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Recover to LiveKick Any Habit, Manage Any Addiction
By CHRISTOPHER KENNEDY LAWFORD
BenBella Books, Inc.Copyright © 2013 Christopher Kennedy Lawford
All right reserved.
Chapter OneToxic Compulsion 1: Alcohol Abuse
It's all right letting yourself go, as long as you can get yourself back. —Mick Jagger
IN THIS CHAPTER:
* Indicators of an Alcohol Problem
* Time to Get Honest with Yourself
* Percentage of Users Who Become Dependent
* Alcohol Is the Most Dangerous Substance
* Why People Quit Drinking
* Clinical Research Ranks Effective Treatments
* Can You Become a "Moderate" Drinker?
* Who Needs Inpatient Treatment?
* Some Treatment Options
* Your 30-Day Challenge for Alcohol
Hawaii enjoys a well-deserved reputation as the vacation and relaxation capital of the United States. Both visitors and residents commonly seek escape from the pressures and stress of "ordinary" life. And that means they spend plenty of time basking in the sunshine, playing on the beach, or relaxing after rounds of golf or boating. I've seen this firsthand because I own a home in Hawaii and have spent a lot of time there over the years.
That "play" state of mind may be why our slice of paradise has earned the dubious distinction of being the Drinking Problem Capital of America. Both of the top two U.S. cities with the highest percentage of problem drinkers and binge drinkers are in the Aloha State, according to statistics compiled by the U.S. Centers for Disease Control and Prevention (CDC). Hilo on the big island of Hawaii ranks as the drunkest U.S. city, with 30.7 percent of the population meeting the criteria for binge and problem drinking. Close behind in second place is the town of Kapaa on the island of Kauai, with 30.5 percent of its citizenry admitting to excessive alcohol consumption.
What does heavy drinking or binge drinking look like? The CDC in its 2009 nationwide survey defined "heavy drinking" for men as having more than two alcohol beverages a day and for women more than one; binge drinking for men means downing five or more drinks at a time on one or more occasions during a month, and for women it means consuming four or more at least one or more times in a month.
Montana claims two of the other top five drunkest U.S. cities—Butte-Silver Bow at 29.3 percent of the population and Bozeman at 29.2 percent. This could make sense for a couple of reasons: 1) frigid temperatures might keep people indoors longer with more excuses to drink, though by that reasoning Alaska should have been at the top of the list; and, a more likely reason, 2) Montana has one of the nation's highest rates of high school binge drinking. Heavy drinking during the teenage years can influence levels of alcohol abuse later in life.
These days, according to the 2009 National Survey on Drug Use and Health, 86 percent of our kids have used alcohol and half of them are binge drinkers by the time they turn 21. Many of the underage binge drinkers will outgrow the habit, but increasing numbers will continue to succumb to their compulsions. Drinking behavior before the age of 16 is a key indicator of future alcohol use. When kids become heavy drinkers before the age of 15, "they are about six times more likely to end up with alcohol problems," said Peter Delaney, director of the Center for Substance Abuse Treatment at SAMHSA (the Substance Abuse and Mental Health Services Administration).
Pamela Hyde, administrator of SAMHSA, added: "The earlier someone starts using alcohol or drugs, the more likely they are to have an issue in adulthood. And conversely, if you can avoid using alcohol and drugs until you're 25 years old, your chances of getting addicted are greatly lessened."
This brings up an interesting question. Should parents be teaching their teenagers how to drink responsibly, just as we are supposed to teach them how to drive a car safely? Or should we be preaching and enforcing strict abstinence?
Though the minimum drinking age is 21 throughout the United States, 31 states allow parents to furnish alcohol to minors in the home. The statistics on use and abuse that I have seen are revealing. According to a 2004 survey of 6,245 U.S. teens, published in the Journal of Adolescent Health, those kids who drank alcohol in moderation with their parents, especially at meals or in religious rituals, were one-third as likely to engage in binge drinking as other teens, and half as likely to become regular drinkers.
There is an additional problem for teen binge drinkers, other than possibly setting a standard for abuse later in life: Alcohol abuse can inflict long-term harm to their developing brains. Using brain scans to study adolescents, university researchers reported in a 2009 issue of the Journal of Clinical EEG and Neuroscience that the frontal cortex and hippocampus of adolescents who have 20 or more alcohol drinks a month begin to change. Guess what those brain areas control—our cognitive and executive functions, our memory, our attention, and spatial skills. In other words, judgment becomes warped and impulse control is diminished. Unfortunately, the frontal cortex and the executive functions it coordinates are not fully developed until our early twenties. Alcohol use in adolescence impairs functions that are not yet fully developed.
