Confronting An Alcoholic: A Delicate Balance

It can be difficult to know how to approach a friend or loved one about their drinking, and it's important to remember that you cannot make them change their behaviour. However, there are ways to start a conversation that can help them see things differently and encourage them to seek help. It's normal to feel nervous or upset, so it's a good idea to prepare in advance by learning about the signs and symptoms of alcohol misuse and addiction. Pick a time when your friend is sober and in a good mood, and use I statements to express your concerns without judgement. It's also important to set boundaries and look after yourself, as well as staying connected with your friend and encouraging their hobbies and healthy friendships.

Notice behavioural changes: frequent anger, secrecy, loss of interest in relationships and activities

Alcoholism is often a disease of isolation and secrecy. People with a drinking problem may go to great lengths to hide it, and it can be difficult for concerned friends and family to spot the problem. If someone is hiding, downplaying, or concealing the amount of alcohol they consume, it could be a sign that they're hiding a drinking problem.

Frequent Anger

Alcohol can amplify emotional expression and inhibition. It suppresses the regulatory functions of the frontal lobe, which is responsible for a variety of functions that can directly influence anger expression. When under the influence of alcohol, people are more likely to express their emotions, including anger, in an exaggerated way. Alcohol is more likely to cause personality shifts related to negative emotions. However, it's important to note that anger is an emotion made up of many different feelings like dissatisfaction, displeasure, hurt, and frustration, and it doesn't always lead to aggression or hostility.

Secrecy

People with alcohol problems may become very good at concealing or minimizing their drinking. They may wish to protect their loved ones from worry, feel shame or guilt about their drinking, or hide their addiction from their employer. It's important to remain non-judgmental of someone’s reasons for being secretive around alcohol use, as this can help them overcome their issues.

Loss of Interest in Relationships and Activities

Alcohol use can cause a drop in motivation. The person may lose interest in things they used to love or struggle to motivate themselves at work. They might also experience a reduction in their inhibitions and impulse control. It's important to help the person acknowledge their drinking problem before they develop a physical dependency. The earlier harmful use is recognized and addressed, the better the outcomes for their recovery.

Assess the impact on their life: are they neglecting responsibilities, health, safety, and relationships?

Alcohol use disorder (AUD) is a common medical condition that can significantly impact a person's life. People with AUD experience a strong urge to consume alcohol and are unable to stop drinking, even when it negatively affects their health, safety, and relationships. Here are some ways to assess the impact of alcohol on these crucial aspects of life:

Responsibilities

Alcohol use may interfere with an individual's ability to fulfil their obligations at work, school, or home. This may manifest as frequent absences, missed deadlines, or a decline in overall performance. Alcohol can become the primary focus of an individual's life, causing them to neglect other important responsibilities and commitments.

Health

Excessive alcohol consumption can have detrimental effects on physical health, including damage to the liver, heart, brain, pancreas, and immune system. People with AUD may continue to drink despite knowing that it exacerbates existing medical or mental health conditions. They may also experience withdrawal symptoms such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating when they are not drinking.

Safety

Alcohol impairs judgement and increases the likelihood of engaging in risky behaviours, such as driving under the influence, swimming, fighting, walking in dangerous areas, or having unprotected sex. These behaviours can put both the individual and others at risk of harm or injury.

Relationships

AUD can strain relationships with family, friends, and colleagues. It may lead to social isolation, as individuals may give up important social activities or hobbies they once enjoyed to prioritize drinking. Additionally, alcohol can impair an individual's ability to maintain healthy relationships, causing conflict and damaging personal connections.

It is important to recognize these signs and seek professional help if alcohol is negatively impacting any of these areas of life. Treatment for AUD is available and effective, often including medication, behavioural therapy, support groups, and counselling.

Evaluate their drinking habits: do they drink more than intended, crave alcohol, or prioritise it over other activities?

It is important to evaluate drinking habits over a period of time to identify if someone has a drinking problem. This can be done by keeping a daily diary or schedule planner for a few weeks to track all activities, including drinking. This will help to identify patterns and habits associated with drinking.

