Finding Help for a Drinking Problem

Time and again, the calls, emails and blog post comments I receive are centered around the difficulty the person has experienced in finding help for a drinking problem, whether it’s their own or a loved one’s. And it is often this time of year, after a holiday season filled with work, social and family gatherings in which heavy drinking is big part of the celebrations, that people are combing the Internet for answers.

KEY REASONS FINDING HELP FOR A DRINKING PROBLEM IS DIFFICULT

Based on my 14+ years working in this field, I’ve identified the following four key reasons people have so much difficulty finding help for a drinking problem.

Not Understanding the Label Doesn’t Matter

Finding Help for a Drinking Problem

Stopping an unhealthy drinking pattern early can prevent an even bigger problem, later.

Time and again people write, call or comment on a blog post to share the things their drinking loved one has or hasn’t done, such as hiding bottles, breaking promises, getting a DUI, driving the kids while drinking, passing out, ruining the holiday meal by being loud and belligerent, etc.  [If you read through the comments on these three posts of mine, “Detach. Detach With Love. You’ve Got to Be Kidding!,” “Fears for Children When Divorcing an Alcoholic,” and “Hidden Half-Empty Bottles – Should I Dump Them Out or ???,” you’ll see what I mean.]

Over the course of my exchanges with these people, they’ll push for a label, asking me, “Is s/he an alcoholic?”or they’ll proclaim their loved one can’t be an alcoholic because “She doesn’t drink everyday” | “He only drinks on the week-ends.”| “He goes to work everyday.”  They want a hard and fast answer because they want me to tell them how to fix it. And I get it. I was there myself on many, many occasions as I struggled to “make” a loved one stop drinking so much during the four-plus decades in which I dealt with secondhand drinking. But as I explain to them, I’m not qualified to diagnose them or their loved one. Only a medical professional trained in addiction medicine can do that. But I can share the latest research that explains it’s not the label: alcoholic* or alcohol abuser* or binge drinker that matters, it’s the simple answer to these two questions: “Do they exceed the low-risk drinking patterns suggested by the NIAAA?,” and “Do their behaviors change when they drink?” If their answer is, “Yes,” then drinking is likely a problem because the ethyl chemical in alcoholic beverages changes how the brain works, which in turn changes a person’s thoughts, feelings, and behaviors. This leads to reason #2…

Not Understanding the Basics of How the Brain Works

Finding Help for a Drinking Problem

New Imaging Technologies help explain how the brain works and how the ethyl alcohol chemicals in alcoholic beverages can change brain health and function.

Unless you understand the basics of how the brain works, it’s difficult to understand, let alone appreciate, how the ethyl alcohol chemical in alcoholic beverages chemically and structurally changes the way it works, which in turn changes the way brain cells communicate with one another, which in turn changes a person’s thoughts, feelings, and behaviors. These changed thoughts, feelings, and behaviors typically aren’t the “real” person coming out, unless that’s how they think, feel, and behave when sober. Rather they are the changes caused by interrupting the brain’s normal neural network functioning.

For some of the scientific concepts to counter this reason, please check out Here’s to Neural Networks and Neurotransmitters: Keys to Brain Health and Understand Brain Maps | Change a Habit | Change Your Life

 

Not Understanding the Majority of People with a Drinking Problem are not Alcoholics*

This is often a surprise to people. It’s also a relief. In fact, according to NIAAA’s Rethinking Drinking website (you’ll get these results yourself if you anonymously answer the “What’s Your Pattern?” Qs), the majority of American adults don’t drink at all or always stay within low risk limits and of those who exceed these limits, the majority are considered alcohol abusers vs alcoholics. Here’s a reprint of NIAAA’s graphic:

What to Say to Someone With a Drinking Problem

Notice I differentiated between alcohol abusers* and alcoholics*. The reason for this distinction is that “stopping” is different depending on which one it is. For the alcoholic*, they have the brain disease of addiction and must stop drinking all together for it is the alcohol that triggers their brain disease. For the alcohol abuser*, it is possible they can can learn to “re-drink” – to bring their drinking pattern within “low-risk” limits. And that’s because they have not crossed the line from alcohol abuse to alcoholism. Check out my eBook, “Crossing the Line From Alcohol Use to Abuse to Dependence.” This post may also help as it sheds light on the “process” – how a person develops the brain disease of addiction (of which alcoholism is but one), “Want to Prevent Addiction? Assess Your Risk Factors.”

But again, it’s not the label that matters because excessive drinking patterns lead to “approximately 88,000 deaths each year in the United States…,” according to the CDC as reported in their Alcohol Use and Your Health Fact Sheet accessed 1.8.18.

Excessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.

Binge drinking, the most common form of excessive drinking, is defined as consuming

  • For women, 4 or more [standard] drinks during a single occasion.
  • For men, 5 or more [standard] drinks during a single occasion.

