How to support people who use substances

This piece is not meant to be poetic or beautiful. This is a what to do and what not to do, based on my experience. Take it or leave it, but before you leave it please reflect on the following:

-Are you leaving what I have to say based on your own personal experience (events and circumstances that happened to you or that you were actively involved in) or not?

-Is your personal experience as someone who used or is using substances? (ones that are prohibited by law, criminalized, pathologized, unregulated, where ppl who use them often are institutionalized).

-Is your personal experience as someone who used substances in a certain way, found a way to change their relationship to substances that you're happy with? If so, please consider that every person is different and that while what works for you is valid, it may not be for another person. This is also relevant for people who supported or support someone who has changed their relationship to substances.

I am writing this because we are currently in a pandemic, an intentional genocide, a systemic mass murder of people who use substances. I do not believe that there is ANY excuse in this time to not know how to support people who use substances.

This piece will not cover acute, urgent ways to support people who use substances: first aid and naloxone training are everywhere. Harm reduction groups are in every major city and many smaller ones. The internet has thousands of groups and educators who are teaching these skills. Go learn about them.

I will be sharing about how to support people in your life who use substances. Your partner, your friend, your co-worker, your parent, your child, anyone.

Right off the top: who the fuck are you to decide or judge how they use substances? And do they even need or want your support? I titled this piece in a very no nonsense way, a basic how to. Surprise: the idea of support in and of itself can be harmful if it is assumed to be wanted or needed in a specific way.

Honestly and truly ask yourself these questions. How exactly is their substance use affecting you materially? Not emotionally, morally or intellectually. And what do they actually need or want from you, if anything?

Now here is where it gets tricky, because we have been brainwashed into being afraid for our safety with substances. Usually, we are actually just uncomfortable and lack the experience, education or skills. However, there are also genuine instances where there "could" be a lack of safety around substances. I will describe what I mean.

...Are you scared or uncomfortable while supporting someone in a mental health crisis? That means you’re likely in a situation that you don’t necessarily have the tools for and your comfort zone is expanding — it doesn’t inherently mean you’re unsafe. Many of us have learned to connect ideas of safety with how good or regulated our nervous system feels. Safety is not the same as a regulated nervous system — especially if you are white or move through this world with racial and class privilege/power. Your ability to feel good, to feel calm, is not what dictates standards of safety.

-From Visions for a Liberated Anti-Carceral Response

Substances are all vastly different, every single person responds to them differently. We don't always know how people will respond to them especially if they are new, from a new source, under different circumstances. So yes, there could be an aspect of "risk" involved.

Maybe people don't have access to safe supply, or they've been cut off from their regular supply. Maybe they feel shame and don't want to use with people around, leaving them isolated. Maybe they are experiencing altered states which could cause them to physically injure themselves or have the cops called on them. Maybe child services could get called on them. These are all realities, caused not by drugs, but by our carceral systems, by prohibition, by lack of education and community care.

Take alcohol. If you drink alcohol, and get behind the wheel of a car, we know you are more likely to get into an accident. If a man comes home, gets drunk and abuses his family, that is a real lack of material safety. If frat boys decide to drink to excess and sexually assault gender marginalized people on campus, that is a real lack of material safety. In these cases, alcohol certainly exacerbates the situation, so we cannot dismiss it. However, it is not the only layer: there is gender, race, misogyny, and ableism that play a role in these cases as well.

I use alcohol as an example and these specific examples because they are not what people think of when they think of people who use drugs being violent. In our society, drugs are generally demonized as the reason people do "bad things" but there is much more to it than that.

Back to the question of who the fuck are you. Truly, what is your level of safety in this situation? If you are experiencing violence of any kind, you are not the person to support the person using substances, and like I said, substances may not be the issue, the issue may be they are an abuser. At any rate, you are not the person to support this person as a victim in their violence.

I say this to separate situations where someone may actually be at risk by an abusive person where there is a power and privilege dynamic, where substances are involved. I don't believe that anyone who is in this situation should have to think about anything other than getting themselves out, and the fact is that our society fails victims of domestic abuse and intimate partner abuse too.

