Breakingthecycles.com – Changing the Conversations

by Lisa Frederiksen

One of the things that can keep family members and alcohol misusers stuck is the debate about how much is too much and what makes a person an alcoholic and does not being an alcoholic make excessive drinking okay. In a recent post, “Controlled Drinking Can’t Work for an Alcoholic,” I discussed what makes a person an alcoholic, and why a person who is not an alcoholic can perhaps learn to drink in moderation.

Recently I found this website, Moderation Management. They offer suggestions for how to drink in moderation, as well as face-to-face and online support meetings. They provide the following answers on their website to these two questions:  “Why is a moderation program needed?” and “What is Moderation Management?”

Why is a Moderation Program needed?
According to the NIAAA and many other independent researchers, there are four times as many problem drinkers as alcoholics in this country. Yet there are very few programs that specifically address the needs of beginning stage problem drinkers, while there are literally thousands of programs for the smaller population who are seriously alcohol dependent.

By the time people reach serious stages of alcohol dependency, changing drinking becomes more difficult, and treatment is usually costly. MM believes that this situation needs to be remedied in the interest of public health and human kindness with early intervention and harm reduction programs. Moderation programs are less costly, shorter in duration, less intensive, and have higher success rates than traditional abstinence-only approaches.

Nine out of ten problem drinkers today actively and purposefully avoid traditional treatment approaches. This is because they know that most traditional programs will label them as “alcoholic”,  probably force attendance at 12 step and abstinence based meetings, and prescribe lifetime abstinence as the only acceptable change in drinking.

They may also have real concerns about how their participation in these programs will affect their jobs and ability to attain future medical and life insurance. MM is seen as a less threatening first step, and one that problem drinkers are more likely to attempt before their problems become nearly intractable.

Not surprisingly,  approximately 30% of MM members go on to abstinence-based programs.  This is consistent with research findings from professional moderation training programs. Traditional approaches that are based on the disease model of alcohol  dependence and its reliance on the concept of powerlessness can be particularly counterproductive for women and minorities, who often already feel like victims and powerless.

Outcome studies indicate that professional programs which offer both moderation and abstinence have higher success rates than those that offer abstinence only.  Clients tend to self-select the behavior change options which will work best for them.

What is Moderation Management?
Moderation Management (MM) is a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal.

Please note: Neither BreakingTheCycles, www.breakingthecycles.com, nor Lisa Frederiksen endorses any specific treatment program over another, nor any particular method for stopping, controlling or changing drinking patterns, rather strives to bring the latest information on various treatment options to readers’ attention.

The following is a guest post by Bill White, M.S., a counselor, author, mentor, blogger and speaker specializing in depression, anxiety and general mental health issues. He hosts a blog, http://chipur.com, and does a lot of E.R. psychiatric emergency work in Chicago’s suburbs where he also spends time with his two teenage children.

“S.A.I.L.” Stop-Assess-Interpret-Logic

Here’s a technique I came up with that’ll be easy to etch upon your mind, allowing it to be there for you at a moment’s notice. The next time you begin to sense the tiptoeing of a panic attack in your immediate vicinity…stop everything. Now, slowly take a few refreshing abdominal breaths and begin whispering to yourself, “S.A.I.L.”…”S.A.I.L.”…”S.A.I.L.” And as you’re saying it, imagine feeling warm and gentle breezes of relief upon your skin. And here’s the magic of the acronym…

STOP everything in your life right now.

ASSESS exactly what’s going on within, and outside of, you.

INTERPRET if the situation is truly threatening and merits alarmed reaction.

LOGIC your way to an appropriate emotional and behavioral response.

Of course, I could go on and on with more details on the technique; however, newsletter constraints won’t allow it. But I think you get the idea. Give it a go, and if you want to learn more about S.A.I.L. and tons of other panic and anxiety tidbits of relief, check out Panic! …and Poetic Justice.

by Lisa Frederiksen

What do you say when someone you care deeply about keeps telling you time and again they’re sorry.

They’re sorry, but they were drunk; or they’re sorry, but they must have blacked out; or they’re sorry, but they don’t remember; or they do remember and they’re so very, very  sorry for…

- vomiting in your car (”Ah man… I don’t feel so good…”)
- peeing in your closet (”Hey… I thought it was the bathroom.”)
- picking a fight with your sister at your mother’s birthday dinner (She started it…it was none of her business whether I was having another beer, and what about you? You went along with her.”)
- trashing your house (”What do you mean I did this. What happened?”)
- trying to pick up your best friend  (”Hey, she kept coming onto me,  and that’s the last I remember.”)

