Supporting a friend in rocky sobriety
December 7, 2024 9:10 AM   Subscribe

My friend just got released from detox and will be staying with us for a few days or more. This is not the first time. How can we best help and support him?

My friend has struggled with his drinking for a long time. He’s been in recovery, with the goal of total abstinence, for at least five years now. Abstinence from alcohol is very important to his physical health as well as his mental health as he has chronic health issues exacerbated by his drinking. During this recovery period he has frequently relapsed, gone on a drinking binge (always alone at home) and has either been hospitalized due to alcohol poisoning or withdrawal symptoms a few days later. He has been to a residential rehab program as well as detox several times. He has a strong social connection through a hobby of his but has not really engaged with the recovery community outside of his detox. He struggles with depression, which he describes as the trigger of his drinking.

He is welcome in my home at any time, for any length of time. My wife and I have also struggled with our drinking and have been sober for almost seven years now. Unlike my friend, our sobriety has been consistent and relatively easy; we no longer consider it an active process. While we of course have complicated feelings about our friend’s drinking and worry about him, we want to do everything we can to support him without seeming like scolds or seeming blasé. How can we help him in the spirit of loving-kindness?

There is some possibility that my friend is reading this, and if so: you are my best friend, I love you, I’m worried about you, I want you to get better, and you will never exhaust my patience. I hope that Mefites in their wisdom can share advice that can help us all.


A quick note: we do attend AA meetings together when he stays with us, which we’re happy to do though none of us love that culture or environment. There are no local SMART meetings though all of us prefer them. He does attend online meetings and we have a golden retriever who will also provide many snuggles.
posted by skookumsaurus rex to Health & Fitness (12 answers total) 6 users marked this as a favorite
 
Best answer: Naltrexone for the Management of Alcohol Dependence [nih]
posted by HearHere at 9:32 AM on December 7


Best answer: The Small Bow (https://www.thesmallbow.com) is a good recovery resource and not just for alcohol. From an Al-Anon perspective, it seems to me that you can be supportive of your friend by offering him what you are offering him and then treating him like a grown-up. If you have boundaries (for example, one of my boundaries is that I do not allow people to drink in front of me if they are people in active addiction), you should let your buddy know what these boundaries are and be prepared to act accordingly if they get poked at excessively. Of course I can’t stop anybody from drinking but I will leave the space if somebody is drinking in front of me whom I know to be struggling with addiction.

The Small Bow folks are mostly but not exclusively people wrestling with alcohol and drug addiction although some are dealing with other things, such as eating issues. All the meetings take place online and The Saturday meeting is specifically focused on mental health. I find myself wondering if your buddy should be seeing a therapist and potentially taking medication for his depression. I am not a professional, I’m just someone with ADHD, depression, and anxiety who also works on various forms of recovery for myself. You are a good friend, best of luck!

(Sorry about not being able to include a link, my device is being super fidgety.)
posted by Bella Donna at 10:39 AM on December 7 [4 favorites]


Best answer: I think any decent rehab program is going to have walked participants through planning for sobriety, and I hope that means he has had those conversations already. Now he needs to share those plans with you. Like, "if I'm at home and I want to drink, I will X", "if I am out in public and the opportunity to buy alcohol/drink is available right there, I will Y". You have to know in advance what you're going to do because in the moment is way too late to decide.

If rehab (or I see you specifically say "detox" which I'm taking to mean a medical hold for withdrawal) did not do that, it has to be one of your first conversations. And that may well be a chain of plans that involve you as well, "if I'm at home and I want to drink, I will tell my friends/hosts and we will ___." "I don't want to go out where bars and stores are open without one of the rexes with me so I will give them X amount of advance notice that I want to go out." And y'all should encourage those plans to depend on activity, not inactivity, not "if I'm at home and want to drink I'll just sweat it out alone."

I think it's also worth discussing, to the extent of his comfort doing so, what it is that initiates breaking sobriety. In the past, home alone, the decision to drink occurs like how? How do we try to engineer around ever reaching that point in the first place? Is it loneliness, hopelessness, physical discomfort, anger, insomnia, hunger, what are the ingredients that put him in a place of relapse, and how can you create an environment of safety around those things? Depression is not just a spectrum but a plot-graph, you have to understand the triggers on a more specific level than that.

Another important component seems to be how they're going to fill the hours they're not drinking. Everyone I know with a successful sobriety habit has put other things to do in the time that used to be consumed with the high-dopamine cycle of obtaining, using, and enjoying (and being sick/recovering is not high-dopamine but it does fill the hours pretty well). You HAVE TO put other dopamine in those slots, and ideally there's a selection of dopamine on offer and not just one thing. You cannot fill that time or fulfill that need with cheap dopamine like screens (though they can be one ingredient of many), and I think part of the reason things are so fragile post-rehab is that they are out of the habit of anything else that might have served that purpose aside from using.

And it's HARD to be at someone else's house fresh out of rehab and you can't repaint the place or do a messy craft or be noisy or learn to do something that's a little embarrassing to have other people watching your learning curve. But this component is absolutely critical to ANY lifestyle change from getting over a breakup to giving up carbs to getting off heroin: you have to fill the hole with something good, or something bad will find that space. No human can maintain their sanity staring at the walls 16 hours a day. You cannot fill your time with "Not Drinking", that's not how time works really.

