Last night I confronted my wife about how she is punishing our son — a bit rich given she ignores her mother’s alcoholism. She broke down sobbing, saying she hates her mother and blames her for our son’s drinking (he drinks like a thoughtless 18-year-old, not an alcoholic) because she allowed her mother to drink like a fish in front of both our kids, normalising heavy drinking.

As I write this to you, my wife has called her mother and told her to stop drinking immediately or never see any of us again. Our son heard our row and is in bits. Our daughter is furious with her mother and grandmother and very protective of her brother. My family is falling apart, what can I do?
Alex

A. Alcohol misuse is the biggest risk factor for death, ill health and disability among 15 to 49-year-olds in the UK. It can destroy lives and relationships. Your mother-in-law, along with more than 600,000 other people, is a dependent drinker, risking her physical health (eg liver disease, pancreatitis, some forms of cancer, brain damage, memory loss, high blood pressure) and mental health (eg depression, anxiety, dementia and psychosis). Her drinking is clearly chronic, meaning that she will be trapped in a worsening spiral of health and mental health difficulties and behaviours as evidenced by her loss of bladder control, resulting in involuntary urination.

Growing up with an alcoholic parent is challenging. By not addressing her mother’s drinking, your wife has enabled and normalised it. However, given that her siblings have ceased contact with their mother, I can understand why your wife has felt a protective responsibility towards her. Indeed, her many years of denial are likely to be the result of the impact of her mother’s drinking on her since childhood. Children with alcoholic parents learn to hide their emotions as a defence mechanism and also normalise their parents’ behaviour, ie living in denial.

It is clear that your son’s accident when drunk has pierced the bubble of denial that your wife has been living in, causing a tsunami of emotion. While this may make you anxious, it is, in fact, a good thing because it allows many issues to be properly addressed. Your wife needs support because she has, in effect, ripped the lid off the Pandora’s box of repressed emotion since childhood. These emotions will challenge and overwhelm her and she will require compassion and understanding as she starts to process the reality of her mother’s drinking.

Your son needs to understand that while he is not wholly responsible for his mother’s distress, he is responsible for his behaviour. Alcoholism can run in families — studies show that a person with a history of alcoholism within their family has a higher risk of developing alcoholism, potentially inheriting genes that predispose them to developing an alcohol use disorder. Although genetics only account for half of a person’s overall risk, this accident is a useful wake-up call for your son, who is already careless with his drinking. I agree that your wife’s reaction to the accident was OTT, but we now understand why — she will have felt significant fear that her son is an alcoholic, blaming herself for allowing this to develop.

There are excellent support groups for relatives of alcoholics — these might be a good place for your wife to find support: wearewithyou.org.uk, adfam.org.uk, al-anonuk.org.uk. Understandably, relatives of alcoholics can feel extremely angry, leading, in some cases, to complete estrangement. Your wife is in an extremely difficult position now she no longer has the relative comfort of denial about her mother’s drinking — does she, like her siblings, also now detach completely, or does she try to address the problem? Given that no one seems to have consistently and compassionately challenged your mother-in-law’s drinking, it would seem that abandoning her without an attempt is somewhat harsh. However, your wife’s denial enabled her siblings to estrange themselves and because she has now changed her position, they too need to change theirs and be part of the solution.

Anger has to become understanding. Alcohol use disorder (AUD) is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse consequences. Lasting changes in the brain caused by alcohol misuse perpetuate AUD, making sobriety a significant challenge. There are evidence-based treatments to help your mother-in-law to achieve and maintain sobriety (eg cognitive and behavioural therapies, support groups, medications). The ultimatum given by your wife (stop all drinking to see the family), though, is unwise.

Because your mother-in-law has been drinking for so many years, she will need a carefully managed detoxification (either as an outpatient or an inpatient) alongside supportive therapies. A medic would supervise her detox by cutting the drinking down incrementally and using medications to prevent withdrawal symptoms (eg Librium) and reduce cravings (eg acamprosate and naltrexone). If your mother-in-law goes cold turkey, she is at significant risk of death due to severe withdrawal symptoms such as delirium tremens (convulsions, seizures, confusion).

What you can do is help your wife to not react in anger and distress. Her mother is extremely vulnerable, and anger needs to become compassion. Given the significance of this moment, I advise that your wife and siblings join together to support their mother to address her alcoholism. Everyone needs to set aside feelings and grievances and find the strength to encourage her to get help.

The challenge for the family is how to confront the denial exhibited by your mother-in-law, which is wrapped up with deep unhappiness. I suspect that over the years she has used alcohol to cope with the stresses and difficulties of life and so is trapped by this maladaptive coping strategy, unable to countenance how to manage without it. She may have used alcohol to numb the complex and overwhelming feelings of what you describe as a tragic childhood. To address her drinking would mean she would need to look at these issues underlying it, which will be frightening for her, and also find ways to cope without her emotional numbing agent (alcohol).

I suggest that the siblings come together to discuss how to support their mother. This will be a provocative and sensitive situation which requires planning. They can write to their mother’s GP and also seek advice and support from addiction charities such as the Drinkaware helpline: 0300 123 1110. They would then stage an alcohol intervention, the aim of which is to meet with an alcoholic, helping them to accept that the problem exists and present the opportunity for support.

Given the long-term and entrenched nature of her drinking, it may take some time to enable your mother-in-law to recognise her need to stop. Therefore, the goal of an intervention is not to force her to stop drinking immediately, but to open up a united dialogue that shows compassion, understanding and support. I wish you well.