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Alcoholism

Alcoholism (Alcohol Addiction)

Many Labels, Many Names, a Myriad of Meanings

In today’s society, the nomenclature ‘addiction’ is conflicting, ambiguous and stigmatising. The act of stigmatising addiction has negative connotations; it creates unpalatable feelings, thoughts, emotions and judgements towards a specific group of individuals. This may segue to negative consequences, such as those individuals having a lack of social contacts and being limited in their interactions unless they are able to stereotypically fit into what is expected of them.

However, contemporary society has taken the term ‘addiction’ and applied the label as both a negative and a positive attribute. An example of a negative attribute is implying that an individual who is addicted is compulsive, obsessive, and unable to control their actions and/or their behaviours. A positive attribute is applied to someone who is addicted to a product or activity, creating excitement for that individual and prolonging their interest. Other nomenclatures utilised under the umbrella of addiction include dipsomania, substance-related and addictive disorders, substance dependence, substance use disorders, process addictions, substance misuse and abuse addictions, and harm minimisation. The list goes on.

When it comes to a person’s inability to control their liquor intake, views in the 19th century varied. The state of habitual drinking (drunkenness) was seen as a sin, a self-inflicted factitious disorder, a moral weakness. The person was blamed for not being able to control their intake, or the consequences of their thoughts and actions after drinking. More often than not a drunk after a serious hangover was sequestered from family, friends, and work colleagues while being known as a town drunk or one who could not handle their liquor consumption.

Today, we know differently, for any individual suffering from the disease of alcoholism is not to be blamed, shamed or ‘written off’ purely because they continue to show an inability to control their consumption and the consequences of an unmanageable lifestyle in their family life, working life, and social life.

Identifying An Alcohol Problem

So how does one define an alcoholic, a heavy drinker, an abuser, a social drinker, or a bender drinker?

The question of who suffers from alcoholism, who may be sitting on the fence, who is able to control their drinking, or who is simply an alcohol abuser or heavy drinker has for centuries tormented and burdened society and its researchers, social theorists, biomedical scientists, and neurologists, to name a few. This continues to the present day, with scholars trying to make sense of the perplexing array of physical and mental symptoms evident in substance use and abuse research and literature.

So What Makes A Person An Alcoholic?

There are a myriad of social and psychological factors that may influence the progression of alcoholism. However, when an individual drinks, how much, and how often they drink is also partially determined by their community, financial obligations, career obligations, and mental health. Italians pair drinking with their food. Business people frequently meet in hotels. Those of Irish descent traditionally drink ale and whiskey at local Irish pubs and bars. Those of German descent meet and greet each other at German bars and restaurants. Bereavement may bring about more drinking when grieving the loss of a loved one. Celebrations of milestones among friends, family, and peers are a time to rejoice.

Even if an individual is a heavy drinker or lacks control when drinking, their physical health is affected, and they are beginning to lose friends and the love and respect of family and co-workers, if they are still able to control or stop their drinking then they are not deemed an alcohol problem. A change in their lives such as moving interstate, changing jobs, joining a church, or seeking medical advice may be a sufficient catalyst to awaken them to the reality of their situation and stop or temper their drinking. While they may find it challenging and discouraging at times, a successful outcome is possible with ongoing help like medical or professional interventions.

The real alcoholic can control and enjoy their drinking in the early stages. As the years go by, they experience an inability to control their liquor consumption after that first drink, and then progress to abusing the substance.

This is the cunning and baffling aspect of alcoholism that raises the question ‘why me?’ Reluctantly and finally forced to acknowledge they live their life around when they can get that next drink, they contemplate why they can’t stay stopped and why it has become such an important factor in their daily life. Perhaps the reason for not being able to control their drinking is because of a dysfunctional upbringing. Others may believe it stems from physical or emotional abuse. Yet another may assume it is due to work pressures, marriage breakdowns, having kids, or even a global pandemic.

In the early years, just like other chronic maladies, alcoholism begins when the individual is unaware that anything is changing.

