Does a person have to hit bottom to get help for alcoholism or …?
A reader recently commented on one of my blog posts stating she agreed that alcoholism is a non-choice but questioned whether the disease is to blame for a person not getting help. I thought it was an excellent question as it also addresses one of the common myths about alcoholism that a person has to hit bottom before they can get help. So I decided to expand on my reply to her in this post to address two questions, “If a person doesn’t choose to be an alcoholic, can they choose to get help?” or said another way, “Do you have to hit bottom to get help for alcoholism?” and “What, if anything, can a family member do to help them choose help?”
Alcoholism is a Developmental Disease and the Person With the Disease Does Not Have to Hit Bottom
Before I answer these questions, I wanted to comment on the point about whether alcoholism is a choice. The answer is a solid, “NO!”
No one chooses to become an alcoholic, rather alcoholism – one of the chronic, often relapsing brain diseases of addiction. It is a developmental disease, and it starts with alcohol misuse (aka alcohol abuse). It is the misusing of alcohol that starts the chemical and structural changes that make one person’s brain more susceptible to the five key risk factors for developing alcoholism than another person’s brain, even though both engage in similar drinking patterns.
The five key risk factors include: genetics, early use, social environment, mental illness and childhood trauma. This post explains, “Want to Prevent Addiction? Assess Your Risk Factors.”
To be clear, however, a person can stop the progression at any time – any time. They can also decide to stop the use of the alcohol to which they are addicted at any time – any time. Sadly, time and again, it’s the stigma and shame attached to “being an alcoholic” and the general belief that all you have to do is “just Stop!” Both are the result of the general societal lack of understanding about the brain disease of alcoholism, why relapse is a hallmark of the disease and what it takes to treat the disease – in other words, to heal / re-wire the brain.
This post addresses the point of the label, “Do You Have to Call Yourself an Alcoholic to Get Sober?” This short video explains the distinction, “Alcoholism is a Disease and It’s Not Alcohol Abuse.” And, this post covers 7 key concepts about alcoholism (one of the diseases of addiction) that are commonly misunderstood or not known, “7 Sound Bites to Update 2014 Conversations Around Addiction.”
What Can a Family Member Do to Raise a Person’s Bottom, in other words To Choose to Get Help
Getting help is a choice, and what helps a person with making that choice is if everyone in that person’s sphere gets on the same page about what it is they are dealing with and the decision to fight excuses with facts. However, it’s equally important to remember the person has a brain disease that confounds “thinking,” so the way to address it is to talk about the drinking behaviors when that person is sober. It’s critically important to recognize the person is still the person – even if they drink – but it’s the behaviors they exhibit when they drink that are the problem.
It’s also important the family member stop blaming, shaming and/or calling them an alcoholic because that’s like a family member calling a loved one a canceric because the family member has decided they have cancer or blaming or shaming a loved one with cancer for having cancer. Just stick with, “I’m really concerned about the behaviors you exhibit when you drink, for example __________(fill in the blank).” You might request they get an evaluation by a qualified professional – the same way you’d want them evaluated [and so would they] if they had cancer. You might let them know you’ve been researching to learn more about what drinking behaviors are all about – what is it about drinking alcohol that makes a person change so much – and then ask they read some of what you’ve been learning, such as this post, for example, or the information I share next.
Another approach is for the family member to first read and then share with their loved one (when sober) the World Health Organization’s anonymous assessment, called the Alcohol Use Disorders Test (AUDIT), and ask if they’d answer the ten questions to see what they (the person exhibiting drinking behaviors) thinks. Or, they (the family member concerned) can do it themselves and then tell their loved one they’ve done it and based on it, they’re very concerned about their drinking pattern.
In the meantime, the concerned family member may want to assess treatment options to suggest in the event their loved one does ask for help, but one key part of that is whether their loved one has a co-occurring mental illness, in which case, that’s a whole other treatment process (check out this post, “Co-ocurring Disorders Require Co-ocurring Treatment) or unresolved / untreated trauma because these require their own treatment protocols, and if left untreated are often the reason a person relapses. These two resources can help with researching treatment options: NIDA’s “Principles of Effective Treatment” and SAMHSA’s Treatment Facility Locator.
Lastly, but as importantly, if not the most important part of this post, is to stress the importance of the family member getting their own help. Coping with a person’s drinking behaviors and alcoholism, something I refer to as Secondhand Drinking, can be crazy-making and eventually sets up The Dance of the Family Disease of Addiction.
Another tremendous resource for families is the recently released book, A Guide for Families, Beyond Addiction: How Science and Kindness Help People Change, written by Jeffrey Foote, Ph.D., Carrie Wilkens, Ph.D., and Nicole Kosanke, Ph.D. These authors are also Directors (and Foote and Wilkens, co-founders) of the Center for Motivation and Change, which offers Community Reinforcement and Family Training (CRAFT). CRAFT helps motivate the alcohol user to seek help and helps the family take care of their own needs and is especially effective because it aims for a healthier, better life for all that is sustainable over time, not just as a way to “get the alcoholic into rehab.”
It’s complicated. A person does not choose to become an alcoholic, but it is still up to them to choose getting help. At the same time, those in their life don’t have to let them “hit bottom” – that bottom can be raised when all understand what’s going on and deal with it from a scientific, supportive place.
Please feel free to call me at 650-362-3026 or email me at lisaf@BreakingTheCycles.com (no charge) if you have further questions.