10 Steps To Take If An Alcoholic Refuses Treatment

When someone’s life is completely taken over by addiction to alcohol, the hardest part is accepting the loss of control and acknowledging addiction. This is usually accompanied by feelings of shame, loss, and embarrassment.[1]

Accepting that you are addicted to alcohol, and even using the word ‘alcoholic’, will give you the power and the motivation that is required to change your relationship with alcohol.

This gives you the confidence to beat alcoholism or an alcohol use disorder and live a long life of sobriety.

Acceptance is about reality. To accept that you are an alcoholic means opening your eyes to the harsh realities of addiction, including its impacts on you and those around you.

Addiction has a domino effect and can impact family bonds, personal responsibilities, and career potential.

Accepting you have a problem with alcohol doesn’t get rid of the problem, or minimise the efforts needed to conquer it. It does, however, provide the first step towards a brighter future.

Accepting that you need treatment can help you in many ways:

• Honestly accept how life is going for you
• Move through feelings of anger, embarrassment, and shame
• Learn from mistakes to move forwards
• Provide the motivation to be successful in the treatment
• Open yourself up to treatment that will be suitable for you
• Give you the opportunity to forgive yourself

Unfortunately, there is no equation nor a complete solution to get someone to accept addiction and enter treatment.

We cannot force grown adults to get the help they need, but there are certain ways you can help them build up the motivation they desperately need to start their recovery journey.

The following tips are 10 steps you can take if someone you know is refusing to get help for alcohol addiction.

What if an Alcoholic Refuses Treatment?

1.     Accept that you cannot force them into treatment

Most individuals with a substance use disorder or alcohol dependency face denial as their first hurdle. Addiction is a disease, one that holds onto you until you fight back. Forcing the idea of rehabilitation, intervention, or therapy can lead to never-ending unsuccessful attempts.

This is because the user only sees people pushing help they don’t need, or regularly pointing out bad behaviour. This air of negativity will push them away from you. Instead, gradually discuss solutions, starting with cutting down or detoxing.

For example, this can be done by making them busy doing things they used to love, or trying to involve them socially in non-alcoholic settings. This may require you to do research about home detox or a detox attending one of our facilities.

It is critical that at this stage you refrain from talking negatively about addiction, as they currently do not have the control to do it on their own. They need all the love, support, and help that you can give in order to break free from the cycle of addiction and make a positive change.

2.     Set boundaries for the future

When you are trying to get a loved one help for addiction, it is important that you set and establish firm boundaries.

This includes enabling addiction. When people are deep into a cycle of addiction, they are usually spending a lot of money on drugs or alcohol. They may turn to you for money, sometimes masking it as money for something else, like food or car servicing.

It may be easy to think of saying that now, but when you see someone having withdrawal symptoms or slipping into depression, you may feel tempted to give them what they need.

Remember that enabling their addiction will only make the process longer, and it will not repair any bonds that have been affected so far.

Set firm and realistic boundaries that you can follow, and let others know so they don’t enable them either. You may have to detach yourself and your feelings towards addiction, as what feels like love may be perpetuating their addiction.

Some examples of boundary setting may include:

• Do not let them stay at home if they continue drinking or using drugs under your roof
• Do not make excuses for them if they miss important events or responsibilities due to addiction
• Do not provide money or resources that enable the use of substances. If they start to steal money, calmly let them know that they must pay it back and then follow through with the consequences.
• Make it clear that if they participate in illegal activities or serious anti-social behaviour that it will not be tolerated, eg. you will not be bailing them out of prison.

The important aspect of boundary setting is putting them to the test. Not all boundaries will work, as all addiction is different. Find the boundaries that work for everyone involved and stick to them.

3.     Offer support and reduce blame

Shaming people for addiction and blaming them for issues is a certain and proven way to push people away. It is very difficult to refrain from being angry when people break bonds and create more problems, but the future can always be brighter.

For example, it is common for families to say “you are ruining this family, and this addiction is going to kill you”. Instead, try using more emotive and inclusive vocabulary such as “I feel sad that this family is going through a tough time”. Reinforce the fact that you love them, support them, and offer to help.

