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Whether you know someone who is struggling with an addiction or you are a professional working in the field, it can be challenging to help someone recover from an addiction.
Addiction can destroy relationships, trust is often strained, and everyone involved can often feel confused and hopeless.
Working in the addiction field, I continue to learn more every day about how to be helpful to someone with an addiction. Recently, my colleague Diana recommended a great book on the subject, so I thought I would summarize the lessons here.
The book is called The Casework Relationship. Although it was originally written in 1957 for social workers learning how to build effective relationships with their clients, the lessons are just as powerful today. In fact, many of the lessons have been recently validated by empirical studies on motivational interviewing.
If you are working in the addiction field, the lessons in this book can help you strengthen your relationship with your clients, contributing to more effective treatment.
If you are attempting to help a friend or relative, the lessons in this book can help you maintain a supportive, yet balanced, relationship with the individual.
It is important to note that if you are using these lessons to help a friend or loved one that you make sure you have taken care of your own needs first. Codependency is a common problem, further contributing to the addiction.
In addition, if you are not working in a professional capacity, the goal is to use the lessons to help someone seek treatment or support them in their recovery. It is not meant to serve as a substitute for treatment.
So how do you help someone with an addiction?
According to The Casework Relationship, a helpful relationship to someone with an addiction consists of the following principles:
- Respect their individuality
- Hold Space for them to express emotions
- Control your emotional involvement
- Maintain an accepting nonjudgmental attitude
- Maintain their self-determination through collaboration
Let’s explore what each of these principles means and how you can apply them to your own situation.
Respect their Individuality
The principle of individualization means recognizing the person you are helping as an individual with unique characteristics.
When helping someone with an addiction, it may be tempting to rely on stereotypes. Just using the word “addict”, “alcoholic”, or “gambler”, we tend to think of specific characteristics.
Although diagnostic labels can be useful, we should never mistake the label for the person underneath it. For example, simply assuming someone is reckless or thrill-seeking because they have a gambling addiction neglects the fact that some people use gambling as a way to escape rather than for thrills.
When we make assumptions about a person based on rigid preconceived categories, we fail to see their reality. When we fail to see their own unique and specific situation, we fail to understand their perspective, causing frustration and a sense of disconnection.
When helping someone with an addiction, it is important to not conflate the person with a category, maintaining a person to person relationship. This will allow you to get to the root of their own experience and help them meet their own unique needs.
It is easy to assume we know someone based on a label. For example, when learning someone identifies as a “problem gambler”, it is easy to assume they are primarily gambling to acquire more money. But this assumption falls short since the primary unmet need is often something else.
When someone takes drugs or alcohol, it is easy to assume the substance is the problem, when in reality, the substance is that person’s short-term solution to an underlying problem.
By carefully listening to the person, we can accurately understand their own specific unmet needs driving them to cope through short-term relief.
Once this understanding has been established, the principle of individualization also means maintaining personal boundaries. Specifically, this means not doing things for the person that they can do for themselves. It may also require letting them fail so they can feel the natural consequences of their actions.
Respecting the person’s individual autonomy helps them learn new skills and build self-efficacy, leading to greater motivation in the long term.
Hold Space for Them to Express Emotions
The principle of “purposeful expression of feelings” means holding space for the person. This requires careful listening without discouraging painful emotions.
We may be discouraging them from expressing painful emotions without even realizing it. When someone is actively expressing painful emotions such as anger or grief, our immediate reaction may be to reach for the metaphorical fire extinguisher. We want to tell them “everything will be okay… don’t worry about it… don’t cry… think positive!”
Through these subtle discouragements, we are inadvertently telling the person that it is not okay to feel these emotions. When the emotions become stifled rather than expressed, they are not fully processed and avoidance becomes a way to escape.
Addictions are a common way of avoiding painful emotions. So by subtly reinforcing discomfort with painful emotions, we are perpetuating the cycle of addiction.
