Category: Assisting Loved Ones

When you think of an intervention, you might picture a classic scene from a movie or TV show. A group of family and friends gather together in a living room, talking to a loved one about their addiction. While this is one way to do it, there are many more ways to stage an intervention. And some of them can be even more effective than what you see in the movies.

Staging an intervention requires a great deal of planning. The more you prepare, the more likely you are to achieve your goals—whatever they may be. You can even get help from a trained interventionist, who can help you plan ahead.

If you want your loved one to get inpatient treatment for an addiction, you don’t have to reinvent the wheel. There are plenty of tools available to help you get through this process. You can use the resources below to define your goals, connect with experts, and find the best way forward.

What Is an Intervention?

Interventions can be helpful when a person doesn’t see how much harm their behavior is doing. This is a regular occurrence, because denial is such a common part of addiction. ((Ponizovskiy, P., & Gofman, A. (2017). Cognitive status and addiction denial in the early stages of alcohol addiction. European Psychiatry, 41(S1), s874–s874. https://doi.org/10.1016/j.eurpsy.2017.01.1759))

The Recovery Research Institute defines “intervention” ((Addictionary®. (2017, January 26). Recovery Research Institute. https://www.recoveryanswers.org/addiction-ary/)) as a meeting between an addicted person and their loved ones, to address the issue of drug or alcohol abuse. These conversations include the “expression of care, concern, and explicit demands.” And usually, loved ones urge the person to get formal treatment for addiction.

You can also stage an intervention for someone with unmanaged mental health issues, whether or not they show signs of addiction. In that case, the goal might be for your loved one to get residential mental health treatment.

Despite what you see in the media, people don’t have to “hit rock bottom” before they can recover. ((Kirouac, M., & Witkiewitz, K. (2017). Identifying “hitting bottom” among individuals with alcohol problems: Development and evaluation of the noteworthy aspects of drinking important to recovery(Nadir). Substance Use & Misuse, 52(12), 1602–1615. https://doi.org/10.1080/10826084.2017.1293104)) This might change the way you plan an intervention. You don’t need to wait for their addiction to get worse. It’s okay — and could even be preferable — to have this crucial conversation as soon as you notice a problem.

The ultimate goal of an intervention is for your loved one to change their behavior. But you can’t make that change for them. All you can do is support them through the process of getting professional help. Then, the hard work of recovery is up to them.

How to Recognize Your Loved One Needs Help

If someone you care about is showing signs of addiction, it might be time to plan an intervention. But your exact plans will depend on the severity of their drug abuse, and their level of awareness. For example, people with alcohol addictions don’t always realize they’re drinking too much. But by the time a person has an addiction to methamphetamines, they probably know it’s a problem. These are some of the conditions that might prompt you to stage an intervention:

• alcohol use disorder
• prescription drug abuse
• compulsive gambling
• sex addiction

If you think someone you love needs an intervention, you can begin planning next steps. In most situations, it’s best to start by talking to mutual friends or family members. Their insight can help in 2 important ways. First, it will give you a clearer sense of what your loved one is going through. This might help you make the intervention itself even more effective. And second, by connecting these people, you’ll also get valuable support. These relationships can be a source of strength for all involved—even the person who needs rehab.

Why Interventions Can Work

Data shows that social support is an important part of addiction recovery. ((Rapier, R., McKernan, S., & Stauffer, C. S. (2019). An inverse relationship between perceived social support and substance use frequency in socially stigmatized populations. Addictive Behaviors Reports, 10, 100188. https://doi.org/10.1016/j.abrep.2019.100188)) Connecting with loved ones is powerful. Even in a fun, easy context, seeing all the people you trust in a single room can be inspiring. When all those people come together for a purpose, they can make a huge difference.

There’s little objective data about the long-term success of interventions. ((Association of intervention specialists—Ais—Certified interventionist. (n.d.). AIS. Retrieved from https://www.associationofinterventionspecialists.org/)) This is partly because you can define “success” in a few ways. It could be that the person stops using drugs, goes to rehab, or just admits they have a problem. But no matter what outcome you’re hoping for, it’s important to approach the issue with care.

Who Should Lead an Intervention?

Most interventions tend to have a few things in common. These are loving conversations between friends and family. They take place in non-threatening environments, like a home or a therapist’s office. The exact details will vary, depending which of the following approaches you use. There are 2 main ways to stage an intervention:

• doing it on your own
• working with a professional interventionist

DIY Interventions

When you do an intervention yourself, your group will be responsible for every part of the process. You’ll schedule it with the other participants, and carefully plan what to say. You’ll also need to collect resources to share during the conversation. These might include contact information for rehabs, local therapists, and similar. If you feel confident in your group’s ability to take these steps, you can use this checklist to get started.

Someone from your group will have to lead the conversation. You should decide who this will be far in advance, so they have ample time to prepare. Make sure this person is ready to stay strong throughout the conversation. If you’re concerned they might be overwhelmed by their own emotions, it’s better to choose someone else. The leader should be ready to calmly respond to any conflicts that arise.

It’s also essential to have a plan for what comes next, especially if the person agrees to get treatment. Someone from your group should commit to helping with this process. Depending on how the intervention goes, that could mean a number of different things. You might end up helping the person research rehabs, or taking them to a doctor to discuss medical detox.

