FAQ

FAQ

Frequently Asked Questions About Alcoholism

Question: Doesn’t an alcoholic need to want help before treatment or support groups will do any good?

Answer: That idea is based on a lack of understanding of alcoholism. What makes alcoholics “want help” is when they are forced to face the consequences of their own behavior. Any help in avoiding the problems that their drinking has caused postpones their recovery. Most alcoholics in recovery will state that they became motivated in recovery during treatment after several days or in some cases even weeks of detoxification. If they are shielded from the consequences it supports the pathology. It is always devastating consequences that drive alcoholics into treatment. There seems to be a belief that at some point alcoholics just decide they want recovery without serious consequences forcing them there and that is a myth.

Question: Will drugs like Valium help them stop drinking?

Answer: There is a yes and no answer it depends on if you are using Valium or similar medications to detox a patient in the proper setting that can be a significant first step. If you prescribe the medication after detox for anxiety you are only complicating their addiction. Valium works similar to alcohol and is a way to continue their addiction and ultimately significantly endanger their health.

Question: Does and alcoholic really need treatment or support after they are detoxed.

Answer: Absolutely the answer is yes. The most optimistic estimates for the length of time it takes for an alcoholic to physically heal is 3 years and often 5 years is likely. During that first three years they are at a high risk for relapse. To find out more about this read either “Under The Influence” or “Beyond the Influence: Understanding and Defeating Alcoholism”. Both books are excellent and are published in paperback.

Question: Is lying one of the most serious problems for an alcoholic?

Answer: My concern is less about lying and more about the delusion that accompanies addiction. There is also the matter of asking the right questions. Several years ago an older female patient that was referred to our unit by her physician was questioned by nursing staff about her drinking and they determined she didn’t drink enough to be an alcoholic. Later when asked she repeated what she had told the nursing staff, that she drank two to a maximum of four drinks a day. When additional questions revealed she considered a drink about six ounces of whiskey. She added that sometimes she freshens her drink. With specific questioning she described drinking up to a fifth of whiskey a day. She was not lying but instead staff had made assumptions that were not accurate. There is also blackouts, repression and euphoric recall that account for what often appears to be lying. More about this in other areas of the web site soon.

Question: Isn’t a psychiatrist or the mental health system the best place to treat alcoholism?

Answer: The best place to treat alcoholism is where the staff is specifically trained for treating that problem. In seeing a psychiatrist or other physician it is most helpful is they are ASAM (American Society of Addiction Medicine) certified. In most cases a psychiatrist is not needed and a regular physician with knowledge of addiction is usually quite competent. If needed the physician will make the psychiatric referral.

Question: After an alcoholic has been sober for a few years isn’t it safe for them to drink again?

Answer: No! They become extremely toxic and experience symptoms at least as bad as or worse than when they quit. Many who have returned to drinking after some years of being sober die within a few months. The Big Book of Alcoholics Anonymous has stories of alcoholics who tried this.

Question: Isn’t there medication that will help alcoholics to stay sober?

Answer: There are medications that may be helpful; however, medication usually works only as an addition to other recovery support. Antabuse is not used very often for several reasons. One is that often patients don’t continue to take it. Another reason is that if their liver is compromised, Antabuse can place additional stress on that organ. Naltrexone can be a good addition to recovery therapy. In some cases antidepressants are helpful. Many medications are only advised after liver tests are normal. The American Society of Addiction Medicine often has excellent information on the use of medication and addiction recovery.

Question: What medical complications are associated with late stage addiction?

Answer: I will only comment on a few because the list almost has no limits. Damaged heart muscles, respiratory problems, calcium loss in bones, brain damage and premature aging are just a few of the complications I have observed.

Question: Many people do not agree that alcoholism is a disease, how do you handle that?

Answer: I don’t; however, I do believe that most rational people do agree that the cost to the individual and to society is very high.

Question: What about stress?

Answer: I recently saw a doctor on TV. When he was asked about stress and a disease he was discussing, I liked his response. He said when we don’t have any idea of what the problem is we say it is either a virus or stress.

