How to talk to someone about their substance abuse: an angry confrontation will not get you where you want to be


This article is brought to you in partnership with Novant Health. All opinions are our own.

Substance abuse is a difficult issue, especially when it affects a loved one. You may desperately want to see a change but may not know how to discuss the problem with the person. Often, intense emotions are also in the mix, causing judgment to be blurred and tension to run high.

We spoke with psychiatrist Dr. Kris Ruangchotvit (pronounced Roong-cha-vit) of Novant Health Psychiatric Associates to learn more about how to approach someone who may be dealing with substance abuse issues.

Recognizing the problem

How do you know if a loved one truly has difficulty with, say, alcohol or opioids? The person may have a problem if they feel like they need to use more of the substance to get the same effect. For example, they may start drinking four beers in an evening when before they were content with two.

Also, a person who has difficulty curtailing their usage may be in danger of a substance abuse problem. The same goes for someone who starts missing daily obligations because of substance use. Symptoms of withdrawal, such as anxiety when the person has not used their substance for a while, are also signs of addiction.

Understanding the person’s issue

Dr. Ruangchotvit had tips for talking to your loved one, but first, it is important to understand their struggle.

At the heart of addiction are two culprits: biological and environmental triggers, he said. For some people over time, their body comes to actually need the substance or go into withdrawal. That’s why alcoholism, for example, is now considered a disease rather than simply “bad behavior.”

As for environmental factors, heavy substance use (think “bar-hopping) is often socially acceptable or encouraged. Marijuana becomes easier to obtain by the day in the U.S. This can create a feedback loop for the addict. They may want to cut back, but have trouble because of social settings, the ease of obtaining the substance, and the biological urge to seek the substance out.

Understanding these challenges can help gain the empathy needed to have a tough discussion.

Talking to the person

Now comes the hardest part: having the talk. The best way? Frame the discussion around the truth without blaming, Dr. Ruangchotvit said. “Yelling and blaming are human,” he said, “but chances are slim that it will lead to change.”

You should also focus on your feelings rather than their actions. Say something like: “I’m starting to realize that I am uncomfortable with how you behave when you drink a lot because it leads to such-and-such situation.” This is much better than “When you drink, you do such-and-such and you have a serious problem.”

Blaming the person only makes them shut down and become defensive. That gets you nowhere. When you are open to their struggle and empathize with them, you show them that you are truly on their side and they are not alone. That increases your chances of a productive discussion, which is the primary goal.

“The first thing is getting the person on board,” Dr. Ruangchotvit said. Without that, all the treatment in the world will not be able to help them.

Resources for you and your loved one

There are many treatments and programs available to help you and your loved one. You are far from alone. Consider talking to their doctor about medications, group settings, and even one-on-one therapy sessions. To start, check out these resources:

Novant Health behavioral health specialists can help you deal with issues and regain control of your life. They’re available 24 hours per day to provide care to children, adolescents, and adults.

How therapy works

Learning to say no


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