Breakingthecycles.com – Changing the Conversations

by Lisa Frederiksen

This article, DUIs in Drug Court Idaho, by Kendel Murrant, published in the Idaho Press-Tribune online, offers an excellent explanation of Drug Court – an alternative to incarceration for drug and alcohol related offenses, such as DUIs. As this article explains, treating the underlying problem — alcohol or drug misuse — for the presenting offense — a DUI, for example — is critical to preventing a recurrence of the presenting offense or the commission of an equally awful crime.

Quoting from Murrant’s article,

…High-risk offenders who don’t receive treatment through drug court either tend to not follow through with treatment, drop out or fail to follow conditions of probation, Jaeger said. But in drug court, “they stay in treatment long enough, are held accountable consistently and regularly enough to really change their behavior,” Jaeger said. “The treatment effect is more than skin deep.”

“Drug court — it gets right to the heart of the problem. They are there to treat people and help them overcome their addictions, period,” defense attorney Charles Crafts said.

And treatment also deals with more than the person’s addiction.

“It’s really focused on all the characteristics that makes a person pro-social, less likely to have attitudes toward committing crime … not just abstaining from the use of alcohol,” Jaeger said.

She said it’s common for repeat DUI offenders to have other attitude adjustments to make.

“They think, ‘Well, I can drink, I just need to be more careful, make plans to not drive.’ When they do drink, their judgment becomes impaired. The decisions they make in that condition are not good decisions.”

Another benefit to rehabilitation through problem-solving courts, Jaeger said, is that offenders can keep social supports.

“Having a job, having a family, taking care of your bills are protective factors, assets in making a recovery,” Jaeger said. “Those social supports are important in making lasting behavior change. The more supports that you can keep for a person, the greater likelihood that they can establish a lasting recovery.”

Crafts said the community-based treatment in problem-solving courts is a “progressive-thinking model” for rehabilitating offenders.

“I think that we have a tendency when someone gets in trouble to just turn around and want to punish them,” Crafts said. “Drug court — it’s definitely a punishment to be in drug court, but they do build in these motivations for people to be successful in the program. … It’s much more of a progressive-thinking model of rehabilitation.”

Click here to read the complete article.

by Lisa Frederiksen

Rona Renner, RN., hosts a weekly radio show, Childhood Matters, that reaches many communities in the San Francisco/Bay Area, Monterey and Santa Cruz Counties, as well as Northern, CA. Her December 13 show was on Secondhand Drinking. I was one of her guests for the program, along with Juliana Nunez-Saksa, clinical psychologist at Kaiser’s Center for Chemical Dependency Rehabilitation Program (CDRP) in San Francisco, CA. Here was the program description:

When a parent is an alcoholic or abuses alcohol, there are serious consequences for children of all ages. Both during the holidays and throughout the year, alcohol abuse is encouraged by social events, advertising, other media, and a need for stress-relief. Nurse Rona and guests address this serious issue whose wide-ranging social effects transcend socioeconomic boundaries.

To listen to the show, please click here to download a podcast recording.

by Lisa Frederiksen

“Nearly 60 percent of high school students say their parents are the biggest influence on their driving,” says Dave Melton, a driving safety expert with the Liberty Mutual Research Institute for Safety, as reported in a Liberty Mutual PRwire piece on October 19. In addition to the more obvious actions contributing to a teen’s potential for a car accident – text messaging, speeding, road rage, number of passengers – there is driving while under the influence. With such a significant influence (60%), parents can go a long way to modeling the behavior that can help keep teens safe in this situation as well. When going out to dinner or to an event or to a family holiday celebration, if a parent drinks alcohol (regardless of how moderately) and then drives, they send the message that there is some level of drinking and driving that is safe.
The following two ads bring this point home so well…

National Teen Driver Safety Week was established by Congress in 2007 to focus attention on the nation’s epidemic of teen car crashes and to find solutions to lower teen drivers’ fatal crash risk. Liberty Mutual offers a driving Ground Rules contract for you and your teen to sign –  it may be a great place to start safe driving discussions.

by Lisa Frederiksen

Look at the numbers of drinks people report consuming before they get behind the wheel presented in Join Together’s September 2, research summary article, “Binge Drinkers Often Drive Drunk, Researchers Say:”

“A study of 14,000 binge drinkers found that 12 percent admitted driving after their most recent episode of heavy alcohol consumption, the Associated Press reported Sept. 1.

Researchers from the U.S. Centers for Disease Control and Prevention (CDC) also found that about half of those who drove drunk did so within two hours of consuming seven or more drinks, and that about a quarter drove after downing 10 drinks or more.”

