Why Share Your Concerns About Addiction If a friend, loved one or colleague became ill, you wouldn't hesitate to offer your help and support. But what if that same person showed signs of a drinking problem or drug abuse? Would you step in as quickly to offer help? Would you know what to do or say? Addiction is a medically diagnosable condition, clinically known as "alcohol use disorder" or "substance use disorder." Like other chronic diseases such as diabetes, hypertension or asthma, addiction can be life-threatening if left untreated. Alcoholism or other drug addiction impacts physical health, mental health and behavioral health—and it's often the behavioral aspects of the disease that can be most apparent and troubling to friends and family. That's because people who are actively addicted can behave in ways that hurt their loved ones, jeopardize their jobs, or cause injury or harm to themselves. It's hard to be a friend to someone who seems to choose alcohol or other drugs above all else, but if you have a friend in this situation, she or he probably needs your help more than ever. What's Holding You Back from Helping? When deciding whether to speak with a friend or loved one about their substance use, it's normal to feel apprehensive. These are not easy conversations to initiate, but they can be lifesaving. Here are five things you might be telling yourself about your friend's situation—and why it's important for you reach out anyway. "It's none of my business how much my friend drinks or gets high. I wouldn't want anyone telling me what to do." Suppose you were in a restaurant and someone at a nearby table was having a heart attack. If you knew CPR, you would perform it right away, wouldn't you? Or if you didn't know CPR, you would try to get help, right? Addressing a friend's substance use problem is just as critical. Addiction is a leading cause of death in America, and many hospitalizations are due to drug or alcohol abuse. By reaching out and talking with your friend about alcoholism or drug use, you could be literally saving his or her life. "I don't want to risk ruining our friendship." Many people fear damaging their relationship by raising the issue of addiction, but—in reality—the opposite is more likely to happen. It's not unusual for people with addiction to secretly hope a friend or loved one will open the door and ask about their situation. "My friend drinks a lot, but at least there are no drugs." Compared with the level of alarm you might feel if your friend were using heroin, methamphetamine, cocaine or other illicit substances, there is a tendency to minimize the dangers of alcohol abuse. Though legal and socially acceptable, alcohol is an addictive drug. According to the Centers for Disease Control and Prevention, excessive drinking is responsible for one in ten deaths among working-age adults today. "How do I make sure I say the right thing? I don't want my friend to get angry or to feel hurt." Even with a close friend, it's not easy to bring up something as personal and emotional as problematic substance use. You don't want to put your friend on the spot or hurt their pride. Your friend may even become angry. That's why it's important to be nonjudgmental in your approach and to keep the conversation focused on the behaviors and consequences you've seen that are related to your friend's substance use. "I'm sure my friend's family would say something if the situation is so bad. I'm only a friend." If your friend has been a drinker or drug user for some time, family members may not notice the extent of the problem (especially if your friend has taken measures to hide their substance use from family members). Some families try to cope or protect themselves by ignoring the situation. One of the tragedies of alcoholism and drug abuse is the chaos and pain it causes families. Another consideration: Heavy alcohol or drug use is an accepted way of life in some families, so family members could be the last to recognize the need to seek help. How to Tell If Your Friend Has a Substance Abuse Problem Addiction is a confusing disease. Contrary to popular myth, your friend doesn't have to drink alcohol or use drugs every day to be addicted. People in active addiction can have good jobs, homes and bank accounts, and they can be good spouses, parents or friends. Alcohol and other drugs affect people in different ways. A mood- or mind-altering substance that makes one person loud and outgoing can have the opposite effect on another person. Some individuals are able to drink or use drugs in large quantities and appear to act normally, while others experience acute personality changes after using even a small amount. So, keep in mind that addiction is not about the quantity of a substance used as much as the effect of that substance. If your friend is experiencing negative consequences related to the use of alcohol or other drugs, he or she probably needs help. In addition to any negative consequences you are noticing with your friend, here are several common signs of substance abuse: A noticeable increase in drinking or other drug use (more than usual) Periodic attempts to "go on the wagon" or to switch from liquor to beer, or from cocaine to another drug Interest only in going to parties or places where alcohol or other drugs are available A change in personality when under the influence of alcohol or other drugs Drives when under the influence (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 or drugging exploits or, if you don't approve, is secretive or withdrawn Trouble on the job or frequent work absences Difficulties at home Spends more time with friends who drink and less time with you Drinks before you 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 credit debt Has legal problems Another important consideration: If your friend shows some of these symptoms but doesn't