How to Help an Alcoholic
You know something is wrong but you don’t know what it is. The person looks depressed and anxious. His face is red and swollen, his eyes watery and red. If you look closely at his cheeks, you might see little red spider lines called spider angiomas that signal a failing liver. Something is wrong and it nags at you. That uncomfortable feeling inside of you grows and you don’t like it.
You have been a natural born healer all of your life. When you were a little kid, you cared a little more about injured puppies and kittens than others did. You didn’t want to squash bugs. People in school talked to you when they wouldn’t talk to anyone else. People recognize a healer when they see one.
There is another side of you that is different, though. It has been in trouble with people like this before. Sometimes this healing thing is not what it’s cracked up to be. Sometimes you have to tell people the truth when they don’t want to hear it. They rebel against you and get angry. You have learned that sometimes it is best to let the truth go, or to change it to make it more palatable. You hate that part of yourself, but you have learned how to live with it. After all, you live in a world full of litigation and managed care. Fear has overcome your best judgment many times.
And there’s that person over there, crying out to the healer in you. This time if you let the problem go, if you take the easy way out, the person could die. Ninety-five percent of alcoholics die of their addiction and the average alcoholic dies 26 years earlier than they would otherwise. To let this person out of your office without confronting the truth is to be potentially responsible for the person’s death.
Yet you have confronted alcoholics before. Alcoholics have two sides to themselves. One side knows they are drinking themselves to death while the other side knows they can drink safely. You and the person are in a war of lies, battling the truth. The trick is to help the person win. You are up against a great enemy. The Big Book of Alcoholics Anonymous (2001) says this illness is “cunning, baffling and powerful” (pp. 58-59). At every AA meeting someone reads how it works, which is the fifth chapter in the Big Book. The chapter ends with this statement: “Our description of the alcoholic, the chapter to the agnostic, and our personal adventures before and after make clear three pertinent ideas: (a.) That we were alcoholic and could not manage our own lives. (b.) That probably no human power could have relieved our alcoholism. (c.) That God could and would if He were sought” (Alcoholics Anonymous, 2001, p. 60).”
So the battle lines are drawn. The enemy, the disease, is confident of victory. It thinks that you will probably take the easy way out. You will handle the acute problem and let the person go home. You will not ask the questions that could lead to the truth.
But the enemy doesn’t know you. The enemy doesn’t know that you are a natural born healer. You will not lie. You are not going to let the person go home to die. You are going to fight. This is who you are inside and it is who you will always be.
THE MOTIVATIONAL INTERVIEW
The alcoholic is sick and doesn’t want to know the reason. Your job is to go with the person toward the truth. It does no good to go against the person. Arguing with the person will not work because the alcoholic is an expert at giving every excuse in the world for abnormal behavior. If you argue, the person will win because he or she will leave your office convinced you are a bad person. You need to gently walk with the person toward the truth. This is person-centered, not self-centered. You must connect with that gentle voice of reason inside of persons that is telling them they are sick. That voice is there and your job is to connect with it, empathize with it and pull for more. The other voice in persons’ heads says something else is to blame. They might have a problem, but it has nothing to do with alcohol.
As a professional, you are used to your persons being honest with you, but this one is going to lie. The person is not a bad person; he or she is a good person with a bad disease. The disease of alcoholism lives and grows in the self-told lie. The person must lie to him or herself and believe the lie or the illness cannot continue. The person will have a long list of excuses for his or her behavior. My spouse has a problem. The police have a problem. The school has a problem. My boyfriend has a problem. I have a physical problem. I’m depressesed. I’m anxious. I have a stomachache. I can’t sleep. The excuses go on and on and they will confuse you if you get caught up in them. They are all part of a tangled web of deceit. Remember, your job is to walk with the person toward the truth, not against the person toward the truth. You are going to spend most of your time agreeing with the person. When the person is honest, you are going to agree with the person. When the person is dishonest, you are going to probe for the truth. Look at it this way: If the person is listening to you, you can work with him or her. If the person is not listening to you, anything you say is worthless.
