Loving through addiction: How family and friends can reduce harm and support loved ones

Lady supporting her friend thru phone call

Loving someone who is struggling with addiction can be an incredibly painful and lonely experience.

“Watching someone you love go through addiction is one of the hardest things someone can experience, because there are so many unknowns,” says Wendy Klinski, clinical director of Home of New Vision in Ann Arbor. 

“Family and friends live day to day, not knowing where their loved one is or even if they survived.”

While going through this difficult experience, family and friends of people who are dealing with addiction don’t always have the support they need. 

“It’s not just the individual who is affected,” says Tom Karpinski, president of Families Against Narcotics in Washtenaw County. “It affects everybody around them. The ripple effect just keeps going and going.”

How can organizations and providers in Washtenaw County support family and friends? Read on. 

Codependency: Risk or myth?

The ideas of codependency, enabling, and tough love are so closely tied to addiction that even many people untouched by addiction have heard of them.

The question for many people who love someone with an addiction is, how do they love that person while setting appropriate boundaries to protect themselves?

“Sometimes family and friends are so hurt by the actions their loved one took when in active addiction, because it’s so hard to understand,” says Klinski. “They struggle to re-establish the relationship when their loved one does go to treatment.”

To avoid enabling and codependency, the common advice is to “love from afar” and to avoid giving the person experiencing addiction money, a place to stay, or other tangible support.

But many families and experts are pushing back against the idea that “tough love” is the best way for family and friends to hold boundaries, protect themselves, and help their loved ones.

“The words and concepts of tough love, codependency, and enabler harm everyone involved, and once these concepts are used, it can damage relationships beyond repair and be deadly,” says Ashley Shukait, a harm reductionist and public health consultant, who says that the research and our massive amount of overdose deaths doesn’t support these approaches.

“Concepts like this, along with allowing someone to ‘hit rock bottom,’ are deadly and unethical. Building people up, helping them thrive, finding ways to set healthy boundaries, and respect are proven in all other behavioral-based interventions. Substance use shouldn’t be any different.”

A different support approach

Shukait is part of a larger movement of practitioners, people with living and lived experience, family, and friends who reject the ideas of codependency and enabling in order to embrace harm reduction.

Kathleen Cochran, mother to a daughter experiencing addiction, encourages other mothers to embrace a science-supported, harm reduction approach through her Substack blog, Moms for All Paths to Recovery.

Cochran has supported her daughter through her 16-year battle with substance use disorder (SUD), including over twenty rehabs. Cochran says her daughter “stopped using when she felt the harms outweighed the benefits – when she was ready.”

“I was told to practice ‘tough love.’ I was called an enabler, told that I had codependency issues, and even told to kick my daughter out,” Cochran writes in her blog. “Some people even said that I was literally killing my child by giving her money because she might buy drugs and overdose.  Everything I heard in [parent groups] went against my mother’s heart. As I learned more, I found out that the advice I was getting also goes against the best evidence on what works to help people recover.

“I’ve spent the last six years unlearning what I had been taught, and it’s been hard. When I finally started to listen to my daughter, I realized that coercing her into rehab, or any sort of treatment, would not work.  It just created distance between us.  Once I was able to listen, I realized that keeping her safe was infinitely more important than getting her off drugs.  I don’t have the power to make her stop using, but I can find ways to keep her safe.”  

Experiences like Cochran’s are one reason it is so important to support each family on their own individual path.

“There’s no one size fits all,” says Karpinski, who is a person in recovery himself and practiced clinically for several years. “There are many different pathways to achieve a desired outcome.”

He emphasizes that the support Families Against Narcotics gives to families is not a “step-by-step set of directions like you’re putting together a chair.” Instead, it’s more like a roadmap to travel across the country. Journeys to recovery can be slow, and most take several detours. Families need support no matter what path they choose to take – including if they choose harm reduction.

Harm reduction for family and friends

“Harm reduction is about trusting relationships and about accepting and meeting the person where they are at, without stigma and without shame,” writes the Canadian group Moms Stop the Harm, an organization of parents supporting harm reduction approaches. “For families, harm reduction means first and foremost keeping our loved ones stay healthy and alive.”

Despite harm reduction’s many benefits, it can be a touchy subject. Some people see harm reduction – which includes providing clean needles and other safer use supplies, overdose reversal medication, drug checking like fentanyl test strips, and overdose prevention centers – as enabling and supporting people in substance use.

Harm reduction can also include Medication for Opioid Use Disorder (MOUD), more commonly known as Medication Assisted Treatment (MAT), where people with an SUD take medication as part of their recovery.

Stigma around MAT has led some family, friends, healthcare providers, and others to see the medications as “trading one drug for another.” But methadone and buprenorphine reduce the risk of overdose by 50 percent or more. It is a safe and effective way to keep people healthy and provide a better quality of life while they recover. Family and friends can share information about medication with their loved ones and support their medication access as part of a harm reduction evidence-based approach.

“If families understood the purpose of harm reduction, they could be more receptive to it,” says Klinski. Its purpose is to keep people safer, and Klinski notes that people often move from harm reduction practices into recovery.

“They’re not just getting harm reduction supplies, they’re being educated on their use and given resources,” Klinski says. “Harm reduction creates an opportunity for the individual to talk with someone about options when they’re ready to move toward recovery.”

