What helps • Choose one calm time to talk. Avoid serious conversations during intoxication. • Focus on specific harms rather than debating how much or how often someone drinks. • Encourage a clinical assessment and evidence-based treatment options, including outpatient care, intensive outpatient programs, residential care and medications for alcohol use disorder. Learn more: https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-use-disorder() • Support yourself with family education and peer support. Family guidance: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/helping-someone-with-alcohol-problem () What to avoid • Covering for missed work, legal trouble or repeated unsafe behavior • Making threats you cannot enforce Safety note • Alcohol withdrawal can be medically serious. Seek urgent medical care if severe symptoms appear. • Withdrawal overview: https://www.niaaa.nih.gov/publications/clinical-guides-and-manuals/withdrawal-management()

What helps • Treat overdose risk as urgent. Keep naloxone available if opioids may be involved. Naloxone information: https://www.cdc.gov/overdose/prevention/naloxone.html() • Encourage treatment for opioid use disorder and ask providers about medication options such as buprenorphine or methadone when appropriate. Treatment overview: https://nida.nih.gov/research-topics/medications-opioid-use-disorder(https://nida.nih.gov/research-topics/medications-opioid-use-disorder) • Look for programs that offer ongoing care beyond detox, since relapse risk is high without follow-up treatment. What to ask a provider • Do you offer medication-assisted treatment • What levels of care are available • How do you support long-term recovery Safety note • Overdose risk increases when opioids are mixed with alcohol or benzodiazepines. Risk factors: https://www.cdc.gov/overdose/prevention/index.html()

What helps • Do not pressure sudden stopping. Encourage medical supervision and a gradual taper. Clinical guidance: https://www.ncbi.nlm.nih.gov/books/NBK470159/ (https://www.ncbi.nlm.nih.gov/books/NBK470159/) • If benzodiazepines are combined with alcohol or opioids, treat risk as urgent and seek medical guidance. Overdose prevention: https://www.hhs.gov/overdose/prevention/index.html() • Ask providers whether anxiety, panic or insomnia is being addressed alongside tapering. What to avoid • “Cold turkey” demands • Managing withdrawal without medical oversight Safety note • Benzodiazepine withdrawal can be medically dangerous. Seek urgent care for severe symptoms.

What helps • Watch for sleep collapse, paranoia, agitation or extreme mood changes. • Keep conversations brief, calm and focused on safety. • Encourage an assessment that includes both substance use and mental health screening. Treatment principles: https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide() When to seek urgent help • Psychosis, suicidal statements or aggressive behavior require immediate evaluation.

What helps • Focus on functioning: school, work, relationships and safety rather than debates about whether marijuana is addictive. • When more than one substance is involved, encourage a full assessment that looks at all use patterns together. • Polysubstance overview: https://nida.nih.gov/research-topics/polysubstance-use() • Set clear boundaries around driving, money and safety in the home. What to avoid • Narrow conversations that focus on only one substance when multiple are involved