DEFINITION OF ALCOHOLISM
“Alcoholism is a primary, chronic disease with genetic, psychological and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.”
“Primary” refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it “Primary” suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.
“Disease” means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specific common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.
“Often progressive and fatal” means that the disease persists over time and that physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, organic complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.
“Impaired control” means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioral consequences of drinking.
“Preoccupation” in association with alcohol use indicates excessive focused attention given to the drug alcohol, its effects, and/or its use. The relative value thus assigned to alcohol by the individual often leads to a diversion of energies away from important life concerns.
“Adverse consequences” are alcohol-related problems of impalement in such areas as: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behavior); interpersonal functioning (e.g.; marital problems and child abuse, impaired social relationships); occupational functioning (e.g.; scholastic or job problems); and legal, financial, or spiritual problems.
“Denial” is used here not only in the psychoanalytic sense of a single psychological defense mechanism disavowing the significance of events, but more broadly to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual’s problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery.
MYTHS AND REALITIES OF ALCOHOLISM
Alcoholism is ranked the number 2 killer in this country, behind cancer. There are over 10 million alcoholics in the United States alone, and hundreds of thousands die each year as a result of alcohol-related causes. Alcohol is involved in 60% of reported cases of child abuse and the majority of cases involving domestic violence. The myths and misconceptions surrounding the disease of alcoholism and its victims must be rooted out and replaced by already established facts if we are to understand why alcoholics drink excessively and what must be done to help them overcome their disease. If the truth about alcoholism is ever to be understood, the myths must be attacked and destroyed.
MYTH - ALCOHOL IS PREDOMINANTLY A SEDATIVE OR DEPRESSANT DRUG.
REALITY - Alcohol’s pharmacological effects change with the amount drunk. In small quantities, alcohol is a stimulant. In large quantities, alcohol acts as a sedative. In all amounts, however, alcohol provides a rich and potent source of calories and energy.
MYTH - ALCOHOL HAS THE SAME CHEMICAL AND PSYCHOLOGICAL EFFECT ON EVERYONE WHO DRINKS.
REALITY - Alcohol, like every other food we take into out bodies, affects different people in different ways.
MYTH - ALCOHOL IS AN ADDICTIVE DRUG AND ANYONE WHO DRINKS LONG AND HARD ENOUGH WILL BECOME ADDICTED.
REALITY - Alcohol is a selectively addictive drug; it is addictive for only a minority of its users, namely, alcoholics. Most people can drink occasionally, daily, even heavily, without becoming addicted to alcohol. Others (alcoholics) will become addicted no matter how much they drink.
MYTH - ALCOHOL IS HARMFUL AND POISONOUS TO THE ALCOHOLIC.
REALITY - Alcohol is a normalizing agent and the best medicine for the pain it creates, giving the alcoholic energy, stimulation, and relief from the pain of withdrawal. Its harmful and poisonous aftereffects are most evident when the alcoholic stops drinking.
MYTH - ADDICTION TO ALCOHOL IS OFTEN PSYCHOLOGICAL.
REALITY - Addiction to alcohol is primarily physiological. Alcoholics become addicted because their bodies are physically incapable of processing alcohol normally.
MYTH - PEOPLE BECOME ALCOHOLICS BECAUSE THEY HAVE PSYCHOLOGICAL OR EMOTIONAL PROBLEMS WHICH THEY TRY TO RELIEVE BY DRINKING.
REALITY - Alcoholics have the same psychological and emotional problems as everyone else before they start drinking. These problems are aggravated, however, by their addiction to alcohol. Alcoholism undermines and weakens the alcoholic’s ability to cope with the normal problems of living. Furthermore, the alcoholic’s emotions become inflamed both when he drinks and when he stops drinking. Thus, when he is drinking and when he is abstinent, he will feel angry, fearful, and depressed in exaggerated degrees.
MYTH - ALL SORTS OF SOCIAL PROBLEMS – MARRIAGE PROBLEMS, A DEATH IN THE FAMILY, JOB STRESS – MAY CAUSE ALCOHOLISM.
REALITY - As with psychological and emotional problems, alcoholics experience all the social pressures everyone else does, but their ability to cope is undermined by the disease and the problems get worse.
MYTH - WHEN THE ALCOHOLIC IS DRINKING HE REVEALS HIS TRUE PERSONALITY.
REALITY - Alcohol’s effect on the brain causes severe psychological and emotional distortions of the normal personality. Sobriety reveals the alcoholic’s true personality.
MYTH - THE FACT THAT ALCOHOLICS CAN CONTINUE TO BE DEPRESSED, ANXIOUS, IRRITABLE AND UNHAPPY AFTER THEY STOP DRINKING IS EVIDENCE THAT THEIR DISEASE IS CAUSED BY PSYCHOLOGICAL PROBLEMS.
REALITY - Alcoholics who continue to be depressed, anxious, irritable and unhappy after they stop drinking are actually suffering from the phenomenon called the “protracted withdrawal syndrome”. The physical damage caused by years of excessive drinking has not been completely reversed; they are, in fact, still sick and in need of more effective therapy.
MYTH - IF PEOPLE WOULD ONLY DRINK RESPONSIBLY, THEY WOULD NOT BECOME ALCOHOLICS.
REALITY - Many responsible drinkers become alcoholics. Then, because it is the nature of the disease (NOT the person), they begin to drink irresponsibly.
MYTH - AN ALCOHOLIC HAS TO WANT TO BE HELPED.
