Written by: Dr. Andrew Wright
Imagine you have a cabin in the woods. You go to enjoy the sun streaming through the trees, starry nights, the singing birds, the peace, the burbling brook nearby. You breathe the fresh air deeply, what bliss! It is a bit difficult to get to the cabin: it’s a long hike with a steep hill at the end, and there’s a cougar prowling the area. You find yourself spending more and more time in the cabin just to experience the peace of it; to the neglect of your family, your job, and even your bodily needs. What was once a beautiful, exhilarating solitude is now a cold, self-imposed prison. You know you need help to get back home--someone to cut through the brush, a distraction for the cougar, a companion to help you down the grade—but you do not know how to ask for that help. Then, when you do get out, you have a nearly constant impulse to return to the cabin.
This can be the experience for someone with an alcohol problem. April, as Alcohol Awareness Month, serves as a reminder that alcohol can be hazardous. Both binge drinking and heavy drinking can be harmful to our body, mind, and spirit. However, there is treatment.
You may be asking yourself, “wait a minute, I heard drinking alcohol was good for me? You know, a glass of red wine with all its health boosting flavonoids.” This is true, for reducing deaths caused by heart attack. However, studies show the overall death rate was higher even for moderate alcohol drinkers. There is a sweet spot for alcohol consumption: 1.6 standard sized drinks per day for men, while for women it is half that. A standard sized drink has 50-60 grams of alcohol: a 12 oz regular beer, 8 oz specialty beer, 5 oz glass of wine, or 1.5 oz shot of hard liquor. The problem for many of us is that we do not limit ourselves to this level of alcohol drinking. Therefore, the recommendation is not to start drinking if you do not currently drink, as the health benefits of not drinking largely outweigh the benefit of that glass of red wine nightly. For those of us who do drink alcohol, working to 1 drink a day or less is a very good idea.
Let’s consider why we enjoy alcohol so much. Drinking alcohol bathes our brain’s reward centers with dopamine causing us to feel really good. It promotes the release of endorphins, causing us to feel much less physical and emotional pain. It also upregulates our GABA receptors and downregulates our glutamate receptors, causing us to feel utterly relaxed. Alcohol use can rewire the brain causing us to crave that good feeling. Some of us are more susceptible than others to this craving, whether because of our genetics or our upbringing—usually both. Once the brain is rewired, it is no small thing to change it back. It is akin to rerouting a road. This is the reason treatment for Alcohol Use Disorder is directed at changing brain chemistry.
Wisconsin leads the nation in adult binge drinking. Binge drinking is defined as 4 or more standard sized drinks for a woman and 5 or more standard drinks for a man on a given occasion. While the national rate is 16%, our rate is 23%. The conservative estimated cost to our state, as of 2012 data is $6.8 billion. This figure does not account for the cost of violence (mostly domestic) or broken relationships or childhood delinquency caused by an absent parent. Wisconsin’s direct costs are 1529 deaths, 48,578 hospitalizations, and 5751 motor vehicle crashes that would not otherwise happen. Alcohol related deaths are the 3rd leading cause of death in the United States. Between 2006 and 2010, 88,000 deaths per year were alcohol related. Sadly, alcohol related deaths often occur at a younger age, such that the average age of death is 50 years. Those who engage in binge drinking have a 29% higher risk of serious injury (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00235-4.pdf). On a national scale, that is 2.5 million years of potential life lost (http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm). On a personal level, I lost a beloved relative in an alcohol-related death. She was in her mid 50s.
The effects of alcohol drinking are especially prominent at the Heavy Drinking level. This is defined as more than 13 drinks in a woman and more than 20 drinks in a man weekly. Those who drink at this level are at a 31% increased risk of dying of any cause. Even those who drink 7 or less alcoholic drinks in a week are at a 51% increased risk of an alcohol-related cancer such as mouth, throat, esophagus, stomach, colorectal, liver, breast, or ovarian. There is also good evidence for both acute and chronic cognitive (ability to think straight) damage from regular drinking. I am sure many of us know someone affected by an alcohol-related injury, cancer, cognitive decline or death.
Before we discuss the treatment, let’s briefly consider the most serious drinking condition: Alcohol Use Disorder (AUD). Whether one engages in binge drinking or heavy drinking, it is possible to have AUD. AUD is diagnosed in those who drink more and longer than intended, have significant cravings to drink, keep drinking even though their work and home life are falling apart, and/or need to keep drinking more and more to get the same “high” they desire (http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders). A good indication of AUD is periods of forgetfulness related to alcohol drinking. This is a sign of a serious problem. AUD affects 1 in 10 adult men, and 1 in 20 adult women. Yes, this is present in our community. Yes, this is treatable.
The key to treatment for excessive alcohol consumption is a desire to stop drinking (Tradition #3 in AA). It does not matter the motivation to quit drinking: avoiding jail time, getting and keeping a job, repairing a relationship with a loved one, or just living in the freedom of not needing a drink to feel normal. Successful treatment will encompass whole person care because the addiction encompasses whole person damage. So, emotional and spiritual support is key. Some find this at AA meetings. Others may find this in Mindfulness Meditation, counseling, or other mutual help groups like a SMART recovery group. In Richland County, a good place to start seeking this type of help is at Health and Human Services: 608-647-8821. In addition, eating a whole-foods diet heavy on the bright and dark vegetables, fruits, and grains, can really help one’s mental state. Making water one’s new favorite drink also helps. Finally, there are medications to treat both the craving related to AUD and other mental conditions, such as Depression and Anxiety, which can impede a meaningful attempt at cutting down or stopping drinking. The medications, by themselves, have not been found too helpful. But, combined with counseling, or a mutual support group, or meditation, or all of the above, the medications are much more helpful. Please talk to your caring clinician about these treatments. For some, successful treatment will constitute a healthier level of alcohol consumption, for others nothing but abstinence from alcohol translates into successful treatment.
A word to those of us who have not experienced AUD or Excessive Alcohol Drinking but live exposed to it: seek help for yourself. This could be in the form of a support group like Al-Anon or your church community or a friend who’s loved one has been treated successfully. A good place to start can be online (http://www.ola-is.org/ ).
It is usually not for lack of will or ambition that a person is not successful in treatment. It is more often because we do not recognize the difficulty and diligence it takes to bypass the new wiring the brain has done in the addicted, dependent state. Nor do we understand that relapse is a normal part of the recovery process. It often takes several attempts to quit or cut down before one enjoys success. While not all of the new wiring can be undone, treatment can help someone find ways to enjoy life without alcohol. Accomplishing this takes emotional and spiritual support, prayer, healthier eating and exercise habits, medication, and most importantly a desire to change course.
So, returning to your old cabin may not the best idea, if you want to change your drinking habit. Rather, finding a new vantage point, with spectacular views and a clear route in and out may help. Inviting friends who embrace your new lifestyle can lead to a healthier kind of fun, with less or no alcohol. You are worth it. Your loved ones are worth it.