Myths and misconceptions regarding Alcoholics Anonymous that continue to prevent people from accessing self-help. For the atheist or agnostic, concerns about having a "Higher Power" are a significant obstacles that can be overcome.

G.O.D. is a great acronym. It stands for Group Of Drunks.

It’s a great Higher Power in and of itself. It’s simply an acknowledgement that the group of Alcoholics Anonymous is more powerful and has more ability to promote sobriety & recovery than does the individual alcoholic.

If worry about believing in God or a bearded guy in the sky keeps you from utilizing AA to achieve transformation, consider this a viable option. As anyone who is working a good program in AA will tell you: “Take what you like and leave the rest.”

The Buffet Approach

Ask a therapist what type of therapy they do and they’re very likely to say, “Cognitive Behavioral Therapy.” Most of us say that because it’s safe and accepted.

However, I have consistently found that the best clinicians practice eclecticism. They take from many different disciplines and approaches to tailor treatment to the individual, resulting in something that is more personal and therefore more effective. This could be conceptualized as multidimensional, but I just call it the “buffet approach.”

The Buffet Approach at AA Meetings

When you go to a buffet, you take what you want and leave everything that doesn’t appeal to you. We’re free to use the same approach with self help programs. Going to an AA meeting allows one to consult informally with a room full of experts on what does and does not work for them individually and collectively.

Plenty of folks in AA don’t care for religion or rigid belief. They just found that they could not stay sober alone and they found that they needed to have faith in something more powerful than self. Some connect to nature, some to religion, some to spirituality, and some to a Group Of Drunks.

Whatever works for you is okay with them.

Overcoming Your Fears by Giving AA a Try

You can search the world over for people who are trying to change their lives while abstaining from use of drugs and alcohol… or you can attend a local AA meeting.

Despite sharing the fact that I am not an alcoholic, I have consistently been warmly welcomed and included in every AA meeting I’ve attended. This inclusion and respect demonstrates their open mindedness and acceptance.

I’ve found that resistance is almost always fear based. When people object to a singular aspect of something they are probably taking a very limited view. Fear narrows our perspective. It’s not hard to find seemingly compelling reasons why we can’t possibly do the thing we’re afraid to do. Ultimately, the question becomes, “What would you do if you weren’t afraid?”

William James said, “Faith is a bet you can’t lose.” If believing in anything brings one peace or purpose or joy, what’s the harm?

Too many of us fear the freedom of choosing our own beliefs, especially via the buffet approach. My friends in AA remind me, “Religion is for people who are afraid to go to hell and spirituality is for those of us who have already been there.” Spirituality is all inclusive. It is whatever you need it to be. To me, it’s about connection. What we can do together is so much greater than what we can do alone.

Go to a meeting with an open mind. What do you have to lose?

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New to AA? Start here – a list of 9 quick-read articles answering all your important questions on getting started with the 12 steps.

Walking into your first AA meeting takes a lot of courage, especially when you don't know what to expect. Fortunately, a little foreknowledge can ease your anxiety. Read a few of the 9 short articles below (pick and choose those that interest you) and you'll feel better about taking that first important step that precedes all the others – walking into a meeting for the first time.

Getting Started with AA, What You Need to Know

1. What Happens at AA Meetings?

If you’ve never attended an AA meeting, start your reading here. Addiction counselor and in-recovery expert Anna Deeds lists everything you need to know and outlines what to expect at your first AA meetings, such as:

• Where do I find a meeting?
• What are the different types of meetings?
• What happens at meetings (a minute-by minute break-down)?
• Tips for succeeding with AA.

2. How and Why AA Works

What happens at AA that helps you stay sober?

Well, after much investigation, researchers identified a number of individual helping mechanisms, for example, AA helps you: build and sustain motivation, increase coping skills, increase self confidence, facilitate a change in social networks, and more.

3. Debunking Negative AA Myths

Is AA a cult? Do you have to believe in God?....

You’ve probably heard a lot about AA – but how much of it was true? In this article, recovery expert Jim LaPierre presents and debunks 7 common AA myths. 

4. AA for Atheists - Is It Possible?

You don’t have to believe in a Christian God to work a 12 Step program – you define your ‘higher power’ and it can match with whatever spiritual beliefs you hold – even G.O.D. – the power of a Group Of Drunks.

5. At Meetings, Do You Have to Talk in Front of the Group?

Don’t let anxiety about speaking in front of a group of strangers deter you. Alcoholism expert Melissa Borlie breaks down the different types of meetings (at open meetings you won’t be asked to participate) and reminds us that you should never be pressured to contribute if you don’t want to. Different groups have different vibes, and if you’re not comfortable in one group (or are feeling unwanted pressure) there’s always another one to try.

Also read about AA donation etiquette – don’t let an in ability to pitch into the basket stop you from attending. 

6. Are You too Smart for AA?

You may be pretty smart, but arrogance and over-thinking can end your recovery efforts before they get started – and if your ways were working so well, you probably wouldn’t need help in the first place!

You don’t have to stop thinking and questioning, but in the early days, keeping an open mind opens you up to a new way of being. Read this article and prevent a high I.Q. from derailing your efforts. 

7. AA in Rehab – Why It’s Useful

Experts often use the toolbox analogy to describe addiction treatment – you go to treatment to learn new tools that you can add to your toolbox – and the more tools you have at your disposal, the better your long-term recovery odds.

Rehabs that offer 12 step facilitation offer a powerful tool for long term recovery – an introduction to the power of community-based support. Research shows that people who get introduced to the 12 steps in treatment attend more meetings post treatment and have better overall outcomes. 

8. Why Helping Others Helps You Stay Sober

To keep it, you have to give it away…

You can attend meetings, or you can attend meetings and get involved with helping out, such as by sponsoring, sharing experiences, taking on 2 month service positions, etc.

Getting involved certainly helps others, but research shows that it probably helps you even more – in fact, people who get involved with 12 steps ‘helping’ develop a stronger connection to the program and are more likely to stay sober over the long-run.

9. Don’t Worry about Making Amends!

Not at first, anyway. Making amends is an essential component of 12 step recovery, and by striving to make up for your past wrongs you free yourself from a lot of relapse-provoking guilt and shame..

However, if you’re just starting out with the steps, it’s not something you’ll have to worry about for a while – not until you’re ready. You do the steps in chronological order and it can take some people years to get to steps 8 and 9.

Never let amends apprehension deter you from getting the help you need.

Try to Keep an Open Mind

If you haven’t yet tried a meeting, what do you have to lose? They’re free, they’re everywhere and millions swear by the steps as literal lifesavers.

That being said, not everyone feels comfortable with the AA program, and there are some great alternatives, but don’t dismiss the 12 steps after a single meeting, to give it an honest try you have to go a few times and keep an open mind. You should also try out a few groups – since different groups can have very different atmospheres, and while one might feel awkward, the next might feel just right.

One of the finest compliments I receive from recovering alcoholics is that despite the fact that I am not an alcoholic, I understand how their minds work. I have profound respect for all the old sayings in AA. Some are open to interpretation - the "insanity of our disease" is a literal statement.

