Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

Excessive alcohol use, either in the form of binge drinking or heavy drinking, was responsible for an average of 88,000 deaths annually in the United States from 2006 – 2010. (Source: CDC>Excessive Drinking, accessed 8/11/17) This is equal to 241 deaths per day.

In view of these statistics, which I find staggering, as is the fact they’re not widely known by the general public, I offer the following suggestions to answer the question, “What can WE do to stop this?” Because it’s going to take the “WE.”

Understand Excessive Alcohol Use

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

Excessive alcohol use is considered binge drinking or heavy drinking.

“I only had a couple of drinks,” or “We each had a drink and then split a bottle of wine.” These kinds of statements are common when someone gets into trouble as a result of how much they’ve had to drink. Sometimes the speaker is absolutely baffled at being pulled over for a DUI or having a hangover in the morning because they are sure they’d only had a few.

So understanding what’s considered “low-risk” drinking can help a person avoid excessive alcohol use.

According to the NIAAA>RethinkingDrinking website,

  • women should not exceed 7 standard drinks/week, with no more than 3 of the 7 on any day
  • men should not exceed 14 standard drinks/week, with no more than 4 of the 14 on any day.

These limits are to help a person avoid the excessive drinking (binge drinking/heavy drinking) that lead to the 88,000 deaths per year in the U.S. reported in my opening statement. Binge drinking is defined as drinking 5 or more standard drinks on an occasion for men or 4 or more standard drinks on an occasion for women. Heavy drinking is defined as drinking 15 or more standard drinks per week for men or 8 or more drinks per week for women.  Most people who drink excessively are not alcoholics or alcohol dependent. (Source: CDC>Fact Sheets – Alcohol Use and Your Health, accessed 8/11/17) In fact, according to the CDC, more than half of these 88,000 deaths were due to binge drinking. (Source: CDC>Excessive Drinking, accessed 8/11/17)

As for “standard drinks,” in the U.S. a “standard” drink is any drink that contains about 0.6 fluid ounces or 14 grams of “pure” alcohol. And it’s the “pure” alcohol that’s the concern as it contains the ethyl alcohol chemicals that interrupt the brain’s cell-to-cell communication, and it’s this cell-to-cell communication that controls everything a person thinks, feels, says and does. Some common standard drink sizes are 5 ounces of table wine, 12 ounces of regular beer, 8-9 ounces of the IPA kinds of beer, 1.5 ounces of “hard” liquor (vodka, scotch, bourbon, tequila).

Often common drinks or beverage containers people serve and/or consume at parties or restaurants contain more than one standard drink as listed below. Not understanding this can cause a person to drink more than they’d planned.

  • a margarita = 2-3 standard drinks
  • a martini = 1.5-2 standard drinks
  • a “stiff” scotch on the rocks = 2-3 standard drinks
  • a bottle of table wine = 5 standard drinks.

To find out how many standard drinks there are in your favorite cocktail, click here, and in your favorite alcohol beverage container, click here.

Understand How the Body Processes Alcohol

Why is this so important to understand? Because alcohol (the ethyl alcohol chemicals in alcoholic drinks) is not processed like other foods and liquids. It is metabolized (processed) by enzymes in the liver. It takes the liver about one hour (often up to two depending on other variables, such as weight, gender, having eaten, stage of brain development or medications) to metabolize the ethyl alcohol in one standard drink.  So if a person consumes 3-4 drinks, it’ll be roughly 3-4 hours before their body is clear of all alcohol. While alcohol waits its turn to be processed by the liver, it is “sitting” in body organs, like the brain. It’s this sitting in the brain that changes how a person thinks and behaves because the ethyl alcohol chemicals in the alcohol beverages consumed interrupt neural networks and therefore normal brain functioning.

Assess Your Drinking Pattern

NIAAA Rethinking Drinking’s website has an anonymous, online, 2-question drinking pattern assessment that can be found here. Another assessment is the AUDIT (Alcohol Use Disorders Test) by the World Heath Organization.

Know that Alcohol Works Differently in the Teen Brain

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

Alcohol (and other drugs) works differently in the young brain that it does in the adult brain due to key brain developmental processes occurring age 12-25.

Little did we know until the Decade of the Brain (1990s) and the Decade of Discovery (2000s) that the brain could take until the average age of 24 for boys and 22 for girls to fully develop. Little did we know that the kinds of brain developmental activities that occur from ages 12 – early 20s, often through 25, explain why teens do the things they do (seek risks, not consider potentially negative outcomes, for example) and why excessive drinking can be so problematic for young people’s brains.

In my fourteen+ years of studying brain research and writing on brain development and the brain disease of addiction, understanding the whole story about puberty and the brain’s evolution [see Image 2 in article linked below] gave me the pieces that finally completed the puzzle on how/why teens do the things they do and how/why their peers are so influential and why all of this is so instrumental in the development of a more serious drinking problem.

To explain why it’s so important we understand puberty and what it does in the brain, check out my posts, Want to Get Through to Teens, Talk to Their Brainsand Give Their Brains a Break – Underage Drinking Prevention.

And by the way, the Europeans don’t have this whole underage drinking issue figured out, either. In fact it’s a huge problem there, as well. So check out the 2015 European School Survey Project on Alcohol and Other Drugs.