I don’t have any answers, other than to say, as long as a person drinks more than their brains and body can process, there will always be a next time, sometime, and once again, they’ll be sorry, but…

by Lisa Frederiksen

One of the more confounding aspects of all this is why some people who drink too much and behave terribly and cause problems within their families because of their drinking can learn to “re-drink,” get their drinking and lives back under control, and why others, who do all of the same things, can’t.

This fact is what causes so many alcoholics and family members, alike, to go along with, “This time, it’ll be different. I’m going to only drink on Friday nights and holidays, but that’s it!” (or some variation thereof). And, sometimes that promise lasts for a while. Sometimes the person even stops drinking all together — for years. But, then “it” starts, again… the glasses get larger and the sneaking creeps back in and pretty soon, it’s right back where it started.

Why?

The reason it works for some — and some can be very heavy drinkers — and not for others is the disease of addiction. Alcoholism is one of the diseases of addiction, which is a chronic relapsing brain disease. This means an alcoholic’s neural networks have been so corrupted – hijacked – by their addiction, the chemical and structural changes that have occurred in their brains makes it impossible for them to EVER drink ANY amount of alcohol, if they want to be able to stop their drinking behaviors long-term.

Watch these two videos to better understand (Note: when Dr. Volkow refers to “drugs,” that includes alcohol):

• The Hijacked Brain — found in the right column, top video.
• Brain Imaging (You can stop watching this one when Dr. Volkow starts her interview with a patient.)

So how can a person (family member or the drinker) tell whether a person should stop trying for “controlled drinking” and get treatment for alcoholism?

One thought is to understand the Risk Factors for developing the disease. The more Risk Factors a person has, the more likely they are to develop the disease of alcoholism; one of the diseases of addiction. Risk Factors include:

• Early use – because of the critical brain development that occurs from ages 12–25, alcohol affects the developing brain DIFFERENTLY than it affects an adult brain. The developing brain is especially vulnerable to the chemical and structural changes caused by alcohol misuse. (See this related link for more information.)
• Genetics – persons whose parent or sibling are alcoholics are 4-7 times more likely to become alcoholics themselves.
• Social environment – people who live, work or go to school in an environment in which the heavy use of alcohol is common – such as growing up in a home where heavy drinking is seen as ‘normal’ or living in a school setting where it is viewed as an important way to bond with fellow students – are more likely to abuse alcohol themselves. That abuse of alcohol causes chemical and structural changes in the brain.
• Mental illness – just over one-half of persons diagnosed as alcoholics or alcohol abusers have also experienced a mental illness (e.g., depression, PTSD, ADHD, bipolar) at some time in their lives. With mental illness there are also chemical and structural changes in the brain. Persons with a mental illness may turn to alcohol to self-medicate and/or their alcohol misuse may make their mental illness worse.
• Childhood trauma – abuse (such as verbal, physical or mental abuse) or neglect of children, persistent conflict in the family (such as that surrounding a family member’s unacknowledged alcohol abuse or alcoholism), sexual abuse and other traumatic childhood experiences can shape a child’s brain chemistry — especially during the early development ages of birth to about 12 — and subsequent vulnerability to alcohol misuse.
• Alcohol Abuse – binge drinking, for example, is alcohol abuse, and it is the kind of drinking that causes drinking behaviors — which in turn causes problems. It is also the kind of drinking that can change the chemical and structural make up of the brain, which is a contributing factor to the developing the disease of alcoholism.

Bottom line…. if a person has tried repeatedly to control their drinking but keeps finding it does not work for one reason or another, it might help to determine how many Risk Factors they have.  If a person can “see” any, they may be able to better “see” the problem and thus more inclined to get help or talk to a professional. Equally as important is for the family member to do this exercise, as well. That way the family member can give up believing that this time the controlled drinking plan will work and instead, do what they need to do to help themselves.

One last suggestion…. a person (family OR drinker) can always go to NIAAA’s website, Rethinking Drinking, to do an anonymous assessment of their drinking patterns and find suggestions for further help.

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©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source.

by Lisa Frederiksen

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 into body tissue in proportion to the body tissue’s water content.  [The brain is mostly water, by the way.]

Alcohol is metabolized by the liver, thanks in large part to enzymes produced in the liver. This is the process by which alcohol leaves the body. The liver can only metabolize a certain amount of alcohol per hour, which means alcohol leaves the bloodstream more slowly than it enters. This is why a person’s BAC can continue to rise after they have stopped drinking.

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 two hours to metabolize two 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. People who weigh less, for example,  have less body water as compared to someone who weighs more, and thus drink for drink a person who weighs less will have more alcohol concentration in their body water than someone who weighs more. People who have lower amounts of the liver enzymes that metabolize alcohol will take longer to metabolize the same amount of alcohol as someone else. There are other factors that influence how much is “too much” for one person as compared to another.

