Alcohol Abuse is a drinking pattern that causes Secondhand Drinking (SHD). Secondhand Drinking is term to describe the impacts on the person who is on the receiving end of another person’s drinking behaviors. Drinking behaviors include:
- drunken arguments
- crazy, convoluted accusations
- physical fights
- verbal, physical or emotional abuse
- driving while impaired, riding in a car with an impaired driver
- unprotected, unwanted, unplanned sex, sexual assault
- problems at work or in school related to drinking or recovering from heavy drinking bouts
- domestic violence
Because we’re so conditioned to “forgive” or “normalize” alcohol abuse “because s/he’s not an alcoholic,” family members and friends repeatedly forgive and/or normalize the drinking and therefore the drinking behaviors with excuses and explanations. Some of these may sound familiar: “he hadn’t eaten since breakfast,” “everyone was drinking,” “he only drinks on the week-ends,” “she never misses a day of work.”
Unfortunately, alcohol abuse can continue for decades; it can also progress to alcoholism. (Alcoholism is one of the developmental chronic, often relapsing brain diseases of addiction.) And all the while, coping with secondhand drinking for those who can’t or won’t leave the relationship changes a person and the very quality of their lives. To better understand, read on…
“I’d have given anything if my doctor would have asked.”
That was my response to one of the medical school students in last week’s Addiction and Eating Disorders Rotation under Dr. Stan Fischman at Stanford Medical School. The student asked me if I thought it was appropriate for a physician to ask a patient about drinking patterns of family members when the patient presents with stomach ailments, migraines, anxiety, depression, skin rashes, unexplained joint pain…something I’d explained commonly occurs as a consequence of the stress associated with ongoing SHD.
My response, “YES!” followed by, “I’d have given anything if my doctor would have asked,” was in reference to my wishing that my physician – way back when – had asked me if the drinking patterns of those I loved and with whom I lived were of concern. Instead, I’d been diagnosed with situational depression and put on Prozac followed by Zoloft.
I’d have given anything if my doctor would have asked about drinking patterns of loved ones in my family. Not my drinking patterns, but theirs.
Had that one question been asked, the floodgates would have opened.
I would have poured forth the pain and confusion and concerns and fear and repeated attempts to make the drinking stop and shared the insanity of what it was like to try to make sense out of something that made no sense.
And my physician – if armed with the facts we know today, though only as recent as this past decade or so – would have calmed me down and explained, “It’s real. It’s a problem. You’re not to blame, but you can improve the quality of your life.” He could have then given me a simple handout that unlocked the secrets to what had been consuming my life and my health for decades. It would have listed anonymous alcohol use assessments; key resources for further information; and programs that could have helped me – the family member of the loved one who drank too much. I could have learned the extreme physical and emotional toll that repeated exposure to secondhand drinking (stress) causes because of the chronically activated fight-or-flight stress response system.
But of course my physician back then – and even physicians of just a decade ago – would not have known all of this [even today, only about 1200 of the 985,375 practicing doctors in the United States are trained in addiction medicine. (CASA Report | Join Together 9.5.12)], let alone the importance of asking one simple question:
- How many times in the past year has someone in your family or someone with whom you are in a close relationship had:
4 or more standard drinks on any day? (for women)
5 or more standard drinks on any day? (for men).
An answer of once or more identifies potential SHD. How? Because it identifies “at-risk” drinking – you’ll understand why “at-risk” drinking is a concern further on in this post.
But today – today it’s a whole new ballgame when it comes to our understanding of alcohol abuse and other drinking patterns…
Today we know the number of drinks that suppresses normal neural network functioning in a person’s brain – the neural networks responsible for judgment, memory, pleasure/reward, emotions, breathing…. We know the drinking patterns that cause alcohol abuse, and we know that alcohol abuse causes drinking behaviors, which in turn cause secondhand drinking. We know that people who abuse alcohol can progress to becoming alcoholics. We have numbers of drinks that define alcohol abuse, which starts with “at-risk” drinking:
“At-risk” drinking patterns that can lead to alcohol abuse are routine binge drinking and repeated heavy social drinking. Heavy social drinking is defined as exceeding the average daily limit of 1 standard drink for women (which totals 7/week) or 2 for men (which totals 14/week). Binge drinking is defined as having 4 or more standard drinks on an occasion for women (which exceeds the 3/day) and 5 or more for men (which exceeds the 4/day). A standard drink is defined as 5 ounces of wine, 12 ounces of regular beer or 1.5 ounces of ‘hard liquor’ (gin, vodka, bourbon, scotch). There is no “number of drinks” definition for alcoholism, however all alcoholics go through a period of alcohol abuse. Alcoholism is characterized by: cravings, loss of control, tolerance and physical dependence.
So in case your physician doesn’t ask, here’s what you need to ask yourself if you’re concerned about a loved one’s drinking:
1. How bad is bad?
- The World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT) is a 10 question assessment that can be used to determine your loved one’s drinking pattern – is it “normal” or problematic or possibly dependence (alcoholism)? [Note: the 10 question assessment is found on page 17. Question 3 for Americans should be read as 4 or more for women and 5 or more for men to coincide with NIAAA standard drink sizes.]
- The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a wonderful website, “Rethinking Drinking” that you can also use to anonymously assess a loved one’s drinking patterns and find additional invaluable information.
2. What do I do, now?
- Learn about the differences between alcohol use, abuse and dependence (alcoholism). The NIAAA “Rethinking Drinking” website offers this information, as does my eBook Crossing The Line From Alcohol Use to Abuse to Dependence. (I don’t mean to plug my eBook, but I wrote it for just this reason – to help people in the privacy of their own computer, tablet or cell phone 🙂 .)
- Learn about impacts on your health and brain – you can find this information in the eBook or the links earlier in this post.
- Consider attending Al-Anon (or Nar-Anon if drugs is the issue) – both 12 step programs to help family members and friends who have a loved one who drinks too much (does not have to be an alcoholic – rather it’s simply whether alcohol is an issue in the relationship).
- Consider talking to a therapist who specializes in substance abuse and addiction – it’s imperative the therapist understand the family/friendship dynamics that result in relationship where substance abuse or addiction are a problem.
- And for immediate relief and the sense of power that comes with doing “something” – take time for yourself to Exercise, Sleep, eat Nutritious Foods, and practice moments of Mindfulness. These four actually heal – re-wire our brains (and of course, our bodies) from the impacts of chronic stress, such as that experienced when coping with ongoing SHD.