And one more point, here, treating an adolescent with alcoholism is not the same as treating an adult – primarily because of the developmental processes the adolescent brain goes through. For more on this, check out NIDA’s Evidence-Based Approaches to Treating Adolescent Substance Use Disorders.

Understand that People Develop Alcoholism (aka Alcohol Use Disorders)

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

A person develops the brain disease of alcoholism. Find out how and why – click here to order

Thanks to all of this brain research, it’s now understood that addiction (of which alcoholism or alcohol use disorder is one) is a developmental, chronic, relapsing brain disease. People are not born alcoholics, nor do they choose to become one. They develop it and often that’s because of the myths, stigma, misinformation and shame that surrounds the disease of alcoholism. To debunk these myths, please check out my eBook, Crossing The Line From Alcohol Use to Abuse to Dependence.

And for more on how alcohol works in the brain and what makes addiction (alcoholism) a brain disease, check out NIDA’s Drugs, Brains and Behaviors: The Science of AddictionYou might also want to check out The Surgeon General’s Report on Alcohol, Drugs and Health (released 2016).

Lastly, I’d shared what NIDA recommends for treating adolescent addiction (alcoholism) above, here’s the link to NIDA’s>Principles of Drug [alcohol is considered a drug] Addiction Treatment: a Research-Based Guide for treating adults.

Understand Secondhand Drinking

One last thing for now… it’s important to understand the very real impact of a Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?person’s drinking behaviors on others – especially family members and close friends. And that is secondhand drinking, which affects 90 million Americans. These impacts are related to stress – the stress a person dealing with a loved one’s drinking behaviors experiences. These stress related impacts can include: depression, anxiety, stomach ailments, cardiovascular problems, sleep disorders, muscle aches, skin problems and so much more. To learn more, check out my eBook, Secondhand Drinking: The Phenomenon That Affects Millions

You might also want to check out my article, What to Say to Someone With a Drinking Problem.

For more information…

Awareness is half the battle, and there are many resources to help reduce excessive alcohol use, so if you have a question or wonder about what I’ve written here, please feel free to call me at 650-362-3026 or email me at lisaf@BreakingTheCycles.com. I’m happy to talk with you or help you find the answers you need.

©2017 Lisa Frederiksen

 

I Could Have Developed Alcoholism | I Developed Bulimia Instead

I still look back with great sadness on the 11 years I spent binging and purging (bulimia) and the year I spent “dieting” (anorexia)  — my lost years from ages 16-28.

To the person whose never been bulimic, it’s impossible to understand why someone would “choose” to eat huge quantities of food and then throw it up — over and over and over; time and time and time again. To the person whose never been anorexic, it’s impossible to explain why someone would “choose” to purposely starve themselves. I try to describe what it’s like in my post, When ACEs are Rooted in Secondhand Drinking.

By the same token, it’s impossible to understand why someone “starts,” let alone “chooses” to continue, their alcoholism (aka alcohol use disorder). What causes them to repeatedly break promises to themselves and to their loved ones to stop or cut down? Why don’t they love their loved ones enough to stop?

In my opinion, based on my own experience and that of the hundreds of people whom I’ve helped or who have reached out to me to tell me their similar stories, the answer is unresolved ACEs – Adverse Childhood Experiences. As I wrote in my post, “When Recovering From ACEs is Recovering From Secondhand Drinking & Visa Versa” (retitled and printed below),

Bottom line, I realized I could have developed alcoholism. Instead, I developed bulimia. Others embraced cutting, spiraled into deep depression, developed OCD (obsessive-compulsive disorder), or experienced a host of toxic stress-related ailments: headaches, stomach problems, skin rashes, anxiety, depression, hair loss, racing heartbeat, back pain, muscle aches, migraines, sleep problems, changes in eating habits (causing obesity or weight loss), and dizziness.

I Could Have Developed Alcoholism | I Developed Bulimia Instead

In 2016, I celebrated 35 years recovery from the eating disorders I’d grappled with from the ages of 16–28. I was 63 years old. But as I shared in my last post, “When ACEs are Rooted in Secondhand Drinking,” I was into my 40s before I realized my anorexia and bulimia were the symptoms of, and soothers for, my deeper, unresolved issues.

First recovery: learning to re-eat

As always, my eating disorders recovery “celebration” last year consisted of quiet kudos to self on Thanksgiving Day. I celebrate on Thanksgiving Day as it was the first major food holiday during which I’d managed not to binge and purge.

I write, “quiet kudos to self,” because back in the early 1980s when my eating disorders recovery began, there was little understanding, let alone treatment for people who either didn’t eat (anorexia) or ate huge quantities of food and then purged (bulimia).

In fact the only thing in my area treating this condition was a phobia group led by doctor who said bulimia was a fear of getting fat. Though that was never a driving force behind my binging and purging, I went along with his “treatment” and attended a few of the group meetings. But I soon gave up. I couldn’t relate to the experiences of an agoraphobic, arachnophobic, acrophobic, and others with diagnosed phobias.

Instead, I double-downed on my commitment to do what the woman who had spent seven years eating huge quantities of food and then throwing it up had done. Her very short story appeared in a Newsweek magazine column on bulimarexia. Her recovery success secret? Exercise and nutrition. I remember the feeling of, “Oh my God – I’m not the only one,” followed by, “Oh my God, if she stopped, maybe I can, too.”

