From the outside, addiction can seem hard to explain, frustrating, and contrary to all logic, especially when it's someone close to you with the problem. How long do you watch the harm being done before you step in? How can I help when I don't even understand what's going on?

Addiction is a chronic disease and, like others, can be more easily and successfully treated when recognized early. Although individuals do have to make the decision to quit for themselves, that doesn't mean you can't do anything to move the process along. Stubborn myths like, "You can't do anything unless an alcoholic wants to stop drinking" or "Drug addicts have to hit bottom before they want help" are common but not true. Friends and family members can play a major role in motivating loved ones to seek help.

When you're ready to help, you may be confused by all the conflicting advice that's out there. Let him hit bottom or get involved now? Tough love or unconditional love? A surprise intervention in the living room with all his friends or a gentle one-to-one over coffee? Which strategy is the right one?

Everyone has different needs, communication styles, reasons for using, and readiness for quitting. You know a lot about your friend's personality and may be able to choose the helping strategy that's most likely to work. You may have to try several different approaches before something clicks. This guide offers a place to start.

UNDERSTANDING ADDICTION

Before you toss on your superhero cape, it may help to recognize a few critical points about addiction. First, no one ever thinks he will get addicted. The crossover line between casual party use and dependence is sneaky and hard to predict. Most stumble over it quite unexpectedly and without even knowing it. Our so-ciety values will-power and self-reliance, and people generally think they can control their behaviors and manage the consequences. Try not to blame your friend for losing that control.

Second, alcohol and drugs cause immediate and profound changes in brain chemistry which result in powerful pleasure cravings and mood swings. At the same time, the brain may start losing its ability to process information and make decisions effectively. An addicted brain gets rewired to choose big doses of pleasure (or relief from pain) at the expense of other options. This may explain why your friend keeps getting drunk or having risky sex while high even after he swears he won't. A brain impacted by chronic drug or alcohol use works very differently. So until he stops us-ing, his thoughts, actions and decisions may seem irrational and, quite frankly, just plain stupid.

Addiction is both biology and psychology. While the cycle of withdrawal-craving-reward is certainly driven by changes in brain chemistry, it is also shaped by deep and often difficult emotions. We often call these our "issues," and they can include anything from poor self-image to internalized homophobia to serious depression or anxiety disorders. Don't assume he can just "snap out" of his problems with the right prescription or a couple of therapy sessions.

Finally, the term "addict" is largely negative in our society. While 12-step philosophy insists that publicly declaring oneself to be an addict is a criti-cal and even liberating step towards recovery, most people associate the term with failure, shame, criminal activity, and irresponsible self-neglect. It's difficult to take on a label like that. So don't insist that your friend does. To start, it's enough for him to simply acknowledge a problem. What you call that problem - addiction, dependency, a rough time - is less important than how you talk about it.

HAVING THE TALK

You may feel anxious about talking with a friend about his drug use or drinking. How will he react? Will he think I'm being nosy or intrusive? What if I push him away? These are common fears, but fears well worth facing when it comes to his health and your relation-ship. He might actually be waiting for you to say something, afraid to bring it up himself. The chance is worth taking.

It's never easy to have this conversation. And when you do, it will probably put your friend on the spot and be embarrassing for him. He may even become angry or deny everything. We often accuse people of "being in denial" when they seemingly refuse to see what's going on. But silence or flat out rebuff is not always a reliable sign of someone's awareness of his problem. It may actually be his way of handling an emotionally threatening situation. Most people with substance use problems know on some level that things aren't going well. Even if your friend doesn't admit that to you openly he may very well feel it or fear it deep inside.

Here are some suggestions on having "the talk:"

1. Before you do anything, make a plan. What do you want to say? What's your goal? Writing down your thoughts may help you organ- ize a strategy and feel calmer.
2. Pick the right time. Avoid when he's drunk or when he's too tired and cranky after a high. The time after a binge may be best, when he might feel more conflicted about his behavior.
3. Don't start by accusing him of being a drug addict or alcoholic. Let him know that you really care about him and your relationship and that things have been different lately.
4. Focus on his specific behaviors or the changes that concern you. "I'm worried about your weight loss," or "You've never had unsafe sex before," or "When you promised to go to dinner and didn't show up, I felt disappointed."
5. Talk about the effect your friend's drinking or drug use has on whatever he cares about most: career, children, relationship, etc. He may care deeply about what the problem may be doing to those around him.
6. Don't preach about future health risks. Most people already know that drugs and alcohol are bad for them. Addiction forces a "right here, right now" orientation; people often can't see far ahead and have a skewed picture of the past. Instead, focus on behaviors and consequences happening right now.
7. Notice your tone. If you feel frustrated, sad or upset, say so sincerely but not angrily.
8. Let him respond. It's normal if he gets angry or defensive. Allow him time to process those emotions.
9. From the beginning, reassure him that even though you may not like his behavior or his choices, you still like him. Highlight his qualities that you still appreciate. These positive qualities may be critical strengths for him during this rough time.
10. Take a list of resources with you. If you offer to go with him for help, follow through if he asks.

WE TALKED. NOW WHAT?

What if he's not ready for help? Don't despair or take it personally. Let your friend know that when he is ready for help, you'll be there. Don't think you didn't present your case. You have planted a seed of recov-ery that may grow when you least expect it. The goal is not to "rescue" your friend from his problem. Your role is to maximize the chances that he will seek help, without losing yourself along the way.

In the meantime, be careful that you don't get caught up in his behavior. You may find yourself reacting to your friend's behavior by focusing on him, what he does, where he goes, or on how much he drinks. You may even try to control his drug use, perhaps by holding his ATM card for him. But getting too involved usually leaves you feeling frustrated and your friend feeling distrusted. That's a recipe for conflict.

