Know significant others may have some reason to be concerned about a loved one's substance use. Don't assume, just like we've been talking about for clinicians, let's not assume that we know that there is a problem, or what the nature of the problem is, or you know what the person should do about it. Let's begin by attempting to invite the person we're concerned about into a meaningful, mutually respectful conversation, and really focus on a relationship and communication. So there's this idea that I think about a collaborative intervention Rather than that old school intervention. 

And so I might talk with the folks about how might you approach your loved one, expressing your concern and inviting a conversation so that it's framed not as a presumption that you have a problem you need to fix it, and you know, we're going to get you to do that, but we have it's framed not as a presumption that you have a problem you need to fix it, and you know, we're going to get you to do that, but we have some concerns we'd love to, you know, have a dialog with you to sort of get some help. We want to help in dealing with our concerns. And in that context, we might say these things have been happening that are leaving me feeling worried or unclear or confused. You know,
can we talk about them?
And it's about me, my concern. I don't really know what's going on for you. I love you, and if there is something concerning, I'd like to be as supportive as I can and just kind And it's about me, my concern. I don't really know what's going on for you. I love you, and if there is something concerning, I'd like to be as supportive as I can and just kind of get the concerns on the table and see if we can come up with a plan for addressing everybody's concerns that everyone can buy into. The person that people are concerned about is an equal participant and contributor to this process, and I've had, you know, you know, tremendous success, I think, in just approaching people with a respect for every member of that system, which is kind of the goal, and to help them begin to talk to one another in loving and mutually supportive ways. When I'm working with family members, I mean, their main concern is for, let's say it's like for a child like a young adult, a child like,  maybe an adult's child,
they're concerned, especially if it's opiates or some other kind of like higher risk drug. They're really concerned for their life. It's like life or death for them, and so if the patient, like the family member, has a hard time managing their own emotion, it just usually spills onto the to the person who's using the substances, and that usually creates a disconnect.

One of the keys is honest education about risk and about safer using practices. I said, Do you know how much is in each bag? Do you know what the lethal? You know the LD 50? That's the the lethal, the dose at which 50% of people die. I mean, we really had this conversation, and he said, I don't know the answer to those questions. So I said, Why don't we both do some research? And he came back the next session. He said, Yeah, yeah, I could have died. So that kind of information can be so vitally important to people's motivation, right?

We talked about it earlier, but I have some clients who will come in and they they know what they're using. They know how they're using it. They know the consequence or the risks involved with other kind of mixing of drugs. Some other patients, they come in and they're like, Oh, I take my Klonopin with my alcohol. I'm like, Oh, well, let's talk about mixing the same kind of class of drugs So what's wrong with mixing Klonopin and alcohol?

Well, they work on the same neuro receptors, and you have a good chance of kind of overdosing, and they're both depressants, so you're going to slowly your nervous system starts to slow down a little bit. So that's a really important point, that there are certain substances that have a synergistic effect, alcohol, which is depressant, benzos, which are depressant, have a synergistic effect, where one plus one equals. Three and so those kind of drug interactions are really important for people to learn about. I know here in New York City, there are some harm reduction clinics that offer some test strips, or kind of where you can go and pick up information about how to test, and they'll test for you. There's other websites nationally that can help you understand, like what to look for in these illicit drugs that you're getting. So just providing them with those resources and referrals, there are actually fentanyl and xylazine test strips that are increasingly widely available, where you can take a small amount of the drug, put some water in it, dip, you know, this sick or whatever in it, and it will tell you if the sample is contaminated. On a very practical level to say, are you aware of that? I understand you like to use alone. Are you aware that there's this hotline you can call, never use alone, and you can use your substance you can inject and have someone on the other phone line waiting for you. So if something you know should happen, there's someone there who's kind of with you, you know, and can call 911, so there's very simple things like that. How much do you know, patient, client, you know, participant, about the risks of the substances that you're using. So I tend to use the craft model I help, you know, yeah, craft like Bob Myers, right? Like it's, you know, community reinforcement and family training. So I usually, when I'm working with family members, I send them to, like, a craft training for them to kind of learn how to stay engaged with the with their loved one, with the person who's using while also maintaining their own boundaries and self care, but staying connected, because there's some older, traditional models that are about pure detachment. And I really don't believe that the person who's using substances needs more detachment from from their loved ones, right? They need a connection. Yeah? I think about craft as kind of a love based, yeah, compassion intervention for concerned significant others. And so it's about, as you said, developing positive communication, creating a context in which to invite the loved one into kind of an exploration of what the concerns are like. There's something about when the person, the patient who's the identified patient, who's someone who uses substances, all of a sudden, everybody, sometimes, either clinicians, like treatment programs, family members, friends, we treat that person as if they can't make their own decisions, like their autonomy has gone because, like they've made bad decisions, or poor they have poor judgment, which may be true, but doesn't mean that they're less human and shouldn't be at the table discussing what's good for them, possibly, or what they want to do, or What they're motivated for, but somehow we take them out of the conversation. We don't have the science to be able to tell who can successfully cut back, moderate use, more safely, and who can't. Most addiction treatment has been abstinence only in its expectations most groups for people that struggle with substance use have been abstinence focused. Aa can be a wonderful community. And also for people that sort of resonate with the AA philosophy, which is a very particular philosophy, I would say, though, that the majority of people in this huge group that we've been talking about don't connect with AA. So we need to have a number of different alternatives. You know, the person that I was thinking of is Philip Seymour Hoffman. I happen to have a client who knew him. He was a very visible presence in the 12 step recovery movement in downtown Manhattan, and he was like a grand sponsor, as the sponsor of sponsors, of sponsors. So I had always wondered when he picked up, he used what, what did he do? How did he experience that? And you know, my client said that he exactly experienced it the way you're describing it, he could not go he could not show his face.