Friends and family of active alcoholics ask me to explain how the alcoholic thinks. I am happy to share what I have learned after we establish what their motives are.

The Insanity of Alcoholism

Sadly, well intentioned folks try to protect the alcoholic from him/herself (enabling) or try to predict what they will do next (no crystal ball available). There are hundreds of wise sayings amongst alcoholics in recovery. Some are meant to make you think and some are meant to be taken very literally. Alcoholics Anonymous refers to, “the insanity of our disease.” This is a very literal statement. I can tell you a bit about understanding the active alcoholic but I cannot make it make sense to you because understanding the active alcoholic requires stripping away a lot of rational thought, the acknowledgement and willingness to learn from mistakes, the ability to recognize obvious patterns of behavior, and quite often, the application of common sense.

There are at least a hundred forms of alcoholism. What I am describing here is the person who is still drinking, is high functioning, and has not yet lost the things they hold dear. The disease of addiction dictates that they will lose these things in time and the rule of threes dictates a grim long term prognosis (jail, institution, and/or death).

Alcoholics think, act, believe, and feel based on distorted perceptions or themselves and the world around them. They live at the extremes of all or nothing. There is no moderation, no middle ground, no compromise, and no gray area in their worldview. To varying degrees, alcoholics live in denial of their destructiveness (self and others) and this further distorts what they are able to make sense of.

"Probably"

Alcoholics are the very best liars because they are able to use rationalization and justification to convince themselves that a lie is truth. This happens subconsciously. They are not aware that they are, if you’ll pardon the term – mind screwing themselves. Alcoholics adopt a language that facilitates lying in a way that sounds very well intentioned. Their favorite word is, “probably.” This word implies intention where in fact none exists. An alcoholic who tells you they will probably do something is highly unlikely to do it. Using words like these provides them a loop hole – an escape hatch in which no absolutes are given and no promises made. The alcoholic relies on words and phrases like: possibly, maybe, would, could, should, I’d like to, I want to, I need to. These words mean nothing. They sound good but almost always lead to disappointment. Progressively, alcoholism blurs every line and impacts every interaction, every relationship, every part of the alcoholic’s world.

Firehouse Management

Putting blinders on a horse leaves it with no peripheral vision – such is the worldview of the alcoholic. They may attend to many things, but in order to do so they must turn their attention away from one thing and toward another. Multitasking for the alcoholic means making many messes at once. There is no balance for the active alcoholic. As one area of their life declines they will often focus their attention on it and take it to an extreme. As this happens, another part of their life declines and gradually their life becomes dictated by “firehouse management” – every course of action becomes based on the most pressing problem. This is an inevitably downward spiral, though some alcoholics manage to maintain it for a very long time.

External Locus of Control

As alcoholics tend to drink progressively more they will generally conceal the frequency and amount they drink. They will tell you they only had three glasses of wine and this is true. What they have not told you is that each glass was a 16 ounce tumbler. It is not only the drinking that gets hidden; it is also the negative affects alcohol produces in their lives. Alcoholics develop what counselors call “an external locus of control.” Progressively, everything is someone else’s fault. If their job is going poorly it’s because their boss hates them. If their marriage suffers then their spouse is unreasonable. If they fail as parents they will see their children as ungrateful. Everything and everyone becomes a reason to drink. The spiraling alcoholic will often say that they don’t even want to drink but that circumstances like their horrible job/spouse/kids “force” them to.

Self-Pity and the Sense of Entitlement

Alcoholics often have a bizarre sense of entitlement. They reason that having such a difficult/stressful/demanding life entitles them to act in ways that are immature, irresponsible, and selfish. To observe their behavior is to conclude a belief that the world must owe them something. The active alcoholic wallows in self-pity and concludes that they are a victim of life. As they demand more from the world they expect less and less from themselves.

Appearance over Substance

The quickest route to self destruction for alcoholics are the words, “Screw it.” This is a declaration that everything is already screwed so they might as well drink. When people decide to stop drinking we encourage them to notice that “It” is actually, “Me.” This is evident in, “It’s not worth it.” On some level the alcoholic always knows the truth and they are usually working hard not to know it. They pretend and demand that those close to them buy into the fantasy that all is well. Life becomes progressively less about anything substantive and progressively more about maintaining appearances. This is well explained in Pink’s song, “Family Portrait.” “In our family portrait we look pretty happy. We look pretty normal…”

Master Manipulators

Alcoholics are master manipulators. They may not have been con artists before they started drinking but they come to have remarkable skills. They are the folks who can sell ice to Eskimos. They will pick a fight with you because they want to leave and they will have you believing it’s your fault. They show little or no accountability. They may have had integrity before their addiction kicked in but it will be conspicuously absent from their lives as they spiral. There is often one exception to this rule for each alcoholic – one thing they do especially well and it will most generally be their sole source of self esteem. We have known a large number of alcoholics who have incredible work ethics because being a good worker is the one thing they know they’re good at…well, they will say that and drinking.

Alcoholism - A Unique Disease

The disease of alcoholism gradually and insidiously strips everything away from a person. We have been asked countless times whether alcoholism is truly a disease or a choice. In truth it is both. Alcoholism is unique as a disease in that it not only hides from view – it also lies to its carrier about its presence. The person who is active in addiction has a unique choice relative to all other diseases. The alcoholic can go into remission at any time and many do. We see that alcoholics will abstain from drinking for a time to prove to themselves or others that they are not addicted, only to return later with a vengeance.

Alcoholics Anonymous (the only real recovery)

Recovery from alcoholism involves far more than sobriety. Recovery from alcoholism involves changing every part of a person’s life. The person who only stops drinking is what we refer to as a “dry drunk” meaning that they are every bit as unhealthy they have simply stopped drinking – a small percentage of folks manage this long term. In my professional opinion, real recovery is only made possible by the program of Alcoholics Anonymous. There are countless positive things that can be added to the program of AA and their importance cannot be overstated. Folks in recovery need the support of family and friends. Sadly, I meet too many friends and family who are unwittingly enabling (protecting an alcoholic from the natural consequences of their behavior) the alcoholic and this always results in a person staying stuck in addiction.

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Early recovery is a difficult time. We must keep it simple and have an open mind, if we are to find our way to a better life.

Too smart for AA? Here's why it's important to have an open mind in early recovery. 

There is an expression in AA that we've never met anyone too dumb to get this program but we have met people too smart to get it.

In his book, “The Thinking Person's Guide to Sobriety”, Bert Pluymen shares the pitfalls of being a very smart alcoholic seeking recovery. As is most often the case with addiction, the truth is counterintuitive:

Being highly intelligent and possessing keen critical thinking skills were a hindrance when it came to getting sober, staying sober, and changing his life.

Despite being a celebrated attorney, the best asset in Pluymen’s early recovery was his sponsor – a janitor with a 4th grade education.

This is one of the most amazing things about AA – it brings together people from every walk of life. 

AA creates a space where we find mentors, supports and friends. Often in the seemingly most unlikely pairings and groupings, folks find their way to a better life.

