There’s a big, orange elephant in the room—and it’s a full, dusty bottle of prescribed medication.

You’ve had this conversation before, or at least tried to. You might’ve gently hinted at your observation that there seems to be a problem with treatment follow-through, or you might’ve gone full-on exorcist mode and spun your head around 30 times, vomiting bile and wailing about someone not taking their meds.

Both are cool with me, to be clear.

But since you’re here, I’ll assume that neither method has really panned out for you and start this article from a place that understands that you’ve tried, you’re frustrated, you’re scared, and you really, really, really just want your loved ones to take their damn meds.

If you’re walking on eggshells (or maybe shards of glass since there doesn’t seem like a way to come out of this without some cuts, right?) then this one is for you.

Watch the Pattern

Look, when you’re dealing with a person in active addiction, early recovery, or experiencing a mental health crisis, they’re liable to act like an ass. They’re going through something—oftentimes without a super clear mind—and might not be reacting from a place of reason. So it doesn’t behoove you to ask why they can’t just be reasonable. Start by letting that expectation go.

What you can do as a support person, perhaps better than anyone else, is notice the things that are normal and abnormal about their behavior. Do you recognize who they are right now, or are you losing them somewhere?

Zoom out of what you’re seeing and try to understand it from a bigger picture. What has shifted recently? Have they been sleeping? Have they started talking negatively about themselves or their outlook on life? Have they—conversely—started on delusions of grandeur? How mobile are they? Are they socializing or isolating more?

And why is that damn bottle of Lithium still sitting untouched?

Before you even confront them about this, consider your strategy and what you want to get out of the interaction. Asking someone if they’re taking their medication has the potential to immediately put them on the defensive. To them, it may sound like you’re saying “you’re acting off, so I think you’re being irresponsible.”

Remember that the goal is not to catch them in a lie, it’s to vocalize the shifts you’ve noticed, speak some reality into the situation, and make it clear that you’re here because you care and you’re paying attention.

You can ask how they’re feeling, if anything’s been hard lately, or if they’ve checked in with their provider recently. Try not to make assumptions about what you think is going on, this is an opportunity for them to lead a conversation about their own health and wellbeing, and an opportunity for you to reaffirm your place as a support that can be trusted in times of uncertainty.

They’ll Have an Excuse. Let Them.

People stop taking meds for a hundred reasons. Maybe they hate the side effects. Maybe they think they don’t need them anymore. Maybe they’re experiencing sexual dysfunction (you may laugh or roll your eyes, but this is more common than you might expect).

Whatever reason they give, let them give it.

You’re not there to win the argument. You’re there to understand the story they’re telling themselves so you know what you’re actually dealing with under the surface.

But understanding isn’t the same as agreeing. You can validate that meds suck sometimes and still hold the line that they need to be taken. Especially if the alternative is a complete meltdown for them and everyone around them.

You’re Not the Historian of Their Downfall

Avoid turning the conversation into a greatest-hits montage of every time they spiraled off meds. They probably remember that manic episode where they invested $5,000 into a shady crypto scheme and then crashed their bicycle into the Christmas nativity scene by the county courthouse.

Am I speaking from experience? Perhaps…

Stick to what’s real and recent. If they’re not sleeping, say that. If they’re lashing out, say that. You’re not diagnosing anything. You’re just pointing out what’s in front of both of you.

The goal isn’t to convince them they’re sick. It’s to show that something is off, and that it needs attention. Whether that means restarting meds, adjusting them, or calling their provider, it starts with what’s happening now.

Terms and Conditions May Apply

If someone’s living in your house, riding in your car, using your insurance, or just leaning heavily on your time and energy, you’re allowed—even encouraged—to set expectations. Medication compliance might be one of them.

This isn’t meant to be an accept-my-terms-or-meet-me-at-dawn-for-a-duel conversation. This is an opportunity to create a shared understanding of how the relationship is going to work when things get hard. If you’re offering help, shelter, support, or stability, you can also say: here’s what I need in order to keep doing that.

You don’t need to spring this on them mid-crisis. Talk about it early on. Ask how they want you to bring things up when you notice them struggling. Be honest about what will make you step back. Let them tell you what they need too. You’re building a plan together, not issuing terms.

The next time things get rocky, you’re not starting from zero. You’re not scrambling to figure out what’s fair. You’re just following through on something you both agreed to when your heads were clear.

This isn’t you versus them. It’s the two of you versus the problem.

The Fire That Warms You Can Burn You as Well

This part sucks, but it matters: if they’re choosing not to treat their condition, you don’t have to keep trying to drag them across some imagined finish line.

A lot of people talk about enablers and addicts being like fuel and fire—and in general, it’s a pretty apt metaphor—but don’t forget that whether the fire is being fueled or not, it’s still a fire. The fire is the problem here. You could be doing everything right and still get burned, because at the end of the day, it’s a fire.

Their addiction, mental health, treatment, and commitment to recovery rest entirely with them. You cannot put your life on hold in the hope that they will start taking theirs seriously. You cannot burn alongside them.

You’re Not Their Doctor

Even if you know what they were on before. Even if you’ve memorized the side effects. Even if you swear it worked the last time.

You don’t get to decide what medication someone should or shouldn’t take. That’s not your job.

What you can do is offer to help them get back to a provider, schedule an appointment, or talk through what’s been bothering them. Stay in your lane. You’re here to support their treatment, not run it.

When It’s Beyond a Conversation

Sometimes it really does get bad. If they’re hallucinating, paranoid, threatening harm, or completely disconnected from reality, you might need to act, even if they hate you for it. That could mean calling a crisis line, getting their provider involved, or seeking emergency care.

And if the situation isn’t technically an emergency, but their refusal to engage in treatment is slowly blowing up your life, you still have the right to step away. You can love someone dearly and authentically and still choose yourself.

You’ve Tried Being Nice. Try Being Consistent.

You don’t have to lecture, nor do you need to tiptoe around the topic, but you do have to stay steady.

If you’ve spent months hinting, suggesting, and waiting—maybe it’s time to be direct. Tell them what you’re seeing. Tell them what’s not working anymore. Tell them what you need in order to stay involved.

And then stick to it. Not just for them, but for you.

A Word for the Worn Out

This is exhausting. Loving someone with a mental health condition or substance use disorder means constantly watching for signs, wondering when to speak up, and trying not to lose yourself in the process.

If you’re reading this, you probably already care enough. You probably already show up, clean up, and hold it together more than you should.

It’s okay to want peace. It’s okay to need distance. It’s okay to be mad, scared, or over it. Just don’t let the chaos convince you that your only option is silence or surrender.

You have options. You have instincts. Trust them. And yeah, if you need to say it out loud, go ahead:

Take your damn meds.