Helping a family member with a substance use problem

When someone you love has a problem with alcohol or other drugs, the whole family feels it. Spouses, children and parents often have stress, worry, poor sleep, and health problems of their own.¹ You may feel angry one day and heartbroken the next. That is normal.

You cannot make another adult change. But what you say and do can make treatment more or less likely. This page explains the approach with the best research behind it, what tends to help, what tends to backfire, how to prepare for an overdose, and how to look after yourself.

Start with understanding, not blame

Addiction changes the brain's reward and decision systems. That is why a person may keep using even when it hurts them and the people they love. A substance use disorder is a medical condition, and treatment works. Many people with alcohol use disorder do recover.⁴

Words matter. Say "your dad has an alcohol problem" or "a person with a substance use disorder." Avoid labels such as "addict," "alcoholic" or "junkie." Labels shame people and make them less likely to talk to you.³ To learn the signs, see signs of a substance use problem.

What is CRAFT?

CRAFT is a skills program for family members and friends. It was built for the very common situation where your loved one does not want treatment. The goals are to help your loved one start treatment and to protect your own well-being.²

CRAFT teaches you to:^1,2

• Reward times when the person is not using, with warmth, time together and thanks.
• Stop shielding the person from the natural results of using, such as covering for missed work.
• Talk in a calm, positive way, and make clear, specific requests.
• Choose a good moment to bring up treatment, and do it kindly.
• Build your own supports and take care of yourself.
• Plan for your safety if the person can become angry or violent.

How well does it work?

In earlier studies, about 17 to 30 out of every 100 loved ones started treatment when families used older approaches. These included a program of joining Al-Anon-style groups and a surprise confrontation called the Johnson Institute intervention. With individual CRAFT, about 55 to 86 out of every 100 started treatment.²

A small pilot study tested CRAFT in a group and as a self-help book. About 6 in 10 loved ones began treatment when families joined a group. About 4 in 10 did when families only read the book.² An expert review also found that CRAFT led to more help-seeking than Al-Anon alone. Families in both programs felt less depressed and anxious.¹

These studies were fairly small, so treat the numbers as a hopeful guide, not a promise. CRAFT is taught by trained therapists, and some programs offer it. Ask a counselor or call the SAMHSA National Helpline (below).

What helps

Moderate evidence Family approaches like CRAFT have good evidence for getting people into care. The ideas below come from CRAFT and from federal health guidance.^1,2,3

You may need several talks before the person agrees to get help. Ask again later, and keep the door open.³

What backfires

Most families try some of these out of love or fear. They rarely work, and they can wear you out.^1,3

• Lecturing, guilt, threats, bribes or pleading.³
• Arguing when the person has been using. Wait until they are sober.³
• Making excuses or lying for the person to a boss, a doctor or other relatives.³
• Taking over their duties so they never feel the effects of their use.³
• Using with them.³
• Blaming yourself. You did not cause the problem and cannot control it.³

Protecting someone from every result of using is often called "enabling." That word can sound harsh. Most of the time it is love in action. The change is to keep caring for the person while letting them face their own results. Keep helping with basic needs, such as food, safe housing and medical care. Stop helping with things that make using easier.¹

Safety and overdose planning

Plan ahead for an emergency. This is called harm reduction: steps that lower the risk of death or injury while a person still uses. It does not mean you approve of using. It means you want your loved one alive when they are ready for change.

Opioids and naloxone

Opioids include prescription pain pills, heroin and fentanyl. Illegal pills can look like real prescription pills but contain fentanyl, with or without the buyer knowing it.⁸ See opioids and overdose for more.

Naloxone (brand name Narcan) is a medicine that can quickly restore breathing during an opioid overdose. It will not harm a person who has not taken opioids.^6,7 It can be bought without a prescription at pharmacies in all 50 states, and some health departments and community groups give it away free.⁷

Anyone can carry naloxone, not only people who use drugs. If your loved one uses opioids, keep it where you can reach it fast, and make sure others in the home know where it is. Ask a pharmacist to show you how to use it.

