| Volume 2, Number 1
When it comes to an alcoholic getting sober most family and friends don’t care how, just that they quit drinking. Many times even healthcare professionals see the problem as if they don’t drink everything will be OK. Some years ago Antabuse was seen as the cure for alcoholism, and in some cases it really did help. Gradually the flaws starting showing up. Some quit taking the medication; others took the medication but were nearly unbearable to be around. After some years of Antabuse being available it no longer was seen as the ultimate tool for alcoholism. Today it is occasionally used and can be of some short term help for certain people; however, it is seldom used.
I remember when I was a teenager my father knew a well driller who had a severe problem with alcoholism. Periodically he would go to a state institution to sober up. His business had way more customers than he could handle. Even though his drinking took its toll he was well liked and his work was respected.
Certainly stopping drinking for an alcoholic is preferable to continuing to drink. There is always the thought that if only he or she didn’t drink too much. When you are focusing on alcoholism then even one drink is too much. Only those who do not understand alcoholism would ever suggest there is an amount of alcohol that is safe.
At some point the well driller got sick of his trips to the hospital and decided he would take Antabuse for the rest of his life to prevent drinking. To the best of my knowledge he did exactly that. Consequently, he became so hard to deal with when he was sober on Antabuse that he was losing customers and the only antidote was for the rest of the family to take over all customer contact. He spent every day out there drilling wells alone.
He was successful in quitting drinking, but you be the judge if his method was a good idea. Maybe there could have been another way; however, I really don’t know. I am not making a case against use of Antabuse, just suggesting there needs to be other recovery support in addition to the Antabuse.
Ernest Hooker, NCAC II . The Dry Drunk
Most of us have encountered a person who quit drinking, using other drugs or quit smoking and then became so difficult to be around that we wished they would start drinking or smoking again. The dry drunk can refer to an alcoholic or drug user who quit but is still miserable.
Actually, when any alcoholic or addict quits using their first experience is that of a dry drunk. There is a long list of physical and psychological reasons why they should feel bad. Even with the right medical care the first three months physically is very difficult and then gradually gets better. After the first year the difficulty should be moderate for another two to four years. Sometimes the physical recovery is ignored and certain problems can go on almost indefinitely.
The psychological problems should be significantly improved in ninety days. Without the right guidance, not only can these problems continue on indefinitely, frequently they get worse.
When the physical issues of addiction have been understood and treated, we are still left with a period of healing and with the psychological damage. The following is a description of a typical patient that seeks help for his or her dissatisfaction with their recovery.
One patient came in to see me after a few years of recovery. He complained that he was tired of A.A. and tired of looking for help because he still felt like something was missing. He had attended A.A. three or more times a week for a few years. When he didn’t seem to improve after trying different healthcare professionals he settled with seeing a psychiatrist for several months. He said none of it helped. He described seeing the psychiatrist, having a diagnosis of depression, and had been prescribed two or three different antidepressants with very limited help.
His complaints to me were that he felt angry much of the time. He had a difficult time getting along with others and really had no close relationships. He had a sponsor and his sponsor had urged him to go to even more A.A. meetings. He said he was sick of all the meetings, that there should be more to life. His whole tone was that of strong sarcasm, with a hint of daring me to tell him to try harder at A.A.
He assured me that he had a physician he saw regularly. When he mentioned the name I was familiar with him and knew he was an excellent doctor. He further complained that he had a problem sleeping, he would go to sleep and wake up after a couple of hours and then sleep on and off for the rest of the night. He described being very close to getting into legal trouble because of road rage incidents. He was afraid if this continued he would “kill one of those idiot drivers.”
I asked him if he would attend outpatient treatment for a few weeks and he said he would attend two groups in the morning and then leave for his job. In addition to his groups he was to see me or one of the staff at least two times a week for ongoing assessment. If he wasn’t improving within two weeks we would order psychological testing. He was in agreement with the plan.
He was given the books “Under The Influence” and “The Grief Handbook”, he also attended a lecture on the dry drunk and a lecture on losses associated with addiction. He claimed improvement by the end of the first week.
Previously he had worked on anger with his sponsor and healthcare professionals without noting any success. In fact, he said the more he worked on anger the more preoccupied he became with how pissed off he was. He discovered during outpatient treatment that his anger was just a defense system that was keeping him from seeing the shame he had due to his previous addiction. After he was able to face the shame without resorting to anger to avoid it, his next discovery was his enormous grief.
He was now about forty years old and realized directly or indirectly he had lost at least $150,000 due to drinking. He made a detailed list of many exact costs. He came up with specific health problems he had, relationships that were lost and numerous other costs that were due to his use of alcohol and other drugs. He talked about how sad he felt about these losses in the groups and also in the one to one sessions.
