“Just as ripples spread out when a single pebble is dropped into water, the actions of individuals can have far-reaching effects.” (Dali Lama). And this applies to heavy drinking. Heavy drinking affects not only the drinker but his or her family, friends, work and social environment.
The research is also clear that friends and family of heavy drinkers have higher levels of stress, depression, and anxiety that stems from their drinking. And the o
ld saying that there’s nothing you can do about it just isn’t accurate anymore. Yes, there is reason for hope that you, as a friend, family member or significant other, can (in most cases) influence another person’s drinking. Here are some suggestions for what to do and for what to not do:
- Ditch the term alcoholic. Even today it carries a lot of stigma and using the label is not productive in having a conversation with another person about his or her drinking. A more accurate description is alcohol misuse and Alcohol Use Disorder (AUD). We describe an individual who meets the diagnostic criteria for AUD a “person with an alcohol use disorder.” NIH (National Institute of Health) outlines the criteria for AUD on their website. Notice there that AUD lies on a spectrum from mild to severe. AUD is like high blood pressure which can range from mild to severe, rather than pregnancy which is a yes or no question. Ditching the label and instead describing the behavior tends to make people less defensive when you talk with them.
- Tap resources. The NIAAA (National Institute on Alcohol Abuse and Alcoholism) has recently released the Treatment Navigator with a great deal of information about evidence-based approaches, treatment options, and strategies to help others. I highly recommend reading this online resource. All of it. And take some time to consider what you’re learning and how you could apply it in your situation.
- How do I convince a friend or family member to stop drinking? Use a protocol with evidence of effectiveness. No, it is not an “Intervention” as is often portrayed on TV and in movies. That process is far less effective than a protocol called the Community Reinforcement and Family Therapy Program (CRAFT). CRAFT is effective in both helping you with strategies to motivate a heavy drinker to get into treatment as well as in helping you reduce your level of stress, anxiety, depression, and anger. It was developed with grants from NIAAA. And NIAAA recommends it on their Treatment Navigator site. The developers, Drs. Robert J Meyers and Jane Smith (full disclosure, friends and colleagues of mine with whom I’ve collaborated over the years) have published a self-help book I highly recommend: Getting your loved one sober: Alternatives to pleading, nagging, and threatening. Dr. Meyers and his colleagues have conducted a number of randomized clinical trials of the CRAFT protocol. Here is a piece of an abstract from just one of their studies: “A total of 62 CSOs participated in this evaluation of the effectiveness of CRAFT. CSOs completed, on average, 87% of offered treatment sessions. During the 6-month study period, 74% succeeded in engaging their resistant loved one in treatment. Reported abstinence both from illicit drugs and alcohol increased significantly for drug users engaged in treatment, but not for unengaged cases. All CSOs showed significant reductions in depression, anxiety, anger, and physical symptoms, with average scores dropping into the normal range on all measures.” If you Google community reinforcement and family training on scholar.google.com you’ll see a wealth of their outcome studies.
- Carefully consider when you’re going to talk to your friend or family member. Only bring up your concerns when he or she is sober. (I can’t emphasize this enough.) Trying to talk to someone who’s intoxicated risks them overreacting emotionally and responding negatively.
- How to approach someone with an alcohol disorder? Plan and rehearse what you’re going to say. Here’s an example: start with an expression of empathy (e.g., “You’ve been under a lot of stress lately and it’s been a challenge to deal with the pressure.”) It’s better to understate the person’s reaction (it’s been a challenge) rather than overstate it. Downplaying the situation will encourage the person to respond more positively. Follow-up with an expression of concern about the concrete negative consequences of that person’s problem drinking: “I’m concerned that your drinking to deal with your stress led to the fall you took last night.” Emphasize that you prefer being with them much more when they’re sober than when they’ve been drinking heavily and offer to help them deal with what’s driving the problem drinking.
- I’m well aware that this process won’t work in some cases. If domestic violence is a concern, then I highly recommend you work with a counselor who has expertise in treating AUDs with empirically supported protocols like cognitive behavior therapy, motivational enhancement therapy, and medications. See NIAAA’s Treatment Navigator for help finding a qualified addiction therapist near you, and consider SMART Recovery’s Friends and Family resources for social support in your efforts.
- Get by with a little help from my friends. Yes, a Beatles reference. It’s true though. If you’ve been dealing with a heavy drinker for years, you can probably benefit from: a) realizing that you’re not alone; b) that others have been in the same boat as you are right now; c) get social support for your efforts both for dealing with your drinker as well as taking care of yourself; and d) learning how others have dealt with similar situations.
- Be hopeful. While what you’ve been enduring may well have been bleak, brighter days can lie ahead.