When nurse Kristen suffered the traumatic loss of her high school sweetheart in her mid-20s, friends and family thought it was understandable she’d get blackout drunk to deal with the pain. They always made sure she got home safe and someone would often spend the night to watch over her—but over time, those, “Did you get home okay?” texts became more infrequent, and no one slept on the couch for her anymore.

“It was obvious that I had a problem, but it was too painful for people to even be around me,” she recalls. “I’d only make plans if we were going to a bar, I didn’t show up to weddings or other events, and I became very isolated. I was right where my addiction wanted me, which was alone.”

Without her network of friends, her addiction progressed. She started forging prescriptions for Adderall—a medication often used to treat ADHD—and quietly yearned for someone to stop her. Yet she pushed people away in favor of her addiction, and lied about getting help to the few friends who asked about her health. Looking back, she wishes someone would have taken the chance to be bold.

“It would have been so helpful for friends or family to say they were concerned,” she says. “Of course, I take responsibility for my actions, but I think just having my behavior pointed out to me would have been valuable.”

Should you say something?

Identifying substance use issues in the current social climate isn’t easy for a couple of reasons, says Erin Goodhart, executive director of core programming for Caron Treatment Centers in Pennsylvania.

Find out more about Caron, a multi-location treatment center with a 94.4 percent rate of recovery at 90 days post treatment, based on an independent study.

For one, we live in what she calls the “wine sippy cup culture,” full of cute t-shirts that read “Rosé all day” and equate self-care with happy hour.

Another reason—and this could be a big one—many women tend to have a friend group who drink the same way they do. Plus, there’s a misperception that people with a substance use disorder have difficulty functioning—when the truth is that they may hit the gym, go to work, get their kids to school on time, be productive, and then go home and start drinking in a problematic way, Goodhart says.

“It’s not easy, but there are ways to address what you're seeing, and help them navigate toward getting what they need.”

“There’s no single model of what someone with a substance use disorder looks like,” she says. “Instead, especially for women, the signs may be more subtle.” Those can include:

  • Changes in routine, usually to have more opportunities to drink or use substances
  • Health changes, such as getting sick more often
  • Shift in self-care, like not showering as often
  • Change in friends, specifically hanging out with others who drink or use substances more
  • Tendency to cut off or ghost friends who express concern

It’s the last one that might cause many friends to hesitate when it comes to bringing up their thoughts, she says. Even if it tends to be easier to avoid conversations like these, Goodhart asks which is harder: Talking about these issues and potentially getting cut off, or saying nothing and seeing a friend fall deeper into addictive patterns?

“The risk [of saying nothing] is that you could lose your friend, literally,” she says.

Here are strategies that Goodhart and Kristen—now a nurse practitioner who assists people living with addiction—suggest as starting points.

Use “I” statements

Starting from the perspective of genuine concern is always a good approach, says Goodhart. Dig into how you actually feel—it’s okay to be angry or hurt—and how you want to express that in a way that’s productive. Confrontational language like, “You’re drinking too much,” will push your friend further away and often fire up their defenses. Instead, begin a conversation gently with what you’ve been seeing, so it comes from your perspective. Here are examples of what you could say:

  • I’ve been concerned about you because it seems like your health is being more and more affected by drinking.
  • I was scared when you didn’t remember what we talked about over the weekend.
  • I feel like the only time we see each other is when we hang out at a bar, and that makes me wonder if something is going on.
  • I really value our friendship and I love you and care about you, so I’m hoping we can talk about what’s changed in the past few months.

Plan what you’re going to say in advance

While some opportunities might crop up for having a deep discussion, it’s better not to wait for those spontaneous chances, Goodhart suggests. Planning what you want to say, and maybe writing it down, can help clarify your own feelings about your friend’s substance use. Plus, it can jog your memory about specific incidents that have prompted your concern.

For instance, it’s less effective to say:

“I’m concerned about you and how much you drink.”

It’s more beneficial to give concrete examples to back up your sentiment:

“I’m concerned about how drinking is causing you to miss work more often and to cancel on your friends—like last Saturday when I asked you to go to the beach with me. That’s been happening more and more.”

Specifics not only help identify patterns of behavior, but also consequences of that behavior, says Kristen.

She says that when she was in active addiction, she wasn’t thinking beyond her next drink or dose of Adderall, and she didn’t contemplate how her addiction was affecting others. Hearing about a friend’s experience can offer a different view that might be jarring, but also highly effective, she says.

In addition, choose the place where you have this conversation wisely. Try not to have the conversation where your friend might feel super-vulnerable. Pick somewhere that you can chat without interruptions and without being overheard.

Set boundaries

The fact is: You might lose a friend by having this conversation, but that doesn’t mean it’s inevitable or even for good. You just may need to take another tactic to show them you care.

For instance, Kristen says her friends set clear boundaries around her behavior—such as not hanging out with her while she was drinking—and that caused her to stop seeing them. But they all came back once she was in recovery.

“They’re my biggest fans now,” she says. “I had to earn their trust back, and I did that over time by showing them how much I value them and myself. In many ways, their boundaries pushed us apart when I was in active addiction, but it strengthened our relationships in the long-term. Now I realize that friends—true friends—talk about all that hard, raw stuff because it matters. That’s what showing up for each other means.”

Caron Treatment Centers have treated patients and families for 65 years with real compassion and real understanding of addiction and accompanying mental health issues.
Learn more.