It may take many conversations before someone gets help, so this first one doesn’t have to land perfectly.1 Pick a calm, private moment when they’re sober. Bring two specific things you’ve seen and one next step you can offer, like a doctor’s visit you’ve already booked. Then listen more than you talk.
What should I do before I talk to them?
Prepare for ten minutes or so. Emotions run high in these talks, and a written plan keeps you on track. The NIAAA suggests thinking through what you’ll say and even role-playing it with someone first.3 This card covers the rest, and you can print it.
Your conversation prep card
Specific beats general. “Last Saturday you didn’t remember driving home” is hard to wave away; “you drink too much” starts an argument.
What do I actually say?
- Open with care: “I love you, and I’m worried about you.” SAMHSA suggests something as simple as “I’ve been worried about you. Can we talk?”2
- Describe what you’ve seen, not who they are. “On Tuesday you missed work, and Thursday you fell asleep at the wheel in the driveway.”
- Say how it affects you: “I’m scared something is going to happen to you.”
- Ask, then listen. “How do you feel about your drinking lately?” Questions that start with “how” or “what” invite more than a yes or no.1
- Offer the option you prepared. “Dr. Lee can see you Thursday at 10. Will you go? I’ll drive.”
- Take a small yes. An evaluation or one appointment is enough for today.
- If the answer is no, end warmly: “Okay. I’m not going anywhere. The offer stands.”
Watch your words. NIDA describes research in which clinicians judged a person called a “substance abuser” as more deserving of blame and punishment than someone described as having a “substance use disorder.”5
Instead of this, try this
“You’re a drunk.”
“I’m worried about how much you’ve been drinking lately.”
“You need to go to rehab.”
“Would you be willing to talk to a doctor, just to get information?”
“You never think about anyone but yourself.”
“When you didn’t come home Friday, I didn’t sleep. I was scared.”
“Why can’t you just stop?”
“What would make it easier to get help?”
“And another thing…” (every past mistake at once)
“I want to talk about two things from this week.”
“This is your last chance.” (unless it truly is)
“I’m not asking you to commit to anything forever. Just this next step.”
How do I listen so they keep talking?
Counselors trained in motivational interviewing use four skills, often called OARS, that families can borrow.4 Ask open questions (“What worries you, if anything, about how things are going?”). Affirm real strengths, like “You’ve kept that job through a lot,” because hearing only what’s wrong makes people shut down.1 Reflect back what you heard: “So you feel like everyone’s on your case.” That helps them feel understood and clears up misunderstandings.1 Then summarize before you ask for anything: “You hate how mornings feel, and you’re not sure about rehab. Would you see a doctor about the mornings?”
What do I say when they get defensive or deny it?
Don’t argue. Denial is the usual starting point. In SAMHSA’s 2025 national survey, 94.5% of adults with a substance use disorder who didn’t get treatment neither sought it nor thought they needed it.6
Addiction counselors are taught that pushback usually reflects normal mixed feelings about change, not a fixed trait.4 The same guidance warns that confrontation tends to increase resistance. In one study it cites, the more a counselor confronted a client, the more the client drank.4 You also don’t need them to accept a label. NIDA notes that treatment doesn’t have to be voluntary to work, and that pressure or encouragement from family can increase treatment entry and retention.7
| If they say | You might say |
|---|---|
| “I don’t have a problem.” | “I’m not here to argue about a label. I’m worried about what happened Saturday, and I’d feel better if a doctor took a look.” |
| “You drink too.” | “That’s fair, and we can talk about mine. Right now I’m worried about you.” |
| “It’s my life.” | “You’re right, it’s your choice. I’m telling you because I love you, and I’ll help if you want it.” |
| “I can stop whenever I want.” | “Would you see a doctor before you stop?” |
| “You’re overreacting.” | “Maybe. Help me understand what you think is going on.” |
| Yelling or storming off | “I can see you’re upset. Let’s stop for now.” |
“See a doctor before you stop” is often an easier yes than “go to rehab,” and it matters: quitting alcohol or benzodiazepines suddenly can be dangerous.