Helping someone with an addiction requires connecting with our deepest human motivators. Since human beings are largely driven by emotions, suppressing them does not help someone change their motivations.
Although emotional regulation is an important skill to develop, helping someone change their behavior requires the helper to remain with whatever emotion is coming to the surface at that time. It requires holding space for that emotion while remaining fully engaged and present in the interaction without attempts to minimize it, change the subject, or give reassurance.
By holding space for painful emotions, we help the person process these emotions, in addition to helping them feel a sense of safe non-judgmental presence.
Control Your Emotional Involvement
The principle of “controlled emotional involvement” means maintaining careful attention to the person’s emotions, knowing how to appropriately respond in a way that is helpful.
Although it is helpful to hold space for the other person’s painful emotions, it is not helpful if we get completely wrapped up in these emotions ourselves. In the book Against Empathy, Paul Bloom argues how empathy can be counterproductive.
Since empathy refers to feeling the emotions of another person, imagine going to a therapist who feels everything you feel. If you’re anxious, they become anxious as well. If you’re depressed, they begin to feel depressed too. You’d soon be quite concerned and perhaps feel worse for burdening this person with your problems.
When helping a loved one, it is easy for our emotions to become reactive. Our underlying fear may manifest as anger, driving the other person away.
The principle of controlled emotional involvement doesn’t mean being cold and detached. It requires being fully engaged and attuned to the other person’s emotions, demonstrating an accurate understanding of their situation. Controlled emotional involvement means being empathetic, but feeling a small amount of the person’s emotional state rather than being consumed by it.
The issue is not empathy. The issue is unrestrained empathy without personal boundaries. It is helpful to demonstrate an accurate understanding of the person’s inner world, allowing them to feel felt. It is also helpful to be grounded in your own self, serving as a solid support and guide for the other person.
Controlled emotional involvement helps you maintain a healthy personal boundary. Becoming overly involved is common among codependent persons. In this case, the over-involvement is not only unhelpful but can be actively destructive for both yourself and the other person.
The key here is to accept what you cannot change rather than making your emotional state dependent on the other person’s success.
This leads us to the next point.
Maintain an Accepting Non-judgmental Attitude
Acceptance refers to accepting the other person as they are, not as you wish them to be.
This does not mean we need to give up hope for an improved future. It means accepting their current state as a starting point and meeting them where they are. This state is most similar to Carl Rogers’ concept of “unconditional positive regard“.
This is primarily an attitude of non-judgment, openness, and psychological flexibility. It means recognizing that the other person as the primary expert on their own life. Tapping into their knowledge and resources requires creating a safe interpersonal environment.
We are all highly sensitive to feeling judged by others. When talking about issues underlying addiction, this is no different. If we display the slightest bit of judgment or criticism, the other person will quickly close up and isolate.
Isolation is such a common issue among persons suffering from an addiction because of the shame associated with it. When demonstrating a judgmental attitude, we drive the person further into isolation, increasing the desire to cope through an addiction.
Again, acceptance is an interpersonal attitude, not a moral stance. It does not mean accepting unacceptable behavior. We still need to maintain personal boundaries and be clear when these boundaries are violated. Acceptance does not mean accepting bad behavior; it means accepting the person underneath all of it.
Acceptance, or unconditional positive regard, can be quite difficult when someone presents particularly annoying, stubborn, or frustrating behaviors. It is tempting to react with judgment, criticism, or arguments.
One tool I’ve found helpful is to distinguish the behavior from the underlying issues. For example, if someone begins angrily sharing a conspiracy theory about how slot machines work, it is tempting to judge them and argue the facts. I’ve fallen into this trap many times, but it is never helpful.
In keeping with the spirit of acceptance, I’ve learned that underneath anger is often pain or fear. Instead of automatically reacting and engaging them on the level of their anger, I’ve found it helpful to ask about the underlying issues.
