Alcoholism: A perspective from a Chemical Dependency Counselor, and long-time drinker.

Drugs are great! Until they aren't anymore. Then, they are horrific and you must discontinue using them immediately. 

That statement crossed my lips at least once a week, while I tried to calm the nerves of a client during an initial evaluation in my office.  The initial evaluation is administered when someone is trying to determine if clinically they are a drug addict or alcoholic. The results of that evaluation are usually 'yes, addiction is present', mostly because not many people came through my door unless they were aware, on some level, of an addiction. 

The qualm most people had with this diagnosis is acknowledging addiction is accepting that you are not in control of your disease; i.e. there is no amount of fanagling you can do to safely continue using. Most people that are seeking help for addiction still want to believe they have just "gotten a little out of control" but once they get treatment and are back in control, they can use again-safely. Unfortunately, that's not how addiction works.  Once addicted, never safe. And you can't substitute one substance for another, insert this conversation: 

That being said, I am going to focus on alcoholism specifically in this article.

So let's address some of the common questions that cross my desk:

1. So why is alcohol even legal if its so addictive and dangerous?

 Because: Drugs are great! (and yes alcohol is a drug). Until they aren't.  Yes, some people become addicted, drinking leads to many health issues and contributes to crime, and accidents. BUT, it is also a multi-billion industry that is entrenched in our culture and for some people...is just fun. Alcohol, in and of itself, is not addictive- for everyone. In fact, one of the initial warning signs of  alcoholism is a person who feels a strong urge to binge drink and continue drinking following that first drink. The reason is, simply, because alcoholism is based on a genetic predisposition. Hence, why it is viewed as a disease. There is a chemical difference between people who become alcoholics and people who do not. People who are predisposed to alcoholism will react to alcohol differently and indulge in it frequently enough to develop a physical addiction. People who do not have that predisposition are very unlikely to drink enough to ever become physically addicted. Picture smoking a cigarette- the first time you take a puff, you cough, the chemicals are in your system, but you're not hooked- it is not until you have had a few cigarettes that a physical addiction occurs and you feel the withdraw symptoms that make you crave another. Having a drink is the same. Alcoholism occurs in stages and the physical addiction is not present in the early stage. It is not until a larger quantity of alcohol is introduced to your system, over a prolonged period of time that you will actually have physical withdrawal symptoms. Craving the euphoric rush? For an alcoholic, that can happen after the first drink. 

For more information regarding the chemical predisposition for alcoholism: a great read is "Beyond the Influence, Understanding and defeating Alcoholism" By: Katherine Ketcham

2. I  have some issues with alcohol, but I am a high functioning person! I'm not an alcoholic because I don't need to hide bottles around my house and drink all day. So how can I be an alcoholic?

Unfortunately, I hear that a lot. Despite research that proves that alcoholism is a genetic predisposition (aka you are born with it) many people still carry the shield of the stereotypical  late stage alcoholic as their justification that they "aren't that bad" and therefore, can compare out and dismiss their own issues. In early stage alcoholism, a person is usually still enjoying the party. He may have a high tolerance, be able to re cooperate quickly from drinking, maybe drinking has led to an underage or even DUI, but that might be the only consequence he has experienced at this point. It is very hard to see the problem that drinking may become because, for an alcoholic, the buzz is an amazing feeling and it is almost impossible to imagine this thing in your life that makes you feel so good, will be the same thing that destroys you. The goal of current clinicians in the chemical dependency field is to identify the disease before a person becomes a late stage alcoholic. 

3. ...Am I an alcoholic?

Well, let's start by providing a copy and paste of the definition of clinical alcohol abuse and dependence from the DSM-IV (the diagnosis guide used by clinicians):

Appendix B: DSM-IV-TR Diagnostic Criteria for Alcohol Abuse and Dependence

Go to:

ALCOHOL ABUSE

(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by at least one of the following occurring within a 12-month period:

• Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household)
• Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use)
• Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct)
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication).

(B) Never met criteria for alcohol dependence.

Go to:

ALCOHOL DEPENDENCE

(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period:

• Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol
• The characteristic withdrawal syndrome for alcohol; or drinking (or using a closely related substance) to relieve or avoid withdrawal symptoms
• Drinking in larger amounts or over a longer period than intended.
• Persistent desire or one or more unsuccessful efforts to cut down or control drinking
• Important social, occupational, or recreational activities given up or reduced because of drinking
• A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking
• Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking.

(B) No duration criterion separately specified, but several dependence criteria must occur repeatedly as specified by duration qualifiers associated with criteria (e.g., “persistent,” “continued”).

