You care about somebody and you’re worried about their opioid usage. You want to help, but you don’t know what to do. This is a 7 step guide to help you through the process of doing your part in their recovery.
People struggling with pain pills are usually defensive about the topic. Substance abuse develops over time, and so do excuses and rationalizations for continuing to use them. By the time the problem is significant, one may have thoroughly convinced themselves that neither they, nor the substance is the problem, and that other people, places and things are to blame.
This will help you talk to your loved one about the problem. If you have a problem and you’re reading this, know that people who care about you sent this to you because they love you and they want to see the best from you. This is a difficult situation, so you have to realize that this is hard on everybody.
Step One: Establish there is a problem
This might not be a single conversation, but rather a series of conversations. Due to the sensitive nature of these conversations, it is important to be prepared and use your words wisely.
It is important to know there is a spectrum of “the problem,” which ranges from physical dependence to addiction.
- Physical dependence: When your loved one does not take their medication, they may experience the following withdrawal symptoms: nausea, vomiting, chills, body aches and pains, skin crawling and irritability. This is physical dependence.
- Addiction is different. Addiction is a behavioral display of a person’s need for a substance over their need for healthy relationships. Addiction is recognized as: lying, manipulation, legal trouble and family issues. A person addicted to opioids may change their social circles, stop showing up for important family events, have difficulty with work and may get in trouble with the law.
This distinction is important because some will call their loved ones ‘addicts’ when they may not be, and using this label of “addict”can sour a conversation. In general, the term addict has a negative stigma, and is best avoided. We like to stick to the high-level issue: there is a problem.
When someone is dependent on medications, but is not an addict, it does not mean that they are not in danger or that you should not approach them. On the contrary, someone who is dependent on high doses of medications is at great risk for medical complications, overdose, and possibly death. Importantly, conversations with loved ones who may not yet have suffered social/legal consequences or who may not yet be addicted or hit “rock bottom” may be more difficult. It is easier in this situation for your loved one to minimize the seriousness of the situation. It also may be easier for your loved one to convince you that the situation isn’t as serious as it is. The result is that these conversations can be very challenging and the following suggestions are designed for discussions with loved ones before they hit rock bottom.
Step Two: Start the conversation
Do not try to talk to your loved one if they appear to be “out of it” or strongly under the influence of their medications. Watch for a lucid interval where they appear to be alert and aware. Do not worry about making mistakes or saying things perfectly. The most important thing is to express your concern in a caring and honest way.
It is a good idea to watch and wait for your loved one to begin to speak about the problem caused by the medications in a negative light. This might be something as simple as complaining about conflict with their doctor regarding prescribing the medication or worry about running out of medicine before their next visit. Even something as simple as your loved one complaining about their sleep or if you notice them breathing differently while they sleep, may be an opportunity for you to start the conversation (more on this later).
Another great opportunity is to sit down with them immediately after any consequences associated with their medication (a DUI or going into withdrawal after running out early. Nodding out in public or falling, etc.). Don’t wait for the perfect opportunity because it will never arise – just watch for a decent moment and then ask them to sit down with you.
Step Three: Have the conversation
What is the right thing to say? We’ve developed a guide called “Script For Talking To Your Love One,” which you can download here.
Remember, the goal is to get your loved one to understand that they are in a difficult life situation and everyone finds themselves in situations like this. Seeking help from professionals makes sense and is a form of personal strength – not weakness. Since you are close to your loved one, your involvement in their treatment is critical. Assure them you will be involved every step of the way to continue to support them.
The guide with sample scripts will help you immensely and simply preparing for the conversation is a big step in a positive direction.
Step Four: Stay positive
Don’t be surprised if your loved one is not ready for help and do not take it personally. You have said what needed to be said. If your loved one shut you down, that is an acknowledgement that they heard you (and also that they didn’t like it or didn’t agree). Even if the conversation doesn’t yield immediate results, that doesn’t mean it isn’t a success. Your point was made. They will be thinking about it. They know that you are there for them when they are ready. Don’t continue to bring it up unless another concerning event occurs. As hard as it might be, give them some time and space to let your words sink in.
Step Five: Get help
On the other hand, your family member may have been secretly hoping someone would notice and reach out to help.
This is where those resources we recommended you have ready come in handy. Choose one facility or doctor (choices are a ticket to procrastination) and make an appointment to see them on the spot.
Plan on physically going with them to the appointment.
Even patients who agree initially oftentimes reconsider and decide they don’t want to go to their appointment. That is why it is important to get a verbal commitment from your loved one while they are agreeable to help hold them accountable. If they agree, try to schedule an appointment immediately to reduce the likelihood that they won’t follow through. If your loved one is receptive, you might want to pre-empt the “cold feet” that come before the appointment by writing down both fears and goals. What is the worst that can happen if your loved one’s fears come true? Addressing this up front can be a powerful tool if your loved one develops doubts.
Step Six: Be prepared for failures
Even if you have made an appointment and obtained a verbal commitment to seek help, it is not uncommon for people to reconsider. They are afraid.
If this is the case, bring your loved one back to the moment where they admitted they were struggling. Bring them back to the concerning episode you discussed. Let them know that fear is normal and that you need to push through the fear. Revisit your list of fears and goals.
At this point you have to get firmer with them. For example, you can point out to them that when they made the decision to seek help, they were vulnerable and honest – now they are having doubts and creating a wall. Point out that nothing has changed between when they agreed and now. They can and need to push through the fear.
There are some really common excuses for cold feet, such as:
- I can do this on my own, I don’t need help
- I think I’ll be OK
- Instead of going to treatment I’ll do XYZ
- I will go in a few weeks when everything (at work, in my relationship, at my home, etc.) stabilizes.
- I can’t go because of work
- I can’t go because of my dog
- It’s not that bad
Even though these are commonly used excuses, we have seen some really bizarre reasons for not wanting to get help, so be prepared for some unexpected, irrational, or unexplainable reasons to come your way. When your loved one is receptive, you might want to pre-empt this by asking what impediments could get in the way and what you can do to clear them out ahead of time (for example, getting a dog sitter or requesting days off from work). Make this easy on your loved one by removing identified barriers, if possible.
Step Seven: Stay strong and don’t give up
Is your loved one or you bailing out? What do you do when your loved one seeks resources but then stops going?
You need to continue to support them following their doctor’s treatment plan. Continue to bring up those initial conversations, goals, and fears.
It is also important to be aware that oftentimes, this is where loved ones can get scared and cease to support their loved one’s treatment and at times even sabotage it. There are a lot of changes during treatment and change (even positive change) is difficult.
Be prepared for this. Hold strong yourself and go back to those initial conversations, fears, and goals. Think about what you are doing and whether or not it is supporting or impeding the treatment plan. If you are having struggles, talk to your clinical team. Remember why you were doing this in the first place. We always recommend that a patient’s support network get counseling in tandem with their loved ones to help prepare them for all the changes that are happening. Doing this will actually increase your loved one’s chance of success.
You can continue to seek support for yourself, even if your loved one does not. You will be in a better position to support your loved one if you are actively taking care of yourself.
We hope these tips have been helpful and wish you the best of luck embarking on this journey.
The door is open.