All it takes to be a member of AA is an earnest desire to stop drinking. All it takes to start making progress is an open mind and willingness to change.

Honesty & Simplicity

If we’re completely honest with ourselves, we find tons of motivation to be open to new ideas. It’s as simple as this: 

My way doesn’t work. My thinking brought me to where I am today. My best ideas didn’t help me avoid the destruction of addiction. My lifestyle, my friends, my family, my choices were not enough to keep me from losing control.

I want my life back. I want to feel like I’m in control. For a long time I tried to get back to where I was before I lost it. Now I see that going back isn’t an option. I get the same result every time. I have to change. I’ve been resistant to change because it scares me.

Woody Allen said, “eighty percent of success is showing up.” If we’re willing to take up a seat and listen, we will hear from people like us who had problems like ours and found solutions. We’ll meet folks who are willing to encourage and support us in one of the hardest things a human being can do – recover from addiction.

Get Your Mind Blown

Hearing what people have to say in a meeting may well leave you skeptical at first, so use the buffet approach – take what you like and leave the rest. You’ll hear some things that are hard to believe. Folks may speak of “having a life second to none.” Or they’ll say, “I wouldn’t trade my worst day sober for my best day drinking.” You’ll wonder how anyone could claim such things, but they’re true.

The most incredible of all is to hear someone describe themselves as a “grateful alcoholic.” You’ll wonder why anyone could possibly be happy about being an alcoholic? The simple truth is that if not for the need for recovery from addiction, our lives would not have changed all that much. Most people do not make huge positive changes in how they live their lives. People in recovery do.

Cunning, Baffling, and Powerful

You will hear people conceptualize their addiction as a part of themselves that is trying to kill them. They will personify it and describe what it tells them. On the surface this may look like a cop-out. It’s not. 

To personify it is to begin creating distance between something that is a part of us and our true selves. This is a big part of how we become free.

Slow Down

You will likely find it discouraging to hear people share how long it took them to get sober, change their lives, and develop the habits and routines that sustain them. Keep in mind that the only finish-line is death. Recovery is not about getting all better. It’s about getting better, twenty four hours at a time.

Everything is a process and it may seem mystifying to hear people talk more about how their Higher Power directed them than what the actual steps were. The good news is that people working on their recovery love to share what they’ve learned and will gladly teach you. All you have to do is muster the courage to ask.

The Promises

One of the most beautiful pieces in all of AA’s literature are the promises of recovery from alcoholism. They may indeed sound extravagant and yet they are attainable to all of us, no matter how far down our disease has taken us. If we are cynical or jaded we will find it difficult to have hope for such things. Yet without hope we are adrift.

It’s normal to doubt. All of us did and many of us still do. Having an open mind means being receptive to learning, growing, and healing. It creates opportunities. If we’re rigorously honest with ourselves we find that we had little or nothing to lose and everything to gain.

You can have what we have and if you’d like to help us, let us help you. The only way we can keep it is to give it away.

It is said that a glass of wine or two a day is good for your heart, and this may be true, although a recent study also indicates that a glass of wine or two a day can also cause a marked increase in colon cancer prevalence, so I'm not sure how beneficial this light drinking truly is; but heavy and chronic drinking is another thing altogether, and is incredibly physically and mentally destructive.

The Physical Damage of Alcoholism

Of all the drugs commonly abused, there aren’t many that destroy the body as thoroughly as alcohol can, and years of heavy drinking prematurely age the body and its organs; leading to a host of serious health complications and greater probability of early death.

Alcohol works its influence throughout the body, and most of the organs, the blood, and most noticeably the brain are all negatively impacted through the effects of too much alcohol. The body is very resilient, and much of the destruction of alcohol can be reversed through a long period of sobriety; other effects, particularly effects to the central nervous system, are to some degree irreversible.

As follows is a small list of some of the organs affected by heavy drinking, although the true extent of the damage possible is far greater than outlined below.

The Glands

Chronic alcohol use can reduce the secretions of the glands throughout the body, and this can result in a number of side effects, most noticeably on the sexual systems. In men, there is often an increase in estrogen, an increase in female sex characteristics such as breast development and a reduction in body hair, and decreased sexual ability. Erections are achieved less easily, erection size is diminished and erections will not occur as frequently. Women are less able to achieve orgasm, and as well less able to feel the pleasurable sensations of sexual contact. Infertility is common in chronic long term alcoholics.

In addition to the discrete effects on all of the body's systems and organs, chronic and heavy alcohol use also greatly increases the risk factors for a number of cancers and other diseases. Alcohol is incredibly destructive, and although some of the changes are irreversible, many are not, and the sooner an alcoholic achieves sobriety, the better their long term health prognosis.

In addition to the social costs of alcoholism, the toll on the body and mind is incredible and tragic. An addiction to alcohol needs to be addressed as early as possible, and the best time to start fighting any alcoholism is now.

Today's treatments are better than ever, and the combination of available pharmaceutical medicines with psycho social therapies, cognitive behavioral training and after care treatment is very effective.

Blood

When excess alcohol is consumed, the blood gets thick and sluggish with red blood cells clumping up together. This causes the cell death as experienced in the brain, but can also cause capillaries to break open near the skin (drinkers nose) and blood vessels can burst within the stomach leading to internal bleeding. Long term chronic consumption can cause anemia and bone marrow changes, affecting the immune system and lessening our resistance to opportunistic infections.

The Heart

Alcohol decreases blood flow to the heart, and can result in heart muscle atrophy, and an increased risk of heart disease and heart attack.

Stomach and GI Tract

Alcohol irritates the lining of the stomach and can cause painful stomach ulcers. Alcohol consumption creates an immediate spike in blood sugar, and this blood sugar spike is followed by a large pancreatic insulin release, which in turn leads to reduced levels of sugar in the blood. This hypoglycemia can cause fatigue, dizziness, headaches, anxiety and a host of other symptoms, and most chronic drinkers suffer from almost permanent low blood sugar. Additionally, because of the overworked pancreatic response, diabetes development is very likely with chronic alcohol use; and the risk of pancreatic cancer and other painful and serious pancreatic conditions is elevated substantially.

The Brain

Alcohol abuse can cause massive cell death in the brain, and lead to irreversible cognitive deficits. Alcohol starves the brain of oxygen, and each session of intoxication results in the deaths of tens of thousands of brain cells. Experienced blackouts occur as a result of this diminished oxygen to certain areas of the brain. Additionally, alcohol abuse can create continual confusion, generally decreased cognitive and reasoning capacity, memory loss and emotional changes such as mood swings, anxiety and depression.

The lack of vitamin consumption that often occurs concurrently with alcoholism can lead to additional brain damage, and the cognitive and language disease Korsikoffs syndrome occurs as a result of a vitamin deficiency. New research also indicates that chronic alcohol abuse can provoke senile dementia in patients as young as 40 years of age.

Alcohol destroys brain cells, eliminates memories, and reduces cognitive capacity. Alcohol abuse makes us emotionally unstable and decreases our intelligence.