If violence and abuse is not the case, go back to the questions at the beginning: what is your personal experience? If you have none, find people with lived and living experience and talk to them.

So many people think that they can read books, attend workshops and courses, read pieces of writing online and that will qualify them to support the person in their life. This is not the case. To actually be a friend to someone who is so stigmatized, you will need to humble yourself and realize that you do not have all the answers. In this case, just knowledge is not enough. Continued support, discussing your thoughts and ideas with people who have lived and living experience, asking them their advice, is essential. In addition continuing to deepen your understanding of substances, the layers, the implications, the perspectives and approaches out there is so important. I know I've been on this journey of exploring, researching, practicing, learning and sharing for almost 15 years and I have so much more to learn.

From an anti-oppression lens, if you are not a person who used substances and you are supporting someone who does, you are their oppressor. Your default will always be to judge their actions, and to think you know what they should and should not do. I as a person who used to use substances and now doesn't, have to watch my judgements, my biases that come with my privilege. Abstinence based "recovery" is a model that gets forced on people, that gets privileged in terms of what we view as best, and in access to resources. While I know what is currently working for me and has worked for me, the fact that I felt resonant to this particular path is based in my privilege: I had no previous trauma or experience with institutions before going to "treatment" or living in a recovery house. It felt right to me, and while I have changed the way I approach this journey along the way, I accessed that and reap many systemic rewards.

In my opinion, the problem is that our society has intentionally attached race and class to substances, and chooses what methods of "treating" the "problem" of substance use based on what is most profitable and aligned with white-Christian-heteronormative-ableist ideals. Because yes, many people in the "treatment centre industry" are getting fucking rich off of people who are struggling.

I personally believe in a one sized fits one approach: each person uses substances differently and has a different way they want to navigate it. If they choose they want to change the way they use in some way, there are also many approaches. Our system portrays things as if there is only one type of person who uses substances and only one type of approach to that.

I also have to mention that even saying "treatment", "support" or "approaching" people who use substances feels othering, dehumanizing and infantilizing: it gives the idea that inherently by using substances people require support. Why do they? I guess you could say everyone does. But because it is so often used as a weapon against people, I feel a certain way about it and struggle to find the right words. Perhaps it is more about "how to be in relationship to people who use substances when you don't". Or maybe "support" is more about how do we reduce harm to people who the state is intentionally murdering every day.

Take some time to reflect on your privilege and marginalization from people who explore this topic as it is essential in finding your role supporting anyone using substances.

Even if you do have personal experience: go talk to your support network of people who have lived and living experience and get their advice. This is something I do constantly.

Substance use is taboo and villainized in our society. You need to find the right people to talk to. Some thoughts on this:

-Honestly, while 12 Step groups are rampant with oppression, I do find Al-Anon to be helpful, AT LEAST in the sense of they are free, receive no government funding, and are filled with people who understand. One thing I will say is that you need to try a bunch of different groups, because every group is different as 12 Step groups are decentralized and autonomous, and each individual can basically say whatever they want to you. If you hear something shitty or disturbing or that feels not aligned for you, try a different ones. There is also Nar-Anon which is similar but supposedly for people who have loved ones who use drugs (although they do classify alcohol as a drug also). It is really about where you find your people.

-I recommend abolitionist, anti-carceral, anti-oppressive, decolonial groups and harm reduction groups and educators

-I personally don't recommend religious groups or groups run by non-profits but that's me, take or leave that based on what works for you

Next up: what is your judgement of the person who uses substances exactly?

Be honest with yourself, what do you think they should do? Don't answer from a place of "this is what I think experts would say" or what you intellectually think should be done. Really what do you want to tell them they need to do? Do you think they need to go to treatment? Get totally clean and sober? Go to therapy? Do trauma work?

Now, ask yourself, where does that judgement come from? Is it your experience? Your schooling? Did someone else in your life do that?

