Alcohol Use and Abuse

While I was living in a conservative, traditional and religious Pukhtoon culture on the border of Pakistan and Afghanistan for the first 20 years of my life, most people I met had a moralistic and judgmental attitude towards alcohol as they considered consuming even small amounts of alcohol immoral, illegal and sinful. For them there were either teetotalers or alcoholics. They did not approve of social and recreational drinking, and a rational discussion about alcohol was conspicuous by its absence. On the other hand in the West where I have lived for the last 30 years of my life, attitudes towards alcohol use and abuse are based on science, psychology and cultural traditions, because most people who consume alcohol are social drinkers who drink alcohol as part of enjoying life. It is socially acceptable to have a glass of beer, wine, vodka, scotch or champagne at a candle lit dinner with a sweetheart, the birthday party of a friend, a wedding or a social get together on a weekend. Most people are quite responsible about their drinking habits. There is only a small minority who overuse, misuse or abuse alcohol and suffer from a clinical condition called Alcoholism. Since alcoholism among this minority has caused profound emotional pain for the people who consume it and much suffering for their families and communities, there is a large body of research into the causes of alcoholism and treatment methods to help alcoholics and their families.


DEFINITION

According to the standard psychiatric DSM IV classification, alcohol abuse is defined as repeated use of alcohol despite recurrent adverse consequences and alcohol dependence as alcohol abuse combined with tolerance, withdrawal symptoms and an uncontrollable urge to drink.


UNDERSTANDING ALCOHOLISM

Although we have not found one single cause or mode of treatment for alcoholism, we have discovered a number of factors that are linked with its causation and rehabilitation.


BIOLOGICAL FACTORS

Some mental health research workers and psychiatric geneticists like John Nurnberger Jr. and Laura Jean Bierut have shown that there are genetic factors that predispose people to suffer from alcoholism. These genetic factors are not much different than those of other mental disorders like schizophrenia and manic-depressive illness. Children born to alcoholic parents, as compared to healthy parents, are more likely to become alcoholics. Such children have abnormal liver and brain reactions to alcohol that can cause serious physical and mental complications. Women who drink alcohol excessively during pregnancy may give birth to children with Fetal Alcohol Syndrome, a condition involving serious lifelong neurological, physiological and psychological problems.


PSYCHOLOGICAL FACTORS

If children who are genetically predisposed are also raised by alcoholic parents, they are vulnerable to developing addictive personalities as they have poor role models in their families and can learn to use alcohol to deal with their emotional problems. When such children grow older they are also likely to choose life partners who either have alcohol related problems or are enablers (one who protects their partner from the public consequences of their drinking) like one of their parents. It is unfortunate that alcoholism, a serious emotional and social problem, can be passed on from one generation to another until the people involved recognize the dysfunction and choose to break the negative cycle.



SOCIAL AND CULTURAL FACTORS

People who have an addictive personality tend to socialize with other people who have dependent personalities and serious addictive problems including regular alcohol abuse. Like some individuals and families there are also some isolated communities that abuse alcohol.


ALCOHOLIC LIFESTYLE

As alcoholism worsens, people become more and more dependent on alcohol to function. Sooner or later they develop symptoms of alcohol dependence, tolerance and abuse. Some of the complications are:
…poor nutrition
…sleep problems
…episodes of sadness and depression
….blackouts
… blood in stools
…cirrhosis of the liver
…missed days at work and eventual job loss
…marital and family problems
and
…increased consumption of alcohol to buffer the effects of drunkenness.

The road of alcoholism is the road of self-destruction that leads to emotional and financial bankruptcy. I have seen a number of men and women in my clinical practice that had to hit rock bottom before they decided to get help as they were in denial for a long time. It was only when they lost their driver’s license because of drunk driving, lost their home, job and family or went to jail because of their irresponsible lifestyle, that they realized the seriousness of the problem.