The Liver

The liver processes the toxins we consume and renders them harmless in the body. The liver can only handle so much abuse, and in response to enough acute or chronic consumption, can go into varying degrees of failure. The liver is very able to cleanse the body of small intermittent quantities of alcohol, but with increasing consumption, the liver loses its ability to cleanse the blood and also becomes damaged. Alcohol abuse can cause liver imbalances that may lead to hypoglycemia, which is low blood sugar, hyperuricemia which causes arthritis, fatty liver deposits which can lead to cirrhosis, and hyperlipemia, which causes fats to be released into the blood stream causing heart problems. The liver is a regenerative organ, but in response to continued abuse may ultimately shut down, and once the liver is rendered ineffective, death soon follows.

If your dad was a drunk, does that mean that you'll be one too?

Not necessarily, but it does mean that you should be pretty careful with the way you drink, because you might carry something in your genes that makes alcohol a bad idea.

The Genetics of Alcoholism

First, understand the science behind the hereditary nature of alcoholism

The neuro chemical mechanisms that leave some people more pre disposed to develop problems with alcohol than others are not yet completely understood, but researchers are now quite certain that there is a hereditary link to alcoholism, and that certain gene expressions are inherited that make the development of alcoholism more likely.

Alcoholic Gene Expression

Research looking at adopted children raised away from their biological parents has helped researchers to reduce the nature versus nurture causation debate from the expression of alcoholism, and children of alcoholics, even those raised exclusively by people who themselves are not alcoholics, are more likely than the general population to develop alcoholism. Additionally, researchers have discovered a unique gene expression that is more prevalent in alcoholics and amongst alcoholic families than in the general population, and this gene expression also seems to make us more vulnerable to depression and anxiety, which themselves increase the risk of problem drinking.

Scientists and clinical researchers continue to chip away at the puzzle, and are gaining a better understanding of the bio chemical factors that increase our predisposition to alcoholism; and hopefully, when enough knowledge on the biological basis of alcoholism emerges, accompanying treatment options will also reveal themselves. But since the human brain is so inordinarily complex, there is no way to say when if ever scientists will gain a complete understanding.

How Can You Protect Yourself?

For now though what seems clear is that if you have a close relative with an alcohol problem, you need to be especially cautious of your own alcohol consumption, and be very aware of the signs and symptoms that may indicate the beginnings of a problem in yourself. What may be a safe level of drinking for others may in fact be dangerous with a biological disposition towards dependence and abuse.

If you know you have a direct genetic link to alcohol dependence, limit the amount you drink and limit the frequency of consumption. You may have nothing to worry about, but the price you may pay for too much indulgence is far too great to risk.

Watch for the Signs of a Problem

Be very concerned if you notice an increasing tolerance to the effects of alcohol or a preoccupation with alcohol. Get help if you seem to be unable to limit your drinking, if you seem to be consistently drinking more than you had intended to, and especially if you find yourself drinking even when faced with the adverse consequences of that alcohol consumption.

A little extra vigilance and caution may save a lot of pain and heartache. Be careful!

Why can some people drink heavily and never become alcoholics when other people get addicted so quickly?

Why can some people drink heavily and never become alcoholics when other people get addicted so quickly?

Contributing Factors to the Development of Alcoholism

Why some people can use and even abuse alcohol without ever developing alcoholism, and why some people seem unusually susceptible to alcoholism, remains a poorly understood phenomenon.

Genetics

There is a genetic component to alcoholism, and people who grow up in alcoholic homes are far more likely to become alcoholics themselves. Children born to alcoholic parents, but raised in homes without alcohol abuse or addiction are also predisposed to alcoholism, so we do know that genetics plays an important role. But all people genetically predisposed to alcoholism do not develop dependencies, and some people with no genetic history of alcoholism end up battling the disease for years. It is now accepted that although a genetic predisposition plays an important influence in the development of the disease, that social and environmental factors are in fact the lager influences towards alcohol abuse or alcoholism.

In addition to genetic influences, the Mayo Clinic considers that there are three additional primary influences to alcohol abuse or alcoholism.

Emotional States or Emotional Stressors can Induce Alcohol Abuse and Alcoholism

People may use alcohol excessively in response to frequent or significant emotional disturbances or stresses. When alcohol is used with enough frequency as an emotional management or stress coping tool the risk of dependency or alcoholism increases greatly. There is also likely a bio physical link with stress and alcohol abuse, and stress hormones have been casually linked to increased alcohol consumption and a greater risk for alcoholism.

People who use alcohol to deal with life's problems or stresses are at a greater risk to develop alcoholism.

The Co-Presence of a Corresponding Psychiatric Condition

People suffering through psychiatric conditions like depression, bi polar disorder, borderline personality disorder or anxiety disorders are at a greatly elevated risk to develop alcohol abuse problems or alcoholism. Psychiatric patients often use alcohol or other illicit drugs to self medicate the negative symptoms of an experienced disorder. Unfortunately, while intoxication may bring some temporary relief, the long term effects of alcohol abuse almost always worsen experienced psychiatric symptoms. Alcoholic psychiatric patients are at a great risk for an accelerated progression of both diseases, and require immediate interventions and treatment.

In addition to clinical psychiatric conditions, non clinical, but still significant factors such as low self esteem can also increase the likelihood to alcohol abuse, and ultimately alcoholism. Alcohol is rarely an effective long term coping strategy.

Social Environmental Factors

As a society, largely due to billions of dollars invested in alcohol advertising campaigns, there is a perception of alcohol being associated with glamour, attractiveness and success, and these lingering subconscious perceptions may influence people to try alcohol at a young age and continue to drink more than they should throughout life.

The immediate environment can also increase the probability of alcoholism. People who socialize, or live romantically with a person who drinks to excess, whether dependent or not, are far more likely to also drink heavily, and put themselves at risk for alcohol abuse and alcoholism.

Even the neighborhood around the home seems to influence consumption patterns, and people brought up in or who reside in neighborhoods of heavy abuse are also more likely to use and abuse alcohol themselves.

Nothing about alcoholism is completely understood, and all we know is that the variables that can induce alcohol abuse and ultimately alcoholism are many, and that what may cause alcohol dependence in one, seem to have little influence over another. We all present with an individual risk profile for our susceptibility to the disease, although those people with a genetic history of alcoholism are undoubtedly at an increased risk to develop the disease.

Regardless of the factors that may induce the occurrence of the disease, the treatments are essentially the same, and alcoholics need intervention, intensive treatment, and long term aftercare therapies. Most alcoholics will never be capable of drinking in moderation, and abstinence is the only recommended philosophy of use for people with alcoholic histories.

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Take the 2 minute alcohol abuse screening quiz TWEAK - designed specifically for women.

This short test was designed by Researchers at the University of Buffalo, Research Institute on Addictions. The test was originally designed, and is still used, as a screening test for pregnant women, but testing has revealed that this easy 5 question test works better than comparable alcohol screening tests for all women.

To score the test, give yourself 2 points for a yes answer in question 1 and question 2, and 1 point for a yes answer in any of questions 3-5. The maximum score possibly is a 7.