A standard drink contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in

  • 12-ounces of beer (5% alcohol content).
  • 8-ounces of malt liquor (7% alcohol content).
  • 5-ounces of wine (12% alcohol content).
  • 1.5-ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).4

Heavy drinking is defined as consuming

  • For women, 8 or more [standard] drinks per week.
  • For men, 15 or more [standard] drinks per week.

Most people who drink excessively are not alcoholics or alcohol dependent. (Source: CDC’s Alcohol Use and Your Health Fact Sheet accessed 1.8.18.)

Not Realizing Your Doctor Is Likely Not Trained to Identify or Treat Alcohol Use Disorders*

David Sheff wrote in his May 8, 2017 article on PsychologyToday.com, “Sobering Truth About Addiction Treatment in America,” “A recent ASAM survey of two thirds of U.S. medical schools found that they require an average of less than an hour of training in addiction treatment.” As such, talking to your primary care doctor will likely prove less than satisfactory in getting the answers you need for finding help with a drinking problem. But the National Institute on Alcohol Abuse and Alcoholism offers a new tool…

Finding Help for a Drinking Problem

Finding help for a drinking problem just got easier with NIAAA’s Alcohol Treatment Navigator.

 

There is SO MUCH great information on this new website. For example: How to Spot Quality Treatment provides key criteria you’ll want to find in a treatment provider’s program, and How to Search and What to Ask gives you specifics for narrowing your search decision. Search for Addiction Therapists and Search for Addiction Doctors can help you find specialists trained in helping people with a drinking problem (as well as their families).

Bottom Line

Don’t wait. The longer a person continues an unhealthy drinking pattern, the worse the problem can get and the more difficult it can be to change.

And as always, contact me with your questions. Start by emailing me at lisaf@BreakingTheCycles.com to schedule a phone call. There is no charge for these kinds of calls.

___________________________

Note About the Terms Alcoholism and Alcohol Abuse
Until May 2013, it was common to use the terms, alcohol abuse and alcoholism, because it’s how they were classified in the 4th edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This manual, updated now and then as a new edition, is for use by clinicians to give them a common language with which to understand, diagnose, and talk about a wide range of mental health conditions. Alcohol abuse and alcoholism were two of those conditions.

In May 2013, the 5th edition was released, DSM-5. This revised edition put both alcohol abuse and alcoholism into one disorder classification and called it “alcohol use disorder (AUD).” Within the AUD, there are three sub-classifications: mild, moderate, and severe.

Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.” Reviewed July 2016, NIH Publication No. 13-7999. Accessed October 26, 2017. https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf

When talking about both alcohol and other drugs, the term is substance use disorders (SUD).

I’ve chosen, however, to continue using society’s more commonly used terms, alcohol abuse and alcoholism, for two reasons. The first is because these are the terms most people know and use. The second is to make the distinction easier to explain and understand because the way a person stops their alcohol abuse is different than the way a person develops and treats their alcoholism. Yet, alcohol abuse or alcoholism have something hugely significant in common – drinking behaviors – the behaviors that can be so destructive to family members and friends’ physical and emotional health and quality of life, co-workers and society at large.

Note About the Terms Alcoholic and Alcohol Abuser
As part of this new brain science is the use of new language to describe a person who has the brain disease of alcoholism. The effort now is to refer to individuals with alcoholism as “a person with alcoholism.” This helps to remove the stigma, misinformation and shame that surrounds this disease and typically keeps people from seeking the help they need. It’s the idea of the individual is a person with a disease. They are not their disease.

As with the above, I continue (for now) to use the terms alcoholic and alcohol abuser because the way these drinking patterns are treated or changed varies greatly and is explained below.

_______________________

©2018 Lisa Frederiksen

Yogic Tools for Recovery – New Book by Kyczy Hawk

Yogic Tools for Recovery is Kyczy Hawk’s latest book (November 2017), and it is powerful on so many levels. Not only for its significant contribution as a tool to help those recovering from addiction*, but also for Kyczy’s ability to paint a picture – a feeling – with words. And it is in the latter, and the way Kyczy (keet-ski) gives the bigger picture of both the yogic practices (e.g., sharing the philosophy of yoga to enrich the poses) and the addiction recovery process (e.g., there are many paths to addiction recovery – the 12 Steps are but one – and recovery takes time) that makes her book especially helpful.

I have personally known Kyczy for many years and greatly admire her work, thus it is my pleasure to share her Q & A.  By the end of this, I’m sure you’ll want to read Yogic Tools for Recovery: A Guide for Working the 12 Steps, and/or share it with a loved one in recovery or use it yourself, whether you are the person in recovery from addiction (aka substance use disorder) or the family member who loves them and has experienced your own compromised health, peace of mind and wellness. [Hint: think holiday gift giving idea :)]

Yogic Tools for Recovery Q and A with Author, Kyczy Hawk

Tell us a bit about how you developed such a passionate interest in incorporating a yoga practice into one’s addiction recovery practice

Yogic Tools for Recovery - New Book by Kyczy Hawk

Kyczy Hawk’s latest book. Click here to order.

