What to Do if an Alcoholic Refuses Treatment

When someone you love refuses to accept alcoholism help, assisting them can be difficult. You can do some things, but there are limitations as well. Addiction to alcohol and other drugs is considered a chronic, relapsing condition that may take multiple attempts at recovery before abstinence is achieved.1 Additionally, only 7.2% of people diagnosed with alcohol use disorder, also known as alcoholism, in the last year received any treatment in that year.2 It may take some time for people with an alcohol addiction to acknowledge their problem and seek out alcoholism help in the form of treatment. When your loved one refuses to go to rehab for their alcoholism, there are some steps you can take to help but it’s also important to be aware of things you cannot do as well.

Things You Can Do

In considering how to help someone with a drinking problem, there are steps you can attempt, while also protecting your own wellbeing.

Educate Yourself

First, you’ll want to educate yourself on what alcohol use disorder is, how it develops and progresses, and its consequences. Many people falsely believe that alcohol addiction is a choice or a matter of will, but that’s a harmful myth. According to the American Society of Addiction Medicine, an addiction like alcohol use disorder is defined as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry.”3

Alcohol use disorder physically alters the structure and chemistry of the brain, causing a higher sense of reward for alcohol use than for other pleasurable activities such as food, sex, and even basic self-care. Alcohol addiction is more than a behavioral disorder; it is a disease of the brain.3

Many people with alcohol use disorder are well aware of the downsides of their behavior and that they need to make a change like quitting drinking, but experience ambivalence about doing so.4 This means that they understand both reasons to change and reasons not to change. Changes in the reward pathways in the brain encourage continued alcohol use, despite being aware of the “right” thing to do.4 People with substance use disorders, such as alcohol addiction, also report several barriers to treatment, including:5

  • Lack of health care
  • Cost of treatment
  • Shame and stigma
  • Lack of social support
  • Fear of treatment
  • Privacy concerns
  • Poor treatment availability
  • Admission difficulty

Also reported were practical concerns, such as transportation and financial hardship.5 Understanding this disease model of alcohol addiction may give you some insight into the difficulty your loved one is experiencing, and why refusal to seek alcoholism help is so common.3

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Suggest Other Options

It may be difficult to get your loved one to agree to attend an inpatient alcohol rehab considering many of the barriers are exacerbated in this setting, such as time away from work or caretaking duties, and possibly a higher financial burden.5 Your loved one may be open to considering more flexible options, such as outpatient treatment or support groups.

Alcoholics Anonymous (AA) is a well-known support group comprised of people in recovery from alcoholism. It’s a nonprofessional, peer support setting available almost everywhere, including online.6 AA meetings are free to attend and are available in various locations throughout most communities at most hours of the day. AA hosts open meetings in which loved ones of addicted individuals can join, which may be a good opportunity for you to accompany your friend or family member to ease anxiety, shame, and stigma.6

Get Personal Support

Support meetings are available for friends, family members, and loved ones of people with substance use disorders. Al-Anon and Alateen are free and anonymous meetings, similar to AA, for people whose lives have been affected by someone’s alcohol consumption. Members share their experiences and insight to help cope with their situations, regardless of whether their loved one chooses to seek treatment for their alcohol use or not. Like AA, meetings are widely available throughout most communities both in-person and online. Alcohol use disorder not only affects the individual, but their loved ones as well, and support meetings can help you process feelings of confusion, shame, and guilt surrounding your role in their life.7

Schedule a Professional Intervention

An intervention is a technique in which you and other members of your loved one’s social circle talk to them about their alcohol use and how it has negatively impacted your lives.8 Each member of the intervention team vows to take action if the person refuses treatment, such as setting personal and practical boundaries. These may include ceasing to provide money, transportation, or housing so long as the person continues to drink, or even stopping all contact not related to getting treatment.8

An intervention is typically led by a trained interventionist such as a professional substance use counselor.8 A pre-intervention meeting is usually held, in which a team is assembled and members decide examples of destructive behaviors to present to their loved one. Specific consequences are discussed, and specific treatment options are decided. The intervention should include people directly involved in your loved one’s life and should not include people who are struggling with substance use themselves or people who may sabotage the intervention.9

For an intervention to be successful, it should be well-planned, rehearsed, organized, timely, and stay on message and focused on the goal.9 A vital component of an intervention is to avoid blaming or shaming your loved one, as they likely already struggle with a lot of shame related to their drinking. Instead, focus on how their drinking has affected you and your willingness to help them make a positive change. People who have undergone an intervention are more likely to enter and complete treatment than those who have not or who undergo other types of referrals.8

Things You Can’t Do

While you can help someone with a drinking problem in specific ways, there are also some things you should avoid.