During these early stages after a night out on the town, they do not suffer much from withdrawal symptoms like anxiety, nervousness, shaking, nausea, insomnia, depression, or the rhetorical voice berating them the next morning for drinking in the first place. During this hidden stage the alcoholic appears normal. He might visit his G.P. who may give him a clean bill of health. What’s more, he has no reason to believe it is time for him to stop drinking. Hence, the alcoholic in the early stages of alcoholism experiences unnoticeable changes.

In bygone times, ‘alcoholic’ conjured up images of the chap on the park bench with an empty bottle inside a brown paper bag. Nowadays, we understand that alcoholism does not concern itself with gender, ethnicity, occupation, family upbringing, or socioeconomic status. Like other chronic illnesses, alcoholism can strike anyone at any time.

Literature about how genetics plays a major role in the diagnosis of alcoholism abounds, and yet controversy and debate continue unabated. Laypersons and professionals have their own theories about alcoholism. It is an illness. It is a sin requiring redemption. It is nature vs nurture. It is self-induced, a moral weakness, a lack of willpower. It is behavioural. It is cognitive.

Like other chronic illnesses such as arthritis, hypertension, asthma, back pain, cancer, cardiovascular disease, mental health conditions, diabetes, asthma, and hypertension, alcoholism is not a malady that goes away post treatment. Rather, there are effective, lasting treatments for those suffering from alcoholism, enabling an individual to go on to live a full and purposeful life, ever mindful, however, that recovery is only one day at a time. Many persons globally have recovered from the disease of alcoholism using many and varied approaches.

The Disease of Alcoholism

Dr. William D. Silkworth was an early medical pioneer in the early 20th century who identified alcoholism as a disease. Dr. Silkworth argued his perspective that specific individuals have a predisposition towards the disease of alcoholism. These susceptible persons, he suggested, have an allergy in the sense they are unable to say ‘no’ to drinking regardless of the circumstances. And once they take the first drink, a physical craving demands they continue to drink against their will, leading to an ‘involuntary suicide’.

On the other hand, if the potential alcoholic during treatment can come to understand the nature of the disease, they can experience recovery ‘one day at a time’. They will come to understand how the substance affects their personality, behaviour, and nervous system; why when ceasing drinking they are depressed, anxious, and afraid; why it makes them feel better; why they experience the need to drink especially in the early stages of treatment; why they cannot ever safely take one sip; why they will return to drinking if the disease is not treated. These fundamental issues must be confronted, answered, and reiterated frequently. Repetition is the mother of wisdom, especially when treating the disease of alcoholism.

Alcohol Addiction Therapy

Like treatment for other chronic maladies, as the person suffering from alcoholism understands their disease, they can then learn how to treat it and live with it. Moreover, once the alcoholic surrenders and accepts the reality that he or she is an alcoholic and commits to implementing the tools necessary to protect themselves against their disease, longevity of sobriety ensues. The heart and soul of recovery from alcoholism is accepting the disease concept of alcoholism whilst moving towards one day at a time. Permanent sobriety with peace of mind is the norm for an alcoholic.

The History of Alcoholics Anonymous

Historically, Dr. Silkworth’s theory on alcoholism birthed the fellowship known globally as Alcoholics Anonymous (A.A.). In 1934, Dr. Silkworth was treating alcoholism at Towns Hospital, New York city, when he met Mr. Bill Wilson who presented with chronic drinking and an inability to stay stopped. His life was becoming more and more out of control, and yet when he stopped drinking, things changed dramatically. He just couldn’t stay stopped over any considerable amount of time.

Notably, on his second consult, Dr. Silkworth shared his theory on alcoholism, affirming Bill was actually physically and mentally sick, AND that he suffered from an allergy to alcohol coupled with an obsession to drink. Only one drink was enough to spark off the phenomenon of craving, leading to periods of drunkenness and loss of self-control. Not completely understanding the disease concept of alcoholism, Bill applied this newfound knowledge, believing he now knew why he drank and it would only be a matter of willpower for him to stop. He felt he now had the ability to stop when, wherever, and if he wanted or needed to.

