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How to Help Someone Struggling with Substance Use

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If you notice someone is struggling with substance use, there are many ways to help. Having a conversation about a person’s substance use can be difficult, but might be the first step to them getting help.

Stages of Change

First, understand the stages of change and that the individual could be anywhere along this continuum:

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To have an effective conversation, meet the person where they are at in the stages of change. Make sure to be an active listener, meaning listening to understand, not to respond, and remember to have body language that signals openness and that indicates you are listening (no cell phones or other distractions).

Using OARS is a great way to frame the conversation:

Open-ended questions
Affirmations
Reflections
Summaries

Open-Ended Questions: Require a full response, not just yes or no.

“How has your relationship to alcohol changed since you’ve been on campus?”

Affirmations: Identify an individual’s strengths, make them feel comfortable and connected.

“It takes a lot of courage to talk about this. I’m honored that you chose to share this with me.”

Reflections: Reflect back what the person has said. It shows that you are actively listening and understand what the person is saying. It also offers the person an opportunity to correct or rephrase if what they said was not heard or understood.

“I heard you say that your relationship to alcohol has changed quite a bit since the semester started and you’ve been drinking more frequently. You’re worried it might be impacting your grades, is that right?”

Summaries: A form of reflection that recaps what the person shared. This allows for a shift in conversation to talk about next steps.

“I appreciate your trust in telling me about your struggle with alcohol use. If I understand correctly, your concerns about alcohol have increased and you’re experiencing some negative consequences as a result.”

With that, you can then offer support and move towards next steps:

“Have you thought about what you might do next?”

“If it’s OK, I’d like to share some resources I know of”¹⁸

Avoid being judgmental, be mindful of nonverbal cues, and do not make assumptions unless the person tells you something directly.

Not all conversations will follow this exact format, and individuals may not yet be in a stage of change where they recognize that there are concerns with their substance use. Regardless, it is critical to let them know that you care about them and that you are there to support them. Another way to approach this conversation is using 3 simple tools:

Focus on the behavior
Express care and concern
Listen and support

Example: “Hey, I notice that you’ve been drinking more since the semester started. I care about you and I want to make sure you’re doing OK. I’m here to listen and I know of resources that can help, if you’re interested.”

Again, make sure to be an active listener and support whatever decision they make. If they are not ready to make a change, that’s alright, but you have opened a line of communication by showing that you care.

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