Though I learned to re-eat (the details of which are beyond the scope of this article), I had no idea there was something far deeper that still needed to be fixed. And that something was the emotional underpinning – namely trauma – for my embracing eating disorders in the first place.

And that’s because back in the day (early 1980s), I’d never had words to describe let alone deal with my mother’s alcoholism and the resulting secondhand drinking* dysfunction in my family. Back in the day, there was little understanding that children coping with secondhand drinking often have multiple relationships with alcohol misusers over the course of their adult life.

*Secondhand Drinking (SHD) refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors include verbal, physical, emotional abuse; neglect; blackouts; unplanned/unwanted sex, sexual assault; breaking promises to stop or cut down; shaming, blaming, denying; unpredictable behaviors; and driving while impaired, to name a few. Drinking behaviors are caused by a number of drinking patterns, including: binge drinking, heavy social drinking, alcohol abuse, and alcoholism. People engaging in these drinking patterns are referred to as alcohol misusers. The negative impacts a person coping with SHD experiences are related to toxic stress.

As importantly, critical research about the human brain and emotional health had yet to be discovered.

So while I’d learn to re-eat, I’d never dealt with my secondhand drinking-related trauma; SHD-related trauma that had multiplied in the ensuing decades as my close relationships with other alcohol misusers multiplied.

Thus the “voice” that had previously ruled my life with bulimia settled on attacking me for not being important enough, good enough, loveable enough – just plain, enough. Enough to make my various loved ones want to stop drinking and thus stop the crazy, convoluted drinking behaviors it spawned.

In order to shout down, block out the “voice,” I became a workaholic, married, became a supermom and workaholic, divorced, re-married and created a blended family, and divorced again. Along the way, I turned into a hawk who saw every move of every person in my compulsion to “fix” the various alcohol misusers in my life. And it wasn’t just the alcohol misusers. I was equally compelled to “fix” the scores of others whose lives were crumbling in the wake of their own and my secondhand drinking behaviors.

I didn’t understand that my thoughts, feelings, and behaviors had deeply, deeply intertwined (enmeshed) with the thoughts, feelings, and behaviors of my loved ones. I had no understanding we were locked in a dance, The Dance of the Family Disease of Alcoholism.

Thus I never dreamed of looking at my ”Self” for answers. I just kept frantically doing something, anything to keep the judging voice – my inner critic – at bay. Thus my 30s rolled into my 40s without my finding the real relief I so desperately sought. When asked how I was, I’d answer, “I’m fine,” with absolutely no idea of, let alone ability to name, how I really felt.

I Could Have Developed Alcoholism | I Developed Bulimia Instead

“True” recovery: healing my heart and soul by rewiring my brain

And then one of my loved ones entered a residential treatment program for alcoholism in 2003, and my “true” recovery began. I was plunged into the world of being labeled a codependent, an enabler, and informed addiction* was a disease.

*Addiction is the common term used to describe a dependence on alcohol or other drugs. The common terms for these addictions are alcoholism and drug addiction. New language based on new brain science now refers to addiction as a substance use disorder. In the case of alcohol, it would be an alcohol use disorder. Alcohol use disorders include a variety of drinking patterns: binge drinking, heavy social drinking, and alcohol abuse. The most severe alcohol use disorder is what we commonly refer to as alcoholism.

I baulked at that one. Cancer is a disease, I argued. All they had to do is put down the bottle. Not only that, I’d learned to re-eat and you needed food to survive – you sure didn’t need alcohol!

But I was also “done” – done – done with what I didn’t know, but I knew something had to change. My life had been reduced to rigid absolutes: black or white, truth or a lie, you’re with me-or-you’re-not. And I was so, so angry.

Fortunately, I took to heart what the treatment center’s family therapist said to do. I attended as many family group programs at the center as were available and started participating in a 12-step program for family and friends of a loved one who misuses alcohol. I found a therapist who specialized in the family side of this disease and spent three years in Cognitive Behavioral Therapy (CBT) with him. I needed to unwire the many stress-related, unhealthy, reactionary coping skills I’d adopted in order to stay emotionally safe in the almost four decades I’d spent grappling with secondhand drinking.

It was also in this therapy I discovered the full impact on me of the sexual assault by a boyfriend’s father when I was a teen – another trauma. I had so deeply buried the stripping away of “Lisa” caused by that experience, thus healing that trauma was as important as healing the trauma caused by SHD.

And in the midst of all this, I did what I do – I researched. I had to understand how I went so far down; why I’d tolerated secondhand drinking for so, so, so long; and on what basis treatment professionals could possibly think alcoholism (addiction) was a disease. What I learned and continue to learn has been life changing.

Finally science that puts it all together

Advances in imaging technologies and the resulting brain research provided and continue to provide insights and answers like never before. In fact much of what we know about the human brain has been discovered in the recent 10-15 years.