Those addicted to alcohol and drugs often feel like they are better off isolating themselves to reduce the impact on others. To eliminate these feelings of shame and anxiety, it is important to offer constant support and prevent yourself from blaming them for all the problems caused.

Positive change and personal growth come hand-in-hand. Pain and challenges are to be expected, regardless of how long the addiction has been going on. Adjustment is a process, and everyone has to learn how to master the nature of addiction.

Here are some ways that you can remain positive through this tough time:

• Practice reframing. Try and change negative situations into positive ones by focusing on the aspects you are grateful for, even if it is just the person still being around.
• Build up your resilience. We must all learn to adapt to different circumstances, and practising acceptance and change is necessary if you are to try and get your loved one help and treatment.
• Mindfulness can help you practice positive thinking, this will impact the overall quality of your life.
• Find a support group for yourself, and try family or individual therapy.

4.     Acknowledge the nature of their addiction, and how hard it may be

Loving someone struggling with addiction is difficult for everyone that is involved and affected. Addiction has long been classified as a chronic brain disease, so people struggling with addiction are far from ‘in control’.

There is a huge stigma surrounding addiction and the people that struggle with it. In part, this can be attributed to people seeing it as a moral failing and a lack of self-control. Addiction is complex, and they will likely give in to their addictive thoughts without proper support.

Addiction changes the way brains work, making people believe that they have to drink. When addiction develops, addiction makes it impossible to cut down and resist the compulsion to drink alcohol.

The brain’s reward pathways change the more someone drinks alcohol. There is a sense of euphoria and pleasure when we drink alcohol, and people seek this feeling time and time again.

Over time, the individual’s tolerance to alcohol will increase, and they will have to drink a higher quantity and more often to achieve this sense of euphoria. This may be accompanied by mental health problems such as anxiety and depression, called co-occurring disorders.

Acknowledging how hard it is for them will form a bond and help communication. Connecting with someone who is struggling can seem challenging when they become overly defensive, remain in denial, and are avoidant. This may ring true, but it is well worth the effort. Just being there as someone to talk to or as a shoulder to cry on can remind them that they are not alone.

This can help bring them out of isolation and encourage communication. Bridging the gap between misunderstanding and treatment starts with support and encouragement.

5.     Let go of any expectations

It is normal to have expectations about addiction and recovery. These ideas usually come from social media, television, and stories. People have unique roads to recovery, and all addiction is different despite the similarities.

Our brains tend to imagine and plan the future, predicting what might happen. When we do this, we tend to imagine the best or the worst, struggling to remain realistic.  When it comes to predictions (things we believe are going to happen), we can be very wrong. It is not a bad thing to have expectations, but they can affect us more than we think. [2]

We can be left feeling very disappointed and deflated when things don’t turn out the way we thought they would. Addiction is not just telling someone they have a problem, entering treatment, and coming out sober. Addiction is an emotionally charged rocky road to recovery.

It is common to start resenting someone when they don’t behave the way we thought they would, or when situations we thought would happen, don’t. How can we manage our expectations of people struggling with addiction?

Stop setting your expectations so high. Mapping out ‘perfect scenarios’ is the product of a lack of experience and research. Plans can go south very quickly, so set achievable and realistic goals, with specific objectives.

For example, saying you will clean the whole house in one day when you have work to do and chores to do in town. This isn’t going to realistically happen, so spread out the cleaning checklist or enlist help. You will feel as though you have accomplished more, you will remain less stressed, and you won’t be let down.

The same works with addiction. They will not accept their addiction and get help on day 1, nor will they walk out of the rehab centre after a week and not have any cravings for alcohol.

We are all different and work in different ways. Expecting someone to walk into rehab and therapy will lead you to negatively criticise them if they don’t. So, what can you do to help instead of expecting the best?

