How to Help a Friend Struggling with Substance Use


It’s not always easy to know how to help when you think you see your friend struggling with substance use. Maybe you feel like they will get mad at you, or worse, stop speaking to you. You’re a good friend for wanting to help—the best way to do so is to meet them where they are at. Together, we’ll take a look at the Stages of Change Model to help you understand how you can help depending on where your friend is in their thought process.


THE STAGES OF CHANGE MODEL


The Stages of Change Model developed by Prochaska and DiClemente in 1982 will be our map to helping your friend. The model outlines six stages a person may be in with regard to changing a specific habit, like substance use.




You might be wondering what the point of this model is. We’re following this model because it helps to emphasise the importance of a harm reduction approach. It emphasises minimizing the damage being done, rather than attempting to get rid of it completely. Not only is it incredibly difficult to change a habit all at once, your friend’s idea of healthy progress may be different than yours. Aim to figure out what kind of change they are open to making in that moment—listen to their side and try to understand how hard this is for them. We’ll be going over what each stage entails, and what the most effective kind of help looks like if your friend is in each headspace.


PRECONTEMPLATION


During precontemplation, your friend does not feel like they need to change anytime soon. They may perceive change as too much of a hassle, or simply unnecessary. At this stage, however, they may not be willing to accept your suggestions. In fact, they may get defensive or frustrated with you.


To avoid this reaction, it is important to voice your concerns in a delicate way that shows them how much you care. It is helpful to use communication techniques specifically tailored to the sensitive situation at hand. We have a Guide to Communication on our website that gives you tips on how to approach these kinds of conversations.


Before this conversation, it is important to ask yourself what your goal is. Try not to have any expectations of what they will do after you talk. It is unlikely they will have a complete change of heart and quit their habit cold turkey. Focus on telling them how you feel, rather than what they should do, because they may have different and totally valid ideas.


CONTEMPLATION/DETERMINATION


Here, your friend is just beginning to consider change, but they are not actively pursuing it. Even contemplating such a huge change can be challenging.


Contemplation is fragile and easily swayed. Remember to respect their boundaries. You cannot make them do anything, even if they spend a lot of time talking to you about options they were considering. The best you can do when they are in this mindset is offer to brainstorm options with them, or ask them if they’d like you to find potential resources. It may feel slow, but they may not be ready to truly start searching yet. Validating how conflicted they feel and simply being there for them are crucial during this stage.


PREPARATION

Your friend has decided that they want to change and are preparing to do so. They’re more receptive to resources and relevant information.


It is still important to respect their boundaries in this stage. It’s normal to be excited that they want to change and to want to guide them through this process. However, change is more likely to stick if people feel like they are the ones making it happen. Don’t bombard them with information they haven’t asked you to find—that can be overwhelming and deter them. Instead, offer a listening ear to their process and ask them what you can do to be the best support for them. To them, that may mean collecting resources, going with them to appointments, or simply being there. Respect their wishes and celebrate their initiative.


ACTION


Your friend is actively changing their behaviour. The change is hard, but they are trying their best.


It’s important to recognize just how new this change is for them. They can easily slip back into old habits. Once again, let your friend take charge of the process. Encourage and celebrate their commitment to change. You can even change your own behaviour in solidarity; for example, if they are trying to quit drinking, you can hang out with an activity that doesn’t usually involve alcohol. Be there for them when they face internal or external resistance and want to quit, because it’s normal to be frustrated by the slow process. Don’t make them feel terrible for thinking of quitting—validate their struggles and believe in them.


MAINTENANCE


Your friend has changed their behaviour for awhile now and works hard not to relapse.


It can be easy to think that the change is permanent when it has been awhile, but it’s still important to acknowledge their efforts and validate their struggles. You will want to check in on your friend periodically to let them know that you’re still there and invested in supporting them, even as the novelty of the change wears off.


RELAPSE


Your friend has fallen back into old habits—this can happen at any time in the stages of change. This could be simply a night of the old behaviour or longer.


You might be disappointed, frustrated, or shocked by this—if you feel this way, imagine how they feel. Do not make them feel awful about relapsing, because they’re probably contending with guilt and shame already. They may not be ready to commit to change again right away. Try not to judge them, because they’re genuinely trying their best even when it is not obvious. In fact, shaming and judging them can exacerbate feelings of hopeless. Once again, simply listen and be there for them.


EXIT


Relapse is not impossible in this stage, but it is less likely. The new behaviour pattern is now routine. Celebrate with them, and support them in any feelings that come up.



Change is not easy. Your friend may move through these changes in a different order than described above. They may go back and forth between them rapidly. It’s important to remember that you’re trying your best, just like they are. Though you wish you could, it’s not your job to “fix” the pain your friend is in. Remember to practice self-care and have boundaries for the support you’re able to give (check out our website for blogs and health packages related to self-care and boundaries—we’ve got tons!). Your wellbeing is just as important as theirs.