How to Help an Alcoholic
Helping a loved one with an alcohol addiction is never easy, and it can even feel like you’re on an emotional rollercoaster at times. If you’re concerned that someone you care about might be struggling with alcoholism, it’s important to know that help and support are available. Keep in mind, though, that you can’t make someone seek treatment when they’re not ready to do so. But that doesn’t mean you should put off the conversation.
It may take several tries before your loved one is willing to hear you, but with the right tools and education, you’ll feel more prepared for the conversation that may help your loved one take action.
Where to Begin
It’s never easy to know where to begin when you want to help a person struggling with alcohol. One of the first ways you can help is to learn more about alcoholism. Educating yourself can help you understand the disease and develop compassion for the struggles your loved one is going through. The more you know and understand about alcohol addiction, the better equipped you will be to help them and yourself.
Read about alcoholism from reputable online sources such as the National Institute on Alcohol Abuse and Alcoholism, talk to your healthcare provider, or call an addiction information hotline to learn more.
The next step is to research addiction facilities in your area and out-of-state. Some people prefer to attend treatment close to home, while others can benefit from leaving behind their environment and the distractions that may have led to addiction in the first place. Your family doctor or other healthcare professional can be a good place to start; they should be able to offer referrals and information about rehabs and addiction counselors in your area.1
Read reviews of different addiction centers and take a look at the information offered on the website of the rehab facility itself. You might want to call an addiction hotline as well and ask questions to get additional information, such as:
- What type of treatments do you offer? Are your therapies evidence-based?
- How long is your treatment program? Do you offer short- and long-term programs? Can program length change based on needs?
- Does my loved one need inpatient or outpatient treatment? What about detox?
- Do you offer additional amenities?
- How soon can my loved one start treatment?
- What additional services do you offer to support people in recovery once treatment ends?
- Do you offer services for people with physical and/or mental health conditions?
- Do you accept insurance or offer payment plans?
Talking to Your Loved One
Next, you’ll want to make a plan to talk to your loved one. Consider the following before you have the actual conversation:1,2
- Plan a time to talk when your loved one is sober. If they’re intoxicated, they won’t be in any shape to hear your message. You both may end up feeling sad, angry, or frustrated. Consider what you want to say in advance so that you are prepared for the conversation. Remember that your loved one might not be ready to hear you; you may need to make multiple attempts.
- Stay calm and avoid getting drawn into a fight. If things get heated, take a step back and let them know you’re going to take some time out.
- Avoid labeling the person as an alcoholic or addict.
- Stick to “I” statements instead of accusations. Say, “I am concerned about your drinking.” Let them know how their addiction affects you and makes you feel. Express your concern and love for them. Let them know that you are willing to help them, but don’t make ultimatums, threaten, or try to force them to do anything they are not ready to do.
- Explain that you’re worried about their health and the effects of alcohol on your relationship.
- Let them know that you want to share some things that you’ve learned about alcohol treatment. Share with them that you have researched treatment centers and anything else you think might be helpful. Or, ask them if they would be willing to talk to an addiction specialist or their primary care provider about it first (some people feel more comfortable with a practitioner they already know). Let them know that you are willing to go with them to the appointment if they want.
- Suggest attending mutual-support meetings like Alcoholics Anonymous (AA). This can be a non-threatening first step because all members of the group have been in the same shoes as your loved one.
- Take care of yourself and remember your own needs. Consider joining a support group for family and friends of alcoholics, such as Al-Anon.
Understanding & Recognizing Alcoholism
Knowing that alcoholism is a chronic disease of the brain may help you understand the struggle your loved one is going through. Alcoholism is not a choice; though your loved one made the decision at some point to have the first drink, but they are unable to just stop drinking when alcoholism takes over. You might wonder, “Why can’t they just stop drinking?” but it’s not as simple as that.
Unfortunately, if they’ve developed a physical dependence on alcohol, they are no longer in control of their use.3 Over time, problematic drinking patterns may develop in association with certain brain changes that affect a person’s self-control and ability to make smart or healthy choices.3 These changes can be persistent and long-lasting. The compulsion to drink may remain long-after quitting, which is why alcoholism is called a relapsing disease and why recovery from alcohol is a life-long process.3
On a neurotransmitter level, brain changes are also responsible for tolerance, which develops as a result of repeated alcohol exposure.3 Your loved one may need to drink more to experience previously desired effects.3 They may also develop alcohol dependence, which means that their brains have adapted to the persistent presence of alcohol essentially to the point of needing it to feel and function normally.4 When they try to stop drinking, they can experience mild to severe withdrawal symptoms that can be difficult to withstand and, in some cases, be life-threatening.4
Alcoholism Warning Signs
Based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), warning signs of an alcohol use disorder (AUD) may include:5
- Drinking alcohol in larger amounts or for longer periods than originally intended.
- A persistent desire to cut back on alcohol use but being unable to do so.
- Failing to meet obligations at home, work, or school because of alcohol use.
- Continuing to drink despite having ongoing interpersonal or social problems that are probably due to alcohol use.
- Giving up activities they once enjoyed in order to drink.
- Drinking in situations where it is dangerous to do so (such as driving or operating machinery).
