‍Host:
“Doctor, we’ve been advising this person to quit alcohol. We've talked about the ill-effects, the way it’s damaging his life… but he doesn’t listen to us. Yet he comes to you — and miraculously, he listens. What is the magic you do?”

Host:
Hello and welcome to Cadabam’s Insights, where serious mental health conversations happen. Today’s topic is extremely important — psychological interventions and therapies for individuals struggling with alcohol use and alcohol-related problems.

We have with us Mrs. Aparna Rani, a clinical psychologist with nearly a decade of experience. She completed her post-graduation and MPhil in Clinical Psychology, and brings deep expertise in working with individuals facing emotional, behavioural, and addiction-related challenges.

Why Do People Trust Therapists More Than Family?

Aparna:
It’s not magic. It’s simply listening without judgement. Most families focus on “Don’t drink,” “Don’t go to bars,” or “Your life is ruined.”
But as therapists, our focus is: Why are you drinking? What pain are you trying to soothe?

Alcohol is everywhere — yet not everyone becomes addicted. Just like food is everywhere, but not everyone develops a binge-eating problem. So we focus on understanding the underlying emotional drivers, not the behaviour alone.

Most people use alcohol as a coping mechanism — to manage stress, trauma, loneliness, or emotional pain. When someone finally feels heard and understood instead of judged, they begin to open up.

Counselling vs. Therapy – What’s the Difference?

Aparna:
Counselling is supportive and surface-level — helping someone feel heard and understood.
Therapy is deeper, structured, and scientifically tailored to the individual.

Therapy explores:

• coping patterns
• personality factors
• emotional baggage
• trauma history
• triggers
• behavioural cycles

That’s why real recovery requires therapy, not advice.

When Someone Comes to You With an Alcohol Problem — What Do You Look For?

Aparna:
First, I try to understand: Why do they drink?
People drink to feel better, to numb pain, or because they don’t know healthier ways to cope.

Families often say, “He drinks so much but says he can stop whenever he wants.”
Others desperately WANT to stop but can’t.
Some are stuck in denial.

To understand where they are, we use Motivational Enhancement Therapy (MET) and assess which stage they’re in:

5 Stages of Motivation in Addiction Recovery

1. Pre-contemplation
   – Denial, no intention to change.
2. Contemplation
   – “Yes, I have problems… but alcohol helps me.”
3. Preparation
   – They start researching help, reading, or considering therapy.
4. Action
   – Actively seeking professional help, therapy, or inpatient care.
5. Maintenance
   – Preventing relapse and building long-term coping skills.

Understanding the person’s stage helps us tailor the right intervention.

What Can Families Do?

Aparna:
This is tricky. Families act out of love — but emotions make boundaries hard. Often, their attempts become:

• Nagging
• Blaming
• Pleading
• Threatening

This only pushes the person away.

What families SHOULD do:

• Give space and avoid confrontation
• Ask open, calm questions
• Offer support without forcing
• Let them know: “I’m here when you’re ready to talk.”
• Seek professional guidance even if the person refuses help

Sometimes, the family should approach the therapist first, so they’re guided on how NOT to worsen the situation.

When Should You Bring Someone to a Therapist?

There is no specific stage.
Bring them in when:

• they are willing OR
• their behaviour is affecting personal/professional functioning OR
• the family is overwhelmed and the situation is escalating

Even if the person is unwilling or denies the problem, bring them in.
A therapist creates a non-judging space — and people eventually open up.

Why Do Some People Become Addicted?

Aparna:
Addiction isn’t about pleasure — it’s usually about pain relief.

One powerful psychodynamic explanation:
People who experience childhood emotional neglect, trauma, abuse, or inconsistent caregiving often grow up with an underdeveloped reward system in the brain.

Alcohol then gives them a feeling they rarely experienced — warmth, relief, comfort.

One patient once said:
“The first time I took alcohol, it felt like someone hugged me.”

So addiction isn’t about weakness.
It’s about pain.
Alcohol becomes a dysfunctional solution to emotional wounds.

Other Therapies That Explain Addiction

• Cognitive Behavioural Therapy (CBT):
  Helps identify and change the thoughts and behaviours linked to drinking.
• Relational Theories:
  Explore how people develop emotional “relationships” with substances — similar to self-harm or other self-soothing behaviours.

Over time, alcohol becomes their way of coping, soothing, and surviving.

A Powerful Perspective

Cutting, overdosing, and drinking seem different.
But psychologically, many people use alcohol in the same way others use self-harm — to numb emotional pain, not to seek pleasure.

This reframing helps families understand addiction with empathy rather than judgement.

