How to Talk to Someone You Are Worried About: Substance Use, Support, and Next Steps
A compassionate guide for family members, friends, coworkers, and supervisors.
Maybe the changes have been small: more canceled plans, a different mood after work, unexplained absences, medication running out early, drinking that regularly goes beyond the plan, or mornings that seem harder than they used to. Maybe there has already been a frightening moment - impaired driving, a fall, a blackout, a workplace safety concern, or a message that did not sound like the person you know.
When you care about someone, noticing a pattern can leave you pulled in two directions. You may be afraid of overreacting, embarrassing them, damaging the relationship, or saying the wrong thing. At the same time, staying silent can feel like pretending not to see what is happening.
You do not need perfect words, proof of a diagnosis, or a dramatic confrontation to express concern. In many nonemergency situations, the best first intervention is a calm, private conversation grounded in specific observations, respect, and one practical offer of help. The goal is not to win an argument or force a confession. It is to communicate: I see you, I care about you, I am worried, and help is available.
Altium Health provides judgment-free, person-centered care for substance use and related concerns. This guide is for the people around the person who are trying to respond with the same combination of honesty, safety, and compassion.
First, decide whether this is a conversation or an emergency
A supportive conversation can wait for the right time. A medical or safety emergency cannot. If you are unsure whether someone may be overdosing, treat it as a possible overdose rather than waiting for certainty.
Call 911 if the person cannot be awakened, is breathing slowly or with difficulty, has stopped breathing, has blue or gray lips or skin, makes choking or gurgling sounds while unresponsive, has a seizure, or may have overdosed.
If an opioid overdose may be involved, give naloxone if it is available. Call 911, try to keep the person awake and breathing, place them on their side to reduce choking risk, and stay until emergency help arrives.
Call 911 for severe withdrawal symptoms such as a seizure, extreme confusion, hallucinations, loss of consciousness, or another life-threatening medical change.
Call 911 when there is immediate physical danger, a weapon, violent behavior, or an unsafe situation you cannot manage without risking your own safety.
For suicidal thoughts, emotional crisis, or concern about someone you care about, call or text 988. If there is immediate physical danger or a medical emergency, call 911.
Do not let an impaired person drive. Do not get into a vehicle with them, and do not put yourself in physical danger while trying to take keys or control the situation.
Do not assume someone who is unconscious will be safe if allowed to 'sleep it off.' Alcohol poisoning, opioid overdose, head injury, medication interactions, and other emergencies can look like sleep. When breathing, responsiveness, or immediate safety is in question, get emergency help.
What patterns may deserve a caring conversation?
A single change does not prove that someone has a substance use disorder. Stress, grief, sleep loss, medical conditions, medication effects, and mental health concerns can look similar. Focus on a repeated pattern and its effect rather than trying to identify a diagnosis from the outside.
Using or drinking more often, in larger amounts, or for longer than before
Repeatedly breaking personal rules about when, where, or how much to use
Changes in sleep, mood, memory, hygiene, appetite, energy, or reliability
Secrecy, disappearing, unexplained spending, early refills, hidden containers, or inconsistent explanations
Missing work, school, family plans, or important commitments - or needing others to cover them
Using to feel normal, get through the day, sleep, calm down, socialize, or avoid feeling sick
Needing more for the same effect, or feeling shaky, sweaty, anxious, restless, nauseated, or unwell when use stops
Blackouts, falls, injuries, unsafe sex, impaired driving, risky work, overdose, or mixing substances
Relationships, hobbies, finances, or daily routines narrowing around using and recovering
You are allowed to raise a concern before you know exactly what it means. A useful opening is not, 'I know you are addicted.' It is, 'I have noticed a few changes, and I care enough about you to ask how you are doing.'
How to prepare before you start the conversation
Preparation can help you stay grounded when the conversation becomes emotional. It also keeps the focus on care instead of a long list of every frustrating moment.
1. Choose a time when the person is sober, medically stable, and not rushing, driving, caring for children alone, or about to start work. Do not begin while they are intoxicated or actively withdrawing.
2. Choose a private, calm setting with enough time to talk and a safe way for either person to pause or leave. A holiday meal, group gathering, public place, or workplace hallway is rarely ideal.
3. Write down two or three recent, observable examples. Use what you saw or heard, not guesses about motives, character, or diagnosis.
4. Decide what you are asking for. Your first request might be a medical appointment, a substance use assessment, a call to a treatment provider, or permission to look at options together.
5. Learn a few realistic options in advance. Do not arrive with only the instruction to 'get help.' Be ready with a phone number, an appointment option, transportation, or an offer to sit with them while they call.
