How to Help an Alcoholic
What Is Alcohol Addiction?
Alcohol is one of the oldest and most commonly abused psychoactive substances in the world (NAADAC, 2005). It has long been recognized that a key component of what we have come to know as alcohol addiction or alcoholism is the inability to control how much a person drinks (Hernandez-Avila and Kranzler, 2011). For some, addiction to alcohol may develop, in part, as compulsive drinking behavior starts in those looking to experience the rewarding, intensely pleasurable effects--and in those who resistant to letting those effects wear off. In other words, people begin to repeatedly turn to alcohol use, since their mood may be temporarily enhanced while everyday stresses may be temporarily blocked out.
Alcohol addiction is a biological, psychological, and social disease, warranting treatment and public policy on its control, distribution, and consumption. It is a multifaceted illness because it affects more than just the individual alcoholic. A key characteristic of alcohol addiction is confusion, pain, disorder, and tragedy for families, communities, and society (Kinney, 2009).
Causes of alcohol addiction may be genetic, environmental or, more likely, are a combination of both. As Charles L. Brewer, an esteemed psychologist and author, expressed it: "Heredity deals the cards, environment plays the hand."
Abuse of alcohol has risen in recent years. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), more than 18 million Americans are living with an alcohol abuse problem.
How to Approach an Alcoholic
It can be scary to think about approaching a loved one about their addiction to alcohol — especially if their alcohol use has affected you on a personal level. As difficult as it may be, try to focus on the present and ask yourself how you can best support your loved one from this point on.
Before approaching your loved one, consider how they may be feeling and how they will receive your support. Try your best to remain calm and caring and never begin any conversation about treatment when your loved one is drunk. Use “I” statements, such as, “I noticed,” or “I have been concerned,” and avoid placing blame.
It is not easy for someone to admit that they have a problem with alcohol use, so take time to prepare beforehand. You may want to consult with a counselor or a physician prior to the conversation or take advantage of the Community Reinforcement and Family Training (CRAFT) model. CRAFT is a holistic approach centered on positive reinforcement. CRAFT teaches family and friends how to effectively motivate and talk to a loved one about treatment. Other approaches you may want to consider using include:
As a concerned family member, friend, or coworker, you are in a position to positively affect change in your loved one’s life. The statistics of alcohol use are grim — the CDC estimated that alcohol consumption shortened the lives of those who died between 2006 and 2010 by an average of 30 years. Getting into treatment early is important, and the sooner you can begin the conversation around treatment with your loved one, the better. A conversation about treatment could help save your loved one’s life and help them start a journey towards recovery. Remember that although your goal might be to help your loved one seek treatment, it is important to meet you loved one “where they are” and allow them the space to come to this decision themselves.
As a concerned family member, friend, or coworker, you are in a position to positively affect change in your loved one’s life.
Also, remember that supporting doesn't mean enabling. The line between supporting and enabling is often a difficult one for family members and friends to discern. For example, you may give your loved one money for groceries but anticipate that it will go solely to alcohol. This would be an example of enabling. On the other hand, if your loved one is curious about what addiction treatment is like, you could help set up a conversation with an addiction professional or make an appointment to view a treatment center. This would be an example of supporting.
Loving someone with an addiction can bring ongoing stress and confusion. Getting support for yourself can help you to more effectively handle the stress of the situation. This support can come in the form of:
Alcohol Addiction Treatment
If you or someone you love has an addiction to alcohol, it is very important to seek medical help because of possible severe medical complications arising from withdrawal. Medically supervised detox can make the experience of withdrawal more comfortable and help the user manage cravings. Sedative medication may be required to help with certain symptoms of withdrawal. These may be administered for a few days and, after the dangerous withdrawal period has passed, the patient will gradually taper off them as their physical health improves.
After detox, in which the alcohol and its effects on the body are eliminated, the patient can begin a treatment program. There are different types of treatment programs, including residential programs and outpatient treatment.
Both types of addiction treatment are very effective, but the type of treatment program which is best is the one that will best address the patient's specific needs. For example, if someone has critical medical needs and/or fewer social support systems where they live, they may have better outcomes for staying sober if they choose inpatient or residential treatment (Finney et al., 2009).
Treatment programs usually consist of:
- Group and individual counseling or therapy.
- Education on addiction and its consequences.
- Relapse prevention strategies.
- Aftercare planning.
Since family and significant others are also affected, treatment programs often offer family programs to help support the entire family as the recovering alcoholic transitions to wellness and recovery. Other activities may address proper nutrition, exercise, and meditation (this is especially prevalent in holistic treatment programs that address the mind-body connection as a key component of recovery).
Ethanol is abused at a higher rate than any other drug among treatment program attendees, as reported by a 2017 survey from Recovery Brands. Nearly 70% of people who took the survey went to treatment to get help with a drinking problem, and a surprising 52.87% of those who responded reported seeking treatment for a problem with alcohol more than any other substance. No matter how many substances of abuse there are, the one that causes the most extensive harm is ethanol.
