AAMFT Consumer Update

Alcohol Problems

It used to be called alcoholism. Today we know better. We know that drinking problems do not come in one form, but can take any of a number of forms. Some people who abuse alcohol start drinking heavily early in life and develop longstanding dependence. Others start using regularly following a setback—such as losing a job, or losing a family member. Still others engage in binges that may last for days, but are spaced weeks or months apart.

Today we know a lot more about this syndrome, this set of different patterns that fall under the term Alcohol Use Disorders (AUDs). And, better still, we know a lot more about how to turn things around—to get things back on track.

Alcohol Use Disorders come in two general forms, or levels: Alcohol abuse and alcohol dependence. Alcohol abuse refers to a problem pattern where the drinking interferes with work, school, or home life, as well as where the drinking is hazardous, such as in driving an automobile or operating machinery. Or, the problem may generate difficulties with the law, with the spouse or family, or in the social realm—such as getting into fights.

Alcohol dependence can include any or all of the above, but it is even more serious. The person may be unable to stop or control the drinking, even after trying. There may be "tolerance" (having to drink more and more to get the same effect), or "withdrawal" (having physical symptoms when drinking is stopped or decreased).

It is estimated that 13% to 16% of Americans develop dependence on alcohol at some point in their lives, and another 9% to 10% develop alcohol abuse. In other words, 22% to 26% of the population experiences this problem at least once. Further, the rate among men is twice that among women and has a much wider range of contributing factors.

Family and Personal Life

A third or more of American families are directly beset by an alcohol problem at one time or another. And the costs are enormous in terms of medical expenses, work difficulties, finances, and particularly, family relationships. When there is someone with an AUD in the home, and that person is drinking, everybody may want to lay low—to get out of the way. Or, maybe some feel like crying, while others are burned up with frustration. And that’s no way for a family to have to feel. Drinking problems take their toll not only on the drinker, but also on everyone else around. If you, or someone you care about, are showing the signs of alcohol abuse or dependence, it is important to get treatment as soon as possible, or at least to call. If you don’t, the situation will probably get worse.

What’s Treatment All About?

In a given year, only about 10% of people with an active drinking problem get into treatment or self-help. This figure is all the more distressing in light of the fact that, for the vast majority of these people, treatment works. So it really is worth (a) entering treatment if you are the one with the drinking problem, or (b) getting your loved one or friend into treatment if you are a family member or friend.

A number of approaches have been demonstrated to be effective with people with AUDs. Some of them are more oriented to seeing individuals, some to meeting in groups, some to involving the family. The majority of programs combine these methods. There are two points that need to be emphasized here, however. First, research has clearly shown that family members and friends are very important in aiding a problem drinker in getting help. Second, the family can be extremely important in helping the treatment to succeed. Part of the reason for this is that, in almost every case, families are important to the person with the drinking problem, just as that person is important to the family. Therefore, the caring, creativity, and wisdom of the family can be put to use in helping to turn the situation around.

Family or couples therapy is an option for those who are dealing with alcohol use disorders. Therapy can help the users and their loved ones deal with the stresses of withdrawal, relapse, figuring out available treatments, and deciding on the best options. Other main roles of the therapist are to help people understand how the drinking affects the family and vice versa, and to help identify what led to the onset or relapse in drinking. A therapist can also collaborate with other professionals who are working with the family or couple around the problem.

Depending on the severity of the AUD, the person may have to be detoxified—"dried out." In most cases, this can be done on an outpatient basis with proper medical supervision. In some instances, the drinker may have medical or withdrawal problems that dictate admission to a hospital to detoxify, even if it is for only a brief period.

There are some medications that help a drinker to stay sober. Some, like Antabuse, cause a negative reaction in the body when the per-son drinks alcohol. When given, however, it is better to have a "significant other" such as a spouse involved to help with the regimen.

Usually, it is helpful to combine treatment with self-help approaches, such as Alcoholics Anonymous (AA), Rational Recovery (a non-spiritual counterpart to AA), or Moderation Management (which is more oriented toward greatly reduced drinking rather than total abstinence). These approaches have been shown, alone, to help many people, but at the very least help they can assist the overall treatment effort to be more effective. Family members can also be helped by Al Anon, Alateen (for youth), or Alatot (for kids) and has a much wider range of contributing factors.

References and Resources

American Association for Marriage and Family Therapy

Alcoholics Anonymous (3rd edition). Alcoholics Anonymous World Services (1976).

Facing Shame: Families in Recovery. By Merle E. Fossum & Marilyn J. Mason. W. W. Norton (1986).

Intervention: How to Help Someone Who Doesn’t Want Help. By Vernon E. Johnson. Johnson Institute Books (1986).

Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking. By Audrey Kishline. Three Rivers Press (1994).

Breaking the Cycle of Addiction: A Parent’s Guide to Raising Healthy Kids. By Patricia O’Gorman & Philip Oliver-Diaz. Health Communications, Inc. (1987).

The Small Book: A Revolutionary Alternative for Overcoming Alcohol and Drug Dependence (Revised edition). By Jack Trimpey. Delacorte Press (1992).

Another Chance: Hope and Health for the Alcoholic Family (2nd edition). By Sharon Wegscheider-Cruse. Science and Behavior Books (1989).

The Resilient Self: How Survivors of Troubled Families Rise Above Adversity. By Steven J. Wolin & Sybil Wolin. Villard (1993).

Two 14-minute videotapes are useful with getting help for an alcohol or drug abuser: Intervention: How Family and Friends Can Help (for adults), and True Friends (for adolescents). They present real people talking about their experiences, along with ideas about what to do if an abuser resists help. For videos, video brochures, or other information, contact the Intervention Resource Center, 332 West Broadway, Suite 1213, Louisville, KY 40202. Toll free number: 1-888-421-4321.

The text for this brochure was written by M. Duncan Stanton, Ph.D.