Question: Isn’t addiction a self -inflicted disease?

Answer: There I would have to defer to physicians I have known who state if they had to discharge all the patients that have a self-inflicted disease 90% of their patients would have to go home. Most diseases in this day and age are either caused or negatively affected by the patient’s life style, why single out addiction?

Question: Isn’t codependency caused by the addict’s behavior?

Answer: If you are referring to the children in the home that is very likely. If you are referring to adults in a relationship the answer is no. This is a convenient place for them to act out attitudes and behavior they had prior to the relationship. Certain types of jobs also are attractive to codependents for similar reasons.

Question: " A cocaine addict doesn’t need to stop drinking alcohol if they drink moderately...

Answer: Addiction to one drug makes using any other drug dangerous. One follow-up on relapse with cocaine addicts showed that 50% of them first used alcohol and often in small amounts. One former patient said it best: “I don’t relapse on cocaine every time I drink alcohol but every time I relapsed I had been drinking first.”

Question: Isn’t stress what makes alcoholics relapse or continue to drink?

Answer: There are a number of problems with this concept. Stress is a very generic term and if you ask ten people exactly what do you mean you will get ten different answers. In general, there is little more stressful than the physical and psychological punishment an alcoholic gets from the severely toxic effects of drinking, it is off the chart. In the eighties a large oil company started screening their employees for alcohol and other drugs. In the treatment center where I worked we assessed several that were long term employees and found they were late stage alcoholics. Many had two options: go to treatment for alcoholism or take an enhanced retirement package, called the golden parachute. Most of them and their families believed their drinking was due to job stress and if their job stress was removed the drinking would return to normal, so they took retirement. In three to six months most of them showed up in the medical/surgical unit of the hospital with life threatening secondary problems due to their drinking. Most of them drank around the clock and it hastened their deterioration. One family member said the job was the only thing holding him together. So much for reducing the stress in their life.

Question: Doesn't eating something sweet helps the alcoholic stay off alcohol?

Answer: Actually the opposite is true. Studies have been done in treatment that show those with a lot of sugar in their diet have significantly more craving for alcohol and consequently tend to relapse at a higher rate.

Question: Does hypoglycemia causes alcoholism?

Answer: Highly unlikely. Most alcoholics show some hypoglycemic tendencies in early recovery; however, after a few months all but a few tend to have normal blood sugar levels.

Question: When it is clear that the person is alcoholic why is there a need for more diagnosis?

Answer: Accurate diagnosis is time consuming and necessary for a good treatment outcome. Here are a couple of examples: The patient has a bad liver and his ammonia level is high which may cause dementia. This usually is temporary; however, if this hasn’t been recognized he may be viewed as unable to benefit from treatment or be an unwilling patient. In one study 40% of the patients had brain damage serious enough to impair their functioning. The damage was often due to falls and accidents. If this isn’t recognized they may not receive proper treatment. Inadequate diagnosis often results in the “bad patient” problem.

Question: Why bother with additional interviewing once you know the patient is addicted?

Answer: If a physician told you have cancer you might want more information; i.e., what stage is it, what treatment options are available and are there secondary medical problems. With all potential terminal illnesses diagnosis and recommendations frequently are complicated if the patient is to be offered the best treatment outcome.

Question: Why not confront the patient about conflicting information and obvious denial in all staff patient contacts?

Answer: Most of the time the diagnostic interview is performed when the patient is in detox and feels very ill. Confrontation tends to stop the patient from giving information so the interview would likely be of no value. This is an attempt to solve a problem before the problem or problems have been identified. If the staff person goes into the interview without a clear goal it becomes evident they don’t know what they are doing.

Question: Isn’t a recovering alcoholic qualified to treat other alcoholics?

Answer: A recovering alcoholic can be helpful to other alcoholics. However, that does not qualify them to treat alcoholics in a professional setting anymore than having a broken arm doesn’t qualify one to be an orthopedic physician.

Question: Aren’t the mental health professionals the most qualified to treat addiction?

