How to help a struggling alcoholic
My paternal grandfather was an alcoholic. My grandmother divorced him when she was just 23 years old, after he threatened her life when he was in a drunken stupor. He continued to be an active alcoholic right up until his death. His younger brother was also an alcoholic and ended up losing his medical license due to his continued drinking.
Alcoholism runs in my family but as far as I know I'm the first to ever get help.
When it comes to treatment for alcoholism, I tried everything—I had a psychiatrist, therapy, medication and meetings. Not one specific thing worked, but a combination of them over a period of time was able to help me recover.
Over the last ten years I have also had two partners who suffered from alcoholism. Even though I struggled with it myself and eventually found sobriety, I wasn't able to help them. I thought just giving advice and leading by example would be enough, but Alcohol Use Disorder is not that simple. Admitting you have a problem is the first step into recovery.
And what's the first step for a person dealing with a struggling alcoholic? Understanding them.
Understand what alcoholism is
It was my friend group's yearly Christmas party and I was talking to my friend Ju. She asked me why I wasn't drinking alcohol. I told her that it was because I was an alcoholic. She said, “Really? I couldn't tell. You seem normal". Many alcoholics may seem to lead a normal life in public. In private, they are suffering with the effects of the disease.
Alcoholism is not a lack of willpower or a fault in a person's character. Alcohol Use Disorder (AUD) is a psychiatric disorder characterized by the continuous use of alcohol and inability to stop drinking even as it generates problems in a person's relationships, health and work. Although there is a certain stereotype that we attribute to alcoholics, nowadays it can be nearly impossible to tell if someone is suffering from AUD.
If you have noticed that someone close to you might be suffering from AUD, you probably noticed one of the following signs:
Drinking more than originally intended
Drinking every day or constantly binge drinking
Hiding their alcohol use
Making excuses to drink more
Tried to cut back on drinking and were unable to
Severe mood changes, especially if they are unable to drink when they want/need
Neglecting responsibilities
Using drinking as a way to deal with problems and emotions
They stop doing things they used to love because of drinking
They have been in physically risky situations while drinking
They have to drink more and more to get the same effect
Lack of control is at the center of any addiction, so understanding that your loved one is unable to stop on their own needs to be part of your own coping process.
Other mental health issues—such as depression, ADHD, anxiety and PTSD—can usually come associated with AUD and are often the underlying condition. In other words, the person is suffering from mental health issues and they use alcohol as a way to numb themselves or self-medicate. For this reason, seeing a medical professional is very important. If you treat the alcoholism but not the underlying condition, the person is more likely to relapse over time.
The most important thing to remember is—it's not the alcoholic's fault that they have an addiction. Even if they did take the first drink on their own, they did not know they would have ended up with this disease. However, it is their responsibility to take control of their recovery and seek treatment.
What actually helps
I had a boyfriend who was an alcoholic. All I could do to help him was show him support and lead by example. I managed to convince him to go to an AA meeting with me once, but that was a dead end. Eventually, we broke up and he continues drinking to this day. As you deal with a loved one suffering from addiction, you have to know one thing—there's only so much you can do.
And what can you actually do?
Talk without judgement
The first thing is: once you realize there might be a problem, you should express your concern without judgement. When my parents talked to me about my drinking, it was always in complaint mode. They complained about my drinking instead of worrying about my health because they didn't understand addiction as a disease. When you realize that alcoholism is a disease just like any other, you are able to look at it and deal with it in more helpful ways. It's not their fault that they have alcoholism, but just like with any other disease, it's up to them to get treated.
Listen, don't lecture
My parents lectured me when it came to my drinking and this went in one ear and out the other. The person suffering with AUD most likely has underlying mental health issues that cause or worsen their addiction. Anything from depression to anxiety to PTSD to ADHD, there are numerous psychiatric conditions that usually occur comorbidly with AUD. This means that your loved one may be suffering in different ways. Alcohol is just a coping mechanism.
One way you can support them is by listening to them. Ask questions, share your concerns and listen to what they have to say. If they are not in therapy or part of support groups, there may be a lot bottled inside that needs to come out. You can help them by just being there for them.