By now, you should be getting a glimpse of your own pattern of alcohol behaviors, the ones you established early in life. Reflect on that for a few moments.
What kind of drinker were you as a teenager?
Were either of your parents a problem drinker?
How often did you get inebriated?
Was it a pattern that you continued into adulthood?
How often have you tried to stop drinking and failed?
Are you able to be honest with yourself about your drinking habits, or do you sense denial that needs to be penetrated for the truth to be known?
Indicators of an Alcohol Problem
It's not always easy to know if you or someone you love has an alcohol problem and is in need of treatment. There are usually layers of denial—both yours and theirs—which must be penetrated, and then there are the social pressures that must be resisted, pressures that tell us drinking alcohol is a "cool" and socially expected behavior, even though more and more there is a stigma attached to its overuse and abuse. Here are the indicators that a personal alcohol problem may exist:
You carry an alcohol-susceptible gene
From Dr. Drew Pinsky, addiction medicine specialist and clinical professor of psychiatry, University of Southern California School of Medicine: One day we will have a genetic spectrum for the disease of alcoholism. The North American Indian version of the gene that makes them susceptible to alcohol will be different from the Irish-Persian, which can be different from the Northern European, and they are going to have different potentials for the disease. When a person's genetic burden is low, the psychiatric burden or environmental burden has to be high for alcoholism to occur. But fundamentally, in my opinion, the most common issue that precipitates the disease from the genetic potential is something called Emotional Dysregulation. Not just more anxiety, not just more depression, which alcoholics have throughout their history, because they often come from an alcoholic family, but an incapacity to regulate their emotions. So their emotions are too prolonged, too intense, and too negative.
You're anxious or depressed
From Pamela Hyde, administrator of SAMHSA: If you take people who have a mental disorder, who are depressed, 20 percent also have problems with alcohol or drugs. Almost half of all people with an identifiable addictive disorder also have an identifiable mental illness. These disorders often go hand in hand. We have a tendency to say, "Let's take care of the depression and that will make the alcohol go away, or let's take care of the alcohol, and that will take care of the depression." I think the science tells us that integrated treatment, treating both concurrently, is the better way to go.
You're overconfident about handling risks
From Dr. Robert DuPont, President of the Institute for Behavior and Health Inc, first director of the National Institute on Drug Abuse, second White House Drug Chief, and clinical professor of psychiatry at Georgetown Medical School: Is it risky to be a social drinker? My answer is yes. I see lots of people who are social drinkers for many years and then become alcoholics, even later in their lives. The addiction switch gets thrown late for these people. Once that switch is on at any age you don't go back to being a controlled alcohol or drug user.
It's clear that everybody is vulnerable, but some are a lot more vulnerable than others and usually what you find is the people that have a problem really liked alcohol a lot and tolerated it. If you're starting to drink and you don't like it, can't tolerate it, and you feel terrible afterward and that leads you not to use, you're protected from becoming an alcoholic. But if the first time you use you say, "Whoa! That was cool. I can drink and I can hold my drinks," that's a very bad sign.
So what aspects of a person's lifestyle contribute to triggering or exacerbating substance use? Willingness to take risks and self-confidence that you can handle risk are very good predictors.
You exhibit these specific behaviors
From Norman G. Hoffmann, PhD, president of Evince Clinical Assessments: We've been looking at very detailed diagnostic data from over 7,000 people recently. And what we find is that there are certain things that are cardinal measures that you're dependent. If you sacrifice activities in order to use, whether its alcohol or other drugs, or if you've not fulfilled your normal role obligations. You were supposed to do something and didn't because you were preoccupied with drinking. You find yourself thinking a lot of about using when you aren't. That doesn't tend to happen for those who meet either an abuse (nondependent) criteria or the moderate substance-use disorder criteria.
If you set rules and you don't follow them, that's another one that tends to be on the list. If you've not fulfilled your role obligations as a homemaker or as an employee or whatever, if you've been very preoccupied with use, had a compulsion to use where you just felt you couldn't not use. If you regularly experience any of these indicators, then you have a serious issue and you're just not a mild user. If you're one of the many who do experience these issues, then you need to understand that abstinence is probably your only stable out.
You suffer from multiple health problems
Finally, when assessing unhealthy alcohol or drug use, you should look at levels of use that may risk producing health consequences.
