Alcohol Around the World and How Other Countries Treat Addiction

Stats on alcohol abuse across the globe and the very different ways addiction is handled

 

On learning that the number of people “hurt by violence” declined in Britain last year, people might not link fact that to the lack of liquor. But a May study reported in The New Zealand Herald (which The Washington Post linked to), found that a decline in binge drinking, which the researchers attributed to a result of the poor economy since 2008, is likely the reason. The decrease actually started in 2001, and to be fair, researchersglobe in wine glass.jpg don’t claim to know all the reasons, and they also credit “more targeted prevention efforts” as well, and possibly “joint efforts by the police, health and local authorities.” (Still, it’s no great surprise, right? Remove alcohol and  people are less violent?)

The decrease in drinking is a worldwide trend, the WaPo article says. There’s a chart that lists drinkers who binge drink at least once a week in tons of countries and that gives figures for men and women. You may find it interesting that living on an island seems to make a person drink more, and that Pakistan has a fairly large drinking problem even though it’s a Muslim country where drinking is prohibited.

Another chart in the WaPo article lists the countries where drinking was most and least likely to result in health risks in 2005. (Moldova has the highest rate of drinking, by the way.) Two additional charts illustrate a number of countries’ favorite drinks, and some that consumed the most liquor in 2005 (by male and female).

According to an article on the Real Time Economics page of The Wall Street Journal business section, drinking will increase in developing nations in the next few years, which unfortunately will cause big problems. These nations will have an enormous public health burden as a result, and could find themselves trying to treat over 200 diseases or injuries, including cirrhosis and infectious disorders. I have a hunch that this prediction will surprise no one in the addiction fied.

How Does the Rest of the World View Addiction?


In June, Huffpost had a wonderful podcast on how different cities and towns treat addiction, and featured several noted speakers.  Kerry Jang, City council member in Vancouver, British Columbia, gave an inspirational talk about what his city has done. In response to the increase in overdose deaths from heroin in Vancouver, they treat addiction as a healthcare issue, with a 4-pillar approach: harm reduction, enforcement, healthcare and treatment, and prevention. Jang said it drives all city policy decisions. The city even has safe injection sites—the first to do so.

Marie Nougier of the International Drug Policy Consortium talked about countries at the forefront of harm reduction, including the Netherlands, Switzerland and Portugal. She reminded listeners that you need an enabling environment for people to get help without fear of arrest, she said, which is what Switzerland does. That country has removed all penalties for anyone seeking help for drug addiction.

Nicolas Clark of the World Health Organization noted that the U.S has been incarcerating addicts for a long time (as if that’s news to anyone here.) There were other interesting speakers as well. Anyone interested in humane policies toward addiction should gain something from listening to this podcast.

Addicted Doctors and Nurses

Huge numbers of medical professionals facing issues with drugs and alcohol


I once interviewed a nurse anesthesiologist in recovery who told me she had often been high in the operating room. She asked me not to mention this in print; she didn’t want former patients to know that she had put their lives at risk. (This was not an MBRC patient, by the way.)

But several doctors have come forward and been quite open about being addicted while treatingserious dr or nurse.jpg—and even operating on—patients. In case you’re not aware of the three specialties who have the highest rate of drug addiction, it’s anesthesiologists, emergency room specialists, and psychiatrists.

In April, The Daily Beast had an article about a resident who overdosed on stolen pain medication --fentanyl -- which he injected in the bathroom at the University of Michigan hospital, where he worked. That same day, a nurse overdosed and died in another bathroom of the same hospital.

The journalist who wrote the article said he knew of two anesthesiologists who OD’d on drugs and he said that the number of addicted doctors is similar to that of the general population. He also quoted an anesthesiologist who said he has no statistics, but he believes the problem is worsening among anesthesiologists, and that alcoholism “may pose the larger risk to …patients.” He doesn’t say whether he means all doctors or not, but he also recalls the addicted traveling medical technician who infected patients with Hepatitis C by putting fentanyl back into circulation the needles he used to inject himself with.

Dr. Stephen Loyd, an internist working in an ER in Johnson City, TN, is in the news again, hoping to help others by speaking out about his addiction on Huffpost Live. Loyd says, in the video, that he realized he had a problem one day in the ICU when he learned that he was taking more pain pills than a patient was!  (He was taking 75 or 80 Oxycodone or Vicodin a day—100 a day at his worst, until his father intervened.)

The internist says he’s amazed that he didn’t overdose. The signs were there, and those around him had to know, he says. Dr. Andrew Kolodny, of Physicians for Responsible Opioid Prescribing (PROP), also in the video, talks about how doctors start making bad choices. Loyd attributes it partly to the stress of his residency, saying that it contributed to his desire to get high. His addiction seemed normal, he said;  it didn’t seem as if he put anyone at risk. But then he admitted that the people around him actually kept him from hurting anyone. (By the way, medical professionals have their own recovery groups, which I wrote about in 2011 for MBRC.)

Loyd is also featured on an NBC Rossen Reports video segment: “Is Your Doctor Stoned?” Rossen says that 1 in 10 doctors are abusing drugs or alcohol. One of Dr. Christopher Duntsch’s patients maintains that the doctor performed surgery while high and left him paralyzed. Duntsch, however, pleaded the fifth about substance abuse on the stand when he was brought to trial.

For those wanting to see a TV program that features an addicted medical professional, I recommend Nurse Jackie, starring Edie Falco as a nurse addicted to prescription pills. My local library has the series on tape, and I’m sure it’s available somewhere on TV (Netflix? On Demand?).  Although he never saw the program, The Daily Beast writer I mentioned earlier says it “seems to be a total Hollywood-ification of a grave problem—addicted health care staff. By report, Nurse Jackie is a fun and loveable nurse who just likes the drugs a bit too much.” I really like the program, for the acting and the plot, and I disagree with him. I think the series DOES have a strong message about substance abuse. Unless I’m projecting my thoughts onto the character, I think that anyone who knows about addiction can see how she’s struggling and what addiction has done to her life. It’s a mess, as most drug addicts’ are quick to admit theirs was, once they’re in recovery.

Drinking in Theaters, in the Workplace and at Dartmouth

four people drinking.jpgWell, well. I just went to Thrillist for the first time because I knew nothing about it and I wanted to write about something I had found that had originally been posted on the site. It took about three seconds to understand that it’s a man’s site, or as Thrillist describes itself, a “leading men’s digital lifestyle brand.”

Actually, that’s obvious, once you look under Food & Drink, where the information about drinking just goes on and on. “Four flasks you’ll want to get a ho-ho-hold of this season.” “How to Become Your Bartender’s Favorite Customer.” And so on.  So that explains why a map on Thrillist of each state’s most popular liquor or beer company showed up on the small business page of the Huffington Post, where I first found it.

That in itself was only mildly weird, and not nearly as odd as another entry on their site: Brews With a View: A Coast–to-Coast Guide to Movie Theaters You Can Drink In. It wasn’t that long ago that I learned you can order hot food in a theater near me, but I had no idea you can drink alcohol in theaters as well. That conjures up an image that seems incongruous, but maybe that’s just me.

What’s even more interesting, is that it’s not just theaters promoting drinking on the premises. It seems that more and more companies are promoting drinking at work, or at least those in NY and in Silicon Valley. One company has a beer-vending machine nicknamed Arnie. AOL has a video of a Wall Street Journal reporter talking about the article she wrote about this trend in the Wall Street Journal. On the AOL site, the line underneath the video says: Plenty of companies offer workers free food, but as the workday in some firms stretches on past the cocktail hour, they’re stocking full bars and beer fridges to loosen up the office and keep workers on the job longer.  I’m not sure if the point was that employees will stay later in the day if there’s liquor at work, or if the trend is a good recruiting tool, but both could apply. The reporter said that another reason companies are doing this is so that employees bond, and that the feeling is that they’re adults and know what they’re doing.

The Aol host interviewing the writer, and the writer herself did note that there might be pitfalls, as in liabilities, if an employee overdoes it and drives drunk, for example. As far as those employees who don’t drink, companies, or at least one mentioned, didn’t seem to think that others drinking would bother them.

Then there was the catchy line that conpanies are “viewing a keg as the new water cooler.” I just can’t imagine drinking condoned at work, but Thrillist seems to have a drinking culture.

Colleges are always in the news because of the problems drinking to excess can cause, and in October, The New York Times had an in-depth article about fraternities on campus and myriad problems at Dartmouth, including students’ drinking. This part was promising, however:

“The drinking problems have flared into view just as the reality might be changing, due largely to former President Jim Yong Kim, who set out to curb alcohol abuse and sexual assault. Under him, Dartmouth started designating students to remain sober at parties and help people who are drunk and vulnerable and counseling students who go to the health center for alcohol-related reasons. He also founded the National College Health Improvement Program, an alliance of colleges trying to curb binge drinking.”