Answer: No, not unless they have the training, education and experience required to be an addiction professional. In fact, numerous studies have shown that mental health professionals without proper addiction credentials have not been successful at addiction treatment. Addiction treatment is based on a separate body of knowledge.

Question: Doesn’t the idea of powerlessness leave the person without any responsibility for their behavior?

Answer: No. The person quits trying to do what isn’t working. At this point, all the time, money and energy that were wasted before can now be applied to realistic tasks. Another way of looking at it is by watching those in recovery. You will soon see they do very clearly take responsibility for their behavior.

Question: I take Ativan and that helps me cut down on alcohol, isn’t that an easier way to recover?

Answer: Trading one addictive drug for another is not recovery, it is polydrug dependence.

Question: My uncle was a bad alcoholic and became a social drinker later in life. Don’t alcoholics frequently return to normal drinking?

Answer: No. They don’t become normal drinkers; it is hard to say about your uncle without more information. Most of the time when I have been asked this question I find that the person is just in the very late stages and they have become very toxic. They will be severely depressed with a long list of health problems secondary to alcoholism. Check out the chart on my website.
http://alcoholismanswers.net/Assess.aspx

Question: Won’t I lose all my drinking friends if I quit drinking?

Answer: That not only will happen but should happen. If they are alcoholics you may find that after a few months of recovery you find them very dull. With some recovery you will be in a better frame of mind to judge if they are friends you want to keep or if they were part of the problem.

Question: Aren’t alcoholics very emotionally fragile?

Answer: There is no doubt that the addiction is very physically and emotionally devastating. But looking at another aspect, there may be nothing else that causes the physical and psychological distress of drinking for the alcoholic. If they can tolerate that without dying they are very, very tough. I have heard many doctors, after doing a history and physical on a new patient, say “That guy must be really tough, what he has been through due to his drinking would have killed an ordinary person a long time ago.” They would just shake their heads at what the alcoholics and addicts could go through and still survive.

Question: Isn’t A.A. the only way alcoholics really get sober and stay sober?

Answer: A.A. is the most common way to stay sober and is widely available. I do know many people who have found other effective routes to recovery. Many have been involved in church recovery groups and some have been in long term outpatient alcoholism programs and did well. The principles of recovery found in A.A. tend to be found in any effective recovery program.

Question: I know of a person who has been taking Antabuse for several years and stays sober. What is wrong with this?

Answer: I don’t know that anything is wrong with it; it certainly is better than continued drinking for an alcoholic. There are some possible problems if it is used to ignore the physical and psychological damage done by the alcoholism. At times, when an alcoholic stops drinking and avoids facing all the losses caused by the drinking, they become a dry drunk. Certainly the person should be involved with a physician so liver functions and other health issues can be monitored. Antabuse can be a strain on the liver and also there are the possibilities of side effects.

Question: I am clean and sober for several years and now I need surgery. What can I do about the dangers of addiction due to the anesthetics and pain medication?

Answer: There is no simple answer. However, I have known of several cases where they went through the surgery and recovery without a relapse problem. Here, in general, is what they did: discussed their history of addiction with all of their healthcare professionals and especially their anesthesiologist; they made sure everyone involved knew there was possibility that due to their tolerance they might need a different amount of anesthesia or pain medication; they stayed in the hospital as long as possible to detox; when they went home they had a trusted friend or relative with them 24 hours a day until well after they no longer needed pain medication; and, they frequently consulted with their physicians and pharmacist.

Question: I have a friend who is sober several years and it seems he doesn’t do much other than go to A.A. He doesn’t even work much and A.A. is his whole life. When he was drinking at least he held a steady job. He said he if he doesn’t do this he will jeopardize his sobriety. He has become a pain in the butt. Is there any hope that he will change?

Answer: None I can guarantee. He might get something out of reading some of Bill Wilson’s history where Bill discovered he was doing that and realized A.A. isn’t your life, it is a way to get back to a normal life. Bill actually saw himself recovered and said at that point he was capable of doing what any other normal person could do except drink. He returned to the stock market. Your friend might benefit from a talk with a certified or licensed addiction counselor.

Question: When an alcoholic has a recovery program in their first year and they still relapse what is the most frequent cause?