Source: Adapted from American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: APA, 2000.

Now, that definition decoded: Ask yourself these 10 questions:

1. Are you unable to stop drinking after having 2-3 drinks?

2. Does your family have a history of alcoholism?

3. Has your health been effected by your drinking? Has your physician advised you cut back?

4. Have you encountered any legal issues due to drinking or drug use?

5. Do you find it hard to control your mood, frequently feeling irritable or frustrated?

6. Have your family members or friends questioned you regarding your drinking habits?

7. Have you ever been involved in a car accident due to drinking?

8. Have you blacked out from drinking or drug use?

9. Have you ever become hostile, belligerent, or been involved in a physical fight while intoxicated?

10. Are you preoccupied with drinking (i.e. is drinking present at all or almost all of your social activities, do you find yourself thinking about happy hour, or the next time you will be able to have a drink when not drinking)?

If you answered yes to more than 3 of these questions OR if you feel that you may have a problem controlling your drinking or drug use, contact a local provider to get an evaluation. 

Remember, addiction is a disease- it's not something to be ashamed of or stigmatized by. If a person has  diabetes and eats poorly, doesn't monitor his blood sugar, and ignores his symptoms; yes, he  is responsible for the decision he made to further the deterioration of his health BUT he is not a bad person for being a diabetic. It is not his fault that he has a medical issue; it is just his responsibility to take action to better his lifestyle and health. Alcoholism is the same. 

Doors

Pregnancy is a wild ride. Its filled with excitement, worries, body changes, and hormones. During the highs and lows of my own first trimester's emotional rollercoaster, I found myself searching for a way to cope with my sudden internal instability. I found solice in writing short stories during my lows (which my fellow expectant ladies can understand, can be extremely low). Being pregnant is difficult. I've forgiven myself for feeling less than zealous about my condition. Yes, my baby is a blessing. My husband is wonderful and I'm very fortunate to be in the situation that I'm in. Yes, I'm excited to be a mom and I will love my baby fully, but motherhood is not the only role I've filled. I've been an  education-centered, career-centered, self-centered, adventurer for 26 years and changing my priorities does not happen overnight -or without fear. That fear lead me to write 'doors', its an exaggeration of the trapped feeling that bubbled up as I cancelled our travel plans, and notified my career that I would have to put it on hold for maternity leave. 'Doors' captured my fear. It put it on paper, rather than allowing it to circle my mind. It gave me peace.

If there are other pregnant women feeling guilty about not always feeling maternal and joyful, you're not alone. Pregnancy is the long, uphill, walk to the paradise which is holding your child for the first time. We all have faith that it will be well worth it, but naturally we notice the blisters along the way.

Doors

I use to run, wild. I had a thousand doors around me, all unlocked, with enticing booming sounds beckoning me to explore where they lead. I opened so many of those doors. Sometimes I became lost. But other times i stumbled across living that can only be described as magic. Each day transforming faces of strangers into loved ones, foreign places becoming my sacred ground.  I lived so fully. Perhaps too fully... maybe we are only meant to see so much before the doors begin to rust, binding themselves shut, so that entry is difficult, if not impossible.

I circled the world, & then quite suddenly, without deliberation,  I traded in my traveling shoes. I did it for love. A noble, logical reason to hang your hat. But, I am a woman and love carries heavier choices for us.

Just the act of being in love, firmly shuts & locks a few doors to the new suitors and the novelties they provide. That was no bother. He loved me truly. I no longer needed the compliments of strangers to see my value when I looked upon his face.

But, then there was a child. More doors slammed quickly shut.

My love became my husband. A formal, heavy contract now binds us,  in case the love itself is not ever lasting.

My body is no longer my own. Every aspect of it now lends to the child. The accomodations and limitations are endless.

It's been decided, to be a proper mother, I should not return to work for a period of time. Tightening our budget, and 'changing our lifestyle'. More doors latch closed.

With out my own money, without my own body, I am expected to live for the family I created, transforming myself into the matriarch of our home.

But,  I was once a bird. I flew to the corners of the world upon my own whimsy. I opened the doors to Asia & Europe. I let the sun kiss my skin and the rain dampen my head, without the shade of a stable home. As doors close, they become the walls of my new house. And I sit safely inside.

Even the most powerful animals, great bears and tigers, seem docile and muted behind the bars of a zoo. For their comforts, they trade their spirits. Sadly, many would never be able to survive if they were released.

How long will it take? Before I forget how to fly? *