Force Them to Enter Treatment

If your loved one doesn’t want to go to alcohol rehab, you cannot force them to go. You can’t commit someone to treatment—it is a voluntary process. The only exception is that completion of a substance use treatment program can be a condition of probation and parole or diversion programs like drug court.10

Recently, civil commitment laws have also been expanded to allow for the commitment of people misusing substances if they are a danger to themselves or others. However, the laws and circumstances vary by state and are often very strict and specific criteria must be met. For example, some states require that an individual have previously been diagnosed with alcohol use disorder to qualify for civil commitment, making it impossible to commit someone who has never been diagnosed.11 Additionally, even in states where these laws exist, they are rarely applied.11

Regardless, committing your loved one to treatment could cause backlash, resentment, and anger on their part. Even if they complete treatment and quit drinking, they may cut off contact with you or refuse to be in your life afterward. A healthier approach to finding your friend or family member addiction care is to meet them where they’re at, understand why they are resistant, listen to their concerns, worries, or anxieties, and offer to help them do research for treatment if and when they are ready. Approach treatment from a collaborative perspective in which you are not forcing them to do anything but rather are aiding them on their recovery journey.

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Do the Work for Them

Even in cases of mandated or involuntary treatment, no one can force someone to do the hard work required for alcoholism recovery. Plus, mandated patients often demonstrate lower motivation for change. So even if someone attends to alcohol rehab, they may not be very engaged in therapy or counseling sessions and may not be doing the internal work necessary to promote long-term abstinence. Recovery is more than just attending treatment or alcoholism help—it is committing to making a change, living an alcohol-free life, and doing the work each and every day.

Ultimately, you have to accept what you can’t change. If your loved one doesn’t want to put in the recovery work, then you can’t force them to and can’t do the work for them. You can, of course, support them as they begin to do the work, whether that involves following the 12 Steps of AA, doing their cognitive-behavioral therapy (CBT) homework, or practicing using their coping skills.

Change Their Recovery Outcome

Even despite all efforts, a person’s recovery outcome is their responsibility and a result of their choices and actions. However, social support can make a positive impact on your loved one’s alcoholism recovery. Research shows that treatment attendees who spent time outside of treatment with friends and family, rather than alone, were more likely to complete treatment.10

Alternatively, feelings of loneliness and boredom are associated with relapse and poor treatment outcomes. Although a person’s recovery outcome is their responsibility, being a positive social support can be a crucial tool in maintaining abstinence from alcohol and other drugs.10

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Resources

  1. Kelly J.F., Greene M.C., Bergman B.G., White W.L., Hoeppner B.B. (2019, July). How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults. Alcohol Clin Exp Res., 43(7), 1533-1544.
  2. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics
  3. American Society of Addiction Medicine. (2011). Public Policy Statement: Definition of Addiction
  4. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.
  5. Owens, M.D., Chen, J.A., Simpson, T.L. et al. (2018). Barriers to addiction treatment among formerly incarcerated adults with substance use disorders. Addict Sci Clin Pract 13, 19 (2018).
  6. Alcoholics Anonymous. (2021). What is A.A.?
  7. Al-Anon Family Groups. How Does Al-Anon Work?
  8. Loneck B., Garrett J.A., Banks S.M. (2015) A comparison of the Johnson Intervention with four other methods of referral to outpatient treatment. Am J Drug Alcohol Abuse, 22(2), 233-246.
  9. National Council on Alcoholism and Drug Dependence. 2017. Intervention – guidelines
  10. Coviello, D. M., Zanis, D. A., Wesnoski, S. A., Palman, N., Gur, A., Lynch, K. G., & McKay, J. R. (2013). Does mandating offenders to treatment improve completion rates? Journal of substance abuse treatment, 44(4), 417-425.
  11. Christopher PP, Pinals DA, Stayton T, et al. (2015). Nature and utilization of civil commitment for substance abuse in the United States. Journal of the American Academy of Psychiatry and the Law, 43, 313-320

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