How to Help a Friend

You know someone who has a problem with alcohol and/or drugs, and you want to help. Where do you start, and where do you stop?

Understanding & Moving Through Denial

Perhaps the best place to start helping someone with an alcohol or other drug problem is with an understanding of why people have such a hard time seeing the reality of their own situation. It's called denial, and it's a very real phenomenon.

Just about anytime we approach the subject of denial with someone who abuses alcohol or other drugs, they become defensive. This is especially true with alcoholics and addicts. They mistakenly associate denial with lying, which is unfortunate because denial and lying are two very different things.

Lying is something that a person does consciously - people know when they're lying. They may not be able to control it, but they are aware of it.

Denial occurs on a subconscious or unconscious level. It is a psychological process that blocks out reality, that is, blocks out conscious awareness of something that feels threatening to the individual. People honestly do not know when they are "in denial." We can often see denial as it occurs in other people; we just can't see it in ourselves. In fact, to the one in denial, it is usually completely invisible.

In terms of alcohol and drug abuse - be it our own or that of someone who is close to us - problems associated with denial can manifest in one or more ways:

• Failure to see that a problem exists at all (total blindness)
• Failure to recognize the extent or severity of the problem (partial blindness)
• Failure to see a connection between the substance abuse and the problems that it causes (lack of insight)
• Failure to understand that they need help to deal with the problem (false pride)

Denial is so common among people who have become addicted to alcohol and other drugs that addiction is sometimes referred to as the disease of denial. Indeed, individuals in recovery from addiction are typically surprised at the depth of their denial as it unfolds before them during the recovery process.

Denial can be the fatal aspect of addiction because it leaves the alcoholic/addict vulnerable to taking greater risks for longer periods of time. It impairs judgment resulting in self-delusion, preventing the addict from seeing and understanding the implications of his or her behavior until it is too late.

One example is a person who honestly believes that they can drive just as effectively under the influence of alcohol or drugs as they can sober, maybe even better. People in denial see themselves as the exception to the rule, and even documented evidence to the contrary won't persuade them differently.

Denial is sustained with psychological defenses. All of us, not just addicts, have our own defense mechanisms. Here are a few:

Of course, there are many more. These are just some of the most prevalent.

Substance abuse is not the only area of people's lives in which denial comes up. In fact, all of us can develop and maintain denial in any circumstance or situation in which we feel threatened, afraid, or unable to handle it.

Other instances of denial might look like this:

• A battered spouse fails to recognize the extent of the abuse until it results in severe consequences.
• An individual fails to see the depth of the dysfunction in his or her relationship until the partner says that he/she wants to end it.
• An individual refuses to acknowledge the decline in his or her physical health until he/she falls very ill.

Movement through denial requires traits that people with strong defenses have few of, such as willingness and open-mindedness. Sometimes it requires us to trust our relationships with other people who are willing to confront us honestly and openly. It always takes humility, the ability to see and accept the truth about ourselves.

The place to start moving through denial is understanding that we have it. This is easier once we know that it isn't just us, but rather, denial is a universal human trait. Everyone has denial. Everyone has blind spots.

The next step is to repeatedly remind ourselves to consider the opinions of others with an open mind. Some people find it helpful to keep handy a few simple, internal questions or statements like these:

• "What part of what he/she just said could be true?"
• "If I feel this defensive, I must be hearing something threatening.
  What might that be?"
• "What does he/she see about me that I cannot see about myself?"
• "Could I possibly be kidding myself about that?"

The next step is to talk openly with someone you trust about the answers to those questions. We can answer our internal questions internally first, but to experience the full benefit of the process, we need to open up and talk out loud with another person. That's when denial loses its power over us. The only requirement is honesty.

We will never be completely free of denial. Our brains are not that efficient. The goal is to move through it bit by bit, honestly and systematically, and to be open to accepting help with the process. For alcoholics and addicts, healing typically does not happen magically or automatically, even after the drinking or drug use stops. Like other aspects of recovery, movement through denial takes time, effort, patience, and willingness.

How to Help: A Simple Plan

You might think that the best way to help is by confronting the alcoholic/addict together with a group of people who share your concern. Perhaps you have seen or heard this activity referred to as an intervention. However, the term "intervention" actually refers to any activity that someone undertakes to bring a substance abuser closer to understanding and accepting the nature of his or her relationship with alcohol or other drugs.

A group confrontation may not always be the most effective approach, but it isn't the only option. Before you round up a posse, try this simple, often effective plan.

1. Be attentive
   Pay attention to specific alcohol/drug related behaviors that appear to be interfering with the person's life, be it relationships, school, work, health, etc.


2. Keep track
   Write down what you see. Record the specific alcohol/drug related behaviors that cause you concern. Note the behavior, when and where it occurred, and the observed negative outcome. Your notes should focus on what you see, not on what you think.


3. Share concerns
   Talk with the individual openly and honestly regarding what you have observed in a respectful, non-judgmental manner. State the specific behaviors and outcomes that have caused you concern. Refer to your notes if necessary. Ask the individual to respond, but if he/she refuses, let it go, at least for the time being. Remember, avoid blaming or judging them, and don't suggest reasons for their behavior or try to "fix" them.


4. Listen
   Once you have stated your case, stop talking, stop thinking, and listen attentively to the individual's response. Don't expect anything, because the response can take any shape or form. Your job is to offer only your undivided attention, no matter how they respond or what they say.


5. State expectations
   State clearly what steps you want them to take, whether it is a visit with a counselor, or simply a behavior change. Hold no expectations regarding their compliance.


