COUNSELING AND ALCOHOLISM
How does one help an alcoholic? To begin, it might be useful to know some things that do not help. These include criticism, shaming, coaxing, making the person promise to stop, threats, hiding or destroying the alcohol, urging the use of greater willpower, preaching, or instilling guilt Most families try all of these, but they rarely work.
The treatment of alcoholism often is complicated by a number of parallel problems, each of which also needs to be treated. Alcoholics, for example, are often depressed or gripped by other psychiatric abnormalities. Frequently there are physical illnesses that have come from excessive drinking and little eating. In an effort to treat themselves, some alcoholics begin taking barbiturates, amphetamines, and other drugs that complicate the alcoholic condition and make recovery more difficult. Early medical intervention is of great importance.
I. Get the Alcoholic to Admit the Need/or Help. This is difficult because many alcoholics deny that there is any problem. Their thinking is dulled and the reality of
The alcoholic's condition sometimes is hidden by the actions of well-meaning family members who cover for the drinker when he or she does something irresponsible. Most experts in alcoholic counseling agree, however, that without the drinker's cooperation, treatment is not likely to be effective.
How, then, can the alcohol abuser understand that help is needed? The members of Alcoholics Anonymous believe that the drinker needs to hit bottom in some way. Only then is the person willing to admit that he or she is powerless to control alcohol and unable to manage life without help. Regrettably some people die or damage themselves irreparably before they hit bottom. Is there some way to help the alcoholic accept the need for treatment before it's too late?
Many problem drinkers first come to the counselor's attention because of some problem that appears to have nothing to do with alcohol. A couple may ask for marriage counseling, for example, or there could be a problem with one of the children. At first the counselor (who may be guilty of thinking that alcoholics are all drunks who can't hold their jobs) fails to suspect that one of the well-dressed, seemingly relaxed counselees is really an alcohol abuser. The husband, for example, could be a successful business executive who anesthetizes himself with alcohol after work every evening while his family goes about the business of life without him.
Even when you suspect alcohol abuse, the counselee is likely to deny that this is a problem. He or she may agree to complete one of the several alcoholism screening tests or you may want to use the Drinking Indicators Checklist (DIE. This is not a rigid screening test and there is no score. Instead it is more of a nonthreatening guide to be used in an interview to help you assess drinking patterns that might be evidence of early alcoholism.
As we have seen, developing alcoholism is characterized by the drinker's denial that a problem exists. Therefore, in a firm, factual, and nonjudgmental way, point out the nature of the drinker's actions. Present specific examples ("Last night around II, you knocked over and broke the lamp") rather than vague generalities ("You're drinking too much!"). One writer has suggested that the message is best conveyed nonverbally. If the alcoholic collapses on the living room floor, for example, leave him there rather than helping him (or her) into bed. If something was broken or knocked over, don't pick it up. This makes it more difficult for the drinker to deny later that he or she passed out or damaged the house.45
One innovative approach for helping the alcoholic has been called the "intervention." This takes careful planning, usually involves rehearsal, and requires great commitment from the people who are distressed by the alcoholic's drinking. One person, often a professional counselor, chairs the group that may consist of the alcoholic's spouse, children, parents, business associates, best friends, employer, pastor, and other significant persons. At an appointed time and without giving the drinker prior warning, the group members all appear and, in a no condemning way, give their perceptions and tell how each is being affected by the drinker's actions. Often this is a very emotional meeting. Sometimes the alcoholic gets angry and walks out; more often the person is faced with the reality of the drinking and agrees to enter a treatment program. This method (which is best used under the guidance of a professional) is one way to help the alcoholic face the need for help.46
Most addicts have high anxiety and low self-esteem. Try to be careful, therefore, not to criticize or condemn in a way that arouses anxiety or is threatening. Convey acceptance of the person but not of the behavior. Listen to the alcoholic but do not give reassurance. Recognize that addicts, including alcoholics, are dependent, often childish, manipulative, and specialists in evoking sympathy. The counselor must resist the tendency to give advice, preach, or act like a parent. Instead show a non condescending, firm, sensitive attitude to imply that responsibility for recovery must remain with the alcoholic. In all of this remember that the best counselors are gentle but not soft hearted in their mannerisms.
2. Stop the Drinking. Detoxification is a procedure that must involve the intervention of a physician. Some alcoholics can withdraw on their own, but most need medical guidance, especially because the withdrawal symptoms (including tremors, nausea, sweating, weakness, anxiety, depression, and sometimes delirium) may be severe. Some physicians use sobering agents, other drugs that are assumed to counter the effects of withdrawal, but debate continues about the wisdom of using one drug to treat the effects of another.
While detoxification usually can be accomplished safely and quickly, this is only the beginning of treatment. A larger problem is preventing relapse and keeping the individual free of further alcohol use. This involves counseling that has at least four goals:
(1) getting medical treatment to repair the damage caused by alcoholism,
(2) helping the counselee learn to cope with stress and function effectively without alcohol,
(3) creating a new identity without alcohol, and
(4) building or restoring self-esteem and dealing with guilt. The first of these goals involves medical treatment. The others can be goals for nonmedical counselors, preferably working with the family, support groups (like Alcoholics Anonymous), and other treatment specialists.
3. Provide Support. Alcoholics and other drug abusers are often lonely, immature people who are being asked to change a lifestyle that is well entrenched and to give up a substance that they depend on and value. This will not be accomplished in one or two hours of individual counseling each week. Many addicts are best helped within the confines of hospitals or rehabilitation centers where help is available on a round-the-clock basis. Some can be assisted through group counseling where recovering addicts can help each other face the stresses of life, interact with people, and live life without chemical dependency.