Even if you don’t hire an interventionist, you can ask someone else for expert support. For example, you might ask a trusted authority figure to participate. This could be the person’s doctor, therapist, or spiritual leader. While their presence isn’t necessary, it may help emphasize the gravity of the situation.

Professional Intervention Services

If a DIY intervention isn’t right for you, you can hire a professional interventionist. These mental health specialists are trained to facilitate difficult conversations. They’ll also help you and your loved one plan for what comes next. For example, this might mean choosing between addiction treatment programs.

If your group of friends and family can’t take on the burden of planning, you might want to work with a professional. This strategy can help people with busy schedules, who just don’t have the time to take the lead. It’s also a good fit for groups who have strained relationships with each other. In that case, the expert can act as a “referee,” helping you process your feelings before the group meeting. This protects the person with an addiction from your interpersonal conflicts. They’ll have to face those issues during treatment, but an intervention is the wrong time to air old grievances.

A professional will also know how to de-escalate potentially dangerous situations. They’ll also be more objective than a friend or family member ever could be. For you, this is a life-changing event, and your loved one’s future depends on its outcome. For an interventionist, it’s an opportunity to help a person they just met. That clarity can help them guide you and your loved ones toward the best possible solution.

Working with an expert can be very effective—but it can also be very expensive. Before you hire an interventionist, make sure you understand the cost.

Cost Can be a Barrier

Drug abuse interventions are not covered by insurance. A rehab program might be able to support the process, or send a professional to help. But it can be hard to arrange this before the person commits to treatment. You should expect to pay for intervention services out of pocket.

The cost can vary widely based on your location and specific needs. Some interventionists use a sliding scale, but even that can be a significant fee. In some cases, the cost can be as much as $10,000 or more.

As you put your budget together, you should also consider the cost of inpatient treatment. Unlike an intervention, rehab is often covered by insurance. Some centers even accept Medicare and Medicaid.

If a professional intervention is too expensive, you can certainly try doing it on your own. And remember that it’s okay to change your mind. If you choose to try a DIY intervention, family tensions might still come up while you prepare. At that point, you can always pivot and seek professional help.

To find an interventionist in the U.S., you can call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) national 24/7 helpline at 1-800-662-HELP (4357). The Association of Intervention Specialists (AIS) also provides a network of professional interventionists across North America and Britain.

Types of Interventions

There are several ways to format these meetings. If you work with a professional, they may have a preferred style. In a DIY intervention, you can choose the structure that works best for you. This can be based on the number of people in the room, or a more philosophical approach.

Choosing Who Should Be Present

The number of people in the room might have a noticeable effect on the person you’re addressing. It’s best to put some pressure on them, without making them feel so overwhelmed that they shut down. Some people may even respond best to private conversations.

• 1:1 Conversation: In this format, a close friend or family member approaches the person by themselves. It’s important to start the conversation in a safe, neutral setting. Although it may seem more casual, it’s important to prepare what you’ll say in advance. You should also plan to follow up with them, to make sure they’re following through on any agreements you both made.
• Group Conversation: This is the classic intervention style you may be familiar with from the media. A group of people gather to talk to one person about their concerning behavior. The group should meet beforehand to plan together and set clear goals.
• Crisis Response: These conversations are normally unplanned. Instead, they happen after an emergency. When you can’t ignore the problem any more, you might have to confront your loved one without preparation. By the time you reach this point, paramedics or police officers may be present. This can make the situation feel more intense, but it may also give you direct access to more resources.

Choosing a Treatment Approach

You can also think about what type of format you’d like your conversation to follow. These styles work best during planned group conversations. They may be less appropriate for 1:1 interventions, or crisis interventions.

• The Johnson Intervention model ((Johnson intervention. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/johnson-intervention)) is non-confrontational. Instead, family and friends communicate facts as simply as possible. You’ll take turns describing the effect your loved one’s addiction has on your own lives. An interventionist will help you plan the session, but it may be a surprise to the person you’re speaking to. With their help, you’ll present possible treatment options for the person to choose from.
• ARISE Interventions ((Comprehensive interventional care: Recovery network. (n.d.). ARISE® Network. Retrieved from https://www.arise-network.com/arise-intervention/)) are invitational. In other words, your group will invite the person of concern to take part in every step of the process. This method is a gentler, more gradual alternative to the Johnson model. These interventions are led by professionals trained in the ARISE method.

With or without expert guidance, it can be hard to pick which format is best for you, your group, and your loved one. As you begin that process, you may find it helpful to set some clear goals. Once you have a destination in mind, you can decide which route you’ll take to get there.

Setting Clear Goals

It’s important for everyone in your group to agree on a specific goal. This will become the focal point of the intervention. And you may already know exactly what you’re working toward. If not, consider the following list of potential outcomes:

• The person acknowledges that their actions have caused harm.
• They admit that they have a problem with drugs or alcohol.
• They agree to talk to a professional, and get more information about treatment.
• The group schedules another meeting to discuss the situation further.
• The person checks into a rehab facility.

In most interventions, you’ll communicate your goals during the first meeting. If all goes well, your loved one will start working toward them right away. Because of this, it’s best to show up with resources in hand, so they can get started quickly.