What Are the Signs of Addiction?
Those with an alcohol problem often experience ongoing troubles, such as arrests, a loss of friends, employment issues, and problems at home. They may find themselves drinking on the job and or making reckless choices, e.g., driving while intoxicated.
Here is a partial list of the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for an alcohol use disorder. This list is used for diagnosis, and outlines some characteristic signs and symptoms of addiction:
- Consuming alcohol in larger amounts or over a longer time span than originally intended.
- Trying numerous times to quit using alcohol unsuccessfully.
- Spending an excessive amount of time obtaining, using, or recovering from alcohol.
- Craving or having an overwhelming desire to drink alcohol.
- Failing to fulfill work and family obligations as a result of continued use.
- Continuing to drink alcohol despite knowledge that certain physical or psychological problems are caused or worsened by alcohol.
- Needing increased amounts of alcohol to achieve the desired effect.
Another sign of addiction is the presence of a withdrawal syndrome, which may include symptoms such as:
- Profuse sweating.
- Racing heart beat.
- Increased hand tremors.
Alcoholism and Depression
Depression is a serious symptom among alcohol abusers. According to data collected by the National Survey on Drug Use and Health (NSDUH), over 3.4 million adults who suffered from alcohol dependency or other substance dependency issues experienced a major depressive episode in the year that the study was conducted. In other words, nearly 17% of all American's suffering from alcohol or drug abuse have also struggled with depression.
Compared to nonusers, alcohol users are much more likely to experience depression.
Am I Addicted to Alcohol?
It takes a lot of courage to ask the question, "Am I addicted to alcohol?" Many alcohol users who suffer from addiction to this substance also deal with denial, often asserting that the problem is not that bad, or lying about the use and consequences of alcohol.
The first step to understanding your alcohol addiction is to be honest with yourself and evaluate your symptoms without bias. Take note of how much you are drinking, and talk to your loved ones about how they feel about your drinking.
A simple questionnaire known as the CAGE questionnaire may help you and your physician to answer the question "Am I addicted to alcohol?" It is made up of 4 very simple questions:
- C. Do I frequently try to cut down on my use of alcohol without success?
- A. Do I ever get angry when someone confronts me about my use of alcohol?
- G. Do I ever feel guilty about how much I drink or how I behave when I drink?
- E. Do I ever take an eye-opener early in the morning to help deal with the hangover?
These are just some questions to help you answer the question. They are not meant to induce shame or guilt, only to indicate whether you need help to stop abusing alcohol.
Looking for Rehab: What to Consider
If you're thinking about getting help for an alcohol use disorder, there are some things to consider when looking for treatment:
- Medical detox. The withdrawal syndrome from alcohol can be very dangerous, sometimes inducing seizures and/or delirium tremens. If you're thinking of quitting alcohol, you need to line up a detox program. Some rehabs will include medical detox as part of the program.
- Qualifications of staff. When searching for programs, ask about staff credentials. This will help you to determine the quality of care you'll receive and may help you feel confident about receiving treatment.
- Cost. First, start by asking if the program takes your insurance, if you have it. Have your insurance card with you when you call so that you have the necessary information at hand. You might also ask about options like financing, loans, and sliding scales (where your cost is adjusted based on your income).
- Amenities. When you're going to live at a rehab for 1-3 months or more, your comfort is important. If there are amenities that you know are must-haves, such as a private room, ask any potential programs if they offer them. However, do remember that your sobriety is priority #1, and benefits like pools, gourmet meals, and more are secondary.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th Edition. Arlington, VA: American Psychiatric Publishing.
- Hernandez-Avila, C.A., and Kranzler, H.R. (2011). Alcohol Use Disorders. In Ruiz, P., and Strain, E., Editors. Lowinson and Ruiz's Substance Abuse: A Comprhensive Textbook. 5th Edition. Philadelphia, PA: Lippincott, Williams & Wilkins.
- Kinney, J. (2009). Loosening the Grip: A Handbook of Alcohol Information. 9th Edition. Boston, MA: McGraw-Hill Higher Education.
- Storie, M., et al., Editors. (2005). Basics of Addiction Counseling: Desk Reference and Study Guide. 9th Printing. Alexandria, VA: NAADAC.
- Meyers, R. J., Smith, J. E., & Lash, D. N. (2005). A program for engaging treatment-refusing substance abusers into treatment: CRAFT. International Journal of Behavioral and Consultation Therapy, 1(2). 90-100.
- Centers for Disease and Control. Fact Sheets- Alcohol Use and Your Health. (February 2016). http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
- Center for Substance Abuse Treatment. (1999). —From Precontemplation to Contemplation: Building Readiness. http://www.ncbi.nlm.nih.gov/books/NBK64968/