Dr. Sarah Wakeman
speaker
484 appearances
2 recordings
2 series
first heard Jan 2025
last heard May 2025
Dr. Sarah Wakeman’s voice in public audio — every appearance, attributed to the second.
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Enabling is the idea that you're kind or caring to someone that you're actually hurting them in some way. And hitting bottom is this idea that people have to just fall so far and suffer some terrible consequence before they make a change. Those are all really problematic concepts for a couple of reasons.
So first of all, the definition of alcohol use disorder is not being able to stop despite bad things happening to you. And many people are drinking because it's a powerful coping mechanism. And some of the things that put you at risk for an alcohol use disorder are traumatic life experiences, untreated anxiety and depression, not feeling good about yourself.
So having the only people that you sort of love and trust in your life try to cut you down to size and tell you that you're doing something terrible and set some ultimatum is actually not going to help you get well. None of us make hard changes when we feel threatened or sort of punished or not supported. We do it when we feel loved and safe and have hope that our life could be better.
And so as a loved one, that's probably the greatest gift you can give to the person. Now, it's complicated because you're impacted by their behavior. So it's very easy as a provider.
One of the things I love about doing this work, because I've been on the other side and had family members and it's a different experience as a doctor, like whether or not my patient continues to drink doesn't impact me personally. I can just be their partner, their champion, work with them.
For families, there are times where the behavior becomes so unsafe that people have to keep themselves safe and set boundaries. And that's OK. I think the distinction there is that it's not doing it for the person's benefit. So if you kick someone out of your house, it's not going to necessarily help them get better.
But there may come a time and a place where people need to do that for their own emotional safety or well-being. But for that human being to help someone get well, and this is where earlier conversations are so important, is to really sort of love and support them and work together on it and make sure they find access to good treatment, which is out there and available.
Yeah, so many important pieces in there. I think there's so much stigma in our society about alcohol use disorder and substance use disorder. And people rightfully so feel really ashamed and secretive. And sometimes long after they've started to worry about themselves, They're scared to tell anyone else because they think someone will judge them or treat them poorly.
And that stigma and fear of bad treatment or judgment actually keeps people from seeking help for a long time. I think the other really important piece is that when you're removing something that has played a powerful role in someone's life, you need to fill up those spaces with other things. I think our sort of Puritan roots as a society is we have this idea that like you're doing something bad.
You need to just pull yourself up by your bootstraps and knock it off and white knuckle it. And in fact, like it should be hard. You know, that's often our sort of these ideas of tough love and hitting bottom is like, well, you're you're like have done something bad and you, you know, you don't have willpower. So we're going to make it tough on you.
When in fact, like the broader concept is why would someone make changes and how is their life going to get better? And how do we make it easy to make a change? And so if you think about any change you made in your life, if you set yourself up for success, you're going to be far more likely to be able to make that change.
So if you're suffering from trauma, depression, anxiety, you're not going to be able to just stop drinking without help. You need help treating the anxiety, depression, trauma and also treatment for the alcohol use disorder. That's not because you're weak. That's not a failing. And if you're not able to sort of
meet your goals with whatever intervention and support you're getting, that's a sign that that support is not enough for you. So really shifting from this idea that the person is failing to thinking like the system, the treatment, the resources are failing. And how do we adjust that instead of blaming the human being who's suffering? I just want to thank you.
Yeah, I think ideally it starts young. Like ideally you're having these conversations very early on with kids in a pragmatic, not in a scare tactic way. So we know that things like dare, you know, this like I'm going to scare you into this is what alcohol and drugs do to your brain. Actually, kids use more drugs after seeing that sort of stuff. It's not helpful.
Kids see right through adults when they're sort of all or nothing about things. So having these nuanced conversations like you're going to be around friends who are drinking really heavy. What do you think about that? What's been your experience? What are some of the worries you might have about that?
And talking about the very practical risks that are not necessarily like liver failure addiction, which are not going to be resonant for a 19-year-old. But, you know, getting into a situation that doesn't feel safe, you know, getting into a sexually vulnerable position with someone, doing something that you don't want to do, missing class the next day.
So talking about sort of relevant, personalized issues that may come up for that kid. And then importantly, that your child feels safe talking to you. You know, you want them to feel comfortable coming to you about small things so that they'll come to you about big things.
And so you can share all of this in a way that doesn't feel judgmental, doesn't feel accusatory, really opens the door to ongoing conversations instead of making someone feel sort of, you know, like they're being blamed or judged by their parent. So for somebody that's never even broached this and
Well, first of all, it is not too late. You have not failed. None of us are perfect in this. These are hard conversations and we haven't learned how to do it. So it is never too late. It doesn't matter how many times you've ignored it or had an unproductive conversation. I think in that moment, probably the most important things you can communicate are, I love you. I'm worried about you.
I'm here for you. I know that treatment works. This is how I can support you. So like many things, you're sort of talking about yourself. You're talking about your care and concern. You're rooting everything and how much you love this person. And you're offering to be a partner and helping them find support and treatment. And it may not happen that day. It usually doesn't.
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