Question: I had to stop drinking for an unrelated digestive crisis. I am a 56 year old lifetime heavy drinker and I know what alcohol does to me. I am moderately dependent physically because I drink every day but I am able to stop with no serious issues when I need to. This time I am sweating an insane amount every night when I try to sleep. I have to get up in the night every night to change my pyjamas and bed sheets because they are literally sopping wet. Why is alcohol detox making me sweat like this when it never did before? Is this a sign of something gone really wrong inside me?

Dr. Mark Abrahams Says...:

You have apparently come to a cross-road in life. Your body may not be sufficiently producing Aldehyde Dehydrogenases, a group of enzymes that are necessary to break down and metabolize ethyl alcohol. Your symptoms are probably commensurate with your degree of dependence. Severe perspiration (hyperhidrosis), occurring at night can be a harmless result of too many bed covers or too warm a room temperature, but based on your disclosure of alcohol consumption, it seems likely to be symptomatic of alcohol withdrawal. I've looked for a link that addresses your question: http://www.md-health.com/Alcohol-Sweating.html , however, the only way you will know if you have become symptomatic due to infection or dangerously compromised liver function, is to have a complete medical workup with an emphasis on liver enzymes. That means you need to make an appointment with a physician ASAP.

Question: Does anyone else have a problem with the 12 steps forcing you to constantly look back at all the shit you did that just makes you feel terrible today now that you are trying to move on? I know I am supposed to learn from it and make amends but the whole process picks away at my selfworth? Are you experts absolutely sure that AA is a helpful program? I feel like I can do this but it is like AA is telling me that I cannot. I feel like even if I can stay sober I will just feel like useless garbage.

Dr. Mark Abrahams Says...:

Bill Wilson created the A.A. (and subsequently, N.A.) after undergoing four years of LSD psychotherapy. Initially, Bill W. wanted to use LSD as part of a step program, but the government was already restricting its use to limited research, and by 1966, it was made a Schedule 1 drug. So, unable to employ psychedelics themselves, what Bill did was to created a system that imitated the increasingly healthy development that he experienced through his psychedelic psychotherapy. The A.A. steps are  very much like classic 8-Limbed Yoga, which seeks to remove the cruder physical obstacles in one's life first, then with increasing subtlety, one eliminates social, then psychological obstacles, eventually arriving at a more-or-less spiritual mode of being-in-the-world. 

However, 12-Step programs are intended to be conducted by laypeople, not psychotherapists, so it is up the the recovering person to supplement their recovery with psychotherapy. Your self worth, or self-esteem may well be a core issue underlying your addiction. The very first three steps requires an attitude of humility with which:

1. 1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. 2. Came to believe that a power greater than ourselves could restore us to sanity.
3. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

Question: Why do I feel so ashamed when I wake up after drinking if I did not do anything that I am ashamed of the night before? I do not think there is anything wrong with getting drunk in my own house. I am not a violent person actually I am supposed to be a very happy and funny drunk but no matter what happened the night before I wake up feeling so ashamed I could almost cry.

Dr. Mark Abrahams Says...:

I am referring to these words specifically: "I am supposed to be a very happy and funny drunk." This clause is like a compressed file, there is so much information in it that you have expressed, yet seem oblivious of. In the first place, you are disclosing your identity as a "drunk," and that alone is a basis for much concern. The term drunk is a colloquial expression for alcoholic when it is used as a noun, which is how it is expressed in your words. It has a meaning of less concern when it is used as a verb, as in 'getting drunk.' 

Being a drunk, an alcoholic, is not, as the supposedly stereotypical notion of being "happy and funny," (often depicted as a partier putting a lampshade on his/her head, because [s]he's 'lit'), is just the opposite. Compulsive, addictive drinking is not indicative of a "happy" person, and as for being "funny," more people are laughing 'at' the antics of a disinhibited drunken person, than 'with' them. They are been made 'fun' of, often behind their backs, which is to say, contemptuously. As for the word 'fun' itself, I used to point out to the adolescents I used to work with that the letters f-u-n are the first three letters in funeral, especially in regards to their experimentation with drugs and alcohol, but the same applies to adults. Alcoholic fibrosis and cirrhosis of the liver are commonly the result of people with Alcohol Abuse and Dependence Disorders, but there are lots of other negative medical consequences, brain shrinkage, Korsakoff's Syndrome, esophageal cancer, etc..

