Approaching a Family Member With a Drinking Problem
Alcoholism, or alcohol use disorder, is excessive drinking that impairs the life of the drinker and can cause serious distress for his or her family and friends.
Alcoholism Signs and Symptoms
Alcoholism, or alcohol use disorder, is characterized by problematic drinking that causes significant dysfunction in the person’s life. 1 It is a progressive condition that begins with social drinking and gradually advances to problematic drinking and addiction.
A person who displays at least 2 of these signs over a 12-month period may have an alcohol use disorder. 1
- Consuming greater amounts of alcohol and for longer periods of time than intended.
- Frequently failing to quit drinking or cut back on drinking.
- Spending a large amount of time buying and consuming alcohol and recovering from its effects.
- Craving alcohol.
- Neglecting home, work or school responsibilities to drink alcohol.
- Continuing to drink in spite of interpersonal or social consequences.
- Drinking alcohol instead of engaging in previously enjoyed hobbies or activities.
- Drinking alcohol in hazardous situations, such as driving a car.
- Continuing to drink even though physical or psychological problems are caused or exacerbated by the substance.
- Needing to drink more alcohol to get the same desired effects or feeling less of an effect when consuming the same amount of alcohol as before.
- Experiencing withdrawal symptoms when drinking is stopped or consuming alcohol to prevent or relieve withdrawal syndrome.
Effects of Alcohol Abuse on Alcoholics and Families
Family members adapt to the person’s alcohol abuse in different ways.
Alcohol addiction doesn’t just affect the drinker – it affects the entire family.
Family members adapt to the person’s alcohol abuse in different ways. They may experience emotional pain and develop coping skills to deal with the suffering. They also may try to cover up the problem by accommodating the person and making excuses for him or her.
Parents, children and siblings may think they’re helping the alcoholic, but they are acting as enablers and may be making the problem worse.
Effects on Family Members
Below are a few ways alcohol abuse can affect family members:
- Physical abuse.
- Emotional abuse.
- Psychological and physical problems caused by stress.
- Negative consequences on children (behavioral problems, poor academic performance, mental disorders, increased likelihood of becoming alcoholics or marrying alcoholics, increased risk of fetal alcohol syndrome). 4
- Financial hardships.
Health Problems From Alcohol Abuse
Family members will often deny how bad the drinking is. But recognizing alcoholism early and treating it appropriately can help avoid serious consequences for the alcoholic such as health problems, DUIs, broken relationships, accidents, and job loss.
Some long-term effects of alcoholism on the alcoholic’s health and other areas of life include: 1,2
- Weakened immune system.
- Cardiac myopathy.
- High blood pressure.
- Cancer (liver, breast, throat and mouth).
- Cirrhosis of the liver.
- Alcoholic hepatitis.
- Fatty liver.
- Poor nutrition, which can cause Wernicke-Korsakoff syndrome (coordination problems, vision problems, confusion, tremors, memory problems and hallucinations). 3
- Mental health problems, such as depression and anxiety.
How to Talk to a Family Member
Confrontation is not recommended because it may push your family member away. 5 The person may become defensive and less likely to consider treatment.
Instead, approach your loved one in a non-threatening and caring manner. It’s likely that he or she feels a great deal of shame and guilt associated with drinking, so speak to your family member in a nonjudgmental way.
Below are a few things to keep in mind when communicating your concerns to an alcoholic family member: 6
- Try to catch your family member when he or she is trying to quit drinking. This means that he or she has recognized that drinking has become a problem and is willing to quit.
- Make sure that you can remain calm and sympathetic. This will show that you are concerned and want the best for him or her.
- Point to specific examples of how the person’s drinking has affected you so that the person can see things from your perspective.
- Demonstrate support for your family member by offering to attend Alcoholics Anonymous meetings with them.
- Have information ready about different treatment options. This will encourage action.
- If you’re approaching your loved one with a group of people, choose family members whom the person respects and who can remain calm during the conversation. Don’t choose anyone who is likely to get angry or confrontational.
Empower your family member with reassuring and caring statements. Self-doubt can be detrimental to the rehab process, so instilling confidence in your loved one is vital to attaining and maintaining sobriety.
If the family member is open to discussing the problem, you can present different treatment options and offer to help him or her find recovery programs. Be an active participant in your family member’s recovery process to maintain motivation.
Community Reinforcement and Family Training (CRAFT) is a program developed for family members that teaches how to properly communicate with your loved one and discuss treatment options. You may want to search for CRAFT resources in your area.
Things to Avoid
Below are some things to avoid when talking to the person:
- Don’t talk to your family member when he or she is drunk. It’s likely that your loved one won’t be coherent and won’t remember the conversation.