Research explains:

  • how the brain works, wires, develops, and maps to control everything we think, feel, say, and do
  • alcohol, trauma, toxic stress, genetics, and environment can negatively change or influence that wiring, development, and mapping
  • alcoholism (aka alcohol use disorder/addiction) is a developmental brain disease that starts with alcohol misuse changing brain structure and functioning, making the brain more vulnerable to the five key risk factors for developing the disease
  • trauma can cause toxic stress; toxic stress can actually change a child’s brain architecture, negatively affecting their lifetime physical and emotional health
  • a person must heal their trauma in order to heal their brain and thereby improve their lives
  • the brain is plastic, meaning it can rewire, it can heal from the impacts of alcohol use disorders and trauma-related toxic stress
  • nutrition, exercise, sleep, and mindfulness are critical to brain health and thus are keys to repairing, rewiring, and healing one’s brain for better thoughts, feelings, and behaviors.

As important as these brain research advances and findings to my secondhand drinking recovery is the ACEs Study. This study measured the impact of adverse childhood experiences* (ACEs) on a person’s health across a lifetime. Finally! Something that explained what had happened to me AND to my various loved ones.

*Adverse Childhood Experiences (ACEs) are divided into three categories, neglect; abuse; and household challenges; and include physical, verbal, sexual abuse; physical, emotional neglect; and growing up with a relative with a substance use or mental disorder, to name a few. Click here to get your ACEs Score.

Information that set me free and allowed me to forgive

Over the course of my 13-year secondhand drinking recovery, I’ve become a speaker, educator, and trainer on the research I’ve shared in this article. The connection chart below is one I developed and use in my work to help people understand how closely the connection is between SHD, ACEs and addiction.

I Could Have Developed Alcoholism | I Developed Bulimia Instead

For example, I learned I had exposure to four of the adverse childhood experiences measured in the ACE Study.

I learned my mother, whose alcoholism had so deeply influenced my life’s trajectory, had experienced five. I realized my daughters both had 4, and they were only 14 & 15 ½ at the time I learned of this study.

I found similar ACEs history patterns repeated in my other alcohol misusing loved ones. One had 5, another 3, and a third 6.

And all of us had long-term exposure to secondhand drinking.

I found similar patterns in the stories shared with me by the hundreds of people with whom I’ve worked over this past decade.

And it wasn’t just “us” in our immediate families. It was intergenerational. When a parent does not heal their trauma, their experiences change them. Those changes in them affect their parenting and/or inter-familial relationships in profound ways.*

*Check out the American Academy of Pediatrics’ article,“Adverse Childhood Experiences and the Lifelong Consequences of Trauma.”

Bottom line, I realized I could have developed alcoholism. Instead, I developed bulimia. Others embraced cutting, spiraled into deep depression, developed OCD (obsessive-compulsive disorder), or experienced a host of toxic stress-related ailments: headaches, stomach problems, skin rashes, anxiety, depression, hair loss, racing heartbeat, back pain, muscle aches, migraines, sleep problems, changes in eating habits (causing obesity or weight loss), and dizziness.

It was all of these understandings that gave me the information – the “ah ha’s” – I needed to forgive my loved ones and to forgive myself. And it was the forgiveness that really set me free. Not the kind of forgiveness that excuses horrific behaviors, rather the kind of forgiveness that lets go of wishing for a different outcome. It is the kind of forgiveness that recognizes we were all doing the best we could with what we knew at the time. And for almost four decades, that wasn’t much. Sadly, for most Americans in this situation, it still isn’t.

Which is where my hope comes in

… for the 90 M Americans who experience secondhand drinking and the 18+ million Americans who struggle with alcohol use disorders and the thousands of communities within which we work, go to school, and live.

It is my hope that understanding the connection between SHD, ACEs and the risk factors for developing addiction emboldens us to embrace a middle ground, namely that we all have been affected and need our respective recoveries. It no longer has to be an us against them, or my hell is your fault, or stop your drinking and all will be well for me.

It is my hope that understanding this connection can be the “Oh my God” moments a person may need to start their own recovery journey.

Sure… our recoveries will be different depending on what went into developing the brain we have, but our recoveries can also be similar in that we can go on to live healthy, joy-filled lives having healed, re-wired our brains. We just need to do it differently.

We need to take advantage of the ACE study findings and modern brain science to create a new framework. In this framework we can discuss, work together, and enhance therapies, preventions, and interventions to affect real recovery from ACEs, SHD, and alcohol use disorders (addiction).

Within this framework, we can break the cycles!

______________________________________________

I leave you with links to a few of my blog posts covering some of the details of my 13-year secondhand drinking recovery journey….

And for more on secondhand drinking:

 ©2017 Lisa Frederiksen

Child of an Alcoholic – a Legacy of Untreated Secondhand Drinking-Related ACEs

Each April since 1987, the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) has sponsored Alcohol Awareness Month to increase public awareness and understanding, reduce stigma and encourage local communities to focus on alcoholism and alcohol-related issues. This year’s theme is “Connecting the Dots: Opportunities for Recovery.”

In honor of this year’s theme, I’d like to connect a dot that is often overlooked in my opinion — the Legacy of Untreated Secondhand Drinking-Related ACEs and the role it can play in developing alcoholism and frustrating one’s attempts to recover.

As I shared in my post of the same name appearing on ACEs Connection

I am the Child of an Alcoholic

My mom didn’t stop drinking until age 79. She died at 84. There was no warning, no lingering illness. She died two days after an unsuccessful emergency surgery. But we had five years during which she did not drink, after forty-five years during which she did.

