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Mike Riehls

A witch's brew is a bad concoction


Health Point


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April 26, 2012
Dear Jeff and Debra:

My sister's life is falling apart because of depression, anxiety and alcohol. She's married with two children and lives in Denver with her husband. She has a successful career in sales and on the outside everything looks fine. But after a recent holiday visit I know her marriage is at a breaking point.


She claims she has to drink in order to function and to deal with her anxiety and depression, but when she drinks (a half bottle of vodka every night), she just becomes argumentative and abusive. It seems like a witch's brew to me. She isn't available for her children after 6 p.m. and she certainly isn't there for her husband.

I don't doubt she has a problem with depression and anxiety, for a number of reasons, but I don't think alcohol can be helpful. If she gets help for the mental health problems, will the alcohol problem go away?

— Worried Sister

Dear Worried:

It is quite possible your sister has three separate problems that will have to be addressed individually. However, they can all be treated at the same time, especially if she gets help at a good inpatient treatment center.

It sounds as though your sister is suffering from several co-occurring conditions: alcoholism, depression and anxiety. Comprehensive assessment, testing and treatment will be required to develop a real diagnosis and an effective treatment plan.

Many people believe depression or anxiety cause alcoholism, but it is not the case. For example, self-medicating anxiety with alcohol may lead to heavy drinking. But without an underlying predisposition it's unlikely the pattern will lead to full-blown alcoholism. If there is a family history of alcoholism however, and the person is self-medicating with alcohol, it's quite possible the drinking will trigger the underlying genetic predisposition for alcoholism.

The difference is important, because effective treatment for the anxiety may allow the person to move away from the alcohol. But if the person has become alcoholic, then he or she won't change the pattern, even if the triggering mechanism has disappeared.

Certain questions arise in your sister's case. Was her depression triggered by an external event, such as a significant loss?

Or are there internal factors which are causing the depression and anxiety.

Tremendous progress has been made in the last 10 years in the treatment of co-occurring conditions. Once upon a time, physicians would prescribe Valium to alcoholics in order to treat anxiety, which is like throwing gas on a fire. But there are now safe and effective treatments that will not adversely affect one's recovery from alcoholism. Non-pharmaceutical treatments like EMDR and other approaches can be especially helpful in relieving these problems.

While it's true many patients experience significant relief from depression and anxiety simply by receiving comprehensive treatment for alcoholism and actively working a program of recovery, there is more help available when needed. Many patients are battling multiple illnesses and while these problems might be inter-related, one will not necessarily be alleviated by treating the other.

It's also important to note medicine alone is not sufficient to treat any one of these illnesses. Ongoing counseling and therapy is recommended in the instructions for most, if not all, of the modern pharmaceuticals for the treatment of anxiety and depression. Many patients and even some doctors seem to want to curtail the treatment to the prescription pad, but this is neither wise nor effective.

It's important your sister follow the treatment team's directions.

First, your sister needs to be fully detoxified and thoroughly assessed. Next an individualized treatment plan must be developed to address the co-occurring conditions. Then she must complete the treatment program laid out for her, including any medications.

Finally, she must continue with her after care plan. In her case, this is likely to include regular AA meetings, continuing psychiatrist consultation and ongoing counseling sessions with a professional therapist specializing in addiction.

This after care plan requires little more than an hour or two per day. Compare this with the endless hours she has wasted drinking. The reward will be the rejuvenation of her family life, the revitalization of her career and the chance to achieve her real potential as a wife and mother.

The Jays are the authors of, "Love First." They head a national private practice of therapists and live in Grosse Pointe Farms. Contact them at (313) 882-6921 or at

lovefirst.net.


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Jeff Jay and Debra Jay are the authors of "Love First: A New Approach to Intervention for Alcoholism and Drug Addiction," and Debra Jay is the author of "No More Letting Go: The Spirituality of Taking Action Against Alcoholism and Drug Addiction." Jeff and Debra Jay are professional interventionists who live in Grosse Pointe Farms. They may be contacted with your questions at (313) 882-6921 or at lovefirst.net.
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