Watch the person’s nonverbal behavior very carefully. You are a healer and you have been given the gift of super-sensitivity. Your intuition will tell you whether the person is going with you or resisting. When persons are going with you, you feel peace. When they are going against you, you feel fear. When the person is ready, you will educate him or her about the disease. This is a gentle, loving process and it takes time. If you are in a hurry, it’s not going to work.
The person has been using alcohol for a long time and trusts it. All drugs of abuse tell the brain, “Good choice!” All organisms have an instinctive way of finding their way in a complicated world. What foods are good and what are bad? What is the best way through the jungle? What is safe and what is dangerous? We all learn these things deeply in the brain. What is good becomes quickly imprinted. If it is very good, it can become imprinted after one trial. Alcohol has been good to this person for many years and now it is destroying him or her. The very thing that gave the person joy now gives nothing but pain. The person is so fooled by this process that direct evidence of alcohol’s harmful consequences are denied. Remember, alcohol has always said, “Good choice!” So how can it now be a bad choice? You are fighting with this person’s basic understanding of the world, and he or she will be convinced that you are wrong. You must help the person see that alcohol is no longer a good choice--it’s a deadly choice. The alcoholic cannot see this alone, but AA has an old saying. “What we cannot do alone, we can do together.” The person cannot discover the truth without your help. You must guide the person toward a destiny he or she finds impossible. You need to help persons see that they need to stop drinking.
What you are looking for is the truth. The person will rarely tell you accurate symptoms. You have to look for signs of the disease.. You will continue to investigate--testing, smelling the air, ordering laboratory studies, and talking to family, friends, court workers, school personnel and anyone else who can help you until you uncover the truth.
Your person cannot tell you the truth because the person doesn’t know the truth. Addiction hijacks persons’ spirit, mind and body. They are trapped in a web of self-deception. They cannot tell you the truth even if they try because they don’t know what it is. Remember, you are the healer. You love your persons even if they hate themselves. You are going to love them even though they are being nasty and deceptive. You are going to help them even though they don’t understand what you are doing.
How to Develop the Therapeutic Alliance
From the first contact, your persons are learning some important things about you. You are friendly. You are on their side. You are not going to beat them up, shame or blame them. You answer any questions. You are honest and you hold nothing back. You are committed to do what is best for them. You provide the information and they make the decisions. They see you as a concerned professional. In time, they begin to hope that you can help them. The therapeutic alliance is built from an initial foundation of love, trust and commitment.
You show the person that he or she does not have to feel alone. Neither of you can do this alone. Both of you are needed in cooperation with each other to solve the mystery. The persons know things that you don’t know. They know themselves better than anyone else, and they need to learn how to share themselves with you. Likewise, you have knowledge that they don’t have. You know the tools of recovery.
The persons must develop trust in you. To establish this trust, you must be honest and consistent. You must prove to them, time and time again, that you are going to be actively involved in their individual growth. When you say you are going to do something, you do it. When you make a promise, you keep it. You never try to get something from persons without using the truth. You never manipulate, even to get something good. The first time your persons catch you in a lie, even a small one, your alliance is weakened.
If you work in a facility, the person must learn that all of your staff works as a team. What persons tell you, even in confidence, they tell the whole team. persons will occasionally test this. They will tell you that they have something to share but they can only share it with you. They want you to keep it secret. This is a trap that many early professionals fall into. The truth is that all facts are friendly and all accurate information is vital to uncovering the truth. You must explain to persons that if they feel too uncomfortable sharing certain information; they should keep it secret for the time being. Maybe they can share this information later, when they feel more comfortable.
persons must understand that you are committed to their recovery, but you cannot recover for them. You cannot do the work by yourself. You must work together, cooperatively. You can only teach the tools of recovery. The persons must use the tools to stay sober.