- Avoid talking down to him or her. People with alcohol problems typically feel a lot of shame. Degrading the person will only add to his or her guilt.
- Avoid negativity and aggressive confrontation. The person may respond by being defensive or argumentative.
- Avoid blaming your family member for his or her addiction to alcohol. Tackle the problem collaboratively.
- Stop making excuses. You may have lied for him or her in the past and enabled drinking behaviors, but this isn’t helpful in the long-run. Instead, allow your loved one to see the negative consequences of alcohol abuse so that he or she is more likely to want to get help.
Getting Into Treatment
When helping your family member get into treatment, take time to learn about the recovery options available for alcoholism and how they work so that you can help the person make an informed decision.
Below are some treatment options you should consider when helping your family member start the recovery process:
- Inpatient treatment centers: require that your family member live at the facility for the duration of the treatment program. These centers provide around-the-clock medical and psychiatric care, medically supervised detoxification, individual therapy, group counseling and aftercare planning. Someone suffering from a severe addiction should consider inpatient due to the highly structured environment and high level of care.
- Outpatient treatment programs: are recommended for those with a mild to moderate drinking problem and who must fulfill obligations at home, school or work while in recovery. These programs give your family member the opportunity to receive addiction treatment services when it works with his or her schedule.
- Partial hospitalization: These programs allow someone to live at home while receiving intensive services in a hospital setting during the day. Partial hospitalization programs offer counseling and drug education classes as well as medical care. Sometimes, people enter partial hospitalization after completing an inpatient program or if they continue to relapse during less intense programs.
- Alcoholics Anonymous: is a 12-step fellowship that creates an encouraging and supportive environment for people recovering from alcohol addiction. Members can share their experiences about addiction as well as have a sponsor, who helps them throughout the recovery process. There are also non-12-step based programs such as SMART Recovery, Women for Sobriety, and LifeRing.
- Detox centers: Before entering a treatment program, a heavy drinker may need to enter a detox program to safely withdraw from alcohol use under medical supervision. Detox is not addiction treatment, but is the first step toward recovery.
Risks of Alcohol Withdrawal
If your family member suffers from a severe addiction to alcohol, he or she should receive detox services under the care of medical professionals due to the risk of serious complications during withdrawal.
Although alcohol withdrawal symptoms are typically not life-threatening, a heavy drinker may experience a serious form of withdrawal called delirium tremens, which can have fatal consequences.
Delirium tremens includes the following symptoms: 9
- Changes in mental functioning.
- Severe confusion or disorientation.
- Deep sleep that lasts for a day or even longer.
- Body tremors.
Treatment programs or detox centers can provide your family member with medication, such as benzodiazepines, to prevent seizures during withdrawal. 11 Benzodiazepines, which are typically prescribed to treat anxiety or insomnia, are cross-tolerant with alcohol and can be given on a fixed schedule or as symptoms appear. 11
Enabling your family member’s addiction leads to unhealthy family relationships and allows the problem to continue and even get worse. If your family member isn’t receptive to treatment, you need to learn to set the boundaries and stop making excuses for him or her. A couple ways to do this include:
- Stop bailing the person out of jail.
- Don’t drink in the person’s presence.
- Refuse to give your loved one money when he or she asks.
- Refuse to pick up the person from the bar or club.
- Stop caring for the person when he or she is hungover.
- Stop covering up for your family member when he or she is drunk.
If you start to set limits, the family member may be forced to look at the damage his or her addiction has done and will be more likely to seek out treatment.
When to Seek an Intervention
An intervention is a face-to-face meeting with a group of family members and friends, and usually a professional as well. Its purpose is to help the loved one, who may be in denial, to understand their problematic drinking and the consequences of it.
A quality intervention will not only address your family member’s alcoholism, but will also provide him or her with a plan to get help. 12
You should consider holding an intervention if your family member has experienced or is at risk of any of the following:
- Hurting himself or herself, or others.
- Losing his or her job.
- Legal ramifications.
- Severe financial problems.
- Mental health problems.
When to Use an Interventionist
Consider bringing in a professional, such as a therapist, social worker or interventionist to provide education on alcohol abuse and suggest treatment options. 12 A professional can also devise a follow-up plan for after the intervention.
A professional is strongly recommended if your family member has any of the following: 12
- A co-occurring addiction to another substance.
- Suicidal behavior.
- A history of violent behavior.
- A co-morbid mental health disorder such as anxiety, depression or post-traumatic stress disorder.
Risks of Interventions
- The family member may feel hurt and continue drinking to self-medicate this pain.
- The family member could become aggressive or defensive.