Answer: Two reasons show up regularly. One, they are using another drug and this starts the addiction cycle up. I will give you some examples: the person has a cold and goes to the pharmacy and gets a cold remedy with alcohol in it and off they go. A cocaine addict drinks some alcohol and soon uses cocaine again. A patient goes to their physician and doesn’t give him/her their addiction history, so they get Ativan or a similar medication. Any mood altering drug can reactivate the addiction. Two, another cause of relapse is he or she does not properly understand addiction. The person believes that their addiction is due to emotional pressure. When they are feeling depressed, anxious or generally not happy they work a rigorous program. Then, when they feel good they believe they don’t need the program and back off, consequently the “I don’t know what happened, things were never going so good.”

Question: Why does Alcoholics Anonymous say you have to go to 90 meetings in 90 days?

Answer: To the best of my knowledge, that didn’t originate from A.A. Sometimes members say that but the recommendation started in treatment centers. I have no problem with anyone who wants to attend A.A. every day. But, there can be some problems with substituting quantity for quality. If a person believes the recovery comes from attending a lot of meetings instead of doing the steps they have missed the whole point and benefit of the twelve step programs.

Question: All alcoholics seem to be very depressed when they first stop drinking. Doesn’t that prove that depression is the real problem?

Answer: No, it doesn’t. Depression is a symptom of middle and late stage alcoholism. Read my next newsletter for more detailed information on this matter.

Question: Hasn’t there been research done that proves alcoholics can learn to be social drinkers?

Answer: I suggest you go to the site below and read The Controlled Drinking Debates
http://www.doctordeluca.com/Library/AbstinenceHR/FourDecadesAcrimony.htm
Then make your own decision. I personally am not aware of any alcoholics who have been successful in returning to drinking. However, I have talked to many late stage alcoholics who returned to drinking and drank rather small amounts. They complained their use of alcohol was causing severe depression and a long list of medical problems. Personally I could not ever recommend any alcoholic returning to drinking alcohol or using any other mood altering chemical.

Question: Isn’t nutrition an important part of early alcoholism recovery?

Answer: Very definitely yes. It is important to have information from those who have scientific knowledge of the special nutritional problems alcoholics and addicts experience. The best nutritionist in this area that I am familiar with is Katherine Ketcham. Doctor Bob Smith, who helped start A.A., studied vitamin B absorption in alcoholics and the problems that often result. The need for mineral supplementation is nearly always ignored or not understood.

Question: What is meant by having a spiritual experience?

Answer: There obviously are many types of spiritual experiences. What I have noticed in watching patients in treatment as they change is that there is a dramatic reduction in their defensiveness and they develop a positive outlook on life. Often it is believed this develops gradually; however, in observing patients and having them describe their experience it appears the change happens in an instant. Many times this happens as they are working on certain step work. In the Big Book of Alcoholics Anonymous there are many stories describing the spiritual experience. Bill Wilson describes a particularly dramatic spiritual experience.

Question: Marijuana doesn’t seem to be a dangerous drug, why not legalize it?

Answer: I don’t have any answers as to why or why not to legalize it. I do have an opinion on the dangers of the drug. Recently there was an article on the high rate of testicular cancer in marijuana smokers. There is a significantly high rate of schizophrenia linked to marijuana. The rate of lung, nose and throat cancer is much higher in marijuana smokers than it is for cigarette smokers. Marijuana is linked to birth defects and chromosome damage. And there are no shortages of other medical reasons to be concerned about marijuana.

Question: What drugs are the most difficult ones to recover from?

Answer: This isn’t a scientific answer, but in following patients for over three decades the following drugs appear to be associated with the most frequent relapses: marijuana, valium (any of the benzodiazepine type medications) and methadone. I suspect the problem is that all these drugs stay in the system a long time. Many people guess that heroin would be on that list; however, follow-up studies do not support that conclusion.

Question: What is the connection between persons convicted of a serious crime and addiction problems?

