How to Talk to an Alcoholic: Reaching Out, Connecting, and Offering Help

When there is suspicion that a loved one is struggling with alcoholism, it can be hard to know what to do. There is a desire to approach the individual and encourage entry into rehab. On the other hand, there’s fear that the loved one will become angry or adversarial and sever the relationship. Underlying the whole situation is fear for the loved one’s health and future wellbeing.

There are ways to approach a loved one with a plan that shows love, concern, and a true desire to help. On the other hand, it is important for anyone who is dealing with this kind of situation to be aware that, ultimately, the loved one has the choice to acknowledge that there’s a problem and accept help or to reject interference. Nevertheless, intervention in a loved one’s alcohol-related struggles can result in positive outcomes.

Alcohol Abuse and Alcoholism

The first step for anyone who is trying to help a loved one dealing with alcohol-related issues is to understand what constitutes alcoholism. Alcohol abuse and alcoholism are different kinds of alcohol use disorders that exist on a spectrum. As such, it is possible that intervention is necessary even if the person is not experiencing the degree of substance abuse that is normally associated with alcoholism.

Alcohol use disorders are measured using the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnosis involves noting the occurrence of 11 different signs and symptoms in the loved one who is using alcohol. These 11 symptoms include:

  • Inability to control the amount of alcohol consumed; consuming more than intended
  • Inability to stop using alcohol, potentially including multiple unsuccessful attempts to stop
  • Cravings for alcohol
  • Large amounts of time spent seeking or using alcohol, or recovering from hangovers
  • Relationship troubles centered around alcohol use
  • Inability to keep up with responsibilities at work, school, or home
  • Decreased participation in favorite activities in favor of using alcohol
  • Participation in dangerous activities while intoxicated
  • Continued drinking in spite of negative mental or physical health effects
  • The need to drink more and more to get the same effect (tolerance)
  • Withdrawal symptoms that occur when alcohol use is stopped

Meeting 2-3 of these criteria indicates a mild alcohol use disorder. A moderate disorder is indicated by 4-5 of the criteria being present, while a severe disorder – what most people might equate with alcoholism – is diagnosed when 6 or more of the criteria are present.

Recognizing Alcoholism

Along with the above guidelines, there are other ways to recognize when a person is struggling with alcohol abuse or alcoholism. Physical and mental symptoms can support the presence of the DSM-5 criteria in helping to confirm a suspicion that a loved one is struggling with alcohol abuse.

Physical symptoms of alcohol abuse, as discussed by WebMD, include:

  • Bloodshot eyes
  • Sleepiness
  • Slurred speech
  • Loss of muscle tone
  • Gastritis or other digestive issues
  • Reddening of the face or nose/ presence of spider veins on the skin
Psych Central describes some of the mental effects:

  • Depression
  • Anxiety
  • Insomnia and fatigue
  • Decreased inhibition
  • Blackouts and memory loss
  • Depressed cognitive function and learning abilities

In addition, people who are struggling with alcohol might have changes in social circles based on friends who also drink or use other drugs. If multiple signs from this list are present, along with DSM-5 criteria, then it may be time to intervene in the loved one’s alcohol use.

The Importance of a Plan

The first step in approaching a loved one about alcoholism is not just marching up to the person and blurting out concerns. In order to create the circumstances most likely to result in a positive outcome, it is important to make a plan regarding the intervention. As explained by Mayo Clinic, the plan includes multiple elements that lead to the intervention:

  • Getting support
  • Engaging in self-care
  • Having the treatment option ready
  • Staging the intervention
  • Participating in treatment

Through these steps, the family members or friends who are trying to help the loved one can prepare for all the potential outcomes and provide the greatest opportunity for the loved one to recognize the problem and get help.

Step 1: Get support.

The first step in planning to approach a loved one with alcoholism is getting help. This entails a few elements. First, it might be helpful to recruit an intervention specialist. These are professionals who are trained in staging interventions, helping family and friends to create a plan and consider all the potential difficulties that may arise during the approach. Intervention specialists are a niche group of professionals who, according to the Association of Intervention Specialists, can provide:

  • Education
  • Guidance
  • Resources
  • Training

Together, these elements can help family members and friends create a cohesive plan for approaching the loved one.

