Alcohol Abuse Going On in the Family? – If Only My Doctor Had Asked

Alcohol Abuse is a drinking pattern that causes Secondhand Drinking (SHD). Secondhand Drinking is term to describe the impacts on the person who is on the receiving end of another person’s drinking behaviors. Drinking behaviors include:

Alcohol Abuse Going On in the Family? - If Only My Doctor Had Asked

Physicians rarely ask about alcohol abuse in the family – not their patient’s alcohol abuse but rather in their patient’s family. Read what happens when they do and what you can do even if they don’t.

  • drunken arguments
  • crazy, convoluted accusations
  • physical fights
  • verbal, physical or emotional abuse
  • neglect
  • driving while impaired, riding in a car with an impaired driver
  • unprotected, unwanted, unplanned sex, sexual assault
  • problems at work or in school related to drinking or recovering from heavy drinking bouts
  • domestic violence
  • blackouts.

Because we’re so conditioned to “forgive” or “normalize” alcohol abuse “because s/he’s not an alcoholic,” family members and friends repeatedly forgive and/or normalize the drinking and therefore the drinking behaviors with excuses and explanations. Some of these may sound familiar: “he hadn’t eaten since breakfast,” “everyone was drinking,” “he only drinks on the week-ends,” “she never misses a day of work.”

Unfortunately, alcohol abuse can continue for decades; it can also progress to alcoholism. (Alcoholism is one of the developmental chronic, often relapsing brain diseases of addiction.) And all the while, coping with secondhand drinking for those who can’t or won’t leave the relationship changes a person and the very quality of their lives. To better understand, read on…


 “I’d have given anything if my doctor would have asked.”

That was my response to one of the medical school students in last week’s Addiction and Eating Disorders Rotation under Dr. Stan Fischman at Stanford Medical School. The student asked me if I thought it was appropriate for a physician to ask a patient about drinking patterns of family members when the patient presents with stomach ailments, migraines, anxiety, depression, skin rashes, unexplained joint pain…something I’d explained commonly occurs as a consequence of the stress associated with ongoing SHD.

My response, “YES!” followed by, “I’d have given anything if my doctor would have asked,” was in reference to my wishing that my physician – way back when – had asked me if the drinking patterns of those I loved and with whom I lived were of concern. Instead, I’d been diagnosed with situational depression and put on Prozac followed by Zoloft.

I’d have given anything if my doctor would have asked about drinking patterns of loved ones in my family. Not my drinking patterns, but theirs.

Had that one question been asked, the floodgates would have opened.

I would have poured forth the pain and confusion and concerns and fear and repeated attempts to make the drinking stop and shared the insanity of what it was like to try to make sense out of something that made no sense.

And my physician – if armed with the facts we know today, though only as recent as this past decade or so – would have calmed me down and explained, “It’s real. It’s a problem. You’re not to blame, but you can improve the quality of your life.” He could have then given me a simple handout that unlocked the secrets to what had been consuming my life and my health for decades. It would have listed anonymous alcohol use assessments; key resources for further information; and programs that could have helped me – the family member of the loved one who drank too much. I could have learned the extreme physical and emotional toll that repeated exposure to secondhand drinking (stress) causes because of the chronically activated fight-or-flight stress response system.

But of course my physician back then – and even physicians of just a decade ago – would not have known all of this [even today, only about 1200 of the 985,375 practicing doctors in the United States are trained in addiction medicine. (CASA Report | Join Together 9.5.12)], let alone the importance of asking one simple question:

  • How many times in the past year has someone in your family or someone with whom you are in a close relationship had:
    4 or more standard drinks on any day? (for women)
    5 or more standard drinks on any day? (for men).
    An answer of once or more identifies potential SHD. How? Because it identifies “at-risk” drinking – you’ll understand why “at-risk” drinking is a concern further on in this post.