Yogic Tools for Recovery - New Book by Kyczy Hawk

Author and Yoga Teacher, Kyczy Hawk

First of all, let me say that I am one of those people who started to practice yoga later in life. Thinking that inflexibility, small range of motion and lack of strength would keep me from a full practice, I discovered, to my delight, that yoga is perfect for me, my body, my abilities and in-abilities.  It is also so much more. In the Lotus Yoga Teacher Training (Himalayan Yoga Style) the philosophy of yoga enriched the asana, or poses, for me. I have come to love all the limbs of yoga; it has opened a life long study for me.

I have witnessed the power of yoga and recovery first-hand.  As a woman in recovery, I know something about the ravages of addiction. I know what damage can be done to the body, mind and spirit when one’s life is turned over to a substance, a  behavior, a destructive way of life.  I have experienced the long climb back to wholeness. The discipline of a life in recovery is never over.

I learned about the power of yoga in relapse prevention when I started yoga in my seventeenth year of sobriety.

It began with my own experience of quiet breathing and exploring physical challenge.  My work on the mat led me to an enhancement of my spiritual condition.

I progressed in my ability to discern healthy relaxation/tension release from a feeling of boredom or being tired.

In this way I witnessed the effectiveness of yoga in preventing relapse in my mind, body and soul. I found incredible ability to give me the strength I needed to continue my recovery. It was this direct experience that gave me the resolve to focus my life and my love of yoga to helping those who are going through what I went through and becoming a yoga teacher.

You’ve been a yoga teacher for many years – tell us a bit about your life as a teacher

Having taught over 1600 yoga classes to people in recovery, I have experienced first-hand the incredible power of yoga to transform lives. I have amazing students; students who come for physical challenge and investigation… students who come for healing… students who come to learn about the tools that yoga offers them and their wellness path… students who have come to enhance their recovery from addiction and to avoid relapse.

I have been a yoga teacher for several years and my primary focus has been classes designed for people recovering from addictions.

I take my classes to jails, recovery homes, halfway houses and detention centers, helping others find inner guidance and strength through yoga and with each other. I hold classes in studios – Y12SR classes (Yoga of 12 Step Recovery)- combining a recovery meeting with a yoga class.

I have been involved with the Art of Yoga Project and the Niroga Institute – both organizations that work with at-risk youth. I am also a certified Yoga of Recovery (YoR) Counselor available for private consultations and group work.

I recently began to broaden my focus to include training others to share the power of “service” yoga. My sincere hope is that we are able to bring yoga to all treatment centers, after care and offer to it in jails and institutions. Bringing the holistic healing powers of yoga to these venues would be a wonderful thing!

Now about your book – please give readers a brief overview

I’d like to answer this question in snippets, if you don’t mind.

  • My book describes an approach to doing the twelve steps of recovery in a new way; using yoga philosophy. This is not for the newly clean or newly abstinent or sober; it is for those who are interested in investigating recovery at a visceral level. This is not a book of poses, but it includes poses. It is not a book of meditations, but it includes meditation. While it is directed at people who are familiar with the twelve steps, there is enough information given that you might discover new aspects of yoga by reading it. It could lead you to yoga; it could lead you to recovery.
  • This book describes a process for recovery that invites you to work the steps from the inside out; dropping out of the head and into both the heart and the body.
  • Yoga is a system of movements, breath work, and meditation in addition to a philosophical system to discover your true self. The yoga we see in studios and gyms is only the tip of the iceberg; a very small part of the world of yoga. (My first book, Yoga And The Twelve Step Path, delves deeply into this philosophy as it pertains to recovery.) Yoga is an ancient philosophy that describes the impedances to being authentic and outlines a path to finding and living from your true self.
  • Very few people who acknowledge they suffer from an addiction, suffer from just one aspect of the disease. We may slip from one behavior or substance to another: also this book is not specifically for alcoholic. We may also have behavioral issues that keep us from being whole. Many of us also suffer from co-addiction. Often a parent will have also been an addict, or have themselves been the child of someone who was an active addict. The adaptive behaviours we develop to survive in a home with addiction has altered the brain and circumstances have trained us in unhealthy coping behaviours. This book is appropriate for family members and friends who are working with their own recovery.
  • Robert Birnbaum coined a phrase: that “yoga is a holistic solution to a holistic disease.” I believe he is referring to the writings in AA that state “Alcoholics Anonymous describes alcoholism as a threefold disease. … The alcoholic is viewed as dealing with a physical allergy to alcohol, a mental obsession to keep on drinking and an underlying spiritual malady that means willpower is not enough.” The word YOGA translates often to “union of body, mind and spirit” and so addresses the disease as defined by AA.
  • This method of going through the steps of recovery is designed to have you experience the steps in your body. It is what I like to call “Gut recovery”.
  • In addiction we learn to distrust ourselves and the messages our bodies give us: we ignore feelings of being hungry, tired, lonely, or ignore it when we are hurt. We have no idea what to do if our past is triggered and invades the present. Even in recovery it can be difficult to discern how we are feeling and to pause to decide what to do with those feelings. This book gives you tools to experience your feelings as they are so that you can choose how to respond. Contemplation, breath work, meditation and poses can all be used to help you determine how you want to be as a person in recovery.

