What to Say (and Not Say) to Someone Struggling
When someone you care about is struggling with substance use, finding the right words can feel impossible. You want to help, but you're afraid of saying the wrong thing and pushing them away.
The words you choose and how you say them can significantly impact whether someone becomes more or less open to seeking help. This guide provides evidence-based communication strategies that maintain connection while expressing genuine concern.
Research on motivational interviewing and family communication shows that certain approaches are more effective than others. Understanding these can help you navigate difficult conversations more effectively.
Why Words Matter
People struggling with substance use often feel shame, fear, and defensiveness. The way you communicate can either reinforce these feelings or help create safety for honest conversation.
Shame-based communication rarely motivates change — it typically leads to more hiding, more isolation, and sometimes increased use. Compassionate communication, while not enabling, can help someone feel understood and more willing to consider change.
Remember
Your goal isn't to "win" the conversation or prove a point. Your goal is to maintain connection and plant seeds for change. Sometimes the most important thing you can do is simply stay in relationship with the person.
Communication Approaches That Help
These evidence-based strategies come from motivational interviewing and family therapy research. They're designed to reduce defensiveness and encourage self-reflection.
Express Concern, Not Criticism
Lead with statements that convey care and worry, not judgment or anger.
- "I care about you and I'm worried about what I'm seeing."
- "I love you and I want to understand what's going on."
- "I'm scared about what might happen, and I want to help."
Use "I" Statements
"I" statements describe your own feelings and observations without labeling or blaming.
- "I've noticed you seem different lately" instead of "You've been acting crazy"
- "I feel scared when you don't come home" instead of "You're irresponsible"
- "I'm concerned about the drinking" instead of "You're an alcoholic"
Ask Open-Ended Questions
Questions that can't be answered with "yes" or "no" encourage reflection and dialogue.
- "How are you feeling about things lately?"
- "What do you think is going on?"
- "What would it take for you to consider getting some help?"
- "What do you need from me right now?"
Listen and Reflect
Sometimes the most powerful thing you can do is simply listen and show you understand.
- "It sounds like you're feeling overwhelmed."
- "I hear that you don't think it's a problem — can you help me understand?"
- "That sounds really difficult. I'm here to listen."
What to Avoid Saying
Certain phrases, even when well-intentioned, tend to shut down communication and increase defensiveness.
- "You're an addict/alcoholic" — Labels feel permanent and shameful
- "Why can't you just stop?" — Implies they're choosing not to; ignores the nature of addiction
- "Think about what you're doing to us" — Guilt doesn't motivate lasting change
- "You're ruining your life" — Catastrophizing can feel hopeless rather than motivating
- "I know exactly how you feel" — Unless you've been through it, you don't; this dismisses their experience
- "If you loved me, you'd stop" — Addiction isn't about love; this sets up a no-win situation
- "You're not trying hard enough" — Addiction involves complex brain changes, not just willpower
- "You should be ashamed" — Shame fuels addiction; it doesn't cure it
The danger of ultimatums
Ultimatums ("If you don't get help, I'm leaving") should be used carefully. If you make an ultimatum, you must be prepared to follow through. Empty threats erode trust. If you're considering this approach, consult with a professional first.
Handling Defensiveness
Denial and defensiveness are common responses. Here's how to respond without escalating.
- Don't argue: You won't win, and it damages the relationship
- Stay calm: If you get angry, the focus shifts from their behavior to yours
- Acknowledge their perspective: "I can see you don't think it's a big deal" (you don't have to agree)
- Return to "I" statements: "I understand you see it differently, but I'm still worried"
- Know when to step back: "I can see this isn't a good time. I love you and I'm here when you want to talk"
- Avoid getting pulled into tangents: Stay focused on your core message of concern
Maintaining Ongoing Communication
Changing someone's mind usually isn't a single conversation — it's an ongoing process. Keeping lines of communication open is crucial.
- Don't give up after one conversation: Seeds may take time to grow
- Continue showing love: People in active addiction often feel unlovable; consistent care matters
- Celebrate small wins: If they cut back, try something different, or express doubt about their use, acknowledge it
- Stay available: Make clear you're there when they're ready to talk more
- Respect their autonomy: Ultimately, the decision to change is theirs
- Take breaks when needed: It's okay to step back for your own wellbeing
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Frequently Asked Questions
Sources & References
This article was informed by the following trusted sources:
- SAMHSA
Substance Abuse and Mental Health Services Administration — national treatment locator and 24/7 helpline
- National Institute on Drug Abuse (NIDA)
Research-based information on drug use, addiction, and treatment approaches
- Centers for Disease Control and Prevention (CDC)
Public health information including data on substance use and overdose prevention
- National Institutes of Health (NIH)
Comprehensive health research and evidence-based medical information
- American Society of Addiction Medicine (ASAM)
Professional society providing level of care criteria and clinical guidelines
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Educational Disclaimer
This information is provided for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment options.