6. Consider safety. If the person has been violent, has threatened harm, has access to weapons, is severely unstable, or there are children at risk, seek professional or emergency guidance rather than arranging a private confrontation.
It may help to practice the first few sentences with someone trustworthy who will protect the person's privacy. Keep the circle small. Support is different from gossip or gathering people to outnumber the person.
A compassionate eight-step conversation
1. Lead with the relationship. Begin with care, not evidence: 'I love you,' 'You matter to me,' or 'I value you and wanted to check in.'
2. Ask whether it is an okay time to talk, when possible. Permission can lower defensiveness: 'Could we talk privately for a few minutes about something I have noticed?'
3. Describe specific observations with 'I' statements: 'I noticed you missed two mornings after drinking,' rather than 'You are irresponsible.'
4. Name the concern clearly and calmly: 'I am worried about your safety,' or 'I am concerned that this pattern is getting harder on you.'
5. Ask an open question: 'What have you noticed?' 'How are you feeling about your drinking?' or 'What does using help you get through?'
6. Listen longer than feels natural. Reflect what you hear, including uncertainty: 'Part of you does not think it is a problem, and part of you is tired of how the mornings feel.'
7. Offer one concrete next step: 'Would you be willing to call a provider with me today?' or 'Can I help you schedule a medical assessment this week?'
8. Agree on a follow-up. If the answer is not yes, keep a clear next point of contact: 'I will give you some space tonight, and I would like to check in tomorrow.'
The conversation does not have to include every step perfectly. A steady tone, a few facts, genuine listening, and a practical offer matter more than delivering a flawless speech.
What can I actually say?
To a loved one: 'I love you, and I am not bringing this up to shame you. I have noticed that you have been drinking more often, you missed two mornings you had planned with the kids, and last weekend you drove after drinking. I am worried about you and everyone's safety. What have you noticed? Would you be willing to talk with a professional if I make the call with you?'
To a friend: 'You matter to me, and you have not seemed like yourself lately. I have noticed you have canceled several plans after using, and you told me you are taking more than you intended. I am not here to judge you. I am worried and want to understand what is happening. How can I support one next step?'
To a coworker as a peer: 'I care about you, and I have noticed you have seemed unsteady and unlike yourself a few times recently. I do not want to assume why. Are you okay? If you want support finding confidential help, I can help you look at the resources available to us.'
When you are unsure: 'I may not understand the whole picture, and I am not trying to diagnose you. I have noticed a pattern that worries me, and I did not want silence to communicate that I do not care.'
What to avoid - even when you are frightened or frustrated
Do not use labels, insults, moral judgments, or identity statements such as 'addict,' 'drunk,' 'liar,' 'selfish,' or 'you always ruin everything.'
Do not argue over the exact amount used as though proving one number will decide the entire concern.
Do not begin the conversation when the person is intoxicated, withdrawing, driving, or in a volatile state.
Do not surprise the person with a room full of people, corner them, or allow several people to speak over them unless a qualified professional has recommended and prepared a formal process.
Do not lecture for an hour, unload every past grievance, demand a confession, or make treatment a test of whether the person loves you.
Do not make threats you cannot or will not carry out. State only boundaries that protect safety, health, children, finances, work, or your own well-being.
Do not promise secrecy when someone is at risk of overdose, suicide, violence, impaired driving, abuse, or another immediate danger.
Person-first language is not about avoiding the truth. It separates the person from the condition and reduces the shame that can make honest help-seeking harder. You can be direct about risk without treating someone as the worst thing that has happened.
What if they deny it, minimize it, or get angry?
Denial or anger does not automatically mean the conversation failed. The person may feel exposed, frightened, ashamed, or unprepared. They may also sincerely see the situation differently. You do not have to settle the diagnosis in one conversation.
Keep your voice calm and avoid matching intensity.
Return to the relationship and the specific observation: 'I hear that you disagree. I am still worried because I saw you fall and could not wake you for several minutes.'
Do not chase every argument. You can say, 'I am not asking us to settle every detail tonight.'
Pause if the conversation becomes unsafe or degrading: 'I care about you, and I am going to stop for now. We can talk again when we are both calmer.'
Leave one practical option and follow up at the time you named.
If every option is rejected, ask what kind of help the person would be willing to consider. A primary care visit, confidential assessment, therapy appointment, recovery-support meeting, or brief phone call may feel more possible than agreeing to a full treatment plan on the spot.