I have one last, weird fact about alcohol to end this post, also thanks to HuffPost. According to research, bed bugs don’t care for alcohol, so if a person has had several drinks, they may get fewer bites. I wonder how much that study cost, and if there might have been a more helpful subject relating to alcohol to study.

 

 

Teens Driving Under the Influence and Others Acting Responsibly

Thumbnail image for teen drinking and driving.jpgAn April article in USA Today discussed a poll of over 1,700 teens who were asked whether or not they drove under the influence. Almost 25 percent said they did. Amazingly, some said drinking improves their driving, and a greater number said that marijuana does. This, despite the fact that car crashes are among the leading cause of death among teens.

If you’re wondering about the authenticity of the poll, one of the groups conducting the survey were students themselves—Students against Destructive Decisions, or SADD.  Yikes. How do you educate against these destructive opinions? The article noted that parents play an important role and should be aware that teens drink during many unsupervised events other than just proms and graduation, such as during summer vacation. 

I found a nice counterpart to this poll and this irresponsible behavior. An MSN video surfaced awhile ago showing men the way to act responsibly when a female has had too much to drink. It was posted on YouTube in response to another video that got a few boys in trouble for allegedly sexually abusing a young girl. (After the assault, one boy posted a video showing the others carrying her by her arms and legs and she was obviously passed out.) The video was a watershed in the power of using social media in the legal process.

In the follow-up MSN video, a young man finds a woman passed out on a couch. He puts a pillow under her head, places a blanket over her, and gently arranges her hair. His closes by saying “Real men treat women with respect.” Short, sweet, and to the point.

Here’s another “good news” news item about drinking, from ABC News: In Suffolk County, Long Island (NY), a few people volunteered to help police officers (including Marine Patrolmen and Coast Guard officers) learn to recognize boat drivers who have been drinking to excess. If you live near anywhere there is water and boating, you’ve undoubtedly heard of boating accidents and deaths attributed to drinking. You know driving a boat after drinking poses a danger to swimmers and other boaters.

It may sound crazy, but the police actually had the volunteers drink until they were over the legal limit so that they would exhibit the physiological signs of inebriation. Then the officers had to guess each volunteer’s level of inebriation, to familiarize themselves with the signs. Now there’s a novel training method.

Similarly, there’s a program in Philadelphia that has volunteers drink to excess and then has officers study them and administer the sobriety tests that are administered in real-life situations. It’s believed that this helps officers better recognize people who may not be obviously inebriated but are still over the limit.

(Most people who are stopped for DUI have a blood alcohol content level of 0.17%. But there are many drivers over the 0.08% legal limit but under 0.17% who are not showing obvious signs.)

It has always amazed me how people who have not been around others who drink to excess can’t recognize the signs that these people are inebriated because so often it’s obvious to many who have grown up with a family member who drinks to excess. There are many alcoholics who seem to hold their liquor well, but so many who have lived with the disease are finely attuned to the slightest sign. When I’ve been out with my husband and pointed out someone who is has had too much to drink, he often doesn’t see it. I see it only too well. 

 

NTSB Urges States to Lower the DWI Threshold

 

alcohol proofs.jpgI’ve written about ignition locks before, here, as tools in the fight to keep drunk drivers off the road. Now there’s a move afoot to add one of the biggest tools of all: The NTSB has recommended that the threshold for DWI be lowered by a third (or by nearly half, depending on what paper you read), from .08 percent to .05 percent. They’ve recommended this because the evidence shows that you don’t have to be falling-down inebriated to injure or kill someone on the road.

Roughly 10,000 people die as a result of people drinking and driving, according to a May article in The New York Times. With this recommendation, the board seemed to target social drinkers as well as heavy drinkers.

The information made it easy to understand what the change would mean. Currently, males weighing 180 pounds can drink four beers or glasses of wine in 1 ½ hours and not exceed the legal limit. With the change, they could only have three. Females weighing 130 pounds can now have three drinks in 1 ½ hours and not be considered over the limit; with the change they could only have two.

It also provided these statistics:

“People with a blood-alcohol level of 0.05 percent are 38 percent more likely to be involved in a crash than those who have not been drinking, according to government statistics. People with a blood-alcohol level of 0.08 percent are 169 percent more likely.”

Not everyone likes the proposed change. A restaurant owner was quoted as saying it would penalize responsible drinkers and does nothing to deter the drinkers society should be going after. Of course, the change, if implemented, will affect restaurants’ profits. Don’t they make most of their money on booze?

Interestingly, most countries have a limit of .05. An editorial in my local paper noted that until 2000, most states had a limit of .10, but that year legislation was enacted to withhold highway construction money from states that didn’t agree to .08. (That sounds like it was a compromise.)

Also, even MADD wasn’t for the new limit. That group would rather see other initiatives implemented, although the article didn’t say what those initiatives were.

Two days after that article appeared, a New York Times editorial appeared in support of the lower standard. As the paper pointed out, separate means can be instituted for heavier drinkers. And as the editorial also mentioned, at levels below .08, the ability to stay in lane, and reaction time diminishes, while sleepiness increases. In essence, the risk of crashing increases.

In effect, what this proposed change would mean is that you can have your glass of wine with dinner and one afterward if you’re female, and two with dinner and another afterward if you’re male, with no fear of exceeding the legal limit. It sounds like moderate social drinking.

Who knows how this will play out.  We may be witnessing history in the making, or the proposal may just fizzle.

 

 

A Policeman with Alcoholism and His Rights Under the Law

policeman.jpgAn interesting test of whether a policeman’s rights were violated when he was fired for driving drunk in an unmarked police car while off-duty is currently taking place in Oregon. As the San Francisco Chronicle explains, Jason Servo is suing well, a bunch of people, saying that his rights were violated because he suffers from alcoholism. He has also been stripped of his police certification and says he was denied due process as well.

I’m not sure how many people know that alcoholism is considered a disability under the Americans with Disabilities Act. I sure didn’t before I started researching this case. (It took me awhile in 2008 to let it sink in that thanks to the Mental Health Parity and Addiction Equity Act, treatment for substance abuse must now be covered in group healthcare plans at a level equal to medical and surgical benefits.)

But back to the case. Servo pleaded guilty and entered a treatment program after the January accident. (He and his car ended up in a ditch.) One of his lawyers said the police department should have worked with Servo because he has a disease and should not have fired him, and the lawsuit alleges that the firing was due to budget cuts. The Chronicle article notes that “The U.S. Equal Employment Opportunity Commission … provides an example of how an alcoholic can justly be fired, and it's similar to the Servo case.

In its example, a federal police officer is involved in an accident for which he is charged with drunken driving. About a month later, he gets a termination notice stating that his conduct makes it inappropriate for him to continue. The officer says the arrest made him realize he is an alcoholic and that he is obtaining treatment. According to the EEOC, the employer may proceed with the firing.”

There’s a difference, however. The police officer in the example was on duty and Servo wasn’t.

This reminds me of the time a colleague I was working with at a high-tech company told me that another worker actually kept a bottle of vodka in a drawer and was constantly taking sips. I believe he was given the option of attending a program. I think the woman who told me was the man’s officemate, but after so many years it’s hard to remember. If it was true, that was a pretty progressive company, because there was no legislation like we have today to support that worker. 

The Christian Science Monitor, in printing the same Associated Press article, asks, in the headline about the case: Can he win? I’d love to hear from some legal analysts what his chances are, and I’d like to read what addiction specialists think. And then you wonder: Are police officers held to a higher standard in some cases because they’re charged with protecting the public?

One thing is for sure—this is another story that highlights alcoholism and the workplace and gets people talking about it. That’s one way to make progress.

Drinking and Gun Deaths

Young Man wth Gun.jpgPerusing information on the relationship between drinking and gun deaths on the Internet is enough to make a person crazy, especially when so many Americans are inflamed about a gunman killing schoolchildren in Connecticut last December and the victims of the Boston Marathon/MIT killings.  These latest tragedies seem to have rallied the group that wants an end to these tragedies, which in many people’s minds means stricter gun controls.  But the people against gun control are vocal as well and present their own statistics. So researching this is crazy-making.

The most recent mass shootings in the U.S. were by young men who were mentally ill. But for anyone touched by or concerned about alcohol abuse, it isn’t a stretch to also start ruminating about the link between drinking and gun deaths when these tragedies occur.