REALITY - Most drinking alcoholics do not want to be helped. They are sick, unable to think rationally, and incapable of giving up alcohol by themselves. Most recovering alcoholics are forced into treatment against their will. Self-motivation usually occurs during treatment, not before.
MYTH - SOME ALCOHOLICS CAN LEARN TO DRINK NORMALLY AND CONTINUE TO DRINK WITH NO ILL EFFECTS AS LONG AS THEY LIMIT THE AMOUNT.
REALITY - Alcoholics can never safely return to drinking because drinking in any amount will sooner or later reactivate their addiction.
MYTH - PSYCHOTHERAPY CAN HELP MANY ALCOHOLICS ACHIEVE SOBRIETY THROUGH SELF-UNDERSTANDING.
REALITY - Psychotherapy diverts attention from the physical causes of the disease, compounds the alcoholic’s guilt and shame, and aggravates rather than alleviates his problems.
MYTH - CRAVING FOR ALCOHOL CAN BE OFFSET BY EATING HIGH SUGAR FOODS.
REALITY - Foods with a high sugar content will increase the alcoholic’s depression, irritability, and tension and intensify his desire for a drink to relieve these symptoms.
MYTH - IF ALCOHOLICS EAT THREE BALANCED MEALS A DAY, THEIR NUTRITIONAL PROBLEMS WILL EVENTUALLY CORRECT THEMSELVES.
REALITY - Alcoholics’ nutritional needs are only partially met by a balanced diet. They also need vitamin and mineral supplements to correct any deficiencies and to maintain nutritional balances.
MYTH - TRANQUILIZERS AND SEDATIVES ARE SOMETIMES USEFUL IN TREATING ALCOHOLICS.
REALITY - Tranquilizers and sedatives are useful only during the acute withdrawal period. Beyond that, these substitute drugs are destructive and, in many cases, deadly for alcoholics.
Material taken from UNDER THE INFLUENCE: A Guide To The Myths And Realities Of Alcoholism by James R. Milam and Katherine Ketcham, Seattle, Washington, Madrona Publishers, Inc., 1981.
THE FAMILY DISEASE OF ALCOHOLISM / CHEMICAL DEPENDENCY
Denial: Alcoholism has been called “the disease of denial”. It characterizes both the chemically dependent person and his or her family. Family members, for whatever reason, do not accept or confront the negative affects of another person’s chemical or alcohol use. The abnormal becomes normal. The whole situation becomes too much to deal with, so families pretend: they act “as if” everything is okay. Family members in denial of the disease of alcoholism will often say, or truly believe, “It’s not that bad.”
Preoccupation: Family members become totally absorbed in the mood, behavior and activities of the chemically dependent person. The addicted person becomes the main focus of the family; this occurs to such an extent that family members often neglect their own responsibilities.
Fear: Because of the unpredictable, often erratic behavior of the alcoholic / chemically dependent person, family life is full of anxiety and dread. No one knows what will happen next, or when – but, based on experience, everybody expects trouble.
Tension / Irritability: Not knowing what to expect from one day to the next, one minute to the next, creates tension and chaos in the alcoholic family home. Family members suppress feelings of anger, shame and worry – then they overact. They lose their tempers, raise their voices, hurl objects across rooms. Normal life situations can be too much to handle for the alcoholic family.
Lying: Family members try to cover up, downplay, or hide the problems caused by another’s drinking or chemical use. They lie to children, extended family members, neighbors, employers and to themselves.
Guilt: Family members assume responsibility for another’s drinking and behavior. They believe that if they did something better or different – or didn’t do something – the drinking or chemical use would stop.
Isolation / Misfit Feeling: Communication among the family and with others outside the family is seriously affected. People stop talking, sharing, and caring.
Role Takeover: Others take over the alcoholic’s roles and responsibilities, including parenting, financial obligations and household chores. In alcoholic families, older children often take over for one or both parents.
Resentment: Family members are hurt and angry about what has happened in their lives. They hold onto negative thoughts and feelings for years, sometimes even after the alcoholic stops drinking or dies, or is no longer in their lives.
Sexual Problems: Sexual relationships suffer along with everything and everybody else. Partners stop sharing feelings – and, very often, bedrooms. Children have no role models on which to form their own healthy sexual relationships.
Avoiding Occasions: Families begin to decline, or stop receiving, invitations to social events. They are embarrassed about previous episodes; there have been lots of broken promises, disappointments, and false hopes concerning the drinking or chemical use. Also, alcoholism saps a family’s energy – people are just too tired to do anything.
Widespread Distrust: Too many years of broken promises, shattered dreams, and false hopes result in a serious distrust of self, as well as other people, places and things. Usually, everything the family member thought would surely work (new car, new job, new house, shift in responsibilities) to stop the drinking or chemical use has failed.
Rigidity, Uneasiness with Change: Once they have come upon a way to live and survive with alcoholism, family members don’t want to try another way. It’s similar to learning the path through a mine field and resisting the suggestion to try another crossway.
Seriously Uncommunicative: Family members learn quickly “Don’t trust, don’t talk, don’t feel.” So they don’t/ At home, family members don’t talk to each other about what’s going on; outside the house, no one talks to others about what’s going on with them or their home life.
Totally Responsible and Controlling: As family members “hit bottom”, the active alcoholic may be totally irresponsible and out of control. In contrast, family members are now in complete charge of everything – household chores, financial matters, family responsibilities. They believe that if they don’t do something themselves or take responsibility for it, it won’t get done.