What to Do When a Family Member Is an Alcoholic: 8 Steps to Help Them and Yourself

How to Tell If Someone You Love Is Dependent on Alcohol

Doctors diagnose alcohol dependence syndrome (ICD-10 code F10.2) based on several signs that persist for at least a year: a strong, sometimes compulsive desire to drink; loss of control over when drinking starts, how much is consumed or when it stops; withdrawal symptoms — tremor, sweating, anxiety, insomnia after stopping; rising tolerance, when more alcohol is needed for the same effect; other interests being pushed aside; and continued drinking despite obvious harm. Three of these signs are enough for a diagnosis.

Families usually notice different things: the person drinks “to relax” almost every day, hides bottles, promises to stop and doesn't, misses work after weekends, becomes irritable without alcohol and has a drink in the morning to “steady” themselves. Binges, when drinking goes on for several days in a row, are a dangerous warning sign. These changes do not mean the person is bad. They mean the brain has already adapted to alcohol, and willpower alone is no longer enough.

Heavy Social Drinking or an Illness?

The difference is not how much a person drinks but how much control they have. Someone without dependence can easily skip alcohol at a celebration or for a month without suffering. With dependence, giving up alcohol is hard: anxiety, cravings and irritability appear, and promises of “not another drop” are regularly broken. If you find yourself thinking more and more about how much your loved one has had to drink today, that alone is a reason to consult an addiction specialist (narcologist).

What to Do If a Loved One Drinks: 8 Steps for the Family

There is no magic phrase that will make a person stop drinking. But there is a sequence of actions that changes the situation in the family so that continuing to drink becomes harder and asking for help becomes easier. The main idea is this: you cannot control another adult's drinking, but you can control your own behavior, your boundaries and how readily help is available at the moment the person is ready for it.

1. Acknowledge the problem out loud, at least to yourself, and stop making excuses for the other person's drinking.
2. Gather information: how dependence shows itself, what treatment exists and where to turn for help.
3. Stop “rescuing”: don't call their boss with a made-up illness and don't pay off their debts.
4. Choose the right moment to talk — in the morning, when your loved one is sober and not hungover.
5. Talk about facts and your own feelings: “Yesterday you didn't pick our son up from school, and I was scared.”
6. Offer a concrete step: a consultation with an addiction specialist, including online and anonymously.
7. State your boundaries and the consequences you are genuinely prepared to follow through on.
8. Take care of yourself: psychotherapy, a support group for relatives, rest and support from friends.

How to Talk to Someone Who Drinks

Talking to someone who is drunk is pointless and often dangerous: they won't remember anything, but they may become aggressive. The best time is a sober morning or a day when nobody is in a hurry. Prepare in advance: write down two or three specific episodes when drinking caused harm, and think about what help you are going to offer. Speak in the first person — “I'm worried,” “I'm scared” — rather than “you're an alcoholic” or “you've ruined everything.”

An approach close to motivational interviewing works well: ask open-ended questions and listen. “How would you rate your own drinking?” “What don't you like about what's happening?” A person is more likely to agree to treatment if they name the reasons themselves rather than hear them as reproaches. If they deny the problem, don't argue until you're shouting: leave the door open and come back to the subject later, when there is a new reason to raise it.

Phrases Best Avoided

Labels like “drunk” or “boozer,” comparisons with other relatives, ultimatums you won't carry out, and conversations in front of children or guests usually trigger defensiveness and anger. Tears and pleading while the person is intoxicated work just as poorly. The person hears blame and shame in them, and shame is one of the main triggers for the next drinking episode.

If You Need Support During the Conversation

Sometimes it helps the family to have a third person present — a psychotherapist or an addiction specialist. A professional helps keep the conversation calm and free of blame and can immediately offer a clear plan. Such a meeting can also take place online: the relatives and the patient join by video, and the doctor explains the treatment options without pressure.

What Relatives Should Not Do

Many actions that feel like caring actually sustain the dependence. If the family cleans up after every binge, pays the debts and lies to the employer, the person never faces the real cost of drinking and sees no reason to change. Attempts at control are just as ineffective: pouring alcohol down the drain, hiding money, searching pockets. This turns the home into a battlefield, and the person who drinks simply learns to hide it better.

