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I Don’t Drink Too Much, and I Don’t Need Help

September 12, 2010

September is recovery month. The U.S. Dept. of Health and Human Services offers online resources, research, news and first-hand accounts of people who’ve been on one side or the other of recovery. I’ve spent many hours of my clinical life meeting with people who were convinced that their alcohol (or substance) use wasn’t a problem, and that they didn’t need help.  Most often they didn’t come to see me voluntarily. They were brought by spouses at the end of their rope, sent by parents, or by an adult child, sometimes even sent by the courts, for a DUI, or possession of an illegal substance.  Perhaps you’re one of those people, or worried about a family member who denies having a substance abuse problem. The problem is, how would you know?

The joke goes, “Denial is a river in Egypt.” As a defense, denial is just about as big and deep as the Nile. You’ll never get an unrecovered substance abuser to acknowledge that he or she has a problem, because  denial prevents this obvious recognition.  That problem (the inability to recognize your own mental illness) is known clinically as anosognosia. About half of all schizophrenic and bi-polar patients suffer from anosognosia, as do people with depression.   By my count, about 100% of substance abusers initially and insistently refuse to believe they’re impaired. How to break through denial?

  • First, shine the light on yourself. Take a simple questionnaire. If you pass that, take another more sophisticated questionnaire. Then read over the AMA guidelines for alcohol consumption for men and women.  Next measure that glass of wine, or pour of hard liquor. When people tell me, “I only have a glass or two,”  my first question is, how tall is the glass?  Most people don’t pour the standard measure of a drink, which is 5 ounces of wine, or 1.5 ounces of hard liquor.  They pour a 10 oz. glass of wine, or a 3 oz. scotch on the rocks.
  • Next, share your own vulnerability. Focus on the problem your loved one can see. Be gentle, don’t hammer, but set limits.
  • Leverage your love. Ask the person to get help for your sake, and the sake of your relationship.
  • If you’re a parent?  Disclose the substance abuse problems that run in the family (the genetic heritability is quite high for these disorders).  Set the example you want your child to follow. “Do as I do,” is more powerful than “Do as I say.”

And if your loved one still doesn’t think they need help?  Go for yourself. You’ll develop strategies and support, which you need. Recovery is for everyone involved.

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