The Conversation Kit: what to say when the words will not come.
Most treatment decisions turn on a handful of conversations: with a doctor, with a person you love, with family, with an insurance company, with HR. The information is on this site. This tool gives you the actual words, built from the communication research our articles cover, and tailored to your situation. Copy them, print them, or just read them twice before you dial.
Nothing you select leaves this page. No data is stored or sent.Talking to your doctor
Helps
- Bring real numbers: drinks per week, days used, how long this has been the pattern. Clinicians calibrate to what you report.
- Name the goal in your own terms: cutting down, stopping, or getting through work weeks safely. All three are valid starting points.
- Ask for a follow-up appointment before you leave. Momentum is the treatment.
Works against you
- Rounding down. Understating use is the most common reason the first plan is too weak.
- Waiting for the doctor to raise it. Most visits end without the topic surfacing unless you open it.
- Accepting "just cut back" with no plan, no medication discussion, and no follow-up date.
What to expect
Talking to someone you love
Helps
- Pick a calm, substance-free moment. The research is unambiguous that timing beats content.
- One specific observation, one feeling, one offer. Then stop. Brevity reads as respect.
- Plan for several short conversations over weeks, not one big one.
Works against you
- Ultimatums you are not certain you will keep. They teach the person the limit is negotiable.
- The word "rehab" in the first conversation. Offer options that fit around their life instead.
- Labels. "Person who is struggling" opens doors that other words close.
What to expect
Do not expect agreement in the moment. The goal of this conversation is that the next one gets easier. The structured family approach this wording comes from engaged about two thirds of treatment-refusing loved ones into care in randomized trials, several times the rate of confrontation-style interventions, and it works through many small conversations exactly like this one. If there is any safety risk tonight, skip strategy and call or text 988.
Talking to your family when they want residential
Helps
- Acknowledge their fear first. They are pushing residential because it feels like the safest thing they can do for you.
- Offer a concrete plan with a named intensity, a timeframe, and a marker for escalating. Vague resistance reads as denial; a plan reads as ownership.
- Invite them into the plan: ask them to hold you to the check-in date.
Works against you
- Arguing that the problem is smaller than they think. Argue placement, not severity.
- Refusing all structure. The credible position is "right-sized care with an escalation plan," and the clinical placement criteria support starting at the least intensive level that is safe.
What to expect
Expect them to ask "but what if it does not work?" That is what your escalation marker is for: agree in advance what happens and when. If withdrawal is a medical risk for you, a clinician needs to be part of the plan before anything else, and saying so out loud will raise your credibility, not lower it.
Talking to your insurance company
Helps
- Write down the date, the representative's name, and the reference number for every call. Ask for everything in writing.
- Ask which level-of-care criteria the plan uses (often ASAM or MCG). You are entitled to see them.
- Deadlines matter: appeal windows are commonly 180 days but can be shorter. Check your letter.
Works against you
- Accepting a verbal "not covered" without a written determination. Verbal answers are frequently wrong.
- Missing the distinction between an administrative denial (fixable paperwork) and a clinical denial (needs a merits appeal).
What to expect
Denials for substance use treatment are common and a substantial share are overturned on appeal. If your internal appeal fails, most plans must offer an independent external review. This tool is educational and the letter text is a starting template, not legal advice; for high-stakes situations consider a patient advocate or health care attorney.
Talking to your employer or HR
Helps
- Go to HR, not your manager, for anything medical. HR has confidentiality obligations your manager does not.
- The phrase "a medical condition my doctor is treating" is complete. You do not owe anyone your diagnosis.
- Ask what certification paperwork is needed and have your clinician complete it. Paper moves this; disclosure does not.
Works against you
- Disclosing details to prove you are serious. Details cannot be un-shared.
- Waiting until performance problems surface. Protections work best when you engage them before a crisis.
What to expect
Seeking treatment is the strong position: federal job protections generally cover employees who are getting help for a substance use disorder, and treatment schedules can often be handled as an ordinary medical accommodation. The details, including where those protections have limits, are in the guide linked below. Read it before the meeting.
If any of these conversations is happening in a crisis: for a mental health or suicide crisis, call or text 988, free and 24/7. For a suspected overdose, call 911 and give naloxone if available.