Figure 1. Chemical structure of ethyl alcohol, CH3CH2O8 1
In my practice, I’m perplexed at how often people with obvious drinking problems push back when I suggest they may be self-medicating and might consider a psychiatric medication instead. If I suggest an antidepressant, for instance, they say they’re very uncomfortable with the idea of taking a drug! Alcohol is a drug, of course. By definition, a psychoactive drug chemically changes perception, thinking, and emotionality.
Alcohol also has more unwanted side-effects that many prescription medications. Although its chemical effects include calming nervousness, when it starts to wear off, people get more anxious. This and its dehydrating side-effect may cause insomnia or make it worse, and make it harder to sustain sleep. Sufficient doses of alcohol also prevent the dreaming sleep that helps us process emotions at night. Even “happy drunks” who drink often find that over time they become more depressed. And although very moderate drinking can have positive health effects, heavy drinking gradually breaks down body and mind. 2
Here’s an effect most people don’t know. Steady or binge drinking affects brain chemistry long after alcohol has left your body. Psychological testing is distorted as much as two weeks after not drinking — one author advises against testing a “wet brain.” 3 And, please be aware that quitting “cold turkey” can be very dangerous. See below for more on this.
Alcohol and Cocaine
Some people take intoxicants in combination. One of the most common of these is alcohol and cocaine, where alcohol may be the gateway to cocaine as the drug of choice. Psychologically, people taking this combination often experience serious problems with regulating their emotions and actions and wreak havoc on their relationships. Physically, this is like driving your car with the gas pedal to the floor and your other foot on the brakes and it risks even more devastating chemical addiction. People with this pattern are at much higher risk for serious health problems, troubles with the law, entanglements with criminals and gangs who traffic in cocaine, and the financial cost of a cocaine habit.
Cultural Myths About Alcohol
Several cultural myths about alcohol lead people to minimize its drug effects. Here are a few of them unmasked.
“Alcohol is natural, so it can’t be harmful.” Alcohol is created in an age-old process of fermenting sugar with yeast. If it’s a naturally-occurring chemical, our bodies must be able to accommodate this, right? Well, consider other modes of food spoilage. If sugar is broken down by other organisms, such as salmonella, our bodies don’t handle this too well. Alcohol is a potent chemical that can kill in excessive doses.
“If it’s legal, it can’t be that dangerous.” Consider the legal sale of cigarettes and the role of tobacco in heart and lung disease and cancer. We don’t need to go back to prohibition, but let’s face it, some people have troubling controlling their ability to keep alcohol consumption within safe or healthy limits — especially those who self-medicate other problems or whose genetics make them more vulnerable to alcohol addiction. Heavy drinking makes people much more vulnerable to auto accidents, and over time, it can destroy the liver and cause Korsakoff’s dementia, where one can’t store new memories. And drinking doesn’t need to be continuous to cause dementia. We now know that binge drinking accelerates the onset and severity of dementia later in life. 4
“I can’t imagine celebrating without champagne!” Alcohol has taken a central place in celebrations for thousands of years. At weddings, people drink toasts to the happy couple. In our culture, drinking has become a right of passage into adulthood, when one reaches the “legal age.” People watch sporting events with beer. Are you able to celebrate without drinking? If not, what does this say about the power of familiarity? What kinds of social pressures would you face if you chose not to drink? And what about when those celebrations are ruined when drunken relatives embarrass themselves at weddings or when fights break out at sporting events?
“In vino veritas (in alcohol is truth).” Most of us have seen someone who, after a few drinks, becomes much more emotionally expressive and may say or do things that reflect wishes they had previously hidden. Some incorrectly interpret this dishinibition effect as showing one’s true self. But “true self” is more nuanced and subtle than this. Its expression requires the interaction of many aspects of personality, including the person with a fully functioning brain who plans, organizes, weighs consequences, and chooses among conflicting wishes. To further disprove the contention that the unmasking effects of alcohol reveal one’s true self, consider the fact that alcohol may sometimes unmask positive feelings and sometimes negative ones. This is one of the reasons that couples who drink in order to better connect can easily get caught up in intense arguments.
Psychological and Social Impacts of Alcohol
Let’s face it. People like to drink alcohol for its positive effects. If you’re anxious, a drink can help you relax. Bored? You can enjoy a gourmet experience. Hurting? You’ll go numb. Shy? You’ll be less inhibited. Lonely? Other drinkers are your instant friends — and “social” binge drinking often starts in high school or college. This habit often continues into early adulthood and is hard to break, because many people have known no other ways to gather socially. Also, your job or identity can link you to alcohol. This is a common issue for restaurant staff, or in any job that requires selling, networking or travel. Other situations can trigger the urge to drink excessively, such as holidays or anniversary dates of important personal events, or longing for a lost love.