It is not only the social consequences of drunkenness that you are becoming emotional to. You know that consumption of alcohol to the point of gross intoxication means not only inebriation but also alcohol toxicity, which is self-damaging on the level of cells, tissues, and whole organs. This is an act of self-destruction that is being repeated compulsively, but the question is 'why?' Are you self-medicating? Is there an old trauma that is in the 'back of your mind' yet eats at you chronically, but which is forgotten when you're drunk? Does your morning-after shame really have to do with a 'shamed child syndrome' because you are unnecessarily ashamed of something that happened to you long ago? And further, could it be possible that the miserable feelings associated with a hangover remind you at some level about miserable feelings you felt long ago after one or more traumatic events? Are you playing 'chemical Russian roulette, secretly hoping that one morning you will simply not wake up, having died from acute alcohol toxicity? These are just a few of the questions that a capable therapist could tease out from a clinical history, psychotherapy, or hypnotherapeutic regression, depending on how available to consciousness your personal history is, or how repressed into your unconscious. 

Checking in at this site was a good first move, and your next move is to seek actual psychological counseling. I wish you well on your path of self-knowledge and recovery from whatever pain you have been seeking to escape from.

Question: I am an alcoholic in recovery. I am 8 months sober and I am feeling OK. I drank for 20 years. Do I need to get my liver checked out if I do not have any worrisome symptoms?

Dr. Mark Abrahams Says...:

...Anything else is entirely your choice. If you haven't been getting blood drawn regularly every year or two as part of a regular medical check-up, then that has been largely your choice as well, although I don't know anything about your life including employment, finances, medical insurance, etc.. Health is at the top of my priorities in life, but I won't assume that is true for most people I meet. So, personally, I would certainly have a blood work-up, with an emphasis on liver enzymes, along with a complete physical, and I'd inquire about whether [s]he recommends an endoscopy to check the condition of my esophagus (checking the blood vessels as well as early signs of esophageal cancer). But again, that's just me, and I am not giving medical advice since I'm not a licensed medical doctor.

Question: Is it within a range of normal that a guy could still have some mild shakes after 2 weeks without drinking. I am also still much sweatier than usual. These shakes are nothing dramatic but I wouldn’t want to try eating a bowl of hot soup at the moment so they are noticeable and they are hard to explain away at work. One of my rowdier students actually asked me in front of the class today if I was nervous about something. I am a teacher so being a drunk is frowned upon though I am sure some of my peers knew I drank rather more than was good for me. I never drank before or at school so I am perplexed to be having such extreme and lasting shakes. For the last 6 months I was a daily 2 bottle of wine a night drinker. Prior to that I was more a heavy but still social level drinker.

Dr. Mark Abrahams Says...:

...And no offense, but typically, readily-admitted amounts of drinking tend to be on the conservative side. I also drink wine on a pretty regular basis, but 1 or 2 glasses is now typical for me, down from 3 (splitting a bottle with my wife). However, being fond of the grape, I have on occasion followed wine consumption with a nice cognac. The cost keeps this practice down to very limited consumption, and honestly, it's been quite a while since I've been truly intoxicated.

Personally, I've never experienced alcohol withdrawal symptoms, but if I did, I would consult my primary care physician for advise on whether my withdrawal needed to be monitored in a live-in detox facility where small amounts of tranquilizers were administered to ease the recovery. Sudden withdrawal from heavy alcohol consumption can be fatal, and no doubt, below that particular threshold, all manner of symptoms can arise and persist. You really should be taking the proper vitamin supplements during this transition (especially B-complex), and consulting with a dietician as well. Some of the nootropic supplements might also be in order, but I am not qualified to make recommendations, so please ask someone who is! It is possible that your physician can cover all of these bases, but that is rare. Moreover, I am assuming that you actually have a regular physician. 

