Alcoholism: What People Don’t Get

Alcoholism wreaks more havoc on individuals and families than any other problem that I see in my practice. Insidious and baffling are words that are often used to describe it, and these words could not be more apropos. Sometimes the effects of alcoholism and drug addiction are obvious, as in the case of the wino who has given up on any pretense of self-respect. Other times the effects of alcoholism are far less obvious, as in the case of the pillar of the community whose shame is a private affair known only (but denied) to the alcoholic and his or her family.GettyImages_134467440

Despite the adverse effects that alcoholism has on people’s lives and its prevalence (there are the same number of alcoholics as there are left-handed people) most people, and I’m including mental health professionals, don’t have a clear understanding of what it is. It is usually equated with nothing more than a drinking problem when, in fact, alcoholism is a complex disease. This does not mean that the public is not more educated about alcohol abuse than when I received my training. Anti-drunk driving programs, the advent of rehabilitations centers, the notion of “responsible drinking,” the notoriety of celebrities with alcohol and drug problems, to name just a few relatively recent developments, have raised the public’s awareness of the significance of the problems associated with excessive drinking. More and more people today realize that old myths, such as “alcoholics need to drink every day,” “alcoholics have weak moral character,” and “alcoholics can’t hold a job,” are simply not true.

Everyone understands, with the possible exception of fraternity members reenacting Animal House and alcoholics who are deep in denial, that consistently abusing alcohol is a problem. There is a general consensus that individuals who are intoxicated act obnoxiously, create great anxiety for their loved ones, and imperil society if they get behind the wheel of a car. There is little misunderstanding about alcoholism as it relates to drinking. Rather, the confusion about alcoholism results from a lack of understanding of what alcoholics experience when they do not have alcohol in their systems. Non-recovering alcoholics may seem cool, calm, and collected on the outside when they are sober, but they are feeling anything but that on the inside. They may be able to wear a fa├žade that hides what they are feeling from public view or they may be able to find a way to distract themselves from paying attention to their feelings, but non-recovering alcoholics are in a constant state of emotional distress when they are sober.

An appreciation of the concept of alcoholism as a disease is necessary to comprehend fully what an alcoholic experiences when he or she is not drinking. Alcoholics process alcohol differently than social drinkers do. When social drinkers take a drink, the liver produces enzymes that break the alcohol down into a substance that gets into the bloodstream and works its way to the brain. Once the broken down alcohol reaches the central nervous system, it enters brain cells and slows down the activity of those cells, which social drinkers experience as a nice pleasant buzz. After an hour the alcohol leaves the brain cells and is discharged by the body, and to a greater or lesser degree, the brain cells are the same as they were prior to the social drinkers having had the drink.

GettyImages_86521850When alcoholics take a drink, their livers produce a different set of enzymes than social drinkers. These enzymes break the alcohol down into a substance that is stronger and more toxic than its counterpart in the social drinkers. This stronger substance gets into the bloodstream and, just like with social drinkers, it works its way to the brain where it enters the brain cells. Once inside the brain cells the same basic process occurs in alcoholics as it does in social drinkers–that is, the brain cell activity slows down–but the strength and toxicity of the substance causes the alcoholics to have a much more intense experience. Alcoholics find being under the influence to be far more pleasurable than the nice pleasant buzz experienced by social drinkers.

This is only half the story. Other factors are at work that cause the allure of drinking to be substantially greater for alcoholics than it is for social drinkers. The brain cells of alcoholics are affected differently by their exposure to alcohol than the brain cells of social drinkers. These brain cells adapt in such a way that they require alcohol in order to maintain their equilibrium. In essence, these brain cells are out of whack without alcohol. Subjectively, alcoholics experience this as some form of feeling “not-right.” This explains my earlier assertion that alcoholics are in a constant state of emotional distress when not drinking. Alcohol is both creating the emotional distress and giving relief for it at the same time.

A clarification of this not-right feeling is in order. As often as not when I tell alcoholic clients that they feel uncomfortable when they are not drinking, they will dispute this, claiming that they feel perfectly fine. Even their spouses may say that everything is great except for the drinking. However, if I ask those same female spouses if they have to “walk on eggshells” so as not to trigger their husbands’ tempers or if I ask those male spouses if their wives are moody, depressed, or anxious most of the time, they will almost always say yes. Perhaps, the most common form of denial is the belief that those emotional states–anger, depression, and anxiety–are “just the way I’ve always been” without the alcoholic being able to see that drinking is simultaneously maintaining and providing relief for these feelings.

The implications of this paradox are huge because it means that quitting drinking is not an adequate way to address the problem of alcoholism. Alcoholics who simply quit drinking without engaging in a recovery program simply leave themselves in a state of discomfort without a way of getting relief. The vast majority of individuals who are in this state of “white-knuckle” distress eventually crack under the pressure and start drinking in order to get some relief. A smaller number of individuals are able to abstain from drinking for extended periods of time but they are either so badly in need of a drink that they are miserable and constantly in a foul, negative mood or they are so cut off from their own feelings that they cannot connect on an emotional level with family and friends.

I believe strongly that the only way to accomplish the two objectives of recovery–abstinence from alcohol and emotional comfort–is through active involvement in a 12 Step Recovery Program. So the answer is simple: go to meetings and don’t drink. Like most things in my life, I relate this to golf: simple concept–hit the ball straight and put it in the hole–but incredibly difficult to do. Counseling and/or rehab can be incredibly helpful with this. My recommendation for people struggling with their own drinking or who are being adversely affected by a loved one’s drinking is to find a therapist or rehab center that is knowledgeable about the disease concept of alcoholism and that respects and understands the value of 12 Step Programs. It can be a difficult process and the answer can be elusive, but the promises of recovery are well worth the struggle.