stops seeing certain friends Has money problems, borrows money from you, or runs up a lot of charges on credit cards Has legal problems How to talk to your friend Don't try to talk when your friend is drunk or high; it's too difficult to take in what you're saying, and the situation could turn out badly. Don't worry if you don't say things perfectly. The scenarios below are just guidelines. The most important thing is that you express your concern for your friend in a caring and honest way. How to get the conversation started Anytime you can talk to your friend when he or she is clearheaded is fine. One approach is to sit down the next day when your friend is hung over and remorseful or soon after, while the drinking or drug-related incident is fresh in your friend's mind. But if you can't get to your friend right away, that's okay, too, since you're not talking about an isolated incident but one in a long pattern. You might want to take someone with you who understands your concern for your friend's problem, perhaps someone with a connection to Alcoholics Anonymous (AA) or a similar group. Or you could tell someone what you're doing and have him or her available by phone for support. It is also a good idea to meet on neutral turf, but not in a bar or where alcohol is available. Keep in mind these key points No matter how "bad" you friend's behavior has been lately, the person is not bad. He or she may be suffering from a medically proven disease that causes abnormal action, including hurting the people closest to him or her. So don't blame or criticize. You're talking because you care about your friend's life and health, not to make someone "get their act together." Be specific when you talk. Bring up incidents such as "When you cancelled our plans the other day" instead of "You never keep your word." And use "I" phrases, such as "I noticed" or "I'm worried," since your friend can't argue with your feelings. Talk about the effect your friend's drinking or drug use has on whatever he or she cares about most: career, children, sports, etc. Your friend may not be concerned about his or her own situation, but may care deeply for the children and what the problem may be doing to them. Everyone has different levels of friendship: good friends, casual friends, and co-workers. You might want to write down what you want to say. Here are some "opening lines" to help you approach each type of friend in the most appropriate way. Of course, your friend can respond in any number of ways besides the few examples given. The main thing is to listen, stick to the facts, show caring attitude and offer to help. Helping a good friend "You know, Barb, we've been friends for a long time now, as close as sisters. And, while I don't want to interfere with your life, I have noticed that you're drinking and getting high more lately, and you don't seem to be getting along with your family as much as you used to. I'm worried about you. Let's talk about it." If Barb says: "You know, you're right. I have noticed that I've been drinking more in the last couple of months. But I think it's because I've been under more pressure than usual at work and at home. It's probably just a phase. I'm sure I'll snap out of it soon." You can say: "I know it appears a drink or two can take the edge off temporarily. But drinking can't solve your problems, and from what you've told me, they seem to be only getting worse, maybe because you're drinking more. A professional assessment will help you find out if drinking is the problem or if it's something else." Helping a casual friend "Jim, I've always enjoyed playing cards with you. But after a couple of beers, I see a personality change, and there are arguments. It's not like you. You usually get along with everyone except when you're drinking. I'd hate to see you lose your friends." If Jim says: "Who are you to tell me I drink too much? We all have a few when we play cards. And the words I had with Al and Walt were no big deal. I just got a little hot under the collar." You can say: "Jim, I don't count how many drinks you or anyone else has. I've just noticed that at some point in the evening, after you've been drinking awhile, I see a more argumentative side of you. I don't want to see you destroy your relationships with people who care about you. So I thought I'd mention it now because I'm your friend and I want to help." Helping a coworker "Barb, you're one of the brightest people I know. But recently, you've been missing a lot of work and coming in late. And this week, my report got held up because I didn't have your input. You don't seem to be yourself. I know you've been drinking (or using drugs) a lot. If you're having a problem with alcohol, drugs, or anything else, I'd be happy to help you get the assistance you need. I'd hate to see you lose your job." If Barb says: "Hey, I know I've been a little out of control recently, and I have been partying more than usual, but don't worry. I'm working on getting my act together." You can say: "Well, I hope you do. But sometimes it's hard to get your act together by yourself. So if you need any help, I just want you to know that I'm here and I'll listen. I value your friendship and will do anything I can." What to do if your friend isn't ready for help Don't be surprised. Denying that there is a problem or that drinking or drug use is the cause of it is one of the unfortunate symptoms of the diseases of alcoholism and drug addiction. So if you feel you're not getting through to your friend, it's not your fault or your friend's fault. Don't take it personally. The only thing you can do is back off and let your friend know that when he or she is ready for help, you'll be there. You could also give your friend the phone number of a local AA group. But don't despair. And don't think you didn't present your case. You have planted a seed of recovery that may grow when you least expect it. Stay in touch and know that there are ways to show your concern. For example, if your friend only wants to meet where he or she can drink, suggest another place. Don't offer alcohol when your friend visits. Don't continue to lend money if that's an ongoing problem. Don't accept late-night calls when your friend is drunk or high. If your friend is ready for help Your friend may have been secretly hoping someone would notice the problem and reach out to help. Maybe others along the way have said they're concerned about it. And now your friend is ready to get assistance. How can you help? Before you meet with your friend, call the local numbers for AA or Narcotics Anonymous (NA) in your area to get a schedule of meetings. If your friend readily admits to having a problem and wants to do something about it, offer to provide a ride to a meeting or to set up a contact in AA or NA. If your friend hesitates or says he or she drinks a lot but doesn't have a problem, suggest a formal assessment by a professional who is trained and knowledgeable about substance abuse. You may also want to talk with someone at a treatment center so you can have the name of a place handy if your friend feels outpatient or residential care is needed. If your friend decides to call a treatment center, offer to be there while the call is made, and if possible, take your friend to the center. How your friend's recovery process can affect your relationship During the early months as the recovery process begins, your friend will be going through a lot of changes. Although your help may be appreciated, your friend may be spending a lot of time at support group meetings and making new friends who are also in recovery. This is a normal phase, but it can hurt to feel as though you're losing a friend—especially one you went out of the way to help. Usually though, over time, many recovering people resume their former friendships—and bring more to them than ever before. Whatever happens, you can feel good knowing that you took the actions a good friend should take. By talking honestly with your friend, you may have saved a life and have definitely made it worth living again. What to do if you live with or are emotionally involved with someone who abuses alcohol or other drugs You first need to take care of yourself. Living day in and day out with someone close who has a problem with alcohol or other drugs can be a difficult, heartbreaking or even dangerous experience. Don't try to handle it alone. You can get the support you need at Al-Anon Family Groups. For information, call your local Al-Anon number in the phone book. In addition, many treatment centers and substance abuse professionals have special programs for friends and family members.