Dr. William Duncan Silkworth (1873– 1951)

(image source: https://en.wikipedia.org/wiki/William_Duncan_Silkworth)

It was only a matter of time (three to four months of not drinking) before the obsession to drink once again was overpowering. He found himself drinking again but was baffled as to why he had begun again, even though he ‘knew’ what he suffered from. Disillusioned, Bill again saw Dr. Silkworth, who reiterated he was hopeless when it came to resisting the substance, explaining to Bill’s wife Lois that Bill would have to be locked up to avoid delirium tremors (brain damage). Once again, Bill optimistically and with great anticipation believed any person receiving such a diagnosis would be compelled to stop altogether. Although he didn’t understand it, this was a stopgap solution as Bill drank again.

Edwin Throckmorton Thacher aka Ebby T(left) and Dr. William Duncan Silkworth (right)

(image source: https://silkworth.net/alcoholics-anonymous/ebby-t-the-man-who-carried-the-message-to-bill-w/)

So What Happened?

One of Bill’s old drinking buddies and his best friend, Ebby T., came to visit Bill in a healthy state of mind and body to share how he did not drink any longer. He told Bill his story about how two men from a spiritual group had vouched for him and got him sober, and he hadn’t had a drink for quite some time. More importantly, he shared with Bill the tenets of a group he attended and as he lived by these tenets, he had not had a drink since. Bill couldn’t believe this was the same drinking mate he had last seen hungover and in no condition to talk.

Finally, implementing the strategies Ebby suggested from the Oxford group, Bill got sober. However, he drank again and ended up back at Towns Hospital for the fourth and final time. Bill trusted Dr. Silkworth, the first medical specialist who seemed to ‘get him’ and who did not demoralise him, talk down to him, chastise him about his inability to stop drinking, or harangue him about the harm his drinking had caused and continued to cause. Once again, Dr. Silkworth detoxed Bill from alcohol, only this time (which also became the final time), Bill experienced his dramatic ‘spiritual encounter’ that released him from alcoholism. As he lay in his hospital bed, Bill wondered if he was sane and shared with Dr. Silkworth this ‘experience’, upon which Dr. Silkworth famously exclaimed, “Something has happened to you I don’t understand. But you had better hang on to it. Anything is better than the way you were” (Alcoholics Anonymous, 1988: p.14).

Bill then identified that the spiritual approach was the missing piece to Dr. Silkworth’s theory of alcoholism. For this spiritual experience to take hold, the patient had to be in a state of hopelessness with no other solution available to produce the desired psychic change. This insight – understanding that the patient was fundamentally suffering from a physical malady and a mental obsession (alcoholism) – went beyond Dr. Silkworth’s primary methodology of redirecting alcoholic patients from trying to find out ‘why,’ ‘how’, or ‘what’ caused their alcoholism and its devastating consequences. They were not a bad person trying to get good, but a sick person trying to get well.

How It Is

After finally experiencing permanent sobriety, Bill started sharing Dr. Silkworth’s theory of alcoholism – the illness coupled with the spiritual solution – with anyone who would listen. Additionally, Dr. Silkworth permitted Bill to go to the hospital to share with his alcoholic patients. Finally, Bill learned that the alcoholic was not interested in his spiritual conversion, but in identifying with Bill’s drinking story; one alcoholic talking to another. Then, and only then, was an alcoholic open-minded enough to learn and come to understand the disease concept of alcoholism and the road to recovery. This all came to fruition when Bill was introduced to the co-founder of A.A., Dr. Robert Smith. An alcoholic of epic proportions who had tried everything to stay stopped from drinking, he found nothing worked … until he met Bill who shared his experiences.

Since the inception of A.A., the fellowship has grown globally. A.A. members have sought and continue to seek treatment from many and varied addiction doctors, clinicians, counsellors, and specialists, who help the individual understand the disease of alcoholism and encourage their patient to attend the fellowship of A.A. The benefits of staying sober are infinite. The majority of recovered alcoholics go on to become long-time old-timers of A.A., still sharing their wisdom and saying what they do to stay sober over many ‘one day at a time’. They talk about how they got their families back, how they now experience peace of mind, how they are fully employed and feel purposeful and useful in society today.

Alcoholism is a family disease, hence a family recovery takes place. There is also help for family, friends, co-workers, and peers of the alcoholic in the form of Al-anon and Al-a Teen meetings and chats. These meetings are global. At the end of this article you will find a link with more information.

Alcohol Addiction Relapse

Just like a person suffering from any type of malady, relapse for an alcoholic goes with the territory. Most people suffering from an illness are given a specific treatment regime to follow. Many of these maladies have support groups, for example for medical illnesses i.e., diabetes, in Australia one may like to attend a Diabetes support group in their state i.e., Diabetes Queensland. For the malady of alcoholism, we at Karren-lee Addictionology® encourage the self-help group of Alcoholics Anonymous (A.A.). No matter the malady, people are human and over time they might decide not to follow their treatment regime, daily care plan or guidance from there treating health care practitioner.

For some individuals suffering from alcoholism if the alcoholic does not follow their treatment plan, they are at the mercy of a relapse. This reiterates the importance of the individual having a complete understanding of the disease of alcoholism; what they must do to get well, and how they can protect themselves from the physical allergy and mental obsession as well as the social pressures to drink after they move on from early treatment into post recovery. It is essential the person suffering from alcoholism learns a new lifestyle that will protect their sobriety.

Karren-Lee Addictionology®

Working in the field full time, I am often asked to explain how anyone can be ‘addicted’ to alcohol because in the 21st century everyone seems to be addicted to ‘something’. This is not a thoughtless question; there is quite a significant difference between suffering from the disease of alcoholism (or other substance abuse) or having a compulsion (whether it be behavioural or cognitive). Comprehending the disease concept of alcoholism is vital and may be the vital link to sustained recovery from the malady of alcoholism.

It is human nature for individuals to downplay the seriousness and severity of any ailment, and suffering from a substance addiction is no different. Generally, a potential alcoholic will call their problems or issues with alcohol something milder than alcoholism. This is because being an ‘addict’ is associated with being weak. It is frowned upon. There is something wrong with them.

Friends, family, drinking buddies, and work colleagues generally find it hard to understand why the potential alcoholic can’t start, moderate, or stop drinking like they can. Well-meaning friends put across the view that they can stop and so there must be something wrong with the potential alcoholic. They must be lacking somehow in willpower because if they really wanted to stop, they would, or they would at least temper their drinking. They may offer some well-meaning advice, such as, ‘Look, stay off the sprits, that is the problem, just drink beer or wine instead.’ Or perhaps, more forcefully, ‘If you don’t stop drinking you will lose your wife, children, or job, and remember what your addiction practitioner told you about the fatal nature of your situation if you don’t quit your drinking.’

Unfortunately, these stereotypical views towards an individual suffering when they drink stem from ignorance and misunderstanding. More often than not, such views are expressed by people who react differently when drinking than the way someone with an allergy to alcohol reacts. Therefore it is not hard to understand why a person suffering from alcoholism tries to minimise the severity of their condition.

Most people using a 12-step facilitation model (and other approaches) know the appropriate starting point for treatment is to become sober – abstain from the addictive substance. Hence, utilising the nomenclature ‘heavy drinker’, they rationalise their impulsiveness towards drinking. This makes way for the two major justifications that keep a potential alcoholic from facing the reality of their situation. It gives them an excuse to avoid facing the lifestyle changes, and it gives them permission to continue to fantasise about somehow, someday, someway, I will be normal when it comes to drinking and controlling my alcohol intake.

