Substance use disorder is a prevalent issue almost everywhere, but especially in the United States. According to data from the Department of Health and Human Services, 48.7 million Americans 12 years or older, approximately 17% of the population, met the applicable DSM-5 criteria for having a substance use disorder in 2022.

For these nearly 50 million Americans and their families, substance use disorder can cause a strain on even the closest relationships. While discussing the use of substances can be complex and emotionally charged, there are ways to discuss these matters in a supportive and productive way.

Understanding addiction

According to Nebraska Medicine psychotherapist MK Schlichting, MS, PLMHP, there are a lot of misconceptions when it comes to substance use disorders, specifically the intention behind them. “There is frequently an assumption that people who misuse substances are choosing that way of living; their behaviors are purposeful. That their actions are malicious,” says Schlichting. “But those struggling with substance use disorder aren’t choosing risky behaviors, isolation, or conflict.”

When substance use is active, especially if you have moderate to severe substance use disorder, that substance is hijacking your decision-making processes. “You’re not making clear decisions. Those who are substance-free may see these decisions as irrational or problematic,” says Schlichting.

When we use a substance, we receive the neurobiological transmission of chemicals, such as dopamine, that trigger our internal reward system to reinforce the use of what makes us “feel good.” This reward system tells us to continue using the substance to receive more of those chemicals, forming habitual use over time. “Once these substances hijack our decision-making processes, all bets are off,” says Schlichting. “You’re no longer making decisions in your best interest, just decisions to get your next reward.”

Substance use disorder is a disease process, which means there are biological, psychological, and social components. Accordingly, recovery management for substance use disorder can involve many interventions, which include:

• Medications to reduce cravings and manage mental health symptoms.
• Mental health therapy works through behaviors, urges and emotions the individual experiences.
• Repairing interpersonal relationships.

Effects of substance use disorder

Substance use disorder not only changes your decision-making; long-term use reshapes the brain's structure. “How you perceive things around you, like how someone’s interacting with you, shifts from an earlier perception.,” says Schlichting. These changes lead to many people with substance use disorder feeling isolated. They believe the people around them, including friends and family, are working against them.

“This mindset continues to change when more risky behaviors happen,” says Schlichting. “Consequently, we see a decrease in a person's ability to care for themselves and a diminishing in physical health over time. Long-term substance use can lead to many different chronic illnesses.”

What to do when talking about addiction

One of the most significant points family and friends can remember when talking to a loved one about substance use is that the actions of the individual with substance use disorder are not intentional and not personal. “If they could choose something else, they would,” says Schlichting. That is why it is essential to know that substance use is a medical and mental health issue.

Another important action is to educate yourself about addiction and substance use disorders. Learn the language around these issues to help you better communicate with your loved one in the most respectful manner possible, as this will nurture trust. Find relevant and trustworthy resources. The Substance Abuse and Mental Health Services Administration (SAMHSA) is an excellent place to start. “You can always call into a local Mental Health facility or Substance use treatment program, and they will have resources,” says Schlichting.

Finally, help yourself and your mental health by building a community. Just like any individual dealing with substance use disorder, their family should feel supported, too. “You need to work on your thoughts/feelings, so you don’t bring them into the equation when trying to help the individual with substance use disorder,” says Schlichting.

Part of establishing this community should include finding other families that are experiencing similar issues. “When we have a support system, it helps us to function better, and we feel less alone,” says Schlichting. “They can help answer questions and listen to your concerns.” This will allow you to be more supportive with your loved ones.

What NOT to do when talking about addiction

The first action to avoid is blaming or shaming your loved one. Shame is one of the most significant emotions that sticks with any person, and those with substance use disorder are especially vulnerable to shaming themselves.” When individuals who use experience shame, “It’s a quick way for them to shut down and conceal their use. And this lack of communication, in turn, will increase the likelihood of engaging in risky behaviors, injury and even death.”

This concealment can lead to additional stress and mistrust between members family members. “It can fracture the family unit and damage interpersonal relationships,” says Schlichting.

Additionally, you want to avoid stigmatizing language. There are a lot of stigmas surrounding mental health issues, especially substance use disorders. “We have to reeducate ourselves on how to talk about these issues,” says Schlichting. Further stigmatizing these issues can contribute to feelings of shame and negatively impact your relationship with the individual.

You also need to monitor enabling behaviors, which can further harm someone with addiction or substance use disorder. While the line between positive and negative enabling can be thin, it is imperative to understand and avoid negative enabling as much as possible.

 Support from family and friends is vital to the recovery of many with addiction or substance use disorder; drawing this distinction between enabling and supporting is crucial. “You have to figure out how to support your loved one in a way that maintains boundaries while still helping the individual,” says Schlichting.

Addiction and substance use disorder treatment with Nebraska Medicine

Nebraska Medicine is committed to treating mental health with the same outstanding quality of care we are known for treating physical health. One critical component of our comprehensive addiction services is our Intensive Outpatient Program (IOP). This IOP provides evidence-based, integrated care for those with addiction and other mental health disorders.

“We have a team of medical providers, including psychiatrists, physician assistants, and nurses, who focus specifically on substance use disorder and psychiatric medications to help with various concerns, including depression, anxiety, trauma-related disorders and more,” says Schlichting.

“We’ve seen a lot of success with this program,” says Schlichting. “So, a great place to start with helping a loved one with addiction or substance use disorder is Nebraska Medicine.”