Encourage professional help
Every person suffering from AUD needs professional medical help. Most avoid it. They are so afraid of the stigma tied to alcoholism that they won't even talk to a doctor. They are afraid of being judged and being labeled. They are afraid of failing.
I once drove an ex all the way to a psychiatrist's office without telling him where we were going. When we got there, he never got out of the car. He rejected the help, but I had done my part. Encourage your loved one to see a medical professional and start getting treatment, but remember that you can't make them go.
Choose the right time to talk
Talking is important but be careful when you choose to do it. During intoxication is never a good idea. One is never really themselves when intoxicated and anything you say might be misinterpreted or distorted.
If a situation arises because of alcohol, wait until they are sober again before bringing up the problem. It's more likely they will listen after the fact rather than while it's happening.
Beware of ultimatums
Ultimatums can easily backfire. The person promises change in the moment and may even commit to a short-term action, but after some time the threat of the ultimatum dies out and they go back to their old ways. Ultimatums can give you the impression that things are improving when really they aren't. They also make the person feel under even more pressure than before.
You can and should set boundaries for yourself. How far are you willing to go to help this person? You can go as far as your mental health allows you. Beyond that, you need to take care of yourself. So, avoid ultimatums, but offer support only to the point where you are able to do so without sacrificing yourself.
What doesn't help
The same way that there are actions you can take to help your loved one, there are some that you should avoid. Sometimes it's hard to control our impulses in the heat of the moment, but it's important to know beforehand what can be helpful versus harmful when dealing with a struggling alcoholic.
Threatening without following through
This goes hand-in-hand with the part about ultimatums. When you set boundaries for yourself, you must be willing to enforce them. If you repeatedly set boundaries and allow your loved one to cross them, they will learn that your word doesn't have any real value. They will learn that they can continue with their behavior and you will accept them despite the threats.
If you set boundaries, respect them. This will teach your loved one that you expect your limits to be respected and that there are consequences to their actions. A well-enforced limit is much more effective than a groundless ultimatum.
Covering up for them
Yes, addicts deserve our respect and understanding, but we don't need to be complicit in their behavior. If you find yourself consistently making excuses for your loved one's actions when intoxicated, you are indirectly enabling them to continue.
Do not lie for them, do not cover up for them, do not let them easily off the hook. Let them feel the consequences of their actions. Only this way will they understand that they need to make changes in their lives. If you are constantly rescuing them, they will never learn to rescue themselves.
Controlling their actions
A lot of people think they can help their loved one control their alcoholism. They will get rid of bottles, they will avoid going to places with alcohol, they will keep an eye when their loved one is drinking to ensure they don't cross their limits. None of this is helpful. You are not in charge of their behavior and you can't control them.
Beyond that, with time they will start to resent you for your overbearing behavior. They might start drinking when you're not around, they will start hiding their drinking and look for other avenues where you're not able to interfere. In the end, it can make matters worse.
The truth is that you can only offer your support. Anything beyond that is taking away the addict's responsibility over their recovery.
Can you make someone quit drinking?
No. You can support them, you can inspire them, you can help them. But you can't make them put down the bottle. Addiction is a terrible disease in the sense that it creates a lack of control and the only treatment is regaining that control. Only the alcoholic can take control over their lives and start a path to recovery.
People rarely recover because someone else wanted them to. The process needs to start with them. They need to learn to accept help. Your actions matter. They help. But they have limits. If you have a teenager or young adult who is suffering from alcoholism, you might have more impact and control than if it's an adult, but even so the process of recovery starts with them.
Setting healthy boundaries
Alcohol Use Disorder is terrible in many ways, but one specific way is that it affects not only the alcoholic, but everyone around them. The disease may affect their work, their relationship with friends and family, their health, their lifestyle, their finances. Entire families suffer due to one member's alcoholism.
This means that it is important to set boundaries. Here are some things you can do to try to contain the damage as much as possible:
Refuse to lie for them: addicts need to learn that there are consequences to their actions. If you constantly bail them out, they will never learn to make good choices.
Do not enable them to drink: don't give them money, don't drive them to bars, don't take them to big events. If it's a spouse, you may refuse to go to a wedding so that you won't have to see them get drunk there. If it's your kid, you may withhold money so they can't spend it on alcohol.
