Breakingthecycles.com – Changing the Conversations

by Lisa Frederiksen

Many of us have known or seen people who seem to be able to drink far more than others without ever seeming to get drunk. Some people even aspire to being able to drink a lot without getting drunk — in other words, building up their tolerance.  But the bottom line is that the impacts on a person’s brain occur whether they appear/feel drunk or not. This is because it still takes their bodies approximately one hour to metabolize one drink.

As you may recall reading other posts on this site, alcohol is metabolized by the liver. Alcohol 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 in body tissue in proportion to the body tissue’s water content. Contrary to popular belief, we cannot rid our bodies of the alcohol we drink by peeing or sweating or vomiting it out. It’s our liver that rids our bodies of the alcohol we consume.

“So, what does that have to do with being able to drink a lot and not appear drunk?” you might ask. The brain is mostly water and highly vascularized (lots of blood vessels). When a person drinks more alcohol than their liver can metabolize, the excess alcohol stays in their bloodstream and suppresses certain brain functions — especially those related to judgment, learning, memory, pleasure, motivation and emotion.

Additionally, “too much to drink” is relative. The impact of alcohol on the brain and body depends on a number of factors beyond this very general rule of thumb that it takes the liver about one hour to process one standard drink. Weight, stress, gender, medications, tolerance, stage of brain development, lack of sleep, amount of food eaten and how quickly the alcohol is consumed are a few of the factors. Additionally, some people have lower amounts of the enzyme ADH in their livers, so their liver doesn’t process the alcohol the same way as someone with normal levels, and thus the alcohol remains in their system longer. Some people have genetic differences, such as a genetic predisposition as a result of having a parent or sibling with the disease of alcoholism. [Alcoholism is one of the diseases of addiction. Addiction is a chronic, often relapsing brain disease.] Other people have brain changes caused by early use of alcohol and/or having experienced one or more of the other risk factors for developing alcohol misuse problems.

But specifically to the issue of tolerance — the ability to drink a lot without seemingly having any consequence — is a problem. It is not good. In fact, tolerance can contribute to a person developing the disease of alcoholism and/or problems related to alcohol misuse. Please find the following links for more information on tolerance and alcohol.

University of Rochester Health Services, “Tolerance and Beyond”

National Institute on Alcohol Abuse and Alcoholism, “Alcohol and Tolerance,” Alert  No. 28 PH 356 April 1995

© Lisa Frederiksen. For this and similar information, order Lisa Frederiksen’s 20-page booklet, titled: “Seven Myths That Can Kill…,” available September 2010.

by Lisa Frederiksen

The following is another  excerpt from our upcoming booklet, Seven Myths That Can Kill… If you’d like to purchase a copy for your college student, high school student, of if a parent, yourself, so that you’ll be prepared with what to say to your middle school student, use the Contact Us link. The booklets are $1.95 each (does not include CA sales tax or postage/mailing), and should be available by September 1, 2010.

Myth #4:  Drink lots of water and eat a big meal, and it will “absorb” the alcohol.

Reality: Surprisingly, this is not true – surprising in the sense that alcohol dilutes in water, so why wouldn’t that dilute the alcohol? And, it all goes to the same place – the stomach – so why doesn’t eating food absorb the alcohol?

It’s because alcohol is not digested like other foods, which are broken down by the digestive system into smaller molecules of nutrients to nourish cells and provide energy. Alcohol avoids the normal digestive process and goes directly to the bloodstream from the small intestine.

Drinking water, however, does help a person minimize hangover symptoms which are caused in part by the dehydration that alcohol can cause.

With regards to food – we are constantly told not to drink on an empty stomach, which is, by the way, excellent advice to follow. But it’s not because the food will absorb the alcohol. (Remember – food and alcohol are processed differently – food is digested by the body’s digestive system, alcohol is metabolized by the liver.)