Resources for Addiction Treatment

If the person you’re talking to is receptive, you can end the intervention by suggesting a path forward. These resources can help them move forward:

• information about how to get treatment using their insurance
• contact information for rehab programs that might meet their needs
• a doctor’s appointment with their primary care physician for the next day
• contact information for a medical detox center
• information about the medical leave policy at their job
• the meeting schedule for a local or online support group
• a person in the room who’s willing to help them research treatment options
• someone who can drive or accompany them to rehab
• a person to host or stay with them that night and provide emotional support
• a small group of people willing to clean their home before they return, getting rid of any drugs and drug paraphernalia

Depending on your situation, some of these resources may be more helpful than others. Whatever you decide to share, make sure you have a list prepared in advance. That way, you won’t have to take time out of the meeting to do research on the fly. You should also be ready to talk about the consequences if they don’t accept your help.

Defining Consequences

Ideally, your loved one will do as you ask. But at first, they might resist what you’re saying. It’s important to explain that there will be consequences if they refuse to get help. There are 2 reasons for this. First, doing this might convince your loved one to take action. And second, if they keep using drugs, it protects you from their behavior.

Any consequences you set should have these qualities:

• Enforceability. You should be able to follow through on your commitments. For example, it’s not realistic to say you’ll never speak to a roommate again. Even if you move out, there will be logistics to discuss.
• Proportionality. Any repercussions should fit the situation at hand. You’d respond one way to someone who shows up late to work, and another way to someone who threatens their family.
• Sense of safety. This process isn’t only for the person with an addiction. It should also help you keep yourself safe. Setting and enforcing healthy boundaries can empower you to meet your own needs.

After you define these goals and consequences, you can make more specific preparations. Use your big ideas to inform the details. You can use the checklist below to take the next steps.

Your Intervention Preparation Checklist

When you start planning, emotions may be running high. It’s best to write everything down, and refer to your notes if you get overwhelmed. Use this checklist to stay on track.

• Decide on a type of intervention. Will you hire an interventionist, or stage it yourself? If you’re working with a professional, get them involved as early as possible.
• Plan who will be present. If you want a group of people to be there, keep the number small. Everyone attending should help with the planning process.
• Choose a format. You can choose the Johnson method, the ARISE model, or something else that works better for you.
• Pick your location. You might meet in someone’s home, a therapist’s office, or another neutral location. It should feel as safe as possible for everyone attending.
• Rehearse what you’ll say. Plan what you’ll say in advance. This can help you avoid getting sidetracked or flustered. You might also look up words to avoid, like “alcoholic” and “junkie.”
• Manage expectations. Your loved one might respond well, or they might get angry. They might even walk out. If that happens, it’s up to you to follow through anyway. Hold your boundaries and keep yourself safe.
• Conduct the intervention. Many people find excuses to avoid difficult conversations. Don’t lose sight of your goal. Once you start planning, it’s important to go forward.
• Follow up. Enforce any consequences you set, no matter how the person responds. And unless you decide to cut off contact, someone should check in with them soon after your meeting.

1 intervention alone might not be enough to motivate change. And even if someone agrees to get help, they may not know where to start. To effectively support your loved one, your group might need to keep working together for some time.

Planning for Long-Term Recovery

Staging an intervention requires courage and preparation. Make sure to care for yourself throughout the process. You might want to see a therapist or join a support group. This meeting is just the first step in a much longer recovery journey. As you prepare for that process, remember that your mental health matters, too.

To plan for the next phase of recovery, learn more about inpatient rehab centers that treat drug and alcohol addiction. Get the information you need about pricing, family therapy, relapse prevention, and more.

It is, in fact, possible to love someone too much. When you care about a person with an addiction, it can be hard to stop yourself from giving. But over time, generosity can become counterproductive. In the very attempt to support them, you may be enabling their unhealthiest behaviors. If what they really need is treatment for a substance use disorder, you both might benefit from a little tough love.

Because addiction begets codependency, it’s crucial for you to set and maintain healthy boundaries. This process might be daunting at first. You may be concerned about being too harsh, especially if your loved one is facing other challenges. But setting boundaries is often the first step toward healing—for yourself, your relationship, and the person you love.

Adding ‘No’ to Your Love Language

Good boundaries are an important part of any dynamic, and they are even more critical when your loved one has a substance use disorder. Although it can be painful to establish ground rules, this process is a vital part of building sustainable relationships, and caring for your own mental health.

Think of healthy boundaries as rules or guidelines for how you want to be treated by the people around you. As therapist and somatics teacher Prentis Hemphill says, “Boundaries are the distance at which I can love you and me simultaneously.” ((Boundaries: Definition, examples & how to set them. (n.d.). The Berkeley Well-Being Institute. Retrieved from https://www.berkeleywellbeing.com/boundaries.html))

It’s up to you to define what behavior you will and will not accept, communicate that to your loved ones, and decide what the consequences will be if you’re mistreated. By protecting yourself, you can also provide better, more sustainable support to a loved one with a substance use disorder. And the act of loving yourself can encourage those around you to set their own boundaries. It may even inspire them to begin recovery.

Defining Your Needs

When you’re ready to start this process, begin by looking inward. It might be helpful to talk to a therapist or trusted friend, or spend time journaling about your feelings. Think about your most deeply held beliefs, your goals for yourself, and your needs in this relationship. Make sure your stated boundaries reflect your core values, without sacrificing your well-being for someone else’s sake.

With the big picture in mind, consider what you need from the other person in order to feel safe. This may seem selfish, especially if you’ve been deprioritizing your own needs for a long time. Try to accept that discomfort as part of the process.

Boundaries can be as simple or as complex as you need them to be. The following examples may help you start thinking about what’s right for you.