- The family member may remain in denial and flee the house or the office where the intervention is held.
An addiction specialist is especially necessary if you are afraid that your family member may respond in a violent or self-destructive manner.
Despite the risks, an estimated 90% of people suffering from an addiction agree to seek treatment after an intervention with a professional is held for them. 12
Taking Care of Yourself
Don’t forget to take care of your own needs while you’re helping your family member. Support groups are available for family members of alcoholics, such as:
- Co-Dependents Anonymous: 7 This group focuses on correcting maladaptive patterns in family systems and creating positive, healthy relationships.
- Al-Anon Family Groups: 8 This is a support group for friends and family members of problem drinkers. Members can share their personal stories about addiction and how it has affected them.
- SMART Recovery Family and Friends: 13 This science-based alternative to fellowship programs provides you with the resources you need to help a loved one.
- Family therapy: In family therapy, a therapist will help to strengthen relationships within the family by improving communication and resolving conflicts.
Other strategies, such as meditation or yoga, can help you to relax and deal with any anxieties related to your family member’s alcoholism.
Whatever you choose, make sure you take time to do something you enjoy or to relax.
What to Expect After Treatment
Your family member will need ongoing support to maintain sobriety.
Recovery doesn’t end when a person completes an inpatient or outpatient treatment program. Your family member will need ongoing support and treatment to maintain sobriety. Usually, staff at the treatment program will create a detailed aftercare plan for your loved one to receive follow-up care and relapse prevention. Some aftercare options include:
- 12-step meetings: Attending Alcoholics Anonymous meetings can offer encouragement and support to remain sober.
- Sober living homes: These are group homes where occupants live with other people in recovery. Many people in sober living attend 12-step groups, go to counseling and look for a job. The homes are substance-free and may require the person to submit periodic urine tests and follow other rules, such as abiding by a curfew.
- Individual therapy: In one-on-one therapy, your family member can continue to build upon coping skills learned in rehab.
- Group counseling: Much like therapy, your family member can continue developing positive social skills and coping strategies in a group setting.
Establishing a Substance-Free Home
Make sure the house does not contain any alcohol or other mind-altering substances. Recovery works best if the family sets a positive example and leads a sober life as well.
You will want to help your loved one avoid trigger situations, such as parties where alcohol will be present.
Dealing With a Relapse
Despite giving your family member endless love and support, relapse is still a possibility. Don’t be upset or discouraged if this happens. It’s a normal part of the recovery process.
If your family member does relapse, avoid negativity and blame. Continue to offer support. Encourage your family member to seek treatment again, and perhaps try another recovery program or one with a higher level of care.
For instance, if your loved one completed an outpatient program, maybe he or she should enter an inpatient program this time. Reassure your family member that relapse doesn’t equal failure.
Recovery is a life-long battle, and it is often very challenging and emotional. If your family member gets sober, it can also be a tough adjustment for your family as everyone tries to adapt to the new dynamic and changing relationships.
Make sure to remain positive and take care of yourself throughout this transition period.
Find an Alcohol Recovery Program
If your family member is suffering from an alcohol addiction and is ready to get help, call 1-888-319-2606Who Answers? to speak to a treatment support specialist about various recovery programs available for him or her. The specialist can confirm your insurance information over the phone and offer treatment options based on your coverage.
If you don’t have insurance, call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) helpline at 1-800-662-HELP (4357) for information on low-cost rehab programs or support groups.
. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association.
. National Institute on Alcohol Abuse and Alcoholism. Alcohol’s Effects on the Body.
. National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol’s Damaging Effects on the Brain. Alcohol Alert #63.
. Diaz, R., Gual, A., Garcia, M., Arnau, J., Pascual, F., Canuelo, B., .Garbayo, I. (2007). Children of alcoholics in Spain: From risk to pathology. Social Psychiatry and Psychiatric Epidemiology, 43(1), 1-10.
. SAMHSA’s National Registry of Evidence-based Programs and Practices. Intervention Summary – Community Reinforcement and Family Training (CRAFT).
. Co-dependents Anonymous. Home page.
. Al-Anon. Welcome to Al-Anon Family Groups.
. National Library of Medicine. (2015). Delirium tremens: MedlinePlus Medical Encyclopedia.
. Alcoholics Anonymous. Home page.
. Bayard, M., & Mcintyre, J. (2004). Alcohol Withdrawal Syndrome. American Family Physician, 69(6), 1443-1450. Retrieved April 4, 2016.
. National Council on Alcoholism and Drug Dependence. (2015). Intervention – Tips and Guidelines.
. SMART Recovery. Help for Family & Friends.