Someone you care about is struggling with addiction, clinically known as substance use disorder. Loving someone with drug addiction or alcoholism can make you feel alone and an overwhelming amount of pressure to get them into treatment immediately.
The recovery process is complicated for families, friends and significant others all around the world. And while it may feel like inpatient or outpatient rehabilitation is the only option for immediate help (or help at all), your loved one’s decision to not enter into treatment doesn’t mean that hope is lost. Even more, it doesn’t mean you’ve failed in any way.
So, where do you go from here? How do you help someone struggling with addiction who doesn’t want help? We’re answering some of the most common questions asked by people in the same shoes, looking for the same answers—how do I help someone I care about if they won’t get treatment?
When someone is struggling with alcohol use or drug use, they may be ready to fully acknowledge their addiction struggle, but aren’t ready to seek treatment. Others aren’t willing to seek treatment because they haven’t yet come to terms with their addiction.
Let’s break those down into two categories so you can better approach your loved one:
As you watch the person you care about battle addiction, it’s understandable to believe you know what’s best. You may even feel strongly about getting them into treatment because you recognize the risks if they continue on their current path, and know they can take steps to interrupt their addiction and head toward recovery.
Your expectations, your motivations for wanting to get them help, your plan—these good intentions may not align with your loved one’s expectations, motivations or current plans.
Rather than approaching the conversation with ultimatums, try meeting your loved one where they’re at by being willing to get curious. Ask the following questions to tune into their perspective and help deepen your connection:
Listen to their responses to discover where their apprehensions for treatment are coming from. Acknowledge their thoughts and feelings to help keep their defenses lowered. Engaging them in a safe conversation will increase the opportunity that they’ll consider what you’re asking them to do or potentially make small changes with a few first steps.
Here’s an example of just one way the conversation might go after someone refuses treatment:
Substance user: “I don’t want to go to rehab. And you can’t force me to do something I don’t want to do. It's my decision!”
Support person: “That's true. I understand going to treatment isn't something you want to do right now. Would you be willing to talk to Dr. Smith about your addiction? What if we go to the local AA or NA support groups together? Or I can drop you off.”
Presenting an end-all-be-all care plan often leads to more adamant refusal. It’s important to instead reinforce small, positive changes. Even the smallest step in a healthy, positive direction can result in more positive outcomes.
It’s common for people struggling with addiction to believe they don’t need help. Clinically, we call this the pre-contemplation stage. The substance user does not recognize that there is a problem, so why would they change their behaviors?
When your loved one is in this stage, it’s important to offer positive support. For many family members or significant others, this isn’t a natural response. Guilt, bribery, threats, pleading—these are the instinctual responses often used to try and help those facing addiction see the light, recognize they have a problem and be forced into help. Unfortunately, the more persistent you are with this approach, the further invested your loved one can become in not seeking help.
At Hazelden Betty Ford Foundation, we incorporate the CRAFT (Community Reinforcement and Family Training) approach to encourage mindful and intentional positive changes. This evidence-based method uses positive communication as a cornerstone for helping family members and friends who have loved ones struggling with addiction.
When compared to only attending Al-Anon family groups or performing an intervention, people trained in using CRAFT were consistently able to get their loved ones into treatment roughly 66% to 70% more often.
Even with the CRAFT method, it’s critical to choose your timing carefully. Seek out moments when your loved one isn’t in the middle of a crisis and is less likely to feel bombarded. Also, focus inwardly on your own emotional state by asking yourself these questions:
Are you prepared to have this conversation?
At this moment, can you have a positive discussion about this difficult topic?
Are you in a headspace to remain calm, no matter your loved one's reaction?
Calmness is contagious. If you’re mentally prepared for the discussion, your chances for a clear, productive conversation will increase.
If your loved one refuses treatment, it’s important for family members, friends and other support systems to maintain positive communication. When working with families in similar situations, our clinicians recommend the book Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening by Robert J. Meyers, Ph.D. and Brenda L. Wolfe, Ph.D.
This book recommends using positive communication guidelines (acronym PIUS) to promote healthy relationships and make treatment an attractive option for your loved one through calm, positive dialogue.
Here's what PIUS stands for:
P: Whatever it is you want to say to your loved one, say it in the most positive way. For example, take a statement like, “You never listen to me” and make it more positive by instead saying, “I want us to be able to communicate openly with each other.”
I: Take accountability for your feelings using I feel statements. For example, I feel scared, sad, lonely, and so on.
U: Express understanding of your loved one's perspective, thoughts and feelings. Test it out by asking yourself if your loved one would agree with your statement. If they wouldn't, revise it to create a safe space.
S: Share responsibility or offer a solution by showing your loved one that you're willing to consider your own role in the situation, and are willing to help them in a way you are comfortable with.
This helps lower their defenses, and invites them to consider their role as well. For example, “I recognize that my nagging hasn’t helped your situation. I’m willing to listen to your perspective without judgement.”
When a loved one says they’re not ready or willing to seek help, you can feel an overwhelming array of emotions from disappointment to frustration, sadness and anger. However, maintaining calm, meaningful conversations will expand your relationship and further open up that safe space your loved one needs to begin making positive changes.
Your motivations for wanting your loved one to seek treatment are likely different than the motivations that would encourage them to accept help. Try to separate the two by guiding the conversation. For example:
Substance User: “I’m so sick of having hangover anxiety. I can’t remember what I did or said the night before and it’s embarrassing.”
Support Person: “I understand and that really makes sense to me. It sounds like you’d feel relieved if you didn’t have to worry about what you did or said the night before.”
As you get a peek at their treatment motivators, continue offering those smaller steps and be flexible about where they’re willing to start. While there’s proven strength in inpatient and outpatient rehabilitation, it isn’t the only treatment option that sets those struggling with addiction on a path to recovery. Any positive action deserves encouragement and support.
Let their “no” be the beginning of the conversation, not the end.
It’s common for those battling addiction to refuse treatment time and time again. And it’s OK if they’re not ready right now. The truth is, you don’t have control over anyone else. You can’t make someone else accept help.
Take a breath. Take a step back from the situation and take a moment to give yourself space for self-care. As a support person, self-care is crucial. The trauma you endure often requires professional care and attention, such as:
No matter how often your loved one refuses treatment, your previous attempts weren’t wasted time and energy. It may not feel like it right now, but you are one of the most influential people in your loved one’s life. Every positive interaction is forward momentum and you’re doing a good job—even when they turn help down. Remember, you can approach your loved one again when the time is right.
As a support person, you only have control over your response. It’s your responsibility to remember your response ability. Meaning, that the only thing you can truly manage in this challenging process is how you respond to the people in your life.
Engage the change process. Hold meaningful, caring conversations. With CRAFT, including the PIUS approaches mentioned above, you can help your loved one feel safe, supported, heard and more open to future discussions on the topic. And as a support person, that’s enough. You are enough.