Friend constantly relapsing

Question
I have a friend who is an alcoholic. Her addiction seems to be a symptom of other problems. I have been her friend for more than 15 years. When we first met she was in an abusive relation with an rough character, before that, she had been a rebellious teen. She had a difficult childhood as she and her mother escaped from the eastern bloc in the early 80?s and she and her mother had to go it alone basically while they built a life for themselves in America.



I had always tried to be the person she could confide and the shoulder she could cry on when she had trouble with her abusive boyfriend. I would always tell her to leave him, but she wouldn?t do it. She would return to apartment with bruises and say she fell down. It was like witnessing a bad made for TV drama.



After 2 years of watching her miserable, I told her I could no longer be her friend. After that, she came to the realization that she was in a bad situation and got herself out of it. She moved back to her hometown, finished her undergrad and internship work, lived with a new boyfriend who was good to her and seemed to be doing well. We reconciled after that and she was doing very well with her new life.



After a while, she and boyfriend parted ways amicably and she decided to move to Chicago and work for her PHD. I was living in Chicago at the time, and so was her mother.



When she started her PHD program, she started to drink a lot with the other students and professors. I started noticing that she was drinking all the time. She started giving me hints about shooting airplane bottles and keeping vodka in her purse. Finally, about 10 years ago, she came to me crying and believed that she was an alcoholic. I told her that all she needed to do was to stop drinking. I didn?t know much about AA, and I was probably a bit in denial that my friend was sick, and thought she was just basically being a lush, and with a little discipline she could lick it.



After about a year of no improvement I cut off all communication with her. I didn?t explain anything to her, I just stopped returning her calls, and we did not talk for nearly 2 years.  When a close mutual friend got married and invited us both to the wedding, I contacted and told her that I was sorry for abandoning her but that she had to understand that  she had  a problem, and that  she would need to handle it herself. I let her know that I loved her, but I would not let myself be put in same situation as when she was in the abusive relationship. For the next 2-3 years we kept in contact, but she was still drinking. She had become very promiscuous, and was basically out of control.



1 day in 2002 she called me and told me she could not find her car, I came to her house and saw she had a traffic citation in her purse, and we found her car that had been parked on the side of the road after a fender bender.



The next day she asked me to go with her to an AA meeting. I did and hoped she was on t he road to recovery.



She did not go to meetings regularly but was able to stay sober for about a year, until she finished her PHD. When she finished her PHD she wanted to drink to celebrate. I was very proud of her success and wanted to share it with her, so I told her I would stay with her that evening and babysit while she drank. I thought it might even be good for her to see, if she was as I put it ?An alcoholic or just a lush?

It turned out she was an alcoholic. She continued to drink heavily on and off for the next year, moved away for a year to work in New York, (Where she started drinking heavily again) came back to Chicago and was now was full blown alcoholic.



I stopped talking again with her for a period of time until she wrote me about 2 years ago and told me she was in bad shape and needed me to help her. I found her drunk and strung out on Coke, She had lost a lot of weight and was crying that she was miserable and wanted to die. We called her mother and told her the whole story. The next month she was in a rehab program. I talked to her a bit about the rehab but she was fighting the program every step. She started having sexual relations with other patients, and was eventually asked to leave the program.



She entered a different program and completed it and started seeing a therapist regularly. But she refuses to go to AA. She used the whole ?I don?t believe in God? excuse, which I know is just an excuse. She kept clean for some time but would briefly relapse occasionally.  I don?t trust her relationship with her therapist, as her therapist prescribes her speed to combat depression and gives her advise like ?You should get a f**k buddy to help with your stress?. She seemed able to maintain and was able to get a  job as a community college professor. But still she would relapse and have brief affairs with people she probably shouldn?t. Recently she ended up getting drunk and having an affair with one of her students. She told it to me and told me she thought she may be in love. I told her that this was unacceptable behavior and she should be going to AA. I explained that I thought her choice in men, was just another way to fix her jones. I think I may have crossed a line by telling her who she should date, but I know that she is not addressing the root causes. She is not addressing her addiction and the causes of her addiction. After this episode, I decided I cannot watch this again. I feel she is lying to me everytime she talks about her drinking. She seems to think she can control it or at  least not let it get too far out of control, Which I usually  respond, that she hasn?t even reached the 1st step of the 12, if she thinks she has control. The relationships she has, start from being drunk, and the acceptance she feels from her lovers  seems to fill some emptiness inside her.



