Do You Have to Want to Change to Heal from Addiction? Helping Families Understand the Value of Intervention

You can’t help someone who doesn’t want to help themselves.
He has to be ready in order for treatment to work.
It’s not going to work unless she wants it.

The idea that an addict has to want to get better is one of the most pervasive narratives in the addiction community. Even people who have no personal experience with addiction will repeat it as a mantra, and it has become a nearly automatic response to people whose loved ones are refusing treatment. As a result, you may feel that trying to get your loved one into treatment before they really want to go is doomed to failure. While well intended, the idea that recovery is only possible if someone is willing and ready for it is a myth, and a dangerous one at that. Believing that recovery comes only for those who are committed to treatment before it even begins can keep people from getting the help they need, and make families feel helpless as they watch their loved ones fall deeper into the arms of addiction.

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“You Have to Want to Change:” Exposing the Myth


Dr. Nora Volkow, like so many others, used to believe that addicts had to want to get better in order to recover from addiction. Now Director of the National Institute on Drug Abuse, she knows better. In an interview with HBO, she says that “research has shown that the outcomes for those who are legally mandated to enter treatment can be as good as the outcomes for those who entered voluntarily.” In one large-scale study on over 2000 men struggling with addiction, men who entered court-ordered residential treatment “reported lower intrinsic motivation at the beginning of treatment, but, 5 years later, reported the same rates of abstinence, employment, and rearrest as peers who sought help on their own.” In fact, some research even suggests that outcomes for those who are legally pressured or mandated to seek treatment are at times even better than those for voluntary participants, as they tend to have higher attendance rates and stay in treatment longer.

The Impact of Addiction


Understanding why addiction treatment works even for people who don’t initially want treatment requires first understanding the nature of addiction itself. Addiction is a chronic brain disease that, over time, changes neurotransmitter activity and damages cerebral matter in a way that impairs rational decision-making. Addiction is inherently self-perpetuating, driving you toward increasingly self-destructive behavior. William C. Moyers, Vice President of the Hazelden Foundation, recalls the evolution of his own addiction, and how drugs and alcohol took over his life. “Listen, nobody made me smoke marijuana for the first time at age 15, or legally drink alcohol at age 18,” he says. But what it did was “hijack the brain and steal the soul.”

I of my own volition took those substances into my body. But then they took over. That doesn’t absolve me of the responsibility of learning to manage the illness, but it helps to explain why good people do bad things, moral people do immoral things, rational people do irrational things. That’s the nature of the disease.

If irrationality is the nature of the illness, it is both unrealistic and dangerous to expect someone in the midst of addiction to spontaneously choose self-preservation.The changes in the brain that result from chronic substance abuse distort thinking and disrupt your ability to assess risk, moderate behavior, and recognize the need for treatment. This is why people continue using despite significant and even devastating consequences such as divorce, overdose, and arrest; addiction removes your ability to see past your desire for drugs, destroying the impetus for healing. Rather than guiding them toward the much-mythologized “rock bottom” that is supposed to make them finally recognize the need for treatment, that recognition becomes less and less likely as brain changes mount and they are thrown deeper into active addiction.

The full impact of addiction, of course, goes beyond neurotransmitters and brain matter; it limits your ability to imagine life beyond addiction. As Maia Szalavitz writes for Time:

While it may seem to family members and friends that addicted people are “doing what they want” and mindlessly seeking pleasure, in reality, by the time you are addicted, the fun is long gone. You are using drugs because they have become your only source of safety and comfort — not because they offer some extra joy or irresponsible bliss. You fear quitting not because you love drugs so much, but because you can’t imagine the alternative.

Without a picture of what life will look like without drugs, using can feel like the best and only choice; even if a kernel of desire for change exists, that change is unlikely to occur unless your loved one is shown that there is life beyond addiction.

Awakening the Desire to Heal


What addiction treatment does is not necessarily respond to a pre-existing desire for healing, but it allows your loved one to recover enough to want to heal. By engaging in a comprehensive, personalized treatment program that combines the best modern addiction approaches in a way that speaks to each individual, your family member can stop the cycle of use and suffering and allow their brain to begin restoring balance, breaking through the distortions that prevent self-care. Free from the grip of active addiction, they are able to see themselves more clearly and gain both the cognition and emotional awareness to make healthy, rational choices that fortify their own well-being, including the choice to engage in treatment and commit to sobriety. Moreover, treatment opens up a sense of possibility and allows people to imagine life beyond addiction. “It provides an opportunity,” says Ute Gazioch, director of Substance Abuse and Mental Health for the Florida Department of Children and Families. She has seen countless people enter treatment without intrinsic motivation, and leave transformed. “It can be very successful, for people who need that push. It’s a window.”

If your loved one is struggling with addiction and does not recognize the need for treatment, you do not have to try to get them into treatment alone. An experienced, compassionate intervention specialist can help you successfully guide your loved one toward the help they need, and can act as a vital source of support for your whole family as you begin the healing process. Although family members often fear that pushing too hard will only cause their loved one to fall deeper into addiction, the true threat is not intervention, which is an act of love and courage, but addiction itself. With the guidance of your professional intervention specialist, you can create a plan that will optimize your chances of bringing your loved one to treatment, regardless of whether they are internally motivated to recover yet.

“You have to want to change” is a nice slogan, but it ultimately fails to recognize the essential nature of addiction. By seeing addiction as it really is, you can take the steps you need to help your loved one begin the journey toward recovery and, along the way, awaken their desire to heal.

Alta Mira offers comprehensive treatment for people struggling with addiction as well as co-occurring mental health disorders and process addictions. Contact us for more information about our innovative programs and how we can help you or your loved one start on the path to recovery. We are always happy to refer you to any resources and supports you need during this difficult time, including professional intervention specialists with the expertise to guide your loved one into treatment with love and compassion.