Finally, ask yourself, what is the benefit to you in them doing that thing? Would it make things safer actually? (Remember if they are violent to you, then you are not the person to support them.) Would it make your life easier if they just did what you think they should? Can you just not imagine how it would work if they didn't do what you want? This could be because of the limitations of your experience and your comfort.

Whatever your judgement is, you need to find a way for that judgement to not guide your interactions with them. Do whatever you can to let go of the idea of what you think should happen. This is not easy. But find ways to do it. Journal, talk it out with supports, say affirmations, do spells, say prayers, whatever. If the person you are supporting is struggling, they will feel any bias you have, any judgement you have, because in this interaction THEY ARE THE SYSTEMICALLY OPPRESSED PERSON.

They are the one who will be criminalized.

They are the one who can be forcibly institutionalized.

They are the one that people in power want to murder.

Yes, you may be suffering due to their substance use and it is not fair. Your life may be really fucked up. It is hard to support people who are using substances when you have a life you need to tend to. When you have kids. When you can't work. When you are afraid they are going to die. When you don't have community care.

But that is why you cannot try to do this alone. Building new possibilities with community is where the solutions you cannot imagine are.

Now again, this is assuming that the person's substance use is in fact affecting your life. Here are some examples of what I would say this could look like, though it isn't an exhaustive list by any means:

-They are using drugs that are prohibited by law in front of your children which could be something Child Services could get involved with

-You are a person who used to use the drugs they are using and are trying to not use them, and it is really difficult to be around

-It's affecting your material security like your money or house and you don't have the resources to cover it

-The person is experiencing altered states that require constant supervision because they are hurting themselves or others

-The person has had medical emergencies as a result of their substance use

Your response to the above things should not be to tell the person they have to change. You are the one that needs to change. Your response should be "what do I need to properly support this person through what they are experiencing". Your response should be "what are my limitations?". Your response should be "who do I ask for help?" Your response should be "how do I get educated?"

Next Up: Boundaries

You need to get really clear about what is yours and what is not yours. You cannot and should not tell anyone what they need to do with their substance use. It is their choice. However, you can set clear boundaries based on actual safety and stick by them. A boundary is different from manipulation. Example:

Boundary

"I respect your right to do whatever you need to do for yourself including using substances however you need to. I want to make sure you have the support to do that as safely as possible. I can't be the only person supporting you to do that, however. I need you to find the support you need and I am happy to help you do that, but it needs to be led by you otherwise I am taking over which isn't right. I can't continue being in the relationship in this way as it is too much for one person to handle, and I will need to shift things by (moving out, asking you to move out, seeing you less)."

Manipulation

"You need to get support for yourself. If we are going to stay together, you need to get clean fully. Here are the supports I've signed you up for."

Manipulation is usually very black and white and then not followed up by personal accountability. The person stating what they need doesn't shift anything for themselves, doesn't get support for themselves, doesn't ask for advice. All the responsibility gets put on the person who uses substances and they are expected to conform. The people "supporting" wait around until the person using substances "gets it together" and nothing changes for anyone.

Next up: Stick to your role and keep expanding your network

True community care is about making accountable spaces for all people. People who use substances, people who love them, people who are fleeing domestic violence, people who are criminalized. In my opinion, part of the reason substance use has become so deadly is because of our lack of community care. Substances have always been a part of human societies. And arguably, there have always been periods of prohibition, criminalization and control.

Substances are not the problem, it is the way we react to them.

Substances are not the problem, it is the way we have disconnected ourselves from our true selves, land, and each other so that we need substances to survive.

Substances are not the problem, it is the lack of care centred approaches in providing people with the substances they need.

Remember that you are not the savior of anyone, and no matter how smart, strong, educated you are, you cannot support a person all on your own. This is because what they (and you) are suffering from is layers and layers of intergenerational trauma and pain; a world that does not understand. Colonialism, patriarchy, capitalism, white supremacy are all evils of this world that need to be abolished and eradicated, and they are at the root of all suffering.

In your network, you need people you can call to check in on your loved one, who have harm reduction supplies, who understand CONSENT (because all of this is their choice and if they want to be left alone, you may need to back off to some extent), who can peer support without prescribing or manipulating.