Ethyl alcohol is a neurotoxin that can damage virtually every system in the body. It may be marketed as a beverage, but make no mistake about it, it is the toxin in the word intoxication. 

Question: I quit alcohol 16 days ago. The first days were really hard but after day 3 I felt better than I had felt for a long time. Yesterday all of a sudden I started feeling disassociated and extreme anxiety for no reason and I have had nagging anxiety bugging me since I woke up today with no cause for it. Could what I am feeling be related to my withdrawal such as related to PAWS? I never took the vitamin regimens that were suggested to me to avoid PAWS but is it still too late to do anything about it?

Dr. Mark Abrahams Says...:

...You need to consult with a medical doctor. I am a non-medical practitioner who is not licensed to dispense either medicine or medical advice. I do not have enough information about you, like whether you required or even consulted a physician about getting off alcohol, what the level of your dependence was, what degree of withdrawal symptoms you had, etc. Abrupt withdrawal from severe alcohol dependence can be dangerous and even fatal, so I'm assuming you weren't in rehab undergoing detoxification (but I don't know), and it's good you're still out there and asking questions! You just need to ask the appropriate experts.

If a physician recommended a vitamin regime (especially B-complex, or an emphasis on B1, that says to me that you had a significant problem and should most definitely be taking these, so please begin! The result of specific vitamin deficiencies can create grave medical conditions. Vitamin B1 (Thiamine) deficiency alone, for example, can result in Korsakoff's Syndrome, with cerebral atrophy - brain shrinkage! This in turn can create all manner of neurological impairments, like a shuffling gait, or confabulation (unintentionally fabricating complicated answers to simple questions), and severe memory loss that can effect one's ability to perform long practiced physical tasks. 

Do yourself a favor and follow a medical professional's advice here, alcohol is a dangerous toxin, ands PAWS is a statistically probable result if your dependence has been significant. Ask your physician if a GABA (Gamma-Amino Butyric Acid) supplement would be advised to relieve anxiety and facilitate sleep, but do not simply obtain this substance and dose yourself! It often helps to research things in order to ask pertinent questions of our physicians, but they are the ones who are versed in contraindications based on your own specific medical history. I know people who have taken GABA with negative effects. Please do not continue to take your recovery lightly.

Question: Life hurts so much I can’t take it unless I am drunk. I has 6 months sober a few years ago and it was the best time of my life but I could not keep it and I can not get it back. My need is too strong it is stronger than anything. I am in so much pain and I feel like I do not know what to do.

Dr. Mark Abrahams Says...:

But you most likely already knew that. This on-line counseling site is great, but it is not a substitute for an Alcoholics Anonymous® meeting. I used to take shy clients to meetings years ago when I was working as a substance abuse counselor on a full-time basis. I wrote a paper of the effectiveness of the 12 steps which was published by a professional counseling journal years ago, and I still support the philosophy.  

Bill Wilson created A.A. much like a Yoga discipline, in which one works to eliminate the grosser problems first, then the increasingly more subtle problem areas. Problem areas range from the gross physical aspects of addiction, up through social consequences, psychological difficulties, and finally spiritual maladies. Bill Wilson corresponded with the great psychologist C.G. Jung over the spiritual problem of meaninglessness that beset alcoholics, and learned how a religious experience is necessary for healing to begin. Regardless of your own religious convictions, or total lack of them, an Ultimate Reality is undeniable. How one regards the Ultimately Real (personal, impersonal, or transpersonal) is up to each individual, but it is critical that one begins to acknowledge a Power that is greater than your ego, and that you need to become aware of 'It' if you are ever to become healthy.

In addition to the steps themselves, you need a social support network, and undoubtedly a sponsor. Sit in on open meetings and find one group that suits you. Please do not shop around, find flaws with every group, and give up. Denial and blaming are first and second, but rationalization may well be the third most common defense mechanism in these matters. Also, the choice to Awaken from the semi-conscious existence you have been trapped in is an individual choice, so you have to be on your own when you choose to attend a meeting. Give yourself a chance and you'll make friends there, which is another motive for doing 90 meetings in 90 days. I wish you the best on your journey!

