How can I get my sister help for her addiction/depression?

September 20, 2009 3:15 PM

My sister has an alcohol and/or prescription and/or depression problem. What can I do to help her, and in what order?

Apologies for the long e-mail, but this is anonymous so I want to get as much of the story here as I can.

My sister was in town this weekend (from 250 miles away), and did some things that really alarmed us. She is a few years older than me, in her mid-30s, married with a boy and a girl who are 6 and 3. I see her a couple of times a year. My two girls are near in age and love to play with their cousins.

This weekend, my sister drank 2 bottles of wine each night by herself while everyone else (her husband, me, and my wife) had either soda pop or one beer each. She would get progressively more angry/aggressive (verbally) as the night went on, but was never in a rage. Just noticeably sharp-tongued and at the same time boasting about herself.

Then overnight last night things got really bad. Apparently, after everyone went to bed she woke up (or never went to sleep) and snuck downstairs. She either drank more (but we couldn't find anything she could have) or popped some pills (again, not sure what they were or could have been). She was up into the night posting incoherently on her blog and on Facebook. Then on her way back to our guestroom she fell on our stairs and bloodied up her face, and fell over into a door (this was at 5:30). When her family left this morning at 8:00, her husband had to literally pick her up off the floor, then support her as she stumbled down the stairs and out the door. He flopped her down into the car and they were gone.

Talking to my parents, this is at least the 3rd time something like this has happened recently. My sister appears to be in complete denial that there is any trouble, and for whatever reason I think her husband is not willing or able to address the issue proactively (or at least not initiate action himself).

My wife and I think she needs help, now. For herself, for her kids, for her husband, and for the rest of our family. Complicating factors are that she has been generally depressed for as long as I can remember, she has MS, and she is without a job (recently) and being chased by creditors (for a long time).

I don't know if we need an intervention or a direct talk with her. I don't know if we should talk to everyone and get them on board behind her back (which could infuriate her and set her off if someone tells her) or address her first (which could set her off into a denial/aggression cycle before all the pieces are in place to convince her to get help). I don't know whether insurance will pay for rehab. I don't know whether I can or should call her own therapist and express my concern/get his advice. I've never done this before but think that my family will look to me for leadership. I am concerned that she could hurt herself; she will surely be defensive/dismissive/angry when confronted. I love my sister and want to help her. She will not be happy that this is happening.

For those who have been through this: how did you do it? In what order? With the addict's knowledge or behind their back?

Thanks for any advice you can give. Throwaway e-mail is [e-mail]

posted by anonymous to health & fitness (7 comments total)

I have little experience with alcoholics, but much with depression. I'm not sure about intervention but the first thing you need to do, IMO, is let her know that you know she's having a tough time and that you're there to support her. Approach her about her depression and be there to help her get through it. I don't think you can save her, but she will probably have a much easier time knowing there is someone who cares and is beside her no matter what. She needs a lot of love right now.
posted by alona at 3:20 PM on September 20

Anonymous, I am sorry your family is having to go through this with your sister. Unfortunately, it is very difficult to change someone who doesn't want to be changed. She somehow needs to face a turning point. For most alcoholics that is what it requires to want help. Rarely will an alcoholic who doesn't want to stop drinking respond constructively to the instinctual desire of family to help. It almost always takes some kind of crisis, or "bottom" as it's called.

In the mean time, you may be able to provide comfort and support to your sister's husband and children. They are having to deal with their wife/mother on a daily basis. It sounds like your brother-in-law may be in denial himself, that he is probably not liking, but accepting the behavior of your sister. This is known as co-dependency. The co-dependent will do whatever possible to keep the addict under control so there aren't blowups, including helping to hide their addiction.

Talk with your brother-in-law about Al-Anon, counseling for himself and his wife if possible, but most of all make yourself completely available to provide support whenever he encounters a tough stretch. My best wishes for you and your family. Unfortunately alcoholism is a family disease. I know that I certainly wrecked my own family.
posted by netbros at 3:39 PM on September 20

Are you sure she took another substance (alcohol, other drugs) before the bizarre behavior that night? If there's nothing obvious she took, and the behavior changed significantly between the drinking and later that night, I worry there might be something in addition to substance abuse going on, such as psychological and/or neurological issues.

