Helping a high-functioning alcoholic in denial

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When a loved one has a drinking problem, it’s hard to know how to help. In this brief guide, experts share best practices.

You suspect that your spouse, close friend or relative has a drinking problem. Or maybe it’s so obvious you’re shocked they can’t see it.

But they don’t.

And you’re tied in knots, with no idea what to do. Or, maybe you tried to approach your loved one. Countless times. But they just don’t listen.

There are empathetic and actionable ways to support someone with alcohol use disorder (AUD) who may be stuck in denial.

People who function well with an alcohol problem “seem to have it all together”, says Matt Glowiak, PhD, LCPC, Certified Advanced Alcohol and Drug Counselor. They are able to successfully manage tasks related to their work, studies, family and finances, he says.

But maybe they drinka few glasses of wine each evening to help them fall asleep. Or they get bombarded every weekend but don’t neglect their demanding work.

However, cracks are beginning to appear.

“The main difference with high-functioning people with substance use disorders is that it usually affects their relationships first and their work last,” explains Lauren GrawertMD, psychiatrist at Kaiser Permanente in Virginia.

“For example, you might notice your spouse drinking more beers at dinner, sleeping less and less, and becoming more nervous long before they start missing days of work,” adds Grawert.

According tovanessa kennedyPhD, Director of Psychology at Driftwood Recovery, other high profile examples include:

  • a stay-at-home parent follows their children’s activities, but drinks more than expected and becomes irritable when they can’t drink
  • high performing sales manager continually takes the wheel after several drinks
  • a pensioner drinks throughout the day, especially when using potentially dangerous power tools

In short, “there is not a single picture of the AUD”, points out Sabrina Spotornoclinical social worker and substance abuse counselor at Monument.

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the diagnostic criteria for AUD present 11 symptoms, including:

  • drink more than expected
  • try to reduce but can’t
  • let alcohol consume your days
  • have an incessant craving for alcohol
  • not being able to fulfill social, domestic or professional obligations
  • having relationship problems
  • developing health or mood complications, such as anxiety and depression
  • engaging in risky behaviors, such as drink-driving
  • develop an alcohol tolerance
  • avoiding activities important to drinking
  • experience withdrawal symptoms, such as problems sleeping, tremors, or rapid heartbeat

Depending on the number of symptoms, their AUD can be:

If your loved one is in denial or unwilling to seek treatment, they are not alone. According to 2019 National Survey on Drug Use and Health,about 14.5 million people have AUD, yet only 7% received treatment that year.

According to Kennedy, when a person does not realize they have a drinking problem, they may:

  • Minimize the impact: “Everyone has to call in sick sometimes because of a hangover” or “It’s not like I come home drunk; I always call an Uber.
  • Return blame: “If my boss wasn’t such a jerk, I wouldn’t need to drink to relax,” “My daughter’s behavioral issues are so stressful I don’t know how else to relax,” or “I need a drink to cope with my family!”
  • Make comparisons: “I’m nothing like Uncle Larry, he had a DUI and I’ve never seen him without a drink in his hand.”
  • Skipping Meals: This way the alcohol hits them harder.
  • Trying in vain to reduce: One drink inevitably turns into more.

People in denial might also point to their past and current accomplishments as signs that they are doing perfectly fine, says Glowiak: “How can I get my kids to school and run my business successfully if I have a problem alcohol?”

To save face, says Glowiak, people with an AUD might:

  • drinking in private
  • hide empty containers
  • make attempts to cover their breath
  • pace their drinking so they’re buzzy but not “drunk”

What might look like denial can actually be much more complicated and multi-layered for people with high AUD.

Normalization of consumption

“For starters, the media, our workplaces, and many social circles normalize heavy drinking,” says Ruby Mehta, clinical social worker and director of clinical operations at Storm.

“In some families, drinking too much is considered comical, not serious or essential during celebrations,” she adds. Therefore, many people may not realize that their drinking has become a real problem.

Stigma

Even if you’re aware that your drinking has become a problem, it’s common to worry about what other people might think. In one 2015 studynearly 29% of participants did not seek treatment due to stigma or shame.