• Discover what motivates them
• Consider an ideal outcome and what you want from the situation
• Make this outcome realistic
• Create steps
• Form more than one plan
• Acknowledge that everyone is different
• Respond, don’t react, if plans go wrong
• Remember to be kind to yourself, it’s not easy

6.     Enlist people you trust to help

Individuals that struggle with addiction start off by denying they have a problem. They will often ignore your concerns and dismiss those that are closest to them to avoid hurting them.

It may take a medical professional or someone outside the family and friend circles to get through to them. It is important that when you enlist someone to help, it is someone that either you or your loved one trusts.

Sometimes this could be a regular GP or health professional. If you are struggling to get your loved one to accept they have a problem, convince them to go for a regular annual check-up. This way, the professional can use facts to convince them they are harming themselves in more ways than one.

Learning about health issues and what is considered ‘normal’ drinking can help motivate them to think about getting help. People tend to think when you say “I think you have a problem”, you are expressing an opinion. When they hear a fact about their health from the doctor, they are more likely to take action.

Delegating tasks and enlisting help means you can free up some time to look after yourself. This means you won’t hold yourself personally responsible when things don’t go to plan, and you won’t feel like you have let anyone down.

7.     Stage a medical intervention

Following acknowledgement, intervention is one of the first steps of recovery. Intervention is a tool used to encourage family members or friends to start treatment at a rehabilitation clinic. Denial often serves as the primary barrier for those who suffer from addiction, and intervention helps them see how serious the situation is.

The addicted member might not realise how their actions are impacting others, and how harmful their behaviour may be. Intervention directly tackles this, where different types of intervention help different types of addiction.

Before actually staging an intervention, it is important to do your research on different types of treatment and therapy. Your loved one will benefit from this, rather than funnelling them down one route, opening up possibilities means it is more likely they will give it a try.

Once the intervention is suggested, you should form a group if you aren’t planning a 1-1 intervention. Normally, this includes a qualified professional in addiction, mental health professional, or a psychologist. Interventions are emotionally charged, so it is important that it isn’t confrontational.

Make sure that everyone involves knows the extent of the severity of the situation, researching addiction and different forms of treatment. This may involve enrolling them into programmes for more information or attending support groups.

It is inevitable that at some point your loved one will not accept treatment, so be ready for that. However, after the intervention, if they still do not accept treatment, you will need to decide on the best set of actions to take. This may involve asking them to move out or getting more medical professionals involved.

Make notes before and follow up on the intervention. Each member attending should try to talk about specific scenarios where the addiction has caused issues for them specifically and how it has affected them. Discussing the toll of addiction can help your loved one realise the extent of the problem.

When you hold the intervention, make sure it doesn’t come across as a confrontation. Present open treatment options at different levels, and offer to fully participate if they want you to. If they do enter treatment, offer up support to help them stay in treatment and tips to avoid relapse.

There are different types of intervention:[3]

• Simple Intervention: if the addiction is mild, it might only take one person to bring about positive change rather than surrounding them with people. This is a one-to-one intervention, most effective when it is carried out by a close family member, friend, or professional interventionist.
• Classical intervention: classical intervention is a group intervention, where everyone participating is present apart from the addict. This is called the Johnson Model Intervention, offering education, support, and counselling for all members.
• Family System Intervention: ‘family framework hypothesis’ is focused on family bonds and relationships. This methodology educates members on compulsion and co-dependency through training and guidance. One example of this is the CRAFT approach, standing for community reinforcement and family training. CRAFT teaches you to positively reinforce pro-social and anti-using behaviour, whilst letting negative consequences of addictive behaviour play out.
• Crisis Intervention: sometimes addicts go through a crisis that leads to an impromptu intervention. This usually occurs when your loved one has become a danger to themselves and others.

8.     Educate yourself on treatment and therapy

Addiction requires tailored treatment and different types of therapy to give people the best chance of recovery. Most rehab programmes start with detoxification, a medical programme that helps manage the patient’s withdrawal symptoms. This is only necessary if your addiction is physical, not just mental.