Protect children: not all alcoholics endanger others, but many do. Make sure the children around you are protected. Do not allow the alcoholic to interact with them when they are drunk. Explain as best you can the situation to both the kids and the addict, so that the kids’ wellbeing is protected above all.
Leave unsafe situations: alcoholics frequently engage in dangerous behaviors and people around them can get dragged into them. Avoid letting yourself get caught in situations where you may get hurt. If you can't help them avoid it, at least save yourself.
Set limits: decide what you will and won't tolerate and enforce those limits. You loved one needs to understand that your boundaries need to be respected.
Encourage professional help
Alcohol Use Disorder comes in a spectrum, from mild to severe. The lower the alcoholic is on the spectrum, the easier it is to treat the disease. As the alcoholism worsens, it becomes harder and harder to treat and the treatments will need to vary depending on each specific situation.
My first recommendation is always to find a primary care physician. Seeing a doctor should be the first step. However, in recovery, any step is one step forward, so understand that each person has their own path. A psychiatrist or an addiction specialist can help identify if there are other comorbid conditions that need to be addressed and treated.
Psychiatrists can also prescribe medications. Depending on the level of severity of a person's alcoholism, medication can be indicated. There is medication to help with compulsion, others that work directly in the desire for alcohol, others that can give you unpleasant symptoms if you take them while drinking alcohol. Your loved one may also be prescribed medication for any comorbid mental health issue they may have.
Therapy is a long-term treatment that should start as soon as possible. The longer you are in therapy, the more it helps. It's especially important when the person is already sober to help them stay in recovery and avoid relapses. There are several kinds of therapy available and each person responds in a different way to different schools. I have been doing psychoanalysis for over ten years and it's helped me a lot, but many people don't like it, so choosing the right therapy is an important step.
For more severe cases, there is inpatient treatment with rehab centers. These can be voluntary or involuntary, depending on the severity of the addiction. Rehab facilities help especially in the beginning of recovery, when the person first stops drinking and needs support in dealing with withdrawal.
Mutual support groups—such as AA or SMART—can be very helpful in making the person with addiction feel like they are not alone. AA was very important for me in the first few months of my recovery process. It helped me to see myself as a normal person suffering from a debilitating disease instead of seeing myself as a person with faulty character for drinking.
Not one approach is perfect. There are many options and most patients need to try several before finding the right one. I was treated for three years before I finally quit drinking. Some people might be able to quit quicker, others may take longer. Just remember that you're there to offer your support and not to do their recovery for them.
Take care of yourself
Dealing with someone suffering from alcoholism can take a toll on you. You find yourself constantly worrying, apprehensive, afraid of what's going to happen. You see your loved one being dragged to rock bottom by alcohol and there's almost nothing that you can do to prevent it. This can be very hard to deal with. So, don't forget to take care of yourself.
Dealing with addiction in a loved one can lead you to having stress, anxiety, burnout. It can cause depression and trauma. The consequences of your loved one's drinking—like losing a job, financial strain—may even impact you directly, so you have to protect yourself as much as you can. There are support groups for family members that can help you learn to deal with someone suffering from addiction. These groups can be effective in giving you tools to deal with your situation.
Make sure you are taking care of yourself. Go to therapy, have a social life, work out. Do not stop your own life because your loved one is going through addiction. You need to worry about yourself as much as you worry about them. But, you always come first. Even if you have a child suffering from alcoholism, how can you help them if you're not doing well yourself?
Final thoughts
Addiction impacts everyone around the person suffering from it. As you watch your loved one suffer the consequences of their drinking, you may feel helpless and lost. Know that you are not alone. It's OK to ask for help, both for them as well as for yourself. Just as they teach you to put your mask on first in case of an airplane flight emergency, you need to take care of yourself before you are able to take care of others.
Lastly, know that none of this is your fault. You did not create this person's addiction and it's not your responsibility to cure them. All you can do is offer your support and know your limits. Your life comes first. Your happiness and health come first. And if you ever feel like you are being brought down by their addiction, you can always choose to leave.
