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About the Author
Doug Thorburn provides continuing education for the California Association for Alcohol and Drug Educators and is the president and founder of the PrevenTragedy Foundation, a nonprofit organization dedicated to educating the public on the importance of early identification of alcoholism. He lives in Northridge, California.
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How to Spot Hidden Alcoholics
Using Behavioral Clues to Recognize Addiction in its Early Stages
By Doug Thorburn
Galt PublishingCopyright © 2014 Doug Thorburn
All rights reserved.
Identifying the Problem
Have you ever known someone who exhibited behaviors that didn't make sense? We always seem to figure, "That's just Billie," don't we? Or, "Suzie must have had a tough childhood," "Robbie must have a mental problem," or "Sometimes Steven acts badly in ways that are out of character with his true self. I just don't understand it; he really needs to learn to control himself."
Even experts often attribute abnormal and erratic conduct to such forces. Such was the case with James, a college student who, as part of a long-term study, was periodically interviewed by mental health professionals over several decades. During his first interview at the age of 19, James, noted by professionals as being emotionally healthy and stable with good moral character, described his parents as warm and understanding. In a follow-up interview nine years later, shortly after his mother's death, he showed normal signs of deep grief.
At age 36, a married father of four, James went into psychiatric treatment for insomnia, guilt and anxiety. When we learn that he admitted to cheating on his wife, gambling and being deep in debt — a result of "irresponsible borrowing" — these symptoms aren't surprising. In fact, considering he had also been dismissed from his position as a university professor, it would be abnormal if he hadn't experienced deeply negative emotions.
James told therapists that his wife didn't appreciate him and that his parents, whom he had previously reported as warm, had in fact been cold. The psychiatric staff felt that his main problem was apprehension over family and job concerns, an anxiety that they believed could have originated with the death of his mother. They concluded that he had been emotionally unstable for the past 20 years, even before researchers reported that he appeared solid. At no point did anyone consider the possibility that alcoholism might explain the behavioral changes and disorders.
Yet, at age 50, James joined Alcoholics Anonymous. He admitted in an interview two years later that by age 30, while writing his Ph.D. thesis, he was drinking constantly and selling stolen university library books to support his drinking. He reported that he was now ashamed of what he called his "psychopathic" behavior.
The Harvard Medical School's 1990 "Mental Health Review" recited this case, originally originally reported by the great alcoholism authority George E. Vaillant, to illustrate "some of the problems in identifying the causes of alcoholism and making judgments about the personality of the alcoholic." However, what do the causes of alcoholism have to do with this story? How are judgments about his personality relevant? The case instead illustrates that no one identified the possibility of alcoholism despite numerous behavioral indications. The message is that even medical professionals are overlooking a diagnosis of alcoholism in such cases. The "Review" didn't even identify the right problem.
On the personal side, I was romantically involved with a beautiful and highly intelligent woman for 2 1/2 years. Like James, she exhibited increasingly bizarre behaviors and suffered from severe emotional problems. The two therapists with whom we counseled for much of that tumultuous period never once suggested the possibility that alcoholism might explain her behaviors or those of her children. Instead, they blamed me for the difficulties in our relationship, even while considering the possibility that she might have a Personality Disorder. I gradually realized that instead, she suffered from alcoholism. Surviving the experience and vowing never to go through anything like it again, I decided I'd better learn something about the subject. I happened upon Alcoholics Anonymous and realized that was a good place to start.
At AA meetings, I heard seemingly good people telling horrifying stories of atrocious behaviors in which they engaged as practicing alcoholics. This led to a very simple question: what was causing what? Did bad conduct or lack of morality cause alcoholism, or did alcoholism cause misbehaviors? As I slowly realized it was the latter, I wondered, what if I reverse the idea? If alcoholism caused poor behaviors, when serial misbehaviors were observed, how often might I find alcoholism? Yet, I knew from experience that alcoholics did not always act badly. Therefore, if I found a modicum of misbehaviors, might that be a harbinger of worse? These questions revolutionized my life.
Single and dating again, I began testing the idea that isolated incidents of poor conduct might be a clue to worse behaviors and, therefore, alcoholism. When I observed erratic or inexplicably destructive behaviors, I looked for evidence of addictive use. In two cases, I quickly found it and didn't stick around. One woman belittled the mutual friend who had been responsible for our introduction, a behavior that will later be shown as symptomatic of alcoholism. At the time, she was enjoying her fifth or sixth drink of the evening. Another began twisting everything I said after she popped Vicodin, which is a prescribed form of synthetic heroin, helpful for pain suppression in the non-addict and getting high for the addict. Mutual friends later confirmed my suspicions of alcohol or other drug addiction in two out of three other women, none of whom exhibited overt signs of heavy use in front of me, but who occasionally acted in uncharacteristically nasty ways. One of them drank a magnum of wine one day while working with a mutual friend and destroyed their business relationship. Another, who occasionally acted nasty, even if somewhat controlled while drinking to excess, was seen drunk several times before 10am. By considering the likely source of occasionally poor behaviors, I was able to protect myself by allowing the option of a quick exit.