You see, my mom knew she had a drinking problem. So did we, the rest of her family. There were times when she fought mightily to stop or control it. There were times when the rest of us fought mightily to help her. She even succeeded in cutting back or not drinking for periods of time, which convinced her and us that she really wasn’t an alcoholic(1). None of us knew alcoholism(1) was a developmental brain disease; a chronic, often relapsing brain disease. None of us knew one of the key risk factors for developing the disease is childhood trauma. None of her primary care doctors who saw her over the four+ decades her disease marched on ever diagnosed it.

Ironically, my mom was also a 17-year cancer survivor when she died. She knew to do (and did) self-breast exams. She found a lump and immediately contacted her doctor; her doctor immediately ordered a biopsy; and she was diagnosed with breast cancer in 2000. She had a mastectomy, went through chemotherapy, lost her hair, and showed such courage and grace in her battle to recover. (If you’ve ever witnessed someone recovering from cancer, you know what I mean by “battle.”)

But cancer was a disease people and their doctors understood. Symptoms and having the disease were openly talked about and medical protocols were routine. There was no denial, secrecy, lying or self-judgment.

This was not the case with my mom’s other disease – alcoholism.

The opportunity for an earlier recovery from alcoholism for my mom would have been:

  • understanding and treating her adverse childhood experiences (unknowable at the time because the ACEs Study had yet to be done)
  • knowing that alcoholism is a developmental brain disease (unknowable at the time because the science was not, yet, available)
  • understanding the legacy of untreated secondhand drinking (SHD)-related ACEs.

Preventing an Alcohol Use Disorder – one of the Legacies of Untreated Secondhand Drinking-Related ACEs

Child of an Alcoholic - a Legacy of Untreated Secondhand Drinking-Related ACEsUnderstanding the connection between ACEs and SHD and their connection as possible risk factors for developing addiction (alcoholism) can help a family prevent alcohol use disorders going forward.

It was this connection and finally understanding that alcoholism (addiction) is a brain disease that set my mom free. She could embrace the fact that she didn’t “choose” to become an alcoholic just as she didn’t “choose” to have breast cancer; nor was she weak-willed, immoral, uncaring or any of the other adjectives used to label persons with this particular disease.

 

Breaking The Cycles – Changing the Conversations

To close this post I want to share one of my mom’s greatest gifts to breaking the cycles of untreated SHD-related ACEs and untreated ACEs in general. It happened during one of our phone calls.

She said to me, with deep emotion, “Lisa – please – please use my story – our story – to help others.”

And so I am.

There wasn’t enough time for my mom to heal from her ACEs, nor for she and I to develop the mother/daughter relationship I now have with my two daughters. Our experience is so different because of the healing work the three of us were able to do to change the legacy.

But my mom started her process by breaking the denial, secrecy, lies, and self-judgment about her alcoholism and its root causes. And it is the four of us together – my mom, myself, and my two daughters – who have now changed the legacy in our family. As such, we pass forward not lies but the truth, not self-judgment but self-compassion, not secrecy but openness, not denial but seeking awareness. Something I didn’t even understand let alone could have imagined possible just fourteen years ago.

To read the full article, please click The Legacy of Untreated Secondhand Drinking-Related ACEs.

_______________________________

Endnote:

(1) Current terminology defines any drinking pattern that exceeds “low-risk” limits as an alcohol use disorder (AUD). In other words, the more commonly used terms most people are familiar with — binge drinking, heavy social drinking, alcohol abuse and alcoholism — are all considered alcohol use disorders (AUDs). Alcoholism is the most severe of the AUDs. 

Additionally, a person with the most severe AUD is no longer referred to as an alcoholic. Rather s/he is referred to as a person with an alcohol use disorder. I like this distinction. It allows us to see the person with an AUD as a person, first, and then second, as a person with an AUD.

When referring to alcoholism, it is also currently correct to use the term Substance Use Disorder (SUD). A substance use disorder is either alcohol or other drug misuse.

©2017 Lisa Frederiksen

Inaccurate | Misleading | Incomplete Information About Drinking Alcohol is Inexcusable

One of my biggest frustrations is the continued inaccurate, misleading, incomplete information about drinking alcohol that repeatedly appears in the news, medical practices, treatment program descriptions, and our social and cultural environments (school, workplace, community, legal and law enforcement, religious practices, family, political arena and the like).

Take this April 6, 2017, article appearing on USA Today’s Network, How a drinking habit becomes a drinking problem.”

In my opinion, it neglects to use readily available, 21st century neuroscience and alcohol misuse-related scientific research to accurately:

  • define a drinking problem and describe alcoholism as but one example of a drinking problem
  • define alcoholism as the developmental chronic brain disease it is and explain what it takes to develop this disease
  • explain why it is the complex nature of this brain disease (in other words, it’s the disease – alcoholism – itself) that makes it so difficult for a person with alcoholism to understand the kind of help they need.

Now I grant you, this is not a long article and likely the author was asked to write a 700 word piece. But what was written perpetuates the old, inaccurate, misleading and incomplete information about drinking alcohol. And that’s a problem — a huge problem.