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 alcohol in their bloodstream.

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©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source.

by Lisa Frederiksen

Likely you are well aware that I preface the key points of just about every one of my talks, articles and posts with a comment about the “new brain research of the past 10-15 years has ______.” So when I read this article by Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), published on the Dana Foundation website, in which she summarizes some of the biggest advances in brain research in the past decade — the decade after the “Decade of the Brain,” I knew had to share it with you.

The following is just the beginning of what Dr. Volkow has to say… I urge you to read the rest of her article, “A Decade After the Decade of the Brain, Challenges and Opportunities in Drug Addiction Research:”

Neuroscience is at a historic turning point. Today, a full decade after the “Decade of the Brain,” a continuous stream of advances is shattering long-held notions about how the human brain works and what happens when it doesn’t. These advances are also reshaping the landscapes of other fields, from psychology to economics, education and the law.

Until the Decade of the Brain, scientists believed that, once development was over, the adult brain underwent very few changes. This perception contributed to polarizing perspectives on whether genetics or environment determines a person’s temperament and personality, aptitudes, and vulnerability to mental disorders. But during the past two decades, neuroscientists have steadily built the case that the human brain, even when fully mature, is far more plastic—changing and malleable—than we originally thought.¹ It turns out that the brain (at all ages) is highly responsive to environmental stimuli and that connections between neurons are dynamic and can rapidly change within minutes of stimulation.

Read more…

by Lisa Frederiksen

I’ll be returning home tomorrow evening from an amazing week in Mexico City working with the other partners of GARNET (Global Addiction Recovery Network). We collaborate with groups, treatment centers and governments to develop culturally sensitive programs they can then implement and in turn use to help families, addicts/alcoholics,  communities and governments grapple with all aspects of the family disease of addiction.

This was my first effort in Mexico with GARNET, and I was truly honored to  be working with our conterparts there. Addiction and its impacts on families and communities is universal. How we prevent and treat it can be greatly advanced by inter-cultural collaboration. We have so much we can learn from each other.

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

A well deserved hat tip to my favorite scientist blogger Abel Pharmboy over a Terra Sigillata for bringing to my attention this article posted by Science Blog’s DrugMonkey. Over there, the medical and science professionals are discussing a study that indicates the stigma of addiction is evident even in the manner that physicians comment on patients involved in judicial proceedings.

Compared to those in the “substance use disorder” condition, those in the “substance abuser” condition agreed more with the notion that the character was personally culpable and that punitive measures should be taken. ~ Research Paper by John F. Kelly and Cassandra M. Westerhoff

In layman’s terms, a person in court labeled as a substance abuser is more likely to be considered personably accountable and criminal whereas those described as having a substance abuse disorder are more often shown leniency and portrayed more as a victim of psyche and circumstances.

I find it a just as interesting matter of semantics that in my bailiwick of advocacy where I am dealing more with politicians, law enforcement, and suffering families that the use of “disorder” or any other disease concept terminology is likely to produce the opposite effect. These groups are more often than not willing to accept the actions of alcoholic and addicts without prejudice, but will react with scorn and disbelief when asked to consider them at least partly the consequence of a complex medical condition. Much of this is probably caused by the fact that addicts and alcoholics can be pathological liars and those that have been to deal with this on a daily basis consider the disease concept just another convenient excuse.

I do not cast blame upon those that have this bias and cynicism. As a recovering alcoholic and someone that had to work especially hard to stop habitually lying long after the drinking ended, I know that those that deal “in the trenches” with practicing alcoholics and addicts have been conditioned by our own actions into this mindset. Now on the other side of the fence it even happens to me (and for good reason), so that I am hesitant to use the disorder term when dealing with practicing alcoholics and addicts for fear that they will use it as an excuse and a rationalization for their behavior.

PS: No doubt I am a firm believer in the disease concept of alcoholism and addiction, but it can be an actual hindrance to those still struggling with sobriety or in early recovery… once again it is a matter of substance abuse semantics.

by Lisa Frederiksen

As follow-up to my January 12 post, “Alcohol Misuse,” the following Alcohol Misuse Impact (AMI) Assessment is designed to help family members determine whether their loved one’s drinking should be considered as more than simply alcohol use (aka “normal” or “moderate” drinking). It is designed to help a family member identify whether there is a drinking problem by assessing the impact of a loved one’s drinking on their (the family member’s) life.  As I have previously stated, so often the focus is on the drinker’s drinking and drinking behaviors. The AMI Assessment is intended to place the focus on the person whose life is being impact, not on the person doing the impacting (drinking too much).