Food is important because it slows down how fast the stomach empties its contents (in this example, alcohol) into the intestine, and from there to the small intestine, and from there into the bloodstream. And, it is this slowing down that can help a person stay in control of how much they drink. Having a couple quick drinks on an empty stomach, allows the alcohol to move quickly into the small intestine and from there into the bloodstream. And, as you read under Myth #1, alcohol dissolves in water, travels through the bloodstream to body tissue high in water content – the brain, for example. Alcohol “sitting” in the brain, while it “waits” to be metabolized by the liver, causes the alcohol to suppress normal brain functions. And it’s that that gets in the way of a person’s ability to think straight, act responsibly and/or behave “normally.” Instead s/he can tell him/herself things like, “I’m f-i-n-e, I’ll just have another, and then I’ll stop.” Or “No worries. I’m okay to drive.”

Bottom line: drinking water helps hydrate you, reducing hangover symptoms; food slows how fast alcohol enters the bloodstream. Neither water nor food, however, will keep you from getting drunk if you drink more than the brain and body can process.

So how much is too much? The rule of thumb for this is to follow what are known as “moderate” drinking limits:
•    For women, that’s no more than 7 standard drinks in a week, with no more than 3 of those 7 in any one day.
•    For men, that’s no more than 14 standard drinks in a week, with no more than 4 of those 14 in any one day.

[Note: Binge drinking was previously defined as 4 or more drinks on an occasion for women and 5 or more for men. The definition here, showing a per day limit of 3 for women and 4 for men, is to help people avoid rationalizing two “occasions” in the same day as a way to drink all, or a majority, of their weekly drink quantities at once.]

As you’ve gathered, the idea behind these limits is to help a person maintain brain and body control. Additionally, it helps a person avoid the chemical and structural changes caused by repeated alcohol abuse. And, these changes are real!

© Lisa Frederiksen, Excerpt from the 20-page booklet, titled: “Seven Myths That Can Kill…” by Lisa Frederiksen, available September 2010.

by Lisa Frederiksen

This is a common phrase repeated by many who have a loved one who drinks too much, as if it somehow excuses their loved one’s drinking too much, or more importantly for most, as if it some how “proves” their loved one is not an alcoholic. But the real issue is, “Do your love one’s behaviors change when they drink?” The label is irrelevant. Why?

“Too much to drink” is relative.  The impact of alcohol on the brain and body depends on a number of factors beyond the very general rule of thumb that it takes the liver about one hour to process one standard drink. When a person drinks more alcohol than their liver can metabolize, the excess alcohol stays in the bloodstream and suppresses certain brain functions – especially those related to judgment, decision making, learning, memory and pleasure. In other words, the very areas of the brain a person needs in order to think straight and act responsibly, which is why a person’s behaviors change so much when they drink too much.

Weight, stress, gender, medications, tolerance, stage of brain development, lack of sleep, amount of food eaten and how quickly the alcohol is consumed or the presence of anxiety or depression or some other mental illness are a few of the factors that determine “how much is too much” for a particular individual.

The less a person weighs, for example, the less body water s/he has and consequently the higher his or her alcohol-to-water concentration. This means a lighter weight person (e.g., a woman) will be more affected than a person who weighs more (e.g., a man) when drinking the same amount of alcohol. This explains why the “moderate” standard drink limits are lower for women than they are for men.

Additionally, some people have lower amounts of the enzyme ADH in their livers, so their liver doesn’t process the alcohol the same way as someone with normal levels, and thus the alcohol remains in their system longer. Some people have genetic differences, such as a genetic predisposition as a result of having a parent or sibling with the disease of addiction. [Alcoholism is one of the diseases of addiction. Addiction is a chronic, often relapsing brain disease.] Other people have brain changes caused by early use of alcohol and/or having experienced one or more of the other risk factors for developing alcohol misuse problems. All of this described here adds to the variables that impact how alcohol affects one person as compared to another.