• I won’t pay your bills or give you money.
• I won’t answer the phone if you call after a certain time of night.
• I won’t communicate with you while I’m at work or busy with other things.
• I won’t drink or take other substances when we’re together.
• I won’t spend time with you while you’re drunk or high.
• I won’t engage in conversations that idealize substance misuse.
• I won’t communicate with you again until you’re in treatment.

These are just examples, and they may not suit your specific situation. Once you’ve determined which boundaries you need to set, you can start thinking about how you’ll respond if they’re crossed.

Establishing Consequences

Boundaries are only meaningful when you’re prepared to maintain them. This can prove difficult over time, especially when challenging situations arise. Do your best to plan in advance how you’ll respond if your loved one crosses a clearly communicated line.

Consequences aren’t necessarily punishments; instead, they’re a way to support yourself through difficult relationship dynamics. For example, you might institute some of the following consequences if a loved one disrespects your boundaries:

• If you show up at my home unannounced, I won’t let you in.
• If you call or text me while I’m at work, I’ll block your number for 24 hours.
• If your behavior puts me in physical danger, I will leave immediately, no matter what we’re doing.
• If you arrive later than planned because you’ve been drinking or doing drugs, I won’t spend time with you that day.
• If you miss therapy or a support group meeting, I won’t speak to you until after you attend your next session.

Make sure these consequences are clear, firm, and realistic. For example, if a long-distance friend lies to you, you can stop speaking to them. That same consequence wouldn’t work for a roommate or live-in partner. Even if you decide to move out and end the relationship, you’ll have to communicate about logistics. If you can’t follow through on these predefined consequences, your loved one may feel empowered to ignore your needs entirely.

Defining your boundaries is an act of self-care. And once you’ve done that work, it’s time to talk to your loved one. This conversation might be difficult, but it’s the first step toward building a healthier dynamic.

Talking it Through

Clear communication is a necessary part of changing a relationship dynamic. And when your loved one has a substance use disorder, you may not be able to rely on them to start these important conversations.

It’s best to schedule this discussion in advance, so that you’ll both have time to emotionally prepare. If at all possible, approach your loved one when they’re calm and sober. If that’s not possible, don’t delay the conversation indefinitely. You have the right to ask for what you need, whether or not they can give it to you.

This is your opportunity to articulate your boundaries as clearly and effectively as possible. You might even take notes in advance, to help organize your thoughts. You can also discuss why you’re putting these guidelines in place, but you don’t have to. Your needs don’t require justification.

Make sure this conversation focuses on the real reason for this new framework: your love for the other person, and your concern for your mutual well-being. If you didn’t want them in your life at all, you could simply walk away instead of doing this work together. Let them know that you care about them, and that this is how you can keep supporting them without burning out or ending your relationship entirely.

Maintaining Healthy Boundaries

After you’ve explained what your boundaries are, it’s up to you to hold the line. Your loved one may be unwilling or unable to respect your limits, especially if their addiction is severe enough to have lasting cognitive effects. Preliminary research suggests that substance misuse may even interfere with empathy, ((Massey, S. H., Newmark, R. L., & Wakschlag, L. S. (2018). Explicating the role of empathic processes in substance use disorders: A conceptual framework and research agenda. Drug and Alcohol Review, 37(3), 316–332. https://doi.org/10.1111/dar.12548)) making it difficult for people to understand others’ needs.

Be prepared for your loved one to ignore or actively disrespect your stated boundaries. This may happen during the initial conversation, if they try to argue or undermine your reasoning. But even if they seem supportive at first, you may come into conflict in the future.

You can prepare for this eventuality by deciding in advance how you’ll react if your boundaries are challenged. While it’s natural to respond with anger, it’s also ineffective. This opens the door for further argument, and may destabilize both your mental health and your relationship.

The other extreme, passivity, is equally unproductive. By quietly allowing the person to disrespect you, you send the message that your needs are not important. This can encourage them to continue treating you poorly, because their bad behavior has no negative consequences.

By planning ahead, you can guard against either of these outcomes. Set the precedent that you deserve love and support. And whether or not you receive care from them, you can give it to yourself. This framework will not only improve your mental health; it can also improve your relationship. It might even show your loved one a much-needed example of self-care, and motivate them to think about recovery.

The Benefits of Healthy Boundaries

It’s ok to be conflicted about setting boundaries. Many people struggle to balance their own needs with the desire to protect loved ones from negative consequences. Remember that this process, while complex, will ultimately benefit you both. In fact, healthy boundaries can improve many aspects of mental health and relationships.

Cultivating Compassion

You can’t pour from an empty cup. When caring for someone depletes your emotional energy, you become vulnerable to compassion fatigue. ((Are you experiencing compassion fatigue? (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/topics/covid-19/compassion-fatigue)) This condition is similar to burnout, and can make it difficult for you to continue supporting the people you love. While the term is normally used to describe burnout in healthcare professionals, anyone can reach a similar limit. And even if you still want to put your loved one’s needs before your own, you might reach a point where you just can’t care for them any more.

By giving yourself room to breathe and recharge through clear-cut boundaries, you can maintain reserves of energy, patience, and mental bandwidth. This practice empowers you to support your loved one in a more sustainable way.