Lena’s husband, Tom, had started having a drink before work. On a quiet Sunday morning she named two things: the night he couldn’t remember, and the drink she saw him pour at 7 a.m. Tom said he could stop whenever he wanted. Instead of arguing, Lena said, “So you feel like you’ve got it handled.” Tom admitted he’d tried twice and felt awful both times. “Would you tell Dr. Patel that? I’ll call Monday.” He said no to rehab and yes to the doctor. That was the step.
What counts as a “yes,” and what do I do next?
Any concrete step toward a professional counts: a visit to their regular doctor, a clinical assessment, one counseling session or support group meeting, or looking at FindTreatment.gov together. You can also call SAMHSA’s free, confidential National Helpline together at 1-800-662-4357; it’s open around the clock.9
Act the same day. Make the call while you’re both in the room. Motivation can fade overnight, and a booked appointment is harder to walk back than a vague promise.
What if they say no?
Plan to come back to it. SAMHSA’s advice is to be patient and keep offering to listen and help.2 You can also get better at this. In a randomized trial, families trained in CRAFT (Community Reinforcement and Family Training) got more resistant loved ones into treatment than families who used a confrontational intervention.8 Read how CRAFT works and what to do after a no.
Should a professional be part of the conversation?
Consider bringing in their doctor, a therapist or a counselor if your loved one has a history of violence, suicidal thoughts, severe mental illness or risky withdrawal, or if your family can’t agree on a plan. Don’t raise treatment alone with someone who has threatened you. Before you hire anyone, read whether a formal intervention makes sense. If your loved one is a teen or young adult, the same approach applies, with some added options for people under 25.
Frequently asked questions
Can I bring it up by text or in a letter?
A letter lets you say things calmly, and they can reread it. Follow up in person. Avoid long texts sent in the middle of a fight.
We already had a bad talk. Can I try again?
Yes. Start by owning your part: “Last time I yelled, and I’m sorry. I’d like to try again, calmer.” A repaired conversation can build more trust than a smooth first one.
Do I have to use the word "rehab"?
No. Many people react to the word itself. “See a doctor” or “get an assessment” describes the same first step, and the clinician can recommend the right level of care.
What if I'm too angry or scared to stay calm?
Wait until you can, and get support for yourself first. See where families can find support.
Sources
- SAMHSA — How to Talk to Someone About Help for Mental Health & Substance Use. samhsa.gov/find-support/helping-someone/how-to-talk-to-someone-about-h… — accessed Oct 2026
- SAMHSA — Supporting a Loved One Dealing With Mental and/or Substance Use Disorders: Starting the Conversation. samhsa.gov/sites/default/files/starting-the-conversation-guide.pdf — accessed Oct 2026
- NIAAA Alcohol Treatment Navigator — Starting the Conversation. alcoholtreatment.niaaa.nih.gov/support-through-the-process/starting-th… — accessed Oct 2026
- SAMHSA — TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (updated 2019). library.samhsa.gov/sites/default/files/tip-35-pep19-02-01-003.pdf — accessed Oct 2026
- NIDA — Words Matter: Preferred Language for Talking About Addiction. nida.nih.gov/research-topics/addiction-science/words-matter-preferred-… — accessed Oct 2026
- SAMHSA — Key Substance Use and Mental Health Indicators in the United States: Results from the 2025 National Survey on Drug Use and Health (2026). samhsa.gov/data/sites/default/files/reports/rpt57150/2025-nsduh-annual… — accessed Oct 2026
- NIDA — Principles of Drug Addiction Treatment: A Research-Based Guide (3rd edition). nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf — accessed Oct 2026
- Miller WR, Meyers RJ, Tonigan JS — Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology (1999). pubmed.ncbi.nlm.nih.gov/10535235/ — accessed Oct 2026
- SAMHSA — National Helpline. samhsa.gov/find-help/helplines/national-helpline — accessed Oct 2026