What to Say: Substance Use Disorder
Prevent severe impact with patience, support and understanding.
Prevent severe impact with patience, support and understanding.
Nathaniel Glanzman
Reviewer URLPrevent severe impact with patience, support and understanding.
What we’ll cover
According to the National Center for Drug Abuse Statistics, 59 million people (21.4%) who were ages 12 and over misused prescription drugs and illicit substances within the last year. Continued use of drugs like opioids, cocaine and heroin, for example, may lead to substance use disorder (SUD). For friends and loved ones, it can be challenging to know what to say—or not say. You may feel helpless, especially if you have a loved one who may feel ashamed, guilty or unsure of how to ask for help.
In this “What to Say” guide, we’ll define substance use disorder and what you can say to express support and compassion to someone who has it. We’ll also look at examples of what not to say to avoid judgment. SUDs can come with specific symptoms and signs like any other health condition. We’ll also look at a few examples of them and suggest ways to support and encourage your friend or loved one on their path to recovery
What it is
Substance use disorder is the overuse of a substance—such as illegal or prescription drugs or alcohol—in an unhealthy or dangerous manner. It can lead to physical and mental health issues, and it can also develop into both physiological and psychological dependency. Long-term substance misuse may affect a person's physiology to the point where they experience withdrawal symptoms if they suddenly try to stop using the drug. The term "psychological dependence,” according to the American Addiction Centers, is “the emotional and mental processes that are associated with the development of, and recovery from, a substance use disorder or process addiction.”
Many individuals with severe substance misuse may tell you they don't have a problem because they are blind to their dependence. Substance misuse can develop into substance use disorder (SUD). It can be mild, moderate, severe, or in the most acute manifestations, an addiction. With an addiction, the repeated use of alcohol or drugs causes clinically significant impairment, including health problems, disability, and failure to meet primary responsibilities at work, school or home.
Not everyone who misuses substances will develop a SUD. However, substance misuse can lead to substance use disorder if it is not addressed and appropriately managed. SUD is a severe mental illness, and in most cases, it requires professional help and treatment.
The risk factors for substance misuse include genetics, family history, mental health issues, early use, peer relationships, popularity, bullying, gang association, physical or sexual abuse, poverty, and the availability of drugs. Adverse childhood experiences (like neglect, violence, or dysfunction in the family) are significant risk factors of later substance misuse.
Impact of substance abuse
Substance misuse can significantly impact a person's everyday life, including causing difficulty with interpersonal relationships, finances, academics, concentration, physical health and legal problems. Substance misuse can also lead to substance use disorder, which can have even more damaging effects on daily life.
Substance use disorder can significantly impact a person's mental, emotional and physical health. Mental health problems like depression, anxiety and psychosis can be exacerbated by or co-occur with SUD. It can also have physical consequences, such as liver disease, digestive problems, a weakened immune system and an increased risk of cancer.
When someone you care about has a substance use disorder, their symptoms may also directly affect you. For example, they may isolate themself out of shame or guilt, which could damage your relationship. Remember that the person is not intentionally trying to cause stress. Instead, they have a condition that affects many areas of their life. And just like other medical conditions, these symptoms are treatable.
Symptoms and treatment
Signs of substance misuse may include changes in one’s behavior, physical appearance, mood and relationships. Physical symptoms can include red eyes, changes in appetite, changes in sleep patterns and changes in physical coordination, depending on the substance. Nausea, sweating, shakiness and intense anxiety are some withdrawal symptoms one could experience. Cravings are intense feelings of need, want or desire for a substance. Continuing to use drugs or alcohol in the presence of severe adverse effects is a crucial indicator of a substance use disorder.
Substance use disorders are complex conditions that require comprehensive and individualized treatment plans. Treatment options vary depending on the severity of the disorder, the type of substances involved and the patient's needs. Common treatments include individual and group behavioral therapies, medication management, and 12-step programs. Treatment plans should also incorporate holistic approaches, such as mindfulness and exercise.
Recovery and relapse
Recovery from a substance use disorder means an individual is no longer engaging in harmful behaviors associated with substance misuse and is making a concerted effort to maintain sobriety. Recovery is a journey; different people may have other goals and paths. Recovery is personal, and everyone should be supported to achieve their goals.
A relapse is a return to substance misuse after abstinence. Relapse is common in SUD recovery and is often a standard component of the process. Relapse is tough on both the individual who relapses and their loved ones. However, it’s essential to know that relapse doesn’t mean treatment didn’t work or sobriety will never be achievable. It is also important to remember that someone else’s substance use disorder is not yours or anyone else’s responsibility. Your loved one’s choice to stay sober is entirely theirs.
