Watching a loved one navigate opioid use disorder can be challenging, emotional, and exhausting. Psychologist Dr. Aaron Weiner speaks with Dr. Geyer and Dr. Lai about how to approach a loved one who is struggling, how to support them through recovery, and how to care for yourself during that process.
- Purchase Ending the Crisis by Dr. Holly Geyer
- Learn more about pain management and safe opioid use on our Opioid Resource Center
- Comments or questions? Email us at mcppodcasts@mayo.edu.
- If you or a loved one are dealing with a substance use disorder, visit Substance Abuse and Mental Health Service Administration.
Read the transcript:
Dr. Benjamin Lai: Hello. Welcome to Ending the Opioid Crisis. I’m Dr. Benjamin Lai
Dr. Holly Geyer: I’m Dr. Holly Geyer.
Dr. Benjamin Lai: This is a podcast series aimed at getting a deeper understanding of the opioid crisis that has ravaged our country.
Dr. Holly Geyer: Today, we’ll be discussing the role that friends and family can play in helping a loved one with addiction. We are so pleased to be joined by Dr. Aaron Weiner. He comes to us with an extensive background in the psychological industry, and we’re going to be talking with him a bit about how friends and family can really support each other, as well as the person struggling with addiction. Welcome, Aaron.
Aaron Weiner: Pleasure to be here. Thanks for having me.
Dr. Holly Geyer: We know that dealing with addiction can be a great toll and it affects families, it affects jobs, it affects our communities, it affects our financial structure. Virtually every aspect of life can really be impacted when there are drugs and alcohols that are being abused.
I was curious from your perspective, when we think about friends and families’ role in addressing addiction within the household, can you give us some high-level overview about how important it is to keep priorities straight during that process because I know there’s heated emotions and it can be very challenging and oftentimes something we fail to do because it is hard.
Aaron Weiner: It’s so difficult on a number of levels when someone you love is doing something that is self-destructive. You’re concerned, and it seems like they’re less concerned about it and it’s affecting you and it’s affecting them and you don’t know what to do and you don’t know if you’re helping sometimes, or if you’re hurting. Ultimately, what’s most important is that you have a method for approaching it for the dynamics within the home that really facilitates them towards health and healing as opposed to potentially either perpetuating or maintaining the problem, and we can certainly drill down into different areas of that.
But if you’re not sure how to do that, and it can be so complex when emotions are involved and substances are involved, that’s when reaching out for help and talking with a professional or even in some cases, joining a peer support group where you can ask others who have been through something similar for their experiences, all of that has a lot of value, so you don’t feel like you’re just making it up as you go along.
Dr. Holly Geyer: Thank you, Aaron. We, as loved ones and family members of someone that might be struggling with addiction, consider the types of responses that we can offer to someone in our households. What types of responses do you think are unhelpful? What are the things that we do that make the situation worse?
Aaron Weiner: Probably the worst thing that you can do in confronting anyone about anything, substances or otherwise, is to come at it from an accusatory or blaming place. Particularly when we’re talking about opioids or other substances of misuse, you’ve got to remember they’re trying to meet some underlying need, whether or not it’s an emotional need or a physical pain related need.
The person using the substance is using it for a reason. That to them is probably really deeply rooted and an important, very basic human need. It’s just the strategy that they’re using to meet that need, overuse of opioids, is the problem. But if you’re trying to wedge yourself between, for them, what feels like a lifeline to just being able to live their daily life, you don’t want to create that triangle because then that creates a tremendous amount of conflict.
Not to say that at certain points you can’t talk about how their behavior is affecting you, but particularly at the outset, you want to start by making it clear you’re on their team. You want them to be okay. You want them to feel okay.
Then hopefully they want you to be okay, too, and you can kind of navigate that together and go about it in a more natural way rather than like: “You need to stop this! Look at what you’re doing! Why aren’t you thinking of other people?! What’s wrong with you?!” When you push, that creates the opportunity for push back.
Dr. Holly Geyer: What great and powerful statements of wisdom there, Aaron. If I read between the lines, I think what I hear you saying is that a lot of this should be focused on that other person, what their needs are, and not necessarily your own, and I can imagine how difficult that must be if you yourself are suffering with awkward dynamics or taking over a lot of responsibilities that person may not be filling. As someone that’s in that situation and is trying to have that conversation. What could be some powerful key phrases they use as they open up the discussion?