He stayed in outpatient about three weeks and then checked in one time a week after that. He said he cried more in those first two weeks of outpatient treatment than he had in his whole life before and realized he almost immediately felt a great relief. He was enthused and full of energy and could sleep without any problem. He often would stop in and talk to a group about his experience as a dry drunk and how miserable and painful it was.
He changed A.A. groups, went to a Back To Basics group and also found a different sponsor. This is a common experience that people in recovery go through and his experience is typical of dozens of others.
Some of the ways that a dry drunk avoids looking at the need to heal both physically and psychologically is to exhibit codependent behavior, act out in disastrous relationships, gamble excessively or other compulsive behavior. One of the obvious signs is being extremely defensive and some do this by isolating.
If the person is attending A.A. they may attend a lot of meetings; however, they are either not offered or avoid any serious step work. They also avoid or do not have a sponsor who gives serious guidance for recovery. At that point they don’t know what the problem is, and finding that although drinking doesn’t work, being sober is nearly as miserable so some return to drinking.
If they are surrounded by codependents they will get support for not facing their problems. Often codependents will advise the recovering person to go slow on the steps or other recovery work and even comment that working the steps or following the advice of an addiction professional will make them relapse. That is like telling a diabetic not to take their medication until they are well, it is very dangerous.
Ernie | | Volume 2, Number 2
When I was in grade school I often amused myself with looking through my grandmother’s “Doctor Book” which actually covered everything that one might want to know in daily living in the eighteen hundreds. She was born about 1867 and had her children in the eighteen nineties, with the last one (my father) in 1909. My grandmother had the same reverence for information in “The Doctor Book” that she had for the Bible.
By the time I was in the fourth grade I realized my grandmother’s information was incredibly outdated, however, I wouldn’t have dared to challenge her on that. She believed that diabetes was a direct result of gluttony, those people were low class, and we were not to associate with them. She knew this to be true because she quoted directly from her medical text.
That attitude about diabetes may appear to be from the dark ages. However, don’t believe we are all that enlightened today. Many of the beliefs about alcoholism and addiction in general by the media and much of the healthcare profession are just as, or even more, absurd.
I want to give you another example of the general unenlightened attitude that often prevails in our society. For many years it has been believed by the general public and healthcare that stomach ulcers were caused by emotional problems. They were often treated by the patient going to some form of psychological therapy, which never worked. For decades Veterinarians knew that ulcers in pigs were due to a bacterial infection and were successfully treated with antibiotics. For reference to the causes of stomach ulcers go to http://www.umm.edu/digest/ulcers.htm. So most ulcers are caused by a bacterial infection and the few that are not appear to be the result of aspirin or similar medications.
This suggests that we are not as enlightened as we would like to believe. There is no shortage of examples of popular beliefs that are both wrong and damaging.
Ernest Hooker, NCAC II
Confusing The Symptoms With The Cause of a Problem.
In the book “Relapse Traps” in the section on assessing your attitudes several models of belief systems about alcoholism are listed. They list the following belief systems: impaired model, dry moral model, wet moral model, the old medical model, the Alcoholics Anonymous model, the psychodynamic model, the behaviorist model and the family systems model. If you have been around the field of alcoholism treatment you may be able to name a few variations. In healthcare there are those who are rigidly stuck in one of these models - believing without any support or evidence that it delivers the only opportunity for recovery.
The following is from the book “Relapse Traps” by Ronald L. McMillin, and Chandler Scott Rogers. “We came to believe that relapse was rooted less in emotional instability than in attitude and behavior. This is contrary to popular wisdom. Most people assume that relapse is always preceded by some type of crisis and is, in fact, a response to intense, painful feelings with which the relapse cannot cope. Not so. In the majority of cases, relapse is the product of a series of bad decisions, each one based on the ones that precede it, until the return to alcohol or drugs seem to be the only “reasonable” choice.” This is quite possibly the best information on relapse that is available. Their information is based on many years of working successfully with patients and is consistent with reliable follow-up studies.
One of the first studies that I remember reading was made in New York (about 70 years ago) on some very late stage alcoholics living on the street. They found that they all had some personality characteristics (what they called psychopathic deviate) and it was assumed that there is a certain type of personality that precedes alcoholism; this was often called the alcoholic or addictive personality. There was no history to compare what their personality characteristics were prior to becoming alcoholic. Many years later more structured studies indicate that the alcohol causes these changes and prior to the onset of the disease and a few years after recovery the individuals personality is quite different than when they are in late stage alcoholism.
Another useless study that was conducted used a standard list of questions to alcoholics on why they started drinking. Their answers included it was easier to dance and easier to talk to girls, etc. Those doing the study concluded that is why they became alcoholics. When at a later date someone came up with the idea that they should ask the same question of those who drank but were not alcoholics. And you probably guessed it - they came up with the same answers.