Working Through Codependency

The concept of codependency ((Stafford, L. L. (2001). Is codependency a meaningful concept? Issues in Mental Health Nursing, 22(3), 273–286. https://doi.org/10.1080/01612840121607)) was originally developed to describe maladaptive behaviors of people married to patients with alcohol use disorder (AUD). In recent years, the subject has become controversial. Some researchers believe that this condition is too vague to be clinically meaningful. Nevertheless, many people continue to find help and support by exploring their own codependent tendencies.

According to the American Psychological Association, codependency is “a dysfunctional relationship pattern ((Apa dictionary of psychology. (n.d.). Retrieved from https://dictionary.apa.org/)) in which an individual is psychologically dependent on (or controlled by) a person who has a pathological addiction.” This pattern may present itself in some counterintuitive ways. For example, a codependent person may attempt to control the behavior of their loved ones, without realizing their own actions are causing harm.

Despite common misconceptions, it’s important to note that relationships are not codependent; people are. By uncoupling your identity from your loved one’s identity—and their substance misuse—you can begin to define the boundaries that will protect your energy and mental health.

Turning to Tough Love

If you love someone with a substance use disorder, you may be concerned about their overindulgence. It’s also possible to overindulge in love. And sometimes, the best way to care for someone is by stepping back, and letting them make their own decisions. As much as you might want to help, you can’t go through recovery for them.

Establishing boundaries doesn’t have to mean cutting ties or refusing to help—although it can, if that’s what you need. However, you may be able to rebalance your relationship, providing support from a healthy distance that respects your needs as well as theirs.

To learn more about the recovery process, you can connect with a rehab center to find a good match for your loved one’s recovery journey.

Reviewed by Rajnandini Rathod

Immediate help is available. If you or someone in your life is experiencing suicidal thoughts, you can call the National Suicide Prevention Lifeline at 1-800-273-8255.

Suicidal ideation, or suicidality, is the act of wanting or expressing that you want to commit suicide. If someone you love shows these symptoms, they should be taken very seriously. Fortunately, there are ways that you can help. Some rehab programs offer treatment for suicidal ideation.

Suicide is a global health concern. ((World Suicide Prevention Day 2021: Global Suicide Statistics. (2021). International Association for Suicide Prevention. https://www.iasp.info/wp-content/uploads/WSPD-Facts-Figures-Infographic.pdf)) In 2019, it caused more than 1 in every 100 deaths worldwide. And 47,511 people died of suicide in the U.S. ((Suicide statistics. (2019, November 15). American Foundation for Suicide Prevention. https://afsp.org/suicide-statistics/)) in the same year, making it the nation’s 10th leading cause of death. Suicidal tendencies may be caused by chronic mental health conditions, adverse life experiences, or a history of trauma. Whatever a person’s circumstances, it’s important to believe them if they express an interest in suicide.

If you’re concerned that a loved one is at risk, there are many ways you can take action. In this event, it’s important to be aware of your own capabilities. No matter how much you care about someone, you may not be able to keep them safe without professional help. But you can absolutely connect them with the resources they need. In order to get them the best possible care, you should first learn to recognize the signs and symptoms of suicidality.

How to Recognize Suicidal Ideation

Suicidal ideation may be a symptom of a number of mental health concerns, including but not limited to depression, schizophrenia, and bipolar disorder. It can also appear in the absence of any other diagnosis. People who have recently experienced a great loss—such as the death of a loved one, the end of a partnership or a job, or another major life change—may be at risk.

Not every mention of suicide is a sign of imminent danger. ((The myths & facts of youth suicide. (n.d.). Retrieved from https://suicideprevention.nv.gov/Youth/Myths/)) If your loved one has major depression, talking about their fears may be a call for help, or a sign that they trust you enough to share their innermost feelings. Pay close attention to the context of the conversation, and the specific details they share, in order to assess how urgent the situation is. A person at immediate risk of suicide definitely requires emergency care. On the other hand, a person who is casually thinking about suicide with no plans to act on those thoughts may benefit more from therapy and increased social support.

However you respond, it’s important to take any suicidal thoughts very seriously. Begin by reaching out to experts who can help. You can always start by calling or texting a suicide hotline, such as the National Suicide Prevention Lifeline, the Crisis Textline, or the Trans Lifeline, which specifically supports transgender clients. In addition, there are some specific warning signs you can look for when you’re concerned that a loved one may be considering suicide.

Verbal Warning Signs

People with suicidal ideation may or may not tell you exactly what’s on their mind. Of course, frequent discussions of the topic are in and of themselves warning signs of suicide. ((Risk factors, protective factors, and warning signs. (2019, December 25). American Foundation for Suicide Prevention. https://afsp.org/risk-factors-protective-factors-and-warning-signs/)) However, the signs aren’t always that straightforward. They may also talk about feeling hopeless, trapped, or “like a burden.” Any of these subjects may indicate suicidality, especially if they come up on a regular basis.

If a person trusts you enough to tell you how they’re feeling, it’s important to respond with kindness and compassion. Consciously or not, this may be their way of asking for help. Understand that you can’t “fix” the problem for them, but you can guide them toward professional help.

Changed Behavior

You can help prevent suicide ((Could You Help Prevent a Suicide? Know the Warning Signs. (2021, September 12). U.S. News. https://www.usnews.com/news/health-news/articles/2021-09-12/could-you-help-prevent-a-suicide-know-the-warning-signs)) by simply noticing if and how a loved one’s habits change. Suicidal ideation can cause people to lose interest in activities they used to enjoy. If you notice that a person you care about has stopped engaging in their favorite hobbies, talking to their closest friends, or taking pride in their work, it may be a sign of poor mental health.

