When one of your friends starts to get messed up on alcohol or drugs, it can be really tough to bring it up and talk to him about it. Most people just keep their mouths shut because they don't want to seem nosy or puritanical. It's much easier to maintain the assumption that everything's cool. Unfortunately, substance abuse is just not cool – in fact, it really sucks. There's nothing worse, apart from being dismembered with a boat hook, than watching a friend get eaten up by her addiction until she's not your friend anymore. The time to talk to your friends about the crap they're ingesting is before it eats them up and they lose everything. If you know someone who might have a problem, read on and see what you think about our advice.

Please note that we are not professional counselors. We'll tell you how to get in touch with counselors or treatment centers, but your friend needs professional help, not you. What we hope to provide is mostly common-sense advice for anyone who wants to be a good friend to someone who needs one.

1. DETECT THE PROBLEM

It's not always easy to see when someone's use of alcohol or drugs is turning into abuse. You are probably aware of some of the occasions on which your friend has partied hearty, but you don't know if she is going home and inhaling cleaning products by herself all night. Do some research on what drug abuse looks like. Needless to say, if you do become aware of that sort of behavior, it is what we refer to as a "warning sign."

A research project called the International Classification of Diseases–10 (ICD-10) identifies a list of warning signs that can help you to determine whether or not your friend has a problem. Have a look.

ICD-10 Warning Signs

Three or more of the following must have been experienced or exhibited at some time during the previous year:

  • Difficulties in controlling substance-taking behavior in terms of its onset, termination or levels of use.

  • A strong desire or sense of compulsion to take the substance.

  • Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects.

  • Persisting with substance use despite clear evidence of overtly harmful consequences, depressive mood states consequent to heavy use, or drug related impairment of cognitive functioning.

  • Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses.

  • A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms.

The funny thing about lists like these is that just about anyone who likes to take a drink from time to time will look at it and think "It looks like I have a problem!" Don't worry about that. This article is about poking your nose into other people's business, not taking responsibility for your own actions. What level of use constitutes a problem depends heavily on what sort of drug a person is using.

For example, it is possible, and some consider it quite healthy, to have a drink a day for your entire life without it becoming a problem. It is not, on the other hand, possible to have a safe level of cocaine or heroin use. One dose of either drug can kill you under particular circumstances, and it's difficult to tell when you're in those circumstances. Furthermore, we've known too many people who claimed that their cocaine use was "just an occasional indulgence" or "something I do at parties." Normal, successful people say things like this and end up addicted, sleeping in doorways, with crack pipes duct taped to their heads.

The bottom line is, look at the list of diagnostic guidelines above, and try to see where your friend fits in. If your friend is using cocaine or heroin, skip the guidelines – there's a problem. Otherwise, if you think a number of the guidelines do apply, resolve to sit down with your friend and talk about his or her substance use/abuse.

2. HATE THE DRUGS, NOT THE USER

It's tough to sit down with your friend and make comments that will invariably provoke the response "Who are you, my mother?" However, you've got to start somewhere, and the best thing to do is to criticize the substance that your friend is taking. If you start by criticizing or questioning some aspect of your friend's behavior, he might just shut you out, become defensive, or become confrontational. Of course, it doesn't take a genius to guess that a conversation that starts out with "Cocaine certainly is a dangerous chemical, wouldn't you say?" is going somewhere other than chemistry. Don't say it that way. Say it in the tone of voice you use when you're commiserating or communicating with your friend, and say something like "Cocaine sure sucks."

If your friend bites at the bait you've laid out and starts talking about it, then you've got an opening to try to find out what's going on. Once the conversation turns to her substance use, casually ask how much she's using, and how often. Then ask if she thinks that's a lot, and, if she doesn't, ask what would be a lot. During this initial conversation, you just want to get your friend to admit to you and herself how much she's using, and to get her thinking about whether she's got a problem or not. Don't push it too far, and never be critical or judgmental. Close by saying that you want to help and that you want to talk about it again sometime.

If your friend does not take the bait, don't push. Once you've said something, both of you will know why you said it, and it will hang there until your friend chooses to acknowledge it. He might be ignoring it just to show you that he doesn't have to talk to you about it if he doesn't want to. He'd be right – he doesn't have to talk to you. So just leave it alone and see if he has the guts to come back to your earlier comment sometime later. If he doesn't, wait for another occasion and try again.

It might sound like we're suggesting you pussyfoot around the issue and keep the kid gloves on forever. What about tough love? We advise you to leave any confrontational approach to the family and/or the professionals. It's not your place to slap your friend around and be confrontational, and if you try it you'll almost certainly do it wrong and make things worse. If your attempts at gentle intervention are continually brushed off or ineffective, you should think about narking your friend out to his family (i.e., telling them he's a junkie), and suggesting they talk to a counselor about one of the more dramatic, tough love style interventions. If we can't talk you out of staging your own intervention, please, please speak to a professional counselor or otherwise seek help (see the list of resources in section 4) before you do it. Know exactly what you want your friend to do, and have a plan. Bust out the 4 Ways to End Drug Addiction, and help your friend work through them.