- Continuing to drink despite knowing that they have a physical or mental health problem that is caused by, or exacerbated by, their alcohol use.
How Much is Too Much?
It’s important to note that alcoholism is not defined by how much or how often a person drinks, but by the effect that alcohol has on their life. A person does not have to drink every day to have an AUD.1
The U.S. Department of Health and Human Services outlines moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men.6 The National Institute on Alcohol Abuse and Alcohol Addiction (NIAAA) defines binge drinking as “a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent” or higher.6 This usually means 5 or more drinks for a man or 4 or more drinks for a woman within about 2 hours.6
NIAAA defines heavy drinking as more than 4 drinks a day for men and more than 3 drinks for women.6 The Substance Abuse and Mental Health Services Administration defines heavy drinking as binge drinking on 5 or more days in the past month.6 Both binge drinking and heavy alcohol use can increase a person’s risk of alcoholism.6
Risk Factors in the Development of Alcohol Dependence
While the amount of alcohol consumed can play a part in addiction, there are other factors that can affect whether a person develops an AUD. The presence of these contributing factors doesn’t guarantee that a person will become addicted to alcohol, but they can increase the likelihood.
Some of the factors that may play a role in alcoholism include:7,8
- Gender. Though not all studies support this as a risk factor, some research has shown that men may have a higher risk of alcohol dependence since they often start drinking at an earlier age.
- Family history. Genetics is not destiny, so a person with a family history of alcoholism is not necessarily going to become addicted to alcohol. However, studies have shown that “offspring of alcoholics are approximately 4 times more likely to develop alcoholism than people without such a history.”
- Psychiatric comorbidity. This means that a person has a higher chance of AUD if they also suffer from another psychiatric disorder, such as depression or anxiety disorders.
- Comorbid substance abuse. Using other substances in addition to alcohol and having another substance use disorder can increase the risk of AUD. Research has shown that people with an AUD are 7.5 times likelier than others to have a drug dependence diagnosis.
- Age. Research shows that people who start drinking before age 15 have a higher risk of AUD.
Life circumstances and stresses can sometimes make it harder for your loved one to avoid alcohol addiction. While the above risk factors play a role, you may also notice other issues in their life that could increase their risk for developing an AUD, such as:8, 9
- High levels of anxiety.
- Antisocial behavior or high impulsivity.
- A history of abuse.
- Marital problems.
- Financial problems.
It’s good to be aware of these factors so that you don’t oversimplify the person’s disorder. It’s not just about putting the drink down. A person’s family history, trauma, comorbidities and other factors can lead to a compulsion to drink that needs treatment attention to manage.
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What is Addiction Treatment?
Even if your loved one has a severe addiction, know that help is available. Addiction treatment has been shown to help people make a significant reduction in their drinking and alcohol-related problems; with research showing that “about 1/3 of people who are treated for alcohol problems have no further symptoms 1 year later.”10 Addiction treatment can help people stop drinking and teaches them the skills they require to remain sober and avoid relapse.10
Different treatment approaches are effective in managing alcohol withdrawal and treating AUD. They include:10
- Medications can help your loved one stay safe and comfortable during the detoxification phase; after successful withdrawal management, other medications can decrease additional drinking behavior and help them avoid relapse.
- Behavioral treatments, or various forms of counseling, are designed to help them change their behaviors and stop drinking.
- Self-help groups such as AA or other 12-step groups.
There are different types of treatment programs, including inpatient, where the person lives and receives treatment at the facility, or outpatient, where they live at home and travel to the facility on a regular basis for treatment.10 Inpatient treatment is helpful for a number of reasons, especially because it removes the person from their usual environment and offers them a safe, alcohol-free place to focus on recovery. Inpatient especially benefits people with moderate or severe addictions or those who require a high level of support.
Outpatient treatment settings may be most appropriate for a person with a strong social support system who is equipped to effectively manage drinking triggers. For many, outpatient programs are utilized as step-down care after completion of an inpatient program or for those who can make strides in recovery without the supervision and round-the-clock care offered by inpatient treatment.
Regardless of the setting, your loved one will receive support and monitoring (including testing) by addiction treatment experts and participate in a wide range of therapies such as group, individual, and family counseling (when appropriate). Some facilities offer additional treatments—such as vocational rehabilitation, recreational therapy, nutritional counseling, or alternative therapies—depending on the facility.10
What Happens After Treatment?
Recovery is an ongoing process that doesn’t end once treatment has been completed. It is important for both you and your loved one to continue to receive support. This is why an aftercare plan, which may include continued counseling or attending AA (for people in recovery) and Al-anon meetings (for family and friends of alcoholics), is crucial to obtaining ongoing help and guidance and preventing relapse.11
Relapse is a common part of the recovery process.11 Relapses occur for many reasons, including stress, problems at work, rejection by friends, exposure to triggers (such as meeting former drinking buddies or being in places where they drank in the past), pre-existing mental health conditions, or poor physical health.11 Some people also experience relapse because of guilt—if they start drinking one time, they may feel guilty and continue drinking to avoid feeling bad.11
It’s important to keep in mind that relapse does not mean that treatment has failed; it does mean, however, that the person may need an adjustment in their aftercare strategies or require a different form of treatment.11