As with any assessment, the answers to this one should not be considered a diagnosis of your loved one’s drinking. They are simply a way to answer for yourself whether you are “looking for trouble,” “blowing things out of proportion,”  “not being supportive enough” or any of the other allegations a family member is told when they question a loved one’s drinking.

Though simple, your answers to this assessment and their importance cannot be minimized. The essence is that it is NOT NORMAL for a person’s drinking to have an impact on others. A person who maintains “normal” or “moderate” drinking patterns does not experience drinking behaviors, and it is the drinking behaviors that cause the impacts on others and demonstrate there is a problem with alcohol misuse.

The AMI will free you of staying in the place of having to ‘prove’  how many, how often, why or when. You can simply be assured that what you are seeing and experiencing is, in fact, the impact of a loved one’s alcohol misuse. Identifying the problem is what allows a family member to let go of trying to control it, and instead find out what they can and cannot do about it.

Alcohol Misuse Impact (AMI) Assessment (1):
1. Have you ever felt your  __________ (i.e., son, mother, husband, parent) should Cut down on his/her drinking?
2. Has your ___________ even been Annoyed by you criticizing their drinking?
3. Has _____________ever felt bad or Guilty about their drinking?
4. Have you ever seen _________take a drink first thing in the morning (eye-opener) to steady his/her nerves or to get rid of a hangover?

IF YES to one or more of the AMI Assessment questions, your loved may have an alcohol misuse problem, which is having an impact on YOUR life.

For a better understanding of your loved one’s alcohol misuse — how bad is it, what can they do about it — visit NIAAA’s website, “Rethinking Drinking.” There you will be able to anonymously assess your loved one’s drinking patterns and learn more about alcohol misuse. Additionally, read my blog this Sunday, January 17, for Next Step Suggestions….

Additional resources for more information:
NIAAA FAQs for the General Public, www.niaaa.nih.gov
“Addiction,” www.hbo.com/addiction

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(1)  The Alcohol Misuse Impact (AMI) Assessment was adapted from the CAGE Assessment used by medical and treatment professionals to determine whether a person may have an alcohol misuse problem.  [The CAGE acronym comes from the underlined letters in each question.]

Revised 1.15.10. Revised 2.5.10.

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©2010 Lisa Frederiksen – Breaking The Cycles – All Rights Reserved

by Lisa Frederiksen

Alcohol Misuse.

People who have a problem with their drinking often try to minimize how bad it is by claiming it’s not that much, or they will compare the quantity they drink to someone else’s and declare, “It’s not as bad as ____.” Family members often think the same thing because they are confused about what makes a person an alcoholic and don’t see their loved one as an alcoholic or are afraid what their being an alcoholic means. They perceive alcoholics as people who are homeless or without jobs or families – conditions that do not apply to their loved ones.

The  fact is, however, that if a loved one’s alcohol misuse is a problem for you or other family members, it a problem. Period.  No matter what you call it. It does not matter how much alcohol is consumed or when or how bad or how often or whether the label, alcoholic, fits or not.  It’s the drinking behaviors — the behaviors caused by that person’s alcohol misuse — that count. Drinking behaviors include:

- Verbally, physically or emotionally abusing someone – often a spouse, girlfriend, boyfriend or child
- Doing poorly at work or school because of the drinking or recovering from the drinking
- Fighting with loved ones about the drinking
- Binge drinking (drinking 5 or more for men and 4 or more for women)
- Experiencing blackouts
- Getting a DUI; driving while under the influence of alcohol
- Having unplanned, unwanted or unprotected sex; date rape

The term, misuse, is used by the World Health Organization, by the way, and by other health and medical organizations that study, diagnose and help prevent alcohol misuse (whether that be alcohol abuse or alcohol dependence/addiction). The reason for the term is to move the focus away from a label and towards the behaviors that result when a person drinks more than their brains and bodies can process.

For family members, this can be hugely freeing. They no longer have to slice and dice and mince words when trying to reason with a loved one whose drinking is a problem for them (the family member).

So, stay tuned for the next blog post, “Conducting an Alcohol Misuse Impact Assessment,” followed by a third blog post on Sunday, “Next Step Suggestions for Family Members Whose Loved One Misuses Alcohol.”

And, by the way — about those labels: alcohol abuse/alcohol abuser or alcoholism/alcoholic — they matter when it comes to determining what effective treatment looks like for the person who wants to stop his or her drinking behaviors. But, that’s another blog post…
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©2010 Lisa Frederiksen – Breaking The Cycles – All Rights Reserved.