Answer: I discussed this problem with a few people who have spent a lot of time looking into the situation and they say that more than 80% of those in prison in California have a serious addiction problem. They also state that there are very few resources for treatment of this population. A study was done in California regarding the cost/benefits of treatment in California and it was determined one dollar spent on treatment saved the state seven dollars. Possibly due to political reasons, there has been no really serious use of this information and recommendations.

Some thoughts about codependency

•    They confuse symptoms as causes.
•    They chronically see themselves as victims.
•    They live a life of constantly feeling overwhelmed.
•    Their life is confusing.
•    Their life is very painful.
•    They gravitate to jobs with vague and general job descriptions.
•    Many have made a successful recovery in Alanon.

FAQ

Question: What are the signs that a treatment staff has codependency problems?

Answer: Staff looks tired, no sense of humor, guidelines are vague and general. Treatment plans are too general without specific goals. Treatment is confusing and chaotic. Staff members work as lone, self -directed individuals, with no effective team work.

Question: What causes codependency?

Answer: Timmen L. Ceremak, Psychiatrist, may have completed the best work on this subject. It apparently is due to children not learning living skills from their parents. Dr. Ceremak describes one important aspect as “under learning.” This would indicate the child never developed the ability for adequate emotional boundaries and reality based decision making. For more in-depth information read Dr. Ceremaks books. He answers the question what is a short description of codependency - he says “immaturity.”

Question: What is common to the defense system of a codependent person?

Answer: The codependent is typically surrounded by chaos and this tends to be a chronic situation. The external chaos needs to be slightly higher than the internal chaos to avoid facing personal emotional pain.

Question: Has codependency had any effect on Alcoholics Anonymous?

Answer: In my opinion it has, by watering down the A.A. program. As an example, in certain groups, it is advised to avoid doing the steps for long periods of time. A.A. recovery went on a downward spiral starting in the seventies. Sponsors sometimes give advice on medication, marriage and other areas that are well beyond the scope of a sponsor. Go to http://www.aabacktobasics.org/
Read the information and make your own judgment.

Question: Does codependency show up in ordinary conversation frequently?

Answer: Don’t we all recall the old saying about “walking on eggshells” around certain people? What better example is there than “politically correct” speech? How often in everyday life do we find it is alright for unethical behavior but not OK to talk about it?

Question: What are common behavior patterns with codependents?

Answer: They are compulsive advice givers without an invitation. They assume the only way to deal with grief is to avoid facing it.

Question: How do I know who to contact for anger management help?
Answer: You might contact Jim Baker at Recovery Today for a referral. http://www.recoverytoday.net/

Question: How can I find competent help for a grief problem?
Answer: Contact The Grief Recovery Institute, they give free referrals.

Question: Is there any physical reason that causes alcoholics in early recovery to be moody and angry?

Answer: Yes. It is called the protracted withdrawal syndrome. This is due to neurotransmitter depletion, malnutrition, hypoglycemia, autonomic nervous system dysfunction and cortical atrophy. You can read the details in “Beyond the Influence” by Katherine Ketcham and William F. Asbury in chapter 11.

Question: Does a special diet help recovery in the early months?

Answer: Yes. Normal nutritional information doesn’t necessarily cover all the problems recovering alcoholics face. Doctor Bob from A.A. spent time studying alcoholism and vitamin B deficiency. He suggested alcoholics tended to have low levels of vitamin B and may have an absorption problem. He questioned the use of brewer’s yeast as a source of the B vitamins for an alcoholic because of a possible allergy problem. He linked it to depression problems. His work was done independent of his A.A. affiliation.
Check Katherine Ketcham’s work for nutritional information.

Question: When alcoholics use anger as a defense mechanism what are they most commonly defending?

Answer: The first thing that comes to mind is their use of alcohol. Many alcoholics are aware that their alcoholism is life threatening and, still, the need for alcohol wins out. When the financial, health, family and other costs are counted, more has been risked for their continued use of alcohol than anything else in their life. When something is more important than life itself, that is very powerful and that is a measure of the craving associated with addiction.
Another related area is facing the exact nature of the losses due to the use of alcohol and other drugs. This is a grief process covered in the steps.

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