Bottom line: protect your brain, and if you have any of the risk factors (see below), be especially careful. Above all, know that the brain can change. Stopping substance abuse allows the brain to rewire and/or repair neural networks.

Risk Factors for Developing the Disease of Addiction (in this discussion, alcoholism), include:
- genetics
- early use
- social environment
- childhood trauma
- mental illness (such as depression, anxiety, bipolar, PTSD, ADHD).
The more risk factors a person has, the more they need to be wary of drinking too much. Addiction (e.g., alcoholism) is a developmental disease. It doesn’t just happen.  The chemical and structural changes in the brain caused by repeated alcohol abuse make a person especially vulnerable to his/her risk factors. In turn, a person’s risk factors make them vulnerable to repeated alcohol abuse.

Cover Design Irene E. Yu

© Lisa Frederiksen, Excerpt from the 20-page booklet, titled: “Seven Myths That Can Kill…” by Lisa Frederiksen, available September 2010.

by Lisa Frederiksen

This NPR news piece, “Food For Thought: Meat-Based Diet Made Us Smarter,” by Christopher Joyce, appearing on KQED’s August 1, 2010, program/website,  brings to mind the importance a healthy diet plays in a person’s recovery from an addiction or the impacts of secondhand drinking/drugging (SHDD). Both (addiction and SHDD) cause brain changes, and its the rewiring of these brain changes (changing them back, if you will) that helps a person recover from an addiction or the impacts of SHDD (living with a loved one who misuses substances – alcohol or drugs). 21st century brain research now shows the importance of nutrition in that change process.

The following is an excerpt from my upcoming book, Loved One In Treatment? Now What!. The other keys to brain health/changes are: exercise, sleep and mindfulness activities. You can read all about these and other important research when the book is released August 20, 2010.

Unlike other body organs, the brain is incapable of making and storing glucose, which is its sole fuel source. No fuel, no brain activity. The brain requires a daily dose of about twenty percent of the body’s glucose supply – a staggering amount given the brain is only two percent of the body’s total weight. (1)

The brain gets its glucose supply from the carbohydrates in the foods we eat, which are broken down and transported to the brain via the bloodstream. For optimum brain health, however, it can’t be any old carbohydrates, like those in candy or sugar-packed soft drinks. The brain needs the complex carbohydrate variety, such as that found in whole grains, fruits and vegetables.

And while glucose is essential, so is protein (like that found in lean meats, poultry, fish, beans, eggs, milk products). Protein serves as “the basic building block of the brain’s tissue,” AND it helps in the production of neurotransmitters(2) and neurotrophins.

Healthy fats, like omega-3 fatty acids found in tuna and salmon, are important for building the neuron’s cell membrane and nerve fiber insulation,(3)  as well as “synaptic plasticity” and functions related to memory and learning.(4)

And it goes on and on from there.

Healthy nutrition is astoundingly important to brain health – something only known and understood as a result of the new brain research. But if you are not inclined to learn the nitty-gritty about nutrition, and let’s face it, who has the time when grappling with a loved one’s addiction and/or treatment, following the U.S. Department of Health and Human Services and U.S. Department of Agriculture’s Dietary Guidelines (visually shown in the Food Pyramid) covers the basics. In a nutshell, these guidelines suggest you:
- emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
- include lean meats, poultry, fish, beans, eggs, and nuts
- keep saturated fats, trans fats, cholesterol, salt (sodium) and simple sugars low
- stay within daily calorie needs(5) (yes, excess calories impact brain health – especially the flexibility of the synapses and increased vulnerability to cell damage(6)).

Visit www.mypyramid.gov/guidelines for more information.

Think of nutrition as “food” for “thought.” The more nutrient-rich the food, the “better” the thought.

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1) Carter, Rita, et al., The Human Brain Book, New York: DK (Dorling Kindersley Limited) Publishing, 2009, p. 45.