How might readers get in touch with you?

I welcome readers to contact me via email at kyczy@yogarecovery.com. I’m also on Facebook, Twitter, and LinkedIn, and my website is RecoveryYoga.com.

____________________________

*For reference : What is Addiction? From American Society of Addiction Medicine (ASAM): Public Policy Statement > Definition of Addiction > Short Definition of Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

 

Addiction Relapse Triggers

Many readers may be surprised to know that addiction relapse is common — something I discussed in my post, “5 Reasons People Relapse After Years of Sobriety.”  As David Sack, MD, explained in his October 19, 2102 article,” Why Relapse Isn’t a Sign of Failure,

As with chemical addiction, patients with chronic illnesses such as diabetes, asthma, and hypertension frequently fail to comply with their ongoing treatments—relapsing, if you will, oftentimes with dire consequences. Thus, no matter the chronic disease, it is ultimately up to the individual to adjust his or her lifestyle and assume responsibility for managing his or her own care. Unfortunately, removing the drug (detoxing) is the easy part. Changing the behaviors that compel the addict to use is significantly more difficult.

Helping readers identify common addiction relapse triggers and what a person can do to avoid them is the topic of today’s post by guest author, Trevor McDonald. Trevor is a freelance author who has shared his recovery story with BreakingTheCycles.com as one of its Faces of Recovery. He can be reached by email at trevorc.mcdonald@gmail.com; via LinkedIn; or through his Website.

Addiction Relapse Triggers You May Not See Coming by Trevor McDonald

Addiction Relapse Triggers

Trevor McDonald shares his thoughts on addiction recovery relapse triggers and what a person can do to avoid them.

No one can tell you what your road to recovery will look like. They can only tell you the experiences of those who have walked this path before you. One person may crave a glass of wine at dinner while another may need a hit before every social gathering. Relapse triggers are as personal as cravings.

You’ll have your major triggers that are obvious. If you are recovering from alcohol abuse, you may be triggered by the mere smell or sight of alcohol. But you may not expect these hidden dangers and relapse triggers.

Family stress

When you were using, you escaped stress by your drug of choice. If you were always drunk or high, you might not even remember your major stress triggers. Family can be a big one for a lot of people, especially when taken in large doses like at the holidays. Answering questions about your past and future may be a trigger you didn’t see coming because they may affect you in ways you wouldn’t expect.

To combat family stress, learn healthy ways to manage your feelings. Meditation, yoga, and exercise are all good outlets for stress.

Television

Watching tv is a favorite pastime for most of us, but it can present recovering addicts with a hidden source of triggers. You don’t always know what you’re going to see. Although that’s part of the entertainment, you may see something on television that triggers a craving.

Try limiting your television time and be careful about the shows you watch. Some are more prone to triggers than others. The news can be especially dangerous for a recovering addict.

Social media

As you scroll through your newsfeed, you never know what you’re going to see. You may see a nice story about adoptable kittens or a tragic tale of a fatal DUI accident. Just like television, social media can trigger cravings, stress or negative feelings that lead you down the path of a relapse.

If possible, give yourself a social media break in early recovery. When you feel it’s time, step back in slowly.

Romantic relationships

There’s a good reason why you’re advised to stay away from romantic relationships in early recovery. Getting involved with someone before you’re ready is one of the biggest dangers people unwittingly face in recovery. Wait until you feel strong on your own and aren’t as concerned about relapse. Co-dependency can be a major issue, and many people use new relationships as though they are drugs. Dealing with heartbreak during recovery can also be a major relapse trigger. It’s best to avoid sex and relationships for the first year out of recovery, if at all possible.

Reasons to Celebrate

Just as you turned to drugs as a coping mechanism, you probably also used them to celebrate. Now, whenever it’s time to celebrate in your sober life, you may get pulled back into your old way of thinking. Celebrations can be a relapse trigger because people tend to want to celebrate with things that make them feel good. Alcohol is especially tied to celebrating in our society, so this is most problematic for recovering alcoholics. Job promotions, weddings and anniversaries are all hidden triggers for anyone in recovery. You can’t avoid celebrations altogether, nor would you want to, but you can find healthier ways to celebrate. Maybe find a non-alcoholic beverage to toast with or suggest taking a friend out for coffee instead of drinks.

The most difficult triggers to manage are the ones you weren’t expecting. You may not even realize their effect until it’s too late. Learn to look for the warning signs of relapse, including depression, irritability and lack of structure, and get help if you think you’re on the verge.

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Healing Trauma Takes Time

Like the brain impacts of substance use disorders (aka substance abuse or addiction), most people do not understand the brain impacts of trauma.