For example, the article starts with this opening statement:

Battling addiction of any kind might be best referred to as a lifelong journey. “Journey” is a word addicts will tell you describes the treatment plan they must follow every day of their lives.

Inaccurate | Misleading | Incomplete Information About Drinking Alcohol is Inexcusable

Inaccurate | Misleading | Incomplete Information About Drinking Alcohol is inexcusable with the abundance of neuroscience and alcohol misuse-related scientific research now available.

This opening section continues with a list of some of the reasons a person starts drinking in excess, and then it presents the following header and paragraphs:

Is it a problem?

So, for the occasional drinker, how much a night is too much? And how do you know if you have a problem?

The answer varies, because no two alcoholics are the same. What they drink will differ, as will the amount they drink.

By this point, I was incredulous. Seriously? The author gives a title of “How a drinking habit becomes a drinking problem,” and then launches into battling addiction and developing alcoholism, as if the only drinking problem to be concerned about is alcoholism.

Then the writer asks how much a night is too much for the occasional drinker [emphasis added] and explains “[t]he answer varies, because no two alcoholics are the same.”

This is patently misleading and incomplete information.

The occasional drinker generally does not have a drinking problem, assuming the writer is defining the occasional drinker in his mind as someone who stays within “low-risk” drinking limits. These limits are defined by the NIAAA (National Institute on Alcohol Abuse and Alcoholism) as no more than 7 standard drinks a week, with no more than 3 of the 7 on any day, for women, and no more than 14 standard drinks a week, with no more than 4 of the 14 on any day, for men. A standard drink is defined as 5 ounces of table wine, 12 ounces of beer, and 1.5 ounces of 80-proof, “hard” liquor.

In fact, according to the NIAAA’s research…

The Majority of People with a Drinking Problem are not Alcoholics

When a person exceeds “low-risk” drinking limits, they are considered “at-risk” for developing a more serious drinking problem. Common terms to label these drinking problems include: binge drinking, heavy social drinking, alcohol abuse, and alcoholism. All alcoholics go through a period of “at-risk” drinking, but not all “at-risk” drinkers become alcoholics.

But it was the third section in the article, “Treatment,” that put me over the top on my frustration meter and prompted me to write this post. Again, quoting from the article:

The journey toward sobriety only begins when the drinker admits there is a problem. 

And herein lies the problem…

Inaccurate, Misleading, Incomplete Information About Drinking Contributes to a Person’s Lack of Awareness About the Problems with Their Drinking

The alcoholic generally knows at some level they have a problem. But they think they should be able to control their drinking like other people who don’t have problems when they drink alcohol or who manage to regain control after an occasional binge. So they try to drink less to prove they can control it, which does nothing to address their underlying chronic brain disease (alcoholism).

In other words, the alcoholic’s problem is not only their drinking, it’s also the chronic brain disease, itself. [FYI – the medical definition of addiction, whether it’s an addiction to alcohol or other drugs, is that it is a chronic brain disease.] Thus understanding the disease can help a person understand the nature of their problem and be more open to getting the kind of help they need to fix it.

Dr. Volkow, Director of the National Institute on Drug Abuse (NIDA), has given a wonderful explanation of all this. It was part of her “Addiction: a Disease of Free Will” lecture given at the 168th Annual Meeting of the American Psychiatric Association (2015):

…[describing] addiction as a chronic brain disease, is sort of a theoretical concept. Say that you have two parents with a very sick child, and they go to the hospital, and the doctor says, “Your child is in a coma because he has diabetes.” And he explains to them that diabetes is a disease of the pancreas, a chronic disease of the pancreas. This does not explain why that child is so severely ill. What explains it is the understanding that the cells in the pancreas can no longer produce insulin, and we need insulin in order to be able to use glucose as an energy source, so without it, the cells in our body are energy-deprived—which explains why this child is so sick.

So when we speak of addiction as a chronic disease of the brain, what does it mean? How does it help us explain the devastating changes in behavior of a person that’s addicted, where even the most severe threat of punishment is insufficient to have them stop taking drugs, where they are willing to give up everything they care for in order to take a drug? How does “a dysfunction in the brain” help us understand that?

Dr. Volkow goes on and provides great detail on how brain science has informed us.

And this is where I get frustrated. Articles like this USA Today Network article perpetuate the inaccurate, incomplete, misleading information about drinking, drinking problems, causes of drinking problems and the myriad of variations thereof. This is what allows the disease of alcoholism to progress in some individuals. It’s also what provides a “cover,” if you will, for the kinds of drinking problems that are not alcoholism but are detrimental to the drinker’s health and to others on the receiving end of their drinking behaviors.

The other kinds of drinking problems include: binge drinking, heavy social drinking and alcohol abuse. Drinking behaviors are behaviors that result when a person drinks more than their liver can metabolize (get rid of) and the excess ethyl alcohol chemicals in the alcoholic beverages consumed changes brain functioning until they are metabolized by the liver. This changed brain functioning results in drinking behaviors (behaviors the person likely wouldn’t engage in if sober), such as: driving while impaired, verbal/physical/ emotional abuse, and unplanned or unwanted sex, sexual assault. Thus it’s not just alcoholism that’s a drinking problem. It’s any drinking pattern that results in drinking behaviors.