6. Offer help
   Tell them what you are willing to do to help them meet your expectations.
• If the person has heard you but chooses to say nothing, let them know that the door is open to discuss the matter at a future time.
• If the individual refuses to consider any change, clearly state the actions you will take in response to his/her refusal. This is your chance to take care of yourself.
• If they initially agree to change, but fail to follow through, seek additional help, for example from a trained professional.
• Keep in mind that doing whatever steps are necessary to help someone get the help they need is the most caring action that anyone can take, regardless of how scary it is to do it.

Additional "How to Help" Resources

Love First: Intervention for Alcoholism and Drug Addiction

The Partnership for a Drug Free America

Intervention Center

Codependency

By Charles N. Roper and Brandy Whitten

Sometimes, our efforts to help another person can drag us down, especially when that other person abuses or becomes dependent on alcohol or other drugs. Their problems can interfere with our own lives and well-being. In such cases, a brief examination of codependency can offer some illumination.

What is Codependency?

Codependency is common in people raised in dysfunctional families. It is especially common in the partners and children of alcoholics and addicts. It describes a pattern of behavior in which a person shapes his or her needs and life around the needs and lives of other people, especially those who have problems. Those people might be dependent on alcohol or other drugs, and you might be dependent on them for a sense of value and purpose.

In a healthy, mutually beneficial relationship, partners depend on each other in an approximately equal balance, at least most of the time. By contrast, codependent relationships contain little or no mutuality.

How do I know if I'm codependent? What are the symptoms?
If you find that you habitually play a supporting role in relationships, or that you do not experience relationships based on mutual interdependence, you might be codependent. Some of the symptoms or traits associated with codependency are:

• Need to control or "fix" situations
• Need to control, take care of, or "fix" other people
• Blaming situations and other people for your feelings
• Difficulty trusting others
• Perfectionism
• Avoiding your own real feelings
• Problems with or fear of intimacy
• Hyper-vigilance (a heightened awareness of potential threat/danger)
• Living through or for another (You're codependent for sure if, when you die, someone else's life flashes in front of your eyes.)

Many codependent people experience emotional problems such as depression, anxiety, or cycling between hyperactivity and lethargy. They can also often suffer from physical problems, including gastro-intestinal disturbances such as colitis or ulcers, migraine headaches, non-specific rashes or other skin problems, high blood pressure, insomnia, sleep disorders, and any other stress related physical illness.

What causes someone to become codependent?
We become codependent through living in systems (e.g. families) with rules in place that hinder development to some degree. The system has developed in response to a problem such as alcoholism, mental or physical illness, or some other "family secret" or issue. Examples of rules within families that may cause codependency include:

• Do not talk about problems.
• Do not express feelings openly. Keep them to yourself.
• Communicate indirectly; let one person act as messenger between two others, known in therapy as "triangulation".
• Be strong, good, right and correct. Be perfect.
• Make us proud - beyond realistic expectations.
• Don't be selfish.
• Do as I say, not as I do.
• Do not play or be playful.
• Don't rock the boat.
• Don't break the rules.

Many families have one or more of these rules in place. Some families have them all. They almost always hinder the free and healthy development of self-esteem and coping skills. As a result, children can cultivate mental, emotional, and behavioral problems and dysfunctional reactions to situations later in adult life.

They lose the ability to be spontaneous and to stay in touch with their own emotions. Because codependent people have a hard time trusting themselves, they don't easily trust others, which often perpetuates the original dysfunctional system rules.

Isn't everyone codependent?
Well, yes and no. No family system is perfect. No relationship is fully functional. Members of families and people in relationships may occasionally put other's needs ahead of their own. Perhaps there is a continuum of codependency, ranging from modest to severe. That continuum might exist because so many people, especially young women, are taught not to be assertive or to avoid asking directly for their needs to be met.

Not all counselors embrace the term codependency. However, most people, even those who take issue with the word, agree that people who organize their lives around the needs of others to the neglect of their own lives develop certain dysfunctions. Therefore, we use codependency as a common language that encompasses this group of dysfunctions and the accompanying situation.

How is codependency treated? Can it be cured?
Individual counseling or group therapy can help codependent people regain much of what they lost through their efforts to successfully negotiate their way through dysfunctional family systems. It can help individuals become more aware of unhealthy attitudes, beliefs, and behaviors, and can teach them assertiveness and healthy coping and communication skills.

Counseling and therapy for codependency only helps if the counselor is either basically free from (or at least aware of) their own tendencies toward codependency. Counselors and therapists who treat codependency absolutely must model appropriate behaviors, especially healthy boundaries, while interacting with clients.

If you are a UT student and would like to talk with a professional counselor about treatment for codependency, you may call our office.
Ask to schedule an appointment with an ADEP counselor.

Alternatively, call UT Counseling and Mental Health Center at 512-471-3515.
Ask to schedule an appointment with a therapist.

Counseling and therapy for codependency only helps if the counselor is either basically free from (or at least aware of) their own tendencies toward codependency. Counselors and therapists who threat codependency absolutely must model appropriate behaviours, especially helathy boundaries, while interacting with clients.

"A 'no' uttered from deepest conviction is better and greater than a 'yes' merely uttered to please, or what is worse, to avoid trouble."
-Mahatma Ghandi

If you are a UT student and would like to talk with a professional counselor about treatment for codependency, you may call our office.
Ask to schedule an appointment with an ADEP counselor.

Alternatively, call UT Counseling and Mental Helath Center at 512-471-3515.
Ask to schedule an appointment with a therapist.

The article Understanding & Moving through Denial on this site may provide some additional insight into codependency and addiction.

Understanding & Moving through Denial