Two years ago the L.A. Times had an article about a study in the British Medical Journal which found that people who own guns are twice as likely to binge drink (“have five drinks in a single sitting”) and are more than twice as likely to drive when drunk. 

What was really scary is the number of deaths cited that were directly related to drinking alcohol:

Of the 395,366 firearms-related deaths reported in the United States between 1997 -- when this data were actually collected -- and 2009 -- the latest date for which the tally of firearms-related deaths is available -- about one-third are thought to have involved alcohol. In 2007, 34.5% of suicide and homicide victims in the United States had alcohol in their systems at the time of death, and 60% of those were considered acutely intoxicated.”

Granted, many of the latest group homicides in the U.S. have been perpetrated by males who are severely mentally ill. But anyone who grew up with a violent drinker can relate and shudder. Perhaps we saw the person take a knife, or throw a lamp across a room. We know their potential for violence. And to think what might have happened if they’d had a gun—and in some cases, what did happen….Numerous domestic violence episodes occurred when a person was buoyed by alcohol or another drug. Unfortunately, some family members can only imagine what might have happened if a violent family member had a loaded gun while inebriated.

The New York Times had a more recent article on this subject last February: “Violent, Drunk, and Holding a Gun.” It was an editorial about the “multiple mass shootings by deranged young men” that I just mentioned, but said that to focus solely on this group overlooks others “at demonstrably increased risk of committing violent crimes but … not barred by federal law from buying and having guns.” Specifically, people known for violent misdemeanors, and alcohol abusers.

Did you know that it’s illegal for someone who uses a controlled substance to buy or have a gun, but not someone who has been found to abuse alcohol? The Times cited a study that found people who have been hospitalized for drinking or gotten in trouble at work for the same thing were in more danger of committing suicide and homicide. 

The article says that the problem is the lack of a useful definition of a pattern of alcohol abuse. That’s hard to believe when the writer goes on to show how Pennsylvania has done it: in that state, anyone who has been found guilty of at least three drunk driving offenses can’t buy a gun. That’s at least a start.

 

 

The U.S. Military and One State Tighten Alcohol Rules

sailor salutes.jpgAs I’ve said before, you don’t have long to look for news about alcohol—there’s always something in the news. In December, the Marines and the Navy tightened up their rules about drinking in what The New York Times referred to as “the toughest anti-drinking policy in the United States military.” Random blood tests were ordered for all marines and sailors twice a year (starting on 1/1/2013), and those found to have a blood-alcohol level of 0.01 percent or higher could be referred for counseling. For a reading of 0.04 percent or higher, they must see medical personnel who will determine if they’re fit for duty.

Recall that drivers in the U.S. are considered drunk if their blood-alcohol level is 0.08 percent, so this policy is strict with a capital S. The article says that the Marines are trying to deter its corps members and educate them, but that individuals can be punished if they don’t stay below the limits. 

(What is the blood-alcohol level if a person has one drink, I wonder?  Can these people have one beer or glass of wine and be safe?) I actually found a blood-alcohol calculator, here, at http://www.ou.edu/oupd/bac.htm It’s from the University of Oklahoma police department and uses how much you weigh, how long you’ve been drinking, and what you’ve been drinking.  I tried it and found that if I have two wine coolers in an hour, my blood-level alcohol reading would be .05.  If  I stick to one, it’s .03. So I’d be in trouble with the Marines even with one. (I’d like someone else to test that calculator, though.)

The point is, the Marines expect their people to stay sober, and according to the article the Navy was planning to introduce mandatory tests in January. The Army and Air Force say that commanders can order tests when appropriate, but of the two, only the Army “prohibits a blood-alcohol content of 0.05 percent or higher.” 

Not long after I read that news, I learned that New Mexico tightened its laws in the hope of deterring drunk driving. No, legislators didn’t raise the blood-alcohol level there, they made it illegal for anyone convicted of drunk driving to buy alcohol in a store, restaurant or bar. (New Mexico has one of the highest rates of alcohol-related traffic deaths in the country, according to the article.)

The new law certainly goes above and beyond the use of the ignition interlock device, which some people say are not always effective. For instance, you can blow into the device and start the car while sober but then start drinking after you start driving. People with interlock devices would be given a specially marked license so that sellers of liquor would know not to sell to people with those licenses. Alaska already has a law like this.

Several people were against the law, including the executive director of the D.W.I Resource Center in Albuquerque. She didn’t think it would work. A Democratic state representative said the law tried to “micromanage alcoholism without providing a treatment option.”

Denzel Washington in FLIGHT, and Radioman - Movie Messages About Substance Abuse

Denzel in Flight.jpegAre you chomping at the bit to see Flight like I am? Surely you’ve seen the ads about this movie, which may garner Denzel Washington yet another Academy Award.  The reviews of this film, in which he plays an alcoholic pilot who dabbles in other drugs as well, sounds like it’s one the recovery community – and everyone, for that matter – will want to see.  I have to say I’m not looking forward to watching the plane Washintgon’s character is piloting run into trouble, but I’ll manage.

Manohla Dargis, a well-known reviewer, found the scene in which the camera focuses on a miniature bottle of vodka nerve-racking because it makes viewers know how much the character (Washington, as Whip Whitaker) watching that bottle wants a drink.

A friend who saw a preview of the movie told me that not only has Whitaker been drinking before he takes the controls, he’s done a line of coke to “even out.” She seemed to think that the movie raises the question of whether Whitaker’s being high actually helped him manage the plane. I want to see if her interpretation is correct, if the movie does indeed pose that question. Also, I want to see if the movie holds that cocaine does indeed “even out” the character’s drinking before the flight. 

This is hard stuff to watch. As Dargis says, Whitaker is shown as an “ugly, mean, angrily unrepentant drunk, the one whose sunglasses hide bloodshot eyes and who, when he passes out on the floor, needs someone to tilt his head so he doesn’t choke on his own vomit.”

I don’t want to tell more of the story, and I don’t know the ending. I do know that Whitaker is given a drug test after the incident and there are legal repercussions. It appears that he’s in court in one promotional photo so I’m wondering—does a judge sentence him to court-ordered rehab? Do his supporters argue for leniency because he saved so many lives? Is there no jail time? And what happens to the female character who is a drug addict? It’s intriguing to wonder about an ending you haven’t seen. 

A comment that appeared under the review on the New York Times website made me even more eager to know the ending:

“A Sobering and Uplifting Flight 

After having seen Flight with three other people, I asked if each one felt the ending of the movie was proper. Lots of debate and discussion prevailed but all were in agreement with the logic that the director took us to. It is a sobering moment and makes us all think if we knew that someone in charge of our destiny was not in complete control of theirs, does that necessitate that justice must take over when our own consciences fail us. Bottomline is that [Denzel] Washington once again shows us how demons can control us to do things without forethought. Reminded me at times of the Desert Storm movie where Washington has to come to terms with his own demons. An Academy award performance indeed.”

It’s been awhile since the last movie on drug use appeared, so Flight keeps the subject of addiction and recovery in people’s faces.  As Dargis frames it, “the story hits many familiar recovery beats, partly because transformation is the only way out when a star plays an addict in an American mainstream movie,” which leads me to believe Denzel will recover. That’s a wonderful message, but it’s also a commentary on movies. Not every drug user recovers, and few (none?) can do it without treatment. That  may sound like an advertisement for MBRC on my part, but sadly, it’s true.

Another movie coming out in the next few months is Radioman. It’s a documentary about a recovering alcoholic who was once homeless and who has appeared in over 100 films. Should be interesting.

News about Teens Drinking and Driving, Ignition Locks, and The Cost of Driving Drunk

The news about teens drinking and driving is that the numbers have dropped significantly, according to federal health officials, ostensibly due to stricter laws regarding drunk driving and limiting the hours teens are permitted to drive at night. The cost of gas might mean that teens are driving less, as welteen drinking and driving.jpgl.

That’s great to hear, of course. I wondered, however, since more teens are smoking pot than drinking today, does that mean that more of them are smoking pot and getting behind the wheel?

There’s news about teens and the alcohol industry as well. In response to industry marketing codes, several brands, including Coors Light, are developing ways to test a user’s age before allowing them to take part in social media. In order to “follow” a brand, for example, teens will have to confirm they are 21, just as they must do when entering an alcohol brand’s website. I’d like to hear more about the whole rationale behind asking teens to give their true age. Do companies feel it’s the least they can do? The only thing?