News journalists, medical practitioners, treatment program providers, and spokespersons in our social and cultural environments (school, workplace, community, legal and law enforcement, religious practice, family, political arena and the like) need to get on board with the new facts if we’re ever going to help people understand all of this.

Bottom line…

Inaccurate, Misleading, Incomplete Information About Drinking Alcohol is Inexcusable Today

It’s inexcusable because it perpetuates all the stereotypes about drinking habits, drinking problems, alcoholism, alcoholics, and treatment that have us so stuck, todayIt’s inexcusable because there is 21st century neuroscience and alcohol misuse-related scientific research that is readily accessible from a host of national and international organizations.

To name just a few, these organizations include: the U.S. Surgeon General’s office, the American Psychological Association, the American Academy of Pediatrics, the National Institute on Drug Abuse, the World Health Organization, the American Medical Association, the National Institute on Alcohol Abuse and Alcoholism, the American Board of Addiction Medicine, and the Substance Abuse and Mental Health Services Administration. Additionally, there are hundreds of public agencies, non-profits, medical schools and brain institutes across the country and around the world conducting and reporting this kind of alcohol-misuse related research, as well.

It is their collective research that allows the rest of us to accurately:

  • define a drinking problem and describe alcoholism as but one example of a drinking problem
  • define alcoholism as the developmental chronic brain disease it is and explain what it takes to develop this disease
  • explain why it is the complex nature of the brain disease of alcoholism (in other words, it’s the disease itself) that makes it so difficult for a person with alcoholism to understand the kind of help they need.

As for why I singled out this article over other similar articles, it’s because of the reach it had.

According to USA Today Network’s August 17, 2016, press release, the USA Today Network reached 110MM unique visitors in July 2016. In other words – it has a big, big reach. And thus an article appearing on the USA Today Network has a big, big reach and a big, big opportunity to perpetuate inaccurate, misleading and incomplete information about drinking alcohol.

They also have a big, big opportunity to get it right.

So What is Accurate Information About Drinking Alcohol

As you can imagine, I’ve written about that, too 🙂

Much of the research I reference above is more fully explained with resource links in these two posts:

I appreciate you reading this post and encourage you to share it. Only with accurate, complete, science-based information about drinking alcohol can we truly help people who drink too much, whether or not they’ve developed the chronic brain disease of alcoholism.

Note: to be clear, current terminology generally defines any drinking pattern that exceeds “low-risk” limits as an alcohol use disorder (AUD). In other words, the more commonly used terms most people are familiar with — binge drinking, heavy social drinking, alcohol abuse and alcoholism — are all considered alcohol use disorders (AUDs). Alcoholism is the most severe of the AUDs. 

Additionally, a person with the most severe AUD is no longer referred to as an alcoholic. Rather s/he is referred to as a person with an alcohol use disorder. I like this distinction. It allows us to see the person with an AUD as a person, first, and then second, as a person with an AUD.

©2017 Lisa Frederiksen

How Do You Know if Someone’s Drinking is a Problem

How do you know if someone’s drinking is a problem? Short answer: “If you are talking or concerned about it.” What do I mean?

The only reason a person would be worried about another person’s drinking is because that other person’s behaviors change when they drink. Their behavioral changes are called drinking behaviors.

Drinking behaviors occur when a person consumes more alcohol, thus more ethyl alcohol chemicals, than their liver can metabolize. When this happens, the ethyl alcohol chemicals interrupt the chemical portion of the brain’s cell-to-cell communications. This suppresses normal neural network functioning responsible for judgment, memory, pleasure/reward, emotions, breathing…. In other words, it changes a person’s thoughts, feelings, and behaviors.

How Do You Know if Someone's Drinking is a Problem

How Do You Know if Someone’s Drinking is a Problem

Contrary to popular belief, it’s not just the drinking pattern of alcoholism that causes these behavioral changes, although alcoholism is certainly one. Binge drinking, heavy social drinking, and alcohol abuse (terms now grouped together as alcohol misuse and/or alcohol use disorders) also cause drinking behaviors. Some of the drinking behaviors include:

  • crazy, convoluted accusations and illogical arguments
  • verbal, physical and/or emotional abuse
  • bullying; neglect
  • driving while impaired
  • domestic violence.

Why Does Knowing Whether a Person’s Drinking is a Problem Matter

Short answer: “There is a direct impact – a second-hand effect – on the people confronted and/or coping with drinking behaviors.” These second-hand effects include:

  • being on the receiving end of drinking-related verbal, physical or emotional abuse; neglect; bullying and believing it’s the “real” person coming out, not understanding the behaviors are the consequence of chemical changes in the brain
  • being seriously injured by an impaired driver
  • feelings of anxiousness, hopelessness, walking on egg shells because of the uncertainty, worry, fear, anger, concern triggered when in the sphere of an impaired person’s drinking behaviors
  • being on the receiving end of domestic violence or a sexual assault by a person whose brain functioning has changed under the influence of alcohol.

