• Raising the subject. There is no perfect time or place to bring up the issue, but do not do it while the person is drunk or drinking. Wait until he or she is sober. Sometimes, a confrontation is more productive when facilitated by a professional who is knowledgeable about alcoholism and alcohol abuse and who can arrange a therapeutic intervention.
• Explaining the consequences. Convey the following message to the substance abuser, in a kind but firm tone: You need to get help or suffer the consequences. These consequences could include loss of your job, chronic illness, divorce, and breakup of the family or friendships. I will no longer cover-up for you.
• Don’t be brushed off. If you are seriously concerned about a person’s drinking, do not allow her to distract you from your concerns. If you are constantly bailing her out of trouble or giving her another chance, the alcoholic or alcohol abuser is likely to interpret this pattern as permission to keep drinking.
• Blame is counterproductive. Someone with an alcohol problem is likely to feel misunderstood. Try to put blame aside because it only feeds such feelings. Remember that alcohol addiction is a disease, not a moral weakness.
• One on one, the alcoholic wins. It is very common to become isolated in the effort of trying to get the alcoholic to accept help. Once you are isolated into one-on-one confrontations, the alcoholic almost always wins because he has the power to manipulate with promises, short-term efforts to improve, and blaming you as the cause of the problem. It is important to build a support network, such an intervention group, to avoid the pitfalls of getting caught in a one-on-one confrontation.
• Don’t wait until it’s too late. Putting off the discussion or confrontation increases the risk of serious health and social problems. As with any disease, the earlier the person gets treatment, the better. The alcoholic does not have to "hit bottom" in order to get help.
• Don’t neglect your own needs. It’s easy for the alcohol problems of one person to overwhelm an entire family. Family or personal stresses often show up as problems with emotional, economic, physical, and social functioning from living with alcoholism. You may feel anger, resentment, depression, betrayal, and disillusionment.
• Counseling may be necessary. You may need counseling to help you understand alcoholism and learn appropriate actions to protect your own well-being. Intervention is a proven method to both get you support and help a loved one get started in treatment. One way to help the alcoholic or alcohol abuser is to attend to your own needs and those of other family members. Going to alcohol support groups such as Al-Anon can be very helpful.
Psychiatrists see patients like Ms. A. in their clinical practices every day. While the importance of quiet, compassionate, and involved listening with patients is crucial, psychiatrists can also help their patients by providing new psychoeducation and treatment options, such as CRAFT or ARISE. These treatments can have profoundly positive effects and bring relief to the family and the person with substance dependence.
Dr. Heru is in the department of psychiatry at the University of Colorado at Denver. She has been a member of the Association of Family Psychiatrists since 2002 and currently serves as the organization’s treasurer. In addition, she is the coauthor of two books on working with families and is the author of numerous articles on this topic. Dr. Ascher is a resident in psychiatry at Beth Israel Medical Center and a candidate in the postdoctoral program in psychotherapy and psychoanalysis at New York University. He is a Sol W. Ginsburg Fellow in the Group for the Advancement of Psychiatry (GAP) Family Committee.