Question: Hi Dr.I am writing on my sisters behalf.She is an alcoholic.This past week she was taken to the er twice.She is not able to use her legs at all and her hands barely move.They did lots of tests and found her liver to be not functioning well,her white blood cells elevated,and severe malnourishment.They did an mri to see what was up with her legs and arms and found she not only recently had a stroke,but that she has spots and bubbles close to her brain.They told her to go to neurologist right away and stop drinking and smoking.She has no insurance and is very ill.Are these things caused by alcohol?Her legs don't support her and she needs to be carried everywhere.The worst is that I think she is still drinking.I love her,but the past ten years have been so hard.Is she dying?She is only 32.Please help.Thank you very much.She has also lost so much weight and her belly is bloated and squishy.It is so hard to see someone you love destroying themselves,our family is suffering so much.She lives in Nevada now but has lived in Ca. for years.Are there any low cost rehabs?I have to keep trying for her.

Dr. David Sack Says...:

You are
in a very difficult situation.  Your sister’s alcoholism is very advanced
and most of the problems she is experiencing can be explained by her alcoholism,
her malnutrition and a stroke.  Most drug and alcohol treatment programs
would have difficulty in providing the level of medical supervision that your
sister needs right now.  A psychiatric  hospital that has
drug/alcohol treatment and is handicap accessible may be her best choice. 
In light of her multiplicity of health problems, she might qualify for
emergency Medicaid services. The hardest part may be getting your sister to
accept treatment as treatment can only be provided on a voluntary basis so she needs
to be willing to stay and participate.

Question: My wife drinks more wine than she used to. A couple/three glasses on weeknights and much more on weekends. We used to party harder when we were young but as I and most of our friends have sort of slowed down as we get older and have kids and jobs and all that, she seems to be picking things up. She takes care of her business and she’s a great mom and she says she’s fine but I think she is starting to have a bit of a problem. It is becoming a sore point between us. How can I know for sure if she is becoming an alcoholic?

Dr. David Sack Says...:

One would need a lot more information to be able to say that someone who is drinking has slid into dependency.  It is not simply a question of how many drinks your wife is having.  Women are more susceptible to alcohol’s effect than men and she is drinking a considerable quantity.  The question becomes is drinking affecting her life?  Is she having health consequences?  Is it a sore point between the two of you because her attitude and mood changes when she drinks (irritability, hostility, depression, anxiety)?  Is she experiencing problems with work (lateness, absenteeism, less productive)?  Is she having legal problems like DUIs or car accidents?  My suspicion is that if you are already concerned, her drinking has become a  problem even if you can’t put your finger on it.  

There are several directions you can go in.  If your wife is willing, the two of you could see a therapist experienced in evaluating and treating alcohol problems and see what conclusions they come to.  If she is not willing to go for an assessment, you may want to attend Alanon meetings to understand more about the disease of alcoholism and to sort out what you can do about it.    

Question: I’m about 8 months in recovery and my question is about how long I should wait before going back to see people from my past life that still party like I used to. My daughter and her husband and his brothers party all day and I’ve told then I can’t be around them when they are like that (I tried to get them to stop like I did but they did not want to hear about it). The problem is, I love my grandkids to death but now my daughter thinks I’m judging them all the time and that I’m just showing off. We had a big fight when I asked if I could take the kids for the day and she said if I am too good to come over then I am too good for my grandkids and maybe I should just stay away. I used to see those kids everyday and I miss them so much. My sponsor says I’m not ready to be at that house again, but I think I am ready and I don’t know if a sober life is worth very much if I can’t be with the people I love. I feel pretty strong and have no desire to drink right now. Is 8 months clean and sober enough time to go back and really face all my triggers?

Dr. David Sack Says...:

The answer is that when people are secure in their sobriety they realize the last thing they want is to be around people who are using and drinking and partying; part of the dilemma is that you don’t recognize how big a problem this is. When you are further along in recovery you will realize how distressing it is to be around your grandkids when they are immersed in a drug culture.