3. PROVIDE A DRUG-FREE OPTION

As people become more involved with drugs, they start to seek the company of others who will do the drugs with them, enable them to obtain the drugs more easily, and won't hassle them about the drugs. Once you decide that your friend has a problem, you must NEVER take the substance he or she uses when you're with him. For example, if you like to drink occasionally, you shouldn't drink with your alcoholic friend. Think up other things to do and talk your friend into doing them. Chances are, he's got plenty of friends to drink with, so you need to provide a sober option.

If you're picturing skipping through alpine meadows or youth group meetings run by Ned Flanders, that's not necessarily what we mean. Try taking your friend out for coffee or dinner (at a non-licensed restaurant, if she's a drinker) and making good conversation the focus of the evening. Or see a ballgame, play pool, or air hockey or cards, or start a Fight Club (maybe not this last one). There are plenty of things to do -- that don't suck -- that do not involve substance abuse. You should make it a point to draw up a (secret) list of things to do, and make it your goal to get your pal to do them all with you. When the two of you do something fun that doesn't involve sitting around getting messed up, your friend will remain aware that there are other ways of living.

Addicts who have strong social or family networks and jobs are more likely to be able to break their addictions than addicts who are alienated and unemployed. Make sure you help to provide the social network, and get in there before your friend loses so much that she doesn't care anymore.

4. RECOMMEND THAT YOUR FRIEND SEEK HELP

Once you've gotten to the point where your friend trusts you to talk to him about his problem, you've got to recommend that he should seek help. Alcoholism and drug addiction don't go away by themselves, and few people are strong enough to quit cold turkey. The help you provide is necessary and important, but it probably isn't sufficient. There are many different ways to get help with addiction, and you should suggest them all to your friend until you hit on one that's acceptable to her.

We'll provide you with a list of suggested places to get help, and you can either print it out and give it to your friend or just remember the ones which seem suitable and talk to him about them.

  • Family Physician
    One simple way your friend can get help is to see her family physician; her physician will be familiar, discreet and aware of all the available resources.

  • Alcoholics Anonymous
    World Services, Inc.
    475 Riverside Drive
    New York, NY 10115
    212-870-3400 (Literature)
    212-647-1680 (Meeting Referral)

  • Center for Substance Abuse Treatment
    National Drug and Alcohol Treatment Referral Service
    1-800-662-HELP
    Referrals To:
    1-800-ALCOHOL
    1-800-COCAINE
    1-800-448-3000 BOYSTOWN

  • Cocaine Anonymous
    World Service Office
    3740 Overland Avenue, Suite C
    Los Angeles, CA 90034
    1-800-347-8998

  • NAFARE Alcohol, Drug, and Pregnancy Hotline
    200 N. Michigan Avenue
    Chicago, IL 60601
    1-800-638-BABY

  • Narcotics Anonymous
    World Service Office
    P.O. Box 9999
    Van Nuys, CA 91409
    818-773-9999

  • National Clearinghouse for Alcohol and Drug Information
    P.O. Box 2345
    Rockville, MD 20847-2345
    301-468-0985
    1-800-729-6686

  • National Council on Alcoholism and Drug Dependence
    12 West 21st Street, 7th Floor
    New York, NY 10010
    1-800-NCA-CALL (they will refer you to a local treatment information center)

  • Rational Recovery Systems
    P.O. Box 800
    Lotus, CA 95651
    1-800-303-CURE

  • Secular Organizations for Sobriety (SOS)
    P.O. Box 5
    Buffalo, NY 14215
    310-821-8430

  • Women for Sobriety
    P.O. Box 618
    Quakertown, PA 18951
    1-800-333-1606

Most of these resources are only starting points. They will either refer your friend to a local treatment center or perhaps only to another, more local, referral service. It can be a bit frustrating, and you need to stick with your friend and ensure that she keeps calling until she finds help.

By help, we mean either counseling or a treatment center. Of course, they do counseling at treatment centers, but we use the two terms as follows. Counseling means you continue to live your life and you go and talk to a counselor once in a while. A treatment center is a place where you go and hang out for three to five weeks while you receive frequent counseling, support, and, if necessary, medication (such as methadone). It will be up to your friend, in consultation with you, his family, other friends, physician, and/or anyone else who wants to stick his two cents in, to determine which of these options is most suitable for her.

5. PRAISE SUCCESSES

Many, many recovering addicts relapse back into addiction. It's a sad fact that once you've been addicted to something you're always somewhat at risk to start using it again, and your friend is no exception. That's why you've got to make sure he knows that any time he spends off the drug is good time. Keep up with his progress, and praise him for any success he has. Comment on how good he looks, how much happier he seems, and how things are really going well for him, even if these are blatant lies. Don't patronize, but be ridiculously positive.

Another thing to remember is that recovering addicts tend to find life extremely boring once they start living life without the drug. Refer back to Step 3; you've got to be the no-drugs fun person who convinces your friend that a sober life is worth living. This might be tough on you, because your friend might actually be kind of boring while she tries to adjust. Be a good friend and stick with her. With your help, your friend could go on to be rich and successful, and then you can borrow money from her. And isn't that what being a friend is all about?

We wish the best of luck to you and anyone who is affected by substance abuse.