I agree with T...

I do take personal confidentiality very seriously with my friends, however my friendship "owner's manual" says I am to be concerned with their well being overall, as a friend. Most of the time keeping a secret fits with keeping them happy and secure. But if I believe they are in a dangerous situation, may hurt themselves or others (physically or emotionally) then I believe that as a friend I should do what is necessary to help.

First step would still be to try to work with them, but if they refused I would quickly go and tell whomever I thought could help. Sometimes I can still respect privacy... contact a doctor but don't tell their family for instance.

It can be hard especially when one is not sure... If someone is in trouble it may be harmful to wait to "convince" myself with evidence that my perception is correct so sometimes I err on the side of caution. I've gotten in trouble for that too. But I've always felt in my heart it was the right thing to do, even if I misjudged the situation.

There is always a possibility of losing a friend but often they come back to you once their mind clears and they realize you acted in their best interest. In the unlikely event that it doesn't work out I'd rather lose a friend by anger over the help he needs than to lose him by something more permanent.

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--http://www.idexter.com