Trauma takes many forms: neglect, sexual assault, physical abuse, emotional abuse, parental divorce, and growing up with a parent who has an untreated substance use disorder or mental illness, to name a few. Thanks to the CDC-Kaiser ACE Study, there is now solid research to help us understand the brain impacts of trauma (aka adverse childhood experiences), which in turn helps us better understand the physical impacts of trauma, as well. These brain impacts are related to toxic stress and how toxic stress changes how the brain works, wires, and maps. The physical and emotional ailments and quality of life outcomes of toxic stress include: anxiety, depression, stomach ailments, skin disorders, sleep problems, neck/back/shoulder pain, and inflammatory diseases, to name a few. Check out the American Academy of Pediatrics’ article,“Adverse Childhood Experiences and the Lifelong Consequences of Trauma.

Healing Trauma Takes Time

Healing Trauma Takes Time

Healing trauma takes time because of its toxic stress impacts on the brain.

Thus understanding the impacts of trauma and what it takes to heal those impacts is critical, which is what prompted me to share and comment on Jonathan Shedler, Ph.D.’s article, “Selling Bad Therapy to Trauma Victims.” Dr. Shedler, Clinical Associate Professor at the University of Colorado School of Medicine, opened his article with, “The American Psychological Association (APA) just issued guidelines for treating trauma. Patients and therapists would be wise to ignore them.” He goes on to write,

“Psychotherapy takes time. Psychotherapy follows a ‘dose-response’ curve. It takes more than 20 sessions, or about six months of weekly therapy, before 50 percent of patients show clinically meaningful improvement. It takes more than 40 sessions before 75 percent of patients show meaningful improvement.1 These findings, based on the scientific study of more than 10,000 therapy cases, dovetail with what therapists report about successful treatments2 and what patients report about their own therapy experiences.3,4 
The RCTs [randomized controlled trials] behind the [APA’s] trauma treatment guidelines studied only therapies of 16 sessions or less. Many were eight sessions or less. In other words, the guidelines considered only therapies that are inadequate. Read his article here.

As someone who spent three years in cognitive behavioral therapy to overcome a number of traumatic events (read my story, here) and as someone who has spent a great deal of time studying current brain research, I cannot help but agree that trauma cannot be healed in 16 sessions or less. Why? Because of the complexity of the human brain — complexity influenced by all the factors that contribute to how an individual’s brain wires, develops and maps from birth and across a lifetime.

As importantly, the impacts of trauma left untreated (whether it occurred before the age of 18, which is the basis of trauma measured in the ACE Study, or later in life, perhaps the death of a loved one, PTSD, living with someone who has a severe substance use disorder) do not go away until the trauma is treated. And until it’s treated, a person will continue to experience the toxic stress-related physical and mental health issues caused by the untreated trauma. For more on this concept, please check out two of my articles chronicling my experiences, “When Recovering From ACEs is Recovering from Secondhand Drinking and Visa Versa” and “The Legacy of Untreated ACEs.”

 

What to Say to Someone Who Drinks Too Much

If you’re reading this post, likely you’ve been hurt, frustrated, concerned, angered, and/or scared by a loved one’s drinking. You’ve likely tried talking, yelling, cajoling, negotiating, looking the other way, believing their promise(s) to stop or cut down, but so far, nothing’s worked. I receive numerous emails and phone calls every week from people in this situation, and I know what they’re feeling. I’ve been there myself.

One of the most common questions people have (and I had) is, “How much is too much?,” because no matter how calmly or angrily or sadly I tried to talk with them about it, there was always a comeback. And their ability to slice and dice and mince words or segue into a counter attack could leave me speechless and defeated.

Based on my years of studying current brain research and working in this field, I can now answer my caller or email querier’s question, “How much is too much?,” with this answer, “Do their behaviors change when they drink?” If their answer is “Yes,” then I proceed with some variation of the following information.

And why do I start with drinking behaviors? Because it’s the behaviors they exhibit while under the influence of alcohol that are the issue – not the numbers of drinks, not whether they’re an alcoholic or “just” an alcohol abuser, not if they’re mostly a good parent and don’t miss work, not because they’re so very sorry for what they did. Understanding the cause of the drinking behaviors is what helps a person better understand…

What to Say to Someone Who Drinks Too Much 

The following information can provide readers with important information to help them effectively talk with their loved one about their drinking.

What does it mean to lose control of your drinking?

  • Doing poorly at work because of the drinking or recovering from the effects of drinking.
  • Fighting with friends or family about the drinking; saying or doing things you don’t remember or regret.
  • Binge drinking (defined as drinking 4 or more standard drinks for women; 5 or more for men).
  • Verbally, physically or emotionally abusing someone – often a spouse, significant other, co-worker or child.
  • Experiencing blackouts.
  • Driving while under the influence; getting a DUI; riding in a car driven by someone who has been drinking.
  • Having unplanned, unwanted or unprotected sex; date rape.
  • Being admitted to the emergency room with a high BAC, in addition to the “other” reason.

The above are known as drinking behaviors. These behaviors occur with alcohol misuse which is when a person drinks more alcohol (ethyl alcohol chemicals) than their liver, body and brain can process. These behaviors cause secondhand drinking impacts for others, including family, co-workers, and friends. Alcohol misuse refers to a variety of drinking patterns, including binge drinking, heavy social drinking, alcohol abuse, and alcoholism (explained below).