Moms, dads, husbands, wives, brothers, sisters, children, grandchildren, grandparents, boyfriends, and girlfriends exposed to and/or coping with these sorts of drinking behaviors experience physical, emotional and quality of life impacts because the drinking behaviors trigger their stress response system. When this system is repeatedly activated, their stress becomes toxic, and they experience many of the following stress-related symptoms:

  • stomach ailments
  • insomnia
  • anxiety, depression, frequent or wild mood swings
  • chronic neck and/or shoulder pain
  • frequent headaches, migraines
  • chest pain, palpitations, rapid pulse
  • increased anger, frustration, hostility
  • feeling overloaded, overwhelmed, helpless, hopeless

I call this second-hand effect secondhand drinking (SHD). For more on this, check out “The Fight-or-Flight Stress Response – Secondhand Drinking Connection.

Now… back to the original question, “How do you know if drinking is problem?” If you’ve agreed with my short answer, “You’re talking about and/or concerned about it,” then you’ve seen some of the drinking behaviors I mentioned above. And that is your answer. Drinking really is a problem because it’s not “normal” to change behaviors when drinking. And that’s because staying within low-risk or moderate drinking limits typically keeps a person from exhibiting drinking behaviors.

Definition of “Moderate” or “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.
A standard drink is defined as 5 ounces of table wine, 12 ounces of beer or 1.5 ounces of liquor (e.g., vodka). Often “drinks” served at  parties or in bars or restaurants  contain more than one standard drink.

Lisa Frederiksen explains the three stages of substance misuseWhat Knowing Low-Risk Drinking Limits Can Do For You

1. Helps you understand when your loved one’s brain is likely changed by the ethyl alcohol chemicals in alcoholic beverages, thus their behavioral changes are not their “normal” (unless that’s how they behave when they’re not drinking).

2. Helps you avoid the unnecessary, unproductive and down right destructive exchanges that can occur when you try to make sense out of the actions and behaviors of someone who has exceeded low-risk drinking limits — especially the “per day” limit.

This 2nd reason can be especially important and makes more sense when you understand the next section.

Blood Alcohol Content Explained

Alcohol is not digested like other foods and liquids. It bypasses the digestive system and enters the bloodstream through the walls of the small intestine. Because alcohol dissolves in water, the bloodstream carries it throughout the body (which is 60-70%) water, where it is absorbed into body tissue high in water concentration (like the brain) and highly vascularized (meaning, lots of blood vessels – like the brain).

The ethyl alcohol chemicals in alcoholic beverages are metabolized by specific enzymes produced in the liver. This is the process by which ethyl alcohol chemicals leave the body. The liver can only metabolize a certain amount of ethyl alcohol per hour, which means it leaves the bloodstream more slowly than it enters. Because the brain controls everything we think, feel, say and do, ethyl alcohol chemicals “sitting” in the brain until the liver can metabolize them changes the chemical portion of the brain’s electro-chemical signaling process (in other words, how brain cells talk to one another, aka neural networks). This in turn changes neural networks (cell-to-cell communications) responsible for a person’s thoughts, feelings, and behaviors.

A very GENERAL rule of thumb is that it takes about one hour for the liver to metabolize one standard drink. A standard drink is defined as 5 ounces of table wine, 12 ounces of beer or 1.5 ounces of hard liquor. Using this very GENERAL rule of thumb, it will take four hours to metabolize four standard drinks — even if the drinks were consumed back-to-back, and it’s been over an hour.

BUT, no two people will necessarily metabolize alcohol in the same manner. Drink for drink, people who weigh less, for example, will have more alcohol concentration in their system than someone who weighs more. People who have lower amounts of the liver enzymes that metabolize ethyl alcohol chemicals will take longer to metabolize the same amount of alcohol as someone else. Additionally, genetics, whether taking medications, having a mental disorder, and stage of brain development will also have an influence on how one person’s liver metabolizes and/or their brain responds to ethyl alcohol chemicals. [See related post for more on this stage of brain development concept, “Underage Drinking – How Teens Can Become Alcoholics Before Age 21.”]

The key message is the liver can only metabolize a certain amount of alcohol per hour. Until the alcohol is metabolized, a person still has ethyl alcohol chemicals in their bloodstream, which means their brain’s electro-chemical signaling processes are still being changed. Hence a person’s decision-making capabilities are being changed, as well. In this manner, a person who’s had too much to drink may actually “choose” to drink and drive, or to keep drinking because “they feel fine,” or engage in any number of other destructive behaviors because of the convoluted “thinking” caused by ethyl alcohol chemicals’ impacts on electro-chemical signaling processes.

Knowing that it is a person’s exceeding low-risk drinking limits – especially the per day limits – that is causing the drinking behaviors is what can help you avoid a whole lot of endless, pointless talk or angst about nothing you have any control over — namely, the drinking behaviors. When a person drinks more than their brain and body can processes, they affect the very areas of their brain needed to think straight and act responsibly.

By keeping this in mind, you will know that as a person exceeds low-risk drinking limits, there is…

  • no point in having a ‘serious’ discussion,
  • no point getting into a fight about their drinking behaviors, and
  • definitely every reason not to get in the car with them (yes, a woman consuming 3 or a man consuming 4 drinks in a two hour period will likely register a .08 BAC).

For more information on drinking patterns…

check out NIAAA’s website, “Rethinking Drinking.” Another resource to check out is the World Health Organization’s Alcohol Use Disorders Test (AUDIT). To see how a clinician might interpret the test results, check out the WHO AUDIT PDF, pgs. 19-20.

©2017 Lisa Frederiksen