How to do a motivational interview
In the first interview, you begin to motivate persons to see the truth about their problem. Questions about alcohol and other drug use are most appropriately asked as a part of the history of personal habits, such as use of tobacco products and caffeine ingestion. Questions should be asked candidly and in a non-judgmental manner to avoid defensiveness. Remember, this is person-centered interviewing, not professional-centered, and the interview should incorporate the following elements (Prochaska, 2003; Delbanco, 1992; Graham. & Fleming, (1998): Miller & Rollnick, 1991; Ockene, Quirk, Goldberg, Kristeller, Donnelly, Kalan et al., 1998; Rollnick, Heather, Gold & Hall, 1992):
- The person should be alcohol-free at the time of the screening;
- Offer empathic, objective feedback of data;
- Work with ambivalence;
- Meet the person’s expectations;
- Assess the person’s readiness for change;
- Assess barriers and strengths significant to recovery efforts;
- Reinterpret the person’s experiences in light of the current problem;
- Negotiate a follow-up plan; Provide hope.
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Chemical Dependency Counseling: A Practical Guide, Fifth Edition: is a best-selling comprehensive guide for counselors and front-line professionals who work with the chemically dependent and addicted in a variety of treatment settings. The text shows the counselor how to use the best evidence-based treatments available, including motivational enhancement, cognitive behavioral therapy, skills training, medication and 12 step facilitation. Guiding the counselor step-by-step through treatment, this volume presents state-of-the-art tools, and forms and tests necessary to deliver outstanding treatment and to meet the highest standards demanded by accrediting bodies.
The Alcoholism and Drug Abuse Client Workbook, Third Edition:An evidence-based program that uses treatments including motivational enhancement, cognitive-behavioral therapy, skills training, medication, and 12-step facilitation. It provides a venue for clients to write down their thoughts and experiences as they progress through treatment.
The Gambling Addiction Client Workbook, Third Edition:An evidence-based program that uses treatments including motivational enhancement, cognitive-behavioral therapy, skills training, medication, and 12-step facilitation. This workbook walks clients through self-reflective activities and exercises meant to help them recognize the underlying motivations and causes of their gambling addiction and to learn the tools necessary for recovery. The Third Edition of this workbook includes coverage of all 12 steps of recovery. Chapters focused on honesty and relapse prevention as well as a personal recovery plan contribute to client success.
Alcoholics are one of the most difficult client groups to treat effectively. To preserve their way of life, they may lie about their problem or deny that one exists; that is the nature of this profoundly powerful disease. Yet if you can guide each of your clients through their own resistance towards the truth, not only will you be rewarded with starting them on the road to recovery, you will no doubt have saved their life as well. Achieving such a victory goes to the heart of being an addiction counselor; it is the experience of healing on a direct and tangible level.
Treating Alcoholism provides a complete road map for assessing, diagnosing, and treating this multifaceted and tenacious illness. Detailed clinical information on the disease accompanies ready-to-use tools for practice. With a special emphasis on the 12 Steps of Alcoholics Anonymous, the author walks you through the first five steps of this established methodology in comprehensive detail, showing how to easily apply each one to treatment.
The Big Book of Alcoholics Anonymous says that only God can relieve the illness of addiction. Here are a few spiritual tools to help you:
God Talks To You: Second Edition:Teaches you how to hear God's voice and details the spiritual path forward. Includes spiritual tests, prophets, prayer, meditation, contemplation and how to find a spiritual friend.
Peace Will Come CD Sit back and let the words and music sink into your soul. Come back often and play the songs over and over again. You won't be sorry. God will teach you many things you need to know.
A Communication From God: A meditation tape that will give you long communications from God. The tape takes you through two exercises where God speaks to you directly.
Addiction stops your spiritual progress.
Begin a new spiritual journey:www.godtalkstoyou.com
Read the latest research for a school paper or project from the National Library of Medicine