Aaron Weiner: The most important place to start with is to be able to acknowledge the impact that their behavior is having on you, while at the same time not necessarily, again, going about it in a blaming sort of way. It could be, for example, keeping it objective, like talking about: “Hey, I noticed that you’ve been a lot more sedated lately. Are you feeling okay?” Or: “I’ve noticed that your mood tends to really go up and down a lot. How are you feeling?” Or: “Hey, when you were snapping at the kids the other night, can we talk about what went on there because I know that’s not how you want to be.”
All of that is very rooted in something that’s objective, so again, it’s not like saying here’s what’s going inside your head or here’s what you’re doing wrong, but instead trying to talk about the situation, maybe even find some common ground where you can start together and eventually get to the opioids, which again, a lot of people who are stuck in a pattern of substance misuse or dependance or addiction, they feel very trapped.
They are very stuck, and it’s not necessarily something they choose as much as it’s something they feel like they can’t not choose, or they can’t get released from. There’s a lot of mixed feelings and a lot of charged feelings. Particularly when you’re starting off really trying to show clearly you are a safe person emotionally for them, even if you might not agree on everything, that you’re with them and hopefully appeal to their better angels of not wanting to be hurtful to you so that you can move towards a solution together.
Dr. Holly Geyer: Excellent. We know oftentimes that those struggling with addiction may not be at a point where they’re willing to acknowledge it. If loved ones find themselves trying to have the conversation that we’re talking about now and just don’t seem to be getting through. What alternative strategies could they employ, or what’s a better way to get to the destination of helping that loved one see what’s happening to the family?
Aaron Weiner: That is a very common problem that folks run into, because when someone’s dealing with an addiction, there’s almost these levels of either psychological denial as well as almost like a biological filter that people have to go through where their decisions, and sometimes it seems like spontaneous thoughts are driven, is the internal experience from those who have been through this, by this substance or craving for a substance.
If you’re in that position where you try to have the rational conversation, where you’ve tried to connect the dots and it just doesn’t seem to be working, the hardest part is sometimes you just have to wait and you have to help people connect dots again and again and again and pair the consequences, the negative consequences that are happening in their life, to that use whenever they occur.
One of the more difficult to unravel family dynamics around addiction is that oftentimes people will buffer their loved ones who are struggling with addiction from the full consequence of their actions, either the interpersonal consequence in terms of will it damage relationships, sometimes the financial consequences. They cover for them. The more colloquial term for this is “enabling” where essentially you support the behaviors continuance through buffering from natural consequences.
Sometimes what has to happen if the rational approach from the logical side doesn’t work is they have to experience more of those consequences of action and link it to their use before those more logical arguments will actually land.
Dr. Holly Geyer: I think you’re making a great point there. There are consequences to drug addiction, and we’ve recognized that the more a person uses, the longer they use, the more likely they are to experience those. Oftentimes those consequences start flooding over into the family, into relationships, into finances, into vocations. From a loved one’s perspective is there a role for creating boundaries for how much of that can really take over your own personal life, and how would you set those boundaries?
Aaron Weiner: I would say the most important part about setting boundaries with someone who’s struggling with an addiction is to gauge your own capacity for being on that roller coaster with them, because that can be what the experience is like. Their life is going up and down, and is very erratic, much in some ways like the level of the opioids in their blood.
When you’re on that with them, that can be extremely emotionally traumatic and emotionally jarring, chaotic, uncertain. If you are at a place where you’re looking at your own mental health and saying: “This is really not working for me, I am basically attaching my mental well-being here to somebody who is not behaving in a healthy way, nor potentially taking steps to care for their health.”
That’s when you’ve got to think about potentially setting those boundaries up. It’s different for everybody. You’ve got to decide what’s right for you, but ultimately, and again, everyone has a different perspective on where that is and how you do it. I know for me, when I’m working with folks around making this choice and how to do it, it really centers on this question of what is going to ultimately assist your loved one in healing?
Sometimes that’s consequences. Sometimes that can be distant, sometimes that can be boundaries if that’s what their behavior has wrought. That can be okay while at the same time being compassionate to them and being compassionate to yourself, because you do have to be mindful of caring for yourself or it’s very difficult to fulfill your other normal life responsibilities, parenting, work or otherwise.
Dr. Holly Geyer: I can imagine how challenging that is to really set up those boundaries or draw those lines. Where do you think is the best way to start those conversations? Let’s pretend someone has a loved one who’s bringing drugs into the home, or people who may not have the best of reputations and potentially have dangerous activities occurring in the household. Can you give us an example of what a conversation might look like as you address it?