So what did he do? He got a bunch of bundles of heroin, and he wound up overdosing and dying. Smart Recovery is more of. Of a kind of cognitive behavioral skills based approach to positive change, and it does broadly fall within this harm reduction framework as I've defined it, because while smart recovery is oriented toward helping people, helping people stop behavior that could refer to an abstinence commitment, or it could refer to a moderation pathway, where you know you're learning to stop the behaviors that are you know at odds with A moderation plan or your ideal substance use plan. The cheeky way of expressing it is, it's aa without all the God talk, without the God talk, because some people are turned around by the higher power, which is not supposed to be God, but they feel like it's religious and so smart sort of got raised from that. Don't have to say, Hey, my name is Susan. I'm an alcoholic. You don't define your cells by the disorder. They do offer sponsors. That's another misunderstanding. People think you don't get a sponsor at smart you do. It's not part of the structure. But you raise your hand. We say, I need a sponsor, and you'll get one. And so I think that was came from where aa was in and I love ADA. Don't get me wrong, the community's exceptional, ubiquitous opportunity finding in a meeting in the globe is valuable and smart is a little bit different. And so I think that might lead us a little bit more towards opening the opportunity. But I don't have to fill all these rules. Say I'm an alcoholic. I lose my day count. I have to talk about God. And so it may meet people who are maybe a little bit more attracted to harm reduction versus pure and unwavering abstinence. Tom Horvath is somebody that used to be the president of smart for many, many years. He runs an outpatient treatment program called practical recovery in San Diego, and what he told me is that people learn skills to stop, but that could be that you stop and abstain from everything, or it could be that you stop at moderation. But another interesting factoid is that in the early days of AA, there was no day counting. I almost think of it as a contamination by the dominant culture, you know, competitive culture, or something. Me, you know, I want to help them navigate through all of these different programs and figure out, you know, the other aa idea is, take what you need and leave the rest. So, you know, if you don't like the god stuff, or you don't like day counting, or actually, you don't have to take it. But so, I mean, I think the more options we have for self help programs, just like with treatment modalities, the more we can help our people find the way to a support system that best suits them. There's also an organization called moderation management, which is very specifically to support people that are concerned about their drinking and are interested in moderation. That's an even newer program. It's got a wonderful website moderation.org and has got a smaller number of online and in person meetings. So this new harm reduction ethos or framework, I think, is now informing groups that don't require abstinence. We might think of them as mixed goals, groups in which what brings people together is that they're all committed to sort of figuring out what their ideal relationship is to substances and can then support one another in this process of figuring that out, a major part of the healing process is to create relational spaces in which people can begin to unpack. You know that relational dynamic that is turning to the substance to care for oneself rather than others, to be able to kind of find those aspects of. Self, put them into words and bring them into relationship. And that can happen in individual therapies, in group therapies, in family therapy, etc. So I think that new relational experience that enables people to kind of reconnect with those parts that have been expressed or cared for by the substance and bring them into the relationship is, I think, where you know significant healing, the power of psychotherapy lies. Can't fix our patients. We can't save our patients, we can't get them to change. And this is really important, because often patients come with these fantasies, can't you fix me? Can't you stop me? And often the families or referring professionals or agencies also, you know, you mean the person has been working with you for four weeks and they're still using and I think that people who have difficulty with self regulation and feel out of control can also induce in us the feeling that, You know, we need to save.

