Expert: Peter L. - 6/20/2011

Question
My mother-in-law is 45 years old.  She has experienced many misfortunes in her lifetime (rap by uncle, sisters death at age 15, three divorces, etc...).  The most recent divorce has sent her in such a downward spiral that we're all baffled at what to do.  Alcohol seems to be a huge issue, but perhaps some additional drugs as well.  Whenever she drinks, she has been known to drive, become violent towards others, and trash anything near her (including punching through windows causing severe cuts leading to hospitalization).  About a year ago (several months after her last divorce) she was locked up for assault on her ex-husband.  We had her involuntarily admitted to a rehabilitation facility where they kept her for one week.  Since then she's had her ups and downs but nothing ridiculous.  Lately she seems to be falling back into the same pattern we saw previously.  She's lying about her drinking, claiming that she's been x number of days without alcohol, yet she's just sneaking her alcohol.  She's drinking and then getting pissed and driving around town.  Last night she beat up her boyfriend, fell through a glass door, punched a few windows, threw most anything in sight around the house, passed out and ended up in the ER with severe cuts that required stitching.  After these episodes she acts like everything is fine and if she's okay then everyone else should be okay.  We've gone through times of not allowing her to see our son until she straightens herself out, and not even that is incentive for her.  Do we just stand by and watch her crumble and kill herself or an innocent by-stander?

Answer
Hi Madison,

Sorry to hear about the difficulties you're having with your mother-in-law.  There's no question she needs more treatment -- a lot more treatment!  One week in a rehab is way to little.  The question is, how do you get her there?  Easier said than done.

In my field, most counselors feel that consequences are the driving engine for change and recovery. The problem is with the idea of hitting bottom, which Alcoholics Anonymous will say is the point of change.  In other words, if I have enough bad things happen to me (like are happening to your mother-in-law) I will be motivated to change.  That is generally true, but...  for some people the bottom is a sliding floor.  In other words, there are yet more bottoms, one worse than the other.  The only real bottom is when one loses one's life due to a substance problem, and sadly I see enough of that.

I have had clients who, even after months of rehab and counseling, still do not achieve sobriety.  I think for many of them they remain convinced they are going to continue a behavior they strongly rely on to live (ironically) and somehow the consequences are going to be manageable.  Just yesterday, I did an evaluation on a fellow, age 70, who's had somewhere around 25 detoxes, and numerous other treatments.  I told him "What can I possibly tell you about addiction that you don't already know?"  And indeed, there isn't much.  He's heard it all.  What he did say would probably stop him would be a physical health problem, and he's managed to avoid those, but not for much longer, as I told him.

Does you mother-in-law ask anything of you and your husband?  You can leverage her there.  How does she support herself?  Is she employed?  If not, who's supporting her?  If employed, does her job have a sense of what's going on?   And what's with the boyfriend?  Is he an enabler?  If so, you have a long ride ahead of you, as he will protect her from the consequences of her actions.  

I would restrict visits between her and your son on the premise that she's a threat to him.  Not really perhaps, but it is a consequence.  This woman has to feel the heat.  The legal system may have to mandate treatment if she continues to get in trouble.  In fact, that might be beneficial.

This is a tough situation, and may have to run it's course.  It might be helpful to attend an Al-Anon meeting in your community, to see how others are coping with similar situations.

Best wishes,
Peter