A separate word about secret “treatment”: slipping medications or “folk remedies” into someone's food without their knowledge is dangerous to their health and ethically unacceptable. Some substances cause severe reactions when combined with alcohol. Any treatment for dependence, including alcohol “coding” (a treatment widely used in Kazakhstan and CIS countries), is carried out only by a doctor, after an examination, while the person is sober and with the patient's informed consent.

• Don't bail them out of debt or repay loans taken out to buy alcohol.
• Don't excuse missed workdays or call the employer on the drinker's behalf.
• Don't drink together “so they drink less” or “under supervision.”
• Don't put anything into their medication or food without their knowledge and consent.
• Don't threaten consequences you have no intention of carrying out.

Codependency: How to Tell That the Whole Family Is Suffering

Codependency is a state in which a relative's life becomes organized around another person's drinking. It is not an official ICD diagnosis, but psychotherapists know the pattern well: constant anxiety, control, a sense of responsibility for someone else's actions, guilt, giving up your own interests, outbursts of anger followed by reconciliation. Insomnia, headaches, low mood and sometimes symptoms of depression or an anxiety disorder are often added to this.

Children in such families learn to read adults' moods, to hide what is going on and to take on roles that don't fit their age. That is why caring for yourself is not selfishness but part of helping. When a relative steps out of the rescuer role and rebuilds their own life, the atmosphere at home changes, and the dependent person gains more reasons to think about treatment.

How to Help Yourself

Start small: get back regular sleep, regular meals, time with friends and at least one activity that has nothing to do with your loved one. Psychotherapy for relatives — individual or family — helps you work through guilt, learn to hold boundaries and avoid losing your temper. Mutual support groups for families of people with addiction are also useful: there you can hear how others have coped.

Can You Force Someone into Treatment?

An adult cannot be treated for dependence against their will simply because the family wants it. In Kazakhstan, under the Code “On Public Health and the Healthcare System,” medical care is provided with the patient's consent, and involuntary measures are allowed only in the cases and in the manner expressly set out by law, and by court decision. That is why the main path is motivation: creating conditions in which the person agrees, on their own, to at least a first consultation.

Emergencies are the exception. If the person is having seizures, is confused, is hallucinating, cannot stand up, has chest pain or threatens their own life or the lives of others, call an ambulance on 103 or 112. In all other cases it is better to say not “you have to get treatment” but “let's just talk to a doctor without deciding anything in advance” — a step like that is much easier for the person to take.

How an Addiction Specialist Helps Online and in Person

The first consultation with an addiction specialist is often held with the relatives: the doctor clarifies the drinking history, assesses the risks and suggests how to talk to your loved one. At Psychiatry Online this can be done by video call from any city in Kazakhstan, anonymously and at a convenient time, including at night. An online addiction specialist will help assess how severe the dependence is, draw up a plan for the conversation, explain treatment options and answer questions about medical confidentiality.

The online format is suitable for consultations, motivational conversations, psychotherapy and follow-up during sobriety. But detox after a binge, severe withdrawal or suspected alcohol withdrawal delirium (delirium tremens) require an in-person examination, IV drips and monitoring. In such cases the online doctor will help quickly arrange a home visit by a doctor or a referral to a hospital. Treatment for alcoholism is a combination: detoxification, medication support, psychotherapy and relapse prevention.

When to see a doctor

• Your loved one has been drinking for several days in a row and cannot stop on their own.
• After they stop drinking, shaking, sweating, anxiety, insomnia or blood pressure spikes appear.
• The person says they want to quit drinking but just can't manage it.
• Drinking comes with aggression, conflicts or driving under the influence.
• You yourself have developed insomnia, low mood or constant anxiety because of your loved one's drinking.
• Children in the family have become withdrawn or anxious, or their schoolwork has slipped.
• You want to understand in advance how to talk to your loved one and what treatment would suit them.

Questions and answers

Reviewed by

Assel Omarova, MDPsychiatrist and addiction specialist

Addiction combined with depression and anxiety, crisis states, online consultations for families.