For example, when hearing a casino conspiracy theory, I now tend to ask, “what brings you to the casino?” Stated in a neutral curious tone, it conveys acceptance, allowing the other person to open up about their actual motivations and issues.
Acceptance is not a moral position whereby anything goes. It is a useful interpersonal attitude, increasing the chances you will be helpful to someone with an addiction.
Maintain Their Self-determination Through Collaboration
When helping someone change, you may feel tempted to take control. If they fail to act, you feel frustrated, wondering why they won’t listen to your advice and why they keep needing your support when the path is so clearly laid out.
Out of anger, you may temporarily ignore them or resort to tough love. You may try to manipulate them using bribes, threats, or ultimatums. You may even take responsibility for them, filling out forms or making phone calls on their behalf.
So how do you help someone change when they seem to be resisting all of your well-intended efforts? Collaborate with them.
Collaboration is like a dance. We give and take, meeting the person where they are, guiding the flow of the dance while remaining in harmony with one another. The goal is to guide them toward action, not force them into submission.
To use another metaphor, we must be like travel agents of change. We may be experts on the matter, but we can never really know what kind of trip will be best for the individual until we collaborate with them.
Even when the plans are set and the trip is booked, it is not our job to go on the trip with them. If things get rocky on the trip, they can call us for support, but it is not our responsibility to fly out to rescue them.
People need space to feel empowered when making changes. When we become confrontational controllers, we disempower people, making them feel incompetent.
When we collaborate with them, guiding the change-process, we empower them to take responsibility for changing, giving them the ability to see small rewards accumulate by their own volition. As these rewards start to accumulate, motivational momentum snowballs into action.
Recall what it feels like when a parent or significant other lectures you regarding one of your shortcomings. You may feel anger, resentment, or perhaps a sense of guilt.
If these difficult emotions spur you to action, the result is usually only short term. You do whatever it takes to get rid of these emotions but fall back into your default way of acting. Lecturing and criticism may be a Band-Aid solution, but it fails to get to the core of the issue, leaving the person feeling disempowered.
Like a travel agent, the best way to collaborate with someone is to ask them questions. For example, notice the difference in tone between the two following statements: You’re so lazy! Stop procrastinating and get your work done vs. It looks like you’re really struggling. What are some things you can do to get started on your work?
Collaboration solves underlying issues by encouraging a problem-solving mindset rather than spurring temporary action driven by the desire to avoid criticism.
When helping people change, you are often tempted to take the lead. We want to direct them on how to make the change, tell them what they need to do, and perhaps even begin doing some of it for them.
We may find ourselves working harder than the other person, wondering why they won’t take control over their life. If we find ourselves in this situation it may feel like we are helping, but we have become part of the problem.
When you over-help you take away the other person’s power. You take away their sense of autonomy, a core psychological need. When you do this, you are taking away a significant amount of their intrinsic motivation without even realizing it.
To avoid this form of counterproductive helping, you need to focus on building the other person’s sense of power. In short, empowerment is the product of collaboration.
Let’s review how each of the elements discussed thus far come together to create the optimal conditions when helping someone with an addiction.
Respect their individuality to get to their unique issues rather than assuming these issues based on a specific label.
Hold Space for them to express emotions to create a safe environment where they can share and work through difficult emotions.
Control your emotional involvement to maintain a helpful and grounded presence rather than becoming reactive or overly involved in a codependent way.
Maintain an accepting nonjudgmental attitude to build trust and reduce the sense of shame and isolation.
Maintain their self-determination through collaboration to increase motivation in addition to maintaining healthy personal boundaries.
None of these principles guarantee change. They simply increase the odds that change will happen by creating a helpful interpersonal environment to engage the other person in helpful conversations about change.
If you don’t see the results you want, it is important to take a step back, maintain your own self-care, and be able to accept the fact that you don’t have control over someone’s behavior. You can only be the most helpful version of yourself.
If you’re interested in learning more, you can read my short book on the topic: