It’s Spring, and all the signs are there that summer’s on the way: the temperatures are rising, the days are getting longer, and every other commercial features beautiful adults having an enviably good time with ice-cold beverages in hand. Alcoholic beverages. We are a culture that loves to celebrate, and sharing alcohol is an almost ubiquitous part of those events where we gather together to do it. According to recent data, 85% of us reported that we consumed alcohol at some point in our adult lives and there is an entire population of underage drinkers whose participation is unreported. Drinking is a rite of passage for many, among the first experimentations for young adults into the forbidden and far-off world of Being Grown Up.
For most, drinking alcohol is enjoyed in moderation, with the occasional binge into drunken indulgence. But, for approximately 15 million people in America, there is no occasional, and there is limited, even zero ability to control their alcohol consumption. These are the members of our communities struggling with Alcohol Use Disorder (AUD), a well-defined condition that combines the symptoms of alcohol abuse and alcohol dependence into one, diagnosable disorder.
15 million people in America, there is no occasional, and there is limited, even zero ability to control their alcohol consumption.
The most common symptoms include:
- Inability to limit the amount of alcohol consumed
- Wanting (and failing repeatedly) to reduce how much alcohol is consumed
- Experiencing strong cravings to drink
- Withdrawing from social, family, or work activities in order to drink
- Using alcohol in potentially dangerous situations, like driving
- Needing to consume more alcohol in order to feel the same effect, or feeling less effect while consuming the same amount
- Experiencing withdrawal symptoms, like nausea, sweating, and shaking when not consuming alcohol – or, using alcohol to ensure there is no onset of such discomfort
In severe cases, AUD may be referred to as Alcoholism, though to be clear, not everyone diagnosed with AUD has or even develops alcoholism, which involves other factors such as a physical dependence on alcohol and genetic predisposition. Physiologically, withdrawal symptoms for someone in the first days of recovery from alcoholism are markedly life-threatening, especially during the 12-72 hours following that last drink. During this time, the body’s efforts to clear the system of alcohol can result in mental or emotional confusion, racing heartbeat, high blood pressure, fever, and sweating; for a rare few, withdrawal causes fatal cardiovascular failure or lethal respiratory collapse. After a week free of alcohol, the physical body becomes free of fatal detox symptoms, and the far more challenging recovery of the emotional dependence can begin.
Interestingly, it isn’t the alcohol itself, but its secondary effect of triggering the release of dopamine in the brain that makes it both a pleasure and a potential torment. Despite the fact that alcohol is a Central Nervous System depressant, the chemically reinforced perception remains that drinking is quintessentially required for the good times to roll. Alcohol, however, has a biological agenda of its own, with far less glamorous effects.
Dr. Helen Farrell notes, “With every drink of alcohol, the frontal lobe of the brain – the part that helps us prioritize, strategize, and filter information – takes a hit. Repeated use disrupts the development and neural circuitry of this key organ. When the frontal lobe is damaged, so is our ability to inhibit impulsivity and delay gratification”. The perceived need for alcohol to enjoy oneself and be accepted, combined with the physical effects of its consumption are fertile grounds for Alcoholism and Alcohol Use Disorder – real illnesses, to be treated like any other imbalance to the body and mind. The unique problem facing those in treatment for these disorders is that the compromise to the frontal lobe feeds the skewed popular beliefs equating AUD and alcoholism with conditions like HIV and herpes. Additionally , the same marketing and entertainment venues that relentlessly portray alcohol as necessary to be socially accepted, loved, and valued have similarly reinforced the portrayal of alcohol abusers as irredeemably violent, dramatically irresponsible and derelict failures.
When beginning the process of recovery, it becomes glaringly obvious within the group dynamic that Someone is Not Drinking, which invites intense peer pressure to resume drinking, as well as ridicule and eventual avoidance when the recovering drinker resists. Even Alcoholics Anonymous mandates the rule of anonymity to protect its members from possible exposure within the community. Recovery can be as lonely as it is brutally difficult: “Alcoholics are equated in social contexts to people who are unlovable, unemployed, and criminals. In short, addictions are treated like moral and criminal issues”, rather than the illnesses they are. Now excluded from the bonding social rituals that once provided camaraderie and context, and without alcohol triggering the dopamine flow, the reward of feeling good evaporates, likely causing anxiety, depression, and relapse.
Until the emergence of the Affordable Care Act, those in need of professional treatment frequently refused to seek it because of a lack of health insurance, fear of being turned away, and anxiety about the costs of treatment. Providers were quick to turn patients away because there was no assurance of reimbursement for their services. Under the terms of the ACA, all health insurance sold on the Health Insurance Exchanges, or provided by Medicaid, must include provisions for services to treat substance abuse disorders. Under this new legitimization and with clear formulas for obtaining treatment, the weight of recovery can shift, from shame to dialog and to healing instead of hiding.
Recovery is a process. It is long, and sometimes soul-grindingly hard. Never far from a relapse, recovering patients must be ever-vigilant and unswervingly dedicated to finding or creating healthy patterns and trigger management techniques that improve the chances of lasting progress. How much more powerful, then, to have those tools made familiar and supportable by friends, family, and co-workers?
April is Alcohol Abuse Awareness Month, and opportunities to eradicate the stigma of addiction with supportive education are plentiful. Organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA), have established pro-recovery programs like the Recovery Community Services Program (RCSP), which provides peer-based recovery support services across the country. While formal organizations are excellent for their work, there are valuable efforts to be made on a much smaller scale, as well. Encouraging and modeling small changes with mindful actions such as hosting events without alcohol have the power to shift perspectives from judgment to acceptance – and perhaps even to self-awareness and prevention. Sharing tips with parents regarding how and when to speak with their children about alcohol and addiction normalizes this kind of communication and has the potential for far-reaching impact on both experimentation and peer pressure. As the weather warms and the coolers fill, take a moment to examine your own position on alcohol, addiction and substance abuse – the most important enlightenment you find may be your own.