Family: What to Do Tonight When Someone Is Using

You need a plan for the next hour, not a five-year family therapy syllabus. Tonight is triage: keep them alive, keep the house as safe as you can, and make one concrete next step if they will take it.

If someone is overdosing, seizing, turning blue, or will not wake, call 911. If opioids may be involved and you have naloxone, use it and stay with them. For suicidal talk, panic that will not settle, or a mental health crisis, call or text 988. Placement can wait until the body is stable.

This page is for families and partners in the first night. It is not legal advice, not a diagnosis, and not permission to force an adult into a private bed. We are a referral service, not a treatment program.

The tonight order of operations

1. Medical danger. Overdose, seizure, severe confusion, chest pain, inability to breathe, or someone who will not wake: 911. Do not drive them yourself if they may stop breathing in the car. CDC frames naloxone as a medicine that can reverse opioid overdose; keep it where others can find it and learn how to use it before the night you need it. Details live on signs of overdose and naloxone.

2. Mental health crisis. If they are awake but unsafe to themselves, call or text 988. The Veterans Crisis Line is 988 then press 1, or text 838255, when that applies.

3. One placement or assessment step. Only after safety: if they agree, sit with them for one call to an assessment, a local emergency department, or a referral line. Offer a ride they accepted. Do not invent consent they did not give.

4. House safety for the refuse path. If they will not go, lock up spare opioids and alcohol if you can do so without a fight that turns violent, move weapons if that is part of your home plan, and decide who sleeps where. Enabling vs. support is covered in enabling and what to do instead.

Write three numbers on paper before the phone dies: 911, 988, and one clinician or referral contact.

If they say yes tonight

Yes is enough to start. You do not need a perfect speech.

Sit together. Call an admissions or referral line, or search FindTreatment.gov for a local assessment. The SAMHSA National Helpline at 1-800-662-HELP (4357) can point families to resources and may ask for a ZIP code rather than a full story.

Bring what you know: substances involved, last use, medicines (including methadone or buprenorphine), pregnancy if relevant, prior overdoses, and insurance card photo if you have it. Ask what level of care they are screening for, what you would owe, and whether medical detox is available if withdrawal risk is high.

Your role is logistics and honesty. The program decides admission. How a first call usually runs is on what happens when you call rehab and how the referral call works. Longer help scripts are on how to help a family member get treatment.

Refuse pressure to fly out tonight without a license check. Red flags are on patient broker red flags.

If they say no tonight

Stop trying to admit them as if volume will create consent. An awake adult who refuses a private program is not a problem you solve with more yelling.

What you can still do:

• Keep naloxone and know 911.
• Offer food, water, and a place to sleep that does not require you to supply the drug.
• Set one boundary you will keep in the morning (no cash, no car keys, no using in the kids' rooms).
• Call Al-Anon, Nar-Anon, or a family peer line for you, not as a trick to catch them.
• Plan a daylight assessment offer when they are less intoxicated.

What usually fails at 2 a.m.: a surprise intervention with relatives on speakerphone, threats you will not follow through on, and flushing their medicine without a clinical plan.

If they refuse and you fear danger that meets your state's emergency criteria, that is a legal and clinical path, not a marketing one. See involuntary commitment basics and how to help someone who does not want help.

Do not run home detox (including pregnancy)

Families sometimes decide the kindest move is to take away every pill and bottle at once. For alcohol, benzodiazepines, and opioids, unsupervised stops can cause seizures, severe withdrawal, relapse with higher overdose risk, or fetal distress in pregnancy.

CDC states that quickly stopping opioids in pregnancy is not recommended, and that methadone or buprenorphine with behavioral care is first-line treatment for opioid use disorder in pregnancy. SAMHSA and clinical guidance treat medication for opioid use disorder as medical care, not a moral shortcut. If the person is pregnant, tell emergency and prenatal clinicians early so substance use care and prenatal care run together. Do not hide the pregnancy to "protect" anyone. Say pregnancy in the first minute to EMS and to any admissions nurse. Postpartum nights have their own risks (sleep loss, mood shifts, unsupervised taper pressure); the postpartum care guide covers that stretch when tonight becomes tomorrow. The pregnancy treatment map is on rehab during pregnancy.

If withdrawal is already starting (shaking, vomiting, severe agitation, hallucinations), that is a medical problem. Call 911 or go to an emergency department rather than white-knuckling it on the couch.

Privacy, kids, and what to tell EMS

You can share what you observe with EMS. You cannot always demand a program confirm that a named relative is a patient. Federally assisted substance use programs follow 42 CFR Part 2 limits on disclosures. HIPAA has separate rules when a patient is incapacitated and a provider judges that sharing with involved family is in the patient's interest. That is the provider's call, not a standing family right to the chart. More detail: privacy and confidentiality.

If children are present, their safety comes before the argument about treatment. Move them to a relative or a quiet room when EMS is coming. Do not leave a child alone with someone who is overdosing or violently withdrawing. Tell the 911 dispatcher if minors are on scene.

Roommates and landlords are not your clinical team. Share only what they need to stay safe (for example, where naloxone is). Do not run a group interrogation in the hallway. If violence is part of the night, leave and call 911. Treatment placement is not a substitute for a domestic violence plan.

Stick to observations for EMS: what they took if you know, when you last saw them awake, medicines they are prescribed (especially methadone, buprenorphine, benzodiazepines, insulin), pregnancy, allergies you know, and whether naloxone was already given. You do not need a perfect inventory. Guessing a brand is worse than saying "unknown opioids" or "unknown pills." Bring the medicine bottles and the insurance card to the hospital if you ride along.

A short checklist you can screenshot

• Is breathing OK? If no: 911, naloxone if opioids possible.
• Suicidal or in psychiatric crisis? 988.
• Pregnant? Say so to every clinician tonight.
• Willing to talk to admissions or a referral line? One call together.
• Not willing? Stop forcing. Secure what you can. Plan morning offer.
• Insurance card and medicine list photographed.
• Three numbers on paper.
• No fly-out under pressure without license verification.

After tonight

Tomorrow is for the longer family work: visitation rules, family therapy offers, and how to support without financing the use. Start with family support during rehab and interventions explained if a structured conversation is still needed later.

If you want help sorting local levels of care, insurance questions, or what is open near you, call or text (800) 653-9376. We are a referral service. We do not admit patients, we do not take kickbacks for steering, and we will not tell you to stop a medicine at home. The person still needs a real clinician.

Additional Resources

Sources cited on this page:

• CDC: Lifesaving Naloxone
• CDC: Stop Overdose
• 988 Suicide & Crisis Lifeline
• SAMHSA National Helpline
• SAMHSA FindTreatment.gov
• SAMHSA: Finding quality treatment
• CDC: Treatment of opioid use disorder before, during, and after pregnancy
• HHS: Sharing information when a patient is not present or is incapacitated
• eCFR: 42 CFR Part 2

Common Questions