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Ask Dr D; ‘I’m worried about my sister’s drinking’

Q: My sister is married with three children and I think she has a drinking problem. She polishes off a bottle of wine every evening (on weekends it’s two). I’ve also seen her putting a ‘drop’ of whisky in her morning coffee yet when I suggested that she had a problem she got very upset. She says she’s a social drinker and it’s under control: her kids are happy, her marriage is fine and so is the rest of her life. She’s avoiding me now and I’m worried it’s only a matter of time before it all unravels – she doesn’t eat well, her skin and hair are looking bad and she’s developed a slight tremor in her hands. Please help!

A: Of course she has a drinking problem! You know it and, very deep down, she does too. Unlike other illnesses – and excessive drinking is an illness – shame, loss of self control and low self-esteem are added factors. An alcoholic’s initial admission of his or her problem is so degrading and frightening that denial is the typical response. You have the best intentions but what your sister hears is ‘you are inadequate and can’t cope’. You want to help but she feels threatened and as if you’re intruding into her life, which only serves to increase her protestations and insist in a loud voice, ‘there is nothing wrong with me’.

Ultimately your goal is to encourage your sister to examine her behaviour, face the problem and seek help. Remain calm, do not over-react or take her rejection personally. Understand that this is part of the illness. The danger is that she can easily shift to focusing on your reaction and use this as her excuse to avoid or blame you while the problem gets worse. It’s worth writing a letter expressing your concern and what you have noticed. Suggest that even if she will not talk to you, she contacts a professional. Also state that you know that it is a disease out of her control and, just as she would with a physical illness, she needs to seek help. The harsh reality, though, is that the situation often needs to gets worse, sometimes a lot worse, before it gets better. While alcoholics are functional they are able to maintain their denial. Unfortunately, it is only when their lives are substantially affected that they develop the motivation necessary to face their problems. Until this point neither threats nor manipulation will work.

 Understand the difference between enabling the problem and helping the person. However much you care, never rescue! She has to face the consequences of her actions, whether it’s getting into debt, embarrassing her children or being arrested for driving under the influence. This is tough for loving family members but what is important is that she reaches what is called ‘surrender’ – recognising that she is out of control and needs help. Everything that you do to get her into treatment before this will probably backfire. Everything that you do after this has a good chance of success. Let her know that you will always be there. Offer to take her to treatment when she is ready and do your homework in advance. Remember the disease is separate from the person and you can still love her even though her behaviour is unacceptable. And finally, help as much as you can when she asks for it.