But today – today it’s a whole new ballgame when it comes to our understanding of alcohol abuse and other drinking patterns…

Today we know the number of drinks that suppresses normal neural network functioning in a person’s brain – the neural networks responsible for judgment, memory, pleasure/reward, emotions, breathing…. We know the drinking patterns that cause alcohol abuse, and we know that alcohol abuse causes drinking behaviors, which in turn cause secondhand drinking.  We know that people who abuse alcohol can progress to becoming alcoholics. We have numbers of drinks that define alcohol abuse, which starts with “at-risk” drinking:

“At-risk” drinking patterns that can lead to alcohol abuse are routine binge drinking and repeated heavy social drinking. Heavy social drinking is defined as exceeding the average daily limit of 1 standard drink for women (which totals 7/week) or 2 for men (which totals 14/week). Binge drinking is defined as having 4 or more standard drinks on an occasion for women (which exceeds the 3/day) and 5 or more for men (which exceeds the 4/day).     A standard drink is defined as 5 ounces of wine, 12 ounces of regular beer or 1.5 ounces of ‘hard liquor’ (gin, vodka, bourbon, scotch). There is no “number of drinks” definition for alcoholism, however all alcoholics go through a period of alcohol abuse. Alcoholism is characterized by: cravings, loss of control, tolerance and physical dependence.

So in case your physician doesn’t ask, here’s what you need to ask yourself if you’re concerned about a loved one’s drinking:

1. How bad is bad?

  • The World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT) is a 10 question assessment that can be used to determine your loved one’s drinking pattern – is it “normal” or problematic or possibly dependence (alcoholism)? [Note: the 10 question assessment is found on page 17. Question 3 for Americans should be read as 4 or more for women and 5 or more for men to coincide with NIAAA standard drink sizes.]
  • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a wonderful website, “Rethinking Drinking” that you can also use to anonymously assess a loved one’s drinking patterns and find additional invaluable information.

2. What do I do, now?

  • Learn about the differences between alcohol use, abuse and dependence (alcoholism). The NIAAA “Rethinking Drinking” website offers this information, as does my eBook Crossing The Line From Alcohol Use to Abuse to Dependence. (I don’t mean to plug my eBook, but I wrote it for just this reason – to help people in the privacy of their own computer, tablet or cell phone 🙂 .)
  • Learn about impacts on your health and brain – you can find this information in the eBook or the links earlier in this post.
  • Consider attending Al-Anon (or Nar-Anon if drugs is the issue) – both 12 step programs to help family members and friends who have a loved one who drinks too much (does not have to be an alcoholic – rather it’s simply whether alcohol is an issue in the relationship).
  • Consider talking to a therapist who specializes in substance abuse and addiction – it’s imperative the therapist understand the family/friendship dynamics that result in relationship where substance abuse or addiction are a problem.
  • And for immediate relief and the sense of power that comes with doing “something” – take time for yourself to Exercise, Sleep, eat Nutritious Foods, and practice moments of Mindfulness. These four actually heal – re-wire our brains (and of course, our bodies) from the impacts of chronic stress, such as that experienced when coping with ongoing SHD.
Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.

28 Responses to Alcohol Abuse Going On in the Family? – If Only My Doctor Had Asked

  1. Hi Lisa,

    That is so great that you are speaking with the Stanford Medical School and sharing how they can better help patients address alcohol concerns within the family. Sometimes it just takes the question being asked by the doctor. Many are not aware when drinking by a family member has become a problem and when it is within the normal range. Thanks for sharing!

    • Thank you, Cathy! I agree — when a doctor asks the question, it helps us realize it’s real and really a problem. It’s so wonderful now that there are assessments and questions and solid research that can help all of us hopefully interrupt the cycle and stop the pain and suffering much earlier in the progression. Take care and thanks for your comment!

  2. Martha Giffen says:

    Education is the key. What wonderful work you are doing! SO many people will benefit from all you do. Glad to have stumbled upon your blog when i joined the Facebook group.

  3. BarbaraJPeters says:

    It’s a shame that so much abuse is happening in our society. People hide in shame instead of seeking the help that they need and families are torn apart daily. Thank you for bringing light to this subject and for the work you are doing to improve the lives of those who suffer.