Quick Facts

  • New brain imaging technologiesof the recent 10-15 years allow neuroscientists and medical professionals to study the live human brain like never before. The resulting discoveries are shedding new light on brain functioning and development and providing visual evidence of the chemical and structural changes that occur in the brain as a result of alcohol misuse (aka binge drinking, heavy social drinking, alcohol abuse and alcoholism). These changes affect areas of the brain that are necessary for a person’s ability to “think straight” and act responsibly.
  • There are stages of drinking: use, abuse and alcoholism (see note at end of post). One does not have to be an alcoholic (see note at end of post) to have significant problems related to their drinking. The earlier a person addresses their alcohol misuse, the better it is for brain health and those within their sphere of influence. Alcohol use is defined as moderate or “low-risk” drinking.
  • Alcoholism is a brain disease– one of the diseases of addiction, a chronic, often relapsing brain disease. Disease by its simplest definition is something that changes cells in a negative way. When cells are changed in a body organ, those cell changes, in turn, change the health and functioning of that organ. Alcoholism (addiction) changes cells in the brain, which is what changes the health and functioning of the brain, making it a brain disease. The American Medical Association (AMA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA) and the U.S. Surgeon General are a few of the prominent organizations that define alcoholism as a brain disease.

 

9 Reasons a Person Can Lose Control of Their Drinking

  1. Not understanding the brain’s electro-chemical signaling process and formation of brain maps.   The brain is the organ that controls everything a person thinks, feels, says and does. It does this through an electro-chemical signaling process and the mapping of frequently used neural networks. These can be influenced and changed (and thereby change a person’s thoughts and behaviors) by genetics, trauma, mental disorder, pain, alcohol misuse, and stress, to name a few examples.
  2. Not staying within moderate, “low risk” drinking limits:
    For women: no more than 7 standard drinks in a week nor 3 of the 7 in a day.
    For men: no more than 14 standard drinks in a week nor 4 of the 14 in a day.
  3. Not knowing standard drink sizes. A standard drink equals 5 ounces of table wine or 12 ounces of regular beer or 1.5 ounces of spirits (ex., vodka)
  4. Lack of awareness that not all ‘drinks’ are the same. A margarita, for example, may contain 2-3 standard drinks; a bottle of table wine contains 5. It takes the liver about 1 hour to metabolize (get rid of) the ethyl alcohol chemicals in 1 standard drink. Therefore, it would take approximately 2-3 hours to get rid of the ethyl alcohol chemicals contained in the margarita drink cited in this example. While the ethyl alcohol “waits” its turn out the liver, it “sits” in body organs, like the brain, and interrupts the electro-chemical signaling process, which is what causes the drinking behaviors described in the opening section.
  5. Not understanding the difference between alcohol abuse and alcoholism. Alcohol abuse is drinking more than moderate limits (#1). It includes binge drinking (defined as 4 or more standard drinks on an occasion for women and 5 or more for men) and heavy social drinking (defined as regularly drinking 2 or more standard drinks a day for women and 3 or more for men).  Alcoholism is a developmental, chronic, often relapsing brain disease. Visit the National Institute on Drug Abuse (NIDA)’s website, “Drugs, Brains and Behavior: the Science of Addiction,” for more information.
  6. Not understanding the impact of early use of alcohol on a person’s brain development. This recent brain research shows the brain goes through a critical developmental stage from ages 12 – 25. The portions of the brain that deal with emotion, memory, learning, motivation and judgment are the last to develop. As such, they are the areas most deeply affected by alcohol (or other drug) misuseAdditionally, this research shows the teen brain handles alcohol differently than a fully developed, adult brain, which explains, in part, why underage drinking can be especially problematic.
  7. Not understanding the risk factors that contribute to a person developing the brain disease of alcoholism. Alcoholism is ‘caused by’ the chemical and structural changes caused by alcohol abuse in combination with the key risk factors: genetics, mental illness, early use, social environment and childhood trauma. These same risk factors also contribute to a person engaging in alcohol abuse.
  8. Not understanding that treatments of alcohol abuse and alcoholism differ.People who abuse alcohol but are not alcohol dependent (alcoholics) may be able to return to moderate drinking limits (#1) and thereby stop their drinking behaviors. Visit NIAAA’s website, “Re-Thinking Drinking,” for tips on cutting down. People who are alcoholics cannot drink any amount of alcohol if they want to stop their drinking behaviors long-term because alcoholism is a chronic, often relapsing brain disease. Alcoholism can successfully be treated, however, and the brain can recover. Check out NIDA’s “Principles of Effective Treatment” for more information.
  9. Not understanding Secondhand Drinking – defined as the negative impacts of a person’s drinking behaviors on others. Living with and/or working with a person’s drinking behaviors when a person does not understand the foregoing can cause that person to develop unhealthy coping skills and/or experience serious physical or psychological problems that interfere with school, work, family and relationships, as a result of stress and the physiological impacts of toxic stress. We call these impacts secondhand drinking (SHD). SHD can also contribute to a person developing some of the risk factors for engaging in alcohol abuse or developing alcoholism.

