My Sister Is an Alcoholic. How Can I Help?

Alcohol use disorder (AUD), sometimes called alcohol addiction or alcoholism, is a form of addiction specifically involving compulsive behaviors around alcohol consumption, physical dependence on alcohol, and behavioral changes that lead to struggles at home, at work, with money, or with the law.

When a person struggling with AUD is a family member, especially a close person like a sister or brother, it may be difficult to acknowledge that problematic drinking patterns are a sign of a larger addiction. Siblings may excuse their sister’s behavior, which is one way of enabling these problems, and they may want to support her when she struggles financially, romantically, or academically. However, it is important to recognize there is a potential problem, and then get her the help she needs.

How to Help Others Struggling with Alcohol

Symptoms of Alcohol Use Disorder

AUD is a medical diagnosis with specific symptoms. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists 11 criteria associated with problem drinking, which could indicate an AUD. If a person meets two of these 11 criteria for at least one year, they may have alcohol use disorder.

Criteria include:

  1. Drinking more, or for a longer period of time, than originally intended
  2. Attempting to cut down or stop drinking, but being unable to stop
  3. Spending a lot of time consuming alcohol or feeling sick after drinking too much
  4. Experiencing an intense craving, urge, or drive to consume alcohol
  5. Continued drinking although it causes problems with friends or family
  6. Giving up hobbies or social activities that were once fun, specifically to drink more
  7. Putting oneself at risk of being harmed more than once because of drinking, including driving drunk
  8. Experiencing depression, anxiety, memory trouble, or blackouts, but continuing to consume alcohol anyway
  9. Developing a tolerance to alcohol, or needing to drink more alcohol to achieve the original effects
  10. Problems at work or school, including failing grades or job loss, because of alcohol consumption or being sick from drinking too much
  11. Withdrawal symptoms when not drinking, including shaking, insomnia, restlessness, nausea, sweating, or sensed things that were not there (hallucinations)

Causes of any addiction, including AUD, are a complex combination of genetic risk; current environment, including stress; and family history of substance abuse or mental illness. While many people have these risk factors and do not struggle with alcohol use disorder, about 16 million people in the United States develop this addiction. Many people know someone struggling with some form of problem drinking, which can become alcohol addiction. These may be friends, family members, even siblings. It is important to know how to help a family member like a brother or sister if they struggle with alcohol abuse or addiction.

If your sister is struggling with AUD, there may be women-specific treatment options that can help. Planning a family-based intervention, finding detox programs that understand how women react differently to alcohol, and identifying female-centered rehabilitation programs can all be ways to help a sister who suffers from this condition.

The Basic Steps to Getting Her Help

Assuming that a person struggles with AUD because they occasionally drink in front of family members is inappropriate; however, if a person’s behavior changes, they begin to neglect their appearance or personal responsibilities, or they smell like alcohol and slur their speech most of the time, they may be struggling with problem drinking. Here are a few steps to helping a loved one, such as a sister, if they are suspected of AUD:

  • Learn about AUD, binge drinking, and heavy drinking.
  • Find treatment resources that may work for your sister, including female-centric treatment options.
  • Learn about the intervention process and which family members should be involved.
  • Offer support to recover from AUD and boundaries if she refuses help.
  • Maintain boundaries if she refuses treatment and follow through with offers of help if she accepts treatment.
  • Express love and concern without enabling problematic behaviors.

Alcohol Abuse Is Deadly for Women

Generally, more men than women are diagnosed with alcohol use disorder. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that 9.8 million men, versus 5.3 million women, are diagnosed with AUD on average. However, recent reports suggest that the gender gap between drug and alcohol addictions is closing, although women suffer much more from abusing alcohol than their male counterparts.

A 14-year study found that alcohol dependence is twice as deadly for women as it is for men. Over the span of the study, which had 4,000 participants, 18 percent of the men died from complications related to alcohol abuse while 23 percent of the women who were dependent on alcohol died.

Because of differences in body mass, hormones, stress levels, and even diet, women have lower tolerances to alcohol, and experience physical and mental problems with fewer drinks. For example, heavy drinking for men is considered about two drinks per day, or 14 drinks per week; for women, the level is half that, at one drink per day or seven drinks per week. Even at one drink per day on average, women are at greater risk for developing cancer, high blood pressure, or stroke in the long-term; they are also at greater risk from becoming intoxicated and being in a car crash or other accident. Women are more likely than men to become the victims of violence, including sexual assault, when they are drunk. Women receive more diagnoses of mental illnesses, including depression and anxiety, and when they drink, they are at a greater risk for suicide than men.

If your sister struggles with problem drinking, she is at higher risk for these problems. If she has children, she may put them at greater risk for addiction or mental health problems later in life, too.

The Family Intervention

There are many stereotypes about interventions that are unhelpful, but associating interventions with family expressions of concern and care can be very helpful. Parents, siblings, and children all care for the person struggling with alcoholism. If your sister struggles with AUD and needs help, planning an intervention with the help of other siblings, parents, or nieces and nephews can get her the help she needs.

Interventions are intended to encourage the person to find evidence-based help with addiction specialists. An intervention conducted by family members can be more emotionally charged than an intervention between a doctor and their patient, so it is important to plan a specific date and time that works for everyone, and develop a script that everyone sticks to. Becoming too emotional, placing blame on your sister, and focusing on the pain caused to the family will not be helpful. Expressing love for your sister, concern for her wellbeing, and offering help, support, and resources will show her that she can overcome AUD.

Certain guidelines can help when planning interventions.

  • Plan which family members will be present at the intervention.
  • Decide who will lead the intervention; oftentimes, it can be helpful to engage the services of a professional interventionist.
  • Make sure everyone agrees to a place, date, and time of day.
  • Decide who will speak at the intervention and what they will say.
  • Focus on expressing concern for specific behaviors without placing blame. Be specific about instances where alcohol abuse harmed the relationship, without burdening her with blame or guilt.
  • Research nearby alcohol treatment programs, and make a list of those that might work for her.
  • Decide which boundaries will not be crossed; for example, you will no longer give your sister money when she asks for financial support.
  • Make specific offers of help, and express love and support for her.

The National Council on Alcoholism and Drug Dependence (NCADD) states that interventions do work. Families often experience deep emotional hardship due to addiction or mental health problems, which can lead to AUD or be caused by AUD. Again, it may be important for the family to find an intervention specialist, social worker, therapist, or religious or spiritual leader who can help the family plan the intervention, and who may even lead the intervention.

Gender-Specific Treatment Options

Your sister may not want female-only, or female-specific, treatment options, but she may benefit from these programs, especially if she has children. Women-focused alcohol recovery often provides family therapy options for children and spouses.

Men and women respond differently to medication management, like naltrexone, so it’s important to find a physician or addiction specialist who understands gender differences in medication and therapy approaches. This may mean finding an alcohol rehabilitation program that allows only women, or it may mean finding an outpatient program that treats both men and women, but is able to address the unique needs of women in addiction recovery.