If you score a 2 or higher, you meet the criteria for likely harmful drinking, and you are recommended to submit to a further and more stringent medical evaluation.

The TWEAK Test

"T" - Tolerance: 

How many drinks can you hold >=6 drinks indicates tolerance.

"W" - Worried:

Have close friends or relatives worried or complained about your drinking in the past year?

"E" - Eye openers:

Do you sometimes take a drink in the morning when you first get up?

"A" - Amnesia:

Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?

"K" - Kut down:

Do you sometimes feel the need to cut down on your drinking?

Tests like the TWEAK test are great tools for medical professionals looking to find evidence of problem behaviors. They are not comprehensive enough to be used as a diagnostic tool for the determination of any disorder.

But if you score highly (over 2) and you felt worried enough about your drinking to take the test, then you likely do have something to worry about, and you should either try to stop drinking on your own, or get some help in doing so.

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Understanding the causes, treatments and prevention of painful pancreatitis.

80 000 People develop pancreatitis each year, pancreatitis is a leading cause of hospitalization and alcohol abuse is a leading cause of the painful disorder. About half of all patients admitted to hospital with alcohol induced pancreatitis will die within 20 years.

What is Pancreatitis?

The pancreas is a gland like organ, nestled below the stomach, that produces enzymes needed for the digestion of food in the small intestine, and also hormones, such as insulin, that regulate blood sugar levels.

During an attack of pancreatitis, the pancreas becomes inflamed, and the digestive enzymes normally released into the small intestines are instead released on the pancreas and surrounding tissue. These enzymes cause cell death; they literally cause the pancreas to consume itself.

Pancreatitis can be excruciatingly painful, as digestion becomes impaired, and enzymes destroy tissue. Frequent or severe attacks of pancreatitis cause scarring in the pancreas, which leads to reduced pancreatic functioning, and a greater likelihood of increased episodes of pancreatitis.

Most pancreatitis is experienced as an acute and transient disorder. In some cases, after a very severe case, or after multiple acute instances, a patient may develop a constant chronic form of pancreatitis.

What Causes Pancreatitis?

The two most common causes of pancreatitis are alcohol abuse and gall stones. Although alcohol is known to damage the pancreas, doctors can’t say why or how it does, or why only about 10% of heavy drinkers will experience the disorder.

What Are the Symptoms of Pancreatitis?

The singular most common symptom of pancreatitis is pain. Abdominal pain begins suddenly and reaches full intensity, usually within a half an hour. The pain is felt in the center of the abdomen, just under the rib cage and is described as intense and constant. In some cases, patients can find some release by bending forward, or lying on their sides.

In moderate cases, symptoms will subside within 3 days to a week. In more severe cases, pain can last for weeks. Other symptoms can include fever, weakness, bloating, shock and nausea and vomiting.

Because digestive enzyme functioning is impaired, eating will usually cause increased pain. Eating causes the increased release of pancreatic enzymes – the enzymes which are the source of the abdominal pain.

Treatment

Most people with pancreatitis will need to be admitted to a hospital, for pain management. Doctors will prescribe pain medications and fluids and nutrition will be given intravenously. There is little that doctors can do to shorten an episode of the disorder and in most cases bed rest and symptoms management are the only treatments available.

In some cases, a tube may be inserted through the nose and into the stomach, as a way to suction off excess stomach acid causing vomiting.

90% of patients with acute pancreatitis will get better, essentially, on their own. In 10% of cases, complications develop that may require medications or surgery to correct.

For alcohol induced pancreatitis, the most important treatment is the future and forever abstainment from alcohol.

Who Is at Risk?

Drinking more than 12 alcoholic drinks per day (for men) dramatically increases the risks for pancreatitis, and once you have had pancreatitis once, you are at greater risk to have a re-occurring episode.

Men are far more likely than women to experience alcohol induced pancreatitis. The most commonly seen patients experiencing the disorder are hard drinking males, in their 40's.

Pancreatitis Means the End of Alcohol Use

For anyone experiencing alcohol induced pancreatitis, there can be no further denial of the extent of the problem. Further drinking will more than likely bring more frequent attacks of the painful condition, and a likely early death. The only answer is to stop drinking, forever.

Image Copyright: INJU

If you’re drinking for health reasons, you may want to think again, because while very moderate drinking may reduce your odds of heart disease, even moderate drinking is being shown to increase your risk for a host of cancers.

There is substantial evidence that very moderate daily drinking reduces your risks of cardiovascular disease, unfortunately, a growing body of evidence suggests that on the whole (depending on your family history of disease) even moderate drinking may be doing you more harm than good, and anything over moderate drinking certainly is.

So if you’re drinking for heart health, weigh the cardiovascular benefits against the statistics listed below and make sure that what you’re doing makes sense.

The Health and Cancer Risks of Drinking

• Only 3 drinks a week increases your risks of breast cancer
  
• 1 drink per day raises your odds of getting mouth and esophagus cancers and 3 drinks per day increases your odds of colorectal and larynx cancers. Those who drink 4 or more drinks per day have a 300% increased risk of developing oral cancers
  
• Men who drink more than 3 days per week have a 55% increased risk of prostate cancer¹ and a 41% increased risk of dying from any kind of cancer. Women who drink 2 or more drinks per day have a 20% increased risk of dying from any kind of cancer
  
• Men who drink 3 or more drinks per day have a 30% to 40% increased risk of developing lung cancer, whether they were cigarette smokers or not²

The Cardiovascular Health Benefits of Moderate Drinking

Women who drink 1 drink per day and men who drink no more than 2 drinks per day experience the following health benefits:

• A 30% to 35% reduction in coronary heart disease
  
• Healthy men experience a 40% to 50% reduction in heart attack risk
  
• A reduction in stroke and dementia risks³

So Should You Drink for Health?

There are pros and cons to both sides of the moderate drinking coin, and what’s right for you likely depends on your family history of disease and personal health risk profile. If you’re not sure, ask your doctor about what makes most sense for you, and if she recommends moderate drinking to reduce cardiovascular disease risk, make sure you stick to the moderate part of that drinking plan!

Anything over very moderate drinking and any regular binge drinking though is very clearly associated with an increased risk for a host of cancers and even for an increased risk of heart disease – not to mention an increased risk of developing an alcohol abuse problem. If you justify your drinking as something you do for your good health, make certain that your drinking habits support your good intentions and that your good intentions don’t give you license to indulge in a practice that actually does you more harm than good.

And if you do find yourself drinking more than a very moderate drink or two per day – you should strongly consider cutting down – and if you can’t, you should consider getting some help so that you can do what you need to do to stay healthy and happy and strong.

Image Copyright: Krikit

Learn what to expect from counseling and find out how a counselor can help you move from use to sobriety and from sobriety to recovery.

People generally have no idea what addictions counseling is about. I’ve had countless people ask me, “I know I’m not supposed to do drugs/drink. What else is there to talk about?” I give them my Mr. Mackey (South Park) impression and jokingly agree, “Drugs are bad, mmkay. You can go now.”

