How to best help a friend ready to address his (problematic) drinking?
July 16, 2017 12:05 PM   Subscribe

"John" has been one of my best friends since high school. Following the loss of his job a couple of years ago and the ensuing financial collapse that contributed to the end of his long-term relationship, he has moved in with his elderly parent and is drinking heavily. Our last phone conversation a few nights ago ended with his acknowledgment that he is ready to address his alcohol use. Given that I am halfway across the country and don't really have any personal experience on this score, what are the best ways I can help/support him?

I think the summary above the fold pretty much gets to the heart of my question, but here's some additional background in case it's useful.

"John" was a successful, well-paid, mid-level executive at a major corporation in the mid-sized city where we grew up, until losing his job about 3 years ago (I don't believe his job loss was due to his drinking; it seems to have been primarily due to restructuring, with a side of personality conflict with his new boss thrown in).

His 20+ year relationship with "Dave" (they met in their mid-20s) is the only major relationship he's ever had, so their breakup earlier this year is essentially the first "real" breakup of his life.

Dave had not held a job for several years preceding John's job loss due to his own depression/anxiety/drinking problems, so John had been supporting them both for quite some time. (He acknowledges that their relationship was highly dysfunctional and codependent.) Despite his best efforts, John was unable to find a new job. Ultimately, John burned through all of his savings and his retirement fund (for which he is now on the hook for a very large tax penalty he is unable to pay), until he got down to his last few hundred dollars, at which point Dave moved in with his family in a small rural town several hours away, and John moved to the college town about an hour away where his father and older brother live. (His mom, who he was quite close to, died in his 20s, right around the time he met Dave.)

John lived with his brother for a few months, and also worked in his brother's small business. Personality conflicts that they've had their entire lives reared their heads, and so John moved in with his father instead, and is now looking for new jobs in town. He has an interview next week that he's pretty enthusiastic about.

John has been deeply distraught over the loss of his identity as a successful businessman as well as the loss of his relationship. He admitted that a few months ago he was having suicidal thoughts (which I'd suspected) but says he didn't act on them by concentrating on the idea of not wanting to devastate his dad/brother/nephews/me/Dave by killing himself. I don't think he's drinking during the day, but it sounds like he is drinking very hard every night; when we talk (once or twice a week) I can usually tell that he's getting progressively drunker as the conversation progresses.

In our most recent conversation, he admitted that he'd gotten blackout drunk while staying at a hotel in our old city (he had gone down there to visit a friend); the last thing he remembers is being pushed out of someone else's room and collapsing in the hallway. At that point, I asked him if he was ready to address his drinking, and he said yes. (It was late and the conversation had gone on for more than an hour at that point, so we both agreed to table it till our next talk.)

He has no real support network -- a small handful of high school and college buddies back in our hometown (but no one he is very close to) and a few new acquaintances that he's met at the local gay bar, but that's it. He is Christian (Lutheran) but doesn't attend services, though he has expressed interest a few times in going back to church. His dad is elderly and in failing health, and while he and his brother do love each other, they don't like each other very much these days. I will be visiting John for a couple of days in the fall on my way to a professional conference.

TL;DR: what's the best way for me to support him? I know he has some fairly strong reservations (which I share) about the AA model of drinking/recovery, but it does have the advantage of being something he can try as soon as he's willing; should I just encourage him to go to a meeting and start from there? (I personally think the SMART Recovery method might be more up his alley; there aren't any meetings, as far as I can tell, in the town where he's currently living, but there are several back in our hometown city.)

If you've gotten sober, or have supported someone who has, I'd love to hear insight into the best ways I can support/encourage him. I totally recognize that I can't make him get sober, and that ultimately he will only make that decision if and when he's ready. But nevertheless, John is one of my oldest and dearest friends, and I want to do what I can to help him help himself. Thanks.
posted by the return of the thin white sock to Human Relations (14 answers total) 2 users marked this as a favorite
He may need medical supervision to quite drinking, stopping to drink alcohol can be more medically risky than continuing to drink. Ditto, it's risky if he goes back to drinking, he will certainly misjudge his tolerance and that could be dangerous, too.