Aaron Weiner: It centers around the objective side of what you need. It’s always helpful to know before you go into that conversation where your boundaries are and what you can accept, and then where, if there are compromises, if there’s patience for perhaps a slower growth curve, what that looks like. Are these behaviors, for example, in the context of someone going to treatment and trying to get better, or is this someone who is potentially in a, what we call a pre contemplative stage of change, or they’re not even sure that they want to change yet. They’re okay doing what they’re doing and they think that you’re way out of line and telling them how to live their life or something along those lines.
They’re not interested in it. But knowing when you’re going in, say this is an adult child who’s in your house and you’re helping them and they’re living there, you do have the right to say: “Here’s what is okay to do in my house,” or: “If you’re engaging in these lifestyle choices, you have the right to do that, but that means that there might be some consequences in terms of the amount of time we spend together, whether or not you’ll be allowed in the house or whether we’re going to pay for your car, for your car insurance,” or if we’re talking about other relationships, if this is somebody’s partner or somebody’s spouse.
In terms of what needs to change and if it doesn’t change where and why, you need to draw the line. Again, it’s very helpful not to couch it in a way that says you are wrong or what you’re doing is wrong. That’s accusatory, that’s going to get pushback. But instead of “this does not work for me” or “when this happens, it really ruins me,” or “This breaks my heart, and if this is your path, this is your path, and I can’t walk down that one with you, and here’s where these lines are.”
Really doing some soul searching and some thought ahead of time, and then approaching that conversation in a way that’s more of sharing and being assertive about where you need things to be, but at the same time respectful, that the other person doesn’t get to make choices for their life and then there’s consequences depending on what direction their choices take them.
Dr. Holly Geyer: Thank you, Aaron. That’s a great insight.
The CDC estimates that nearly 2.7 million people in the United States have dealt with opioid use disorder. If you or a loved one are managing opioid use, my book, Ending the Crisis can be your guide through addiction with resources for those struggling with addiction. Information about interventions and treatment centers have much more. This book is a How to Guide to Navigate opioid use. Visit the link in the notes of this episode or visit mspress.mayoclinic.org/opioids. To get your copy today.
Dr. Holly Geyer: I can tell you from personal experience with family members that have had other loved ones struggling with chemical dependency issues, it’s an easy reaction to say: “You know what? We’re done with the relationship. I’ve been burned too many times. I’ve been wounded. There’s too much chaos. I’m cutting them off.”
In my experience, I’ve seen people that needed help have nowhere to go to get that help, and I’ve seen relationships destroyed long term. On the other hand, there’s a role for protecting ourselves from individuals that might cause ongoing pain and destruction in our own lives. Where do you draw the line between cutting a person off permanently or keeping a relationship where there is drug and alcohol involved to help that person find treatment?
Aaron Weiner: As a psychologist, I’d be hypocritical if I didn’t feel like people couldn’t change. They can change and things can get better. My frame for families always rests in the place of how can you help this person towards healing? Sometimes that means their consequences have actions that take them further away from you. But it also means when they’re ready for change, if they reach out a hand and say: “Help me. I would like to move in the direction towards healing and recovery and stabilizing my life,” ideally, then you reach back.
That’s actually, ultimately, if you love this individual, if you care about them, when they are ready to make choices that move them towards greater well-being, you’ve got to be there to assist them with that. That doesn’t necessarily meanthat you’re going to immediately bring them back into your home or whatever it may be. Everyone needs to make those decisions depending on what’s come before.
It doesn’t mean that you have to get over broken trust or that you have to assume that someone has changed or they should receive special access to your heart or to your finances or to anything because they’re telling you they’re ready,but it does mean that if they are ready, ideally you want to provide them with a support structure so that they can get better because as you mentioned, Dr. Geyer, it’s something where when people are really mixed up in this, they might have very few resources and nowhere to go and have lost their insurance and all sorts of different factors that make it so much harder to get care.
Having that perspective of everything that I do is in the best interest of my loved one, and then also in myself and recognizing that at the end of the day, if it’s a choice between the two, you have to watch out for your own health. You have to do that. At the end of the day. You have to make sure you are okay.
But if you can be okay and assist somebody who you love, even if they’ve broken your trust in the past or even if they have struggled, then I would generally highly encourage you to do that because that will help facilitate someone’s healing.
