Compassionate guidance for families from David Gulden, LMFT, LMHC
When You’ve Tried Everything
As a family member watching someone you love struggle with addiction or mental health issues, you’ve likely experienced a roller coaster of emotions—hope when things seem better, despair when they deteriorate, and constant worry about what might happen next.
You’ve probably tried everything you know how to do: heartfelt conversations, setting boundaries, maybe even ultimatums. But how do you know when it’s time to seek professional intervention help?
“And so if you have someone in your life that you’re close to and you don’t know what to do because of their drug or alcohol use, or behavioral mental health issues—I think the question is: what would I be willing to do to save this person’s life?”
If you’re feeling overwhelmed and uncertain about next steps, you’re not alone. Here are five clear signs that indicate your loved one may need professional intervention.
Free Resource: If you recognize any of these signs, I’ve created a comprehensive Family’s Guide to Understanding Professional Interventions that provides detailed guidance on each warning sign and what to do next.
Sign #1: Dangerous or Life-Threatening Behavior Continues Despite Consequences
When substance use or mental health issues progress to a point where your loved one is regularly engaging in behaviors that put themselves or others at risk, professional intervention becomes urgent.
These behaviors might include:
- Driving while intoxicated
- Combining substances in dangerous ways
- Experiencing overdoses or blackouts
- Engaging in risky sexual behaviors
- Becoming violent or expressing suicidal thoughts
“We’re talking about an intervention, meaning you know there’s a problem, you know there’s a solution to that problem, which is going to be treatment, but you have no idea how to get your loved one there. That’s when you would be thinking about potentially contacting an interventionist and/or a treatment center.”
What makes this particularly concerning:
The natural consequences of these behaviors—legal troubles, health problems, relationship damage—aren’t enough to motivate change. Your loved one may minimize these events, blame others, or simply return to the same patterns shortly after a crisis passes.
This is a medical emergency, not a moral failing. When someone’s brain is affected by addiction, they literally cannot consistently make decisions in their own best interest.
Sign #2: The Family System Has Adapted to Accommodate the Addiction
One of the most reliable indicators that professional intervention is needed is when the entire family has reorganized itself around the addiction.
You might notice:
- Family members have specific roles in relation to the addiction (enabler, rescuer, scapegoat)
- Predictable cycles of crisis and calm have become normalized
- Family celebrations and traditions have been altered or abandoned
- Conversations regularly center around the person’s behavior
- Other family members’ needs are consistently placed on hold
“The way that I kind of conceptualize interventions and psychotherapy in the substance use disorder and mental health field is based on a concept called the addicted family system—say you have an impaired person using drugs and alcohol. Well, everyone around that person is kind of playing a role in that system.”
Why this matters:
This adaptation happens gradually, and families often don’t realize how much they’ve changed to accommodate the addiction. A professional interventionist can help the family recognize these patterns and begin the process of healthy change—whether or not your loved one initially accepts help.
Important insight: You don’t have to wait for your loved one to want help before you start changing these patterns.
Sign #3: Multiple Attempts to Get Help Have Failed
If your loved one has tried treatment before—perhaps outpatient counseling, a brief detox stay, or even inpatient rehabilitation—but returned to substance use afterward, this pattern indicates that a more structured approach is needed.
Failed treatment attempts can happen for many reasons:
- The wrong level of care was provided
- Underlying mental health issues weren’t addressed
- The person wasn’t ready for change
- Family patterns remained unchanged
- There was inadequate aftercare planning
“When I talk about changing the narrative, I’m trying to identify all those maladaptive behaviors in the system and how do we just stop doing that in a way that’s safe but also doesn’t contribute to anything other than recovery.”
What this means for your family:
A professional interventionist can assess these previous attempts, identify what went wrong, and help create a more comprehensive plan that addresses the specific needs of your loved one and your family.
Hope reminder: Previous treatment attempts weren’t failures—they were learning experiences that provide valuable information for creating a better plan.
Download the complete Family’s Guide to Understanding Professional Interventions for detailed information on how to evaluate previous treatment attempts and what questions to ask when selecting appropriate care.
Sign #4: Your Loved One Shows Signs of Compromised Decision-Making
Addiction and some mental health conditions affect the brain’s decision-making capacity. This isn’t about willpower—it’s about neurobiology.
