Joe has been increasing his alcohol use for several years, and now he’s drinking an entire bottle of wine or more, four to five nights a week. He doesn’t think he’s impaired; after all he’s built up a high tolerance. But his family is angry and embarrassed. Joe doesn’t drink at work, so he doesn’t think he has a problem.
“So what if I like to have a couple of glasses of wine at the end of the week or on Saturday night,” says Joe. He’s not like his uncle and his mother who both drank heavily during the day and died from liver failure.
But his family has an entirely different story about his alcohol use. They notice how he slurs his words and forgets what they tell him. Frequently, he passes out in his easy chair and has to be led to his bed.
Joe’s biggest problem is that he doesn’t think he has a problem.
He’s developing many of the symptoms of Alcohol Use Disorder (most recent way of classifying a range of alcohol problems): increasing use, growing tolerance, cravings, and denying the impact of his alcohol use on himself and others. Plus, he has strong genetic loading for alcohol dependence. His wife has talked to him, his teenage kids have spoken to him, but he’s stubborn and won’t seek help. Secretly, he’s tried to cut back his drinking, but he hasn’t been successful.
The problem of alcohol abuse and dependence is huge in the United States. According to the National Institute of Alcoholism and Alcohol Abuse (NIAA), 16.6 million adults had an Alcohol Use Disorder in 2013. Nearly 88,000 people die from alcohol related deaths yearly, which makes it the third-leading cause of death. It’s a serious problem. For every alcoholic, there is a family that struggles with their alcoholic husband, wife, mother, father, son or daughter.
The Behavioral Health Department of The Everett Clinic sees hundreds of men and women like Joe every year. They come in for a visit because their primary care provider sends them. They’re depressed (alcohol is a potent depressant) or their family has pressured them to see someone.
Many of these adults leave a trail of crumbs behind them. Part of them hopes that the clinician will follow the trail of crumbs and identify alcohol as the culprit, and part of them hopes they won’t. They are ambivalent about their use of alcohol.
Helping these individuals find their way into alcohol treatment is the challenge for primary care providers, clinicians, and family members. The more we push them to get help, the more they push back. Confrontation can strengthen their resistance to change.
A more collaborative, interactive approach is helpful. When Joe comes to see me, I ask him “What do you like about drinking? What are the negative effects? How much do you want to make a change? How confident are you that you could cut back or stop drinking?” These questions facilitate a discussion, rather than an argument. My goal is to help adults like Joe identify their own motivation for change.
I like to send individuals with alcohol problems to Alcoholics Anonymous (AA) so that they can check out a meeting and see what they learn. If I had a dollar for every person I sent to AA, I could retire. It’s a great program, it’s free, and moreover, if an adult sticks with it, they will find themselves on the road to recovery.
When they come back to see me, I talk to them about their experience and find out what they learned. I explore their reactions. It’s a dialogue. For many adults, it’s a first step toward acknowledging that they have a problem and then seeking help. I also send family members to Al-Anon, to learn about how to cope with their alcoholic parent, spouse, or child.
For AA meetings and more information about the program, visit www.aa.org. For specific services in our county, visit snohomishcountywa.gov/462/Alcohol-Other-Drugs-Treatment.
Dr. Paul Schoenfeld is Director of The Everett Clinic’s Center for Behavioral Health and has been a clinical psychologist for more than 30 years. Read more of his blog at the Family Talk Blog at www.everettclinic.com/family-talk-blog.
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