For readers who may be wondering about their own BAC should they have chosen to drive after consuming alcohol recently, consider, The Intoximeters Inc. “Drink Wheel”.  According to the Intoximeters’ website write-up, it is a form you can fill out to compute your estimated blood/breath alcohol concentration (”BAC”) or blood alcohol content.  The findings simulate the breath alcohol testing done by an Intoximeter Alco-Sensor IV used in both Law Enforcement and Workplace Testing for alcohol testing.  The company states it is presenting it as a public service.  I’m including it here as an information piece… NOT to encourage driving while under the influence of any amount of alcohol, rather to help readers better understand how alcohol can impact their driving skills.

by Lisa Frederiksen

I’ve written several posts lately dealing with the impact of a loved one’s alcohol abuse or alcoholism on their children. On Saturday, I ran across this article by Dr. Tian Dayton, Clinical Psychologist and author, “Diane Schuler: The Heartbreak of Denial,” published August 15 on The Huffington Post.

Here is the opening to her article, and I encourage you to read it in its entirely. Dr. Dayton covers so many excellent points we all need to keep in mind as we work to address the fall out of a loved one’s alcohol abuse and/or alcoholism on the family — especially the children. And, the way to help the children is to help the non-drinking parent understand the disease and to understand that alcohol abuse produces the same horrific drinking behaviors as alcoholism.

Quoting the opening paragraphs of Dr Dayton’s article:
“An August 13th, New York Post article Blood is not Thicker than Alcohol reports that, “William Hance, was enraged not just that his sister, Diane Schuler, had guzzled vodka and smoked pot while driving his kids — but that her husband, Daniel, concocted bizarre medical excuses to try to explain away his wife’s condition and denied that she had a drinking problem, said a lawyer familiar with the situation.”

This is the kind of heartbreak that alcohol and drug abuse engender.

Families who hide parental alcohol and drug abuse put children at risk. The case with Diane Schuler is the horrific extreme of how children can be affected by, in this case, a drunk driver.

But there are other ways of “driving drunk”. There is the mother who simply ‘forgets’ to pick her children up on time, or to get them to school functions, friends or doctor’s appointments. There’s the Dad who doesn’t come home at night because his relationship with a bottle takes precedence over his relationship with his family.

Then there are the silent sufferers, the kids who become little adults too soon. The ones who stand guard at the gate of the family ready to swing into action to get younger siblings up, dressed and fed when mom or dad are “out of it”, to act in loco parentis not for physically absent parents but for parents who are absent because they have disappeared temporarily into a bottle or a drug.

The long term effects of this kind of constant preoccupation with whether or not the adults who are supposed to be in charge of our lives are on or off duty are what we have been discussing in previous blogs on codependency and will continue to discuss in that series….” Click here to finish the article.

by Lisa Frederiksen

By way of background…
If a loved one enters a residential treatment program – it usually lasts around 28 days. At the end of treatment, clients are encouraged to go to an SLE – Sober Living Environment. That can be their home (as long as all alcohol has been removed and all persons in the home agree to abstain from drinking) or it can be a treatment center sponsored SLE (usually a home in a residential neighborhood where other clients also reside, along with an employee of the treatment center).

Now to my experience…
I’d told my loved one of my fears about what might happen if he insisted on coming home as his SLE, instead of following the treatment center’s recommendation and going to one of theirs.

Yet, when the time came, he started doing that “thing” he did, and I started doing that “thing” I did. He with that “I’m so sorry” expression, pressing me to let him come to our home instead of a treatment center SLE, to let him do what he wanted — playing on the notion that if I loved him, I would. And there I was acting on my feeling that I needed to somehow make it okay for him because if I loved him, I should. After all, he’d stopped drinking, gone into rehab — what more could I want or expect him to do? But I wasn’t ready. I was scared – what if I didn’t do what he needed done and he relapsed. And I was enjoying not having the constant worry about “what if…”.

It was us doing the “dance” we’d done a thousand times before. That day, I was furious to find myself even considering doing it, again. I erupted!

I erupted from a place so deep — a place where years of broken promises, lies, disappointments and deceit had festered, until this one. . . more. . . tiny. . . little request proved to be the last straw. I erupted because I simply didn’t know how to feel, let alone say, “No, this isn’t right for me. I don’t care if it’s right for you or the man in the moon. It isn’t right for me!