Locally, we’ve seen access to harm reduction tools like naloxone expand in recent years. Naloxone is now available over the counter, and many sites throughout the county offer free naloxone and fentanyl test strips thanks to outreach efforts from groups like Home of New Vision and the Washtenaw Recovery Advocacy Project (WRAP). The Washtenaw County Health Department’s It Is Possible campaign promotes harm reduction tools and strategies to prevent overdoses and save lives. 

Various additional syringe service programs exist within Washtenaw County, including but not limited to: SOOAR; Harm Reduction Michigan, LEAF Harm Reduction (coming soon), HARM:LESS, as well as mutual aid groups like Peace House, Solidarity Hall, Washtenaw Camp Outreach and many others. Advocates are working to expand harm reduction services throughout the county. 

For family and friends, harm reduction is a way to support their loved ones no matter what situation they are in.

So what should family and friends do?

First and foremost – get support, get guidance, and reach out. 

“There’s a lack of participation in family programs,” says Klinski. “People don’t access them until they have to, which means they wait until the problem has gotten really bad.”

Sometimes family and friends avoid support groups because the groups do not feel welcoming, whether because of racism or ableism in the groups, because the groups are based on a 12-step program, or for other reasons.

But many family and friends wait until their situation is serious before reaching out for help for the same reason that so many people experiencing addiction are isolated as well – stigma.

“Stigma affects people around the individual with an addiction too,” says Karpinski. “They might not want to talk about addiction. They don’t know who to share it with, they’re afraid that neighbors, doctors, and others will judge them for having a spouse, parent, child, or friend who’s going through this. They worry about what people will think of their loved one and what people will think of them by association.”

But this isolation can prevent family and friends from accessing the support and tools they need to care for themselves and their loved one.

One of the main tools that can help family and friends, and which every expert supports, is education.

As Cochran writes, “We mothers often feel powerless to act on behalf of our own (and our family and children’s) best interests. But we know the antidote to powerlessness: KNOWLEDGE.”

To best support their loved ones, family and friends need accurate information on the cycle of addiction, harm reduction, and how the disease of addiction works. This education can help families realize why their loved one acts the way they do, which can build empathy and help prevent long-term damage to their relationship with their loved one. It can also show family and friends why they have no control over their loved one, which can help release some of the pressure to “fix” them.

“If people understood more, they may have a different outlook on how to support the individual going through it,” says Karpinski.

Education is especially important in the area of harm reduction.

“Family and friends can support their loved ones through a harm reduction approach by learning about the spectrum of substance use, including substance use disorders, harm reduction practices, and harms of criminalization and stigma,” says Shukait. 

“Building trust, compassion, and learning skills to help themselves and their loved ones, regardless of what has occurred in the past, can build better relationships and keep their loved ones healthy as possible.”

Beyond education, family and friends can give their loved ones the encouragement and love they need. “Encouraging words, fond memories, and simply saying ‘I love you, you’re a good person,’ can help people with that transition,” says Klinski. “Remind them that they still have value and worth, that they’re loved.”

Dreams for the future

Washtenaw County has a lot of room to grow in our support of family and friends of people experiencing addiction.

“The family component is a very underserved and glossed over part of the disease,” says Karpinski. “We talk about recovery for the person with the disease, but we don’t always talk about recovery for those around the individual.” Families Against Narcotics provides specific family peer recovery coaches to address this need.

Karpinski emphasizes how important recovery is for family and friends – especially when their loved one is working on recovery. Sometimes, an individual experiencing addiction goes into treatment, develops new skills, and makes significant progress, but then they return to find that their family and friends are stuck in the same spot – full of anger, confusion, and resentment. That can create a barrier to the individual’s recovery, as well as continuing to harm the family and friends. Karpinski dreams of a recovery process where the individual and their family and friends progress in tandem, so that there can be a healthy relationship from both sides.

Shukait often finds that working with family and friends alongside the individual is an important part of her harm reduction work as well. “Very often, many  harm reductionists are not only working with the individual, but with their parents and family members to unlearn and relearn to build connections and health practices [after they have] been failed by drug prevention and abstinence-only punitive treatment.”

There are many ways that support for family, friends, and the individual with an SUD can improve.

  • Community-based programs that provide the education, resources, and equipment needed to keep individuals who use drugs healthy would save lives. 
  • Providers and public health professionals could offer person-centered care and evidence-based information to empower patients to make informed choices. 
  • Harm reduction services must be expanded and advocated for.
  • Education – for family, friends, health care providers, and everyone touched by addiction – remains critical and often difficult to access. 
  • More educational resources on how addiction works, how to deal with crises and conflict, healthy boundaries, stress management, how to advocate with someone with an addiction, the impacts of historical and ongoing trauma, racism, classism, and stigma will help family and friends stay as well as possible. 
  • Even simple changes like avoiding stigmatizing labels can make a difference in our community.

Family and friends cannot “cure” their loved one, and it can be so difficult to accept that their loved one may not want support at this time. 

But no matter what path a family or friend chooses – harm reduction, love from afar, or others – they need support from their community and professionals to protect their well-being, so they can be there for their loved one when needed.