When you suspect someone you care about is struggling with substance abuse issues, it can be really scary. Whether it’s your child, partner, family member or a good friend, you want to help them, but it’s tricky to know the right way to approach the situation. What if you say the wrong thing and lose their trust? What if your concern backfires, and they go on a life-threatening bender in retaliation? 

“People are often afraid to ask people if they’re using drugs or have an alcohol problem. What I would say is, they need to really think about what could happen if they don’t ask,” says Dr. Deni Carise, the Chief Scientific Officer of Recovery Centers of America (RCA).

The clinical psychologist and substance abuse specialist gives us her advice on the best way to help a loved one get on the path to recovery.

Don’t be afraid to say something 


Bring up your concerns, but don’t be confrontational. One way to ease into the conversation is by saying something to the effect of, “I noticed you’re having trouble with things that would usually come easy to you. Is there something going on?” suggests Carise. 

“The more you can err on the side of not seeming like you’re making a judgement, but that you’re concerned, the better,” she advises. 

If they deny there’s a problem, come back with the facts you’ve noticed, whether they’ve missed work recently or they’ve been nodding off during dinner, Carise says. 

Stage an intervention with a medical professional 

If you feel like you need some extra help, you can have a medical professional intervene. At RCA centers, it’s free to hire an interventionist to help you plan an intervention with close friends or family and the person you’re worried about. There’s strength in numbers: if one person thinks they have a problem, that’s one thing, but if say, three do and a doctor, it’s harder for them to deny it. 

An interventionist will not only serve as a mediator to make sure you calmly and effectively communicate your support and concern for your loved one, but also to help you come up with a treatment plan. Ideally, the goal is to enter them into a rehab program immediately after the intervention.

“What we know about substance abuse is that there’s a window where people see it as a problem, and that window closes pretty quickly,” says Carise. For example, if you stage the intervention on a Thursday, and a person agrees at that time to check into rehab on Monday, there’s a good chance they’ll change their mind by then. 

What if the person is a high-functioning user? 

It’s arguably easier to stage an intervention or convince someone they have a problem after a catastrophic event — say, they lost their job because of using, or, god forbid, got into an accident. But what about high-functioning users, who still excel at work and meet their responsibilities, despite their dependence on drugs or alcohol?

“You want to look at other things: Is it impacting their physical or mental health? Their social or family obligations? You want to focus on the problems caused by the drugs or alcohol and have that discussion with the person,” Carise advises.  

Signs of addiction 

Many people struggling with addiction use in secret. Here are some telling signs that someone might be abusing drugs or alcohol.

“Typically, you’re seeing a behavior you didn’t use to see that’s worrisome,” Carise explains. It could be that the person stops showing up to work or social engagements. You might find that they’re being more secretive. Especially in the case of teenagers, they might start spending time with a different set of friends.


With prescription opiates or heroin, a user will often “nod off” — drop their head and start to fall asleep as they’re sitting there. Their pupils will appear smaller. Frequent scratching is common. They might lose a lot of weight. 

Alcohol abuse 

The user might have puffy skin from retaining water, and a red nose from enlarged blood vessels. You might see them stumble or smell alcohol on the breath. They might be irritable or experience tremors — shaky hands — if they’ve gone too long without a drink. 


Users will appear hyperactive, talk rapidly and express ideas of grandeur. They will have a decreased need for sleep and might experience a major loss of weight. 

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