One warning sign is drinking more than intended. This could be drinking more than the recommended guidelines, which is two drinks or less per day for men and one drink or less per day for women. It could also be drinking more than you intended in a single session, which is known as binge drinking. Binge drinking is defined as consuming five or more drinks (male) or four or more drinks (female) in about two hours, bringing the blood alcohol concentration to 0.08% or higher. Binge drinking can further be categorised into levels of intensity, with high-intensity drinking being two or more times the sex-specific thresholds for binge drinking, i.e., 10 or more drinks (male) and eight or more drinks (female).

Another warning sign is craving alcohol. When someone has a drinking problem, they may experience a strong urge to drink that is triggered by people, places, things, or times of day that remind them of drinking. Certain emotions or physical sensations can also trigger cravings.

Finally, a person with a drinking problem may prioritise alcohol over other activities. Alcohol may edge out other activities and prevent someone from doing things they used to enjoy. It may also interfere with responsibilities at home, work, or school, causing issues with family or friends.

Look for withdrawal symptoms: do they experience shakiness, irritability, anxiety, nausea, or sweating when not drinking?

If you're concerned that someone you know may have a drinking problem, it's important to look for certain signs and symptoms. One of the most telling indicators is the presence of withdrawal symptoms when they are not drinking. Alcohol withdrawal syndrome (AWS) is a set of symptoms that can occur when someone suddenly stops or reduces their alcohol intake after a period of excessive drinking.

Withdrawal symptoms typically appear within six to twelve hours after the last drink and can include shakiness or tremors, especially of the hands. If the person experiences anxiety, nervousness, or irritability when not drinking, this could be a sign that their body is going through withdrawal. Excessive sweating, an upset stomach, nausea, and vomiting are also common indicators of AWS.

The severity of withdrawal symptoms can vary depending on several factors, including the person's overall health, the amount and frequency of alcohol typically consumed, and any co-occurring mental health issues. In some cases, AWS can lead to more severe symptoms such as hallucinations, seizures, and delirium tremens (DTs), which can be life-threatening if left untreated.

If you notice that your friend or loved one experiences these withdrawal symptoms when they are not drinking, it may be a sign that they have developed alcohol use disorder (AUD) or alcoholism. AUD is a common medical condition characterized by a person's inability to stop drinking, even when it negatively impacts their health, safety, and personal relationships.

If you suspect that someone close to you has a drinking problem, encourage them to seek professional help. They can start by speaking with their healthcare provider, who can recommend treatments such as behavioural therapy, medication, or support groups. Remember, recognizing the problem is the first step towards recovery.

Encourage them to seek help: present options and offer support, but avoid being demanding or judgemental

If you think your female friend has a drinking problem, it's important to approach the topic with sensitivity and compassion. Here are some ways to encourage her to seek help without being demanding or judgmental:

Offer Support and Understanding

Let your friend know that you are there for her no matter what. Be a good listener and validate her feelings and thoughts. You don't have to agree with her choices, but try to avoid being judgmental or shaming her. You can say things like, "I've been concerned about you," or "It seems like you're struggling. What can I do to help?" By expressing your concern in a caring way, you can show her that you're coming from a place of love and support.

Provide Concrete Options

Instead of simply telling her to seek help, present her with specific options. Offer to accompany her to doctor's appointments, group meetings, or counselling sessions. Look up local Alcoholics Anonymous meetings, counsellors that fit her insurance plan, or treatment facilities. Having a concrete plan with specific steps can make the idea of getting help feel more manageable.

Encourage New Interests and Activities

Suggest that your friend develop new hobbies and interests that don't involve drinking. Encourage her to join clubs, take up a sport, or pursue creative arts like painting or writing. Filling her time with enriching activities can help reduce her reliance on alcohol and give her a sense of purpose and community.

Seek Outside Help

Remember that you don't have to go through this alone. Reach out to a trusted friend, counsellor, or support group for guidance and emotional support. Organisations like Al-Anon, SMART, and Recovery Family and Friends offer support for those dealing with a loved one's drinking problem. It's important to take care of your own health and well-being during this challenging time.

Choose the Right Time and Place

When you decide to talk to your friend, choose a time when she is sober and you are both calm and focused. Select a quiet and private place where you won't be interrupted. This will help ensure that the conversation stays calm and doesn't trigger strong emotions that could be counterproductive.

Remember, recovery from alcoholism is a bumpy road, and your friend will need your ongoing support and patience. You can't force her to change, but by presenting options and offering non-judgmental support, you can encourage her to take steps towards getting the help she needs.

Frequently asked questions