Support, enabling, and boundaries are not the same thing
Support reduces isolation and helps someone move toward safety or change. Enabling is a common everyday term for actions that unintentionally protect the pattern from its natural consequences or increase risk. A boundary describes what you will do to protect health, safety, finances, children, work, or your own well-being. It is not a punishment and it cannot control another person's choices.
Transportation boundary: 'I will not ride with you or allow the children to ride with you if you have been drinking or using. I will help arrange a safe ride.'
Home boundary: 'I will not have alcohol or unprescribed drugs in my home. If that happens, I will ask you to leave and we can talk when you are sober.'
Work or school boundary: 'I will not call your employer or school with an excuse that hides what happened. I will support you in making the call honestly and asking about help.'
Financial boundary: 'I will not give cash when I am concerned it may increase harm. I can pay the clinic or pharmacy directly, bring food, or help with transportation.'
Good boundaries are specific, realistic, connected to safety or well-being, and followed consistently. If you fear violence or retaliation, do not announce a boundary alone without a safety plan. Seek help from a qualified professional, domestic violence resource, or emergency service as appropriate.
If the person is a coworker
Concern at work requires extra care because privacy, safety, performance, authority, and organizational policy may all be involved. Your role matters.
If you are a peer
A brief private check-in can focus on well-being without diagnosing: 'I have noticed you have not seemed like yourself. Are you okay?' Do not investigate, search belongings, access private information, spread rumors, or ask other coworkers to compare stories. You can offer information about an employee assistance program, benefits resource, or confidential treatment option if one is available.
If there is an immediate safety concern - impaired driving, dangerous equipment, threats, unresponsiveness, or another urgent risk - use the workplace's emergency and reporting process rather than trying to manage it alone. A caring relationship does not require keeping a dangerous secret.
If you are a supervisor or manager
Your job is not to diagnose or counsel the employee. Follow the organization's current policy and involve the appropriate human resources, safety, or leadership contact. Address timely, observable performance or safety facts: an absence, an error, a smell, unsteady behavior, a policy violation, or inability to perform work safely. Document facts according to policy, not conclusions about addiction.
Procedures, benefits, testing rules, leave options, confidentiality, and legal obligations vary by employer and role. Managers should use their organization's approved process and obtain qualified HR or legal guidance when needed rather than improvising a clinical intervention.
When should a formal intervention involve a professional?
The word 'intervention' is often associated with a surprise meeting in which several people confront one person. That is not the only meaning, and it is not automatically the best first step. A private conversation, medical evaluation, family consultation, or professionally guided engagement plan may be more appropriate.
Consider consulting a qualified addiction or behavioral health professional when risk is escalating, repeated conversations have not changed the situation, family members disagree about boundaries, treatment needs may be medically complex, or you are considering a planned group meeting. Professional support is especially important when there is a history of violence, suicidal behavior, psychosis, severe withdrawal, overdose, child-safety concerns, pregnancy, serious medical illness, or access to weapons.
A responsible professional process should assess safety, prepare each participant, use respectful and consistent language, confirm that appropriate treatment options are actually available, and plan for more than one possible response. It should not rely on humiliation, public pressure, or promises that one meeting will force lasting change.
What kind of help can you offer?
The first professional step is often an assessment. It can help clarify the substances involved, current health and safety risks, withdrawal history, mental health, medications, home support, goals, and the level of care that may fit. The person does not need to know which program to request before making the call.
Offer to sit nearby while they call, without taking over the conversation.
Help write down questions about services, insurance, cost, schedule, privacy, medications, and transportation.
Offer a ride or childcare if that is safe, realistic, and welcome.
Ask whether they want you included in an appointment; respect privacy and consent unless immediate safety requires action.
Help compare the recommended level of care rather than assuming that weekly therapy, outpatient detox, IOP, or residential treatment fits every situation.
Altium Health's whole-person approach considers health, mental health, substance use, safety, daily responsibilities, support, strengths, and goals when discussing appropriate next steps.
For some medically and psychiatrically stable people, an Intensive Outpatient Program (IOP) can provide structured treatment while the person continues living at home. It is not appropriate for every person or every stage of withdrawal.
When withdrawal can be managed safely outside an inpatient setting after medical assessment, ambulatory detox may provide scheduled medical evaluation, monitoring, and symptom support. Some people need a higher level of medical care.
Depending on the substance and individual needs, medication-assisted treatment may be one part of a coordinated plan. A qualified prescriber must determine whether a medication is appropriate.
What if they are not ready for help?
You cannot make another adult become ready on your timeline. You can make help easier to reach, stop participating in unsafe patterns, respond consistently, and keep the door open. Sometimes the first conversation plants a thought that becomes actionable later.