I’ve kept an article that has an example of the actual cost of drinking and driving because you don’t often hear about the actual charges. It starts with the writer being stopped, arrested and then taken to the police station, where he the paid $40 in bail money. The next day he paid $134 to get his car out of the pound, and when he appeared in court, he paid $600 in fines and court fees. His brother-in-law lawyer went with him to court, so we never do learn what that would cost someone who had to pay a lawyer. Then he had to take an alcohol education class for $571, and also pay his nephew to drive him to pick his son up from college. That fee wasn’t mentioned.

After 45 days, he paid $500 to get his license back and saw his insurance premium double. He doesn’t give that amount, either, but it must be several thousand dollars.  These prices probably vary depending on the section of the country, but it’s pretty astounding to consider what a couple of drinks too many can cost when you’re driving. But as the writer said, the cost of killing someone, and possibly himself, doesn’t compare.Thumbnail image for ignition interlock.jpeg

If a letter to the editor in my local paper is to be believed, research shows that a first-time drunk driver has driven under the influence at least 80 times before getting stopped. I searched on the letter-writer’s name and town and learned why he’s so insistent that ignition locks would cut drunken-driving deaths (which is both the title of his letter and his argument). In college, Steven Benvenisti was hit by a drunk driver and suffered a traumatic brain injury. He recovered (miraculously, if you saw the photo on the website) and went on to become a lawyer.

Benvenisti gives some surprising statistics. Ignition interlocks are more effective than suspending someone’s driver’s license to stop repeat drunk drivers, he says, because 50 to 75% of convicted drunk drivers continue to drive on a suspended license. If offenders are required to have an ignition lock, they’ll have to prove they’re sober before driving, and they’ll also be able to drive to work (which is not the case if their license is suspended). Finally, he says, “according to the Centers for Disease Control and Prevention, interlocks have been proven effective in reducing drunken-driving recidivism by two-thirds.” Not surprisingly, Benvenisti serves on the board of directors for Mothers Against Drunk Driving (MADD).

 

Joan added:  I like the idea of an ignition interlock.  One of our former staff members had one of the first genration kind.  It was attached to his steering wheel.  He had to blow into it not only to start the car, but to keep going.  I found the above photo of this newer, more high tech ignition interlock on the website of the Florida ignition Interlock Program. 

 

 

Primary Care Doctors Screening for Alcohol Abuse

patient speaking with MD.jpgLast year I landed in the emergency with a nosebleed that wouldn’t stop. When a nurse entered the room to ask me some general questions, one of them was whether or not I drank alcohol. I answered that I do. The next one was how often, and the one after that was how much. I said I probably drank every day, and indicated two inches with my finger and thumb.

If that wasn’t a look of sheer doubt she gave me, I don’t know what was. “How much again?” she asked. (Some friends marvel that I find any more too filling.)

“This much,” I said, showing her again. “And every day?” she repeated.

“Yes,” I answered, now annoyed and defensive.

“I write about addiction and recovery, and I don’t have a problem”, I told her. “No, no, I’m just asking,” she said, as she busily wrote on the questionnaire.

Our exchange shouldn’t have annoyed me. I know she was just doing her job—and I was especially interested that this questioning had made its way to the emergency room and that a nurse was doing it. I posted quite awhile ago about the majority of ER visits being related to some form of drug use, and that post also mentioned that doctors are now being trained to perform a quick screening during normal office visits.

After that experience, I was drawn to a headline in The New York Times late last month: “Doctors Reminded to Ask Patients About Alcohol Use.” The article said that a panel of the U.S. Preventive Services Task Force found that a third of us misuse alcohol (but fewer are addicted). Even the misuse results in 85,000 deaths a year, however. More astounding is that ”alcohol abuse is the third leading cause of preventable death in the U.S., after smoking and obesity.”

But if primary care doctors ask patients a set of questions during the person’s office visit and offer a brief counseling session (or even more than one), it could help people cut down on their drinking, the panel said. One of the questions is the all-important: “How often do you have five or more drinks on one occasion?” (That indicates binge drinking.)

The article noted that the panel doesn’t suggest this technique be used with adolescents, however, because it could cause anxiety or make them feel singled out.

I remember reading that people are prone to be honest with their doctors, and if that’s true, this should help. But I don’t know, do you think those who abuse alcohol are really honest with their GP if they’re not even honest with themselves? I think of my friend’s 20-something daughter, who years ago was met by the authorities when her plane landed because her behavior was so outrageous after a few drinks in the air. Two years later she got a DUI.  I’m not sure if she’s addicted, but she definitely abuses alcohol. Would she be honest with a doctor about the amount she drinks? And would a brief intervention help her and those like her?

I also remember reading several years ago about primary care doctors being taught about screening. The New York Times article I referred to earlier was a reminder to them, reaffirming the advice given in 2004. The article does say that the technique does not help in cases where people “are already addicted and need more extensive help…like therapy in rehabilitation clinics.” Thinking about it, it sounds like a good idea for people starting to go down the wrong path. But that includes adolescents!

Should you have thoughts on the panel’s recommendations, there’s a public comment period. Anyone in favor of this screening should take heart that the Affordable Care Act requires insurance companies to cover it.

Alcohol News: Women Over 50 Drinking and What the Future Holds for Treatment

mature woman drinking wine.jpgThere’s always something new about alcohol. We’ve heard for awhile that drinking in moderation (one to two drinks a day) helps protect against heart attacks, for example. Now a new study of women in their 50’s and early 60’s indicates that it may also help prevent bone loss, according to an NPR segment this month.

Women lose bone during menopause (it’s dissolved), after which new bone is formed. But put simply, more bone is lost than is formed. For this study, researchers measured the amount of bone that was reformed in 40 women and then told them to stop drinking for two weeks. They found that bone was lost during the period of abstinence, but once the women started drinking again the levels went back to what they were previously. Or, “…alcohol seemed to slow the bone turnover rate.” That doesn’t mean that young women who are still building bone mass should think it’s OK to binge drink, however. The one or two drinks a day -- for older women  --  should be spread over 7 days.

For women like me who simply hate the idea of osteoporosis medications like Actonel, Boniva or Fosomax because of the possible side effects, that’s good news indeed. (Men weren’t studied, by the way, and would you believe there’s actually a journal called Menopause, in which the study was reported?)

There is other news on the alcohol front that I found interesting. In May, the New York Times had an article titled Drugs Help Tailor Alcoholism Treatment that mentioned the medications which “combined with therapy, help alcoholics break the cycle of addiction.” I know this is a controversial subject. Some people say medication is a crutch and counseling and other methods are the only path to recovery. But some alcoholics, like the woman mentioned in the article, say they don’t think they could have stayed sober without help from drugs like naltrexone to help control the cravings. Even the CMO of Hazleden was quoted as saying that the relapse rate is high during the first 12 to 18 months of sobriety, so anything that can be done to help during that period affect people’s progress. 

Acamprosate (also called Campral) also helps reduce cravings, and gabapentin, an epilepsy drug, shows promise, the article said. Topiramate, used to treat seizure disorders, is occasionally prescribed to alcoholics, as well as ondansetron, an anti-nausea medication.  I love statistics, because while they can be dismal, they can also hold out hope. More than one clinical trial has shown that for people taking naltrexone or acomprosate, about one in seven alcoholics has been helped. Is that depressing? I prefer to think about the one person for whom the drugs have been life-changing. Addiction is an insidious disease once it takes hold. And one doctor said that naltrexone “is supposed to work better in patients with a family history.”

What stayed with me from the article was the thought that in the future, treatment for alcoholism may become like that for depression. We’ll have a range of drugs to choose from, that can be added to “therapy and other tools to achieve long-term recovery.” Nora Volkow, director of NIDA, said, “Just as breast cancer isn’t just one type…alcoholism is heterogeneous as a disorder, so there’s clearly not one drug that is going to work for everybody.”

 

 

 

Books on Addiction and Recovery - and Publishing Information for Medical Professionals

We’re drawn to books about addiction and recovery because we relate to people’s struggles, or we want to know how they recovered, or we want to hear about their redemption.

Here are a few, along with a yet unpublished, but promising one. I’ve also included some tips for medical professionals on getting published.

Drunkard: A Hard-Drinking Life” by Neil Steinbergdrunkard-hard-drinking-life-neil-steinberg-paperback-cover-art.jpg

Powerful title, isn’t it? I read this book by Neil Steinberg, a columnist at the Chicago Sun-Times, in April. I didn’t think he could talk about his drinking day after day after day and still hold my interest, but he did. He wrote about how much he drank and how he sneaked drinks and hid bottles so matter-of-factly, that I suspended disbelief and went along for the ride. Actually, I marveled at how blasé he could be. His denial was enormous, until, at the end, he acknowledged to himself that he’s an alcoholic. Ultimately, he had already laid it out; the truth was there all along. What seemed like simply a daily regimen was a path to destruction. I found the columnist’s story different from others because of his matter-of-fact tone.