I really think he might need a doctor, and or to quit in a medical setting. There are scam rehabs, so be very careful, but this is what I recommend.
posted by jbenben at 1:05 PM on July 16

I really think he might need a doctor, and or to quit in a medical setting.

I've wondered if this might be the case. Is this possible to do without health insurance or financial resources? (He does not qualify for Medicaid or any other type of assistance in the state where he lives.) In other words, can he just go to the local hospital and essentially check himself in for detox (and presumably figure out payment later), or is this a sort of specialized medical supervision he'd only be able to get in rehab?
posted by the return of the thin white sock at 1:12 PM on July 16

Also, are there specific signs to look for that would definitely indicate that he needs medical supervision? How does one differentiate between it being medically safe and medically dangerous to stop ingesting alcohol?
posted by the return of the thin white sock at 1:16 PM on July 16

You can encourage and support, and be there for them, but until they want to be sober I don't think there's anything you can do to make them improve. It's a rough process, a friend of mine has been on and off the wagon for years. Sometimes just pointing out obvious things can be a help, "no you can't keep going to aa because they are your friends and you want to drink on the side and hang out and not tell them".
posted by TheAdamist at 1:24 PM on July 16

Also, are there specific signs to look for that would definitely indicate that he needs medical supervision?

Well, I am not a doctor, and this is not medical advice, but to me it seems like when a person has become physically addicted to alcohol, like they start getting the shakes if they don't have a drink, that's definitely detox country there. If they are drinking a large quantity of alcohol (like a fifth of liquor) every day, it also seems to me unadvisable to try to stop abruptly.

How does one differentiate between it being medically safe and medically dangerous to stop ingesting alcohol?

I don't think there's really a way to know for sure. I stopped w/o detox or prescriptions. I didn't drink every day, though - my system was accustomed to huge drinking bouts, followed by a couple of days of sobering up. So one day I just stuck with the sobering up phase, and it was fine. A little anxiety and insomnia. Deciding that was an acceptable risk for myself is really different from making blanket pronouncements about who can self-detox safely, though. Your friend, ideally, would talk to his doctor.
posted by thelonius at 1:32 PM on July 16 [1 favorite]

Couple things -

Regarding detox, every State is different so he needs to find out what is available. In my California town, detox is $150 per day out of pocket if you have no insurance. First people go to the Emergency Dept. for medical clearance, but that assumes they have Medicaid, which it sounds like he is not qualified for. You can help by calling around to see what is available/paid for in his State.

Regarding getting help, he probably needs/can afford outpatient drug treatment, not just a support meeting like AA. You could help him out by finding out what is available near him, how much it will cost ($60 per week here in my CA town.) They are in the best position to help him talk through, in depth, his treatment options and how to detox from his high levels of alcohol use. If you can help him get there, they will take it from there.

The two biggest factors in people getting clean are the criminal justice system forcing people into treatment and family/friends persuading loved ones into treatment so he is lucky to have you. Just keep in mind that you should never work harder than he does to help him into recovery. Ultimately, it is a voluntary system and if he isn't motivated to seek treatment, there is nothing in the system that will compel him to do so (unless he gets a DUI.)
posted by eleslie at 3:15 PM on July 16 [3 favorites]

You said something that struck me as a symptom of your friend's problem. He's lost basically everything, money, job, relationship and he's on his way to killing himself, either through drink or something else. And he can't access AA, because he has "reservations." It's like someone is drowning and won't grab the rope that they're being thrown because it's not made of the right material.

Many people have reservations about AA. AA doesn't work for everyone, but people can (and do) manage to put their reservations to one side and go to meetings and work on their recovery. It's a long, hard journey, but I'm not sure what other options there are. Many people have gone to 12 step groups and hated some aspects of them, and still managed to save their lives. You can certainly call a treatment center like Hazelden / Betty Ford and see what charity or payment plan options they offer, but your friend will probably have reservations about that too.