Dr. Holly Geyer: What great advice. Thank you. You mentioned some key things in there, keeping yourself healthy through this process. I know that many people struggle with their own mental health issues as they’re helping loved ones that have addiction problems and the strains and the responsibilities they take over.
Perhaps accommodating either someone going through treatment or the person isn’t interested in treatment, and you’ve assumed their responsibilities for bringing in an income. Things of that nature, child rearing. From your perspective, what are some key things that a person can do to keep themselves mentally and physically healthy through the process of navigating the addiction problem?
Aaron Weiner: That is a really good question that has a lot of different answers. I guess that’s the good part, is that there are a lot of ways that you can support yourself through difficult circumstances like this. If I was going to break it down into two halves, I would say make sure that your internal supports are strong and that your external supports are also strong.
By internal supports I mean, do you have good solid coping mechanisms for dealing with stress and dealing with anxiety and dealing with uncertainty? If that is not the case, if you are walking around very tense, if you’re having potentially some maladaptive coping strategies of your own, whether or not it’s just feeling a lot of anxiety or depression, eating disorder or your own substance use concerns, you want to make sure you have that under control.
Things that can help with that a lot, I know I’m biased as a psychologist, but therapists are awesome. We can help. Very useful in that way. Consider working with a therapist if you’re not already doing so. Beyond that, though, I’m a huge proponent of diaphragmatic breathing, deep breathing and using that to calm the body and the stress down, as well as mindfulness meditation and a lot of the theories that go along with those techniques in terms of really trying to see the world for what it is and not layer really stressful stories on top of it, because a lot of our emotional experience is created not just by the world, but how we react to it.
Our perceptions of it, then feeding into our emotions. If I were going to just go with a couple, they’re really good coping techniques. Again, there’s not, by the way, just like getting dinner out or a pumpkin spice latte or something like deescalate your body, bring your nervous system back down more at rest space. They’re talking with others through therapy and through mindfulness. Mindfulness meditation would probably be my quickest hits.
The external factors have to do with who you surround yourself with. That could be a really good opportunity if you’re taking on a lot of stress from one particular relationship to really say: “These other relationships in my life, what are they doing for me? Are they uplifting? Am I just absorbing a lot of drama and negativity from some places?”
You may need to be a little more selective about what you’re exposing yourself to? But even beyond just having really uplifting, healthy personal relationships and drawing those people close to you, it can be worth getting involved in a peer support community with others who have loved ones struggling with addiction because this is unfortunately a very common problem.
8% of the country has a diagnosable substance use disorder, so it’s not uncommon to have a loved one struggling with this, and entering into these sorts of communities, whether or not they’re in person support groups, online support groups, social media groups that are more like message boards and chatting that way. There’s so much support out there you can find validation, understanding, wisdom.
You want to surround yourself externally with these robust support structures, both of people who really get you and see you maybe on a personal level, but also who understand what you’re going through in terms of your loved one. Having an addiction.
Dr. Holly Geyer: What great thoughts, Aaron. You’ve really made a good point about the importance of community through all this process and that’s one of the things I wanted to touch on today.
We’ve often heard of the concept of an intervention, and an intervention has historically been really bringing together either a person or a group of people who’ve been impacted by somebody else’s addiction to address that addiction with that person.
And I know that the literature has talked a bit about bringing that community together to prepare for it so you’d know what to say, how to address it if things are truly at that point.
I was wondering if you could maybe give us some perspective about interventions in general and when they work, when they don’t work and perhaps who to have at the table if you’re going to do one.
Aaron Weiner: This is an issue, I think, where there’s a lot of misunderstanding. Interventions in general, you’ve got to be careful about when to employ them and the bring everybody together, potentially bring a professional in as well, to have a confrontation because confrontations are not the best for instilling intrinsic motivation.
They can be great for promoting guilt in the moment, hopefully not promoting shame, although that can happen sometimes as well.
But it can definitely create a sense of defensiveness when you feel ganged up on. If you’ve ever had that experience where you feel like a whole room is against you. Very rarely is your response there just to surrender per se, you’re more likely to fight back.
Sometimes an intervention, if someone just will not listen or cannot see it can be helpful to create that sense of context for them.
Look at all these places where this is going on. I would be very mindful about that gang up mentality, the cornered mentality, and that what we know about behavioral change is that when people choose it for themselves and when they take ownership in the process of asking for help seeking it out, that’s when we see them most follow through and then the most compliance long term.