More important, as the ideas developed, I began experimenting with these questions in my professional and business life. As the owner of an income tax preparation and financial planning firm, I need to hire additional employees each January. Using this tool, I began weeding out likely alcoholics. In addition, my wife and I own vacation rental town homes in Mammoth Lakes, California. I take most of the reservations and inadvertently confirmed that if I suspected alcoholism over the telephone, I was usually right. They were the guests who didn't deserve a refund from their cleaning deposit after having parties to which the police were called. I learned to inform such prospective guests that the dates they requested were unavailable.
Most important, as an Enrolled Agent (tax professional) and Certified Financial Planner licensee®, I used this idea with clients experiencing inexplicable financial problems. If I suspected that one was romantically or professionally involved with a practicing alcoholic or other drug addict, I'd sometimes suggest the possibility. After a series of questions, I'd point to the likely culprit — even if I didn't know the person. The response was invariably something along the lines of, "No way. He's my best friend/spouse/partner/child/parent. I've known him for twenty years. He's too smart to be an alcoholic." Countering that intelligence seems to have nothing to do with addiction, I'd suggest to my client that he might want to take another look.
In most cases, I'd hear back a day, a month, even six months later. "You were right. How did you know?" I was confirming my theory that one can spot alcohol or other drug addiction solely on observable behaviors and their effect on others. It began to dawn on me that I was on to something with enormous ramifications.
I learned from recovering alcoholics, as well as from clients, that my story and James' are typical. The reason is that psychologists and physicians rarely receive training in this area. Therapists are usually either taught that alcoholism is caused by environmental influences, or believe this despite having learned that it's not. "You drink because your parents abused you," is a common message that many practicing alcoholics hear in therapy. In sobriety, recovering addicts tell us that the therapist was often the biggest enabler, providing all the excuses needed to continue drinking. Most of the time, the therapists don't know about the drinking and, as in the case of James and my own addict, don't even suspect it. The latter may be a worse form of enabling, since they are using therapeutic techniques in a futile attempt to treat symptoms brought about by chemistry.
Until recently, medical schools required no training in the field of drug addiction. Today, they generally require at most only 24 actual classroom hours. By contrast, I have spent thousands of hours interviewing recovering alcohol and other drug addicts and researching the disease. Even psychiatrists — the drug doctors — don't get it. Dr. Martha Morrison, who tells her story in White Rabbit: A Doctor's Story of Her Addiction and Recovery, recounts how she was variously misdiagnosed by fellow psychiatrists as Paranoid-Schizophrenic, Obsessive-Compulsive, Bipolar, Manic, Borderline, Narcissistic, Psychotic and Sociopathic. She was using almost 20 different substances a day from the age of 12 and, incredibly, went unidentified as a practicing addict until having been a licensed psychiatrist for two years. She says that she had none of these Personality Disorders and confirms that she was, quite simply, an addict. No wonder a user of the single drug alcohol, who may be only occasionally obnoxious or unreasonable, or might exhibit symptoms of what appears to be only one of these Disorders, often goes undiagnosed or, worse, misdiagnosed, for decades.
Chemical dependency experts, often referred to as "alcohol and drug abuse counselors," have the greatest familiarity with the subject. Yet, even they sometimes lack depth of understanding. In presentations on identification of early-stage alcoholism, I ask these experts what the average age is at which one triggers alcoholism. Usually more than one member of the audience responds "age 20 or 25." I then ask, "What's the average age at which one takes his first drink in the United States?" They correctly respond, age 12 or 13. Then I say, "Let's go back to the first question." Since these experts know that the typical recovering alcoholic confides that he triggered his addiction during his first drinking episode, they quickly revise their answer.
At the beginning of these talks, I put on a bit of an act, in which I attempt to convince the audience that I will play some music on my little violin, just to get us warmed up. When I open what looks like a small violin case, I let out a shocked "oh no! I brought the wrong case!" As I reach in and pull out a bottle of what appears to be vodka, my shock turns to solace. I quickly gulp a shot and ask what this indicates. The response is, of course, alcoholism. I ask, "what stage?"
It's obviously not early-stage. For addiction to progress to the point at which the alcoholic is hiding his drug, at least one close person must have made the connection between behaviors and use. Along the way, the person I'm portraying has probably betrayed friends, ruined personal or professional relationships, and even destroyed lives. He likely has drunk beyond the legal limit and gotten behind the wheel of a car thousands of times. He has also probably displayed other misbehaviors indicative of alcoholism in private settings among friends, family and co-workers in hundreds, if not thousands, of incidents. Yet the odds are that only a few have ever suggested that he "drinks too much," almost no one has explained that the use is responsible for the bad behaviors, and he's never been the subject of a professionally aided intervention.
