It can be very hard to know how to behave and what to say when someone close to you is trying to recover from an addiction to alcohol. You know they need all the help they can get and you want to be there for them but it’s oftentimes a very emotionally challenging situation.
Simply admitting that you have and addiction and choosing to get assistance from professionals takes quite a lot of courage so it’s important that you tell them that and show them how much it means to you that they took this first step and how much you want to see them succeed in getting better.
Understand what they’re dealing with
Alcohol use disorder isn’t limited to drinking too much or too often, it stems from a compulsion to drink alcohol that’s very difficult for the individual to regulate. It actually causes changes in the chemistry of the brain so alcohol becomes imperative in the production of dopamine. Reducing consumption leads to physical and psychological distress – withdrawal symptoms.
You and others in their social circle have probably noticed some of the following signs of chronic alcohol use:
- They have mood swings
- Frequent complaints of digestive problems
- Shakiness, especially of the hands – this can happen when they haven’t had a drink in six or more hours, that’s why it’s especially evident in the morning. Alcohol is a central nervous depressant which means that it slows down activity in the brain as well as reduce overall energy levels, but after a longer period of continuous presence in the system, the brain tries to compensate for these effects by releasing more excitatory neurotransmitters than what is considered standard.
When the level of alcohol in the body decreases considerably, the individual gets into an amped-up state caused by these chances and they’ll experience tremors, increased anxiety, elevated heart rate, sweating and nausea. They’ll also seem more hyperactive than usual.
- Problems with concentration and memory
- They seem to focus all their social activities on drinking
- They become irritable if changes in plans result in them not being able to drink any alcohol
- You can sense a small that lingers on their breath and clothes – this isn’t just the smell of alcohol on the breath, if they still have alcohol in their system that hasn’t been metabolized yet their sweat will have a distinct odor and as we explained before, they tend to sweat more when they’re going through withdrawal. The smell can be indicative of heavy alcohol consumption the evening before.
- Higher tolerance for alcohol – they seem to be able to drink more than the average person before they start to show signs of intoxication – this is caused by the chemical changes in the brain described above. There are also genetic factors involved and studies have shown that individuals with a family history of alcoholism tended to adapt faster to the effects of alcohol which translates to them having to drink more to feel the same level of “buzz”. “Reverse tolerance” happens after a few years of heavy alcohol use if the liver has been damaged to the point that it’s unable to metabolize or break down the alcohol at the normal rate, so even small amounts will rapidly increase the BAC (blood alcohol concentration).
- Despite the fact that they’re not showing signs of intoxication you can see marked differences in their personality once they’ve had a few drinks – initially they might actually seem “happier” because they’re getting relief from the withdrawal symptoms but later on you may notice that they find it hard to “call it a night” or to restrict their drinking.
We often have this stereotypical image of “the alcoholic” that drinks cheap liquor out of a brown bag at any hour of the day and can’t hold down a job, but in many cases people struggling with an alcohol addiction still manage to perform well career-wise and complete most of their day-to-day duties – they’re high-functioning.
What we fail to consider is that nobody wakes up one day and decides they want to be an alcoholic. They may have already tried many times to at least reduce their drinking but couldn’t cope either with the cravings or the distress produced by the withdrawal symptoms.
Genetic factors have been shown to account for 50% of the risk of developing an alcohol use disorder. The genes that have the strongest impact are ADH1B and ALDH2 but it also has to do with how well the frontal cortex is able to regulate impulses, how powerful the signals from the amygdala are and how reactive the reward pathways are to consuming alcohol.
If you have someone close to you who is dealing with alcohol use disorder, the first thing you need to do is build a relationship based on trust. Granted, this may be difficult to do since they may have disappointed you in the past by making false promises and not following through with commitments.
However, name-calling, nagging and criticizing won’t make the treatment they get in the rehab center more effective. Ideally, you want them to feel safe talking to you about their difficulties, to see you as a reliable support system. That doesn’t mean enabling, you don’t have to shelter them from the consequences of their destructive behaviors, just to be able to listen to them and show empathy and a willingness to understand.
Once they’ve started treatment, the best thing you can do is keep in close communication with the healthcare professionals. They’ll initially go through a process of detoxification because withdrawal symptoms start 6 to 8 hours after their first drink and this goes on for about 24 hours, but after 2-4 days it can get considerably worse. That’s why it’s not advised that they try to stop on their own.
Depending on how strong the dependence is, medications such as benzodiazepines, disulfiram, naltrexone and acamprosate may be necessary both to help them get through detox as well as not relapse.
The inpatient treatment typically takes one to three months and afterwards they will visit the rehab center regularly as an outpatient.