Uncomfortable Conversations: Talking to a Loved One About Their Substance Misuse.
We invite you to join Freedom Institute’s Frank Wells, LCSW, Director, Family Services and Family Therapist, and Salah Bustami, LMHC, Family and Individual Therapist, in a conversation on talking to loved ones about concerns surrounding their substance misuse or abuse.
Frank Wells, LCSW
Frank Wells, LCSW
Frank Wells: The idea today is to take a look at our perspective on talking to loved ones about your concerns around substance use or overuse and share some of our thoughts and experiences based on what we've seen in our own work. We will talk about what might be helpful to people and what is less helpful. Often, we start with getting a sense of what the person seeking advice needs and wants to do. Salah, if I called you and said, “I am concerned about my husband's or my sister’s or my son’s drinking,” what would you ask me? What would you say?
Salah Bustami: I would start with some concrete questions like “How often has he or she been drinking? How long have you noticed this issue? What changes have happened in your relationship? How is it affecting your relationship? How has it affected his or her life in other ways such as work, other relationships?” I start off with those concrete questions.
FW: I agree. I always begin with trying to learn more about what makes them feel like it's a problem: ”What about the behavior seems like an issue and creates concern?”
SB: I would also be curious about to what extent they, the loved one, sees it as a problem.
FW: I might ask whether or not this is something you have all talked about already? Do you have a sense if this is on the person’s own radar as a concern? Do you think it's something that you can talk to them about? How would they react if you brought up your concerns with them? You have been concerned about this, but is it on their radar that their drinking might be an issue? Do they know you're worried about it?
SB: And if they have had those conversations how have they gone? Have they been hard to have?
FW: Exactly. Have you tried to talk about this before, what was the reaction? Maybe thinking about if there have been other moments where the topic has come up, which often it has on some level, and what was helpful about those moments? What worked and felt like it moved things forward a bit? Was it helpful even just to put the topic on the table or did starting the conversation make it harder to talk about it or ever bring it up again? As a therapist, I always want to understand a little more about what works for them and what doesn’t. Salah, what problems have people told you they have faced when having or trying to have this conversation?
SB: A lot of people get worried about shaming their loved one or that bringing up the issue will lead to disconnecting them from their loved one. They worry the loved one will get defensive if they broach the topic. That's one area where a lot of people struggle. ‘I don't want to bring this up because I don't want it to lead to an escalation or I don't want this person to feel ashamed.’
FW: That is an important frame. There is a belief or worry that bringing up this conversation inherently leads to shame. That there is judgment implicit in even naming the issue as a concern or problem.
SB: And that’s not true.
FW: Not at all. However, it is an understandable worry that you create shame by bringing up substance use with a loved one. It's a common fear because it’s a conversation that asks for vulnerability and, as such, we are at risk of falling into shame pretty readily. That’s perhaps one of the things that gets in the way of trying to even talk about the problem. We worry that to bring it up is to take a shame stance. The main thing that helps with this conversation is to come at it from an angle of love and shared concerns. Approach it with an expectation that things can be better, not that it's someone's fault or shortcoming or a mistake, but rather it's simply an aspect of your life together, which is a little off from where you'd like it to be and you'd like to work together to get it back in its place.
SB: That is a fine line to walk in terms of the conversation and I would explore with the individual if there's a way that they might raise the conversation to a level of it being a shared concern rather than only the family member’s problem.
FW: That’s a great point. A really important layer of this is when you're approaching this conversation and want to talk to your loved one about your concerns surrounding their substance use, it's important that you take that first step and start the conversation when you're in a state of mind of non-judgment, when you are feeling relatively calm and at peace, and you're not angry, upset or frustrated. The conversation should not be a reaction to something awful that's happening or just happened. As the person who is bringing up the issue, you want to do so when you're feeling balanced and when it feels like an extra thing that you're bringing in rather than something that's been forced on you or you’re forcing on them.
SB: That really resonates with me. When you are talking to a loved one about your concerns, it is helpful to remember the positive aspects of your relationship with the person. You need to hold on to those even if those are things that aren't expressed in the conversation, but hold on to those positives gems in your relationship in order to foster an attitude and feeling of love and acceptance, total non-judgement even as you're bringing up something really tough that you'd like to improve or work on.