“AUD is one of the only disorders you get yelled at,” points out Eileen Conroy, mental health specialist at Beyond Anxiety. “It’s often mistakenly perceived as a personality flaw, and that lack of understanding and empathy breeds judgment and criticism – which people notice.”

According to Conroy, it can be easy to get caught in denial with AUD if you subconsciously sense that something is wrong with you. It could also mean admitting that they don’t have everything together and their outer (and inner) world is falling apart.

Grawert adds that in communities of color, “mental health and addictions treatment is even more stigmatized.”

chemical dependency

Another major deterrent for some people can be chemical dependency.

According to Spotorno, “Over time, the brain stops associating alcohol with pleasure or relaxation, and may begin to recognize alcohol consumption as necessary for basic functioning. For this reason, drinking may seem innate, which makes it more difficult to recognize the need to make a change.

Personality

Sometimes a person’s personality can influence their tendency for denial. Certain traits, such as independence and perfectionism, can add to a person’s hesitation or reluctance to ask for help, Grawert says.

All experts agree that when talking to your loved one, it’s best to be patient and compassionate.

“Always approach a loved one from a place of support and a desire to help them, instead of leading with judgment or anger,” says Omar Elhaj, MD, senior medical director at Health LifeStance.

Anger and frustration can be difficult emotions when supporting someone with AUD. Remembering that you can’t “fix” your loved one, but can be there for them, can help calm you down, says Elhaj.

According to Mehta, it’s also helpful to remember that your loved one may feel shame and fear, which can cause them to feel defensive or hesitant.

Ask permission

“To keep the conversation going smoothly, it’s a good idea to get permission from the person chatting,” says Grawert, for example:

  • “Is it okay to talk about your relationship with alcohol?” I’m worried and would like your opinion.
  • “I thought about you and the alcohol. Can we talk more about it? »

Or try this conversation starter from Mehta: “I wanted to talk to you about something because I care about you so much. And I hope that if you saw me struggling with something, you’d offer to help me too.

What if your loved one refuses?

Grawert advises against pushing. Instead, she recommends seeking more formal support with Al Anon or therapy to help you create boundaries and take care of yourself.

name what you see

Bring up the specific behavior that needs support, Mehta says, such as:

  • “I noticed you passed out the last few times we went out.”
  • “I noticed you weren’t feeling well after drinking for the past few weekends.”

Reiterate your concern

According to Mehta, you might say:“I care about you and want to be there for you, just like I want you to be there for me.” The latter “shows them that you respect them and that you do not frequent them”.

Communicate your limits

Don’t neglect your own well-being. To set your boundaries, Kennedy and Mehta suggest saying:

  • “I’m so concerned about your drinking that I don’t want to activate the behavior. So I will no longer buy alcohol for you, or cover you when you miss family events.
  • “I want to be there for you. But right now it’s too hard for me to be there when [unhealthy behavior] happened. I’m here for you if you want someone to hang out with and do non-drinking activities together or go to a recovery meeting together.

Consider trying these additional empathetic strategies for yourself and your loved one.

Ask about their support needs

Learn about the best ways to help them get help and offer actionable ideas.

According to Mehta, you could:

  • search for treatment resources online
  • participate in a support group together
  • text them when they would normally drink
  • invite them to a non-alcoholic activity during the weekend

Stop drinkingg

Consider not drinking yourself (at least temporarily), says Kennedy. You too may find that your relationship with alcohol is negatively affecting your life. And you may find that you feel healthier and happier without it.

Suggest therapythere

Mental health care is essential for long-term success in overcoming AUD,” says Elhaj.

“People can have an unhealthy relationship with alcohol for many different reasons. Like any other condition or disease, addressing it head-on with a professional is an important step in getting healthy.

Prioritize your needs

Consider seeing a therapist or joining a support group. In addition to supporting your own mental health, it serves as a role model for your loved one.

“When you take action to heal, it gives everyone around you permission to do the same,” says Spotorno.

It’s hard to watch a loved one deny their drinking problem. But in reality, denial is complex. There can be many reasons why a person is reluctant to seek help, from lack of awareness to stigma and shame.

So when you support your loved one, it can be beneficial to lead with love, compassion, and understanding. If they’re not receptive, keep trying and set limits to protect your own well-being.

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