In your network, you need people who can support you with their lived experience, with your fears, with your grief, with your material needs.

In your network, you need people from many different perspectives and experiences of substances because you do not know which direction could be useful to your loved one.

You need to make sure all the people supporting your loved one are on the same page: the worst thing is when no one is communicating, when different things are being shared with different people including the person using substances. Get together, make a group chat, get organized, be united. This is not about interventions: this is about everyone coming together to provide resources for the person who needs it and sharing with one another. Allowing for transparency and honesty creates an environment where people can be more themselves.

Be critical of professionals. Some are great. Others not. Many in between. I strongly recommend that most of your support come from unpaid community members and people with lived and living experience.

I really recommend highly against residential treatment especially paid treatment, UNLESS that is what the person you love wants to do without being coerced into it. For many reasons, but one major one is that residential treatment is a temporary band aid. I personally lived in a residential recovery house for one year and it was a fit because no one coerced me into it, in fact my family was against it. However, while I was there, I built an extensive network of care for myself outside of it. It was paid for while I was on income assistance, it was a women's only and women's empowerment based place.

One more thing about knowing your role: understand that folks who use substances are also full human beings with many other things going on. Take their whole selves into account. What is their race? Their class? Are they neurodivergent? Do they have a mental health diagnosis they identify with? What is their physical ability? Seek to understand these factors as well and where you identify or don't within that.

Realize that there is nuance in privilege and positionality with people who use substances. Are you a Black, Indigenous or racialized person who does not currently use unregulated drugs and is currently housed supporting a white person who is currently using unregulated drugs and is unhoused? They could be racist towards you. Are you a Trans person in the same circumstance supporting a cis gendered person? They could be transphobic. Is there a gender power imbalance? Have you been the gender marginalized person who has had all their money taken without consent to be used on substances? This all shifts the way you may need to approach, and AGAIN why you need a network of different people supporting.

There are complexities, and we have to work to understand that when people are experiencing altered states, having mental health crises and being treated like garbage by most of society, they do not owe us comfort. But we may have to set boundaries. Real ones where we shift OUR actions and behaviors, not set out rules for the other person to change.

If someone is lying to us constantly, there are reasons for that. They know what society wants them to do: smarten up, pull themselves up by their bootstraps. They may lie to tell you what you want to hear or to hide what they think they will get in trouble for. This is why we have to continue to assure them and show them that we are not there to judge or punish or tell them what to do. They get to live their life with dignity no matter what, and you will not be the one to take that from them. At the same time, if someone never feels safe enough to tell you the full truth, regardless of how you've shown up non judgmentally, remember that there are layers of internalized shame that have been embedded for them. Don't take it personally.

Finally: allow this experience to change you

People are dying because of systemic oppression, racism, classism, ableism. They are not dying because they are using substances, they are dying because of our society's refusal to value marginalized people's lives and our need to punish those that do not conform. The drug war is rooted in anti Blackness, genocide and resource extraction. It will continue as long as the status quo prevails.

Whatever your circumstance, you are most certainly not the only person experiencing loving someone who lives this life outside the societal norm. If you're otherwise relatively privileged, this can awaken you to deeper radicalization.

Let it open your eyes to the layers of oppression and intersectional marginalizations that affect people who use substances. Understand the generational ways that bias is passed down, the ways people who are marginalized are more likely to need substances to survive, learn about the ways substances are medicine to people. If they are medicine, then what are they treating? A systemic disconnect with care.

I believe in a world where people do not have to die because of a lack of care, a lack of resources, a lack of community who was willing to show up and learn. Be relentless in your pursuit of creating a network of community care for yourself and others. I hope you join me in this.

© 2025. All rights reserved.

Email: slowmotionradical@proton.me

Linktr.ee: https://linktr.ee/slowmotionradical

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Kara Bullock lives on the Unceded Territory of the Sinixt People. Learn about how the colonial government has declared the Sinixt Extinct and support the Autonomous Sinixt here.