All of this boils down to "you have to talk about all this" because this is an adult with agency and I know y'all don't want to be jailers, but I think The Unspoken is a real enemy to sobriety or change. I also don't think sobriety is especially sustainable until you have had this dialogue with yourself; if you just get turfed back on the streets without having done the visualization of what a sober life looks like to you, how can you attain it? If you're standing there unarmed with any reason to not drink except "not supposed to", what else are you going to do?

I think having anybody left who wants to help you achieve that life is one of the primary differences between success and failure, but that's not a thing until you have a goal.

And the depression has to be treated. It would be fantastic if they could actually be assessed by a professional to figure out from self-reports which neurotransmitters are most likely the primary suspect and it would be spectacular if they could access pharmacogenomic (gene testing to see which psychiatric drugs are most likely to work) testing. In the US, serotonin is generally considered the most important and SSRIs are generally first-line treatment for Alcohol Use Disorders, and it's probably better than nothing if real assessment isn't available.

To expand on the link in a previous comment, naltrexone is often available pre-combined with or alongside SSRI or NDRI (aka Wellbutrin, Zyban, or generic bupropion) which we don't even entirely know how it works but it has been effective across multiple addictive spectra including nicotine addiction, misuse of food, and alcohol use, plus many people with ADHD use it to reduce dopamine-seeking behaviors.

You say he just came out of "detox" so I fear none of these things have happened for him, and it probably means that substantial mental health treatment is difficult to access. If he's game to work with you on the research project of DIY assessment and convincing (not that difficult though - we're not talking about controlled substances prescriptions) a GP to put together a medical treatment plan, please do. Most people wouldn't willingly choose the life of relapsing alcoholism, that doesn't happen unless something else is missing - and while yes 'a happy childhood' or whatever but truly on the day-to-day there's something in the brain that isn't doing what it should, and luckily the medications for that are mostly widely-accessible and cheap, you just need to find the regimen that works.

I wish you all success in this process.
posted by Lyn Never at 11:18 AM on December 7 [14 favorites]


Best answer: What’s his schedule going to be like? I’m guessing that detox was pretty structured and that will be missing once he’s out. If you can engage him in the household (help peel carrots, come walk the dog with me, whatever he’s up for) that gives him less time to ruminate and he can feel like he did something today.

And +1 treating the depression if possible. If medication and therapy aren’t on the table, some assortment of lifestyle things like exercise, journaling, eating some fruits and veggies can help. They’re good things to do in themselves, and also develop the habit of treating yourself like you’re valuable and deserving.

You’re doing a really good thing, all the best to all of you.
posted by momus_window at 11:18 AM on December 7 [2 favorites]


Response by poster: Thank you for the information and please keep it coming! I think we do need to have some clear conversations with him about his goals and his plans. To date we’ve erred on the side of “he’s heard plenty of negativity from himself, let’s show him unconditional love and set a positive example of a full life without alcohol” but I’ve become increasingly worried that we may come across as “we’re healthy and fulfilled, why aren’t you?” We’re also very worried that he is engaging in self-harm through his drinking and that he may be considering more. He hasn’t worked a regular job in some time, and though we’ve urged him to think beyond the corporate work he used to do before “taking a break” and to do some of the volunteering he’s talked about wanting to do, he hasn’t seemed to take any forward steps in a couple of years now. So a kind, clear, but opened-eyed conversation is probably merited, though I expect he may be evasive or feel exposed by it.
posted by skookumsaurus rex at 12:58 PM on December 7


Best answer: There's already some great stuff here. I want to bring up a less heartwarming aspect (from my own path as a stepdad to a now young adult who has been struggling with many substances for almost as long as I've known her, and from my own path of slowly letting go of my own issues... including being just over a year out of alcohol). There's an acceptance component that you may want to try to keep in mind. That acceptance extends to your friend's experience being the way it is. This includes the possibility that the details of their experience won't change, and that your goodwill may need to be something that may need to experience changing. A notable shift in my daughter's life was the point after which I could provide a place for her to come for meals and hugs and rest and recuperation, but not a place for her to stay unattended. That... took a very long time to think about before I could bear to speak it. With that framing, it is a good time for you to hear that it's worth thinking about, even if you never have to speak it.

Also, good on you.
posted by late afternoon dreaming hotel at 2:35 PM on December 7 [4 favorites]


Best answer: Thank you for the update, skookumsaurus rex. I am going to suggest that you and your partner consider attending some Al-Anon meetings (online or in person) to potentially help you better understand how to take care of yourselves as well as your buddy. I also want to mention the concept of a recovery job.

Many of us dealing with recovery cannot go back to exactly the same type of work as we did before. Temp employment agencies as well as volunteering can be helpful ways to ease into a more responsible life. Some folks find work at Starbucks. It doesn't really matter where you start, as long as you start somewhere.

But that part is not up to you, that is up to your friend. One question to ponder might include, "How am I willing to support my buddy and how am I not willing to support my buddy, and can I accept that whatever I do may not prevent the worst from happening?"

