5 Things not to say to Someone with Alcohol Use Disorder

While most people with a friend or family member with alcohol use disorder (AUD) mean well, it can be easy to inadvertently say something that hurts more than it helps.  In fact, even calling someone “an alcoholic” rather than “someone with alcohol use disorder” can be problematic, because it can lead to a loved one feeling defensive or stigmatized;  the term “alcoholic” also downplays the fact that AUD is a health condition that can be successfully treated and lead to recovery.

Although terminology might seem minor, it can play a major role in how your words are received.  With the goal of showing support and having productive, compassionate conversation, here are five things to avoid saying when talking to someone with AUD – and what to say instead.

• YOUR DRINKING DOESN’T SEEM THAT BAD, MAYBE YOU JUST NEED TO CUT BACK.  This comment appears to offer reassurance that someone wit AUD doesn’t have behaviors that seem especially problematic, but it’s actually harmful because it downplays the condition.  Someone can have alcohol use disorder and still be functional in terms of balancing work, family and everything else.  We cannot dismiss an alcohol use disorder because people appear to be productive.  By saying their condition “isn’t that bad” also fails to acknowledge that alcohol use exists on a spectrum from low-risk drinking to AUD, and you don’t know where the individual might land on that spectrum.  Assuming someone is on the less-sever end of the spectrum where they’re still able to exert considerable control can be dismissive.  What to say instead:  “I know you’ve recently spoken a bit about some challenges with alcohol.  I’ve found some resources that might help if you’re open to exploring them together.”
• WHY CAN’T YOU JUST STOP DRINKING? This is one of the most common comments that those with AUD hear.  Saying this can make someone feel unworthy, weak or ashamed.  It can also make someone with AUD feel like a failure if they’ve relapsed or have had multiple attempts at sobriety.  The question implies that recovery is a matter of willpower and is a simple choice.  In reality, it’s a medical condition that’s defined by a hampered ability to stop or control alcohol use despite negative consequences on relationships, work and physical and mental health.  In fact, AUD is considered a chronic brain disorder that can lead to long term changes to the brain that make people more vulnerable to use and relapse.  Framing AUD as a personal failing isn’t “tough love.”  It simply shows someone with AUD that you don’t know the nuances of the condition.  What to say instead:  “I may not know what you’re dealing with, but I care about you and I’m here for you.  How can I help and support you?”
• YOU DON’T CARE ABOUT ANYONE OR ANYTHING BUT ALCOHOL. This statement is problematic because it implies someone with AUD is unaware of the consequences of their behavior, or that they’re being stubborn in continuing to drink.  But in reality, they may be using alcohol as a coping mechanism or numbing agent.  Most people with alcohol use disorder have had a desire or made multiple attempts to quit.  Often getting to the point of an alcohol use disorder indicates use as a maladaptive coping mechanism where one is trying to mask the pain of something else such as a co-occuring mental health disorder, trauma, low self-esteem or another issue.  Being told “you don’t care” adds to the shame someone is likely experiencing with AD.  Ultimately this feeds into a negative reinforcement cycle in which the person drinks to cope with the emotional pain of their shame, negative comments perpetuate the shame and the cycle continues.  What to say instead:  “Overcoming addiction is one of the most challenging things anyone can face.  I want you to know I love you and always want what is best for you.  Let me know how I can best support you through recovery”
•  CAN’T YOU HAVE JUST ONE DRINK?  Whether it is a champagne toast at a wedding, a beer at a ball game or a glass of wine at Thanksgiving, alcohol is often part of a celebratory atmosphere and this question seems to be encouraging- like you want the person with AD to feel included.  But it can come across as highly disrespectful.  For people with this condition, it may feel nearly impossible to stop at one drink.  One drink doesn’t make relapse inevitable, but it is certainly on of the factors that can contribute to lower chances for recovery.  On the other hand, a supportive social network that doesn’t revolve around alcohol has been shown to be protective against AUD relapse, which means showing support in these types of situations can be particularly important for someone dealing with the condition.  What to say instead:  “What can I get you to drink?  We have plenty of options including sparkling water, soda, juice or coffee.  Let me know what you prefer.”
•  YOU DON’T LOOK LIKE AN ALCOHOLIC.  In addition to using the term “alcoholic” this comment implies that someone with AUD has a certain appearance or set of behaviors that sets them apart from others.  This can be hurtful and demoralizing.  It also conveys a lack of support and encouragement because you seem to be dismissing what the person with AUD is trying to tell you about their recover.  People with AUD already struggle with guilt and shame.  Acting as if you don’t quite believe someone when they tell you about their disorder/disease can lead to shutting down communication and making them feel less supported.  What they need instead is empathy without judgment because this fosters trust and is more likely to spart discussion.  What to say instead:  “Thank you for telling me about what you’re going through.  I’m proud of you and your courage.  I want to understand what you’re dealing with, so please let me know if I say anything that seems like I’m not getting it.

 

THE TAKEAWAY:  When talking to someone with AU, comments you thin are helpful might actually be hurtful and could negatively affect communication and trust.  Trying a “tough love” approach of being aggressive can easily backfire since those who struggle with this condition tend to feel guilt and shame, and these comments can make those feelings worse.  Communicating with empathy and openness and without judgment can go a long way toward showing support and building trust.

The DRH Health Plaza Behavioral and Addiction Health clinic is here to help anyone who is caught in the throes of addiction.  We provide comprehensive outpatient treatment that addresses those elements that have been disordered due to addiction.  If you or someone you love is willing to accept treatment, we are here to provide.

Dan Criswell, MD
Plaza Behavioral Health and Addiction