Breaking the Bad
Published Jul 1, 2015 8:00 PM
Most people in recovery got help because someone was honest with them. But how do you approach those sensitive conversations?
Experts understand that addiction isn’t a weakness or moral failing; it’s an illness, much like cancer or heart disease. The difference, though, is that because this illness affects the brain, the person hooked on alcohol or drugs is often the last to recognize the symptoms. “With neuroscience, we’ve been able to show that the addict’s brain changes structurally, functionally, chemically and electrically — it’s operating differently,” says Dr. Timothy Fong, director of the UCLA Addiction Medicine Clinic. “The loss of control, intense urges, denial and lack of insight into the problem are signs of the brain dysfunction, just like chest pain and shortness of breath are signs of heart dysfunction. This is a disease in which a symptom is not being able to see the signs of the disease.”
The onus, then, is often on family members and friends to convince their addicted loved one to seek help — indeed, Fong estimates that for as many as 50 percent of patients who visit UCLA’s addiction treatment clinics, the idea wasn’t their own. Given that many of us are naturally inclined not to meddle in the personal affairs of others, this can create a quandary. If we suspect a problem, when is it time to intervene?
The evidence isn’t always going to be right in your face. Is your friend or family member not acting like him or herself? No longer doing the things that make him or her happy? Acting anxious, irritable, unreliable, withdrawn? Then it’s certainly worth bringing up your concern, Fong says. But the reality, he adds, is that most addicts aren’t so adept at keeping their problem out of plain view. “You can’t hide consequences,” Fong says. “You can’t hide lost opportunities or the neglecting of responsibilities or everything in your life starting to go south.” His simple advice: If you’re moved to ask whether there’s a problem, it likely means something not healthy is going on, and you should speak up.
Perhaps the more difficult challenge is knowing what to say. Approaching a friend or family member with your concerns about an alcohol or substance abuse problem can feel like negotiating an emotional minefield, with anger, obfuscation and denial among the likely outcomes. How to do it right? Fong stresses that every situation is different, but he offers some general guidelines.
Right Place, Right Time
If you’re concerned about a loved one’s drinking or drug use, seeing him or her in a clearly intoxicated state may give you the urge to finally say something. Hold off. “Emotions are going to be running high on both sides — it just doesn’t make sense,” Fong says. Instead, wait until the individual is sober and you are in a quiet, neutral environment. Maybe it’s the two of you, maybe it’s the whole family, but be careful about putting the loved one on the defensive — at least at first. “We do from time to time encourage the kind of intervention you see on TV, where the person walks into the room and there’s a big surprise,” Fong says. “But that’s a pretty intense activity that I don’t recommend unless people have a professional facilitating it and they’ve exhausted all other approaches. On the other hand, a dinner in which all family members talk about how the person’s behavior makes them feel can be very powerful.”
All About You
“Focus on ‘I’ statements, not ‘you’ statements,” Fong says. “Saying ‘I’m worried that you have a drug problem’ is very different from saying, ‘You have a drug problem.’ ” Avoid the use of “should” and “why” — statements like “You should stop drinking” or “Why do you have to always get high?” There’s often little we can say or do to change someone else’s behavior, but we can share how the behavior affects us: “I feel scared when I see you like that.” “I worry about your health.”
If at First You Don’t Succeed …
Given the power of denial and the instinct to resist, be prepared for your first attempt at coaxing a friend or family member to seek help to fall short. “The first way to crack through denial is to let the person know you’re worried,” says Fong. You may be told to back off when you initially suggest a professional evaluation, and that’s fine, he explains. Continue collecting information, talk with other friends or family members, and then maybe escalate the effort the next time by having reinforcements there to present their concerns.
Don’t Be an Enabler
Even if you can’t change the person’s behavior, don’t make it easier. If your son or daughter is abusing drugs and you control the purse strings, cut off access to your credit cards or stop making the car payments. If your spouse’s drinking is making you uncomfortable, don’t continue to participate in alcohol-centered activities, and don’t cover up when your spouse is sick the next day. Ultimately, you may need to send a more powerful message by sleeping in separate bedrooms or temporarily moving out of the house, Fong says.
Offer to Be Part of the Solution
When approaching your friend or family member with your concerns, don’t criticize or judge. And when encouraging him or her to seek professional help, convey that you want to be involved in the solution. “This is a condition that should never be treated in isolation — we need to remove the stigma and involve a whole network of family and friends,” Fong says. “Ask if it would be all right to make an appointment and go together to see a professional about this. If a family member were being treated for cancer or a stroke, you would want to be there, and this is no different.”
We hear much more today than in the past that addiction is a brain disease, but Fong suspects that most of us don’t fully appreciate what that means. “There’s still this false belief that it’s all about willpower — if you want it badly enough, you can change your behavior,” he says. “In reality, the natural functioning of the addict’s brain isn’t working, which means you have impairments in thinking and decision-making. And unless you’ve been there, it’s hard to understand what it’s like to go through an entire day constantly consumed with these urges and cravings.” His final piece of advice: Appreciating that this is a powerful disease — in the same way that cancer is a powerful disease — will go a long way toward making us more compassionate and helpful in the recovery process.
Getting Clean: More information on the UCLA Addiction Medicine Clinic can be found at www.semel.ucla.edu/clinic/addiction-medicine.