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The Scenario:
For many years, Fred drank alcohol pretty much daily. He rarely appeared intoxicated, and his work was unaffected, but the flow was steady most evenings -- a drink always in his hand. While dating, his drinking did not appear to be a big problem. But after getting married, his wife began to complain that he never wanted to go out and do anything anymore, that he seemed moody and brooding, and that they rarely spent time with friends. She felt increasingly unhappy with their relationship. To compound matters, his alcohol intake just seemed to increase in response to her concerns. Sometimes he became belligerent and aggressive in a way that she had never seen before.
She finally decided to take action. She got members of his family together and decided to confront him more directly with the family's support. The meeting went better than expected. After being a bit defensive, he admitted that he too had begun to think he might be drinking too much. He talked about what he might do, and decided to just cut down a bit on his intake.
Questions:
Answer:
Fred shows many signs of being an alcoholic. He is drinking regularly and to the point that it is affecting his personality. His family has expressed concern about his drinking, and he himself has begun to think that his drinking has become a problem. Recognizing that there is a problem is the first major hurdle an alcoholic must overcome. Without this recognition, no recovery or treatment is possible. Even with recognition, nothing is assured, but at least the door to recovery is open.
What should Fred do at this point? Most people felt he should stop drinking completely, that moderation was only a tease, and that sooner or later he would slip back into his old habits. This is the traditional viewpoint of AA: "A thousand drinks are not enough; one drink is too many." This is certainly the easiest path to recommend to Fred, but the hardest for him to follow. So many alcoholics have tried without success to moderate their drinking that it is hard to recommend any course other than complete abstinence.
A few Tripod members felt that cutting down was a good way to start. Perhaps he was capable of moderation, and wasn't it at least worth a try? There is, indeed, evidence that some (a small number) of alcoholics are able to moderate their drinking successfully. This means that they no longer become obviously intoxicated, or paradoxically, that their tolerance of alcohol is reduced to normal. (An alcoholic is able to drink larger amounts of alcohol before becoming intoxicated because their liver learns to metabolize alcohol more rapidly.) It also means that their social and work lives are not adversely affected, and that their emotional, physical, and psychological well-being is maintained. If you advise Fred to be moderate in his drinking, there is a definite risk that he well continue to drink surreptitiously, or that you are becoming an "enabler." By trying to be gentle and supportive, by trying to avoid arousing his anger or alienating him, you may be playing into the hands of an alcoholic who will find fiendish ways of manipulating others in order not to have to quit. It's a definite risk.
The twelve step program of AA has been of invaluable help and changed the lives of thousands of alcoholics. Quitting alcohol is very difficult to do without the support of people who have been through the process before. I might recommend that he see a counselor privately -- someone with expertise in substance abuse, who could help him work out some of the problems that have developed with his wife as well as some of the personal problems that are likely to surface once he does quit. Ideally, before he quits, he should talk to a doctor or substance abuse counselor who can help him determine whether or not a stay in a detox unit would be helpful. Detox units are able to use medications to control potential serious reactions to withdrawal of alcohol from the body. Delirium tremens, the full-blown reaction to alcohol withdrawal, has a mortality rate of about 10%.
Fred should be given lots of support for acknowledging his problem, and reminded that if his wife didn't care about him, and love him, she never would have brought the subject up. He should check out some AA meetings, looking for the ones where he feels the most comfortable. If in the past he has been able to stop drinking for a few days without serious withdrawal reactions, and if he looked in good health and capable of managing this transition on his own, it would probably be safe to let him stop on his own. But if there were any doubts, referral to a detox center would be a wise thing to do.
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