“You Need Help”

“You Need Help.”

partner giving silent treatment after saying you need helpEveryone knows that if someone has addictive problems, they need help, right? “Treatment works.”

There is an alternative perspective. If there is an individual with problems (IWP), concerned significant others (CSO’s) may start a conversation. Perhaps there is smoldering resentment and withdrawal by the CSO, and the IWP starts the conversation.

If as CSO you initiate such a conversation, I suggest that the best message is a combination of concern about the problems that the IWP has experienced, hope that the IWP will focus on solving these problems, and a description of any changes the CSO will make.  Such changes might be, for instance, “if you are intoxicated… I will depart for the evening; I will ask you to sleep in the other room; I will take the kids and go to my parent’s house.”

“Getting help” can be an excellent idea, but many if not most IWPs want to address addictive problems on their own. They should be encouraged to do so. Many will be successful. If they are not their motivation to consider consultation or deeper help may increase. Part of a CSO’s announced changes can also be how much time and flexibility to grant the IWP in changing. For instance, is the CSO ready to divorce after one more major incident, or is it not yet that bad?

If you are the IWP and noticing that the costs of your addictive behavior are increasing and that CSO’s are reacting differently to you, what is your next step? Initially you could address your problems the way you would address any bad habit. You could think through the costs and benefits (to increase your motivation to change), decide to focus on changing, record your progress, think through what you have learned with each little success or backslide, change your environment, cues, and schedule to allow the environment to help your change efforts rather than relying solely on willpower, avoid high risk situations for now, set milestones for success, and persist on a daily basis until it is clear you are making sufficient progress or not. You might look at relevant books or websites (they are not hard to find), or attend a mutual help group.

If for a long time you have put off addressing addictive problems (you know who you are), and you are using a substance that might have medical complications or withdrawal symptoms, it is time to see your doctor.

If within a reasonable timeframe you are not making the progress you want, what would a good initial consultation look like? It should 1) identify the IWP’s goals (for instance, around how much to engage in the addictive behavior if at all; related problems to address—such as depression or anxiety; relationships to heal), 2) identify the IWP’s existing resources (e.g., past successful experiences in addressing other addictive problems, strong relationships, strong motivations and goals, strong positive habits, etc.), 3) propose additional resources the IWP might not have been aware of (e.g., websites, books, mutual help groups, treatment options, sober living homes, etc.), 4) create an initial plan (to the extent the IWP consents to one), 5) create a backup plan (in case the primary plan was overly optimistic), and 6) consider how to address the relationship stress already existing (perhaps with a couples or family session, if that is not already occurring). Covering all these topics might require more than one session.

Rather than taking a rigid and not necessarily helpful stance (“you need help”) the CSO can be less demanding and hopefully more motivational. The CSO is beginning a conversation rather than laying down a law (and the sooner that conversation starts the better). The IWP is then supported in being successful by themselves or seeking help in a motivated state of mind.