Re: help for the unwilling (and unwilling helpers)

Posted By Amei on January 14, 1999 at 10:57:44:

In Reply to: Re: help for the unwilling (and unwilling helpers) posted by HVMA R.N.,C.S.- Deb S. on January 12, 1999 at 16:51:44:






: : My sister is in her early 40's and has been drinking and smoking for most of her life. She also used pot and other controlled substances but as far as I know no longer does.  The problem is twofold, my sister and her husband.
My sister finally admitted a few years ago that she had an alchohol problem and we thought that was the beginning of getting over it.  She now says a) she's not an alcholic because she doesn't drink every day (the days she doesn't drink she is recovering from being drunk); b) she can quit drinking for a week just to prove she can but she won't be happy, the only time she thinks she's happy is when she's drinking; c) she won't ever go to AA because even if she did quit drinking the last thing she wants to do is listen to a bunch of people talk about not drinking.  
Her husband unfortunately belives he can convert her to a light drinker.  He also smokes but only drinks occaisionally.  He tries to convince her to stop after one or 2 drinks and doesn't realize that she just can't, she has no control over that anymore.  I told him recently that if he really wanted her to quit then he would have to quit as well so there would be no temptation.  He either doesn't understand that or doesn't believe it.  
A little more history might help.  Alchoholism (alcoholism) seems to run in the family, many uncles and one aunt as well as my brother have battled it and won (if there is such a thing as winning).  I rarely drink (maybe 3 or 4 a year) because I'm afraid I won't be able to stop eventually.  Our mother doesn't drink at all for the same reason.  
She is chronically depressed and on medication at the moment.  She has other symptoms like dizzyness and insomnia which are quite likely caused by the interaction with the anti-depressants but she won't believe us on that one.  
At this point it is starting to strain the marriage and I don't want to see that happen.  I don't know what I can do if she is not willing to seek help.  Any suggestions on that one or how to convince her husband that he can't get her to just cut back?
We have discussed an inpatient detox but that will be very expensive and he is reluctant to commit to that.  Personally, I think that may be the only way.  
Any insights you can provide would be greatly appreciated.



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People like your sister who lose control of their drinking and drink to get drunk are NOT candidates for controlled or moderate drinking.  They should stop altogether and abstain indefinitely.  It is extremely frustrating that what is so obvious to you (that your sister would be better off eliminating alcohol altogether) is not at all obvious to your sister or, for that matter, to her husband.  Although they are both manifesting significant denial with regard to the seriousness of her drinking problem, I find it most helpful to assume that someone like your sister probably has some mixed, or ambivalent feelings, about whether or not it is advisable for her to go on drinking.  I might ask her to answer the following question:  Is there anything that you can imagine occurring to you in the future that would indicate to you that you would be better off stopping drinking for once and for all?   If her answer is that she cannot imagine such a situation, then I would probably back off and just repeat this question periodically until she gave me a more positive answer.  The only other thing I might do is to let her personal physician know that you believe that your sister has a drinking problem.  Many doctors don't know how severe their patients' drinking problems are.  Once clued in, it is possible that your sisters' doctor might examine your sister more thoroughly in order to detect some of the many medical problems associated with alcoholism and alcohol abuse.  Your sister might be more likely to cut it out altogether if her doctor informs her that she is already manifesting evidence of alcoholic liver disease and that she should not be drinking at all.
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: If your sister answers your question by saying that she can envision some circumstances which would indicate to her that she needed to stop, then I would say that the situation is a bit more hopeful.  You could try to get her to make a commitment, that she will, indeed, stop altogehter once that situation arises.
The bottom line is this:  Your sister is not going to stop drinking until she is convinced that she would be better off doing so.  Until that time, you should attend Al-Anon meetings, and get to know some other people who are contending with loved ones with serious drinking problems which fail to respond to the help and concern of others.  Check out the Drinking Section of my Ask DrSteve web site, which is conveniently hyperlinked below, for additional information about how to approach such situations.  Good Luck!
Steve Adelman, M.D. (a.k.a. DrSteve)

: This information is provided for general medical education purposes only. Please consult your physician for diagnostic and
: treatment options pertaining to your specific medical condition.

: Keywords:  alcoholism, denial, Al-Anon, co-dependence
Thanks for the input.  As I suspected, you didn't shed much new light on the subject but you did put it in different terms and the suggestion of the question I haven't tried.  I have done a lot of research and found most people say what you have outlined above.  I know that she is not going to change until she decides it's time.  
Unfortunately, I don't know how much I can do as we live on opposite coasts.  I tried to talk to her about it when I visited recently but didn't get very far.  
I will get this information to my brother-in-law and maybe, since it's coming from a doctor and not just me, he'll be more inclined to believe it and do something.  
One thing you didn't touch on that would be very helpful to know (I haven't come across this in my research either)... are there any studies or statistics on alchoholism (alcoholism) and chronic depression and the interaction between alchohol and the common psychotropic drugs used for treating depression?  I think she is using Effexor right now but is weaning herself off due to a bad reaction.  
Also, one of the strongest reasons for her to stop would be if she got pregnant (they have been trying unsuccessfully).  I have heard that alchohol can interfere with the chances of conception but don't have any firm info on it.  If there is any chance that she will conceive more easily if she quits drinking that would be a big step in the right direction.  
In a situation like this would you recommend that someone one quit on their own (with family support, of course) or participate in an inpatient program?  
Thanks again for the information, I will let you know if we are successful in getting her to face the problem.  
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Dear help for the unwilling;
There has been much written about the association between  chronic depression and alcoholism, both in regards to causes and effects.  In other words, alcohol use may be in service of self medicating an untreated depression,  but chronic use can also induce depression, and make an already existing depression worse.  Alcohol is a central nervous system depressant and at first will provide sedation and mild euphoria, but with increasing, frequent use will alter normal brain chemistry associated with mood.  It is held in some circles that  ANY use of alcohol,  while taking an antidepressant,  will interfere with the therapeutic action of the antidepressant, and in general, is not recommended.  The sedating effects of alcohol can also be compounded by the antidepressant , making the person even more sedated. Chronic alcohol use in women of childbearing age has been associated with menstrual irregularities ,anovulation (failure to ovulate), and spontaneous miscarriage, hence it would be prudent to abstain if pregnancy is a goal.
It is true that some people quit on their own, however for many this is quite difficult.  There are different levels of intervention, such as day treatment programs, out-patient groups, and of course, self help programs such as AA or Smart Recovery.  I think people helping one another is a great support,  which is how Al Anon can be helpful to you too.  Good Luck!
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.

Keyword:  Alcoholism and depression, pregnancy
Thank you.  I will send this to her and (maybe) she will realize that I want her to quit not because I don't like it myself but because I can't stand to see what it's doing to her.  I want her to be happy & healthy and I don't see how this can happen as long as she keeps drinking.  Unfortunately, she doesn't see how it can happen WITHOUT drinking.  
I will let you know if we are successful in getting her into some kind of program.  Since she works at home and is unsupervised most of the time I don't think she has much of a chance at doing it on her own.  
Thank you again, you've been very helpful.
PS - I went to the DrSteve website and liked it a lot.  A lot of good information easy to access.  I will spread the word to my friends.