Talk To Me: My brother will not cut back on alcohol despite heart condition

Psychologist Caroline Martin is here to answer your questions on whatever issues you are dealing with in life, from work pressure and stress to loneliness and grief

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My brother and I have always been close. He’s in his late 50s and recently told me he has a heart condition. He will be on medication for the rest of his life. He is improving his health by exercising regularly and cutting back on high-fat foods. However, his alcohol intake has not decreased. I’ve told him about the health warnings but he refuses to listen. It’s heartbreaking to see him ignore the scientific evidence. I’m not sure what else I can do.

It can be exasperating when the people we love don’t behave in a way we feel they should. This is one of the big struggles for parents of teenagers who predictably exert their newfound sense of autonomy, often rebelling against rules there to safeguard them.

In much the same way, I wonder if your brother is asserting his sense of control as new restrictions are being imposed on his behaviour.

It must be incredibly difficult for him to accept that he must make lifestyle changes to avoid significant health risks. The decision not to reduce his alcohol intake may not be as simple as choosing right from wrong. Maintaining the status quo may be a rebellious reaction driven by an inclination to have a drink and give his health concerns the proverbial two fingers. Or it could be a more considered decision.

Empathy requires us to sit with the other person’s perspective, even if it is uncomfortable. Approach conversations at a time when he’s receptive and you are both relaxed rather than in moments of conflict or stress. When your brother senses that you genuinely get his point of view, then he can begin to hear you. Until then, he will either defend his behaviour or wait for you to hear him.

Understanding the underlying motivations can help you to find ways to address them effectively. By using open-ended questions, you will be better able to engage him in conversation. Avoid asking ‘why’ questions as they tend to result in defensive answers. Be curious about the drivers behind his drinking. Perhaps specific emotional or social aspects are tied to his drinking habits. These considerations may be aligned with qualities core to your brother’s sense of identity. 

Encourage him to explore what he gains from drinking. For example, he may have gained recognition and validation in the role of wine connoisseur. As he struggles with a sense of his own fragility, feeling confident in this role may give him assurance that he still has value.

If your brother is open to it, you could suggest he connect with a registered therapist to work through any unresolved fears or old wounds that may be influencing his choices.

Caroline Martin, psychologist. Photograph Moya Nolan

You may want to share your feelings and thoughts about seeing him drink to the point where he could damage his health. It can be helpful to use “I” statements in this case — owning your concerns ensures he does not feel blamed or responsible for your wellbeing. You might say: “I feel worried when I see you continue with your current alcohol intake, given your heart condition.” Focus on how much you care about his happiness and longevity. Be aware of your reactions and strive to respond in a way that expresses support. You may discover old family dynamics are afoot, and you could also benefit from therapy to disentangle yourself from these.

Your brother is evidently capable of making good decisions and has taken steps to adapt his lifestyle to his new reality. Highlighting these choices and celebrating these positive changes can reinforce his ability to make tough decisions. When we take time to recognise our successes, we are more likely to believe we can be successful in other areas of our lives.

His capacity to make changes based on medical information indicates that his autonomy ought to be respected. Despite your caring and love, your brother has the right to make his own decisions, even if you believe they are wrong. It is clear he is listening to the advice of his medical team and is capable of determining which interventions to employ and which he is currently unwilling to do. Everyone’s journey is unique, and he may need time to come to the same conclusion as you.

If your brother begins to feel harshly judged by you, he may pull away. Keeping the lines of communication open without judgment is helpful. Let him know you’re there to listen and support him. Create an environment conducive to change by reducing your alcohol consumption. Show your commitment to a healthy lifestyle. Our sense of confidence in our ability to achieve a goal is enhanced when we see those we care about achieving that goal.

Taking care of your overall wellbeing is critical. Dealing with a loved one’s health issues and what you perceive to be self-destructive behaviours can be emotionally draining. When this person is a sibling, it may hold up a mirror to your fears of your mortality. Ensure you have a support network and engage in self-care activities to help you manage your stress.

• If you have a question for psychologist Caroline Martin, please send it to [e-mail]