Dr. Richard Saitz, professor of medicine and epidemiology and director of the Clinical Addiction Research and Education (CARE) Unit at the Boston University Schools of Medicine and Public Health, proposes asking one single straightforward question to assess risk: How many times in the last year have you had more than five drinks (for men), or four drinks (for women) in a single day? If your answer is one or more times, you have a risk of health consequences from alcohol. It's that simple.
Most people know about some of the obvious health consequences of alcohol abuse, from hangovers to chronic conditions such as liver disease and brain damage (yes, chronic use actually damages and shrinks parts of your brain that control judgment, impulses, and memory, along with regulating social and sexual behaviors). But did you also know that the chronic medical condition of alcohol abuse is the third leading cause of death in the United States and has been linked by medical studies to premature aging, high blood pressure, heart attack, stroke, and cancers of the breast, esophagus, stomach, liver, mouth, and throat?
Time to Get Honest with Yourself
We all possess layers of denial and self-deception about aspects of our lives. Whether it's about our vanity ("I look younger than anyone my age.") or about our skill levels ("I'm indispensable in this job.") or our impact on people ("I am universally loved by others."), our minds have a great capacity to trick us and shield us from unpleasant truths.
When it comes to alcohol and drugs and the other Seven Toxic Compulsions, our capacity to fool ourselves, which ordinarily serves to protect us from the wounding of pride, has much broader and deeper repercussions. These can include exclusion, the loss of one's job, family, home, self-respect, and freedom, and even death. Substance abuse is a nasty and devious disorder of the mind that further empowers any natural tendency toward denial so that we end up playing complicated games with our thoughts and our rationalizations in ways that smother the truth and inflict harm on ourselves and others.
That's one reason why it sometimes takes a life trauma such as a spouse leaving or bankruptcy or an unpleasant encounter with the criminal justice system for the layers of denial and the mind games finally to be punctured so that the light of honest self-reflection can shine through.
What sort of denial are you engaging in? What does the echo chamber inside your head sound like? Does any of this feel and sound familiar?
I don't have a problem.
I've never had a problem.
I will never have a problem.
I can always control my drinking.
Okay, occasionally I slip up.
But I can always stop drinking if I really want to.
I enjoy drinking too much to ever stop.
If other people have a problem with my drinking, that's their problem.
Okay, getting drunk and crashing my car into that tree was a slip up.
It will never happen again. I promise.
I know I can control my drinking.
And the mind games and the endless chatter of delusional thoughts go on and on and on.
It's time to get real with yourself, and if you're playing dangerous mind games, it's time to stop. The following two questionnaires are useful screening tools to help you gauge the severity of your drinking. It's an opportunity to shed some light on the matter and help you avoid inflicting unnecessary harm to yourself in the future.
Still not convinced you have an accurate insight into your drinking habits? Don't know if you have an addiction or just a festering bad habit? What follows is a more in-depth series of questions that, if you're able to be honest with yourself, should dispel any doubts about your drinking status.
AUDIT scores in the 8–15 range represent a medium level of alcohol problems, whereas scores of 16 and above represent a high level of alcohol problems.
The AUDIT (Alcohol-Use Disorders Identification Test) was developed by the World Health Organization (WHO). The test correctly classifies 95 percent of people into either alcoholics or nonalcoholics. It was tested on 2,000 people before being published. The pdf format version of the AUDIT is available through the WHO Web site, where you can also find the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST): www. who.int/substance_abuse/activities/assist/en/index.html.
Percentage of Users Who Become Dependent
This information comes from the only major study that estimates the percentage of persons using a specific substance who will become dependent on that substance. If you think about the number of people who periodically drink alcohol, the 15.4 percent who become "problem" drinkers translates into tens of millions of users with a habit that may be evolving into a dependency.
(Source: "Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey." Anthony JC, Warner LA, and Kessler RC. Exp Clin Psychopharmacol. 1994 Aug;2(3):244–68. doi: 10.1037 /1064-1297. 2.3.244.)
Alcohol Is the Most Dangerous Substance
Here is another collection of comparisons for you to keep in mind. The authors of this study evaluated the relative harm that alcohol, tobacco, and other drugs cause to users and others, whether they be friends, family members, coworkers, the local community, or the broader society. The authors assigned each a harm score on a 100-point scale. The higher the score, the greater the overall harm associated with the substance.
Excerpted from Recover to Live by CHRISTOPHER KENNEDY LAWFORD Copyright © 2013 by Christopher Kennedy Lawford. Excerpted by permission of BenBella Books, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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