Vehemently denying that one has a problem with alcohol is challenging to maintain, especially in the face of the reality that the person is yearning to minimise their drinking. the individual may also downsize the issue: ‘I’m just impulsive when it comes to drinking, I’m really compulsive and obsessive around alcohol and I can’t help it.’ This is saying all they have to do is learn how to be less impulsive or compulsive, or temper their drinking. Using the terms ‘heavy drinker’, ‘compulsive’, and ‘impulsive’, ‘drinking behaviour’, or ‘habitual drinking’ is so much less stigmatising than ‘alcoholic’. It gives the person a façade of hope and integrity that addiction does not. In summary, the notion of being a heavy drinker, or compulsive around alcohol, is not as hard to accept as having a disease – alcoholism.

Using another term for one’s drinking problem does not demand a remedy, but at least they will get some attention to help them with their drinking ‘problems’. They could not possibly be an alcoholic. Words other than ‘alcoholic’ disclaim any responsibility for their behaviour. A person seeking help for their compulsion, habit, or behaviour learns how to moderate, but a person seeking help for alcoholism/addiction becomes sober/abstinent.

I reiterate it is human nature to minimise the condition. Let’s face it, the notion of not drinking, being sober, abstaining is overwhelming and frightening to say the least. Modifying the terminology used to describe one’s drinking has the additional benefit of keeping alive the fantasy that ‘yes, it is possible that someday, someway, somehow I will return to being a normal drinker’. There is no finality here. Either one is pregnant or one is not. One cannot be half pregnant. Either one suffers from the disease of alcoholism or one doesn’t. In the early days of learning about the disease of addiction – alcoholism in this case – one begins to understand the difference between compulsive elements involved in the addictive illness and the real necessity of abstinence for recovery from alcoholism.

At Karren-Lee Addictionology® treating the malady of alcoholism begins with a first inquiry, reaching out for information or help by email or by calling 1300 95 25 35.

My aim is primarily to provide a safe, confidential environment to work with the potential heavy drinker, abuser, or alcoholic. In dealing with a potential alcoholic, at whatever stage they are at in their drinking career, it is paramount that we begin by understanding what addiction is. This enables the individual to discern if they have a drinking problem or if they actually require help in another area. More importantly, the individual has sought the first stage of asking for help which may lead to being referred to a health care practitioner more specialised with what the individual is presenting with.

What Happens In Therapy?

12-Step Facilitation Therapy

I use 12-step facilitation model (12-Step Facilitation Therapy) which is a modality founded on several key principles. These aim to create a sense of purpose around abstinence – not including the substance of abuse – and ideally help an individual with an addiction shape their lifestyle accordingly. A major emphasis in self-help therapy is a strong social support system, helping each other to stay sober, clean, or abstinent (depending on the substance/s used).

Narrative Therapy

The 12-step facilitation model is complemented by Narrative Therapy. I form a collaborative relationship with the individual with an aim of reaching a substance-free outcome. As we externalise the individual’s issues, the individual begins to have insight on the negative consequences of substance abuse or addiction. This leads to recognising and developing an understanding of what the disease is and how it has manifested in the individual’s life. This non-pathological approach aids in dispelling restrictive labels. I highlight and focus on the individual’s strengths, instead of focusing on the patient’s weaknesses.

Motivational Therapy

Lastly, and particularly in post-recovery, when the individual has recovered from the disease of alcoholism – the addiction is in remission, and they are aware of the need to continue to treat the malady daily, I implement Motivational Therapy. This encourages patients to understand the reality of their addiction or substance abuse, helping to develop an intrinsic desire to change their lifestyle. Empathy is a core component underpinning the patient’s ability to understand where they are at when it comes to drinking.

PLEASE BE AWARE, that just because one has recovered from the malady of alcoholism and learns the importance of a daily program to specifically treat this malady, it does not mean the individual is immune to other health problems, issues and or concerns. Though the splendour of healing is indeed miraculous, it is important to not disparage the myriad of health practitioners and their services in post recovery.