However, this alone is not necessarily a cause for concern. People grow, and their interests may change over time. Specifically, a person who pulls back from beloved activities in order to spend more time idle and alone may be at risk.

Isolation

If a person starts to withdraw from social plans they once enjoyed, or puts significant distance between themselves and their closest loved ones, they may be exhibiting warning signs. Many of those with suicidal ideation worry that their poor mental health is hurting those around them, and withdraw from relationships in order to lessen that perceived burden. However, this increased isolation may just exacerbate their symptoms.

Sudden Improvement

It may seem counterintuitive, but a seemingly rapid recovery can also be a warning sign. Many people experience a sense of peace or relief when they fully commit to the idea of suicide. To an outside observer, this may look like improvement. In reality, healing from suicidal ideation is a complex process, and may take a long time. If a person is talking about suicide one day, and seems to be perfectly healthy the next, it may be a serious cause for concern.

In particular, sudden generosity may be a sign that the person is planning to commit suicide ((Suicide risk | syracuse university school of education. (2018, October 21). https://soe.syr.edu/departments/academic/counseling-human-services/modules/suicide/)) in the near future. It’s common for people to start giving away their most prized possessions in preparation for the act itself, in the attempt to avoid being a burden on loved ones after they’re gone.

Making Plans for Suicide

When a person starts talking about specific plans for suicide, ((Warning signs of suicide. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide)) or starts collecting items that may be used for self harm, you should take emergency action. This may include going out to buy a gun, hoarding prescription medications, or performing internet searches on the subject of self-harm.

Some people plan to commit suicide on a particular date, after a certain milestone is reached, or under other specific circumstances. If someone you believe to be suicidal starts talking about a day after which “they’ll be gone,” you should do your best to get them professional help as soon as possible.

Supporting a Loved One through Suicidal Crisis

If someone you love is showing any of these warning signs, they may require urgent medical care. Depending on your area, there may be a variety of options available.

Stay Present

If you believe someone is in imminent danger, do not leave them alone. Psychologist Ursula Whiteside explains that even the most intense emotions “usually resolve or become manageable in less than 24 or 48 hours.” Just staying present, either in person or by phone, can significantly lower your loved one’s risk of suicide. ((Chatterjee, R. (2020, December 15). Reach out: How to help someone at risk of suicide. NPR. https://www.npr.org/sections/health-shots/2019/04/20/707686101/how-to-help-someone-at-risk-of-suicide))

Don’t be afraid to discuss the issue head-on. Some people are afraid to mention suicide, for fear it can trigger a loved one’s symptoms. However, Doreen Marshall, psychologist and vice president of programs at the American Foundation for Suicide Prevention, says “there’s no research to support that.” Instead, she recommends asking direct questions, like “have you ever had thoughts of suicide?” or “what do you think of people who kill themselves?” These questions can open up a conversation, inviting your loved one to ask for the specific kind of support they need.

If at all possible, try to discourage a person in crisis from using substances. There is a strong link between substance misuse and suicidality, ((Division (DCD), D. C. (2013, February 9). Does alcohol and other drug abuse increase the risk for suicide? [Text]. HHS.Gov. https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-alcohol-increase-risk-of-suicide/index.html)) and substances may be especially tempting for a person who is used to self-medicating. However, this behavior can destabilize brain chemistry even further, making it hard for a person to safely navigate a crisis.

Find Professional Help

Although you may be able to sit with someone for a few hours or even a few days, you can’t provide your own loved one with professional mental health care. No matter how well you know them, or how well-trained you are in the field of psychology, the simple fact of your relationship means you cannot be objective. And a person in crisis deserves to receive high quality care.

If the person is not in immediate physical danger, you can take the time to research inpatient programs that treat suicidal clients. You might start by looking for behavioral health providers that are in-network with their insurance. Substance Abuse and Mental Health Services Administration (SAMHSA) also recommends contacting your loved one’s “primary care physician to arrange a mental health screening and evaluation.” In less urgent circumstances, a loved one who is suicidal ((Substance Abuse and Mental Health Services Administration, Helping Your Loved One Who is Suicidal: A Guide for Family and Friends, Publication No. PEP20-01-03-001. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2021. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-01-03-001.pdf)) may find this process less jarring than being taken to the emergency room.

Get Emergency Care

If your loved one is in immediate physical danger, you should call emergency services. ((Calling 911 and talking with police | nami: National alliance on mental illness. (n.d.). Retrieved from https://www.nami.org/Your-Journey/Family-Members-and-Caregivers/Calling-911-and-Talking-with-Police)) In the U.S., you can dial 911 and explain to the operator what’s happening. They may respond by sending an ambulance or a police officer. In this situation, the police can take a person to the hospital either voluntarily or involuntarily.

You may be in the same room as your loved one, and so able to meet a team of emergency service providers in person. However, if you’re concerned because you can’t reach a loved one, you can also call and ask for a wellness check. In this case, you should “call the non-emergency number for the police department in your community and explain why you are concerned.” When you explain the situation, they may be able to visit your loved one and check on them even if you’re not physically present.

Rehab for Suicidal Ideation

In an emergency situation, it’s important to act quickly. But don’t assume that the situation will immediately be resolved. Short-term care is just the beginning of a much longer healing process. And for some clients, it’s best to attend rehab to treat suicidality.