In terms of lasting sobriety, where we see the best result. In terms of how you broach this with folks, I generally would recommend having those personal conversations that we alluded to earlier in the program where it’s not everyone coming in all at once bringing out an expert to tell them what the real deal is and what’s going on.
But instead really trying to connect with them on a personal level about what’s going on for them and about how they’re hurting, about how what’s going on right now is hurting you, drawing that connection between cause and effect of their use and the consequences in their life, and then perhaps even encouraging other people the family to do the same.
Really talk to them about this and let the person put it together for themselves rather than converging all at one time and hitting them from all angles.
If that really does seem like the best course of action and you’ve tried talking to them individually and it’s not working.
Certainly there are individuals who specialize in doing interventions to get people to at least go to treatment. Again, hopefully that takes and then it’s not just going to treatment, leave treatment and then fall back into their previous patterns. I can’t recommend anybody specific on this program, but there are folks who do this and that is their profession, and I would recommend probably reaching out to one of them if you felt like: “Tried everything else. They are not putting these thoughts together by themselves and we really need to try something that’s a bit more aggressive and direct.”
Dr. Holly Geyer: Thank you, Aaron. That was great advice. Dr. Lai, any thoughts on this?
Dr. Benjamin Lai: Aaron, this is just a fantastic session. You’ve given so many great pearls. I work as a family doctor and part of the joy of my job is I get to take care of the whole family. There are times when I encounter parents or spouses of patients who’ve overdosed or who have relapsed. Guilt and regret can be a predominant feeling.
“I should have set this to him.” I should have done that. “I should have caught the signs.” All you mentioned earlier already about support groups. Do you have any advice for perhaps family members and loved ones about how to deal with that guilt and regret?
Aaron Weiner: That’s really tough. The first thing that I would always do is validate. I think sometimes as either friends or even health providers, we tend to want to swoop in and be like: “Here’s how we’re going to solve your problem. Here’s how you should think about this.” First, really acknowledging and honoring the grief and the loss and the fact that this is coming from a place of love is really important.
I would always start there. The second part, once folks are ready potentially to question that belief, “I could have done something about this if only I had done this one thing. If I’d called them back, if I had gone over there that night, if I hadn’t cut them off, this would have ended up differently.” We as humans like to feel like we can control things.
We get very uncomfortable when we can’t, and sometimes we’ll even rewrite history or wish that we could thinking like: “Wow, like maybe I had the control here and I could have made a difference” when in fact, often times, addiction is this vast web and constellation of where people are getting substances from somewhere. They might have a whole life built around opioids or substance use.
Psychologically, they’re deep in it. That person themself they’re not a therapist, they’re not a treatment program. Of course, you could always make the argument, “well, what if this one well-placed comment had changed things?” Or “if I’d been there at that time?” However, when you look at responsibility, I think the best question is did you do everything that you felt like you could at the time?
Were you in an incredibly traumatic circumstance, trying your best with the tools you had available? And if the answer to that question is yes, then that’s just something we have to accept. Even if somebody is scared. Even if someone feels like they were being self-protective and keeping to themself, that’s because they were very, very hurt, and you can’t go back and rewrite that.
People do whatever they can at the time to support the people they love with whatever emotional burdens they’re carrying and with whatever consequences have occurred from that person’s actions. At the heart of it, being able for people to show a self compassion for themselves in their actions, understanding that for all of us, hindsight is 20/20 and we can look back on situations without being mired in all of that emotional muck that affects our own decision-making and say: “Well, maybe I should have done this thing that now I can see.” It’s not the way it works at the time.
And so if you can be gentle with yourself and just know that you were doing the best you could, that’s where I’d go. Compassion and then recognize that you might not actually have had all the control that you thought you did and it might not have been up to you. It might have been like spitting into a hurricane when you look at the extent of the addiction.
Dr. Benjamin Lai: That’s wonderful advice. Thank you very much. That is all from us on today’s episode of “Ending the Opioid Crisis.” You can check at our website at mcpress.mayoclinic.org/opioids for more episodes of our podcast series and other resources for safe opioid use.
If you or someone you know are struggling with an opioid or another substance use disorder, we recommend speaking with your health care provider or going to the Substance Abuse and Mental Health Services Administration website.
Relevant reading
Ending the Crisis
An authoritative guide to understanding the current opioid crisis in America and how it can be solved.
Shop Now