People familiar with computer programming know that you get junk data unless you process both zeros and ones. Similarly, frequent alcohol and drug use to feel better filters out negative experience but robs us of needed perceptions. Consider what it would be like to turn off the pain receptors in your feet. You wouldn’t notice much difference at first, until you step on a sharp object without knowing it and make the injury much worse — people with leprosy experience just this problem! My point is that we need access to unpleasant feelings to alert ourselves to situations that need a course correction.
Although alcohol in moderation doesn’t create problems for some people, for many, moderate or binge drinking has unwanted psychosocial effects, even after alcohol has left their system. These include irrational thinking, defensiveness, aggression, mood problems, and worsening of mental illnesses. It also promotes interpersonal problems that include failures of integrity, family and relationship difficulties, and career problems. Here’s a list of these issues in more detail, so you can see if they may be impacting you or those you love.
Lack of integrity, such as broken promises; underfunctioning that leads to codependency; driving under the influence (DUI) — a serious danger to self and others; infidelity; refusing to take responsibility; and facilitating other addictions, like pathological gambling
Mood problems, including depression, anxiety, anger and irritability, low self-esteem, increased risk of suicide and homicide
Family problems, such as arguing, bickering, stonewalling, withdrawal, and generally poor communication; neglectful, emotionally abusive, codependent or stagnant relationships; infidelity or not coming home; poor sexual performance; financial distress
Worsening of other mental health issues, such as anxiety, phobias, panic attacks, depression, bipolar disorder, mood swings, Attention Deficit Hyperactivity Disorder (ADHD), paranoia, personality disorders, schizophrenia, poor anger management
Alcohol problems can range from mild to severe. After reading about the many potential problems, you may see that it’s hurting your relationship. People easily underestimate alcohol’s effects, especially if they haven’t had a healthier relationship than the one they’re in. Also, some people haven’t had an extended period of not drinking since their teen years or earlier. Here are some of the ways you can address the problems you may be seeing. I’ll cover some of the resources for getting help and discuss potential pitfalls. These resources include psychotherapy; medical consultation and treatment, such as outpatient and inpatient detoxification (“detox”); residential rehabilitation (“rehab”) centers; Alcoholics Anonymous and Al Anon and alternative programs to these; church and community organizations; friends and family.
Resources listed in this section include:
In-Patient Rehab and Detox
Alcoholics Anonymous (AA)
Alternatives to 12-Step and AA
Churches and Spiritual Groups
Friends and Family
Psychotherapy for individuals, couples and families. You may be reluctant to seek psychotherapy for a number of reasons. Some people are turned off watching TV personalities with a pushy style. Others would be ashamed to admit they need help. Whatever the reason for hesitation, it’s common to feel vulnerable when discussing personal issues. So shop around until you find a therapist who’s knowledgeable and has a personal style that helps you discuss these things. Psychotherapists who specialize in addictions understand that it may be difficult to stop drinking and avoid ongoing temptations to drink. They’re also aware of impacts on family life and the stages people go through when changing lifestyles. If you choose to participate in Alcoholics Anonymous (AA), Al Anon or other twelve-step programs, many therapists are supportive of those programs and can explore your discomfort with them, focusing on your personal struggle rather than insisting on AA participation as the only way.
Medical consultation. Some physicians specialize in addiction medicine and can help you safely clear alcohol and other drugs from your system (detox). Please be sure to consult with your physician before stopping drinking, because quitting “cold turkey” can lead to life-threatening medical complications, including seizures. You may also want to consult with a psychiatrist, a physician who specializes in treating mental health issues. Some people use alcohol and drugs to self-medicate depression, anxiety, bipolar disorder, or other mental health issues and could benefit from an appropriate medication regimen in addition to behavioral health treatment. You may work with a physician as an outpatient or need in-patient hospitalization for medical necessity, such as intense withdrawal.
In-patient rehab. There are many rehabilitation centers that help people detox and then take the time to review the effects of their addiction, open up to the recovery process and start to make necessary lifestyle changes. Some who struggle with psychological or physical addiction or both can benefit from a time away from life’s usual pressures to loosen the grip of their habit and the lifestyle that supports it.
