He Has Stopped Engaging with Life

catair is deeply concerned about her 62-year-old brother who drinks non-stop and has repeatedly returned from treatment and begun drinking immediately. Is there any reason to believe a civil commitment would have any better results?
 

"Hi. I have a brother who is very sick with his alcohol addiction. It is so bad he has become unable to walk and at times is incontinent. He was recently in a well-known hospital for 12 days then taken to a rehab/nursing home. At this time he is still considered able to communicate and take care of himself supposedly and he signed himself out. Within two days he was back to hard-core drinking, he did call and make an appointment at a treatment center for two weeks. My question is if he is so sick that his body is shutting down how can he live. He can’t stand by himself he can’t shower himself he does not eat, he only drinks. In the past two years he has gone into a treatment center four times and as soon as he leaves he comes home and drinks. He refuses to leave his house and go into a sober house. He has family and friends who care he had a job but was let go due to his drinking last year, he was a working alcoholic his boss told us. He is 62 years old and still in denial about his drinking . I am afraid that he will probably die either from falling or alcohol withdrawals. Are there any suggestions that family can help him? We did consider a section 35 which last year he probably would have been able to survive but right now I don’t think he could survive. As the person who lives closest to him are you should get the calls I try to be kind but it’s not always possible especially when it’s been going on for so long and he has very little respect for me or himself at this time."

You are writing in with a difficult question: where to draw the line in influencing your 62-year-old brother who is seriously drinking and has “given up…engaging in life.”

Is there a moment when the family heeds the Loved One's apparent desire and lets the person drink themselves to death?

You might do it out of frustration as you describe it, or despair, since it looks like there are no good choices. Your brother is not able to stop drinking at home.

Your brother, though, is not completely resistant to seeking help. He books himself in for short-term detoxification but refuses the longer stays in less intensive care. He comes home and starts to drink again.

Your brother isn't totally resistant to care, or he wouldn't have gone to rehab, and wouldn't have reserved a spot in treatment two weeks out.

Resistance to addressing addiction is very common. The CRAFT approach was designed precisely for families who have Loved Ones who are resistant to seeking help. That was the main outcome of CRAFT studies. In every study of CRAFT, family members were able to get 65-70% of their Loved Ones to agree to go to treatment.

Anyone who's addicted has moments of wanting to stop. In Module 8 segment 1, How Do I Get My Loved One Into Treatment, we insist on the fact that, whether or not the family members are aware of it,  "there are moments in your Loved One’s life when they want to change."

Your brother, despite being in his early 60's, can still get abstinent. Part of him is tired of the drunken shuffle. It's hard to imagine what a hangover feels like at 62. Your brother must need to drink around the clock. He isn't eating. His situation is serious and dangerous.

Catching these moments of willingness, encouraging, supporting and generally providing all manner of enabling to help get your brother to treatment… this is the dance. You are dancing.

A civil commitment might keep him in treatment longer

I suggest you get all the paperwork and forms ready for a section 35 (if you're in Massachusetts, a civil commitment is known by this name). In the meantime, make sure his treatment spot coming up is still open. Put the day on the calendar, call the place and inform yourself as to what's needed for the admission. Let’s hope he goes. If he doesn’t, I suggest you commit him.

We have some experience with Loved Ones in civil commitment in Massachusetts. These civil commitment programs do more than just detox a person. They will start to look at his depression and they should hold him long enough that the mental fog begins to clear (perhaps a couple months). This will give the clinicians time to evaluate whether the depression is from the drinking or is organic mental illness.

I recently spoke to a mom whose 18 year-old has amassed such a track record that he is committed for several months, if the family needs it. The length of stay for a civil commitment varies, according to the professional staff's assessment. The staff is working with this young man’s mom and the courts. I don’t know how common this is, where everyone is talking and working together, but this is what you should fight for when your brother gets into care.

Is any of this ideal? No. We can’t guarantee the sectioning program will work. Your brother can’t be home. He goes back to drinking and you end up managing serious active alcoholism. Some sectioning programs are locked, others are not. It may not matter to your brother once he's admitted. The priority is to get him into treatment again. Treatment gives him a pause and will detox him through the dangerous withdrawals. I disagree that they'll just release him after the detox. We just can’t be sure what the program will do. Your brother is racking up detox admissions but he needs more than just a detox.

So let’s see if your brother goes to the rehab he set up. In any case, please start the process of a commitment. You need this mechanism should your brother not go to the rehab, or come out and start drinking again. Given his age and the severity of his drinking, use the influence we teach you about in the modules to keep pushing him into more treatment. This is your part in the dance. Your brother knows the score. He has experienced coming home from treatment and starting to drink. He may do it again after the “rehab” in two weeks. He may also have learned by now that coming home after a detox isn’t going to work for him.

He needs time, safety, and attention to his mental health. So keep doing the treatment dance, and let’s see if we can get him to stay somewhere longer. For instance, when you call the rehab about your brother’s upcoming admission, please ask what the plan would be for discharge if he can’t come home. The longer the treatment, the better. What happens to the providers if you say he is homeless, he cannot go back to his house?

At some point in this past month, your brother was willing to go to treatment. Let’s get him there, and then work on the tail end of these inpatient places, whether it be the upcoming rehab or a civil commitment, so that he stays longer in treatment and chooses to step down to structured housing.

So, step one: call the place your brother has booked for treatment. Make his admission smooth. Put an X on the day of the calendar, ignore his drinking for the moment, and do all you can to get him to the rehab.  Step two: work on the admission process through a civil commitment.

You've found this site. You're writing in to us. You're on the right path. The situation can indeed not stay like this much longer. You're going to need your own support. We're here for you. You're in the right place.