We know that physical violence is not uncommon in a house where someone abuses alcohol, and Steinberg got into trouble for hitting his wife when he was drunk. She called the police; he ended up in court and then in court-ordered rehab. He went to self-help meetings, too, although for most of the book his heart wasn’t in it. He relapsed and then relapsed again, until the effort finally clicked. Somehow he makes it appear seamless, which is surprising because he was so difficult at times and had such a hard time in groups. 

Basketball Junkie: A Memoir” by Chris Herren

Last month I got an email from The Partnership at Drugfree.org about Chris Herren, who wrote a memoir with Bill Reynolds called Basketball Junkie. Herren was a high school basketball star who had it all—a book written about him, an appearance on NPR, and a contract with the Boston Celtics. However, he had started with alcohol and progressed to cocaine and then heroin, and quickly lost it all. It’s a story of redemption, as he reclaims his dignity if not his career. Back with his wife and three children, he’s been sober for several years now. 

A Golden Voice” by Ted WilliamsA-Golden-Voice-Ted-Williams.jpg

Remember Ted Williams, the former DJ who appeared all over TV after a YouTube video showed him disheveled on a street corner in Columbus, Ohio? He told his story of addiction and said he had stopped using, and got offers of jobs, a place to stay, and a future. But he hadn’t stopped. Dr. Phil gave him a good talking-to and he entered rehab but left shortly afterward. He’s back now and says he’s sober for real this time. Look for another story of redemption from Williams and his ghostwriter. He’s had a hard road and some of his truth-telling may amaze you. I wish him the best. 

Permanent Midnight: A Memoir” by Jerry Stahl

You have to take Amazon reviews with a grain of salt. Sometimes authors have their friends write reviews, so those are always glowing. Others are honest about disliking the book, and still others—especially people with a competing book or those who “have it in” for the author—write simply scathing reviews.

In any event, the review of this book by Booklist, the American Library Association’s magazine, is positive. Stahl has had quite a career. Started as a pornographer for Beaver magazine. Wrote fake sex letters for Penthouse and articles for Hustler. Earned about $7,000 a week writing scripts for Moonlighting,Thirtysomething, and Alf

He was also addicted to smack, coke, crack, Dilaudid (a pain reliever),and other substances and soon lost everything, including a possible gig as a writer for the second season of Twin Peaks. The review goes on to say:basketball junkie.jpg

“Permanent Midnight is not for people with delicate sensibilities or any other low thresholds for truth. Stahl's autobiography provides no glitzy Hollywood confessional with raised letters on the dust jacket, and it's not a self-help book on recovery. Instead, it explores, with brutal honesty and humor, the author's struggle between the nightmares of addiction and the nightmares of sobriety. Permanent Midnight is one of the most harrowing and toughest accounts ever written in this century about what it means to be a junkie in America, making Burroughs look dated and Kerouac appear as the nose-thumbing adolescent he was.”

A Novel Yet to Be Published

I thought this next entry would be instructive for medical professionals with a book idea. An addiction specialist friend of my coauthor, who has written a novel about a young person’s journey to hell and back, is trying to find an agent. The book emanates from his practice and if I correct, is a composite of many clients. In April he sent me the manuscript and asked for advice. 

I thought it was wonderful—he delves into legal problems an addict often incurs—but since he’s marketing it as medical fiction and fiction isn’t my specialty, I wasn’t able to help him much with plot, characterization, and so forth. I gave him suggestions for polishing his writing in some areas and then introduced him to an editor-friend at a publisher. 

In case there are other addiction professionals interested in writing books (not fiction), here are some tips: 

1. The publishing industry has changed dramatically in the last few years. It’s harder to get a book commercially published today, although it can be done. On the other hand, self-publishing is a viable alternative if you can’t attract a commercial publisher, and sometimes publishers pick up self-published books and re-publish them under their auspices. 

2. You need a “platform” to attract an agent and also a publisher. In other words, you have to show you have some credentials that wil sell a book, and it’s work with a capital W. Have you been in the media, been quoted in publications? Have you been on radio or TV? Do you have a blog? A website? These are expected today. Look at the website for Helping the Addict You Love by Larry Westreich, which Dr. Westreich uses to market his book.

3. The amount of information you need to know about publishing is enormous. There are books on getting published, but older ones are outdated in this market.  Read, read, read and talk to people so that you know the basics of the publishing industry. The author of Understanding the High Functioning Alcoholic is another good site to take a look at.

4. There are conferences especially for doctors wanting to publish books. One is given by Harvard Medical School, Department of Continuing Education, http://cme.med.harvard.edu/cmeups/htm/00292363_schedule.htm. The doctor I mentioned who’s writing the medical fiction book attended a SEAK (www.seak.com) conference in Hyannis, Mass., like this one: How Physicians and Lawyers Can Get Their First Book Published, August 10, 2012. I’m not pushing these; but there is a lot to learn and these conferences do offer good information.

 

Book Review: Sober Siblings by Patricia Olsen and Petros Levounis

Susan Sullivan, a counselor at Malibu Beach Recovery Center, who previously reviewed the DVD series "Meth Inside Out," reviews "Sober Siblings" which Pat Olsen co-wrote with Dr. Petros Levounis, MD.   Sober_siblings book cover.jpgPat is a regular contributor to the Malibu Beach Recovery Center blog.

 

Addiction is a family disease. Whether that addiction takes the form of alcoholism, drug addiction or any of the many insidious compulsions that can plague an individual, misdirected dependency creates havoc with the home. These behavioral maladies can rip families apart and create lifelong distress for the loved ones of the afflicted. Family members may feel resentful at the implication that they too need to seek help.  After all, he/she is the one causing all the problems. Why do I need to change? The undeniable truth is that once addiction infiltrates the home, no one escapes unscathed. For family members who do not look for some kind of plan, guidance, or program themselves, the wounds will quietly fester within and eventually lead to troublesome personal problems - even if that is simply alienation. There will always be that sore spot within (surrounding the sibling) and often much greater angst and acting out in our own lives. Feelings of guilt, shame, helplessness and hopelessness may take over and darken our lives obliterating our chances for joy and happiness.

Sober Siblings by Patricia Olsen and Petros Levounis, MD, MA, shines a 10,000 watt light bulb on a subject that many families keep in the dark, revealing secrets, judgments and gnawing apprehensions that have festered in the minds of those less focused-on family members – the siblings.

As a sober sibling myself, I found this book tremendously insightful and illuminating. Many sober siblings (whether recovering addicts themselves or the blessedly non addicted) have a basic knowledge that somehow, we need to ‘take care of ourselves first’, ‘create boundaries’, ‘release with love’, and ‘not buy into the drama’.  Sober Siblings breaks down the structure of the complex issues of living with an addictive family member, defines the characteristics that allow one to identify with the problem and then sets out to provide a clear, cognitive set of tools to deal with the uninviting life with an addicted sibling. Chapter after chapter, I gleaned enriched knowledge in areas I thought I already basically knew.  I saw my own siblings in a more compassionate light, leading to an understanding of how to approach taboo subjects. Fear of confrontation falls away in the face of the loving but firm approaches laid out for us.

Organized in a logical progression of categories (Description of the Uneasy Triad, Definitions of Addictions and Other Disorders, [the extremely helpful] Division of Responsibilities, Defining Relationship Goals, Establishing Boundaries, Validation of Feelings, Finding Support, Getting Help and Acceptance), the authors take us on a journey of personal recovery – each step building to an eventual structure of support, clarity and most welcoming – personal relief.  The weight of living with an addicted sibling is crushing and through the information in this book, that weight lifts with ease. The authors’ professional experience and expertise are evident on every page giving the reader a sense of trust – we are in good hands, they know their stuff – so to speak and the reader gets an immediate sense of hope that the journey through this book will lead to not only a greater understanding of the unique position a sober sibling lives in, but also relief from the deeply scarred over wounds that have taken a lifetime to form. Relief is almost instantaneous when chapter by chapter this reader found new and compassionate ways of dealing with an old problem.  Describing the nature of addiction, identifying feelings of anger, shame, and frustration, providing actual scripts to use when setting boundaries (and direction on how to maintain them), unveiling the pros and cons of interventions and looking at treatment and therapy options for both the addict and the sober sibling, the book delivers information in an uplifting, cogent manner.  

Sober Siblings is like a how-to manual of preparation for the non-addicted family member, not unlike an earthquake preparation manual helps save lives in a natural disaster. 

