Up Close With Dr. E

A new understanding of alcohol problems


What is the drug of choice for adults, a growing but hidden problem for senior citizens, and the companion of death for car crashes, falls, drownings, fires and suicides?

What is its name? AL-CO-HOL.

What does it do? Kills and maims.

What can we do? Learn about it.

Why? Because alcohol strikes the ones we love.

Today’s column is presented in the following format:

A. Three questions will be asked.

B. Two guest speakers — Mr. X, a 25-year-old graduate student, and Miss Y, a 43-year-old accountant, will answer from the perspective of having achieved victory over alcohol.

Question #1: What is a relapse?

Here is a case example. Mr. Taylor, 39, has a severe problem with alcohol, so he began a treatment program. After being sober for five months, he had a horrible argument with his boss. While driving home, his anger boiled over. So, he bought a case of beer, went home, and got drunk.

Was his relapse (the return to drinking after being sober) proof that he was unwilling to quit drinking?

Miss Y: “My first alcohol treatment program defined “success” as 90 alcohol-free days. So, on day 13, after I had a relapse, guess what they said? “Miss Y, you failed! You are not being honest about wanting to quit drinking. You are out of this program.” Wow! I’m a lazy lying failure.”

Mr. X: “I was lucky to have a clinician who kept up with the latest treatments. I received, Relapse Prevention Training. RPT has three parts: 1) Triggers for drinking are identified. 2) New ways to handle stress — exercise, prayer, friends — are learned. 3) Practice, practice, practice, and bam, I have powerful new skills to stop drinking.

Here is my relapse record for the three years that I was in treatment: first year = 10, second year = four, third year = two. Every time I relapsed, a new triggering event was discovered. The real shock came when I saw, for the first time, that the single most powerful trigger was my overly harsh self-judgment, which said, “Loser, you are a weak, pathetic failure.” I was taught how to get rid of the critical voice.

By comparing alcohol problems to asthma, a new model for treatment can be explained. Asthma is a chronic respiratory disease, where wheezing and attacks of breathlessness occur. Let’s create a case example, by saying that your 16-year-old son, John, has just been diagnosed with severe asthma, and is given this two part treatment plan: 1. Identify the triggers (smoke, pollen, cats); 2. Prevent attacks (carry an inhaler, take medication).

John decides to stay overnight at his friend’s house. While playing with his friend’s cats, he begins to wheeze, but he forgot his inhaler. When he is taken to his doctor, he is told, “John, you are irresponsible, your attack is your fault.” As a parent, would you be upset about how your son was treated?

Just like asthma, alcohol problems are chronic, relapsing diseases, requiring periodic and life-long treatment, delivered with compassion.

Question #2: One cause of alcohol problems is genetic vulnerability. What does that mean?

Mr. X: I have a predisposition for problems with alcohol. It is like being born with a fully loaded pistol, inside my brain. At 12, when I began to drink, I pulled the trigger, and bam, I am on the fast track for alcohol problems.

Miss Y: I was raised in an Irish Catholic family, where we worked hard and drank hard. Alcohol abuse? No way. It was just the way we lived. I had no idea I was at risk for alcoholism.

Question #3: Is alcohol used as a form of self-medication?

Mr. X. Yes. At 12, I had my first beer buzz. It was on a hot and humid July 4th. After three beers, I felt closer to my friends, and the sky, trees and grass looked like a landscape painted by Monet. What was this new feeling? It took years to find the answer. My new feeling was called, “happiness”. The beer was my medicine for my undiagnosed childhood depression.

Miss Y. In college, my heart ached to be in a sorority, but I was crippled with severe anxiety. I had panic attacks in social situations. What could I do? Wine. Red wine, please. I was transformed by the wine. All my social anxiety went away.

Alcohol problems are the symptoms of a psychiatric illness, originating in early development.

Conclusion: Alcohol problems are not caused by sinful behavior, poor moral fiber or lack of motivation. Developmental events — trauma, illness, exposure to violence, child abuse, neglect — unlock genetic vulnerabilities. Once this happens, all it will take to create severe alcohol problems is to begin heavy drinking on a regular basis.

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.

References: “Text of Substance Abuse Treatment,” Galanter, 2004.

“A Primer of Drug Action,” Julien, 2008.

“Understanding Your Health,” Payne, 2009.


Dr. Richard Elghammer contributes his column each week to the Journal Review.


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