Handle immediate danger first
If the person is unconscious, cannot be awakened, has slow or stopped breathing, is having a seizure, is severely confused, or may harm themselves or someone else, call 911. If opioids may be involved, give naloxone if it is available and stay until emergency help arrives. Naloxone can reverse an opioid overdose when given in time and is available over the counter in the United States. Do not wait for the person to agree to treatment during an emergency. For a mental health or suicide crisis, call or text 988. When the situation is stable, you can return to a calmer conversation about longer-term help.
Choose a calm time and speak without judgment
Do not start the conversation while the person is intoxicated, in withdrawal, or in the middle of an argument. Choose a private time with few distractions. Describe specific things you have noticed and how they affect safety, health, work, or family, rather than using labels or listing every past mistake. Use a calm tone and listen for what the person fears about treatment. SAMHSA recommends open-ended questions, such as what they like and do not like about their current situation or how they would want life to be different. Reflect back what you heard before offering solutions.
Offer choices and remove practical barriers
A refusal may be about a specific option rather than all help. Ask what they might consider: a primary care visit, medication, individual therapy, telehealth, an outpatient program, a support group, or a confidential assessment. Offer to research licensed providers, sit with them during calls, arrange transportation, care for children, or help verify insurance. Present two or three credible choices instead of one ultimatum. If every option is rejected, leave written information and ask permission to check in later. It may take many conversations before someone accepts help.
Set boundaries around what you will and will not do
Support does not require protecting someone from every consequence or accepting unsafe behavior. Decide which boundaries are necessary for safety and your own wellbeing, such as not providing cash, not allowing substance use in your home, not lying to an employer, or not driving with someone who is impaired. State the boundary clearly, explain what you will do if it is crossed, and follow through consistently. Avoid threats you cannot keep. You can say that you will help arrange treatment, transportation, or meals while also declining requests that increase risk or take over your life.
Prepare for the moment they become willing
Motivation can change quickly, so do the research in advance. Keep contact information for a licensed treatment provider, the person's insurer, the state substance use agency, and SAMHSA's National Helpline. Ask programs how quickly they can complete an assessment, what identification is needed, whether withdrawal requires medical care, and which payment options are available. Do not promise that one program will cure the problem. Offer a first step that can happen soon, such as calling a clinician together or attending an appointment, and let the person participate in choosing the plan whenever it is safe to do so.
Get support for yourself
Living with another person's substance use can be exhausting and isolating. Family therapy, a licensed counselor, and peer groups for relatives can help you make decisions, practice conversations, and maintain boundaries. Support for yourself is useful even if your loved one refuses treatment. Protect your sleep, finances, medical care, and connections with other people. If children or vulnerable adults are affected, seek professional guidance about safety and legal responsibilities in your area. Your support can matter, but the other person remains responsible for their choices and recovery.