We need to stop. However, I think what we can do is offer people a certain kind of relationship that is a powerful, powerful antidote to what many people have experienced throughout their lives, maybe both as people who are struggling with problematic substance use and other stigmatized behaviors, but also people that have experienced trauma, is that offering this new relationship creates a space that many people have never had that's supportive of reflection, of insight, of growth, of supporting better affect emotion regulation and creating a therapeutic team that can support people in strategizing to make positive change in their lives, and we've got a lot of You know that relational dynamic that is turning to the substance to care for oneself rather than others, to be able to kind of find those aspects of. Self, put them into words and bring them into relationship. And that can happen in individual therapies, in group therapies, in family therapy, etc. So I think that new relational experience that enables people to kind of reconnect with those parts that have been expressed or cared for by the substance and bring them into the relationship is, I think, where you know significant healing, the power of psychotherapy lies. Can't fix our patients. We can't save our patients, we can't get them to change. And this is really important, because often patients come with these fantasies, can't you fix me? Can't you stop me? And often the families or referring professionals or agencies also, you know, you mean the person has been working with you for four weeks and they're still using and I think that people who have difficulty with self regulation and feel out of control can also induce in us the feeling that, You know, we need to save. We need to stop. However, I think what we can do is offer people a certain kind of relationship that is a powerful, powerful antidote to what many people have experienced throughout their lives, maybe both as people who are struggling with problematic substance use and other stigmatized behaviors, but also people that have experienced trauma, is that offering this new relationship creates a space that many people have never had that's supportive of reflection, of insight, of growth, of supporting better affect emotion regulation and creating a therapeutic team that can support people in strategizing to make positive change in their lives, and we've got a lot of expertise and knowledge about
theory of the struggles that people have and therapeutic techniques. So to acknowledge our limitations is not to say that we don't have a lot of value to offer people around behavior change and growth. I had a an older man walk into my office in his mid 70s, and he had decided to stop smoking cigarettes. You know, you started to have some breathing problems. And he thought, you know, for the last chapter of his life, he wanted to see if he could breathe better, breathe his way through, you know, to the end. And he pulled out this pack of cigarettes, and it was so touching, he said, but I'm not sure how I'm going to get through life without these 20 little friends you know, that have been with me for so many years, which speaks so you know, to so much of what we've been talking about, the relational meaning of his little friends that he could turn to when he couldn't turn to other friends or other people. But also, you know the inevitable grief and loss that people have to confront, even if ultimately they decide it's a better choice to cut back or stop, you know, the behavior because of other things that they value. I think everybody grieves or deals with a loss in in their own way.

I think that it's important to
acknowledge and help people acknowledge that it is a loss, you know, if I'm, you know, a person who loves getting wasted with my friends, staying out until 6am or maybe even keeping the party going, you know, in a way that then leaves me wasted for the next week, and I realized that I need to let that go. I have a family now, I have a job, I have my health. I'm growing older, so I'm going to keep it to two drinks over dinner a few times a week. There's a major loss of the substance use of. The experience of myself, of the experience of connecting. I mean, there's loss there. I think it's different for different people. And also weaning down, gradually cutting back, cutting back, cutting back, cutting back might be, you know, kind of also an easier way to mourn. Something about, you know, this group of people, huge group of people, as we've been talking about it, are one of the most underserved groups of people in the country, and
I think in part, you know, that's because of stigma and a kind of Social I'm not sure what the right word is, you know, the disease concept and the you know idea about problematic drug users as being morally weak, and the stigma related to that, I think, are convenient ways to locate the problem in the individual, and then avoid looking at the bigger picture of a society that renders many, if not most of Its members to be suffering and feeling overwhelmed, right? I'm hopeful that with you know, and I guess that's what I would like to communicate to people, there's always hope for quantum change. You know, if you just get started, you.

Most people affected by substance use—whether personally or through someone they love—have already tried the obvious things: advice, pressure, ultimatums, treatment referrals, even “interventions.” Often, those efforts backfire. This is not a program that assumes abstinence is the only path forward.

This video is for people struggling with alcohol or drug use who want options beyond rigid abstinence models. It is for partners, parents, siblings, and friends who want to help without losing the relationship. It is for anyone who feels that traditional approaches haven’t fit—or haven’t worked. 

You’ll Learn

• How to talk to someone about substance use without triggering shutdown, denial, or escalation

• How to understand risk realistically, including dangerous drug interactions and overdose dynamics

• Alternatives to one-size-fits-all recovery models

 Change does not have to begin with certainty or perfection.

It begins with better conversations, clearer understanding, and safer next steps.