JENNIFER’S STORY

When I asked Jennifer to share her struggles with alcohol abuse she wrote,

I started drinking the day my father was buried. I was 33 and that was 23 years ago. I started drinking rye, years later I switched to beer and I now drink Vodka and beer. I drink daily and on average I have 10 to 12 drinks over a span of 3-4 hours. I grew up in a family that drank every day and for 53 years did not know that daily drinking was a problem, in fact in my family we thought people who did not drink were abnormal. I would not have even realized I had a problem, but at age 53 my husband had had enough and he insisted I get help. I have since been to Rehab. twice, DeTox once, and I've had an addiction counselor and I've been to AA. Every morning I pray to God that I will get it and stop drinking. NOTHING has worked and I'm desperate. I go to bed every night inebriated, wake up early every morning slightly hung over and every morning I desperately want to quit but every afternoon I start to get edgy and I pour that first drink and suddenly I've had 10 to 12 drinks, and I go to bed and the cycle starts once again. Now I realize my drinking is a problem (only because my husband, my daughter, AA has told me) but I can't do anything about it. Intellectually I know what to do but emotionally I am unable to change and at a gut level I don't want to stop drinking. It's my safety net. It helps me survive. I used to drink because my husband was verbally and physically abusive. He no longer abuses and I realize his actions came from his alcohol problem, which he no longer has, unlike me. Alcohol helped me deal with the fear and the pain of the abuse. Then I drank because I realized if I drank, I wouldn't eat so I lost the weight I wanted to lose. Now I drink because I'm lonely, tired and I don't know of any other option. I hate it but I love it. This confusing issue is too much for me. I don't understand why I have to have that first drink, but I have to have it. I also have trouble thinking of myself as an alcoholic--I struggle with that term as neither of my siblings who are 4 and 11 years older than me have admitted to having a problem and they drink every day also, and they drink a lot. The only change that I have made since 2 Rehabs, 1 Detox, and 1 Addiction Counselor, plus AA. is that I measure my drinks and count them accurately, unlike before. Also I DO NOT drink and drive. So now I drink alone. (I no longer can go and have "happy hour " with my brother and sister who are only 5 minutes away). Now I'm not terrified of my husband coming home and how he will treat me, I'm terrified that he will come home before I've had enough alcohol in my system.

LIVING WITH AN ALCOHOLIC

Alcohol abuse does not just affect one person—it affects the whole family, especially the spouse. When I asked Suzanne to share her struggles living with an alcoholic she wrote,
If you ask the spouse of an alcoholic, “What will your life look like when you are married?� they will never say to you, “I want to take care of someone like a child for the next 60 years and have them be sneaky, lie to my face, and embarrass me at family functions. I want to be behind in paying my bills, have checks bounce, and walk into a bank feeling humiliated when they give you a hard time over a simple mortgage or car loan that many people take out every day.�

I don’t think you would hear them say, “I want to give a lawyer our family vacation money and still end up paying up for criminal driving offences, remedial driving, and years of high insurance that has nothing to do with the way that you drive, but because you are married to an alcoholic.�
They definitely won’t say to you, “I want my children to feel like they are unloved by the alcoholic parent when, in fact, it is the alcoholic parent who does not love himself and with every drink he plunges himself further into darkness and despair.� There isn’t an ounce of you that says, “I know this wonderful person who is kind, caring and loving but I want them to continue to drink so that I can feel lonely and helpless. Like every second of every day impending doom is around the corner, and the rug is about to be pulled out from underneath my feet.�

I know that no one aspires to these goals in life. I do believe that you wake up one morning and you are there, whether you want to be or not, and the best questions you can ask yourself are
Am I strong enough to see where I am?
Am I strong enough to get the help I need for my self and my family? Am I strong enough to continue on?
But no one ever says, “I want to marry an alcoholic when I grow up!� It just happens.



REHABILITATION

Once people become dependent and addicted to alcohol it is not easy for them to break the habit as it is a physical as well as a psychological addiction. In the last few decades there have been a number of programs developed to help such people and their families.

DETOX CENTRES In the Western world many communities have detoxification centres where alcoholics can admit themselves voluntarily and receive professional help. These detox centres also provide special medical care.

ALCOHOLICS ANONYMOUS (AA) There are a number of self help programs like AA that help people to accept that they are alcoholics through attending regular meetings. They also provide sponsors so that when a member has an urge to drink, they can call their sponsor rather than going to a bar and getting drunk. AA people follow a 12-Step program of reviewing their behaviour and making healthier choices. I have met many people who have abstained from alcohol for years because of the help and support they received from AA.
AL-ANON Al-Anon is a sister organization of AA that helps friends and family members by teaching them how to cope with their dear ones who are alcoholics.

