Irish Times – Confronting the alcohol issue

Alcohol affects every part of the body and heavy use can be a contributory factor in more than 80 illnesses. writes IAN McCABE

In Ireland, we are sometimes shocked when people at the height of their career, particularly men between the ages of 35 and 55, suddenly drop dead with a heart attack. While there are several reasons for fatal cardiac arrests, the contributory effects of alcohol are often ignored. Given our national relationship with alcohol, perhaps we should come out of our collective denial and acknowledge alcohol abuse as being one of the causes of heart attacks.

The popular image of the alcoholic as the wino in the gutter allows society to turn a blind eye to the many alcohol-dependent people who appear to function relatively normally. While functioning alcoholics seem to be “getting away with it”, their bodies often tell a different tale.

Alcohol affects every part of the body and heavy use can be a contributory factor in more than 80 illnesses, including cirrhosis of the liver, kidney infections, pancreatitis, gastritis and cancer of the oesophagus and larynx.

Psychological problems include defence mechanisms such as rationalisation and minimisation – “It helps me cope and it’s not really a problem” – or projecting blame onto family members – “I wouldn’t drink as much if they didn’t nag me”.

Blaming a partner is a symptom of denial which is the principal psychological symptom of alcoholism. Indeed, alcoholism is the only illness that tells the victim that they don’t have it! Denial can be so strong, it’s as though the illness has a life force of its own and hijacks the person and uses their body as the vehicle to drive them to their own self destruction.

The good news is that once drinking is stopped, the body and mind can recover. If an alcoholic is willing to seek help, a visit to a doctor may be the first step to recovery, but it can be counterproductive. Since the person will present in a sober manner and be on their best behaviour, some doctors will simply offer well-intentioned advice such as “try to cut down” or even worse, prescribe long-term mood-altering drugs. The ideal outcome is for the doctor to explain that they need to see a specialist and convince the person to immediately attend for an assessment at an alcohol treatment centre.

Even if the alcohol-dependent person is endangering their career and health, the family cannot force them to get help. Gerry Cooney, a senior addiction counsellor at the Rutland Centre, says: “Rarely do people present themselves for treatment without being prompted by a family member.”

According to Cooney, “a person in addiction can easily argue and dismiss the concerns of a friend or family member acting alone”. However, there is strength in numbers and the combined intervention of the family together with friends and work colleagues may be the power that is necessary to persuade the person to seek help.

The idea of a group intervention came from the late Dr Vernon Johnson, who was open about being a recovering alcoholic. It is based on the theory that confrontation is necessary to break through the defences of the denial system associated with alcoholism.

Johnson believed the person with an alcohol problem should be made to face the reality of the damage they are inflicting on their immediate family members.

Group interventions normally involve an experienced counsellor forming a group composed of the family, friends and work colleagues of the addicted person. They then meet in an agreed neutral location, such as a hotel room. Each member of the group prepares a letter expressing their love and concern for the person but also describing in a non-judgmental manner how the person’s drinking is affecting their lives. The group rehearse by reading their letters to an empty chair. Next they invite the person to the location where they are gathered.

Certainly this is a highly charged, emotional confrontation and can be upsetting for all involved. From the alcoholic’s perspective it can be interpreted initially as a surprise attack. But this intervention process is not about deciding how to tell someone in the least embarrassing way that they have bad breath. It may be a last ditch effort to prevent the person from going to an early grave. Far from being an attack, it is the kindest and most loving effort family and friends can make.

Nicole Kidman organised an intervention for her alcohol-dependent husband, Keith Urban. Five sober years later, he commented: “She made a decision to turn around and initiate, ultimately, this intervention . . . It was Nic and a small group of people I’m close to in Nashville. To see love in action to that degree, at that time in that way, I’d never experienced anything like that, and all the rest of it is very, very, very personal.”

An ideal outcome is that the person agrees to attend for a pre-arranged assessment at a treatment centre. Not surprisingly, sometimes the person being confronted feels overwhelmed and abruptly leaves the gathering. While it can appear to be a wasted opportunity for the person, it is not wasted time. The intervention plants a seed for recovery in the person’s mind.

Also, it may be the first therapeutic step by which family members affected by alcoholism seek support and help for themselves. The process will also teach family members more about the illness of alcoholism and how they may be enabling the alcohol-dependent person, and how support groups such as Alateen and Al-Anon can help them care for themselves.

There are many Twelve Step support groups in Ireland for families of people who have alcohol problems. Al-Anon provides regular meetings for partners and family members while offering a support group for children. At the support group, family members realise that they are not the only ones living with this problem and feel less isolated.

Above all, they learn that the priority is to protect and care for themselves so that they remain strong enough to help the still suffering alcoholic.

Ian Mc Cabe PhD, PsyD is a clinical and counselling psychologist with a certificate in alcohol abuse studies from UC Berkeley and is a director of Alcohol Counselling Services,

Source: The Irish Times. 01/02/11