How to Help a Friend Struggling with Alcohol and Mental Health Issues?

Q: How to Help a Friend Struggling with Alcohol and Mental Health Issues?

Hello Ms. <br>Tsai： Dealing with individuals who lack insight into their illness and motivation can indeed be the most challenging. <br>In the case you mentioned, it may involve alcohol abuse, potentially combined with alcohol-related psychosis (characterized by hallucinations an

What should I do?

Hello Dr.
Tang: I have a close friend who works as a driver and has a severe drinking problem.
I'm not sure how much he drinks, but after drinking, he often claims that someone is trying to poison him, even saying that his mother is putting poison in his food.
He has threatened his family with arson and has physically assaulted his wife.
Whenever he gets agitated, he has called the police, but by the time they arrive, he returns to normal and denies any of these behaviors, leaving his family in a state of constant fear.
They worry that one day, his actions may lead to a tragedy.
It is impossible to convince him to seek psychiatric help, and the law requires immediate violent behavior for involuntary treatment.
How can we prevent future incidents? This person has no religious beliefs, and those around him are unable to persuade him effectively.

Cai Xiaojie, 30~39 year old female. Ask Date: 2001/02/13

Dr. Tang Xinbei reply Psychiatry

Hello Ms.
Tsai: Dealing with individuals who lack insight into their illness and motivation can indeed be the most challenging.
In the case you mentioned, it may involve alcohol abuse, potentially combined with alcohol-related psychosis (characterized by hallucinations and delusions).
According to the current Mental Health Act, "In cases where severely ill patients pose a clear risk of harm to themselves or others, or exhibit harmful behaviors, and a specialist physician diagnoses the necessity for full-day hospitalization, the guardian should assist the patient in seeking hospitalization at a mental health facility." (Article 21) This regulation, of course, has its limitations.
Generally, we recommend that family members seek assistance from the local health department and coordinate with local law enforcement to facilitate involuntary hospitalization.
A more contentious issue is whether cases of alcohol abuse or dependence meet the criteria for "severely ill patients" and "involuntary hospitalization," which remains a matter of personal interpretation.
Another viable direction is that the case you mentioned may involve domestic violence issues, and perhaps assistance can be sought from the local government's "Domestic Violence Prevention Center." Sometimes, the intervention of public authority is crucial in dealing with such cases! Wishing you peace and joy.

Reply Date: 2001/02/13

More Info

Helping a friend who is struggling with alcohol use and mental health issues can be incredibly challenging, especially when their behavior poses a risk to themselves or others. Your friend's situation, characterized by paranoia, aggression, and substance abuse, is concerning and requires a thoughtful approach.

Understanding the Situation
Your friend's alcohol use appears to be a coping mechanism for underlying issues, possibly stemming from past trauma or mental health disorders. Alcohol can exacerbate mental health problems, leading to increased paranoia, aggression, and erratic behavior. The fact that he has threatened violence and exhibited delusional thinking (e.g., believing that someone is poisoning him) indicates that he may be experiencing a severe mental health crisis, possibly exacerbated by alcohol use.

Immediate Steps to Take
1. Safety First: The safety of your friend and those around him is paramount. If he exhibits violent behavior or threatens harm, it is crucial to involve authorities or emergency services to ensure everyone's safety. While it may seem extreme, sometimes a crisis intervention is necessary to prevent harm.

2. Open Communication: If you feel safe doing so, try to have an open and non-confrontational conversation with him when he is sober. Express your concerns about his drinking and the impact it has on his life and relationships. Use "I" statements to avoid sounding accusatory (e.g., "I feel worried when I see you upset after drinking").

3. Encourage Professional Help: While you mentioned that he is unlikely to seek help voluntarily, gently encouraging him to consider talking to a mental health professional can be beneficial. You might suggest that he speaks with a counselor or therapist who specializes in addiction and mental health issues. If he is resistant, you could offer to help him find resources or accompany him to appointments.

4. Support Groups: Suggesting support groups like Alcoholics Anonymous (AA) or similar organizations can provide him with a community of individuals facing similar struggles. These groups often foster a sense of belonging and understanding, which can be crucial for recovery.

5. Educate Yourself: Understanding the nature of alcohol use disorder and its effects on mental health can help you provide informed support. Familiarize yourself with the signs of alcohol dependence and mental health issues, as well as the resources available for treatment.

Long-Term Strategies
1. Establish Boundaries: It’s essential to set boundaries for your own well-being. If his behavior becomes too erratic or threatening, you may need to distance yourself for your safety. Supporting someone with these issues can be emotionally draining, and you must prioritize your mental health.

2. Involve Family or Friends: If possible, reach out to other friends or family members who may be concerned about him. A united front can sometimes be more persuasive in encouraging someone to seek help.

3. Crisis Plan: Develop a plan for what to do in case of a crisis. This could include having emergency contacts ready, knowing when to call for help, and identifying safe spaces for him and others.

4. Regular Check-ins: Maintain regular contact with him to show that you care. Sometimes, just knowing that someone is there can make a difference. However, be mindful of how these interactions affect your emotional health.

Conclusion
Your concern for your friend is commendable, and while you may feel helpless at times, your support can make a difference. It’s crucial to approach the situation with empathy and understanding while also recognizing your limits. Encourage professional help, prioritize safety, and take care of your own mental health as you navigate this challenging situation. Remember, change often takes time, and your friend may need multiple interventions before he is ready to seek help.

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