SOS…SECULAR ORGANIZATIONS OF SOBRIETY
Some alcoholics who are atheists, agnostics or secular humanists are reluctant to attend AA, as the AA philosophy relies on the belief in a Higher Power who provides support. Such alcoholics prefer to attend meetings of SOS for help as it is a secular organization and does not involve God or a Higher Power as part of their healing. They are also known as Save Our Selves.

ANTABUSE Although there is no medical cure for alcoholism, there are medications like Antabuse that are used to deter people from consuming alcohol. People who take Antabuse must not drink. It is an effective method but prescribed only to committed and reliable people because if someone drinks after taking Antabuse, they experience serious physical and emotional complications. Some people have died after mixing Antabuse and alcohol.

PSYCHOTHERAPY The more we know about alcoholism the more we realize that many people who have alcohol problems also have other personality and lifestyle problems and need ongoing therapy. Some get involved in individual, marital, group and family therapy, as their families also need ongoing support to cope with serious alcohol problems. Many rehabilitation programs offer comprehensive care including support, education and therapy.

COMPASSIONATE ATTITUDE In the Western world in the last few decades many communities and organizations have developed a sympathetic and compassionate attitude rather than a punitive and judgmental attitude towards people and families suffering from alcoholism. This is partly due to the increasing education and awareness of mental health issues. Many organizations and institutions have special assessment and treatment programs for their workers to help them to rehabilitate themselves and try to become productive members of society again.


Alcoholism is a treatable condition provided the people suffering from it acknowledge their problem and get involved in treatment for their own reasons rather than because of coercion by their spouses or bosses. It is difficult to overcome such a serious mental health problem until the person is committed to their recovery and rehabilitation. It is more of a marathon run rather than a 100-meter sprint. Similarly, rehabilitation programs also require workers and counselors who are dedicated to the program.


THE STORY OF A RECOVERED ALCOHOLIC

When I asked Graham who has not touched alcohol for more than ten years to share his story, he wrote,

“Dr. Sohail, when you asked me to share my struggles with alcohol and how it stopped me from living properly I started thinking of all the negative effects it had on my life. I was so focused on alcohol, KING ALCOHOL as it is referred to in the Big Book of AA. I was willing to go through almost anything to get it and sometimes I did do anything from stealing cars, taking items from department stores and selling them to get money for alcohol. My life was a total mess for a long time. Things did not change for me until I was 42 years old. Because of alcohol I could not be the son I should have been. I gave my mother a lot of sleepless nights waiting until I was home safe or if I came home at all. I slept in abandoned buildings or under bridges covering myself with cardboard boxes. I was not the brother I should have been. I was not the father to my son and daughter I should have been. I caused many disasters for the family being arrested for hit and run accidents and police coming to my house to arrest me. I was not the husband I should have been. I was not available when my wife needed me for the most important things. I lost my license seven times because of my drinking.

Finally I went to jail when my 12-year-old son called the police. Going to jail was the most horrific event of my life. That event made the change for me to do something about this serious problem. While I was in jail I went to AA meetings and later on went to a treatment centre in Brooklin Ontario for 28 days. After leaving the centre I continued to go to AA and believe me that made a drastic change for the better. Some TEN PLUS YEARS later I know I took the EASIER SOFTER WAY as I realized that King Booze was the EASIER SOFTER WAY.

It took me a long time to realize that I had major problems in life only when I was abusing alcohol.

Yours in recovery,
Graham.


FUTURE DIRECTION

When we review prevalent attitudes towards alcohol use and abuse we find people on a wide spectrum. On one extreme are those individuals, families and communities who have a conservative, traditional and religious attitude and consider alcohol consumption an immoral and sinful act and want to impose their views on others. On the other extreme are those who misuse and abuse alcohol and suffer unhealthy consequences. In the middle are the majority who have a balanced and healthy attitude towards alcohol and use it only for social and recreational reasons. They have a sympathetic attitude towards alcoholics and encourage them to get professional help. The availability of scientific and psychological knowledge about alcohol use and abuse allows people to make responsible choices rather than hiding the problem or relying on traditional myths that are hundreds of years old.