Instead, I was getting it all mixed up in my love for him and my ingrained belief that I had to do what he wanted as a demonstration of that love. I was getting it all mixed up in my belief that not doing so would be selfish on my part and in my world, being selfish was bad, bad, bad. Suddenly, it all came crashing in, and my fury poured out as we engaged one more time in the dance of manipulation we both did so well – a dance choreographed by years of fear, anger and love.

In dancing, it only takes one partner to change the step and thus the entire dance; it may even end the dance. The same is true in family recovery from this family disease. It just takes one, but if both change and learn the new steps and practice those steps, together, a new dance is created. Sometimes one or both will go back to the old one – that’s normal – it’s what is most comfortable; it’s what they’ve practiced for years. But a new dance is possible. It may be together; it may be solo, but it is possible. It just takes practice.
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To read more about experiences like “the dance” and find the tools that helped me get a grip on my life, please read my book, If You Loved Me, You’d Stop!…

by Lisa Frederiksen

I was reading a recent post, “Repeat Drunk Drive Accused in MLB Player’s Death,” reporting on the tragic death of a young, promising baseball player and two others at the hands of a repeat DUI offender, and was taken by Lou C’s comment on the post. He questioned “how you stop the problem drinker / alcoholic from taking the first drink while allowing the ’social drinker’ to drink responsibily?” Lou C went on to say,  “Once the alcohol touches the mouth of the problem drinker/ alcoholic, all the statistics, education, meetings, rehabs. charts, books, past problems, are no longer thought about.” He is absolutely right. We need to attack the problem ahead of “that” drink.

As I’m sure you’ve gathered if you’ve been following my blog, alcohol abusers get DUIs, as do alcoholics, as do social drinkers who binge now and then. There is much being done to fight this, but in my opinion,  two areas that can be most effective for the near future are:

• 1) Helping people understand their drinking patterns. Most bar pours contain more than one standard drink, for example, so people may think they’ve only had a couple of drinks when they’ve actually had 4 or 5. NIAAA’s new site can help with this, http://www.rethinkingdrinking.niaaa.nih.gov/.
• 2) Providing parents, educators and young people with science based education on addiction, the developing brain and the impact of substance use/abuse on the brain during ages 12 – 25. NIAAA reports half of all alcoholics are addicted by age 21 and two-thirds by age 25. It is clearly a young person’s problem/disease, but we don’t recognize this because so many who finally get treatment don’t do it until later in life. These two websites can help: www.hbo.com/addiction and http://www.drugfree.org/parent/ . This post explains brain development, ages 12 and up.

With over half of American adults and one in four of it’s children living with or loving a person who abuses or is addicted to alcohol, much work is still necessary. Perhaps the one thing we can all do is learn more about the disease of addiction and the role of alcohol abuse in the development of the disease and then talk about it.

by Lisa Frederiksen

You may have nagging thoughts about your drinking or that of a loved one. You may have running discussions with yourself about whether drinking a couple of glasses of wine every evening or having 6 or 7 on Friday or Saturday nights is a problem or whether a DUI is a sign of alcoholism. While there are no definitive answers when it comes to “diagnosing” a person’s drinking, here are some guidelines.

The Moderate (Social) Drinker. This is someone who drinks within “safe” limits – limits defined by the National Institutes on Alcohol Abuse and Addiction’ Clinician’s Guide as not likely to cause alcohol-related problems. You’ve read these limits before on this website: no more than 3 in a day NOR 7 in a week for woman and no more than 4 in a day NOR 14 in a week for men. Part of this definition includes the understanding that a standard drink is 5 ounces of wine OR 12 ounces of beer or 1.5 ounces of 80-proof spirits. Click here for additional standard drink definitions.

The Alcohol Abuser. This is someone who is not addicted to alcohol (not an alcoholic) but whose drinking is causing problems. These might include a DUI, blackouts (doesn’t remember anything or parts of a drinking episode), getting into fights with a spouse, parent or siblings about their drinking, missing work or not being as effective at work due to a hangover, engaging in unprotected sex, getting involved in unwanted sex or sexual assault or doing or saying “things” while drinking that you would not normally do. The alcohol abuser has not crossed the invisible line to addiction, so that person is able to change their drinking habits (which may include stopping all together).

The Alcoholic (a person with an addiction to alcohol). The alcoholic engages in the same drinking behaviors as the alcohol abuser (DUIs, relationship problems, unwanted sex), but they also have the disease of addiction; a chronic, relapsing brain disease as a result of the chemical and structural changes in the brain caused by alcohol abuse. All alcoholics go through a period of alcohol abuse, but not all alcohol abusers become alcoholics. The disease includes the following four symptoms:

• Craving–A strong need, or urge, to drink.
• Loss of control–Not being able to stop drinking once drinking has begun.
• Physical dependence–Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
• Tolerance–The need to drink greater amounts of alcohol to get “high.”

