On Healing 3/21/2005: Substance abuse takes toll on abuser, families

Dr. Dan: Can you address the effect of addiction or alcoholism on the addict’s family?

So often we read about the reasons for substance abuse and possible cures, but little about the fallout on the family. Do we abandon addicts when they refuse treatment because we too cannot be pulled down by its horror? The survivors wrestle with guilt when we say, ‘Don’t call me, I can’t take it anymore.’ You want to keep the person you loved – before their addiction – in your life. But to witness the downward spiral, after a half dozen rehabs, often becomes overwhelming. Yet by discontinuing contact, we feel we’re abandoning them, isolating them further.
– Anonymous

Dear Anonymous: Alcoholism and addiction are terribly complicated diseases. First, substance abuse is a biological disease with a genetic component. Brain chemistry is affected, and often substance abuse is a form of self-medicating for other brain disorders such as depression. There is a psychological component; alcoholics usually come with very low self-esteem and great shame. And there is a spiritual component. Often alcoholics have no faith in anything besides alcohol. Many say it is no coincidence that alcohol is also called “spirits.”

So despite recent breakthroughs with medications, we still cannot get substance abusers to treatment unless they are willing. So here we are, watching someone we love spin out of control and maybe putting their lives in jeopardy.

All 12-step programs begin with Reinhold Niebuhr’s Serenity prayer: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

So, first you try to change what you can because no one could stand idly by as a loved one spins out of control. Typically, we start with pleading, which quickly deteriorates to confrontation. Then, we stay awake all night, trying to think of the right phrase that will unlock their mind and break the denial. Soon, we move on to finding the right doctor, clinic or detox program.

At the extremes, people have tried intervention in which a leader organizes friends and loved ones to confront the substance abuser in an effort to break down the denial. Sometimes it works. Sometimes.

And then what? Then it’s time to revisit the Serenity prayer and realize you are dealing with something you cannot change.

By the time you are staying up all night, counting empty bottles, lying to relatives or hiding car keys, you also need help. That help could take the form of counseling or family therapy.

But whatever you do, I recommend you do Al-Anon as well. This 12-step program is for families of substance abusers and follows the same model as Alcoholics Anonymous.

Eventually you will come to realize that you cannot change the alcoholic. However, there is much that can be changed. Everyone who has loved or lived with a substance abuser has felt impotence and helplessness. Most have felt great fear and anger. And at the root of these emotions is grief. We long for the person we loved before they started this downward spiral. Rarely can we change their behavior, but we can change how we deal with it.

Acknowledging your powerlessness and giving up control is a good beginning. Often your spirituality comes into play. You must have faith that you can survive this regardless of whether the alcoholic stops drinking. The group will help you identify and care for these very difficult emotions. And, in time, you will help others through a crisis.

But, first things first. You cannot do anything for anyone until you reclaim your life. Do so with care and compassion. Love helps a great deal. Focus your attention on those you love and enjoy loving them. Then try to love yourself. You need it.