Few, "experts" included, are identifying alcoholism until it becomes tragically obvious. There are a number of reasons for this potentially lethal delay in diagnosis. The main one is that the commonly accepted definition of alcoholism, approved by the National Council on Alcoholism and Drug Dependence (NCADD) and the American Society of Addiction Medicine (ASAM), precludes the possibility of early identification. Yet, in the next chapter, we will show that the flaw in the definition should be obvious from the biochemistry.CHAPTER 2
A Matter of Biochemistry
We can all spot the latter-stage drunk. The person who's already lost his job, family and all sense of self-worth has also eliminated something else: the brain's ability to produce "feel-good" neurotransmitters, such as endorphins and dopamine (see Appendix II), in sufficient quantities to feel right on its own. He needs the substance to "normalize." This takes many years of heavy use, usually at least three decades (and often far longer), if he uses only the drug alcohol.
As I heard the stories of recovering alcoholics in AA, I began asking myself how they got to the point at which they lost control over their use. In my college fraternity, many of us did our best to "become" alcoholics. Most couldn't, although later the affliction became obvious in a few. In college, these were the ones who could drink the rest of us under the table — but at the time, I didn't know it. I wasn't counting the drinks and they didn't appear inebriated with blood alcohol levels at which others could barely walk. What was different about these men, whose alcoholism later became obvious? What allowed them to drink so much that they eventually diminished their own brain's ability to produce neurotransmitters? I realized that the only thing that could explain this was that the body of the alcoholic had to be processing the drug differently than the non-alcoholic. I began to suspect that latter stage alcoholism might result from a difference in early-stage biochemistry, with which we are born.
It turns out that the early-stage biology of a person who develops alcoholism does not just allow him to drink excessively; it motivates him to do so. With enough heavy use, he eventually reaches the point at which his neurotransmitter activity suffers. The early-stage biochemistry of the person who inherits alcoholism also causes specific brain damage that results in destructive behaviors. The distinction between early-stage alcoholics and non-alcoholics is in a differential processing that involves two chemicals, acetaldehyde and acetate.
The human body converts alcohol into acetaldehyde, a poison, and then into acetate. However, the speed with which the conversion occurs varies. Non-alcoholics make the transformation slowly into acetaldehyde and very quickly into acetate, resulting in a buildup of the latter substance. This provides the equivalent of immunity from alcoholism because, while otherwise harmless, acetate causes feelings of nausea, hangover and sleepiness. These are felt at relatively low blood alcohol levels in the non-alcoholic, in most cases .06 to .10 per cent (barely legally drunk).
The person with alcoholism, on the other hand, converts alcohol into acetaldehyde quickly and then into acetate very slowly. The resulting increase in levels of acetaldehyde causes a release of neurotransmitters called isoquinolines, opiate-like substances that make him feel really good. Therefore, there's no feedback from a buildup of acetate suggesting "slow it down" as there is in the non-alcoholic. Instead, a voice soaked in acetaldehyde says, "keep on truckin', you're feeling fine!" At the same time, the chemical causes brain poisoning, resulting in brain damage.
This damage is particular to the neo-cortex of the brain, the seat of reason and logic. Because the lower brain center, the limbic system, is fixed at birth, it escapes the deluge of chemistry relatively unscathed. Referred to as the pre-mammalian or "reptilian" brain, the limbic system is the origin of basic instincts, including impulsive actions and reactions responsible for survival and procreation. Damage to the "human" part of the brain leaves the primitive area in relatively greater control over behaviors. This may explain the tendency to act without considering consequences, along with the manifestation of other uncivilized behaviors. Because few non-alcoholics exhibit such conduct, we can predict that most persons convicted of felonies would be afflicted with this disease. The fact that at least 80-90% of incarcerated prisoners have alcoholism supports these ideas.
Damage to the neo-cortex also leads to a decline in the ability to accurately perceive and judge, resulting in distortions of perceptions and memory. The key distortion is one that is apparent in all persons with alcoholism: euphoric recall. This causes the addict to remember ("recall") that everything he says or does during a drinking episode is good or right, and nothing bad or wrong. Since only God is always good or right, this might be predicted to result in behaviors that make the addict appear to think he is god-like. We will find that the observable evidence in the form of behaviors not only bear this out, but also that such behaviors provide our best and most numerous clues to early-stage alcoholism. They are common because they occur both during and in-between drinking episodes.
Excerpted from How to Spot Hidden Alcoholics by Doug Thorburn. Copyright © 2014 Doug Thorburn. Excerpted by permission of Galt Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
PART I - Redefining Alcoholism,
Chapter 1 - Identifying the Problem,
Chapter 2 - A Matter of Biochemistry,
Chapter 3 - Alcoholism Redefined,
PART II - Early Stage Clues,
Chapter 4 - A "Supreme Being" Complex,
Chapter 5 - A Sense of Invincibility,
Chapter 6 - Physical Signs of Early Stage Alcoholism,
PART III - Middle-Stage or Poly Drug Clues,
Chapter 7 - Poor Judgment,
Chapter 8 - Apparent Mental Confusion,
Chapter 9 - Middle-to-Latter Stage Physical Signs,
Chapter 10 - So What Do You Do?,
Appendix I - New Thorburn Substance Addiction Recognition Indicator,
Appendix II - Alcohol Takes a Shotgun Approach,
Appendix III - Resources,
About the author,