 

Sober Siblings by Patricia Olsen and Petros Levounis, MD, MA is available through Lifelong Books. www.dacapopress.com and on amazon.com.  

Native Americans and Alcohol

Alcohol abuse among Native Americans in the U.S has been a problem for a long time. Michael Dorris, author of The Broken Cord, which detailed his adopted Native American son’s fetal alcohol syndrome, called attention to it when his book was published in 1989.American Indians.jpg

If you don’t live near an area with a high Native American population, you may tend to think of this group’s alcohol problems only when you hear or read about this tragedy. A recent article reminds us that the problem is not going away.

Alcohol has been banned on the Pine Ridge Indian Reservation in South Dakota since 1970. I presume that was the result of an Oglala tribal decree, since “fetal alcohol syndrome, fatal drunken driving accidents, and beer-fueled murders have cast a pall over Pine Ridge for decades,” according to the writer. So some Pine Ridgers go to Whiteclay, a nearby town, for their poison, and as a result, the tribe has filed a lawsuit against brewers and the stores selling liquor just yards from the reservation, in Nebraska. Whiteclay residents have several responses to this finger-pointing, including the thought that the problem will just move and at least it’s contained in one area now.

The Oglala reservation’s tribal head said the majority of criminal court cases and illnesses on the reservation were the result of alcohol bought across the state line (in other words, in Whiteclay). There were 20,000 alcohol-related arrests in 2011 alone on the reservation. Four of five families have a member with a drinking problem, and there are high rates of teen suicide.

Pine Ridge is the only dry reservation left in SD, but about 1/3 of the other 310 reservations already ban alcohol. People who want to legalize alcohol on all reservations say that doing so would allow tribes to control it better and have a revenue source for providing treatment programs. The CDC, for its part, says “Excessive alcohol consumption is the leading cause of preventable death among American Indians, and they are affected at about twice the rate of the national average.”

Here’s a link to a Sioux City Journal article about the controversy. Also, an issue of Alcohol Health and Research World on the National Institute on Alcohol Abuse and Alcoholism site contains an interesting article on American Indians and Alcohol.

 

Naloxone and Overdose Rescue Kits and Hangover Helpers

When I first saw the headline, “Overdose Rescue Kits”, I thought it was a joke, a takeoff on articles about overdose rescue kit.jpghangover remedies. But it wasn’t a joke. (FYI, since that day, the “New York Times” has changed the headline to “Kits Using Naloxone Revive Addicts After Opiate Overdose”. They make those changes occasionally.) I knew about oral activated charcoal used for drug overdoses, but this was different.

Last October I posted about states passing legislation to help those who overdose by removing the fear of being arrested if someone calls 911 to get the person help. This article is about helping people in other countries who overdose on drugs like heroin and Oxycontin.

In Europe, someone dies from a drug overdose every hour, the article says. (I wonder what the figure is in this country.) With naloxone (or Narcan, the brand name), which blocks opiate receptors, the person may be revived. I don’t know if it’s possible in every case, but it’s been “shown to work” and “has been used for decades by surgeons and paramedics.” Naloxone is “a secondary chemical in the drug Suboxone”, according to Wikipedia.

The article mentioned there’s a question about how legal it is to distribute these kits the way other countries do it, but there are groups in Central Asia and in Europe hard at work. In China, if you call a hotline, someone on a motorcycle will deliver the kit to you. In Afghanistan, however, the person who gave you a heroin injection may also provide the Naloxone shot. L

Now the cost. Roughly between  25 cents and $2.00 in other countries, in contrast to about $6 or $9 in the U.S, depending on what article you read.

Be sure and check out the photo of the kit in the article. It looks very professional, like a first aid kit you might buy for your house. A nasal spray is available as well. I wonder why I never heard of these kits before.

In a 2009 article in Time magazine, addiction writer Maia SzalavitzMaia Szalavitz.bmp wrote about programs in Chicago and North Carolina in this country.  I also found mention of the kits by a Canadian blogger. Here’s an article from the Harm Reduction Journal on a government site about a study of a program in New York City. The conclusions seemed pretty positive. Finally, NPR has had a story on the kits, too.

As the New York Times writer mentions, if someone is revived with this kit, it may send him or her back to rehab. On the other hand, Szalavitz notes a problem with these programs: could drug users also think that if this is something that can resuscitate them they can continue using drugs with impunity? Which, as we know, is playing Russian roulette with your life.

About hangover remedies…there’s news on that front as well. Just before New Year’s, several new products hit the news. Enterprising entrepreneurs have been busy.

One product, a patch, goes on an area like a forearm 45 minutes before drinking and should be worn for eight hours after the last drink. It contains B and other vitamins, Acai berry, and folic and pantothenic acid. But even the doctor that helped produce the patch said that nothing will help those who drink a lot, so doesn’t this appear senseless?

Another supposed remedy is a pill that is a blend of aspirin, an antacid, and caffeine, and yet another is a mix of vitamin B and C, magnesium and cysteine. It seems to me there are so many more productive things to be doing with one’s time, and so many better things to invent for mankind.

Update from Joan Borsten:

Fifteen minutes after we published Pat's article, the phone rang.  A woman had already read it and wanted to know where to get a Naloxone kit.  She said she wanted to have one on hand in case her brother, a heroin addict, overdosed.   While researching this article, Pat had looked without luck for a manufacturer of these kits.  She tried again and discovered that kits require a prescription and the local pharmacy may or may not have a kit on hand, but there are apparently 200 naloxone distribution programs around the country.  There is a large program in New York directed by Sharon Stancliff with the Harm Reduction Coalition.  To find one in your area, type http://hopeandrecovery.org/overdose into your search engine and enter a zip code into the program locator.

 

Drunk Shopping

Joan mentioned recently that I post about alcohol frequently. It’s true, I do. You have to admit—it’s woman ordering from a catalogue 1.jpgeverywhere. It’s in newspaper ads, it’s paired with entrees on restaurant menus…And it’s easy to see why. It’s the “socially acceptable” drug. A friend of mine recently said that kids smoking pot today are as ubiquitous as people drinking wine. Sad analogy, but it shows once again, alcohol is everywhere and often considered socially acceptable.

One example of how rampant alcohol is in our culture is the articles about the increase in people who shop online after drinking. You’ve probably heard of “drunk dialing” (making phone calls you otherwise wouldn’t make if you were sober); now we have “drunk shopping,” or more elegantly  “shopping under the influence,” according to an article in The New York Times.

It was especially popular to drink and shop online over the holidays, according to the writer. Boutiques have long been enticing shoppers with wine and cheese, and over the holidays, at least one brick-and-mortar retailer, A.Line Boutique in Denver, used alcohol and food platters in the hope customers would shop more after imbibing.

As a society, we use alcohol in many ways, such as to mark important occasions, in the Catholic ritual of communion, and when socializing with friends and family. In moderation it’s harmless and even has protective effects on the heart. (Doesn’t it seem like researchers are always finding more benefits?)

Most people can drink socially with no problem. But for others, those who abuse alcohol or become addicted to it, alcohol has serious consequences. (That’s over 14 million people in the U.S.) Socially, it’s a disaster for the drinker and those around him or her. (You’ve probably heard that 1 in 4 people are affected by a loved one’s drinking.) And physically, alcohol can kill.

As I’ve written before, in The Physical Toll of Alcoholism, it affects countless organs in the body, can lead to cancer, and impacts your brain. It’s also the cause of car accidents and accidents in the home. Less deadly but still sad are how it affects one’s judgment. Drunk shopping indeed.

Drinking and the Holidays

When I saw the headline, I had a feeling I knew what the article would say. The Medpage Todayholiday ornaments.jpg article was titled: “Relatives, Alcohol, Knives, and Other ED [Emergency Department] Thanksgiving Tales.” I was right; it warned readers about holiday merriment when drinking is involved. "People need to minimize their alcohol consumption. But if they don't, stay away from relatives and carving knives," if offered.

Articles like this start appearing around Thanksgiving each year. At a minimum, it certainly doesn’t hurt to remind people of the dangers of drinking and driving at a time when people may imbibe more (especially people with a problem). Besides parties with family and friends, there are those holiday office parties, too.

 Also, college students returning home for the break and congregating in bars can be a real concern. Here’s an article (“Home for the Holiday, Time to Party”) on this yearly ritual from the Wall Street Journal. The paper referred to these events as “the alcohol-fueled get-together[s] of the old high-school crowd.” Of course you think about the drive home and hope the young drivers don’t get behind the wheel.