Not every rehab facility is equipped to treat people with these symptoms. Clients with suicidal ideation may need specialized care. If your loved one is considering inpatient treatment, make sure to ask the admissions team which of the following amenities they offer:

24-Hour Supervision

During a suicidal crisis, clients often require round-the-clock care. This high level of supervision is a temporary emergency measure, and not a long-term solution. Certain rehab facilities offer constant monitoring to prevent clients from inflicting self-harm.

Anti-Ligature Protocols

In a facility with anti-ligature protocols, providers take special care to keep clients from accessing items that might cause them harm. Specifically, an anti-ligature fixture is designed in such a way that clients cannot attach any other objects to it. Facilities with these protocols might also ask residents to surrender their shoelaces, or prohibit them from using knives during meals.

Emergency Pharmaceutical Treatment

During and immediately after a crisis, some clients may benefit from pharmaceutical treatment. Specifically, doctors may administer ketamine ((Witt, K., Potts, J., Hubers, A., Grunebaum, M. F., Murrough, J. W., Loo, C., Cipriani, A., & Hawton, K. (2020). Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. The Australian and New Zealand Journal of Psychiatry, 54(1), 29–45. https://doi.org/10.1177/0004867419883341)) or benzodiazepines ((Chiles, J. A. (2019, October 11). The appropriate use of medications in suicidal patients [News]. Psychopharmacology. https://psychnews.psychiatryonline.org/doi/abs/10.1176/appi.pn.2019.pp10a2)) (such as xanax) to interrupt urgent suicidal ideation. These treatments are not appropriate for all clients, nor are they long-term solutions. They’re simply a way to temporarily relieve symptoms, giving you, your loved one, and their medical team the time to plan for longer-term care.

Life Beyond Suicidality

Suicidal ideation is extremely serious. However, it doesn’t have to result in an emergency. If you can recognize the warning signs, you may be able to get your loved one help before they attempt self-harm.

Whenever you take action, make sure to respond with an appropriate level of urgency. In some cases, it’s appropriate to admit the person to a hospital immediately. In other situations, it may be even more beneficial to simply help them find a therapist.

Remember that you, too, have limits. There’s only so much that any one person can do to help someone in a the midst of a suicidal crisis. And that’s why it’s so important to seek out professional help.

To learn more about your options, you can browse our list of rehabs that treat suicidal ideation.

It can be hard to talk about substance use disorders. And that’s especially true if your loved one is in crisis, or in denial about their condition. But these conversations are crucial, and they can have a hugely positive impact. If you’re concerned about a friend or family member’s substance misuse, these strategies may help you show them that rehab can help.

Remember that everyone’s journey is different. The following tips are only suggestions, and they may not resonate with everyone. As you prepare to talk to your loved one, consider their needs, goals, and values. By taking their unique situation into account, you can make them feel even more supported.

1. Prepare Carefully

These conversations should not happen at random. It may not be appropriate to tell your loved one what you’d like to talk about in advance, because a person in denial may avoid the subject at all costs. However, you should show up for this conversation intentionally, instead of bringing it up in the middle of another activity. Even if you see a good segue, don’t take it. Remember the moment for a future date, and reference it when you start your well-planned conversation.

Choose a private, comfortable environment where your loved one is likely to feel safe. Decide who’s going to be there. Depending on the situation, it might be best to approach them one-on-one, or with a group of trusted family and friends, or even with a trained interventionist.

In a group, you’ll have support from more people, which makes it harder for your loved one to evade accountability. On the other hand, this dynamic might make them feel ganged up on or threatened. You know your loved one best; try to choose the format that you think will have the greatest impact on the specific person you’re talking to.

On the day of your meeting, make sure to care for yourself as well. Your emotional state will set the tone of the conversation. If you can approach them from a calm, centered place, you’ll be able to communicate much more effectively.

2. Stay Sober

These conversations aren’t effective if anyone in the room is using substances of any kind. That includes you, and it includes substances that your loved one isn’t misusing. For example, if they struggle with the overuse of cannabis, it may seem safe to talk to them over a beer. It’s not. This can impair your judgment, erode their trust in you, and invite them to disregard your opinion.

It’s important to set an example for your loved one, through both your words and your behavior. Spending sober time together can show them that there are ways to connect with people without engaging in substance use. This is an extremely important part of healing, and may give them hope that change is possible.

3. Be Compassionate

This conversation is going to be hard, and likely painful for both of you. There’s no way around that. Your loved one may lash out at you, argue, or simply ignore what you’re saying. It’s natural to feel anger and sadness in response.

However, it’s absolutely vital that you remain level-headed. Don’t express your frustration to them. By engaging in a fight, you send the message that this subject is negotiable, and that you might be in the wrong. Instead, state your case as simply and kindly as you can, and listen to their response as a way of collecting more information. Plan a time to process your own feelings with someone else after the conversation ends.

4. Validate Their Struggle

It’s important to understand that having a substance use disorder is not a choice. Your loved one’s impulses may be outside their control, and caused by a combination of brain chemistry and adverse life experiences. This is because substance misuse activates the brain’s reward system ((How addiction hijacks our reward system. (n.d.). Dana Foundation. Retrieved February 28, 2022, from https://www.dana.org/article/how-addiction-hijacks-our-reward-system/)) “by directly raising the levels of dopamine. Although each addictive drug also has its own unique effects, which is why alcohol feels different from cocaine or heroin, stimulation of the dopamine component of the reward system seems to be a common denominator.”