If you are an alcoholic, the only way to treat your disease is to abstain entirely from drinking alcohol. There is no amount of alcohol that can safely be consumed at anytime in the future if one is an alcoholic. But this concept is the subject of a whole other post.

Are You At Risk For Becoming an Alcoholic? Because alcoholism is a disease, it is like all other diseases in that there are risk factors that contribute to the development of the disease. Here are a few:

• Genes. Just as woman with a mother who has breast cancer or a man with a father who has prostate cancer have a genetic predisposition to those cancers, so it is true of alcoholism. People born into families with alcoholism run a genetic risk for developing alcoholism.
• Environment. Growing up in a family with alcoholism (or alcohol abuse) causes a young person to develop coping skills and perceptions of drinking that increase their own chances of developing an addiction to alcohol.
• Mental Health Illness. Having an untreated mental health illness (depression, ADHD, PTSD, bipolar) can cause a person to turn to alcohol to self-medicate without any understanding that that is what they are doing — it just feels better. It is important to treat the mental health illness in order to stop the alcohol abuse or treat an addiction.
• Psychological Factors. People who are highly impulsive or sensation seekers are also at higher risk for addiction. The need for high-risk “adventure” or the inability to think something through to assess potential negative consequences can cause a person to embrace binge drinking, which can in turn, can lead to alcohol abuse and perhaps addiction.
• Age of First Use. Age of first use, independent of other factors (e.g., genetics, environment, mental health issues [ADHD, depression, bi-polar, PTSD]), strongly predicts the development of a lifelong addiction to alcohol.(1) Children who begin drinking before the age of 15 are five times more likely to develop problems with alcohol than those who start after 21.(2) For each year a teen delays alcohol use, their chances of becoming dependent (addicted to alcohol) drops by 14%.(3) The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that one-half of alcoholics were addicted by age 21, and 2/3 were addicted by age 25.(4)

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(1) NIAAA Statistical Snapshot Underage Drinking, <http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm>
(2) The National Survey on Drug Use and Health Report, 10/22/04
(3) Spear, L.P., The Adolescent Brain and Age-Related Behavioral Manifestations, Neuroscience and Biobehavioral Reiews 24 (2000) 417-463
(4) NIAAA Statistical Snapshot Underage Drinking, <http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm>

by Lisa Frederiksen

How many times have you found yourself uttering incredulous gasps, “What do you mean you don’t remember?” or engaging in an argument with someone you care about because of something they said or did while they were drunk?  Have you ever had them just stare at you, stone faced, as if to challenge your recollection and/or flip it around to somehow being “your fault,” something you’d simply dreamed up or were blowing all out of proportion?

You may be surprised to learn that that person could be incapable of remembering their behaviors while intoxicated — even if they were fully “there,” (meaning not passed out but still standing, talking, doing “stuff”). This is because they’ve likely experienced an alcohol-induced blackout.

Aaron M. White, Ph.D, wrote in “What Happened? Alcohol, Memory Blackouts and the Brain,” published on the National Institute on Alcohol Abuse and Alcoholism’s website, “Alcohol interferes with the ability to form new long-term memories. Large amounts of alcohol, particularly if consumed rapidly, can produce partial (fragmentary) or complete (en bloc) blackouts. Blackouts are much more common among social drinkers — including college drinkers — than previously assumed, and have been found to encompass events ranging from conversations to intercourse.” [emphasis added] People who experience “fragmentary blackouts” while intoxicated often don’t remember all of what they said or did until they’re reminded of their behaviors by someone else who was there. People who experience “en bloc” blackouts are unable to recall any details whatsoever — even if prodded and taken through the sequence of events, blow by blow — they just can’t remember.

So how is it a person can have enough mental capability to talk or drive or get into a fight or vandalize a building or have unprotected sex but not remember it the next day?

Several factors contribute to blackouts, but two of the key contributors are gulping drinks and drinking on an empty stomach. Each of these contributes to a rapid rise in BAC (blood alcohol content), and it’s the rapid rise in BAC that gets in the way of the brain’s ability “to transfer information from short-term to long-term storage.” According to extensive research on this phenomenon, the brain can capture information in short-term memory while intoxicated (at least for a few seconds, anyway), which is why the person can carry on a conversation or drive (albeit erratically], but the information relevant to these events does not transfer to long-term storage. This is not to say it’s only impaired memory functioning that results in a person engaging in risky behaviors. Other cognitive functions – judgment, decision-making, impulse control, as examples – are also seriously impaired by excessive alcohol use.