At the opposite extreme, I’m often asked, “How am I supposed to not do drugs/drink?” At face value, the question is, how do I not do something? What’s really being asked is, “What am I going to do instead of doing drugs/drink and how am I supposed to deal with life, problems, and my emotions without them?” So this is often where we start in addictions counseling:

1. How to achieve and maintain abstinence
2. How to move from sobriety to recovery
   
3. How to deal with life on life’s term

Getting Clean & Sober

Keeping it simple, a person who has become dependent on a drug should always consult with their primary care physician (PCP) before they begin to withdraw from a substance. It’s common sense and it ensures safety. In some cases, medical support will be necessary to monitor the body as it goes through detoxification. An addictions counselor will consult with your PCP and can make referrals as needed.

Generally, the first seven days are pretty rough. It gets easier as we go and after 30 days we experience notable improvement physically, emotionally, and mentally. Our health continues to improve for at least twelve months.

Maintaining Sobriety

Relapse prevention plans are a vital piece of addictions counseling. These are very pragmatic and specific plans that describe how we will respond to urges and triggers that tempt us to resume using/drinking. The plans are custom made to suit the individual but should always include:

• Skills & Strategies for maintaining awareness of our thoughts, feelings, and behaviors (remember were accustomed to ignoring much of them).
• Implementing immediate steps to be taken when triggered/feeling the urge to use (phone contacts, coping mechanisms that can be used in any setting/environment, ways to refocus and identify what is needed to avoid further wrestling with the urge).
• Habits and routines that reduce stress and promote healthy actions
• Planning for known stressors. (Times when we have to be amongst people or places that we associate with using/drinking due to work or family obligations).
• Back up plans and emergency plans. (Measures we’ll take to ensure safety and abstinence when all seems lost).

Regardless of your confidence level in your ability to stay abstinent, having a solid relapse prevention plan will serve you well if you view it as an investment in your overall well being. The strategies outlined do more than keep us sober; they improve our overall health and quality of life.

Moving from Sobriety to Recovery

All that is required to be sober is that we not drink/use. By the time a person reaches addiction, there is assuredly wreckage in their lives. Some of us lost friends, family, jobs, money, and/or material possessions. To regain what was lost is a major undertaking and simply must be done with support. For all of us, the wreckage includes the loss of self, the destruction of self, and the emotional fallout of having succumbed to the disease of addiction.

We seek to change, to transform and to become something greater than we are. Most of us are simultaneously overwhelmed and in a hurry. This is a very problematic combination.

Addiction counseling is a process of prioritizing. After sobriety is attained, we need to make choices regarding what’s most important and develop manageable plans on how to attain it.

• Treatment plans are developed collaboratively in counseling and should accurately represent what our goals are. Goals are broken down into short (generally 90 days) and long term (generally one year) measurable achievements. They are further broken down into objectives. Step by step we incrementally achieve the results we seek.

Recovery has been defined as “awareness of the attitudes, beliefs, and behaviors that block change.”

A good addictions counselor will call us out on these. It’s uncomfortable to be confronted, but the use of subtlety or handling a person in recovery with “kid gloves” is ill advised. Those of us in early recovery remain very adept at lying to ourselves. We need to have it pointed out to us when we rationalize or justify because these undermine our ability to trust ourselves and our perceptions.

Emotional Immaturity

Courage is the choice not to allow fear to stop us from learning, growing, and healing. For most of us, we don’t know what we don’t know. We feel much older than we are due to the impact of past experiences and we feel much younger than we are due to our development being arrested by abuse, neglect, and substance abuse.

Addiction treatment supports us in learning to be more mature in our perception and behavior. We learn that we have emotional reflexes and that we must get to a place in which we respond instead of reacting.

Integrating Addiction Treatment & Natural Supports

The goal of any good addictions professional is to put themselves out of a job at the earliest safe juncture. This is achieved most readily when natural supports are integrated into treatment.

• Involving family, friends, and supportive others (sponsors, contacts, recovery coaches) in the process of implementing change ensures mutual understanding and cohesion toward shared goals.

When progress is made in this direction, we move away from the need for professional service and toward living more authentically. It’s common that folks fear this loss of support and so this can be done incrementally.

Moving On

Aftercare plans are a compilation of resources, ongoing goals and planned steps to be taken following discharge from treatment. There should be contingencies in place for returning to treatment if needs arise.

Addiction treatment is simply a linear progression. It’s common that folks come in and out as they meet new challenges and milestones.

Check out part 1 of this article - Choosing the best alcohol addiction treatment for your needs.

The most challenging aspect of answering this is that it depends entirely on what we believe an alcoholic is.

Alcohol is entrenched and celebrated in our country. It is expected that adults drink in most social situations. It's normative for people to use alcohol as a way to relieve stress and have fun. Conversely and hypocritically, our society stigmatizes those who develop problems with alcohol.

Prevailing social norms dictate that all we need to do when drinking causes us problems is to temporarily abstain. We're encouraged to go "on the wagon" for a brief period and then resume. Despite our knowledge that alcoholism is a disease, we respond to it as though it were some variation of the flu. All a person needs is to rest and regroup. Millions of us have cycled this way. The red flag we often ignore is that it gets worse each time we return.

The Question We Don't Want to Answer

The question that gradually haunts many of us is:

"Am I an alcoholic?"

The most challenging aspect of answering this is that it depends entirely on what we believe an alcoholic is. Clinically, we've come to define substance abuse and addiction as existing on a continuum, which is anything but definitive.

It's uncomfortable to consider a question when we're afraid of the answer.

We are further hindered by our inability to fully trust ourselves. The bottom line is that it's a personal choice whether or not to identify yourself as an alcoholic.

As the literature of Alcoholics Anonymous invites, determine for yourself whether or not drinking has become a problem for you.

When the Losses Start to Mount Up

At the start of each new year, treatment centers and 12 step programs tend to see an influx of folks who seek to reduce or eliminate their use of alcohol. The catalyst is most often being uncomfortable with what drinking has cost us. We experience losses financially, in health, relationally, and in our overall quality of life.

This is one of the greatest red flags for alcoholism: The cost progressively increases. Until we're confronted by major losses, this can be difficult to identify. We tend to be externally focused, which means that instead of truly taking stock of our own lives, we measure our drinking and our problems relative to others.

"I'm Not Like Them (Y.E.T.)"

Comparisons are always problematic. Measuring how alcohol has impacted our lives relative to others is most often a means of minimizing our problems. We generally won't contrast ourselves to those who show no evidence of a problem, only to those who do. We then consider that we're okay because we haven't fallen as far as they have.

To this sentiment we must add, "Y.E.T." It's a great recovery acronym for "You're Eligible Too."

The fact that we haven't experienced the losses others have in no way ensures that we won't. We must be willing to broaden our perspective. When we compare, we're not seeking to relate or identify, we're looking to be different. In recovery this is referred to as being terminally unique and should also be considered a red flag for alcoholism.

100 Forms of Alcoholism

We are unique and we're the same. We drink in different ways for different reasons and we're all the worse for it. Some of us drink until we black out. Some of us only need a few drinks to make really bad choices. Some of us drink very little, everyday, and find we can't be okay without it. Closet drinkers, whiskey drunks, wine snobs, binge drinkers...

