Intervening when a loved one drinks too much is a difficult call to make. It’s fraught with feelings of betraying a loved one, of wanting to believe it’s really not as bad as it is or wanting to believe that this time really will be different. But alcoholism is a developmental disease. It always starts with alcohol abuse, which is what chemically and structurally changes the brain and makes a person’s brain more susceptible to the five key risk factors for developing addiction. So it’s important for brain health and for stopping the progression from alcohol abuse to alcoholism (aka alcohol dependence) that we do intervene early.
To help readers with this decision, the following are four common reasons people don’t intervene early when a loved one drinks too much.
Not Understanding the Disease of Alcoholism and That It’s Different Than Alcohol Abuse
Alcoholism is one of the diseases of addiction. Addiction is a chronic, often relapsing brain disease. Everything about our body — what we can see and what we cannot see — is made up of cells. Diseases change cells in our body — that’s what makes a disease a disease. A disease might change cells in body organs (like the heart or liver or eyes) or in body organ systems (meaning several organs working together), like metabolism or cardiovascular. For example, the disease of breast cancer attacks cells in the breast and the disease of diabetes, attacks cells in the metabolism system. The disease of addiction changes cells in the brain, which helps to explain why addiction is a chronic, often relapsing brain disease. Addiction also often changes cells in several other body organs, as well, such as the liver, heart and kidney.
But it is the brain changes that are most important to understand because it is the brain changes that cause a person to behave differently (drinking behaviors). It is the brain changes that cause a person to pick fights, to minimize how bad it is, to flip the discussion to something or someone else as the cause of what they did while drinking, to think they are ‘okay’ to drive, to keep on drinking in the wake of promises too many to count to stop or cut down, to…. (See related post, Secondhand Drinking, Secondhand Drugging (SHD).)
Because it’s a developmental disease, it’s important to understand that all alcoholics go through alcohol abuse, but not all alcohol abusers become alcoholics (WHO AUDIT) so the sooner we interrupt the unhealthy drinking patterns, the better. Here are some statistics from the Center for Behavioral Health Statistics and Quality, Data Spotlight, National Survey on Drug Use and Health April 7, 2011 that reinforce this point: only 1.2 percent of the nation’s more than 7.4 million adults aged 21 to 64 with alcohol abuse problems perceive they could benefit from treatment. Of the 5.99 million with alcohol dependence (alcoholism), only 7.8% perceive they could benefit from treatment.
Believing High-Functioning Alcoholics Are Less At Risk
I would hazard a guess that a significant number of alcoholics start out high-functioning. I think what pushes those who become homeless or down-and-out is an undiagnosed or untreated mental illness — thus a dual diagnosis – having two brain diseases (mental illness and alcoholism). It is important to understand mental illness and dual diagnosis. NIDA has written an excellent piece, “Comorbidity: Addiction and Other Mental Disorders.”
Another reason is a loved one’s best of intentions, the ones from which they keep “helping” their loved one (and thus keep them from becoming homeless, for example) as the disease progresses [this is not to suggest a loved one/friend allow their alcoholic to become homeless or down-and-out as a solution -- rather it's about setting what are called "boundaries."]
Not Understanding the Common “Things” Alcoholics Often Do to Keep People From Helping
Two of the most common are denial and through the denial, plausible excuses (check out pages 28-30 of my book, If You Loved Me, You’d Stop!). From there, the alcohol abuser or alcoholic goes on the offensive – turning the tables, if you will, so that the family member or friend becomes defensive. This is where a family member/friend understanding the disease (and why it’s not alcohol abuse) can become better able at stating the facts and not backing down or getting side-tracked from their (the family member/friend) setting healthy boundaries. To that end, here are a few resources:
- How Much Is Too Much? “At-Risk” Drinking Explained (10 minute video)
- Alcoholism is a Disease and It’s Not Alcohol Abuse (10 minute video)
- Understand How the Body Processes Alcohol: Prevent Secondhand Drinking (blog post)
- The Addiction Project (online resource created by NIDA, NIAAA, The Robert Wood Johnson Foundation and HBO
- Crossing The Line From Alcohol Use to Abuse to Dependence (eBook)
- NIAAA’s Rethinking Drinking (website)
Not Knowing How To Express Concern
If a loved one is breaking promises about how much they’ll drink next time or hiding bottles of alcohol or trying to blame you as the cause of their problems, you are right to be concerned. Hiding bottles of alcohol, for example, is definitely a sign of someone who is losing (or has lost) control of their drinking. Equally important is that it doesn’t have to be this drastic to be a problem. It’s a problem when the drinking behaviors get in the way of the relationship or the quality of your life. However, it is not helpful to confront your loved one until you have more information so that you are more equipped to counter the arguments or cover-ups he or she will likely offer.
Once you understand this additional information (listed above), an approach to start to intervene is to wait until your loved one is sober and then ask to talk to him/her. Explain that you are deeply concerned about the way their behavior changes when they drink a lot (or abuse drugs). Explain that it’s because you love them (or care about them) that you decided to learn more about what happens when a person drinks too much. Ask him/her to review the same information you’ve reviewed and then invite him/her to have another conversation about what you’ve both learned. Remember alcoholism is a progressive disease that always starts with alcohol abuse.
Feel free to email me with further questions at lisaf@BreakingTheCycles.com or call me at 650-362-3026.