When someone you care about engages in risky substance use

If you have a relative or friend who may have a drug or an alcohol problem, it's important to know the warning signs of substance use disorder (SUD). It’s also helpful to understand how to approach the situation and learn about the resources available to your loved one, to you, and to any others who are affected by the problem.

Substance use disorder can be a very serious problem. When someone uses illicit drugs or misuses prescription drugs, alcohol, or cannabis, it can create serious impairment and lead to dependency on the substance. This dependency, in turn, can make it very difficult to stop using. Fortunately, with the right supports it is possible to limit the harmful consequences of substance use disorder, such as health problems and damage to personal relationships.

Effects of substance use disorder

…on the person engaging in the unhealthy behaviour

Risky drug and alcohol use can cause serious problems, including significant health concerns. Untreated alcoholism can lead to conditions such as cirrhosis of the liver, increased cancer risk, heart disease, and damage to the brain. Drug misuse (or use other than prescribed) can lead to respiratory problems, a weakened immune system, increased strain on the liver, heart conditions, seizures, stroke, brain damage, problems with memory and decision-making, death from an overdose, and other problems that are related to the drug that's used.

Substance use disorder can also result in:

• family conflicts
• loss of friendships
• chronic feelings of guilt
• low self-esteem
• financial problems
• difficulties at work
• legal problems
• mental health conditions such as anxiety, depression, psychosis, or even suicidal depression

…on others

Relatives and friends of those with substance use disorder may also be affected by the problem. The stress of living with or caring about someone with problematic drug or alcohol use can lead to:

• resentment
• insomnia
• anxiety
• irritability
• depression
• frustration
• guilt
• embarrassment
• social isolation

The effects of substance use disorder on a family member or friend can be dramatic. The mood swings and crises that occur are often felt by loved ones—the spouse or partner, children, or a friend—who may find their own lives becoming unmanageable and may develop unhealthy ways of coping with the alcohol or drug problem.

A spouse/partner or a loved one of someone with substance use disorder may fluctuate between hope and disappointment. They may experience increasing feelings of fear, confusion, anger, anxiety, and loss of self-esteem, especially if there have been numerous relapses. As the problem progresses, the partner or family member may struggle with knowing how to support their loved one without inadvertently reinforcing the substance use. For example, the parent of an adult child with SUD who is unemployed and living at home may be unsure if giving their child financial support is helping or hurting them. The term "co-dependent" is sometimes used to describe what happens when loved ones rely on one another in unhealthy ways. For example, a spouse might call their partner's employer and tell them they are sick, when in fact they're hungover.

When it comes to a parent’s substance use, children may experience feelings of embarrassment, insecurity, and tension which can develop into social withdrawal, powerlessness, and depression. As a parent's substance use continues, the family may begin to live from crisis to crisis, and children’s development may be affected.

Warning signs

The warning signs of unhealthy alcohol or drug use aren't always easy to recognize because the person may go to great lengths to hide the problem. Alcohol or drugs may have a negative effect on the person's:

• relationships with family members or friends
• work
• physical health
• mental health
• recreational activities
• finances (caused by an inability to work or by spending money on drugs or alcohol)
• legal concerns (which may include charges of driving under the influence of drugs or alcohol)

The person who is misusing drugs or alcohol may:

• show personality changes when under the influence of drugs or alcohol. For example, they may become extremely sad or happy. They may also be anxious and irritable when they do not have access to drugs or alcohol.
• break commitments or promises because of the drinking or drug use, either while under the influence or while recovering from the effects.
• experience significant behaviour changes. For example, they may become aggressive, violent, withdrawn, have obsessive thoughts, or insist they don’t have a problem. The person may miss work regularly.
• seek out activities that include drug or alcohol use or change who they socialize with.
• engage in risky or impulsive behaviours, such as driving under the influence of alcohol or drugs.
• be unable to stop using alcohol or drugs even when really trying, possibly to the point of hiding their use.

Another common warning sign of substance use disorder is that the person's family, friends, or employer may express concerns about the person's drinking or drug use. Even just one of these signs may mean that a person requires professional help.

Treatment options

The type of treatment that makes sense for someone with SUD will depend on a number of factors, including the frequency and type of substance(s) they’re using, how severe the problem has become, and how accessible treatment is given their circumstances. Professional help is often required if the person’s substance use has developed into substance use disorder.

Treatment usually starts with a formal assessment or evaluation to determine the extent of the problem and the best level of care. A trained professional will perform a face-to-face assessment, either in a treatment program or other professional setting. After the assessment is completed, a referral to an appropriate treatment program is made.

Many kinds of help are available, including:

• Educational classes for learning about substance abuse and addiction.
• Self-help support programs, including 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous. As an alternative to the 12-step programs, there are secular programs such as Smart Recovery. These group programs provide support and guidance about how to abstain from drugs and alcohol and how to avoid returning to risky use.
• Withdrawal management (“detox”) programs, where medical professionals can monitor a person's wellbeing as they withdraw from alcohol or certain drugs.
• Outpatient programs, including individual and family counselling with a therapist or mental health counselor experienced in treating substance use disorder.
• Inpatient programs, also called residential programs which can be anywhere from 30 days to 12 months depending on the program.
• Intensive out-patient programs in which a person receives individual counseling, group therapy, family counseling, and educational groups that focus on addiction and relapse prevention.
• Recovery residences (formerly known as halfway houses), which provide longer-term emotional, residential, educational or vocational support.

Getting help for someone facing substance use disorder

Some people with substance use disorder are aware of their problem and know they need help. Others have difficulty recognizing their issues and acknowledging the seriousness of their problem. A variety of methods—sometimes called interventions—can help relatives and friends raise their concerns with someone who is dealing with a drug or alcohol problem. Those methods include one-on-one discussions between the individual and a trusted family adviser, family meetings organized with the help of experts, and more structured formal interventions.

Getting help for you and your family

There are many supports and resources available if someone you care about is engaging in unhealthy drug or alcohol use. These may include:

Your primary health provider. Your primary health provider can refer you to a clinician who works with families and friends of those with substance use disorder. They may also advise you about helpful resources in your area such as community treatment programs, advocacy agencies, or support groups.

Self-help groups for relatives and friends of those with substance use disorder. You may want to look into Al-Anon, Nar-Anon Family Groups, or Smart Recovery which are self-help programs for relatives and friends of people dealing with alcohol or drug addiction.

Your organization’s assistance program. If you have access to an assistance program, reach out to them for support and resources.

Compulsive alcohol or drug use is a serious and sometimes life-threatening problem. Many people with substance use disorder recover and go on to lead healthy and rewarding lives free from drugs or alcohol. You can help by encouraging your loved one to get professional help and, if you are having difficulty coping with the behavior, getting help for yourself, too.