I'd suggest he go to an AA meeting *tonight,* tell his story, tell his reservations, and then listen as hard as he can to other people's stories as well and see if he can find anything to relate to.

I'd also suggest the same to you, except make it an Al-anon meeting.

This sounds like a very dire situation and also a moment of opportunity for your friend. It's no time to get picky about whether a particular approach is not *exactly* what he has in mind.
posted by jasper411 at 4:06 PM on July 16 [9 favorites]

There are online SMART recovery meetings and a forum. I also have reservations about the AA model but it does have the major advantage of access to a support network so it would be worth a try for him to check out some local meetings-- all AA groups are different so he may like one over the others. Some people prefer NA, and to my knowledge it's acceptable to go even if your only substance abuse issue is with alcohol. A therapist trained in substance abuse treatment is another option; without insurance he would want to look for affordable sliding scales.

You can call local hospitals to find out what their criteria for detox admission is and what it might cost. Most hospitals have some sort of financial assistance program for people without insurance. Alcohol is one of the only drugs where withdrawal can be fatal so he should go to the hospital if he's experiencing withdrawal symptoms, especially those associated with delirium tremens.
posted by fox problems at 4:37 PM on July 16 [2 favorites]

If he has reservations about AA those reservations should be respected. He doesn't lose all autonomy because of the nature of his addiction. Non-12-step options for addiction treatment absolutely exist, and others can speak to better than me.
posted by colorblock sock at 5:49 PM on July 16 [5 favorites]

The #1 advantage of AA is that he can go there and have a face-to-face, in-person conversation with someone who has been where he is. They might even be able to have a laugh about the whole thing, where you and I might be utterly horrified. An online forum is pretty weak sauce compared to that. It's not like fixing your car, after all.

If he's open to that, I recommend it. In fact, if there's anything I'd recommend to someone who's stuck drinking, it's to at least open yourself up to some alternative approaches to life.
posted by billjings at 12:35 AM on July 17

SMART recovery also have face to face meetings. They focus mainly on CBT and REBT based approaches and don't require belief in a higher power.
posted by Laura_J at 3:20 AM on July 17 [3 favorites]

Tell him to read /r/stopdrinking. It's a very welcoming and supportive group. You can get a lot out of it just by lurking and listening, but actively contributing is likely to work better.

Secretly, the best bit the little badge that automatically counts up your sober days.

Good luck to you and your friend.
posted by ZipRibbons at 8:03 AM on July 17 [1 favorite]

See if there are Lifering meetings in his area.
posted by ethical_caligula at 10:13 AM on July 17

I've gotten sober maybe a dozen times, and never made it stick until the last time. The last time, two things were different. I was scared for my life if I kept drinking, and I finally tried AA meetings. Something worked, because I'm still sober 12+ years later. Moreover, I enjoy my sober life, and consider quitting the best decision I've ever made.

I can't say that it's all because of AA, but it was a huge help in learning to live sober. It is a readily accessible community of other people who understand exactly what it means to be alcoholic and to get sober. The meetings are plentiful and free. (They ask for donations to cover room rent, but welcome everyone who wants to be there, whether they have a dollar or not.)

I was sure AA wasn't for me, until I tried a meeting. I found that it was exactly for me. I found it was a huge help. I didn't do the program whole-hog, but I still got lots of help and support and learned to live sober permanently.

My advice to your friend is to go to his most convenient AA meeting, raise his hand when they ask if anyone is new, and speak to other people. It's a good idea to try lots of different meetings, and keep going back to the ones that click for him. I'll also add that not every meeting is fun, but I've heard something useful in every one I've been to. They are also a good hedge against drinking that day. has a meeting finder on its home page.
posted by Cranialtorque at 2:33 PM on July 17 [3 favorites]

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