We think of this set of ideas as a narrative story that fits together as a whole.  Here’s the story:

What we’ve all heard: Once an addict, always an addict. He won’t change until he hits rock bottom. Clean, Dirty, Junkie, Alcoholic, User, Codependent, Enabler. A drug is a drug and you don’t give drug addicts drugs. If he really cared about his kids, he would stop drinking. 

Thankfully, over 50 years of scientific research and clinical experience have given us a new way to understand substance use problems. Here’s what we know:

Behaviors make sense, including using substances.

People don’t use substances because they’re crazy. People don’t use substances because they’re bad people. People use substances because they get something they like out of it. We all engage in a variety of behaviors (like exercising, drinking alcohol, taking pain pills, eating cookies), because we get something out of it. The behaviors we choose to engage in might help us feel good or reduce depression and anxiety. They might helps us feel accepted by our friends or be more focused or even stop nightmares and reduce pain. The choice to use substances is like any other behavioral choice we make: if we choose to keep doing it, it must be working in some way. Understanding and respecting a person’s reasons for engaging in a behavior is a crucial part of being able to help them change. (By the way, understanding doesn’t mean agreeing, but understanding matters!)

Ambivalence about change is normal, and to be expected.

When we try to give up a behavior pattern that works in some way there is understandably ambivalence. We may know that we should make a change, like going to the gym or learning to meditate instead of having a drink after work to reduce stress. The problem? Learning to meditate is actually pretty difficult and takes lots of practice and repetition, while picking up a drink is easy and works very quickly! So it’s hard to give up! If someone you love is trying to quit or reduce using substances don’t be surprised by ambivalence; that is, the desire to go back to the old way from time to time. Expect change to take time.

One size doesn’t fit all.

“Addicts are all the same”.  Not true.  We are all different and unique. As individuals, as families, as people using substances, as people helping others. Likewise, there are many paths towards change and each child and family is different. What works for one family may not work for the next. Do you think the soldier with PTSD who drinks to cope with his nightmares is going to respond to the same treatment as the insecure teen who is smoking pot to fit in with his peer group? Does the grieving 60 yr old who lost her husband and is overtaking her xanax need the same help as the firefighter who is taking more and more opiates to deal with his chronic pain from falling through a floor? We are all different and develop problems for different reasons. And we all change our behaviors in different ways.

Changing any behavior takes Practice, Practice, Practice.

When we try to change a behavior pattern we typically have to do 2 things: step away from an old, well-developed habit and try to engage in a new, unfamiliar one. All this new learning requires trial and error. Being willing to practice and being open to the messiness of learning something new requires compassion, patience, and encouragement.

No one needs to hit rock bottom.

“Hitting bottom” refers to the belief that people with addiction problems won’t change unless they are “punished enough” by their own behavior. It dangerously implies that for those around the substance user, there’s nothing to be done but wait until the bottom is reached. But reaching bottom can come in the form of life-altering consequences and even death. Research shows that people change for all sorts of different reasons and friends and family can play a huge role in both helping someone decide to change and in sustaining that change over the long haul. You can help. No one needs to hit rock bottom.

Yelling won’t help.

When someone you love is using substances or engaging in a host of other risky behaviors, it’s natural to feel afraid, angry, betrayed, ashamed, and confused. It’s also normal to find yourself expressing these emotions by yelling, lecturing, shutting down, and maybe even throwing a few things. The problem with this approach? It actually takes attention away from the problem at hand and puts it on you instead: “You drank too much last night!’ leads to: “You’re always yelling and being so negative… I can’t do anything right for you!”. Even worse, research has repeatedly shown that direct confrontation leads to increased push back from the person you are hoping will change. You can learn to express your feeling while also lowering resistance and increasing motivation to change in your loved one.

You can help.

If you love someone with an addiction problem, you may have been told to ‘detach with love,’ to use ‘tough love’ to help them, or that you are a ‘codependent’ who is enabling them. The end result of these messages is that you are probably confused about your role in helping and may even believe that being caring toward your loved one is somehow causing the problem. But the research evidence is clear: you can help a loved one struggling with substances. In fact, family influence is the most commonly cited reason for seeking treatment for substance use problems.

Helping yourself helps.

Your emotional resilience, physical health, social supports, and perspective on change all matter when it comes to helping your loved one. First, by taking care of yourself, you are modeling the behavior you hope to see from your loved one. Second, to sustain your helping, you need fuel in your tank. We want you to feel better, learn how to take care of yourself, and remember to have some fun. We want you to notice what’s not working for you, try something different, and practice, practice, practice. To paraphrase the classic airplane safety announcement: you both need oxygen; we want you to put on your oxygen mask first.

The world isn’t black and white.

Traditional notions of addiction give you two, and only two, options. People are addicts or not. Addicts are ready to change or not. They’re either recovering or they’re in denial, “with the program” or not. Treatment is rehab or nothing. Success or failure. Healthy or sick. “Clean” or dirty. Abstinent or relapsing. And for friends and family: “intervening” or “enabling.” The good news? These black and white assumptions are not true! The current scientific evidence shows the complexity of the problem and supports an explanatory model involving psychological, biological, and social factors. It also shows that substance use disorders fall on a continuum of severity and can be positively influenced at any time. The upshot? There are so many ways people can be helped!

Labels do more harm than good.

Black and white thinking naturally leads to labeling, including an us-and-them mentality that divides people into “addicts” and “the rest of us.” Branding more than twenty million Americans with a single label and treating them according to that label sends the message that everyone struggling with these problems is basically the same. We invite you to put aside the question of whether someone is an “addict” or “alcoholic.” Because it simply doesn’t matter. What matters is what matters to you and to them: What effect is the substance use having in their life and in yours? What will motivate your loved one to change? More often, true help is based on how well you know your loved one as an individual and the particular ways you matter to each other. Rather than reaching for a label, save your energy for the more constructive work of problem solving.

Change is a Process.

For many people change is gradual, a process of weighing the costs and benefits and experimenting to find out what works. Change often happens incrementally and rarely in a straight line. Change takes time, and effort, and practice. It is more of a process than an end result.

Celebrate Small Victories

Change is hard and when it comes to addiction, it is easy to focus on relapses as they are often scary and maddening. A person trying to give up substances is facing having to make changes is multiple areas of their life: how they think, manage their feelings, relate to their bodies, connect with family and friends, how they work, and possibly their sense of identity. If they have started the change process, it is important to notice and remind them that any changes made are steps forward.