Even if a person does not enjoy the feeling of being high, they may be driven to use substances in order to increase their dopamine levels. It can be difficult to see a way out of this cycle. And no matter how hard it is for you to be around their unhealthy behavior, it’s likely harder for them to experience it.

Despite this, people who misuse substances are still responsible for their behavior. It’s possible to hold them accountable for their actions, without attacking them or thinking of them as “bad people.” The best way to encourage change is to approach them with kindness, understanding, and respect.

5. Be Honest and Specific

You can be kind without minimizing the impact of their behavior. Be compassionate, but firm. This is your opportunity to share your experience of their addiction, with as much detail as you can. Talk about how their behavior has affected you, and how you’ve seen it affect them.

However, “brutal” honesty can easily turn into an attack. Instead, make simple, objective statements that brook no argument. For example, saying “you ruined my birthday” is an accusation. On the other hand, saying “you showed up 3 hours late on my birthday, and we missed our dinner reservation,” conveys the same idea through purely factual information.

5. Be Firm

It’s likely that your loved one has a different narrative than yours. They certainly have more information about their own behavior than you do, but they may also have excuses that you find questionable. These different narratives can make it hard to agree on the facts of the issue.

Denial is the tendency of people with substance use disorders ((Addictionary—Glossary of substance use disorder terminology. (n.d.). Recovery Research Institute. Retrieved February 28, 2022, from https://www.recoveryanswers.org/addiction-ary/)) to ignore their symptoms “in spite of evidence to the contrary.” This is a very common symptom of substance use disorders. If your loved one is in denial, they may try to argue with your version of events. You may be tempted to give in to their arguments, out of compassion or just exhaustion.

However, it’s important that you not give in. Doing so can validate their denial, and enable their substance misuse. Instead, accept that this conversation will be stressful for you both. That’s ok. While it may be painful in the short term, this particular type of discomfort may help them grow and heal over time.

6. Share Resources

Before you start the conversation, it’s best to do some research into your loved one’s options. Starting rehab can be very daunting, and people with severe substance use disorders might not be able to handle the logistics without help.

You may need their help with certain specifics, but you can certainly get started on your own. As you prepare to talk to them, try to answer as many of these questions as you can in advance.

• Will their insurance cover rehab?
• Will they be able to take time off work to attend rehab?
• Are there programs that meet their unique needs? For example, some rehabs treat the misuse of specific substances and co-occurring disorders.
• Are there appropriate rehabs in their area? Or, can your loved one travel to rehab?
• Which treatment styles suit them best? For example, they might benefit from a 12-Step program, gender-specific treatment, or an intensive outpatient program (IOP).
• Is your loved one a candidate for alternative treatment, like ibogaine therapy?

In order to get this information, it may be helpful to talk to the admissions team at a rehab center. These experts have a great deal of experience helping people begin treatment, and they may have valuable advice.

Arrive at the initial conversation with specific resources in hand. Remember, though, that this is your loved one’s process, and not yours. Unless you’re their parent or guardian, all you can do is make suggestions. It’s up to them to decide how to proceed.

7. Plan Together

At the end of the conversation, it’s time to make a plan. If your loved one is receptive to your ideas, you can help them decide which steps to take next. This may mean any number of things, from attending a local support group to connecting with an inpatient rehab program.

In some cases, however, they won’t be willing to accept your help. If that’s the case, be prepared to set boundaries and care for your own mental health. Only you can decide what boundaries are appropriate here. However, if there are no consequences to their refusal, you’ll send the message that your opinion is unimportant.

If you’re struggling to set boundaries with someone who has a substance use disorder, you may benefit from learning more about codependency. ((Codependency: An Educational Fact Sheet from the Florida Alcohol and Drug Abuse Association. (n.d.). Florida Alcohol and Drug Abuse Association. Retrieved January 5, 2022, from http://ocw.umb.edu/counseling-and-school-psychology/substance-abuse-and-the-family/New%20Folder/codependency.pdf/at_download/codependency.pdf)) This pattern of behavior often develops in response to dysfunctional relationship dynamics, and it may impact other areas of your life. After the crisis passes—either because the person gets help, or because you decide to step back—you may need to make time for your own healing process.

Following Through

After you talk to a loved one about their substance misuse, it’s important to follow through on your commitments. If they accept your help, that may mean helping them get into a rehab program, advocating on their behalf, or just spending time with them. Alternatively, it may mean setting strong boundaries with them, or even severing the relationship.

People in the throes of substance misuse often lack structure. If you really want to help, it’s absolutely vital that you do exactly what you say you’re going to do. Don’t agree to help with anything specific unless you have the capacity to carry it out to completion. And in the same vein, don’t articulate boundaries unless you’re prepared to uphold them. Doing otherwise might just serve to destabilize the person you’re trying to help, and may even lead to further self-destructive behavior.

And remember that while this conversation is extremely important, it’s just one step. No matter how well or poorly it goes, life will go on, and both you and your loved one will move forward. You can’t predict or control the future. But you can set the intention to heal, and encourage the people around you to do the same.

If you’re looking for a rehab program for a loved one, you can browse our directory of rehabs, which lists key information like pricing, location, insurance accepted, and more.

Reviewed by Rajnandini Rathod