How to Talk to a Family Member About Addiction

SAMHSA's clinical guidance points families toward positive reinforcement rather than confrontation. The approach it describes is CRAFT — Community Reinforcement and Family Training — a structured, family-focused method, usually four to six sessions, that teaches family members strategies for encouraging a relative who is misusing substances to change that behavior and enter treatment. SAMHSA states directly that people pressed into substance use disorder treatment by confrontation are more likely to return to use than those encouraged to enter through positive reinforcement.

If you have already tried talking, and pleading, and money, and ultimatums, you are not doing this wrong and you are not late. What follows is not a script that makes someone say yes. It is what the published guidance describes, so that the next conversation you have is at least built on something.

What CRAFT is

CRAFT stands for Community Reinforcement and Family Training. SAMHSA's TIP 39 calls it “another much-studied family-based intervention” focused on concerned significant others — its term for the family members and close friends around the person, whether or not they are related by blood (source 1).

TIP 39 describes CRAFT as a structured, family-focused, positive reinforcement approach, usually four to six sessions in length, that teaches family members strategies for encouraging the family member who is misusing substances to change his or her substance use behaviors and enter treatment. The counselor's role, in TIP 39's description, is to work with family members to change the way they interact with the person who has a substance use disorder, which in turn has an impact on that person's substance use behaviors (source 1).

Two things about that description are worth pausing on, because they run against how families usually expect this to work.

• The focus of the intervention is the family. TIP 39 says this in those words. CRAFT is something family members are trained in and do; the person using substances does not have to agree to anything for it to start.
• Its underlying assumption is that environment matters. TIP 39 states the assumption behind CRAFT is that environmental contingencies are important in promoting treatment entry — that what happens around a person shapes whether they go (source 1).

TIP 39 gives a deliberately ordinary example of what positive reinforcement looks like in practice: telling the family member how much you enjoy spending time with him when he is not smoking marijuana, or going to a movie with him after a day without drinking (source 1). It is smaller than most families expect. That is the point.

SAMHSA also describes CRAFT as a prime example of community reinforcement, whose goal it states as working together to provide positive incentives for people with substance use disorders to stop using substances, to get progressively involved in alternative, meaningful, positive social activities not associated with substance use, and to enter or stay in treatment (source 1).

Why the confrontational intervention is not the default

The televised version of this — everyone in a room, a letter each, a car waiting outside — is not what the guidance describes.

TIP 39 puts it plainly: community reinforcement helps family, friends and social supports positively reinforce behavior change instead of confronting continued substance use or other risk behaviors, and people pressed into substance use disorder treatment by confrontation are more likely to return to use than those encouraged to enter through positive reinforcement (source 1).

TIP 39 also frames the general sequence for families as starting with the least intensive option — naming counseling and Al-Anon or CRAFT — before moving to the most intensive (source 1).

This is not a claim that a confrontational intervention never works, and this page is not going to tell you that a particular approach will produce a particular outcome. It is a statement about what the published guidance points to first.

The four communication skills

TIP 39 notes that CRAFT is highly structured, and that it can also be adapted into a less structured family-focused approach — psychoeducation on the effects of substance misuse on the family, plus coaching on communication skills. It lists those skills as (source 1):

• Refraining from blaming and shaming the family member.
• Expressing concern about the family member's substance use behavior and its effects on the family.
• Expressing hope that the family member will get help.
• Offering affirmations and positive reinforcement for any positive change in substance use behaviors.

Those four are the whole list. Everything below is how they tend to look in a real conversation — not additional clinical guidance.

Putting it into practice

Pick the moment, not the speech

Sober, private, not in the middle of a fight, and not the day after something bad happened. If the moment turns, you can stop and come back. The conversation is not a single event you get one shot at.

Say the effect, not the diagnosis

“You are an addict” is a label, and labels invite an argument about the label. The second skill on TIP 39's list is expressing concern about the behavior and its effects on the family — which is describable without diagnosing anyone. What happened, what you saw, how it landed on the people in the house.

Notice what is already going right

The fourth skill is affirmation and positive reinforcement for any positive change. “Any” is doing real work in that sentence. A shorter binge, a kept appointment, one honest answer — families often skip past these because they are so far from the goal. In this approach they are the material you have to work with.

Have the next step ready before you start

If the answer is yes, “I'll look into it” loses the moment. Know beforehand which level of care you would be asking about and roughly what is available nearby — our care-type guide narrows it down, and the questions to ask a facility checklist is what you would take into the call afterward.

Keep hope separate from promises

The third skill is expressing hope that they will get help. That is different from promising an outcome. Nobody — not you, not a facility, not this website — can tell you how this ends.

When it does not work

Sometimes the answer is no, or nothing, or a fight. TIP 39's framing of least-intensive-first implies the obvious corollary: there are more intensive options, and moving to them is a normal progression rather than a failure of the conversation.

Some states have legal processes for involuntary or court-ordered treatment. Those are state-specific and they are not something to read a summary of — we cover them on separate pages, statute by statute:

• When they will not go: what the options actually are
• The Marchman Act in Florida
• Baker Act vs. Marchman Act
• Casey's Law
• Section 35 in Massachusetts
• Court-ordered rehab and how drug court works

Whatever you decide about that, one thing is worth doing now rather than later: if opioids are involved at all, read the overdose response page and get naloxone in the house. It does not require anyone's agreement.

Support for you, separately

TIP 39 notes that family members and concerned significant others may need encouragement to attend community-based recovery support groups like Al-Anon and Nar-Anon, and that research has associated Al-Anon with positive psychosocial and physical outcomes for family members (source 1).

These are free, they are not treatment, and they do not require the person you are worried about to participate or even to know. We list meetings here: support groups.

SAMHSA's National Helpline is also for family members, not only for the person using substances. SAMHSA describes it as a free, confidential, 24/7, 365-day-a-year treatment referral and information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders, and states it will not ask you for personal information (source 2). It is 1-800-662-HELP (4357).

Where this goes next

This page is the second of three planned Family Resources pillars. The first — what the options are when someone will not go, including state involuntary-treatment law — is live across the pages linked above. The third, on choosing between programs once the decision is made, is partly covered today by the care-type guide and the facility questions checklist.