Question: I know my son has smoked marijuana. He is the type of person who is probably going to experiment with different things whether I want him to or not. I know better than to try to stop him from doing what he is going to do anyway, so I prefer to try to just steer him away from the most dangerous choices he could make. He is smart and he can spot bullshit a mile away, so I also can’t lie to him or tell him something unless I am sure it is true. I want to give him a list of drugs and rank them from most dangerous to least dangerous, based on their addictiveness, and risks of short term and long term consequences. I think if he and his friends had this information they might make better choices about what they will use. If it is not too much trouble, can you tell me what are the worst and what are the least dangerous drugs for teenagers to experiment with?

Dr. Mark Abrahams Says...:

Your question is based on a false premise, namely, "what are the worst and what are the least dangerous drugs..." For example, I have known heroin users, who used for 30 years without an overdose - including a favorite cousin of mine. Am I saying that heroin is not dangerous? No! 

More recently, I met the 20 year old brother of a middle school girl, who attended a family counseling session. He was in a helping profession himself, and never used recreational drugs, until one night when his new girlfriend gave him a single tablet, probably what is now called 'Molly.' Molly is supposed to be the 'relatively less dangerous' drug 'Ecstasy' or MDMA. Unfortunately, 'Molly' often contains all kinds of dangerous analogue drugs, and this strong 20 year old man felt ill, called his mother to pick him up from a large warehouse party, and went to the hospital. He suffered brain-death that very night, and was taken off the ventilator by morning. The toxicology report was inconclusive. True story.

The issue is not which drug is more dangerous, the issue is that you do not know what you are actually getting on the street unless, quite frankly, you know the chemist. I have known heroin users who were intentionally killed with a 'hot shot,' poison of one sort or another sold as heroin. Even LSD-25, which is not physically poisonous or addictive, despite the bad rap its gotten over the decades, is being replaced by a new substance, 25I-NBOMe, which also works in extremely tiny amounts, is sold like 'acid' as small blotters, but IS toxic, and HAS resulted in a number of deaths, according to Wikipedia.

The slogan, 'Just Say No,' might work in elementary school, but by middle school, it is useless (I have 27 years of experience as a substance abuse specialist in middle schools). A better slogan is 'Just Say Know,' and by this I mean that young people need to know not only what the effects and hazards are for recreational drugs, they have to know that in the past few years the risk has gone way up because of the the substitution of 'relatively less dangerous' drugs for some very dangerous drugs.

There is nothing I could recommend in this case. Marijuana has not killed anyone directly by overdose to my knowledge, but people have driven while very stoned and killed others. If one knew that Psilocybin-containing mushrooms were actually that, and not a poisonous look-alike (inebriating 'Liberty Caps' sometime grow right next to deadly Galerinas, and look identical to the untrained eye), then toxicity wouldn't be the problem, but a hallucinogen-induced psychosis, or dangerously reckless behavior might still remain a danger. Pharmaceutical drugs are the cause of more overdose deaths than anything else at this time, and should be avoided for multiple reasons, but purportedly 'less dangerous' street drugs might turn out to be a whole lot more toxic than one expected, with tragic consequences. 

Question: I have spent almost half my life in active addiction primarily to alcohol but I am a functional addict. My addiction may cause me a lot of health and family problems but I always got to work on time and got my job done and I am proud of this. I cant stand people who bring their personal life to work. Now I am 21 days sober and it’s the longest I have been sober in years and I admit that I am very on edge and irritable and most of all I really can’t focus on my work. I can’t think straight and my short term memory is pathetic I am just trying to take things one day at a time and going to meetings every evening. I am a county clerk. Ironically I was a valued employee while drinking but yesterday my supervisor called me into her office and reprimanded me for my poor work attitude and sloppiness. I am so discouraged right now because I can’t do any better than I am doing and now I might risk my job. I don’t want to tell my workmates about my alcoholism so I don’t know how to explain myself and I am worried that I am going to be sober but unemployed.