Many individuals struggling with alcohol don’t like to think of themselves as “patients.” They feel it’s just a habit that has gone out of control — something they can manage with a bit of help. And yes, some people can be managed on an outpatient basis.
But we also see individuals who are severely dependent, where home-based support is no longer safe or effective. Others need longer, structured programs to stabilise and maintain sobriety.

In our last podcast with Dr. Madhukar, we discussed outpatient care, inpatient treatment, and de-addiction centres. From a psychologist’s point of view, how do you see these settings? And what exactly is your role?

Understanding OPD, IP, and De-addiction Settings

Aparna:
From an OPD (outpatient) perspective, we focus on the immediate presenting concerns. We educate the person, help them identify struggles and barriers, and begin building coping mechanisms — supported by their family system.

But if we find that they’re unable to manage, or their environment itself is triggering — frequent conflicts, interpersonal issues, lack of support — outpatient care becomes limited. That’s when we recommend inpatient treatment.

In an inpatient setting, therapy becomes more intensive.

• Regular individual sessions
• Family sessions
• Group therapies
• Structured routines

This environment provides safety, containment, and consistency — things that are often missing at home.

If someone completes 1–2 weeks of inpatient care but still needs long-term support to maintain sobriety, that’s when de-addiction centre programs come in. These centres offer:

• Structured day-to-day schedules
• Behavioural routines
• Group therapy
• Yoga and meditation
• Skill-building
• Motivation and relapse-prevention work

All three settings — OPD, IP, and de-addiction — play critical roles depending on the severity and stability of the individual.

Host:

So as a therapist, does your role change depending on whether you’re seeing someone in OPD, IP, or in a de-addiction centre?

How the Therapist’s Role Changes Across Settings

Aparna:
Yes, absolutely. The role changes significantly.

• In OPD, we work on basics: understanding the problem, building insight, teaching coping skills.
• In IP, the work becomes deeper and more intensive. We work not only with the patient but also actively with their spouse or family.
• In de-addiction settings, group therapy, behavioural shaping, structured routines, and relapse-prevention become central. There’s also time to explore hobbies, interests, and long-term life skills.

The intensity increases at each stage.

Host:

Can a person with alcohol problems come to you on an outpatient basis, take therapy, and become sober?

Can OPD Therapy Alone Make a Person Sober?

Aparna:
No — not in most cases.
Outpatient treatment has many limitations, especially when:

• cravings are high
• triggers are everywhere
• the home environment is chaotic
• there’s easy access to alcohol

Someone might feel motivated during the session, but the moment they leave and pass by a bar, their cravings spike. Without a protective environment, progress becomes difficult. So based on severity, we must decide whether OPD, IP, or rehabilitation is appropriate.

The Importance of Family Work

Host:
Do therapists also need to work with families?

Aparna:
Absolutely.
Many issues begin within the family system. I’ve seen families say, “We give him alcohol at home in a supervised manner.” But this actually reinforces the behaviour and increases dependence.

We also need to address modelling — if a child grows up watching parents drink, they believe it’s normal. The parent may have control, but the child may not. So psychoeducation becomes vital.

Family involvement reduces relapse, strengthens boundaries, and helps create a supportive home environment.

Understanding Relapse & Why It Happens

Host:
People with alcohol issues do relapse, sometimes after months or years of sobriety. Are there psychological reasons for this? And how do you help them?

Aparna:
Relapse is very common — and very normal.
One important message is: Relapse is part of progress, not a failure.

Relapse happens due to:

• emotional triggers
• unresolved trauma
• interpersonal stress
• environmental cues (a bar sign, an old drinking spot)
• overconfidence (“One drink won’t hurt”)

Relapse-prevention therapy prepares people for this. Even after completing rehabilitation, OPD follow-ups are mandatory to sustain the progress made over months or years. The goal is not perfection — it is resilience.

Alcohol & Abuse: How Common Is It?

Host:
One common consequence of alcohol use is abuse — physical or emotional. How often do you see this in therapy, especially with spouses?

Aparna:
Abuse does occur, and it can come from both men and women.
Under the influence of alcohol, judgment is impaired. If cravings are high and access is denied, the person may become:

• irritated
• verbally aggressive
• destructive
• occasionally physically aggressive

Verbal aggression is more common; physical aggression is less frequent but still occurs — especially when the person feels desperate for alcohol.

Often, families reach a breaking point and request urgent inpatient admission for safety.

Closing Thoughts

Host:
This has been such an insightful conversation. From understanding treatment settings to psychological approaches, family dynamics, relapse, and abuse — it’s clear how complex the work is.

The biggest takeaway for me is this:
Help is available at every stage, for every person — and relapse is part of recovery, not a failure.

Thank you so much, Aparna, for this articulate, clear, and deeply informative conversation.

Aparna:
Thank you so much for having me.

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