FW: With a topic that creates an atmosphere of fear, there is always a worry that we will create distance or separation due to feelings of judgement or shame. Our state of mind and the emotional state we are in when we go to have difficult conversations conveys more of a message than the words we choose. I have worked with a lot of people on this concept. If you are angry, it doesn’t matter what words you chose. If you are angry, and you tell someone ‘I love you!’ it's going to sound more like ‘I'm mad at you!’. If you're feeling loving and connected and as if you're reaching out to embrace someone, that's driving your heart in the moment. It doesn’t matter if you stumble with the words. Your words will be imbued with your emotional state and filled with the desire to bring someone closer.
SB: Yes, it’s critical to check in with yourself, where you're at emotionally in terms of your relationship with this person before you have the conversation.
FW: As an extension of that, whether it is a spouse or partner, a sibling or a friend, a child or a parent, prepare yourself, do some research. Take a week and track your own emotions, make note of the times of day and different times of your daily cycle when you feel a little more balanced and at peace and your best self. On the flip side, there tend to be times of day when we are not feeling great. So, don’t confront your loved one right when they walk in the door from work, don’t wake someone up out of a deep sleep to have a heavy conversation or wait until bedtime when someone is exhausted or approach them before a meal when they have missed lunch and may be starving. Nor should you do that to yourself. Noticing the times of day when you yourself are at your best, when you feel the channel is open with them is important. Make note of these times of day and have the conversation then.
SB: Interestingly though when you are having a good time with someone and you are feeling in a good place with them, the moment is sweet and full of love and this is exactly when you might NOTwant to have the conversation, as you don’t want to ruin the moment.
FW: Absolutely. You might be worried about ruining this great moment and instead that is the perfect opportunity to have the conversation, because you are already connected. It feels so counterintuitive. However, if you believe that this is an invitation to come closer and work on something together, if you believe it is something that does NOT come from a place of shame or blame or of being right -- being right doesn’t help anybody -- if it’s from a place of love and connection, it is not a bad thing. That doesn’t mean that it will be an easy conversation, but you can begin the conversation from a place of positive energy and potential. Always tap into the strength of the relationship.
We work with families and people who are struggling with substances, whether it's overuse, misuse, abuse, addiction, all the time so we as clinicians don’t see the stigma. We just see natural, significant, human struggles and really important issues to address both individually and relationally, and we hope to help the individuals we work with to feel this way too.
SB: Letting go of the stigma, and the stigma of the conversation, and having the conversation in a moment of love and connection helps it feel less like THE conversation.
FW: Right. And that's not to minimize it or deny that it can feel really stressful and fraught, but it really can be just another conversation that you have in your relationship. And it's usually a series of conversations. It's not one time that you bring this up and then a decision is made and you're off to action and treatment and recovery.
SB: The conversation in my mind is a more fluid conversation, not a rigid one with a start and end. It makes me think that the parallel is when parents are trying to talk to their kids about sex for the first time. THE conversation seems so awkward for everyone and you just want it to have a beginning and an end to get it over with.
FW: I think we tend to bookend and really have a beginning and an end to the tough conversations because we feel a degree of discomfort with them and we want them to be a brief moment since we don't want to stay in a place of discomfort. If we feel less uncomfortable and we're just open about it, then there is no pressure to get it right the first time in that exact moment.
SB: It's not something that can't be touched upon again in the context of a different conversation or moment. You can start talking about a difficult topic when you are in a playful moment. Often this is better because when you have that laser focus on a topic, it can feel much more overwhelming and intense.
FW: How might the topic be introduced or come up organically in a broader context that's not as focused on substance use or abuse?
SB: It’s more about beginning with the idea of why you want to talk about it? How substance use is getting in the way of parts of the relationship that you enjoy, or you feel are missing now.
FW: Exactly. It can be an ‘I miss you’ conversation so it's not shaming. It's more of an invitation to come closer. Perhaps you approach it with reminding your loved one about positive moments in your life together. “We used to hang out and talk after dinner for hours. Remember how we would sit together and watch our show and joke with each other. I miss that. Now you start cooking dinner and start drinking while you're cooking just because it's part of the ritual. We both have that glass of wine before dinner and then by the time we get to dinner you've been in the kitchen and you've been drinking throughout and I'm already starting to lose you. I feel like we don't have as much of a connected conversation then. And then after dinner we are in different places. I just miss you. I miss us. We spend all day apart at work and I like when we're really together all night. This is our time to be together again and it’s just lonely without you.”