If there are a hundred ways to drink, then how many forms of alcoholism are there?

Our greatest commonalities are that alcohol negatively impacts the course of our lives and we won't see it until we're forced to. It's the fishbowl affect. When you're living in it, it's hard to see the big picture. If you're on the outside looking in, spotting the red flags is like watching an ice fishing derby.

Drawing Lines

One of the biggest red flags for developing a problem with alcohol is when we negotiate with ourselves. We establish limits as lines we won't cross. When we say, "weekends only" or "no more than two or three" we often find a progression in which the limits change. We start telling ourselves, "not before noon" or "I'm not getting drunk tonight."

At the same time, we start to rationalize and justify our drinking. We say things like, "It doesn't affect my job performance" or "Everything at home is just fine." It doesn't seem to occur to us that if it wasn't a problem, we wouldn't feel any need to justify why it's okay to keep doing it.

It's Not Fun Anymore

We find that we don't enjoy drinking as we once did. We feel bored, empty, and angry. Depression becomes a constant companion. We drink not to feel good but to avoid feeling bad. We find ourselves frustrated with how other people drink. Progressively, we either drink alone or with those who drink like we do. As my friends in AA say, "We needed more and more of what doesn't work."

We're all or nothing people. How much is enough? All of it. Yesterday. We're control freaks who progressively lose control of everything. The most tell tale aspect of having a problem with alcohol is when we cannot with any degree of certainty predict whether we will lose control when we drink.

What Kind of People are Alcoholics?

Despite our addictive personalities, my experience is that alcoholics are disproportionately intelligent, talented, hard working, and creative. Unfortunately, we are most often building on a foundation of fear and shame. This results in being our own worst enemies with an uncanny knack for getting in our own way.

Getting Off the Road to Ruin

Embracing simplicity allows us to move toward a clear course of action. Rather than endlessly considering whether we're an alcoholic, we can reason as many have that, "If drinking alcohol causes you to have a problem, then you have a problem with alcohol."

Please also consider the recovery adage that, "Even if you're not an alcoholic, you still don't have to drink."

Alcoholism takes countless forms. The most important distinction may be that of being a "high-bottom drunk" or a "low-bottom drunk." We say that folks have to hit bottom before they embrace change on this magnitude. Losses accumulate and they're painful. Alcoholics tend to have a high pain tolerance. The problem with this is that for most of us, as long as we can tolerate it, we probably will.

Here’s how it works: take a pill each morning and know that for the rest of the day even a sip or two of alcohol will make you feel horribly ill. Need to quit drinking? Is disulfiram a good option for you? Read on to learn more about this FDA approved alcoholism treatment medication.

Disulfiram: Take a tiny pill each morning and know that for the rest of the day even a sip of alcohol will make you feel terribly ill…sound like something that might help you stay motivated and sober?

In America, disulfiram is marketed under the trade name Antabuse. Disulfiram won’t help you quit drinking, but once you’ve managed to stop it can help keep you from relapsing since you’ll know that even a small amount of alcohol will have very negative consequences.

Disulfiram is an FDA approved alcoholism medication that has been in use for more than half a century.

It may help you to maintain your sobriety but it has some downsides, such as:

• You have to remember/decide to take this pill each day
• You run the risk of a bad reaction from accidental alcohol ingestion (through cooking sauces, some medications etc.)
• It won’t help you with alcohol cravings
• It can cause liver damage
• If you drink on it and have a very severe reaction you could die

How Does It Work?

1. When you drink, your body converts the alcohol into acetaldehyde and then quickly converts this acetaldehyde into acetate and then into carbon dioxide and water.¹
2. Acetaldehyde is highly toxic and a known carcinogen – and it causes much of the hang-over pain you feel the day after drinking.
3. If you take disulfiram and then drink alcohol, this process gets interrupted after the first step. You still convert the alcohol into the toxic acetaldehyde, but then the process stops, and levels of acetaldehyde in the body quickly rise to between 5 and 10 times their normal post drinking levels.

So imagine the worst hang-over you’ve ever had...and then multiply that by 5 to 10. This occurs within minutes of combining disulfiram and alcohol and the symptoms will last for between an hour and a few hours.

Disulfiram + alcohol will cause symptoms such as:

• Severe headache and neck pain
• Nausea and vomiting
• Dizziness
• Flushing
• Tachycardia
• Sweating
• Dry mouth
• Blurry vision
• Weakness
• Breathing problems
• Very low blood pressure
• Confusion ²
  
• Chest pains
• Convulsions
• Coma

Combing alcohol and disulfiram can result in a very serious and sometimes fatal reaction. Never take this medication before consulting with a doctor. People with certain underlying conditions, such as liver, heart or kidney problems (and many others) probably can’t use disulfiram safely, especially since you can inadvertently set off a reaction through exposure to trace alcohol in foods or even in colognes or perfumes.³

How Well Does It Work?

It works pretty well.

There are no magic-bullet medications for the treatment of alcoholism, but medications help, and when combined with behavioral therapies, they generally offer people the best shot at lasting recovery.

Because of the risks of use and because it does not reduce alcohol cravings, disulfiram is now prescribed less commonly than newer alcohol treatment medications, like acamprosate or naltrexone.

But although prescribing is down, disulfiram is still an effective medication, suited particularly for newly abstinent and highly motivated people.

• A 2011 Cochrane Review of 11 clinical trial studies on the effectiveness of disulfiram revealed that most studies found that over the short term disulfiram was more effective than placebo and other addiction treatments for helping people achieve longer periods before relapse and for helping people reduce their total number of drinking days.⁴
• Another large German study found that disulfiram worked better than acamprosate, particularly for patients with a long history of alcoholism.⁵

What Are the Risks?

Disulfiram is a serious medication, but if used as directed, and under a doctor’s care, it’s pretty safe for most people.

• Disulfiram used to be more dangerous, but today's commonly used dosage is much lower than it used to be and now patients with heart disease and some other medical problems don't get prescribed this medication.
• Disulfiram can be hard on the liver, and your doctor will want to monitor your liver enzymes over the course of your use of this medication. If you have very compromised liver functioning you may not be a good candidate for disulfiram. Disulfiram can cause hepatitis, but this occurs rarely, only in about 1 in 25 000 people.⁶
• Disulfiram may worsen psychosis

Is It Right for You?

A panel of clinical experts at SAMHSA concluded that disulfiram is most effective/appropriate when:

• The patient is highly motivated to stay abstinent and well informed of the risks and necessary routines of use
• The patient is capable of staying abstinent for at least 12 hours
• The patient’s treatment is being closely monitored by an addiction treatment professional
• No medical conditions or allergies preclude its use
• The patient does not have significant impulse control problems or significant cognitive impairment

Think it’s what you need? Well, don’t take this medication lightly and never take without a doctor’s supervision, but if it sounds like it might help you stay sober, one day at a time, talk to your doctor about your appropriateness for a prescription. 