If the intervention has been successful, the patient will enter either inpatient or outpatient rehabilitation. Inpatient rehab, also called residential therapy, is a live-in rehab designed for the most severe addictions.

Inpatient therapy is not referred to patients through the NHS, so you will have to pay upfront. However, this is all-inclusive and includes everything from rent and food to medication and therapy.

Outpatient therapy is more flexible, where patients attend therapy at a centre but return home every day. Here you can attend therapy and receive treatment on your own time, around work and responsibilities.

Both inpatient and outpatient rehab treatment facilities offer similar therapy programmes such as: [4] [5]

• Cognitive behavioural therapy
• Dialectical behavioural therapy
• Individual and group therapy
• Contingency management
• Motivational interviewing
• Rational emotive behavioural therapy
• 12-step facilitation (eg. alcoholics anonymous)
• Self-help groups and mutual support groups

These treatment plans offer recovery from both drug addiction and addiction to alcohol. They work on:

• Destructive behaviours
• Alcohol cravings
• Alcohol consumption
• Detox from alcohol
• Abstinence from alcohol
• Influence of alcohol
• Mental health conditions
• Substance abuse
• Alcohol dependence

Both inpatient treatment and outpatient treatment focus on drinking behaviour using intervention professionals through motivational interventions to help family relationships.

This is proven to be an effective treatment that helps heal the effects of heavy drinking. Alcohol abuse and alcohol use disorders can be all-encompassing, so treatment options such as these can provide the motivation people need to start recovery. [6] [7]

9.     Take care of yourself and affected others

People with drinking problems often have mental health conditions and mental health issues. The effects of alcohol can spread far and wide, causing emotional and physical distress to all affected.

The disease of addiction causes destructive behaviours, so it is important that you take care of yourself and others during the whole process. [8]

Addiction treatment is not an easy or straight road, that is why there are so many therapy and rehab options to try. Whilst you discuss intervention, inpatient and outpatient rehabilitation, and therapy such as CBT, you must look after your mental health.

Addiction doesn’t just affect the addict, like other diseases, the effects can have a negative impact on everyone involved.

Here are some tips to get you started:

• Exercise for at least 30 minutes a day, even if it is just walking to and from different shops
• Drink lots of water, and try and swap alcohol or fizzy drinks for healthier alternatives
• Eat healthier meals, 2-3 times a day rather than snacking
• Try and regulate your sleep pattern, making sure you are winding your mind down at an appropriate time
• Try and start relaxing activities or hobbies, like yoga or reading
• Set your goals and priorities for this recovery journey
• Practice mindfulness
• Stay connected and talk to others about how you feel

10.  Get in contact with us

Getting sober can start today, with one free and easy phone call. For both you and your loved one, getting help is worth it. We are here to support you through every phase of recovery – all of our helpline advisors have been through these steps themselves.

We can help you choose the right treatment programme, long or short, near you and how we can help get you started. Selecting the right recovery programme is the key to successful recovery, and we have that in mind when we recommend treatment to you.

References

[1] https://sscouncil.org/2020/05/acceptance-in-recovery-from-addiction/

[2] Frederick, Calvin J., Harvey LP Resnik, and Byron J. Wittlin. “Self-destructive aspects of hard core addiction.” Archives of General Psychiatry 28, no. 4 (1973): 579-585

[3] Riessman, Frank, and David Carroll. “A new view of addiction: Simple and complex.” Social Policy 27, no. 2 (1996): 36-47.

[4] Ryan, Frank. Cognitive therapy for addiction: Motivation and change. John Wiley & Sons, 2013.

[5] McCrady, Barbara S., and William R. Miller. Research on Alcoholics Anonymous: Opportunities and Alternatives. Rutgers Center of Alcohol Studies, 1993.

[6] Peele S. What works in addiction treatment and what doesn’t: is the best therapy no therapy? Int J Addict. 1990-1991;25(12A):1409-19. doi: 10.3109/10826089009088552. PMID: 1966834.

[7] https://www.samhsa.gov/

[8] https://www.nimh.nih.gov/health/topics/caring-for-your-mental-health

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