So You Know an Alcoholic: How Can You Help?

Alcoholism is an older clinical term for a chronic disease called alcohol use disorder (AUD). When excessive drinking becomes compulsive, you are not able to control how much or how often you drink, and you experience negative mental and physical symptoms when you are not drinking, you may have AUD. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), more than 16 million people in the United States have this condition.

If you know someone who drinks a lot, whose behaviors around alcohol have changed, and who is unable to meet work, school, or social obligations because of alcohol, you may wonder how you can support them in overcoming this disease. You can help them by understanding the symptoms of AUD, learning about evidence-based approaches to treatment, and encouraging them to accept help.

What Is Alcohol Use Disorder, and What Are the Signs?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists 11 criteria clinicians use to diagnose alcohol use disorder. They are:

The person drinks more alcohol, for a longer period in one session than they intend to.

1. The individual tries several times to control, reduce, or stop drinking, but they are unable to.
2. They spend a lot of time drinking or being sick after drinking too much.
3. They experience cravings for alcohol or urges to drink.
4. Drinking too much or being sick from drinking interferes with going to work, attending school, or spending time with friends and family.
5. Drinking too much causes problems with friends and family, but the person continues to drink anyway.
6. They cut back on activities or hobbies to drink more.
7. Drinking too much puts the person at risk, like driving drunk or walking through a dangerous area.
8. The person continues to drink although they develop physical or mental problems, like stomach ulcers or depression.
9. The person feels like they have to drink more alcohol to achieve the original levels of intoxication.
10. The person experiences withdrawal symptoms, like cravings and mood swings, when they cannot drink.

Short-term effects from drinking too much include memory loss, blackouts, hangovers, injuries from falling, physical illness, mood swings, and changes to sleep, meals, and hygiene habits. Long-term, excessive drinking increases the risks of heart disease, liver disease, cancer, brain damage, stomach problems, and mental illness.

About 1 in 12 Americans struggles with AUD, according to NIAAA. The most affected age group is between 18 and 29 years old. However, anyone can struggle with alcohol addiction, and if someone you love exhibits the DSM-5 symptoms or struggling in other ways that may be related to alcohol, there are things you can do to encourage them to seek treatment and support them through the process.

It may be hard to know when someone struggles with AUD because many people who have this problem hide it or deny it for a long time. Alcoholism can move through several stages, many of which are easy to cover up or overlook. 

1. Stage 1: The person may experiment with alcohol in many settings, alone or in social groups. They may test their limits for drinking, which may look like frequent binge drinking, especially among teenagers and young adults. 
2. Stage 2: The person drinks more often, or maybe even drinks heavily. They drink to relax, spend time with friends, because they’re bored, or for any combination of these reasons. They may drink alone more often during this stage, and they are likely to have emotional associations or attachments to alcohol or drinking habits. 
3. Stage 3: Problem drinking develops during this stage. The person may begin to worry about having issues with alcohol, including early compulsive behaviors, but they may not be able to stop. They may try to hide how much they drink, or lie to themselves or loved ones about how serious the problem is becoming. They may be depressed, anxious, or lose sleep. Someone in this stage is more likely to drink and drive or exhibit other dangerous behaviors. 
4. Stage 4: Alcohol dependence develops during this time. The person may drink not to enjoy the experience but because they feel like they need alcohol to feel normal. When they don’t drink, they may feel sick because of withdrawal symptoms, or they may obsess over drinking, which can lead to a relapse. 
5. Stage 5: Although symptoms of addiction begin with Stage 1, this final stage is the diagnosis of addiction. The person does not drink for pleasure, and they cannot control their behaviors around buying alcohol and drinking it. The problem escalates quickly, and they may seem like a different person. They may lose their job, close friendships, and even experience legal problems.

Many stages of AUD involve hiding drinking problems or denying that there is a problem. You can intervene during any of these stages if you have concerns about your loved one. But what is the best way to approach someone you care about who might be struggling with alcohol abuse?

Helping a Loved One Overcome Alcohol Use Disorder

Before you express your concerns to a loved one about their drinking, learn about the signs and symptoms of AUD. The above list of stages and diagnostic criteria can help, but consider speaking with an addiction specialist, therapist, or physician about your concerns as well. Not only can this help clarify your worries, but these professionals can help you find and manage treatment resources, which can be important when speaking with your loved one. You may find it difficult to confront someone you love about their potential drinking problem. This may indicate that you also need support. You may struggle with enabling behaviors or codependence, so you should seek out therapy so that you can support your loved one.

What Is Codependency and Enabling?

Enabling refers to behaviors on the part of a spouse, partner, child, or close friend or relative that encourage one to continue their addictive behaviors. This includes giving the person money because they may not be able to afford rent, food, or necessities otherwise; excusing the person’s behaviors or intoxication, especially to employers or other loved ones; and otherwise making the person’s life easier because you want to avoid conflict.

Enabling can occur regardless of relationship, and it does not mean that you struggle with codependency, but it can be one sign of a codependent relationship. Signs that you may be in a codependent relationship with someone struggling with alcoholism include:

Codependency can occur without the presence of one partner struggling with addiction, but the concept of the codependent relationship developed from spouses of alcoholics who supported their partners in unhealthy ways. If you love someone who struggles with alcohol abuse, you may develop codependent behaviors simply because you care about the person and want them to be well. However, helping someone struggling with addiction means that you cannot protect them from the risks of substance abuse; you have to set boundaries for your own safety to best help your loved one.

Once you have the support you need to overcome any mental struggles of you own, you can consider an intervention for your loved one. You may consider working with a therapist, spiritual or religious leader, physician, or intervention specialist to structure the intervention. If you prefer to keep the intervention among loved ones, there are some steps to take that show compassion for your loved one, support for their struggles, and encouragement to seek treatment.

Creating an Intervention to Encourage Alcoholism Treatment

Although cable television has made interventions seem like intense emotional meetings, they should not be structured this way. An intervention is a gathering of family, friends, and some professionals like a therapist to express concerns about a loved one’s health and behaviors, and encourage them to seek treatment.

It is crucial that concerns about their health are expressed clearly, but there is no blame for harm caused to individual relationships. Show support for them getting treatment, but set clear boundaries on time and assistance. If the person continues to exhibit problems with alcohol, they will not receive financial or social help to cover up the consequences of the addiction.

Here are steps you can take to plan an intervention: 

Evidence-Based Alcoholism Treatment Works

Treatment for alcohol use disorder is, like other approaches to other substance use disorders, founded in medically supervised detox and behavioral therapy at a rehabilitation program. Medications such as disulfiram, acamprosate, and naltrexone may be used after safely detoxing from alcohol, but the biggest component of treating AUD is therapy. Inpatient and outpatient rehabilitation programs focus on behavioral therapy. 

It is also important to know that alcohol use disorder, like other addictions, is a chronic brain disease, so relapse is part of the condition. Treatment can manage symptoms of the disorder and promote sobriety and health, but a return to treatment may sometimes be necessary. If you have a loved one who struggles with AUD, remember that this condition is a chronic illness, and your ongoing support is a vital part of their recovery.