Here are 2 facts about alcoholism: It tends to get worse over time (it is progressive) and most people experience a fairly similar progression of symptoms and consequences. Here is a timeline which charts the progressive experiences of alcoholism through the early, middle and late stages. If you have a drinking problem, find out where you fall on the timeline and consider what’s coming in the future.

Alcoholism follows a fairly predictable course - it gets worse over time.

Do you have an alcohol addiction? If you do, addiction researchers say that unless you stop drinking, they can predict your future...and they don't need a crystal ball to do it.

So how do they know?

• After observing enough alcoholics experience the same problems and situations in the same basic order, researchers can now predict with some confidence that alcoholics drinking today will likely also progress through very similar types of experiences in a similar order.
  

That is unless you quit, then the future's yours for the taking, once again.

As a cautionary guide, the Substance Abuse and Mental Health Administration (SAMHSA) developed a behaviors of alcoholism progression chart, which lists the types of behaviors and situations a person endures through the early, middle and late stages of this disease.¹

This list may help you:

1. Determine the severity of your disease – by matching your current experiences with those from the list you can see how far down the timeline you’ve traveled.
2. Get motivated to try for abstinence – if you see that the experiences early on the list match yours up till now, you’ll hopefully get motivated to try for abstinence now, before you progress further down the list, into progressively worsening situations.

So take a minute to read through the list - see where your current behaviors put you on the stages of disease progression…and what the future holds, unless you commit to changing your path.

Behaviors of Alcoholism: a Progressive List

The Early Stages

• You start sneaking drinks or minimizing how much you actually consume
  
• You start to feel preoccupied with drinking
• You start gulping drinks - especially that first one
• You stop talking about your drinking with most people (drinking buddies excepted) - you’d just rather not bring it up
• You start having blackouts
• Your tolerance goes up
• You start drinking before and after social drinking occasions
• You start drinking as a way to relieve uncomfortable emotions/stress, etc.
• You start feeling uncomfortable in social situations that don’t allow alcohol
• You start to feel a loss of control over how much you drink (sometimes you stay out way later than you had intended on, for example)
• You start to lie to others about how much you drink
• Your habits of drinking as a way to relieve negative emotions get more entrenched

Middle Stages

• You start hiding your alcohol, or making sure you’ll always have a good supply
• You start to NEED a first drink of the day
• You try to force yourself into periods of abstinence (you go on the wagon)
• Other people start commenting on how much you’re drinking
• You start becoming occasionally aggressive or grandiose
• You start to feel real guilt about your drinking
• Eating becomes less important than drinking
• Personal relationships become less important than drinking
• You start to develop unreasonable feelings of resentment
• You start thinking of getting away temporarily as way to stop drinking
• Your sex drive diminishes
• Your drinking leads to your quitting or losing your job
• You start feeling overly jealous
• You get into a habit of solo drinking
• You get morning shakes or tremors
• You start drinking early in the morning
• Your guilt has blossomed into constant remorse
• You have multi-day drinking binges
• Your thinking becomes scattered and impaired
• You start drinking with people you wouldn’t have associated with earlier in your life

Late Stages

• Your alcohol tolerance goes down
• You start experiencing fear that is not attached to any outside definable threat - just vague fear
• You are no longer able to work or hold down a job
• Your physical condition/health deteriorates
• Your lose your sense of morality - start doing things you wouldn’t have considered previously
• You are hospitalized for your drinking
• Your remorse becomes a constant feeling
• You can no longer count on any family or friends to help you

Image Copyright: Flannol

Morning after drinking guilt and shame - why do you feel so low that next morning and what can you do about it?

Shame after drinking...

He tells me about his most recent episode of binge drinking, “I didn’t do anything wrong… but I still feel bad. “ I ask him to name an emotion that describes it. “I don’t know if it’s guilt or if it’s shame?” I explain the difference as, “Guilt is I did bad and shame is I am bad.” He identifies feeling guilty and “kind of ashamed.” I ask is he disappointing himself? He shrugs and tells me, “It’s my depression. I just need to figure it out.”

The pitfalls of trying to “figure it out” are many. When folks are trying to ascertain why they’re depressed, they often overlook the fact that alcohol is a depressant. We throw kerosene on the fire and wonder why it burns. The toll is most evident not in the wreckage caused by drinking so much as in the emptiness of things that no longer provide the desired outcome.

When It’s Not Fun Anymore

There’s a fine line between You Only Live Once (YOLO) and being a hot mess. We do the same things for different reasons. Signs that the party is over:

• Drinking a lot but alone, or in the company of people we don’t really care about.
• We still don’t have a plan but it’s no longer an adventure. It’s becoming predictable.
• Random hook ups used to be exciting. Now they’re unfulfilling at best and regrettable at worst.
• Hangovers are different now. They last longer and take more of a toll on us physically and emotionally.
• The thought keeps coming, “I’m not a kid anymore. I should be doing other things.”

What Would You Rather Be Doing?

We are creatures of habit. We stay with what’s familiar until we’re compelled to change. A lot of us just don’t know how to enjoy ourselves without using drugs or alcohol to relax, unwind, or lose our inhibitions. Some of the most successful rehab programs I’ve seen take this problem seriously and teach folks how to have fun sober.

Sometimes we rediscover what we loved as children:

• Being creative (drawing, painting, molding clay)
• Unstructured sports (Frisbee, volleyball, hacky sack)
• Reading (stories about lives like the ones we want to live)
• Spontaneity (having friends to be silly with, laugh, joke)

Sometimes we tackle a fear for the benefit of fun:

• Learn how to drive a motorcycle, snowmobile, or ATV
• Downhill skiing, mountain biking, martial arts, kick boxing
• Seek adrenaline highs (sky diving, hang gliding)

Sometimes fun comes by learning cool adult skills:

• Taking a cooking class
• Learning about computing and different programs
• Take classes that support a hobby, interest, or that supports a potential career change.
• Explore civic and volunteer opportunities that foster a sense of belonging
• Identifying interests that lend themselves to new connections and making new friends.

Healthy Distractions

We all need down time and it’s healthy to develop habits and rituals that support relaxation. When we rely on chemicals to achieve relaxation, we set ourselves up for dependency. Even if our drinking or drug use never reaches addiction, we form a powerful association between the substance and the desired feeling. Substituting a healthy distraction for the substance allows us to get our needs met without consequence.

Taking a break (guilty pleasures we don’t have to feel bad about later)

• Movies, television
• Plays, musicals, theater
• Web surfing
• Video games
• Magazines, catalogs, light reading

Unwinding and coping

• Listening to music (picking stuff that elevates our mood and/or helps us relax)
• Yoga, stretching, exercise that connects us to our physical selves
• Humor (stand up, books, pod casts)
• Grabbing coffee with friends instead of an alcoholic beverage
• Massage, Reiki, Qigong , other healing exercises that increase energy and release toxins

The adage, “all things in moderation” should be at the forefront of our thoughts. Excessive escapism is a form of avoidance. Limiting the amount of time we engage in these activities is a common sense approach. The keys are self discipline (accountability to self) and connection to healthy people (accountability to others). These ensure that our needs are met in a balanced fashion.