2) Gilmour, Patricia, “Nurturing Health Brains,” Bardstown City Schools Comprehensive School Health, January 4, 2010, http://bardstownschools.us/health/bloghealth/?p=146

3) Gilmour, Patricia, “Nurturing Health Brains,” Bardstown City Schools Comprehensive School Health, January 4, 2010, http://bardstownschools.us/health/bloghealth/?p=146

4) Wolpert, Stuart, “Scientists Learn How What You Eat Affects your Brain – and Those of Your Kids,” UCLA News, www.newsroom.ucla.edu, July 9, 2008, <http://newsroom.ucla.edu/portal/ucla/scientists-learn-how-food-affects-52668.aspx>

5) USDA’s Dietary Guidelines, U.S. Department of Health and Human Services and U.S. Department of Agriculture, <http://www.mypyramid.gov/guidelines/>

6) Wolpert, Stuart, “Scientists Learn How What You Eat Affects your Brain – and Those of Your Kids,” UCLA News, www.newsroom.ucla.edu, July 9, 2008, < http://newsroom.ucla.edu/portal/ucla/scientists-learn-how-food-affects-52668.aspx>

by Lisa Frederiksen

NPR’s news program, today, “Commanders Have Ignored Major Mental Health Issues, Army Report Concludes,” reinforces the importance of talking about the connection between substance abuse and mental illness. [Note: substance abuse and addiction are two different things, although both cause changes in the brain.]

Substance abuse (whether it is of alcohol and/or prescription or illegal drugs) causes chemical and structural changes in the brain (see SPECT scan below). Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers [NOT addicts or alcoholics but drug or alcohol abusers] also have at least one serious mental illness,(1)(2) such as depression, PTSD, bipolar, anxiety, schizophrenia. Often what happens is the person starts to drink or use drugs to self-medicate the mental illness.

When you change the chemical and structural make-up of the brain, you change how the brain works, which in turn, changes how a person thinks, feels and behaves. This is because “neural networks” in the brain control EVERYTHING we think, feel, say and do. “Neural network” is a name for the process by which neurons talk to one another. In the brain, neurons are also known as brain cells. The way our brain cells talk to one another is determined by how our neural networks wire – talk to one another. Drinking too much or abusing drugs interrupts neural networks, which is part of what makes a person unable to think straight or behave “normally.” Repeatedly drinking too much or abusing drugs can cause chemical and structural changes in the brain like those shown in the image on the left, below.

SPECT Surface Scans, Courtesy Amen Clinics, Inc., www.amenclinics.com

LEFT = SPECT Surface Scan confirming substance abuse. RIGHT = SPECT Surface Scan of normal brain.

Now look at SPEC Surface Scans of the brain of a person with ADHD below (for comparisons, look at the bottom, right scan — that’s the same view as the two scans above). As you can see, mental illness also changes the brain.

SPECT Surface Scan Showing ADHD, Courtesy Amen Clinics, Inc., www.amenclinics.com

Looking at scans like these helps one see what substance abuse (such as repeated binge drinking) and  mental illness, such as ADHD, do to the structural make-up of the brain. This in turn can help you appreciate why a person whose brain has experienced these kinds of changes does not “think” or “behave” normally. It helps explain, in part, why suicide can seem like the best option to those who suffer from an undiagnosed, untreated mental illness and a substance abuse problem. A person suffering PTSD or bipolar or anxiety or depression needs help (see Resources below). A person who is abusing substances also needs help (again, see Resources below).

Looking at these kinds of scans also helps us appreciate that just removing the substance – the “coping skill” – without replacing it with something else (such as treatment and/or medication for the mental illness), or treating the mental illness without stopping the substance abuse, is a set-up for failure.

THE BOTTOM LINE: the brain change change. A person can heal their brains with proper treatment. Healing the brain changes how a person thinks, feels and behaves.

RESOURCES:

The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services offers a Locator database with comprehensive information about mental health services and resources in the United States.