My advice is that if you want to visit with your grandchildren try to work out a scenario where you can take them out for the day but you don’t have to spend time with your daughter when she’s partying.  You can plan trips to the zoo, movies, or other events.

If your daughter still balks, take a gentle approach. First it’s important not to discuss this with your daughter when she is under the influence.   Keep the focus on your issues, not hers: ask her for support and to understand how difficult it is for you to be around drinking. Your daughter says she wants you to visit, and you want to visit, but it can’t work if you are around people who are high.  Emphasize that you are not criticizing them for what they’re doing, but if they care about you then they will respect the fact that it is very uncomfortable for you to be around people who are drinking or using drugs.

If you emphasize that this is your issue, not hers she may not feel like you are judging them.  You might also ask her if she has seen any improvement in your behavior – are you a better grandmother than you were a mother because you’re now sober?

Your sober life is most definitely worth finding a way to get through to your daughter without compromising your health and well being. And right now, you might be the sanest person in your grandkids' life. You don't want to take that away from them.

Question: Does AA work? I’ve known people that have gone to a few meetings and never had it really take hold, but as far as I can tell it’s not based on anything very scientific. I’m 24 and drink every day, and have been drinking for about 10 years and drinking hard for about the last 6 and drinking way too much for the last couple; and I can’t seem to stop on my own anymore. I know I need some help but I can’t help but think the whole 12 steps thing is kind of ridiculous and old fashioned. My fiancée says she might leave me if I don’t start going to meetings and quit (she wants me to go) but I keep telling her I’ll go do the whole the rehab thing once I can save up some money for it and that there’s no point on wasting time on something that’s not going to work. I am willing to get some help, I just want to get real help and I figure I’m only 24 and that even if takes me a year to save the money I need it’s not like I’m going to die or anything. So, is AA worth doing, or am I right to wait, save my money for something real, and get real help when I can?

Dr. David Sack Says...:

The reasons many people are successful in AA is more scientific than you
think. There is good evidence that people who go to AA are three time
more likely to be abstinent as people who don’t go; when people are also
given support by family and friends to go to meetings they do even
better. 

There isn’t one treatment approach that works for everybody. It sounds like you are really quite ambivalent about giving up drinking. It’s not really a choice between AA and saving up money for rehab; if you are really serious you could find a state-funded rehab.

Many people need to take more than one approach to stay sober over the long-term. You might not be able to benefit from meetings at this stage of your addiction, so the real question becomes: what are you prepared to do next to get well?

I have long spoken about the value of AA in recovery, and for good CLINICAL reasons. For one, alcoholism causes cognitive deficits in a majority of alcoholics.  It turns out alcohol impairs not only memory for things that have occurred but it actually impairs what we call prospective memory, meaning it interferes with your ability to learn new things.  So how does the 12-step program help people with impaired memory? You have to remember, the 12 step process evolved in response to what appeared to be helping other alcoholics. There’s tremendous experiential wisdom about how this process works so that the first thing I would ask is, how does 12-step recovery help memory? First off, the damage to memory means it’s easy to forget what to do next.  The repetition of certain core concepts in meetings addresses that deficit prospective memory (e.g., one day at a time, keep it simple, call your sponsor, go to a meeting).  Second, when sharing at meetings and retelling your story, you remember the negative consequences. This is important because when you actually look at the deficits in memory there is a specific deficit in alcoholics that has to do with negative reinforcement and avoidance. Alcoholics, even when they are in recovery, have more difficulty avoiding situations that are going to be painful or have a consequence to them. Telling the stories reinforces the idea that you must avoid situations that once got you into trouble. These are just a few of the reasons AA does work for many people.

There are other options as well for you. There are medications that can help to support recovery, outpatient programs, residential programs, and non-12-step support groups such as Rational Recovery. The real question is how committed are you to finding a treatment that will work for you?