Why It’s So Important That You Talk to Your Loved One – Coping With Their Drinking Behaviors Has a Direct Effect On You – Your Physical and Emotional Health and Quality of Life

To answer why it’s so important to talk with your loved one is to understand Secondhand Drinking (SHD).

Secondhand drinking refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors occur with a variety of drinking patterns: binge drinking, heavy social drinking, alcohol abuse and alcoholism.

Lisa Frederiksen helps reduce the impacts of secondhand drinking in the workplace.Generally, drinking behaviors (see side bar) are not “intentional,” unless that’s how the person behaves when sober. Rather they are the result of brain changes caused by the ethyl alcohol chemical in alcoholic beverages interrupting the brain’s electro-chemical signaling process and thereby changing how the brain works.

Understanding:

  • how the body processes alcohol via specific enzymes in the liver which metabolize [rid the body of] the ethyl alcohol chemicals in alcoholic beverages at an average rate of 1 standard drink per hour;
  • standard drink sizes;
  • staying within normal or moderate drinking limits; and
  • the other variables listed in the side bar

can help a person avoid exhibiting drinking behaviors. It can also help a person protect themselves from secondhand drinking.

Two-thirds of the people whose drinking patterns cause drinking behaviors are not alcoholics. They are the binge drinker, heavy social drinker or alcohol abuser. Persons who are not alcoholics – don’t have the brain disease of addiction, aka a dependence on alcohol – have the potential to change their drinking patterns to fall within low-risk, normal or moderate limits.

A person with alcoholism, however, cannot drink any amount – ever – due to brain mapping around the characteristics of this brain disease, which include: cravings, tolerance, physical dependence and loss of control, as well as any untreated, underlying risk factors, such as mental illness or childhood trauma. Alcoholism is a fully treatable disease, however.

Why is Secondhand Drinking a Serious Concern?

Two reasons: the sheer numbers of people affected (approximately 90 million Americans) and its connection to stress.

The primary consequence of SHD’s impacts on a family member or close friend is stress. Coping with drinking behaviors triggers the fight-or-flight stress response system (FFSRS) centered in the limbic system, the reactionary part of the brain.

The FFSRS was “designed” in the human species to prepare a person to fight or run when faced with physical danger, and it causes a number of physiological changes to occur. For example, blood vessels to the skin constrict to lessen blood loss in the event of injury; the digestive system shuts down to conserve glucose needed for energy to run or fight; and heart rate increases to push blood flow to large muscles to allow a person to run more quickly.

The FFSRS also leads to dysregulation of the cerebral cortex (the thinking part of the brain) so that a person reacts immediately without considering the options when confronted with danger. As a result of another brain design feature – “neurons that fire together, wire together” – the brain “maps” the reaction (fight or flight) that kept the person safe. This map becomes a person’s default reaction the next time a similar triggering event occurs. This was especially important back in the day when early man’s only immediate threat was physical danger.

Today, however, and especially in families with untreated alcohol misuse, the FFSRS is more often than not triggered by things other than physical danger – emotional cues, for example, such as simmering fear, anxiousness or anger, memories and constant worry.

What Happens to the Person Affected by Secondhand Drinking?

Coping with drinking behaviors causes ongoing activation of the FFSRS. When a person doesn’t fight or run, all of those physiological changes described above sit – “marinate” – in body organs, like the brain, heart and muscles, resulting in physical and emotional ailments, such as: sleep disorders, migraines, headaches, stomach ailments, changes in eating habits, dizziness, distracted “thinking,” depression, anxiety, memory impairment, heart disease and digestive problems.

In addition to these physical and emotional impacts, the chronic activation of the FFSRS causes a person to wire unhealthy coping skills, because their brain maps the behaviors that kept them “safe” when confronted with the drinking behaviors. These can include:

  • shutting down emotionally, retreating inside one’s mind when confronted with abusive or scary behaviors
  • being hyperaware of others’ feelings or actions and adjusting one’s own accordingly
  • yelling, crying, blaming, shaming or verbally lashing out
  • carrying pent up, explosive rage that spills out in other situations because it cannot be expressed to the person exhibiting the drinking behaviors
  • attempts to be especially good to make up for or fix the problem
  • withdrawing from family, friends or activities out of embarrassment over the drinking behaviors.

These reactionary coping skills and the physical and emotional consequences change the family member and interfere with their work, school, relationships and ability to see, let alone enjoy, the pleasures in everyday life. All of which explains why family members need help – not a one-size-fits-all kind of help – rather the kind of help that addresses their bio-psycho-social issues in order for them to reclaim their lives in long-term secondhand drinking recovery.

What to Say to Someone With a Drinking ProblemSometimes knowing what to say to someone with a drinking problem is as much as knowing what NOT to say.