The National Alliance of Mental Illness (NAMI) offers excellent, free self-help programs. Visit www.nami.org for information and locations in your community.

NIAAA’s (National Instittue on Alcohol Abuse and Alcoholism) Rethinking Drinking website can help a person anonymously assess his/her drinking patterns and find tips for cutting down.

NIDA’s (National Institute on Drug Abuse) Info Facts: Science-Based Facts on Drug Abuse and Addiction

Bring Change 2 Mind.org – working to end the stigma associated with mental illness.

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(1) “Factsheet: Dual Diagnosis,” Mental Health America, <http://www.nmha.org/index.cfm?objectid=C7DF9405-1372-4D20-C89D7BD2CD1CA1B9>
(2) “Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder,” National Alliance on Mental Illness, <http://www.nami.org/Content/ContentGroups/Helpline1/Dual_Diagnosis_and_Integrated_Treatment_of_Mental_Illness_and_Substance_Abuse_Disorder.htm>

Gender-Related Influences of Parental Alcoholism on the Prevalence of Psychiatric Illnesses: Anlysis of the National Epidemiolgic Survey on Alcohol and Related Issues

Abstract:

Background: Offspring of individuals with alcoholism are at increased risk for psychiatric illness, but the effects of gender on this risk are not well known. In this study, we tested the hypothesis that the gender of the parent with alcoholism and the gender of offspring affect the association between parental alcoholism and offspring psychiatric illness.

Method: We analyzed the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) data to examine the gender-specific prevalence of axis I and axis II disorders in 23,006 male and 17,368 female respondents with and without a history of paternal or maternal alcoholism. Adjusted odds ratios were calculated for the disorders based on gender and presence of maternal or paternal alcoholism.

Results: Maternal or paternal alcoholism was associated with a higher prevalence of...

…for the rest of this abstract of the study conducted by Peter T. Morgan, Rani A. Desai, and Marc N. Potenza from the Departments of Psychiatry (PTM, RAD, MNP) and Child Study Center (MNP), Yale University School of Medicine, New Haven, Connecticut, as well as the link to request a reprint, click here.

NPR: Talk of the Nation, “Alcoholics Anonymous: 75 Years of 12 Steps”

click here to listen to this July 22, 2010 program.

Giving Kids Booze, Medicines Can Be Child Abuse

The malicious use of alcohol and medicines is an under-recognized form of child abuse, according to a new report.

The U.S. study reviewed cases of pharmaceutical-related child abuse reported to the National Poison Data System between 2000 and 2008. The cases included the use of alcohol, painkillers, cough and cold medicines, sedatives, sleeping pills and antipsychotic medicines.

The findings are scheduled to be published in an upcoming issue of the Journal of Pediatrics. To read the remainder of this July 22 post appearing on healthfinder.gov, click here

Just a reminder…. binge drinking for women is defined as 4 or more standard drinks per ocassion, and for men, it’s 5 or more standard drinks per ocassion. A standard drink is 5 ounces of table wine, 12 ounces of regular beer, 3.3 ounces of champagne and 1.5 ounces of 80-proof liquor. Know your limits – stay safe.

Look for Lisa’s latest book, Loved One In Treatment? Now What!, an Essential Handbook for Family Members and Friends Navigating the Path of a Loved One’s Addiction, Treatment and Recovery, coming late August 2010 — just in time for National Recovery Month in September!

Cover Design by Irene E. Yu

How can addiction be a brain disease?

There is a great deal of 21st Century brain and addiction-related research now possible thanks to advances in brain imaging technologies. These findings are exploding long-held beliefs about addiction and addiction treatment and the impacts of a loved one’s substance misuse on family members and friends. Loved One In Treatment? Now What! simplifies this research and answers questions, such as:

- What causes addiction? Why do some people become addicts/alcoholics and others do not?
- What is “effective” treatment? Is there a difference between treatment and recovery?
- Who among family members and friends can help a loved one get treatment? Or can they?
- What does coping with a loved one’s addiction do to family members and friends, and what is available to help them?

