Helping Someone Who Is Using: Research-Based Dos and Don'ts

Helping Someone Who Is Using: Research-Based Dos and Don’ts

Someone you love is still using, and you are trying to figure out what to actually do about it. The honest starting point from SAMHSA’s guidance for families is also the hardest to hear: you cannot force someone into care. What you can control is how you show up, and the research says that matters more than most people realize. Here are the dos and don’ts that hold up in the evidence, plus the emergency preparation nobody should skip.

Your influence is real

The strongest evidence here is a program called CRAFT (Community Reinforcement and Family Training), built for exactly this situation: a loved one who is using and refusing treatment. In a randomized trial, about two out of three families trained in CRAFT got their loved one into treatment, compared with under a third using more traditional approaches. The VA’s CRAFT manual lays out what those families actually did, and most of it is learnable by anyone.

The dos

Do pick your moment. SAMHSA’s conversation guide starts with timing: a private, calm setting, and not during or right after use. Express concern directly (“I’ve been worried about you. Can we talk?”), listen without judging, and stay patient. These conversations rarely work once; they work as a series.

Do reward the behavior you want. CRAFT’s core move is noticing and reinforcing time when your loved one is not using, with warmth, attention, or shared plans. It feels backwards at first, and it consistently outperforms pressure and criticism.

Do let natural consequences happen. CRAFT coaches families to stop cushioning the fallout of use, the missed shifts, the fines, the mornings after, while staying warm and available. Consequences are often what finally shifts motivation; protecting someone from them postpones the change.

Do take care of yourself. Caregiver strain is real and documented, and a burned-out helper helps nobody. CRAFT builds in sessions on the helper’s own support system, and free groups like Al-Anon and SMART Recovery Family & Friends exist for exactly this.

Do have a safety plan. If there is intimidation or violence in the picture, that outranks everything else. The VA manual treats safety planning as standard, not dramatic, and it is worth writing yours down.

The don’ts

Don’t argue with someone who is intoxicated. This is one of CRAFT’s most practical rules. A person who is high or drunk cannot process a serious conversation, and trying usually ends in a fight that makes the next calm conversation harder. Note what you want to say and bring it up sober.

Don’t hand over cash. As we covered in our post on helping versus enabling, untraceable money with no accountability tends to fund the problem. If you help, pay the bill itself and keep the terms out loud.

Don’t make threats you will not keep. Ultimatums you walk back teach the lesson that words are negotiable. Small, real boundaries you actually hold beat big dramatic ones you cannot.

Don’t lecture. Shame is not a motivator; if anything it deepens isolation. The approaches with evidence behind them are warm, specific, and consistent, not harsh.

Prepare for the emergency, too

This part is not pessimism; it is arithmetic. CDC data shows a bystander was potentially present in more than 40% of overdose deaths in 2023, and about three quarters of those deaths involved opioids. Bystanders who act save lives, and the tools are now easy to get.

Keep naloxone (Narcan) at home. It has been over the counter since 2023, sold in pharmacies, grocery stores, and online. It reverses opioid overdoses, will not harm someone who took something else, and more than one dose may be needed with fentanyl.
After giving naloxone, call 911 and stay with the person until help arrives.
If your loved one uses alone, tell them about Never Use Alone (800-484-3731), a free, confidential, 24/7 hotline that stays on the line while someone uses and sends EMS if they stop responding. Nobody wants to need it; it exists anyway.

When they are ready

People move from using to help on their own timeline, but they move faster when the next step is concrete. If the day comes, the SAMHSA National Helpline (1-800-662-4357, free, confidential, 24/7) can point to options, and stable, structured recovery housing like S Florida Oasis is there for the stretch after. Your job today is smaller and harder: stay warm, stay consistent, stay safe, and be ready.