Signs of an opioid overdose

Look for:⁶

• Very small ("pinpoint") pupils
• Falling asleep or not waking up
• A limp body
• Slow, shallow breathing
• Choking or gurgling sounds

Other ways to lower risk

• Do not use alone. Many overdose deaths happen when no one is there to help. Ask your loved one to tell someone when they are using, or to use where a person can check on them.
• Fentanyl test strips are small paper strips that can show whether fentanyl is in pills, powder or other drugs.⁸
• Take only pills prescribed to you. Pills from other sources may contain fentanyl or other strong drugs.⁸
• Be extra alert after a recent overdose. A person who has had an overdose is more likely to have another.⁸
• Keep medicines locked up if a person with a substance use disorder lives in or visits your home.

Alcohol and sedatives: withdrawal can be dangerous

If a person who drinks heavily every day suddenly stops, withdrawal can be life-threatening. It can cause shaking, sweating, a racing heart, seizures, and seeing or hearing things that are not there.⁴ Doctors can use medicines to make withdrawal safer.⁴

The same is true for sedatives such as benzodiazepines (often used for anxiety or sleep). Stopping them suddenly can cause withdrawal that includes seizures, which can be life-threatening. Doctors lower these drugs slowly, with a plan.⁵

So please do not ask a loved one to "just quit cold turkey" on their own. Encourage them to see a doctor first. Call 911 if the person has a seizure, is confused, cannot be woken, or has trouble breathing. See alcohol use disorder and cannabis, sedatives and stimulants.

If the person talks about suicide

Substance use and suicidal thoughts often go together. If your loved one says they want to die, take it seriously. Stay with them, ask directly, and remove access to anything that could be used to cause harm. Call or text 988 or call 911 if there is immediate danger. See when a family member is in a mental health crisis.

Setting limits with love

A limit is a clear statement of what you will and will not do. It is not a punishment. It protects you and your home.³

1. Decide what you can live with. For example: no using in the house, no money for anything that might buy drugs, no rides while impaired.
2. Say it calmly when things are quiet. "I love you. I cannot give you money. I can drive you to a doctor's visit."
3. Pick limits you will keep. A limit you do not enforce teaches that limits are not real.
4. Offer what you can still give. Meals, time together and help to get care are all ways to show love.
5. Get backup. Share the load with other relatives, a counselor or a support group.³

For more ideas, see setting boundaries as a caregiver.

Taking care of yourself

You cannot pour from an empty cup. Caring for someone with a substance use problem is a long, tiring road. Lean on trusted family and friends, and tell them what you need. Seeing a counselor who knows addiction can help, because substance use affects the whole family.³ If you notice signs of depression or anxiety in yourself, talk to your own doctor.

You are also allowed to rest, work, laugh and keep your life going. Read about caregiver burnout and use a care circle to share tasks.

Family support groups

• Al-Anon is for people worried about someone's drinking. It offers in-person, online and phone meetings. Alateen is for teens.⁹
• SMART Recovery Family & Friends offers free online and in-person meetings, plus free worksheets, for people with a loved one who struggles with addiction or other problem behaviors.¹⁰
• Counseling or CRAFT therapy from a licensed professional. Ask the SAMHSA helpline for referrals.¹¹

The SAMHSA National Helpline is free, private and open every day, all day, at 1-800-662-HELP (4357). Family members can call for treatment referrals and information. Help is offered in English and Spanish.¹¹

When a loved one is an older adult

Older adults may hide drinking or medicine problems out of shame, or because they think "it is only a glass of wine." Their bodies also react more strongly to alcohol, and many take medicines that mix badly with it. Be gentle, ask to join a doctor visit, and treat it as a health issue. Treatment works at any age. See alcohol, medicines and older adults.

Questions families ask

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.