Alcoholics Anonymous (AA). In a 1995 Consumer Reports study, 5 people expressed higher satisfaction with AA than with psychotherapy. AA offers a supportive fellowship of people from all walks of life who have struggled with alcohol problems. It provides the opportunity to receive around-the-clock support from people who have “been there, done that” to prevent relapse or get back on track after a slip. The AA 12 steps are principles for systematically overcoming the denial that keeps addiction in place, taking responsibility for your actions, and surrendering to a spiritual “higher power” or, alternatively, collective support — an AA saying is “GOD can mean Group Of Drunks” — for facing life’s challenges. Many people have difficulty with adopting all of the AA principles. They may not believe that they are powerless over alcohol (AA first step) and return to controlled drinking, a risk that’s easy to underestimate. They may reject the idea of alcohol dependence as a disease or believe they could succeed if they could only muster enough willpower. They may object to the principle of surrendering to a higher power, to accepting the label of “alcoholic” or identifying with others in the fellowship. Many of these objections can emerge from avoidance of shame or guilt, denial of the wreckage that alcohol dependence has caused to themselves or loved ones, fear of public exposure of an alcohol problem, codependence with others who continue to drink, and so on. Far more often than not, my clients who have gone to AA have been thrilled to see their lives turn in a more positive direction. Those who haven’t still receive my support, and I don’t believe AA is the only way people can achieve freedom from alcohol. AA’s many benefits include the ability to work through the 12 steps and receive support for sobriety from an experienced sponsor, the availability of meetings during many times of the day, in many places, and interventions to offer sobriety and support to loved ones whose lives have been overtaken by drinking.
Al Anon. This is a sister organization to AA that helps people whose lives are impacted by close relationships with alcoholics. It employs the AA model of meetings, sponsorship and step work to help people overcome co-dependency and relationship patterns learned when trying to cope with significant others, like alcoholic parents, spouses or siblings, especially.
Alternatives to 12-step programs. There are alternatives to AA, Al Anon and similar programs. An Internet search for AA alternatives or 12-step alternatives should bring up a list of some of these resources. Whatever program you choose, consider whether it offers sufficient social support and help in recovering from relapse, especially for people having trouble staying away from alcohol despite problems it’s causing.
Churches and spiritual groups can help you deal with issues of faith, such as trusting in a higher power to assist your sobriety or healing from a dysfunctional relationship. Many churches also help people facing financial distress that can exacerbate alcohol problems and addictions.
Community organizations. Some churches offer a variety of community services. Some community organizations, like Salvation Army, are faith-based, non-profits. Others may be sectarian and wholly or partly funded by government agencies. An example is community mental health services that may be offered in your county.
Friends and family can provide much-needed emotional and financial support and encouragement in times of distress. Often family members alert their loved ones to problems they see with alcohol use and may bring in external experts for counseling, rehabilitation or intervention.
Take Courage and Find an Approach that Works for You
If you believe that alcohol may be spoiling your romance or causing some of the other problems discussed here, take courage, and reach out for help. There’s no single way that works for everyone, but if you truly want help and look for it, you can find an approach that’s likely to work for you.
1. Image of alcohol structure downloaded from Wikipedia on 11/2/08 from https://en.wikipedia.org/wiki/Image:Ethanol-3D-balls.png#file
2. Here, I’m referring to such alcohol induced health problems as dementia, which is accelerated even with binge drinking, loss of ability to store new memories, which is associated with heavy drinking over time, cirrhosis of the liver, an increased risk for cancer. Also, chronic alcoholics can lose their very sanity, experiencing blackouts and hallucinations. And heavy drinkers who attempt to withdraw from alcohol without medical help may die from seizures.
3. Arden, J. B. (2002). Surviving job stress: How to overcome workday pressures. Franklin Lakes, NJ: Career Press.
4. Backer, K. (2008). “Binge-drinking culture may cause dementia epidemic, experts warn.” In The Independent. Downloaded 12/16/08 from https://findarticles.com/p/articles/mi_qn4158/is_/ai_n30967162.
5. Seligman, M. E. P. (1995). The effectiveness of psychotherapy:
The Consumer Reports study. In American Psychologist, December 1995 Vol. 50, No. 12, pp. 965-974. Downloaded 12/16/08 from https://homepage.psy.utexas.edu/homepage/class/Psy394Q/Research%20Design%20Class/Assigned%20Readings/Readings%20for%20Final%20Exam/Selig