‘My sister is an alcoholic and she’s refusing treatment’

Question: My sister, who is in her 20s, is an alcoholic. This came to light over the last 18 months after being kept under wraps by her for probably a good few years prior to this.

While she initially engaged in treatment and support (a residential programme; subsequent counselling) she now is refusing to. She’s lashing out and being verbally abusive to everyone at home, putting herself in extremely dangerous situations while drunk and blames everyone around her for stressing her out and making her turn to alcohol. She is somehow managing to hold down her job, but I honestly don’t know how.

She has said she has no intention of giving up alcohol and I know that only she can choose to do that, but it is heart-breaking and terrifying to watch her self-destruct in this way. She won’t listen to our fears, tell us the root cause of the alcoholism or tell us what she needs from us to help her escape from where she is. She wants nothing from us other than our silent observance as she does this to herself, but by not imposing boundaries as to what is and isn’t an acceptable way to treat her family and insisting on them is, in my opinion, enabling her to continue to control and bully and avoid the consequences of her actions.

How can we get through to her?

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Answer: Your question highlights just how heart-breaking it can be to watch someone you love engage in a self-destructive addiction. You can feel powerless as nothing you do seems to help your sister and when you try she can push you away angrily. You also have to live with your fear that things will deteriorate and face your worst fear that your sister's self-destructive actions could prove fatal.

You are not the first family member to wonder how best to respond. On the one hand if you pressure your sister about giving up drinking, this can push her away and make her cut off from you more. On the other, if you accept her drinking and say nothing then it feels like you are colluding with and enabling her drinking. There is a common idea that you should engage in “tough love” – that you should refuse to tolerate her drinking in any way and even not talk with her until she is willing to start on a programme for change.

However, this approach can be very problematic and in extreme cases can lead to the person with the addiction feeling more isolated and stressed and engaging in increasing addictive behaviour.

It is important to realise that there is no one right way to respond and each family member must decide for themselves what is the best approach depending on the relationship they have with your sister. The key to responding well is to strike a balance between being supportively there for her while not colluding with her addictive drinking.

Below are a couple of ideas.

Communicate your concern

Find a way of communicating your love and concern for your sister and your hope for her to get well without cutting her off. You might send her an email or text or arrange a conversation. You don’t have to keep repeating the message, but try to make sure she understands you are there for her.

Stay in touch with her

Find a way of staying in touch with your sister that does not collude with her drinking. This might be going for a walk with her during the day when she has not been bingeing or meeting her for lunch during her work day. Try to find a non-drinking activity you can share with her that allows you to stay in regular contact.

Don’t worry about causes at the moment

Don’t worry about finding a “root cause” for her drinking – this can be a wild goose chase and simply deflect responsibility. Simply focus on telling your sister how much you care for her and asking her to get help to stop drinking. Once she is in treatment she can engage in counselling to understand the reasons for her drinking. Praise the fact that she had the courage to get help once and affirm that she can now do that again.

Be empathic

Don’t judge her for why she continues to drink. It will really help if you can appreciate the stress she is under and what she is going through. When someone has dropped out of treatment like your sister, they can often feel more hopeless about being able to give up. Take time to understand this, and be empathic about her fears and stresses.

Be patient

As you already know, it is ultimately your sister’s decision about whether she continues her addiction or not. You can do your best to be there for her but you can only go so far and you are not responsible for her actions.

Seek your own support

Do seek your own support as a family member. You could start with the HSE Drugs and Alcohol Helpline Freephone 1800 459 459 who have lists of services throughout the country. You could also contact Al Anon (al-anon-ireland.org) who offer group support for families and friends of alcoholics in an anonymous environment. It can really help to talk to other people experiencing similar worries and dilemmas.

– John Sharry is a social worker, founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. See solutiontalk.ie