seem to drink or use very much, he or she may be using substances in secret or may be "cross-addicted" to both alcohol and prescription medications or illegal drugs. You might be seeing the alcohol use, for example, but not the drug use. When to Talk with Your Friend Timing matters when dealing with 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 escalate. Instead, talk with your friend when he or she is clearheaded. One approach is to reach out when your friend is hungover or remorseful following a drinking or drug-related incident—when the negative consequences are fresh in your friend's mind. If you can't meet with your friend right away, that's okay—in any case, you will want to bring up a whole pattern of events that you've noticed rather than an isolated incident. How to Get the Conversation Started Don't worry about saying things perfectly. Expressing your concern for your loved one in a caring and honest way is the most important message you can convey. 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 with your friend on neutral turf, but not in a restaurant or bar or where alcohol is available. Key Points to Keep in Mind Be supportive. No matter how "bad" your friend's behavior has been lately, he or she is not a bad person. Addiction is a disease, and it's been recognized as such by the American Medical Association since 1956. So don't blame or criticize. You're speaking up because you care about your friend's life and health, not to make them "get their act together." Be specific about what you're seeing. Bring up particular incidents such as, "When you cancelled our plans the other day" rather than sweeping statements such as, "You never keep your word." It's also helpful to frame the conversation by using "I" phrases, such as "I noticed" or "I'm worried" because your friend can't dispute your perceptions and feelings. Be encouraging. 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 his or her children, for example, and the impact on them. Be prepared. You might want to write down what you want to say, and that could vary depending on the level of your friendship: close friend, casual friend or coworker. Here are some ideas for "opening lines" to help you approach each type of friend in the most effective way. Of course, your friend could respond in any number of ways besides the few examples given. The main thing is to listen, stick to the facts, show a caring attitude and offer your assistance and support. What to Say to a Close Friend or Loved One "You know, Barb, we've been friends for a long time now, as close as sisters. And, while I don't want to meddle, I've 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, things seem to be getting worse, maybe because you're drinking more. A professional assessment by a counselor or therapist can help you figure out if you're dealing with alcohol addiction or what else might be going on with all of this stress you're experiencing." What to Say to a Casual Friend or Acquaintance "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." What to Say to a Coworker or Colleague "Chris, 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 Chris 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, please 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, and don't take it personally. Denial is one of the unfortunate symptoms of addiction. So if you feel you're not getting through to your friend, it's not your fault or your friend's fault. It's okay to back off and let your friend know that whenever 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. By raising the issue with your friend, you've planted a seed of recovery that could grow when you least expect it. In the meantime, stay in touch and continue to show your concern and support. 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. What's Next If Your Friend Is Ready for Help Before getting together with your friend, contact AA or Narcotics Anonymous (NA) to get a schedule of meetings in your area. That way, if your friend readily admits to having a problem and wants to do something about it, you'll be prepared with meeting dates and locations. You could even offer to provide a ride to a meeting or connect your friend with an AA or NA contact person. If going to a meeting seems like too big a first step to your friend, suggest an assessment by a counselor, physician or mental health professional who is knowledgeable about substance abuse and sobriety. You may also want to call a local outpatient or inpatient treatment program to learn about services and options. If your friend wants to know more about going to an addiction treatment program, offer to be there when he or she calls for more information. How Might Your Friend's Newly Sober Life Affect Your Relationship Especially during the first few months of recovery, your friend will be making significant life changes. Although your help may be appreciated, your friend will likely need to focus on attending support group meetings, establishing healthy new routines and making friends with other alcoholics or addicts who are in recovery. This is an intensive and normal phase of early recovery, but it can hurt to feel as though you're losing a friend. Usually though, over time, many recovering people resume friendships—and they are able to bring more to the relationship than ever before. What to Do If Your Partner or Family Member Abuses Alcohol or Other Drugs First, it's important to take care of yourself. Living day in and day out with a partner or family member who has a drug or alcohol problem can be a difficult, heartbreaking or even dangerous experience. You can find support, answers and resources through Al-Anon, a mutual support group for people affected by a loved one's addiction. Many treatment programs and substance abuse professionals offer support and education for friends and family members, too.