As a person who’s very open and public about her recovery from alcoholism, I often get questions from people who are worried about the substance use of a family member or friend.

And one of the common themes I’ve encountered is something to the effect of: Why are they doing this to themselves? Is there anything I can do to help?

If you haven’t struggled with addiction or a substance use disorder (SUD), it’s really hard to understand why someone continues to use in the face of negative consequences that result.

It seems absurd in any other context: If someone turns into a belligerent, shouty jerk every time they eat pizza, for example, it seems logical that, no matter how delicious pizza is, they’d stop.

Sure, it’s a bummer. But is it really worth regularly being a monster to your loved ones? That’s how most people without a SUD or addiction would view life without alcohol.

For a person who’s actively addicted to alcohol, though, booze isn’t something you can take or leave. It’s often something you need to stay alive.

This is true on both an emotional and physiological level.

I truly believed that if I stopped drinking, the pain of sobriety, of not having the numbing salve I needed to move through the world, would kill me.

And when I got to the point that I was physically addicted — where the homeostasis in my body was thwarted by the absence of alcohol, where my hands shook in the morning until I could find something to drink — stopping really could have killed me.

It’s one of the few drugs that doesn’t just make you feel like you’re dying when you abruptly stop. It can follow through and actually do it.

If you’re worried about a loved one having an addiction to alcohol, it’s helpful to understand the emotional and physical reality of what that means.

Like many alcoholics, when I was criticized or even questioned about my alcohol use, I would immediately fly into an indignant rage, denying that my relationship with alcohol was even the slightest bit problematic.

I couldn’t very well tell the person, no matter how well intentioned, that I was terrified of what would happen if I could no longer drink. I couldn’t tell them that I was afraid the mental or physical pain would kill me.

I knew what would happen if I admitted that to anyone, including myself: I would have to stop. It was a terrifying, nightmarish Catch-22. So, when people questioned me about my drinking, I lashed out.

I want to be clear: Not everyone who reacts defensively or angrily when questioned about their alcohol or drug use necessarily has a SUD. But it’s important to understand how terrifying confronting addiction can be — and why many of us react this way.

So, what to do when you think a loved one is struggling with their substance use?

First, ask yourself why you think that. In my humble opinion, the number one cause for concern is when someone continues using a substance despite repeated negative consequences as a result of that use.

The second thing to know is that it’s damn near impossible to convince someone to get treatment for a SUD if they don’t want to.

It’s possible to push them into getting started, but it’s really hard to force them to stay the course if they don’t want to be doing it. Don’t approach the conversation with getting into treatment as the end goal.

Treat the conversation like an honest, nonjudgmental exploration of a friend’s behavior that you find confusing.

Let them know you’re concerned about the negative consequences of their use. Try to be as specific as possible. Focus on the negative consequences as opposed to the use itself.

For example, if the consequence is anger when they drink, focus on what that anger looks like and how upsetting you find it.

Then you can inquire about their use. Ask them if they think it’s a factor, or if it ever concerns them. Let them know you’re there for them if they ever want to look into options for getting help with it.

Then? Let it go.

Your goal is to plant the seed in their mind and let them know you’re there if they ever want to talk about exploring options for getting help.

By focusing on the behavior, you’re letting them know you’re worried about it, but you’re not demanding that they stop using. You want to be there as a source of support, not admonishment.

Of course, that’s for a first conversation. There may well come a time when you need to be more direct about their substance use. But for now, you just want to crack open the door for dialogue.

In other words? Your most important job is to let them know they have a friend, should they need one. And chances are, if not now, they’ll almost certainly need one in the future.


Katie MacBride is a freelance writer and the associate editor for Anxy Magazine. You can find her work in Rolling Stone and the Daily Beast, among other outlets. She spent most of last year working on a documentary about the pediatric use of medical cannabis. She currently spends far too much time on Twitter, where you can follow her at @msmacb.