Probably the most effective group support comes from Biblically Principaled Alcoholics Anonymous (AA) and related groups such as Celebrate Recovery and Most Excellent Way. These organizations meet in cities and towns all over the world, are free of charge, listed in the phone book, and established as perhaps the most effective approach for helping alcoholics and their families. Even though Aa and NA are not specifically Christian, these groups use principles that in general are consistent with biblical teaching: acceptance of reality; faith in God; commitment of one's life to divine care; honesty with God, self, and others; desire and readiness to change one's way of life; prayer; making amends; and sharing with others. Some have suggested that supportive group membership in an alcohol-free environment is likely to be more effective in treating alcoholism than efforts to provide psychological insights or better drugs.
Much of the supportive help should be provided by the church where members it of the congregation are understanding, familiar with the facts about addiction, and available to give encouragement and practical assistance. Too often, however, church members are critical, condemning, or unwilling to help. Other believers are ... sympathetic, but their support may be limited because they are unfamiliar with the E facts of alcoholism or unable to empathize with the struggles of alcoholics and their families.
Some churches have developed Alcoholics Victorious or similar groups that are based on the AA model but more openly Christian. If these are not available in your area, you may consider encouraging your counselees to be involved in both in AA and in the broader, more diversified fellowship of a local church.
4. Help with Stress Management. In the past, alcoholics dealt with stress by escaping through the use of drugs. Counseling must show that there are better ways to meet the pressures of life. To show this, the counselee must learn that he or she can trust the counselor, who in turn must be patient and dependable. Stress in general can be discussed, but a better approach is to take each problem as it arises and help the counselee decide how it can be handled effectively. This will include considerations of interpersonal relations and how to get along with others apart from the use of alcohol.
5. Encourage Self-understanding and a Change of Lifestyle. When a trusting relationship has been established, there can be value in considering some of the reasons for the alcohol abuse. These discussions can lead to insight, but insight is of little value unless it is followed by practical, specific plans for changed behavior. Sometimes these plans may involve vocational counseling, an evaluation of self-esteem,a discussion of marital issues, or consideration of spiritual issues.
Then there is the issue of lifestyle. After the alcoholic has stopped drinking, how will life be different? One's style of life depends on making decisions concerning what will or will not be done now and in the future. As you and the counselee consider life planning try to be sensitive to the unique needs that may be experienced, for example, by female alcoholics, older alcoholics, or teenagers. In all of this, remember that decision making will involve both the counselee and the family.
6. Counsel the Family. Since alcoholism is a family problem, the whole family must receive support, understanding, and help. At times they must be encouraged not to withdraw, but to live as best they can despite the circumstances. Sometimes it is helpful to give factual information that better enables the family to understand the addiction. Often family members must be helped to see how they might be contributing to the addiction problem or how their protection of the drinker might prolong the condition. Before the drinker agrees to come for help, the family members may need your guidance and encouragement to confront the alcoholic relative with specific evidences of his or her alcohol-induced behavior.
As the alcoholism develops, family members are forced to take responsibility for running the household. When sobriety returns, the family must readjust to this change and learn to accept the recovering alcoholic as a responsible member of the home. This may be difficult either because of a fear, based on past experience, that the present dry spell is temporary, or because the family has grown accustomed to functioning smoothly around the drinker. Family change is risky for the family, important for the counselee, and accomplished best when there is encouragement from the counselor or outside support group.
7. Be Prepared for Relapses. AA has long maintained that one drink can plunge an alcoholic quickly back into addiction, although some professionals disagree. Everyone agrees, however, that relapses are common among alcoholics. If these are followed by blame and condemnation from others, the alcoholic is inclined to give up and conclude "I'll never win, so why should I bother to try?"
It’s not easy to work with chemically dependent people or their beleaguered family. The counselor can expect failures and after a relapse he or she must help the counselees pick up and keep working on the problem.
8. Recognize That Evangelism and Discipleship Are Basic. Professional books and articles about alcoholism almost never mention the role of the rescue mission in helping to free people from alcohol addiction. It is true; perhaps, that these missions reach only a small number of alcoholics, but the approach is often effective. The mission leaders (who frequently are recovered alcoholics) are a rarely tapped but potentially very useful source of information and encouragement for the counselor of alcoholics.
If the counselee is to find new meaning and purpose in life, he or she must come to see that true and lasting fulfillment is found only in Jesus Christ. The counselor must depend on the Holy Spirit's guidance to determine when and how to present the gospel. Highly emotional preaching sometimes produces false decisions that later are rejected, although there are many examples of persons converted to Christ, freed from their alcoholism, and permanently changed through the preaching of evangelistic messages.
Counselees are most responsive to the gospel when they recognize that they have a need that can be met only by Christ. Alcoholics are masters at manipulating other people, but the counselor must be careful not to fall into the same pattern, attempting to manipulate individuals into the kingdom. The counselee should be presented with the facts of the gospel (presumably during times when he or she is sober enough to understand). Then urge, but do not coerce, the person into making a decision to commit his or her life to Christ.
In all of this, prayer is of central importance. Through the intercession of believers and the availability of concerned human helpers, God works to restore those who are controlled by alcohol or other chemical substances. He also helps to prevent alcoholism in others.
Points of Interest
1. Early medical intervention is of great importance in the treatment of alcoholism.
2. Because alcoholism is characterized by the drinker’s denial that a problem exists, it is important for a counselor to point out – in a firm, factual and nonjudgmental way – that nature of the drinker’s actions.
3. Most addicts have high anxiety and low self-esteem.
4. Detoxification is a procedure that must involve the intervention of a physician. Detoxification, however, is only the beginning of treatment. A larger problem is preventing relapse and keeping the individual free from further alcohol use.
5. Because alcoholism is a family problem, the counselor must try to help the alcoholic’s whole family.
In our next lesson we will look closer at ways we can prevent alcoholism and substance abuse.
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