She has been a dear friend of mine for a long time, but I know I have enabled her in the past. My desire to leave her is no longer entirely for her own good, but more out of my own anger and frustration, that she continues to behave the same way, and refuses to truly admit the problem. She can admit  she is an Alcoholic, but just doesn?t want to take the steps to correct it. Whenever we talk, she tries to explain how she doesn?t want to drink, and how she is getting better, and how she ?Can?t drink because she needs to keep her job? or ?  I am taking anabuse so I know I can?t drink? but I have heard it all before. She cannot understand the pain she puts her friends thru by making us all watch her kill herself slowly.

I have told her that I don?t want to see her until she gets to step 7 and realizes that she needs to apologize to her friends for what she has put us thru, and understand how her behavior effects the people that want to love her.

A bit long winded I know, but should I feel bad for abandoning her? Should I be insisting on an apology (its not just for me, but for her to understand the consequences on her friends) Does individual therapy have a good success rate? Is promiscuity another way t o fill a void with alcoholics and addicts? I want to be a good friend. I don?t want to cause her pain. But I want her to know that I don?t think she is going at this the right way, and I don?t want to have to drag her to rehab again or go find her car, or get a call from her mother telling me that she is dead. Should I be angry?  


Answer
Hi Donald,



I commend you on the commitment you have demonstrated in your attempts to help your friend overcome her very serious alcohol problem.  I think you have used reason, passion, tough love, and every means you could think of to help her reverse the progression of her use.



Over the years I have come to define an individual's relationship with alcohol as being similar to what characterizes intimate relationships.  There's can be the sheer elation, a soulmate-type connection, inseparableness, devotion, passion, drama, transcendence.  But there can also be extreme disappointment, disloyalty, regret, betrayal, and, of course,codependence.  Have you ever known couples who seem to relish conflict?  Have you had friends who will talk about a problematic relationship endlessly but when you recommend they leave the relationship they act like you're talking in a foreign tongue?  Consequences can motivate change but the question becomes what level of it does it take?



Obviously your friend has found a very close ally in the manner in which alcohol changes the way she thinks and feels.  But again, she has identified the downside and that has prompted periods of recovery attempts.



I'm wondering what in her upbringing set her on this path, not that understanding the history will reveal a solution.  Many individuals with protracted substance abuse problems have experienced severe early childhood circumstances, particularly women.  They may have suffered trauma, abuse, neglect, loss.  I and many others feel there can be inadequate structures in these individuals to facilitate responses to stress in non-self destructive ways.  It is possible someone may become emotionally and behaviorally "typecast" early on.



Here we also might be able to make some sense of the higher functioning person who, despite significant life achievement, continues to evidence problematic decision-making despite numerous interventions.



I have worked with hundreds if not thousands of individuals who have continually relapsed, sabotaged, and even brought about their own demise.  They have had repeated treatment episodes lasting decades. I attend conferences about how to treat the "treatment resistant".  Nevertheless, I can say no one has figured out and implemented a truly revolutionary approach to

addictive behavior rehabilitation.  We may be getting closer, however, as we explore holistic approaches.



I don't feel anyone should feel bad about letting someone like your friend go, in the sense that they have burned out and can feel helpless.  I would not make your difficulties with her recalcitrance an issue in your relationship with her.  She knows how people around her have suffered.  Individual therapy can have a good success rate with someone who can use the time to delve into what really lies behind problematic behavior and emotional disturbance.  For others, group therapy works more effectively.  I think both together is a powerful combination.



Should you be angry?  I don't think that will help in any way.  Her life has gone in the direction it has gone, at this point.  She can exploit the guilt of others to dramatize her crisis, and to attract concern, and in the process stay stuck.



She needs treatment.  A lot of it, over a long time.  If she doesn't get it, the only thing left is for her to hit the wall harder than she has, and hope that will instill greater motivation to stop.  But then, "hitting bottom" does not mean someone has necessarily hit bottom.



Insist on treatment, make it a point of every conversation.  And don't cause adverse consequences for yourself if she doesn't respond.  She has to be the one to recognize the danger signs.  If she doesn't like AA she can go to a SMART Recovery meeting if there's one in your area.  smartrecovery.org



I hope this helps.



Peter