Even if an interventionist isn’t hired, it can be valuable for the family members or friends to recruit others who are concerned about the loved one to participate in or provide support for the intervention. When the loved one is surrounded by those who hold the loved one’s health and challenges as priorities, it can make it more likely that the person will hear the message of concern and respond with a willingness to get help. Still, those who participate should be able to be objective and neither overly emotional nor intimidating, to avoid a negative, fearful, or rebellious response on the part of the loved one.

Step 2: Engage in self-care.

The need to avoid overly emotional or intimidating responses is not only important to the loved one struggling with alcoholism. It is also important to help those who are approaching the loved one to prepare for potential negative responses, accusations, or rejections. Self-care is therefore an important element of any intervention that family members or friends should take seriously.

In any situation where a loved one is approached with concerns about alcoholism and its effects, there is potential for aggressive or combative responses. For this reason, it helps for family members and friends to be prepared for this potential and take steps to care for and protect themselves.

This means that these individuals should be prepared to state and stand behind certain consequences if the loved one refuses to get help, as presented by Healthline.

As an example, a family member who has been providing shelter to the loved one should decide if discontinuing that provision is an appropriate response should treatment be refused. This can be important to the family member’s wellbeing, as well as that of anyone else living in the home.

Self-care can take many forms. No matter what the consequences are that family and friends decide on, it is important that they are committed to. If the loved one refuses to respond to the request to get help, family members and friends should be prepared to enact the consequences and not back down. In addition, to help in managing the emotional challenges of the situation, family and friends should remember that getting their own counseling or other therapy can be helpful in dealing with and processing the situation.

Step 3: Have treatment options ready.

Before the intervention or approach occurs, family members and friends should make sure that a treatment option is ready and waiting in case the loved one does agree to get help. As stated by the National Institute on Drug Abuse, having resources ready and available when the person is ready to get treatment makes it more likely that the person will actually follow through, participate in, and complete the relevant treatment program.

Because of this, it is important to find a reputable, certified, research-based treatment program that specializes in alcoholism and set up entry into that program before the individual is approached. This can ensure that there is no hiccup between the loved one’s decision to accept help and the ability to implement it.

Step 4: Stage the intervention.

Finally, when all of these elements are set up, the team assembled by the family member or friends, including the professional interventionist, can approach the individual. It is helpful to set up the meeting in advance and let the individual know that it is important. On the other hand, letting the loved one know the nature of the meeting can cause them to avoid it. Discretion based on the individual’s state and needs are necessary. Neutral ground, such as a community center or other place outside the family home, might help to prevent the person from feeling ambushed and responding defensively.

Above all, it is helpful to remember during the intervention that everything is meant to help the individual out of love. If at any point any members of the intervention team become defensive, accusatory, combative, or otherwise counterproductive to the process, they should be asked to leave. The primary objective is to present the individual with the facts of how the alcoholism is affecting the family and friends involved and offer options and consequences for getting help or resisting it.

Step 5: Participate in the loved one’s treatment.

Once the person has agreed to get help, entry into the preplanned treatment program can be completed immediately because of the advance preparation. This enables an intake analysis that provides professional diagnosis and preparation of a treatment plan. Family members or friends who helped set up the treatment program should be prepared to participate in treatment through family therapy or other activities that can help the individual learn to manage the symptoms of alcoholism. The individual will learn they can return to meaningful daily living with the love and support of family and friends who can provide motivation and understanding as the person begins to adjust to life in sobriety.

This can include the family and friends participating in:

  • Family therapy
  • Alcoholism education
  • Individual therapy to deal with issues of codependence and enabling
  • Interaction with the loved one as required during treatment

Heading toward Recovery

Finally, the person who has accepted the need for help can start to get well with the help of the family and friends, and begin the journey toward recovery. It takes effort on the part of everyone involved to learn new ways of approaching life and addiction that are most likely to help the loved one continue in recovery after treatment.

It can be a challenging road; however, with motivation, compassion, and love, family members and friends who are determined to approach a loved one struggling with alcoholism can also provide the strongest support for that person to achieve and maintain meaningful and long-term recovery from alcoholism.

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