What readers are saying about this book:

“A thoughtful, well-researched, and highly accessible review of the neurobiology of addiction. Lisa Frederiksen captures this exciting and developing field of science with clarity, compassion, and hope.” Catherine M. Bitler, Ph.D., FACN

“Loved One In Treatment? Now What! is an outstanding, fact-filled, clear, easy-to-read and understand book aimed at helping friends and family, as well as the medical community, comprehend and approach one of the most baffling conditions that we face today.” Stan Fischman, M.D., Child and Adolescent Psychiatry

“Revolutionary…science-based answers, a checklist of next steps – a must read for anyone dealing with a loved one’s addiction.” Caroll Fowler, M.A., MFT, Addiction Specialist

“…what good is the latest research if it can’t be put to good use? This is one of the few practical guides to recovery tailored specifically for the family – highly recommended!” Gavin DeFreese, discoveringalcoholic.com

To pre-order a copy of Lisa’s upcoming book, click here.

This is a guest post from The Discovering Alcoholic, who writes a top rated recovery blog, www.discoveringalcoholic.com, covering alcoholism, substance abuse, treatment and recovery issues.

This is an interesting lecture by Professor Philip Zimbardo about modern man’s perspective of time and how it relates to relationships, learning, and behavior. Pay close attention to the last half where he talks about kids living in a world they create separated from reality, where knowledge of consequences doesn’t necessarily change behavior, and why they don’t wear watches. I think another example he could have used is why drunks never learn. It’s this kind of stuff that reinforces my belief in the mental disease (faulty brain programming/training) aspect of addiction. Regardless of your thoughts on the disease concept, watch this video anyway because it’s a great topic presented in a unique graphic manner that really reinforces the content. Enjoy.

by Lisa Frederiksen

There is an age-old saying when it comes to offering reasons for why a person does not seek recovery or treatment or why a person relapses (goes back to drinking). Namely,  “He (or she) hasn’t hit bottom, yet.”

It’s long been held that the person has to “hit bottom” before treatment can work. The new brain research I present on this site and in my books shows this is not the case — especially for young people. Consider these statistics:

– 18-20 year olds have the highest rate of alcohol dependence of any age group in the U.S. (source: U.S. Surgeon General’s Call to Action to Reduce and Prevent Underage Drinking, 2007).

– Early use, independent of other risk factors, strongly predicts the development of alcohol dependence.  Of all people who have meet the diagnostic criteria for alcoholism in their lifetime, nearly half were addicted by age 21 and two-thirds by age 25.   (NIAAA, “Snapshot of Underage Drinking”)

The reason a person should not wait until a loved one hits bottom before they offer help is the fact that alcoholism (one of the diseases of addiction) involves a a combination of risk factors (genetics, early use, childhood trauma, mental illness, social environment and alcohol abuse). The drinking pattern, itself, follows a progression and begins with alcohol use, then moves to alcohol abuse and from there, to alcohol dependence (alcoholism).

Unfortunately, family and friends (and the person abusing alcohol) will go to the ends of the earth to rationalize a person’s alcohol abuse as something excusable for fear of the label alcoholic. Yet, it is the period of alcohol abuse that actually changes the chemical and structural make-up of the brain. Additionally, recognizing and dealing with a person’s combination of risk factors is critical. The earlier in the process you intervene in a healthy, productive manner, the better for your loved one’s brain health and recovery (although it is NEVER too late to start recovery).

The first step to understanding what it means to ‘help’ in a healthy, productive manner is to learn more. Please watch Dr. Kathleen Brady’s interview. Dr. Kathleen Brady is a professor of psychiatry at the Medical School of the University South Carolina and an expert in addiction and co-occurring psychiatric disorders. While on this site, you can browse further and learn a great deal of information about addiction, how to help, what’s involved in treatment and the like.