With support and understanding, you can help your loved one develop healthy ways of coping and stay in recovery. It's essential that they have a strong support system, including family, friends, self-help groups and healthcare professionals. There is no one-size-fits-all approach, and there is no guarantee of success. However, a combination of understanding, patience, and support can help your loved one make progress in their recovery journey and help them maintain sobriety.
What not say
When speaking to a loved one with substance use disorder, it’s essential to be mindful of your words. The power of your words can profoundly influence how they respond and feel, potentially in either a positive or negative way. It's important to show support and understanding, using language that encourages and doesn't accuse or make anyone feel ashamed. It's also important to be mindful of assumptions and advice, as they can sometimes have the opposite effect of what was intended.
“When you hit rock bottom, you’ll be sorry.”
Why it doesn’t work: This statement can be read as insensitive and unhelpful. It implies that the person must reach a point of desperation before taking any action, which may lead to feelings of guilt and shame. Instead of saying something that could be interpreted as a threat or ultimatum, it is essential to emphasize the importance of your loved one seeking help and offering support and encouragement in a non-judgmental, understanding manner.
“You’re so selfish.”
Why it doesn't work: Using accusatory language can be damaging. Substance misuse is often a symptom of deeper issues. Getting to the root of the problem can be challenging without a supportive environment. Instead of using language that blames the individual, offer help and understanding.
“It’s not hard; just stop doing it.”
Why it doesn't work: Suggesting that it is easy to stop using substances is often not the best approach. It implies that the person is somehow able to control their substance use. Substance use disorders are complex and nuanced conditions that require professional treatment and support. It is difficult to make a lasting change without understanding the root causes and contributing factors leading to the disorder, which is where therapeutic interventions come in.
“You never seemed like someone who would deal with this.”
Why it doesn't work: Making a statement like this to a loved one with a substance use disorder is insensitive and damaging. It implies that the individual’s experience is somehow invalid because it doesn't fit a preconceived idea of who may have this disorder. We cannot assume what a person is going through. It can also be seen as placing a stigma on individuals with a substance use disorder, which can be discouraging and damaging to the individual's self-esteem. Focus on understanding the individual's experiences, providing support, and helping them access resources.
“You have no willpower.”
Why it doesn't work: Substance use disorders are complex conditions that involve biological, psychological and social factors, and your loved one’s inability to abstain from substances may not have anything to do with their willpower. Phrases like this can make the individual feel inadequate and embarrassed. Instead of using language that puts an individual down, it is more beneficial to express support and understanding for their situation.
Nothing.
Why it doesn't work: Finding the right words can be difficult for anyone, but that doesn't mean you should neglect to say anything to your friend or loved one. During especially difficult situations, your loved one will appreciate any kind or reflective words you can offer during their time of need. Saying something—with intention and thoughtfulness—is better than saying nothing.
Instead of avoiding a conversation in a fraught moment, try a phrase like, "I can't begin to know what you are going through, but I am here for you." If the moment is more lighthearted or celebratory, a simple, "I am so happy for you right now!" goes a long way.
What to say
“I-statements” are a great way to tell your loved one how they make you feel in a non-threatening way. They encourage understanding and respect instead of hostility and resentment. You can start by saying things like, "I'm a little concerned because..." or "I've observed that..." Allow the other individual to speak their mind and react to your questions. Do your best to hear the other person without passing judgment or making accusations.
Note: These conversation starters are just suggestions. Each individual’s experience will vary and users should measure their words based on what they know and do not know about their loved one.
“I care about you and want to see you get the help you need.”
Why it works: Expressing concern and care for a friend or family member experiencing a substance use disorder is essential in offering support and encouragement. This statement demonstrates empathy and understanding for your loved one. It assures your loved one that they are not alone and there are people who wish to see them succeed.
“I’m proud of you for the effort you’re making.”
Why it works: Letting your friend or family member with a substance use disorder know that you are proud of them is a great way to show your encouragement and motivation for them to continue making positive life changes. It's a way of expressing your support and pride in them, an essential part of their recovery journey.
How to recover
It's important to apologize sincerely after making a mistake when conversing with a loved one with a substance use disorder. Try to be specific about what you said wrong and how it made them feel. Show empathy and understanding for their experience. Offer to listen if they need to express their feelings and remind them that you are there for them.
Other suggestions
People experiencing problems with drugs or alcohol can get assistance from a wide variety of sources. Help them locate a drug and alcohol treatment center in their area if they express interest in getting professional help. You may be of assistance if they decide to get help by offering them food, running errands and checking in on them periodically while they undergo treatment.
Praise even the smallest achievements, and continue offering support even if they relapse. Rehabilitation from substance misuse is a long process; many individuals fail at it on their first attempt. Setting boundaries with the individual is also crucial. Make an effort not to overpromise. Think realistically about how much you can provide emotional, practical or financial assistance.