Dr. Mark Abrahams Says...:

I sympathize with your plight, you are 'between a rock and a hard place,' as the expression goes. I understand that you do not want to reveal the exact nature of the condition that you are working hard to correct, but you are in a 'rocky' phase of that treatment, and it is manifesting in your work performance. Whether or not you are being forthcoming, your supervisor will be venturing guesses, and she may even have arrived at an accurate conclusion. What she doesn't realize is that your drop in performance is due to a treatment process, not as a result of using alcohol on the job! I would suggest that you see your medical doctor, who really should be aware of your secret life anyway. If you have been attending a 12-Step Program, you should be able to come away with a 30 day chip, if your physician needs some kind of proof that you've been attending meetings, but regardless, ask him/her for a note that you are undergoing a period of treatment. 

You have to be open about this to your physician, because [s]he needs to be part of the treatment process to ethically write such a note. It does not have to be specific, no doubt your supervisor will figure it out herself, but it presents a picture of you being in control rather than intentionally acting in some irresponsible way, and trying to deceive people at work. This is the best compromise I can come up with. Consider the bringing of your physician into the loop to be a fulfillment of Step #5: "Admitted to God, to ourselves, and to another human being the exact nature of our wrongs." If you do not have a regular physician, or the answer is 'no,' consider seeing a psychotherapist who has experience with substance abuse issues, to help you through this phase, but first ask if in the course of therapy, [s]he would be able to supply you with such a letter. If you were my client, and you were earnest about getting clean, I would write such a letter. 

Your secretiveness is a form of deception that you need to forego anyway. You already are seeing the writing on the wall with regard to your job. It may be something of a gamble to bring your supervisor into your personal life, but if you do not take a chance on her ability to understand, in her current view, she is suspicious of what's up with you. Continued paranoia of your supervisor may well result in your termination. Best wishes!

Question: Smokers who quit smoking by a certain age and stay quit for decades eventually have the same risk for cancer and early death as people who never smoked at all. Is this the same thing with heavy drinkers?

Dr. Mark Abrahams Says...:

Putting carcinogens into your body can result in mutations that lie dormant for years. I had a co-worker who fell in her classroom and broke her knee. They X-rayed her for broken ribs but found a lung cancer the size of a golf ball. She had quit smoking 19 years earlier. They removed half a lung and several years later a tumor was found around her spinal cord in her neck. They could not remove all of it. Another few years went by and she developed a brain tumor, which was removed, rendering half her body paralyzed. In all probability, it all stemmed from her smoking. 

As for the drinking, I had half a dozen friends from high school who began to drink at age 15. By age 20-21, they all developed fibrosis or cirrhosis of the liver, and had to stop drinking forever or die. That was 1973. At our high school graduation, 30 years later, five of those guys were doing well in life. Whatever medical problems they may have shared (like Bipolar Disorder in one) was unrelated to their alcohol dependence. The sixth guy just surfaced recently. The others all thought he was long dead. Not! He's married, has kids, is OK. We're all 60 years old. Too much liver being destroyed will require a transplant (not an easy thing to get or a guarantee), but I've clearly seen people survive for decades, once they stop drinking.

I realize that this is neither a medical or a statistical response but a personal one. Genetics is a huge factor. I disagree with your statement, and think that smoking greatly increases one's risk for certain kinds of cancer (throat, lung, pancreatic for example). Of course, I had a colleague who died from cancer of the mouth and never smoked, so this kind of thing does happen. I've heard physicians say that 50% of smokers do develop life-threatening diseases such as cardio-vascular disease, emphysema, or cancers. The other 50% suffer from diminished health of various sorts, often with the loss of skin elasticity, early and excessive wrinkles, yellow teeth, gum disease, stained fingers, etc.. Loss of energy, stamina, and a compromised immune system from regular destruction of Vitamin C from tobacco smoke reduce the quality of life in my opinion, and there is the negative social effect on non-smokers.