On the other end of the reaction spectrum is enabling or overprotecting your friend from the negative con-sequences of his addiction. Do not cover up for him. He needs to feel the downsides of his drug use or drinking even if it's hard to watch. Remember that his drug use is NOT your faultand you are not responsible for his struggles or suc-cesses in recovery. All you can do is talk honestly with him, show him you care, and encourage positive steps. Helping a loved one with a drug problem is hard work. Find support if you get discouraged. Talk with another friend, counselor, co-worker, etc. Many find help in special support groups for friends and family like Al-Anon.

Finally, model the behavior you wish to see. Don't drink or use drugs around a friend who you wish would stop. If a major focus of your relationship with this person has been drugs or alcohol -- say, you hang out with friends who party, or you're in the habit of having cocktails together -- it's best to reexamine how you spend time together. Then try to find alterna-tive activities, such as going for walks or attending cultural events.

It can be hard to love and support someone who breaks promises, borrows money and doesn't pay it back, and spends more time getting high with others than spending time with you. The time may come, particularly after you've tried to help repeatedly, when you need to walk away from the situation. It's hard to do, but sometimes losing people you love temporarily is what it takes to keep them in the long run.

Decide how much you are willing to put up with. Let your friend know what will happen if he pushes this limit. And whatever you decide, stick to it. It's essential to pull back if his addiction threatens your security or well-being. Pulling back rarely feels like a "good" option, but it may feel like the "right" option. Trust your gut feelings.

SHOULD I PUSH TREATMENT? IS IT THE ONLY SOLUTION?

In our self-help culture many of us seek solutions to our problems at Barnes & Noble or on the Internet before we call a real live professional. Signing up for treat-ment may not be your friend's first choice either.

Many who struggle with addiction will tell you that nagging rarely helps. Often, the more you push to cut back or quit, the more your friend is likely to deny the problem. Not everyone needs treatment. Some can quit on their own with the support of groups or a ther-apist. Others need much more structure. But almost everyone tries to control his drug use/drinking on his own first. Entering a formal treatment program may be the "last resort" of a series of steps or attempts.

There are different types of treatment that vary in intensity, length, and cost. In reality, treatment choices are usually determined by how they will be paid for.

To learn more about types of treatment and funding options, call your local Alcohol and Drug Helpline or Community Information Hotline.

TREATMENT AND RECOVERY

This is both a hopeful and stressful time during which the following suggestions may be useful

• Expect changes in personality. Mood swings are frequent in early recovery. Your friend might begin to act and talk differently as he learns to relate to himself and others in new, healthier ways. Be patient.
• Your friend may also become more sensitive to things that never bothered him before or to things that trigger him. If you're not sure if something is OK, just ask.
• Especially in early recovery, people often sense that their friends and family are watching every move they make, just waiting for that first sign of relapse. It's hard to live under a microscope, so give you friend a little room and privacy.
• After treatment, your friend may feel very bored. Or worried that he has become boring without drugs or alcohol. This is a great time to discover new interests. Get a gym membership together or take him for a fun, new hair makeover!
• Give regular feedback that affirms his hard work. Tell him how proud you are. If you like the progress you see, say so!
• At times, your friend may need to be so focused on his recovery that he doesn't have room for anything else. At other times, he may have "recovery fatigue" and need to get refreshed through other interests. Take your cue from him.
• Don't mention his recovery in every conversation. He'll need a break from recovery talk from time to time. Remember that his addiction is only a part of his whole expression. Give the other parts some attention as well.

AND FINALLY, THE "R" WORD

Yes, relapse is probably going to happen. Although they can be demoralizing and painful, occasional slips or complete bellyflops off the wagon are actually valuable to the long-range process. Sometimes the best thing for recovery is a good relapse. That's how you learn about your needs, your limits, and your strengths to regroup.

If your friend relapses, it doesn't mean he's back to square oneor that your efforts and support were a waste of time. Understand that he may need a number of tries to really stop for good. Most people do.

Sometimes it's the very pressure to succeed in recovery that overwhelms people and prompts a relapse. People learn to drink and get high as a way to cope with uncomfortable feelings and stress. And nothing can be more uncomfortable and stressful than recovery, all that "in touch with your feelings" stuff and everyone's high expectations. It's not uncommon for people in recovery to hear them-selves say, "hurry up and relapse" just so they canbreak the pressure, get it over with, and move forward.

And remember all those attempts to quit before? Over time, all that failure really puts a dent in one's confidence. People struggling with addiction have a hard time believing in themselves, especially during and after a relapse. So even if you feel like the situation is hopeless, you can not act like it. Your friend will really need your cheerleader enthusiasmbecause he's probably beating himself up inside more than you know. Encourage him to keep trying and remind him of his past accomplishments.

But truth be told, by the time your friend got into treat-ment, you were likely at your wit's end. So if your friend relapses after all you went through, it's under-standable that you might feel angry, taken advantage of, or just plain "over it." The key is to stay focused on the process of his recovery, not today's status of his recovery. Things will change.

IN CONCLUSION

Granted, all of this is far easier said than done. Intellectually, you understand addiction is complex. You know you can't make your friend change. You know you shouldn't blame yourself. You know that his issues are his issues and yours are yours. But sometimes your reactions and emotions will not follow accordingly. That's OK. Addiction isn't very logical or rational either. Have faith that you are doing the best you can. And that your friend is doing the best he can. In the long run, you may be very surprised how it all turns out.

Authored by Susan Kingston, Educator Consultant with the Drug Use and HIV Prevention Team, Public Health - Seattle & King County. susan.kingston@metrokc.gov