Having said all this, please know that I’m not trying to excuse a person’s drinking behavior by labeling it a blackout — “Oh well, they can’t remember, so it’s not their fault” — absolutely not. I’m sharing this information because understanding alcohol-induced blackouts may help you avoid the useless arguments about what a person does or doesn’t remember, and it may help the person whose drinking resulted in an alcohol-induced blackout to see that, in fact, they “really could have done that!” Lastly, this information points to the importance of avoiding binge drinking for a number of reasons, not the least of which is to  avoid the rapid rise in BAC that can lead to an alcohol-induced blackout. Binge drinking is defined as 4 or more standard drinks for women and 5 or more standard drinks for men.

For a great article about blackouts among college students by Aaron M. White, Ph.D., click here.

by Lisa Frederiksen

December is National Drunk and Drugged Driving Prevention Awareness Month and the statistics surrounding drunk and drugged driving are staggering. Here a just a few:

• Alcohol-related motor vehicle crashes kill someone every 31 minutes and non-fatally injure someone every two minutes (NHTSA 2006).
• During 2005, 16,885 people in the U.S. died in alcohol-related motor vehicle crashes, representing 39% of all traffic-related deaths (NHTSA 2006).
• In 2005, nearly 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics (Department of Justice 2005). That’s less than one percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year (Quinlan et al. 2005). (1)

These statistics show there’s a lot still to be done, and while the obvious answer is “Don’t Drink and Drive,” the less obvious is what makes someone think they can still drive after having several drinks and how can that be avoided? In my opinion, it’s staying within the drinking limits that allow you to still think clearly and make wise choices — not only choices about whether to drink and drive but about what you say and do.

As for drinking limits? The NIAAA defines [ongoing] alcohol use that’s not likely to cause problems as:

• no more than 3 drinks in a day AND no more than 7 in a week for women
• no more than 4 drinks in a day AND no more than 14 drinks in a week for men.

So if a woman has three drinks at an event, for example, she may only have 4 more drinks that week in order to stay within these recommended limits. Of course, these “safe” limits can vary by size, weight, health, age, height, etc. of the individual. [Note: these limits also differ from USDA's recommendations of one drink/day for women and two for men, but that's another post.]

So how do you stay within safe drinking limits?

• Understand what constitutes “A” drink. You’ve heard it before and have read it in many articles but have you tried to measure it and see what it looks like? “A” drink of wine is 5 ounces; “A” drink of beer is 12 ounces; and “A” drink of spirits (vodka, gin, scotch) is 1.5 ounces. This means that drinks poured and consumed at bars and holiday parties often contain more than one drink as follows:
  • a margarita = 3-4 drinks
  • a martini = 2-3 drinks
  • a scotch on the rocks = 2 drinks
  • a standard bottle of table wine = 5 drinks.
• Know your glasses. What I mean here is understand that various homes, restaurants and holiday party locations will have different types of glasses, which means a glass of wine, for example, can have far more than just “A” drink of alcohol, depending on the type of glass that’s being used. This is another reason to actually measure out 5 ounces or 12 ounces or 1.5 ounces in various, common glass shapes, so that you have a clear visual of what “A” drink looks like.
• Don’t let them refill. When you’re at holiday parties, it’s easy to loose track if a waiter is constantly refilling your glass. Don’t let them until you’ve completely finished your original drink. That way you will know when you’ve had your limit.
• Alcohol interacts with medications. Just a reminder that alcohol and prescription drugs and some over-the-counter medications do not mix – be sure to read the label and heed the warning.
• It takes at least one hour. Again, depending on age, health, weight, metabolism, height, etc., it “typically” takes one hour for the body to process one drink. So for every drink, it takes the body at least one, alcohol-free hour to rid itself of the alcohol in that one drink (two drinks, two alcohol-free hours, and so on).

All of this said, please know it’s not meant as a formula for how to drink and drive. Impairment begins with the first drink. Rather, it’s shared in hopes that understanding what constitutes a drink and how easy it is to over-drink can help all of us make wise decisions [such as sticking with the plan to designate a non-drinking driver and only driving home with that person] in order to be safe on the road and in the many other social settings where drinking can compromise one’s judgment, decisions and behaviors.

Here’s to happy and safe holidays!

(1) Department of Health and Human Services, Centers for Disease Control and Prevention http://www.cdc.gov/ncipc/factsheets/drving.htm