Helping people with issues related to alcohol use

AlcoholIssuesIf alcohol is affecting someone you love, it may be helpful to look beyond how much alcohol they're consuming, or how often, and explore with them the effect of their drinking on their work, health and relationships.

Michael Hollen, L.P.C., a supervisor with outpatient mental health at Providence St. Vincent Medical Center, answers important questions about the consequences of drinking, and offers advice on how to go about motivating positive change.

What areas of a person's life are most easily affected by alcohol?

Alcohol use, regardless of amount, has the potential to affect every aspect of a person's life. At Providence St. Vincent's, we see people whose alcohol use has had a negative impact on their health, jobs, relationships, school performance, parenting and freedom. One of our challenges is to help people consider that quantity, frequency and type of alcohol are less the issues than the consequences of drinking. A person doesn't have to overindulge to experience negative consequences, and focusing on amount or frequency can activate a person's defenses and interfere with the change process. Disclaimers such as "I don't drink every day," "I only drink wine," "I don't drink as much as my friends do" and "I never get drunk" often distract from the real reasons why people should reassess the effects of their drinking. The bigger challenge is that potential consequences are poor motivators for change when compared to the positive function that alcohol serves for people. That someone's drinking might negatively affect their life someday does not dissuade an individual from having a good time out with friends tonight.

What health issues might someone who drinks experience?

Newspapers, TV news and the Internet are replete with seemingly daily advice about the potential consequences of alcohol use. Some of the warnings about consumption are tempered with qualifiers like "excessive," which softens the impact. The advice we always give patients is to talk to your health care provider specifically about how your existing medical issues may be related to your alcohol use. Ask your provider pointed questions:

  • "What is alcohol's effect on the medication you are prescribing?"
  • "Is there a chance that stopping drinking will help alleviate my medical concern?"
  • "Do you think my alcohol use could be contributing to my medical condition?"

If your provider sees a connection, find a way to quit.

Do you have to be an alcoholic to experience fallout related to drinking, or drinking too much?

The term "alcoholic" comes with preconceived notions that seem to light up a person's defenses and interfere with his willingness to change. I've known people who for 20 years have acknowledged to themselves and others that they are an alcoholic but who never considered quitting because their drinking wasn't causing problems in their lives, or at least any they cared to solve. I've also known people who wouldn't meet the definition of an alcoholic but who decided to quit because they were tired of the negative consequences. There's a big motivational difference between someone saying, "I have an alcohol problem" versus "I have a problem in my life that is related to my alcohol use." The latter allows the person to choose to quit drinking as a step toward solving a bigger problem, rather than focusing on drinking itself as the problem.

What red flags might signal that a person's drinking is affecting his relationships?

The best, and perhaps only, measure is the opinion of the person partnered with, related to or friends with the person whose drinking raises concern. Telling someone, "I don't like your behavior when you drink" seems to work better than, "I think you drink too much." If someone close to you expresses concern about your alcohol consumption, it could signal a problem related to your drinking.

How would you approach someone about their alcohol use?

No one can make another person quit drinking, although we may be able to exert some influence. People change when the pain of staying the same outweighs the fear of changing. One traditional approach is to assume that when a person has suffered enough – or hit bottom – they'll be willing to change. Our approach at Providence involves exploring and reducing the fears associated with change so that a person can become willing to change earlier on. To want to quit drinking, a person has to perceive some benefit from making that change. It's complicated, because alcohol has a self-reinforcing quality; in general, people like something about it. From a motivational standpoint, we want to highlight the discrepancy between the person's values and their behavior. In our treatment program, we work with patients to help them identify cause and effect and to encourage them to take responsibility for their part in any life problem. Patients tell us, "As the result of my alcohol use, I'm on a last-chance agreement at work," or, "As the result of my alcohol use, I have elevated liver enzymes," or, "As the result of my alcohol use, I'm sleeping in the den." Connecting cause and effect also can lead a person to a clear solution.

In cases where there is little question that a person's drinking has crossed the line between questionable and problematic, when – if ever – is the right time to stage an intervention?

There are different schools of thought on the whole intervention concept. Setting and sticking with some behavioral expectations and holding a person accountable and responsible for his or her behavior are important in helping a person move toward change. Personally, however, I'm not a fan of the made-for-TV intervention that seems to be popular recently. The process tends to be shaming and seems to trigger a person's defenses. Whether or not it's effective is unclear.

What effect does a parent's drinking have on a child?

A parent under the influence may pay less attention, or be more irritable or prone to anger toward the child or the other parent. Parenting experts agree that the key to good parenting is consistency, something often lacking in a household where one or both parents use alcohol and drugs. Kids never know which parent is going to show up – for example, will it be the permissive parent or the angry parent when the child returns from her day at school? Children look to their parents as models for how to live, how to deal with life and how to form and maintain relationships. Alcohol use can interfere with that.

How can drinking affect your job performance?

Absenteeism and tardiness are the most obvious. Less obvious factors include hangovers, withdrawal symptoms and mental confusion, as well as time spent at work thinking about and planning activities after work that involve drinking. Being "under the influence" extends beyond just drinking on the job.

Why do some people become addicted to alcohol while others can drink occasionally without experiencing any repercussions – save, maybe, a mild hangover?

Alcohol problems appear to develop as the result of a combination of biological, psychological and sociological factors. Clearly, there are biological differences in how people process alcohol. People who experience a strong, positive reaction to alcohol are more likely to develop problems than those whose experience is less pleasant or even negative. People come to depend on alcohol for a variety of psychological functions: to manage stress and anxiety, to sleep, to escape depression, to be assertive, to calm their anger or to increase enjoyment. Cultural, family and social traditions also greatly influence the part alcohol plays in a person's life.

For more information on how to help yourself or others, visit the Substance Abuse and Mental Health Services Administration or the National Institute on Drug Abuse, a division of the National Institutes of Health. More information about Providence's broad range of behavioral health services is available online.