Sometimes knowing what to say to someone with a drinking problem is as much about knowing what NOT to say.

Here’s where it’s helpful to start with WHAT NOT TO SAY:

  • You’re a drunk!
  • Do you know how stupid you sounded last night!
  • Once again, you broke your promise. You broke YOUR PROMISE!!
  • If you loved me you’d stop!

Although these kinds of statements are totally normal, they generally stem from not understanding that when a person drinks more than their liver can process (rid the body of), the alcohol continues to change brain function, which is why the person behaves the way they do. It’s not “them,” it’s alcohol changing brain function. Check out “Why BAC Can Keep Rising After a Person Stops Drinking” and “Understand Brain Maps | Change a Habit | Change Your Life.”

Not only this, but these kinds of statements are of the blaming and shaming type and while they make you feel better (believe me, I know from my own experiences), they don’t help the situation because the person with the drinking problem already feels ashamed and filled with self-loathing for why they can’t stop at one or two.

Instead, try these possible entry statements to the conversation BUT ONLY when they are sober and you’ve asked to talk with them:

  • I don’t know if you’re aware how much your behaviors change when you drink, but last night, for example____________.
  • I’ve been doing some googling trying to figure out if I should say anything about how you behave when you drink too much and found this great website, Rethinking Drinking. I’d really like you to do the anonymous assessment and take a look at the other information on the site.
  • I’ve finally found a name for what happens to me when you behave the way you do while drinking – it’s called secondhand drinking. I’m going to be learning a great deal more about this, but I wanted you to know that your drinking behaviors – the way you act when you drink too much – are causing real problems for me. I’m not sure what to do about them, but I’m also understanding that my old ways of talking about this don’t work, either.

Know it doesn’t have to all be done at once

We tend to want to get it ALL out there and then have a solution – an action plan – by the end of the conversation. But with these kinds of conversations, rarely is this possible. The better approach is to calmly state your concern and then ask if you can talk about some of your other observations and research findings in a day or two – and then be sure to set a date/time to talk. They may want to keep going, but likely they won’t. And if they get defensive at any point, remind them you are doing this out of love and concern. You’d be doing the same thing if you were concerned about some other aspect of their health and wellbeing.

Remember – they are a person, first, and then a person with a drinking problem

It’s so easy to see them as their problem because their drinking problem is causing drinking behaviors that in turn cause you problems. You’ll want to be clear in your own mind that you are taking a stand against their drinking behaviors – against secondhand drinking (the negative impacts of their drinking behaviors on you and the quality of your life) – and not against them as a person.

Learn More About Drinking Behaviors, Secondhand Drinking, and What to Say to Someone Who Drinks Too Much

  • For research-based information on drinking and its impact, visit from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) website, “Alcohol & Your Health.”
  • Visit the National Institute on Alcohol Abuse and Alcoholism (NIAAA)’s website, “Rethinking Drinking.”  There you will can anonymously assess a person’s drinking pattern, better understand what’s considered “low-risk” drinking, and find suggestions a person can follow to cut down on their drinking.
  • Check out my short eBook, Quick Guide to Secondhand Drinking: A Phenomenon That Affects Millions.

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Note
 About the Terms Alcoholism and Alcohol Abuse

Until May 2013, it was common to use the terms, alcohol abuse and alcoholism, because it’s how they were classified in the 4th edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This manual, updated now and then as a new edition, is for use by clinicians to give them a common language with which to understand, diagnose, and talk about a wide range of mental health conditions. Alcohol abuse and alcoholism were two of those conditions.

In May 2013, the 5th edition was released, DSM-5. This revised edition put both alcohol abuse and alcoholism into one disorder classification and called it “alcohol use disorder (AUD).” Within the AUD, there are three sub-classifications: mild, moderate, and severe.

Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.” Reviewed July 2016, NIH Publication No. 13-7999. Accessed October 26, 2017. https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf

When talking about both alcohol and other drugs, the term is substance use disorders (SUD).

I’ve chosen, however, to continue using society’s more commonly used terms, alcohol abuse and alcoholism, for two reasons. The first is because these are the terms most people know and use. The second is to make the distinction easier to explain and understand because the way a person stops their alcohol abuse is different than the way a person develops and treats their alcoholism. Yet, alcohol abuse or alcoholism have something hugely significant in common – drinking behaviors – the behaviors that can be so destructive to family members and friends’ physical and emotional health and quality of life, co-workers and society at large.

Note About the Terms Alcoholic and Alcohol Abuser
As part of this new brain science is the use of new language to describe a person who has the brain disease of alcoholism. The effort now is to refer to individuals with alcoholism as “a person with alcoholism.” This helps to remove the stigma, misinformation and shame that surrounds this disease and typically keeps people from seeking the help they need. It’s the idea of the individual is a person with a disease. They are not their disease.

As with the above, I continue (for now) to use the terms alcoholic and alcohol abuser because the way these drinking patterns are treated or changed varies greatly and is explained below.

©2017 Lisa Frederiksen