Follow through on the boundaries you stated without adding new punishment in the heat of the moment.
Notice and reinforce movement toward safety or help: an honest conversation, a medical appointment, a sober ride, a treatment call, or a request for information.
Continue to respond to emergencies as emergencies; refusal of treatment does not change overdose or immediate-safety guidance.
Seek your own support through a therapist, clinician, trusted community resource, or family-support program. You do not have to carry the situation alone.
Protect your sleep, finances, work, physical safety, and other relationships. Caring for yourself is not abandonment.
If the relationship includes intimidation, coercion, violence, stalking, or threats, prioritize safety over persuasion. A substance use concern does not excuse abuse, and a private conversation may not be safe.
Frequently asked questions
How do I know if someone's substance use is really a problem?
You may not be able to know from the outside, and you do not need to diagnose them. Pay attention to repeated changes in control, safety, health, reliability, relationships, work, finances, tolerance, withdrawal, secrecy, or recovery time. Use specific observations to start a conversation and encourage a professional assessment.
What is the best thing to say to someone with an addiction?
There is no perfect sentence. A useful structure is: care, observation, concern, open question, concrete offer. For example: 'I love you. I noticed you have been missing work after drinking, and I am worried about you. What have you noticed? Would you be willing to call a provider with me?'
Should I call them an addict or alcoholic?
Avoid assigning a label. Terms such as 'person with a substance use disorder' or 'person experiencing problems related to alcohol or drugs' are more respectful and less stigmatizing. In a personal conversation, it is often best to describe what you have observed and let a qualified professional assess the condition.
What if they say I am overreacting?
Listen without surrendering the concern. You can say, 'I understand that you see it differently. I am still worried because of what I observed.' Avoid debating every detail. Offer one next step, pause if needed, and return to the subject later when it is safe.
Can I force someone into substance use treatment?
In most ordinary situations, another adult makes their own treatment decisions. Laws and emergency processes vary, and immediate danger may require emergency intervention. A treatment provider, crisis professional, or qualified local attorney can explain options in a specific situation; do not rely on a blog post for legal guidance.
How do I help without enabling?
Offer help that moves toward safety, honesty, assessment, treatment, or recovery. Avoid giving cash that may increase harm, making false excuses, hiding dangerous behavior, or repeatedly removing every natural consequence. Set specific boundaries about what you will do and seek professional support when the line is unclear.
What should I do if I am worried about a coworker?
As a peer, check in privately and focus on well-being without diagnosing or gossiping. Use workplace resources when appropriate. Report an immediate safety risk through the organization's emergency or supervisory process. If you are a manager, address observable performance or safety facts and follow current policy with HR or other designated support.
When is a formal intervention appropriate?
A formal intervention may be considered when risk is escalating, previous conversations have not helped, and a qualified professional believes a planned process is appropriate. It should include safety planning, participant preparation, confirmed treatment options, and a plan for different responses. A surprise group confrontation is not the default first step.
When should I call 911 or 988?
Call 911 for suspected overdose, unresponsiveness, breathing problems, seizure, severe withdrawal, immediate physical danger, or another life-threatening emergency. Call or text 988 for suicidal thoughts, emotional crisis, or concern about someone you care about. If immediate physical danger or a medical emergency is present, use 911.
You can be kind and still be clear
Compassion does not require pretending the pattern is harmless. Honesty does not require humiliation. The most helpful conversation often holds both truths: 'I care about you exactly as a person, and I am worried enough to speak clearly about what I see.'
The first conversation may lead to treatment, a smaller step, an argument, or no visible change at all. Your role is not to manufacture the perfect response. It is to speak from care, protect safety, make help concrete, and take care of yourself as you remain honest about what is happening.
If you are looking for substance use treatment in Utah or support for how to approach someone you care about, talk with Altium Health about what you have noticed and the next step you are considering. You do not need to know which service to request. Call 801-613-9843 or text 385-342-3490 to ask about current services, scheduling, insurance, referrals, and availability.
Urgent and crisis support: Call 911 for a suspected overdose, severe withdrawal, seizure, breathing problems, unresponsiveness, immediate physical danger, or another life-threatening emergency. For suicidal thoughts, emotional crisis, or concern about someone you care about in Utah, call or text 988 at any time. Altium Health is an outpatient provider and is not an emergency service.
Medical and workplace disclaimer: This article provides general education and is not a diagnosis, individualized treatment plan, legal or human-resources advice, or a substitute for medical or emergency care. Workplace policies, benefits, laws, and reporting duties vary. A qualified professional must evaluate individual clinical needs and situation-specific obligations.
