The Beast of Confrontation

Have you ever struggled with how to communicate with people you suspect may be abusing substances? Wondering about someone’s involvement with substance abuse is one thing; confronting them about it presents an entirely different conundrum. 

Red Flags

There are certain signs that are observable in someone who is abusing substances. Let’s take a moment to examine those red flags. If any of them resonate with you as something you’ve seen in your loved one, this could indicate a need to have a conversation with them. They range from apparent physical signs to signs that are more subtle and unfold over time.

Physical signs of substance abuse are usually the most noticeable. While these include body changes like weight loss and differences in skin (i.e. more blemishes), they can also include behavioral changes. You may notice your loved one is missing work or school more often than is typical for them. You may notice that your friend seems less sociable and more withdrawn as they cancel plans. It can feel very uncomfortable to confront these out-of-character behaviors even if substances aren’t involved; but when substance abuse is suspected, the need for confrontation becomes more pertinent because these behavioral changes don’t usually just stop. They usually escalate and become more egregious as substance abuse increases.

I’ve seen one concern cited often over time, and it relates to changes in finances. This may manifest as struggling to pay bills or asking to borrow money. I feel it’s important to note, however, that these struggles are common for many people and often don’t point to a problem with substances. In fact, I’ve worked with dozens of families who have been impacted by addiction who have been surprised when substance abuse comes to light because there were no significant changes in finances; bills continued to be paid on time and no money was borrowed or stolen. Financial stability is used often as a rationalization for continued substance use, but this easily leads to people denying the negative impact of their use on other areas of life. 

Dynamics Considerations

Once you’ve identified some red flags in your loved one’s behaviors or appearance—and especially after you’ve observed them experience consequences as a result of these changes—you likely find yourself wanting to address your concerns with them. This is no easy undertaking, and it probably won’t be contained to just one conversation. I’ll review some approaches for communicating concerns to someone you suspect may be abusing substances. These aren’t one-size-fits-all approaches, and you’ll need to adjust boundaries according to the relationship dynamic.

Parent-child Dynamics

It goes without saying that parenting a child with a potential substance abuse problem is a challenging dynamic to navigate. Communicating regularly about the impact of drug and alcohol abuse is an effective way to build transparency. The hope is that this open-door approach to discussing substances would be preventative, but statistics show that many adolescents will engage in substance use regardless of how approachable parents are regarding substances. According to the CDC, approximately two-thirds of high school students try alcohol by the time they graduate, and about 50% and 40% try cannabis and tobacco, respectively. 

If a parent suspects their child is abusing substances, clearly defined boundaries and expectations are needed. It may be tempting for parents to shift into lecture-mode to address their children about the dangers of substances, and this approach is a fine one to take. After all, lecturing parents are deeply concerned with the safety and overall well-being of their children. It’s important, however, to also lay out exactly what consequences will occur if boundaries are broken. Even more important is follow-through. Parents must be consistent with consequences and communicating the reasons behind consequences, even when it’s more tempting to ease up on the consequences of overstepped boundaries.

Adult to Adult

The ways you would communicate concerns with another adult can vary according to the dynamic in place. You may have a coworker, sibling, friend, or partner you’re concerned is abusing substances and different boundaries could apply in each of these situations. I’ll use some real-life examples from clients who have given me permission to share their experiences with confronting the adults in their life who may struggle with substance abuse. 

One person was concerned that his sister was abusing substances based on her history of substance use during her high school years and some then-present-day behaviors that were red flags to him and other family members. Those behaviors included isolating more than usual, asking to borrow money, and missing work; the latter was the most subtle and my client only knew about her work absences because he knew one of her coworkers well. For this family, the most appropriate boundary to establish came in the form of an intervention. Again, this person’s sister had already displayed problematic substance use behaviors and had been confronted in the past. The intervention was the family’s last resort and the strictest boundary they had ever established with her. It was simple: either accept help from a long-term treatment program, or they would no longer have contact with her. Boundaries like this often come with the risk of severe consequences, especially emotional pain that comes with the decision to cut someone out of your life. In addition, this family experienced financial pain, because my client’s sister initially chose not to go to treatment and told the family members she would no longer pay them back for money she owed them. Thankfully, she decided to pursue treatment several weeks later and their family continues to enjoy a healthier relationship dynamic with her to this day. 

Another client’s story had a less fortunate ending in some ways. This person was fearful that his wife was abusing alcohol. His experiences as an ACOA (adult child of an alcoholic) alerted him to some red flag behaviors he had been observing in his wife over the course of about two years of their 13-year marriage. He struggled throughout that two years with boundary setting and boundary maintenance after he confronted her with his concerns. I remember being in therapy with this client a few days after he first communicated to her that he was worried about her drinking behaviors. There was a lot of gaslighting. His wife wrote off his concerns and told him he was projecting his own issues with his parents’ alcoholism onto their marriage. He even began questioning himself and downplaying his own feelings, but her drinking behaviors became more and more concerning to the point that he began calling out her problems with alcohol despite her repeated gaslighting. Problems escalated and led to legal issues associated with her drinking, and she had two attempts at treatment and sobriety that weren’t maintained beyond a couple months. Their adult daughter eventually chose to cease communication with her, and my client—after many trials and errors with boundaries—eventually filed for divorce. Although no one in the family wanted these outcomes, my client continually reports significant improvements in his life now that he is no longer impacted by his ex-wife’s alcohol abuse. 

Boundary Maintenance

My client in the first story often wanted to give his sister some of his money and his time, and it hurt him when he held a boundary and repeatedly told her “no.” My client in the second story felt very resistant to confrontation, and scaled back his own boundaries at times when maintaining them caused him a great deal of pain. Although one gave in and lent his sibling money sometimes and one bailed his partner out of jail twice, they both agree that they have suffered less in the long-run as they have practiced the skill of boundary maintenance. 

What these and many other stories have in common is the painstaking process that comes from maintaining boundaries followed by relief from the issues that led to the need for boundaries in the first place. Time, patience, and consistency are required because that relief sometimes won’t come to fruition for awhile. This is why I always recommend that boundary maintainers seek and accept help from others whenever they can. Boundaries start by verbalizing to your loved one that you feel worried about their health and if the worrisome behaviors persist, you continue verbalizing how you’re feeling—even when it’s painful in the moment to communicate. While I can’t guarantee a timeline for when you can expect to feel relief from healthy boundaries, I can guarantee that that relief will come. 

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