One of the confusing issues with alcoholism is that it is rarely diagnosed or recognized until it is late stage. Some years ago most cancer was not diagnosed until it was very late stage and the person may have had a variety of symptoms long before the real disorder was found. Research in the later years has shown that prior to the onset of alcoholism the rate of mental illness is the same as the general population and after five years of recovery there is no more mental illness in alcoholics than in the general population. Yet a portion of the healthcare field and most of the media prefer to believe the myth.
In training interns for over three decades I found that most interns when asked for the early stages of alcoholism actually gave late stage symptoms, but they could not name any early stage symptoms and many could not identify middle stage symptoms. This didn’t stop them from believing that they were experts on diagnosing and treating alcoholism. Fortunately, most of the interns were open to new ideas and reading reliable research and studies. All the interns had some education in counseling and also were experienced in groups and one-to-one counseling, some even had a Ph.D. About half of the physicians I have worked with after completing a history and physical on a late stage patient will write the diagnosis of abuse when clearly the accurate diagnosis is dependence. When there is someone paying attention at the insurance provider, this can cause a big problem because hospitalization and detoxification is not covered or needed with the diagnosis of abuse.
Many people believe that there is such a thing as an alcoholic personality. This is another myth. Anyone attached to that belief needs to read some of the work that the late Sidney Cohen, MD, completed. He may well be the most respected researcher in addiction. He simply states “there is none”.
As James Robert Milam states in “Under The Influence” addiction to alcohol is primarily physiological. Alcoholics become addicted because their bodies are physiologically incapable of processing alcohol normally.
From 1989 through 1993 I was director of a dual diagnosis unit in a psychiatric hospital in California. After we had several patients with approximately a year of recovery we suggested the patients consider an alumni group. The patients had regularly been attending an aftercare group. I went to the CEO and asked him for permission and had him meet two of the ex-patients that would be in charge. A staff member would be present at the meetings only to be sure there were accommodations for the group. The meeting was held in the hospital cafeteria.
About a month after the alumni group was formed the social workers department made a screaming and unified protest about why we were letting patients “run a group.” They ranted endlessly to the CEO and anyone else who would listen. He tried to explain to them that of the two leaders one was a vice president of a large steel company and the other one was an upper level manager at a large utility company. Of course, this made no difference to the social workers and their belief system about recovering alcoholics. Finally the CEO was sick of the whining and told them to just shut up about it. I doubt if they ever got over their outrage.
This demonstrates the difference in belief systems. The psychiatrists at the facility were very supportive of the alumni group. The CEO had previously been in charge of military hospitals.
For those who are familiar with studies on alcoholism and genetics there is little doubt left that alcoholics are genetically predisposed to the problem. Still, the media and many healthcare professionals prefer to believe that stress causes the problem. Many claim that by reducing the stress the alcoholic will no longer drink “too much”. Starting in the seventies there has been no shortage of studies attempting to teach alcoholics to drink socially with disastrous results.
Numerous follow-up studies after treatment are consistent on relapse patterns for those following a recommended recovery program. Use of mood altering prescription medication or an over the counter medication containing a mood altering drug. This is not a conscious attempt to use but a lack of understanding of cross addiction or not understanding the ingredients in a product. An example of a lack of understanding on ingredients is the use of Nyquil which has a high percentage of alcohol.
Another common pattern for relapse is based on the belief that they are only in danger of relapse when they are feeling depressed or anxious. They tend to work a disciplined program when they feel emotionally uncomfortable and when they feel good they slow down or quit their recovery program. Consequently many people relapse and when asked if they knew why they will say “I don’t know because it was the best I have felt for years”. Obviously, if those who were considered living in a “high stress” situation were also the ones that most frequently relapsed, there would be some logic to “stress” being the primary cause of relapse.
Depression is believed to be a frequent cause of alcoholism. The reason this is believed is because when depression is diagnosed, the alcoholic most often has an advanced case of undiagnosed alcoholism. So the alcoholism is already at the stage where it has altered the brain chemistry and has caused depression and, of course, there is also the declining living situation. Curing a depression does not cure alcoholism. If the person has a pre-existing depression (no more likely than the general public) drinking makes their depression significantly worse; if they had no pre-existing depression by the time they are late middle stage they definitely will have developed a depression as a result of their alcoholism.
If you need recovery information go to the experts that have a proven track record. When you are betting your life on recovery information make sure it has worked well with others just as you would with any other potentially fatal disease.
If you are seeking information about Alcoholics Anonymous go to the “Big Book” or other A.A. sponsored literature instead of a person who may have another agenda.
Ernie
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