On the other end of the scale, inebriated family members have caused heartaches, arguments, and worse during holiday get-togethers. Every family in this situation knows what I’m talking about, and families are at different places as to how they handle a family member who drinks. Some try to overlook the drinking and enjoy the holiday despite it. A number of people roll their eyes about their “Uncle Harry” whose drinking is quite obvious during the holiday celebration. Some families insist the the family member who drinks refrain from drinking, or some family members stay away if that family member is allowed to attend. Each family – and family member – has to handle it their own way.

 Then there are the questions regarding family members in recovery. Do you drink around them? Do you only have non-alcoholic drinks? Do you ask them their preferences? It’s not always easy to know what to do.

 

 

 

Substance Abuse on College Campuses

girl and martini.jpgThere are a lot of good things happening on college campuses, but there are always those less than desirable events going on as well, often involving drinking to excess and all that accompanies that during the college years.  Girls Gone Wild, the risqué TV show, was due to arrive at a bar near Rutgers University in my state recently. In fact, two Rutgers University students arranged it.

Not surprisingly, some students and administrators were upset because allowing the TV program to do a video shoot at the bar “detracts from the university’s effort to promote responsible drinking and prevent sexual assault.” The Alcohol and Beverage Control stepped in and said that nudity and liquor cannot mix in a bar and the bar stands to have its liquor license revoked if the event took place. The head of the Student Assembly spoke out against the idea, too, which was nice to see.

I found it interesting that at the same time, Linn State Technical College in Missouri  was in the news for its mandatory drug testing policy as condition of enrollment. Talk about controversy. The ACLU has filed a lawsuit to fight the policy, which

“…requires all first-year degree or certificate-seeking students, as well as those students returning to the college after a leave of a semester or more, to pay a $50 nonrefundable fee and submit to testing by the collection and analysis of their urine. Students began to be pulled out of their classes the day after the policy was adopted so they could be tested, and a refusal to submit to the test will result in students being dismissed from the college.

Students whose tests come back positive will have 45 days to take a second test with a negative result in order to avoid being dismissed from the college.”

Can you imagine if every college had this policy and the courts approved? It might just mean that substance abusing students would have to take a hiatus if they wanted a degree and would return to drug abuse on graduating. But who knows? They’d be studying with a clear mind, and maybe some of them would never go back to drugs.

 

Wet Houses, Where Alcoholics Aren't Urged to Get Treatment

I suppose you can characterize attitudes toward certain drugs as either liberal or conservative. But there’s a movement regarding drinking that is so liberal as to redefine the word.alcoholic = silouette and bottle.jpg

Proponents of this theory hold that it’s OK to allow alcoholics to drink rather than try to move them to treatment and save their lives. In some places across the country, alcoholics are allowed to live in houses where no treatment is provided and people are allowed to drink themselves to death. A piece on Minnesota Public Radio ("MPR") dubbed the St. Anthony Residence in St. Paul, where 60 men were living in December 2010, a "hospice".  At the time that article appeared on the MPR website, Minnesota had four “wet houses” in the state.

The arguments for and against wet houses are fairly obvious. Those in favor say treatment doesn’t work for some people and the more humane act is to give these people a home and allow them to live out their days as comfortably as possible. Some alcoholics are simply hopeless, advocates say. Why make them continue the cycle of DUIs, incarcerations, and relying on emergency rooms for emergency care? (They’re provided with medical care if they get sick in these Minnesota homes.) They also cost the government (and taxpayers) a ton of money living this way.

Critics, however, including William Moyers, author of "Broken: My Story of Addiction and Redemption," say this thinking makes no sense. Just as you don’t give up on people with cancer, you just don’t give up on people with an addiction.

A more recent article about wet houses appeared in The New York Times Magazine in April. In this article, an employee at one of the houses said people who live there actually moderate their drinking, and the houses save taxpayers money since they’re funded by non-profits and others.

These houses have to be one of the most controversial topics ever.

Drinking Diaries: Women Writing about Alcoholism

I’ve said it before and I’ll say it again: It never fails to amaze me how people are driven to write about substance abuse or addiction—both those who have battled it, and those who have been affected by it. (One example is the NYT Proof blog, which is supposed to be resurrected at some point.)

I ran into another example of writing about addiction recently after finally seeing the movie Julie & Julia. I wanted to know more about Julie Powell, the woman who blogged about following Julia Child’s recipes and got a book published (on which the movie is based) as a result. I found an interview she had done on a site called Drinking Diaries.  Thumbnail image for Drinking Diaires LeahandCaren6-251x300.jpg

Drinking Diaries, the founders tell us, is “a forum for women to share, vent, express, and discuss their drinking stories without judgment.” Writers Caren Osten Gerszberg and Leah Odze Epstein have both been affected by alcoholism in their family, so it’s natural that they got the idea for the blog. They solicit stories about drinking from women and have compiled essays into a book that will be published in September 2012:DRINKING DIARIES: Women Serve Their Stories Straight Up”.

I could spend a lot of time on this site--there’s lots of good stuff here, like an interview with Alexandra Styron, daughter of author William Styron, who wrote about his depression in his memoir, “Darkness Visible”. His daughter  has written a memoir about growing up with him, “Reading My Father.”  I also liked the Resources section, which lists books related to drinking. I’m including them here:

MEMOIRS:

At Home in the World, by Joyce Maynard

Drinking: A Love Story, by Caroline Knapp

Dreaming: Hard Luck and Good Times in America, by Carolyn See

Hungry Hill: A Memoir, by Carole O’Malley Gaunt

Mommy Doesn’t Drink Here Anymore: Getting Through the First Year of Sobriety, by Rachel Brownell

Red, White, and Drunk All Over: A Wine-Soaked Journey From Grape to Glass, by Natalie MacLean

Slow Motion, by Dani Shapiro

Smashed, by Koren Zailckas

NONFICTION:

Drinking, Smoking and Screwing: Great Writers on Good Times, edited by Sara Nickles, with Bob Shacochis

It Will Never Happen to Me, by Claudia Black

Love on the Rocks: Men, Women, and Alcohol in Post World War II America, by Lori Rotskoff

Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton

NOVELS:

Rosie, by Anne Lamott

YOUNG ADULT NOVELS:

Love You, Hate You, Miss You, by Elizabeth Scott

A Room on Lorelei Street, by Mary Pearson

 

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Understanding the High-Functioning Alcoholic

I’ve run into several people whose alcoholic family member gets up each morning and goes to a job, so the sober person says their loved one doesn’t have a problem. For people who don’t understand substance abuse and addiction, the high-functioning alcoholic can be difficult for some people to wrap their brain around.Sarah Allen Benton.jpg

Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton, explains that some of us are influenced by the stereotype of the jobless and homeless substance abuser who’s all tapped out. That’s what an alcoholic is to them. Benton calls people who represent this stereotype “low-bottom drunks.” and I take that to mean drinking takes over these peoples’ lives to the point where they lose everything and can barely function.

Roughly 18 million people suffer from alcohol abuse or dependence in this country, and about 9% of those fit the stereotype just mentioned, according to the book. However, 20% of people who abuse alcohol may be high-functioning, Benton tells us. They work, often in prestigious careers, and they can maintain a life outside work. They often hide their disease well. Plus, their success makes it even easier for them to deny they have a problem.

But this group exhibits the same warning signs as anyone with a drinking problem: They experience blackouts, they feel shame about their drinking, they obsess about it, and they can’t stop. There are several other signs as well. Plus, they’re on the road that leads to one place only: death.

Benton speculates that there’s not a lot of research on this segment of drinkers simply because they’re higher functioning. They don’t pose as severe a problem for society and government systems as their severely addicted counterparts. Her discussion of famous “HFAs”, as she calls them, reminds us that no one is immune. The list goes on and on: Buzz Aldrin, Elizabeth Taylor, celebrity host Pat O’Brien, Representative Patrick Kennedy, Grammy winner Keith Urban, Eric Clapton, and more recently, Charlie Sheehan, to name a few. There but for the Grace of God go you and I.high functioning alcoholic bookcover-200.jpg

The book is divided into two sections: Active Alcoholism and Recovery, which I found to be an interesting approach.  It stands to reason that the author discusses the controversial topic of cutting down, or drinking in moderation, since it’s an option most HFAs probably consider. She presents a ton of research, both pro and con, and you can guess, on reading her background, which side she’s on.

A high-functioning alcoholic herself, Benton is a mental health counselor in Boston entering her 7th year of sobriety. Her story of alcoholism and recovery, woven throughout the book in actual entries from a journal she kept, seem especially poignant, probably because as a professional she has great insight into her experiences. “The longer I have been in recovery, the more I change my perspective on my past,” she writes.