You might notice that your loved one:
- Makes impulsive decisions with significant negative consequences
- Cannot follow through on stated intentions to cut back or stop using
- Expresses desire for help when in crisis but refuses it when offered
- Shows dramatic personality changes when using substances
- Seems unable to recognize the connection between substance use and life problems
“And that’s the addicted family system—you have an impaired person using drugs and alcohol. Well, everyone around that person is kind of playing a role in that system. And what we would want to do with the intervention is give that person help.”
The science behind this:
These signs indicate that your loved one’s brain is affected by their substance use to the point where they cannot consistently make decisions in their own best interest. Professional intervention becomes necessary because you can’t reason someone out of a condition that is impairing their ability to reason.
This is why love alone isn’t enough—the brain needs time to heal before clear decision-making returns.
Sign #5: You Feel Increasingly Hopeless, Frightened, or Exhausted
Sometimes the clearest sign that professional intervention is needed comes from your own emotional experience. Pay attention if you find yourself:
Experiencing these feelings:
- Lying awake at night worrying about what might happen
- Feeling a sense of dread when your loved one calls or texts
- Experiencing anxiety or panic about their safety
- Feeling emotionally and physically exhausted by the situation
- Beginning to believe that the situation will never improve
“And if you really look at the numbers of drug and alcohol related deaths, it’s far more. I mean, people are dying every day from substance use disorders, and they’re not seeking help. So, you know, I’m a huge advocate for family recovery and for getting someone into treatment.”
Why your emotional state matters:
The toll of living with addiction in the family is real, and these feelings are often reliable indicators that the situation has progressed beyond what you can manage without professional help.
Your wellbeing matters too. Taking care of yourself isn’t selfish—it’s necessary for everyone’s recovery.
What Professional Intervention Offers
A professional intervention provides several key elements that family-only approaches typically lack:
Objective Leadership
An experienced guide who isn’t emotionally entangled in the situation
Clinical Expertise
Understanding of addiction, mental health, and family systems
Structured Process
A clear framework rather than an emotional confrontation
Treatment Navigation
Help finding and accessing the right level of care
Family Support
Guidance for the entire family system, not just the individual
“If you really have an impaired person, there are going to be times where they’re incapable of wanting to get better. And what I say is you don’t have to want to get sober or clean or enter recovery, but after you’re there for a while and your brain starts to heal and you start to develop coping skills and things, then you have to want to stay clean and sober or healthy.”
Self-Assessment: How Many Signs Do You Recognize?
Take a moment to honestly assess your situation:
☐ Sign #1: Dangerous behavior continues despite consequences
☐ Sign #2: Family has adapted to accommodate the addiction
☐ Sign #3: Multiple treatment attempts have failed
☐ Sign #4: Decision-making appears compromised
☐ Sign #5: You feel hopeless, frightened, or exhausted
If you checked 1-2 signs:
Your situation may benefit from professional guidance, even if intervention isn’t immediately necessary.
If you checked 3-4 signs:
Professional intervention should be seriously considered. The situation has likely progressed beyond family management.
If you checked all 5 signs:
Professional intervention is urgently needed. This level of severity requires immediate professional guidance.
Taking the Next Step
Reaching out for help doesn’t mean you’ve failed or that you don’t love your family member enough to handle things on your own. It means you love them enough to seek the specialized help they need.
If you recognize these signs in your situation, a professional intervention may provide the structured, caring approach needed to break through denial and resistance. The decision to seek help is an act of courage and love—potentially the most important step you’ll take on your family’s journey to healing.
What Happens Next?
When you’re ready to explore professional intervention:
1. Confidential Consultation
Discuss your specific situation without obligation
2. Assessment
Professional evaluation of your loved one’s needs
3. Family Preparation
Education and planning for the intervention process
4. Intervention Planning
Customized approach based on your family’s dynamics
5. Ongoing Support
Guidance for your family regardless of the outcome
Ready to Talk About Your Options?
If you recognize these signs in your situation and are ready to explore your options, I offer confidential consultations to discuss your specific circumstances. During this conversation, we can determine whether professional intervention might help your loved one and your family.
Schedule Your Confidential Consultation
No pressure. Complete confidentiality. Compassionate guidance when you need it most.
Additional Crisis Resources
If you’re in immediate crisis:
- National Suicide Prevention Lifeline: 988
- Crisis Text Line: Text HOME to 741741
- SAMHSA National Helpline: 1-800-662-4357
Remember: You don’t have to face this alone. Help is available, and recovery is possible.
About David Gulden: Licensed Marriage and Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC), with extensive treatment center experience progressing from primary therapist to clinical director. Specializing in family systems approaches to intervention, bringing clinical expertise to support families in crisis.