Al-Anon really helped me learn that it was possible to support the people who I loved when they were not okay and still find ways to be at peace myself.
posted by Bella Donna at 8:41 AM on December 8


Best answer: A very silly suggestion for the depression part: this is the right time of year to stock up on Advent calendars filled with anything you think might appeal (except alcohol). Disregard the numbers (or relabel them somehow) and just let your friend open one door per day. Sometimes, it just helps to know that there's at least one thing per day that does not suck.
posted by demi-octopus at 11:21 AM on December 8


Response by poster: It’s been a week and I figured I’d update everyone and thank you again for your advice and well-wishes.

So friend, let’s call him Job, came and stayed with us. This went well. He stayed sober (according to him and to the best of our knowledge) while he was here. He attended a few online meetings and we attended an in-person one together. We took lots of walks and had lots of talks about making plans, sticking with commitments, focusing on the positive, understanding triggers, etc. we talked about looking for a job and volunteering. He registered to volunteer. He seemed “vacation positive”. But he seemed surprised and dismissive about questions about finding a sponsor, going to an employment agency, working the steps.

A few days into his stay he asked my wife if he could order packages to our house, which of course he can. Later that day he told me he was planning on returning to his apartment for a few days to pick up packages he had just ordered. It seems clear that this was when he made a plan to drink again, whether or not he intended to follow it. He returned home, told us he was attending a meeting and was tired but would check in in the morning. After he didn’t I texted and he didn’t respond. This was yesterday. I left him a voicemail asking him to just let us know he was safe. Late this morning I texted again and he responded that he had “fucked up” and relapsed. I told him I’ll call him tonight to talk.

I’m of course disappointed that he relapsed, and annoyed. My wife and I are both clear with each other that we can’t make him do anything that he doesn’t want to do, and right now it seems like he doesn’t want to stop drinking. I think he does want to not suffer the consequences (and to be clear his doctor has assured him that his global health is on the line here), but he was very resistant to our characterization of sobriety as an active positive process. We talked about how we quit not just by abstaining from alcohol but by engaging in therapy, in community, and in alternatives to drinking. He frequently attends AA and SMART meetings but is openly disdainful of engaging in the work outside of the meeting: getting a sponsor, doing his homework. He has a wide range of excuses: sponsors aren’t professionals, he hates religion (an attitude that he doesn’t seem to connect with the fact that I’m quite religious, albeit not an evangelical Christian that he’s reacting to), he’s never gotten a dui or gone to jail, he’s not like those people. But the truth of the matter is that according to his doctor and his family history, he will end his life, by suicide or by organ failure, if he does not stop drinking.

We know we can’t prevent that. Only he can. We’re on top of taking care of ourselves, as much as I’m ranting here. But I thought you all should know.

Our next steps are to encourage him to keep working at it. Those days counted, today counts, tomorrow can too. My wife and I want to meet with a suicide prevention specialist to talk about how to talk about it. And I think I’m going to strongly encourage him to look into Oxford House and other residential programs. He was happy about being sober while he was here. He just can’t be alone. We work full time and he already told us that being home with the dog was a strain while we were working. So I think supportive living may work for him. If he wasn’t so reactionary about religion I’d recommend L’Arche, anything to keep him in community and in service to others.

If you all are still available for advice I’d love to hear some about good resources for preventing self harm, about sober living houses and what you know about them, and about non-religious service settings like L’Arche or Moishe House where he could feel dignified about living with others. Many thanks again to this wonderful community!
posted by skookumsaurus rex at 4:08 PM on December 15 [1 favorite]


Response by poster: Oh forgot to add that I would definitely love to talk to him about pharmaceutical therapy options, but him engaging in medical treatment (beyond detox) is dependent on him wanting to engage in medical treatment, and he’s made no indication that he’s ready or willing to go for that.
posted by skookumsaurus rex at 5:47 PM on December 15 [2 favorites]


Best answer: If you all are still available for advice I’d love to hear some about good resources for preventing self harm, about sober living houses and what you know about them, and about non-religious service settings like L’Arche or Moishe House where he could feel dignified about living with others.

Alas, I do not have any advice on this. But I suspect that Small Bow's A.J. Daulerio, or someone he knows, will have recommendations or advice.. You can find his email here. So sorry your friend is allowing his skepticism about religion to cloud his judgement about the work. It is fucking painful to watch a buddy teetering on the edge of disaster. Best of luck again in helping your friend while staying in recovery yourselves.
posted by Bella Donna at 6:51 AM on December 17 [1 favorite]


Best answer: I think you are in Washington state, so I have a suggestion for a local rehab, and I also have a local friend who is a non-traditional therapist who has successfully dealt with their own alcoholism.

I have friends whose adult son went to this place one and half years ago. He has been clean and sober since leaving and has continued weekly virtual therapy with them. If you would like contact information for the therapist, please MeMail me. I wish you and your friend good luck.
posted by obol at 12:50 AM on December 19 [2 favorites]


« Older How should I oganize art size info for framing?   |   Where did all the soy go? Newer »

You are not logged in, either login or create an account to post comments