    • Thank you, Barbara! I’m sure you see a lot of the fall out of the misunderstandings and convoluted communication patterns that occur in families where substance abuse is not understood for what it is. I appreciate your comment. Take care.

  4. Lisa what great information! I have never heard of the term “second hand drinking” but it makes total sense. Thank you for what you are doing-raising awareness surrounding alcohol abuse. It’s such an epidemic and there are plenty out there who need to hear your message!

  5. You do wonderful work Lisa! You really do make a difference… Loving your posts! Thanks.

  6. I commend you for the wonderful work you are doing, Lisa. It is a problem that has been around for ages but only now, are people able to get the proper help….if they want to get help. Thank you for all you do! God bless!

  7. Sherie says:

    Excellent article, Lisa. I think that it would be so beneficial if doctors were taught to ask those questions. In the meantime, though, the questions that you advise people to ask themselves are great, as are the resources.

    • I so agree, Sherie. Now that we understand the physical and emotional impacts of chronic stress – like that caused by repeated SHD – it’s so important doctors understand and ask these questions. Hopefully, they’ll start asking a similar one of people in general with regards to their individual drinking patterns. There’s powerful new information and research available now that could really make a difference. Thanks so much for your comment.

  8. Ruth Hegarty says:

    What great info here. We can get so “normalized” when we are in a situation that we don’t think to bring it up; we just deal with it as best we can. This is all so helpful. Thanks!

  9. Terressa Cortez says:

    I love to see the work you are doing. So many people need help and to be able to recover form thier addiction with proper treatment and care. People need to understand addiction far more than they do.

    • Terressa – thank you so much for your compliment. Let’s hope this new brain research and the science behind the nature of this brain disease can really get out there and make a difference. I very much appreciate your comment.

  10. You do such great work in raising awareness Lisa and it is vital that first line health practitioners to ask about alcohol abuse. As you point out, not just the patient but their family members! The addicts behaviour can impact directly on someone else’ physical and mental health but if they dont’ think to share that, or the doctor doesn’t ask, a major clue is missed!
    There’s also a move in the UK to train up nurses in the Emergency Rooms to ask about alcohol issues after someone has been treated because alcohol often plays such a key role in the patients injuries/health problems.

    • Thank you, Carolyn – I so appreciate the compliment. That’s great to hear about the movement in the UK to train ER nurses to screen for alcohol use. I worked with the ER medical teams at one of our local hospitals to develop talking points and a brochure they could give to the patient, as well as a brochure to display in the ER waiting room for pick-up and reading by the family. So often, it’s just that people don’t know, and using that moment of emergency, when they might be open to looking at drinking or drug abuse as the underlying problem – both the family member and the patient can learn more about this new research and hopefully take a different approach to how they’ve previously been dealing with it.

  11. Elizabeth Maness says:

    I love that you are making people aware of the real crisis in addiction. What wonderful work you are doing. It’s sad how much this affects so many people. Thank you for sharing.

    • Thank you, Elizabeth – I appreciate your compliment and taking the time to comment! As you said, it’s the bigger – ripple effect – that we often don’t understand when we think or talk about alcohol or drug abuse. Take care.

  12. So glad help is available for those who really need it. What a great question to ask and I am super glad you wrote about it. If it can save just one person…!

    this is a great reminder for us, too, to ask our friends when we see something going on with them. often we are fearful to ask or say the wrong thing, but we need to speak from the heart and ask out of love. Good lessons.

    • You are absolutely right – it’s so important to ask our friends and share our concerns as you’ve described. So much of the problem is people just not knowing the numbers of drinks that define “low-risk” (“normal”) drinking — something we’ve only understood recently. So questions like these provide a great opportunity to share the information in a non-threatening manner. Thanks so much for your comment, Dorien!

  13. Thank you for sharing your great wisdom and knowledge. I wish I had access to your blog many years ago when I was married to an alcoholic. I blamed myself in the beginning, as I allowed him to make me feel it was partly my fault that he drank. Keep doing the amazing work that you are doing.

  14. You always give us such great information, Lisa! Thanks so much.

Leave a reply