So, while you are coming from a place of loss, which is a negative place, you are presenting a positive invitation to come back. This is a fine line because another thing that a lot of families will say when talking to their loved one about substance abuse is “I want to get ‘the old you’ back.” That is a tricky thing because what they may hear is “you don’t like who I am now.” Healing is about growth, so you want to express that it’s not that you just want ‘the old you’ back, but you want to recapture those elements of the relationship that were central to your happiness together.
SB: Often what is helpful when you are having conversations about other people's behavior, for example if somebody has done or said something that upset you when they were intoxicated or high, is to say something about how you are feeling, to show your own vulnerability. You might say, “You know I'm really sensitive about these things, and really sensitive in general” as a way of placing yourself in the conversation. Being honest about your own triggers or uncomfortable feelings can be an effective way to help them better understand where you are coming from. Something about this often allows the other person to hear you and your message better.
FW: Exactly. You are taking ownership of the idea and framing it as a relational problem not just something they are doing wrong. You are not blaming them. You are acknowledging that there are issues and dynamics that you are bringing to the relationship and its problems.
SB: We don’t want to come out attacking but our message might be received in that way anyway and I think it's a good thing to just name that you yourself have certain qualities as a person that are sensitive to certain things that happen and certain behaviors, to put yourself in it. We have to recognize that the other person's behaviors are not universally upsetting -- in this case substance abuse is not universally upsetting, rude or insensitive to other people, but it is to you. The issue is specific to the two people in the relationship and to the actual relationship.
FW: It’s more of an invitation to a conversation if you're saying, ‘I'm motivated for us to change too because of my own needs.’ It's not about being right or wrong, it's about feeling like this is a place I want us to be and that relates to someone's substance use patterns and how that informs their behavior in the present. It also relates to our needs in a relationship and what is going unmet or getting triggered.
SB: If you can name your vulnerabilities or what you miss about a relationship with that person or choose a moment that you want to hold onto, being vulnerable helps the conversation greatly.
FW: I totally agree. Because you're asking for vulnerabilities from your loved one and for them to acknowledge that there is an issue, it's risky for them to put themselves out there and validate what you're saying. But in this way, by making your own self vulnerable first or as well, hopefully they will acknowledge, “Yes, I could see that my drinking or substance use is something I need to work on.” Leading with vulnerability is key but it has to be sincere, not a script, not patronizing but really from your heart.
SB: Fortunately, only you know when you're being vulnerable.
FW: Right, you cannot get a script from one of us or from your therapist, but what we can offer is what we believe is the helpful spirit of the conversation. What is the catalyst within your heart and what is your state of mind, what are the elements that are the best inspiration for such a conversation? It’s not anger, not reaction, not judgment, but a desire for connection, an awareness of your own needs, love and calmness, and a faith that there is a connection there and that things can be okay.
SB: Can you say a little more about the faith that things are going to be okay?
FW: Yeah, the idea of calmness and that things are going to be okay means that you are not coming from a place of anxiety, hopelessness and panic, and not from place of shame or judgment, but more with an expectation that in order to keep growing as individuals and as a couple (or as a parent or friend) we have to engage in change and believe that people can change and that the relationship can evolve. The idea is to look at this as another opportunity to go through something together that has the potential to make us even closer and help us tap into more of what we enjoy about our relationship. So, you are looking at this huge worry as an opportunity for growth and change.
When you're in a relationship with someone, whether it's a romantic relationship or a family member or even a dear friend, if it's a long-standing relationship there are going to be a lot of moments where it benefits from renovation and you need to work on some aspects. One of you grows a little differently than the other and you have to figure out how to reconnect around those new aspects without losing the core parts of you. There is something beautiful about that. It does stir up uneasy feelings in people as it threatens loss and conjures those moments when we felt dropped or not taken care of or not held in the way we needed to be as children. So instead of it being about anxiety around loss, quite the contrary, it's just part of being in a relationship and can be an opportunity to become closer. When you weather an intense storm together, it's a little bit scary as you go through it, but when it’s over, there is often a deeper understanding and a stronger, closer bond. That’s what I mean about the belief or faith that everything will be okay.
If you enter into the conversation with the belief that things will be okay and it's all about strengthening the connection between the two of you, you are more likely to have a positive conversation.
SB: Right, there's an opportunity there and you'll have access to that opportunity if you let go of the need to be right. Being right doesn't help anyone or fix anything and if you let go of the drive to judgement but instead really come at it from a place of openness and kindness and desire, you will find that opportunity.