Here’s a blog post Benson wrote for Psychology Today: http://www.psychologytoday.com/blog/the-high-functioning-alcoholic/200903/high-functioning-alcoholics-are-everywhere-are-not-gettin

There’s a lot of information in this book, but if it’s the personal story that always gets you, Benton certainly has one.

An ER Doctor's Humanity

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Do you ever wonder what doctors think about their patients who drink or abuse other drugs? There’s an online publication called www.medpagetoday.com  that says it’s “PUTTING BREAKING MEDICAL NEWS INTO PRACTICE®.” I get the organization’s email newsletter. It also offers a couple of blogs written by the staff, many of whom are doctors.

Recently one of the blogs by a doctor who calls himself Shadowfax caught my eye. The title of his blog is “Movin’ Meat: The Accidental Blog of a Semi-Accidental ER Doc Living in the Pacific Northwest.” The name of the particular post I read was “Just Another Drunk.” 

He wrote about an older homeless alcoholic who ended up in his ER. We never learn the man’s name. Someone had found him passed out in a bush and had called an ambulance. The man, who had been in jail recently, was in the bush in the first place because he’d had too much to drink and couldn’t find his way back to the bridge he lived under. Shadowfax laments the fact that there’s nothing the ER can do for this man, and marvels that he has lived to age 75.

The doctor asks the man if he has any family and waits as he hesitates for a minute and then says no. It’s the hesitation that grabs the doctor’s attention and makes him try to imagine this man’s life and the family he may have had at one time. Did each of his loved ones drop off along the way? Did he once have friends?  Then the doctor makes it personal, talking about his own family which includes uncles who were lost to alcoholism and what it did to their families. The doctor is yet another person touched by alcoholism, illustrating once again the reach that this disease has.

Shadowfax was sympathetic to this man’s plight and didn’t judge. But I’ve read that there are some doctors who still judge alcoholics, who think that drinking is a moral failure instead of a brain disease. Hard to believe when they’re in the medical field. But that was before the HBO Addiction series appeared on TV, so let’s hope the doctors who still think that way saw the program and it changed their attitude.

I wonder how many other people have a family member who was homeless at one time or maybe still is. I especially like his last line: “Of all the sad things we see in the ER -- and there are plenty -- this seems to me to be one of the saddest and least appreciated, and by far among the most common.”

 

The Physical Toll of Alcoholism

We hear over and over again that alcoholism wreaks havoc on the human body, but I’ll never forget the first time I learned how pervasive the damage can be.  Hearing about it is one thing, however, but seeing it in print really brought it home to me. It’s not pretty, and that’s a good place to start this cautionary post.Man and bottle.jpg

 

People who drink to excess suffer from poor nutrition because they can’t absorb vitamins properly, so aside from the physical complications, their appearance suffers. Overall poor health from alcoholism can make someone’s skin appear pasty and their hair look dull. If you’ve seen broken capillaries on someone’s face, you’ll probably agree they’re unsightly, too.

 

But that’s not the half of it. Let’s start at the top. Brain degeneration is a big problem, along with the possibility of severe memory loss and Wernicke-Korsakoff (“wet brain”) syndrome. Symptoms of the latter disorder include unsteady walking, hallucinating, confabulation (making up stories), and vision changes.

 

Experts say alcoholism can also lead to cancer of the colon, liver, larynx, and esophagus. Not only that, liver disease (alcoholic hepatitis), followed by cirrhosis of the liver, and esophageal bleeding are not uncommon, nor is pancreatitis.

 

The list goes on. Alcoholics can experience depression, insomnia, high blood pressure, and nerve and heart muscle damage. In women, alcoholism can lead to the cessation of menstruation, and in men, to an inability to get an erection.

 

On one hand, many of these are clinical-sounding unemotional medical terms that read like a Scared Straight script, the talk prison inmates give to young people to try and keep them on the straight and narrow. On the other hand, if you or a loved one has experienced some of these complications, you know how serious they can be, and how heart-breaking.

 

 

 

 

Proof: The New York Times Addiction Blog

Excessive drinking is portrayed in movies (Lost Weekend, Barfly and 28 Days are three), recorded in books (A Drinking Life: A Memoir by Pete Hamill), and, of course, detailed in blogs. While many blogs provide the latest research on addiction or other pertinent information, one thought-provoking, literary blog is The New York Times’ blog called Proof. It’s described on the site as follows:

For the past 10,000 years or so, wherever humans have gathered, there has been alcohol. Some never touch the stuff. But most do. It is used to celebrate, commiserate, mourn, remember and, often, to forget. It is different things to different people: libation, anesthetic, emotional crutch, social lubricant, addictive substance, sacred potion, killer or commodity. In “Proof,” contributors consider the charms, powers and dangers of drink, and the role it plays in their lives.

The contributors are superb writers, and many are recovering alcoholics. I happened upon “Proof” in 2008 and fell in love with the writing immediately, so I was crestfallen when it went on hiatus last year. It promises to return, however. (If you enter http://proof.blogs.nytimes.com/2009, you’ll see a drop-down menu that allows you to access all six months of the blog.) There’s also a timeline of alcohol in modern history for the curious, and if you click on Read More underneath the editors’ farewell message, you’ll find comments from readers that the editors chose to publish.

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I’ve never had a drinking problem, so I can’t write about what alcoholism is like. But many of these writers can, and they’re eloquent and….human. It’s as if they’re driven to record the seduction they experienced, the monster they have dealt with, or their journey back.  I’m reminded of a quote from F. Scott Fitzgerald: “You don't write because you want to say something; you write because you've got something to say.” There’s something about alcohol that makes people have something to say.

Here’s writer Tim Kreider musing on youth and alcohol:  

“My years of heavy drinking were roughly coterminous with my youth, and looking back now, it’s hard to figure out which one of them I really miss. The association between the two is not just Pavlovian. Drunkenness and youth share in a reckless irresponsibility and the illusion of timelessness. The young and the drunk are both reprieved from that oppressive, nagging sense of obligation that ruins so much of our lives, the worry that we really ought to be doing something productive instead. It’s the illicit savor of time stolen, time knowingly and joyfully squandered.” 

And from writer Sacha Scoblic:

“Lots of addicts in recovery worry that they might relapse if they hang out with old friends, if they lose their job, or if a loved one dies. I worry I might relapse if an exciting opportunity to get wasted with a celebrity comes along.”

Perhaps those excerpts whet your appetite for reading the Proof blog.

 

Ready for Rehab

Whether or not an addict enters recovery as a result of an intervention, a court mandate, or a personal choice, the important thing is that they get there, right? Actress Elizabeth M., one of the success stories on this website, is interesting for many reasons, but one is that she knew it was time. Granted, her talent agent had recently fired her, but her story is uplifting because of how she so willingly gave herself over to the program from the start. She drank on the ride there, but there was no denial. She had told herself, ‘This is it. I have to do it.”Thumbnail image for chardonnay glass.jpg

 

You might argue that she had hit bottom when she found herself without a career, and because her marriage was on shaky ground because of her drinking. She’s quick to point out that she was afraid of what her drinking was doing to her son, too. He was 9 when she entered Malibu Beach Recovery Center.

 

But the self-realization she owns up to is inspiring. It’s common to find people in deep denial after years of hurting themselves and others. Recently I interviewed a man who said that even weeks into his stay at a Pennsylvania program he was still lying to everyone—and himself. It’s the nature of the disease.  Elizabeth is also looking back from the perspective of a year’s sobriety, but if she’s to be believed (and there’s no reason not to) she desperately wanted her life back. Her mother had been an alcoholic and started drinking when Elizabeth was 9, the age her son was when she decided to get sober. The irony is striking. Or, as Elizabeth says about the coincidence, “the planets were aligned.”

 

When I asked Elizabeth to describe a little of what rehab was like, she said she doesn’t remember the first two days because she was detoxing. She remembers how frail she was when she started, and that the food was “the best she had ever eaten 28 days in a row.” She also recalls that she was determined to succeed, because she didn’t want to have to return.

 

Like most people I’ve talked to who are in recovery, Elizabeth has gained a truckload of wisdom about herself and about life since achieving sobriety at 46. She attends daily self-help meetings, and she still talks to her sponsor. Perhaps most important, she’s confident she’ll be around to see her son graduate from high school now, which a doctor had told her, before rehab, might not happen.

 

An addiction specialist I interviewed once told me that the hardest people to treat are those who are down and out financially and those who are successful. The first group figures they have nothing more to lose if they don’t stop drinking, and the second group figures they have enough financial resources that they can continue drinking for quite some time with few consequences.

 

Both groups are mistaken.  Just ask Elizabeth.