I agree with alona that letting your sister know that you've noticed she seems unhappy and you'll do anything you can to support and help her is the first step.
posted by xingcat at 4:09 PM on September 20

It sounds like nobody has actually talked to your sister or her husband directly. As uncomfortable as it may be in deciding what to do going forward you can't afford to rely on appearances or assumptions. Talk to your sister and if she does not acknowledge that there is something wrong with what she is doing talk to her husband later. Sometimes people are waiting to be confronted and that is their turning point, but in any event you need to know where things really stand. This opinion does not come from a hypothetical foundation, incidentally. If your sister is indeed in true denial about her problem it is going to be very difficult to intervene if you can't get her husband on board, and of course nobody can force an alcoholic to get help until they are ready to accept that they need it.
posted by nanojath at 4:30 PM on September 20

I would start by talking with her and her husband, separately. When you speak with her, try to ask non-confrontational questions and just listen to what she says. For example, "You've been on my mind lately, how are you doing these days?" and/or "Is there anything I can do to help out?" Seems simple, but it really isn't. It will be very difficult to refrain from voicing your very real concerns, but her answers will tell you a lot about where she is emotionally and what her perception of things is. This is an information gathering stage, which you need, before you can explore your options. Maybe she will be obstinate and defensive even with very neutral and open questions. This will be as telling as much as her giving an honest and thoughtful answer would be.

When you speak with her husband, be a bit more specific, but again refrain from sounding judgmental. For example, "I've been thinking about sister's behavior this weekend, and I was wondering, what's your take on it?" and/or "What can I do to help?" Again, this will give you a sense not just of where she is, but also the dynamic of her household. It will be very tempting to formulate a plan of action while talking to him, but I would encourage you to listen and sit with what he says for at least a few hours before you try to intervene.

Once you have a better idea of their perceptions, then you can figure out how to proceed. IANAD, but I have a long history with depression. Since she has struggled with depression for a long time, her alcoholism could very well be a form of her self-medicating. I'm not saying she isn't an alcoholic, at this point it's hard to say, but the depression seems to be a long-term underlying cause. The alcohol feeds the depression and vice-versa, but from what you've said, I think the primary issue is her depression. I don't think it's out of line for you to call her therapist and express your concerns, but go into it knowing s/he cannot tell you anything about your sister or her condition. You can ask for resources or suggestions, but first acknowledge you understand that her therapist cannot divulge any information about your sister.

I'm really sorry you, your sister, and your families are going through this. It is hard to watch a loved one spiral downward, and no one wants to sit idly by and let her hit rock bottom (though at some point, it may come to that). She is very lucky to have such a caring family, but it may be hard for her to see that right now. If so, try not to let that get to you and discourage you from reaching out. Ultimately, for anything to change, she has to want help, and it's easier to do that when you are surrounded by people who love and sympathize (if not empathize) with you, even if your first instinct is to resist and retreat from your loved ones outstretched hands. Really and truly, best of luck to you all.
posted by katemcd at 4:55 PM on September 20

Interventions are not a good idea. Some large proportion of families never go through with them, sometimes they go drastically wrong (Kurt Cobain's was immediately before his suicide) and they actually increase the risk of relapse if you do actually get the person into treatment and can cause lasting family rifts.

So, what to do instead? There's a kinder, gentler and more effective method called CRAFT (Community Reinforcement and Family Therapy)-- if you can't find a nearby practitioner, the link has info on a book about how to do it.

Given the MS and the depression, the best way to approach this is to find professionals who specialize in "dual diagnosis" and recognize that treating both at once is better than sequentially (some addiction people have the idea that if you clear up the addiction all the mental and physical stuff will just go away; some mental health people think just dealing with the depression will clear the addiction-- no, both need to be treated).

If she has pain related to the MS, she may well need to be on opioid pain pills and addiction does not necessarily preclude this-- just because someone is an addict doesn't mean they can't feel pain and opioids are sometimes the only thing that helps. Extra controls may be needed to deal with this-- but untreated pain is more likely to produce relapse than appropriately treated pain.

It is unlikely that she will change overnight, but the best way to help is to be supportive, nonjudgmental and to make sure she recognizes you are not trying to control her, take away the only thing that lets her function or her only source of relief and/or pleasure. If you can make this clear-- and that you are there to support her, not to confront or attack or humiliate her-- that's half the battle. Let her know that the goal is to help her reach *her* goals of being happier, more productive, a better mom, etc-- and that you will advocate for her to make sure that she isn't put in some kind of situation where she is denied pain relief or antidepressants because of some outdated ideas about addiction.
posted by Maias at 6:26 PM on September 20

First I would try to get her to a doctor who can check her out for neurological problems or any other complications of MS.

Deciding that she's an addict is putting the cart before the horse. I don't think you can make that determination on your own in this case.
posted by kathrineg at 10:35 PM on September 20