Defining Alcohol: What You Need to Know!!!

Today on the show we talked about Alcoholism.  We asked one of our guests Dr. David Reiss to give us more information about the disease.

Caveat:   I am not an “addictionologist” or a psychiatrist who works primarily in the area of addiction and substance abuse.  However, in over 25 years of experience as a psychiatrist, I can offer my opinions from a wide perspective, based upon the evaluation and treatment of well over 10,000 patients, many of whom were dealing with substance abuse issues personally or within their relationships and/or family.

“Alcoholism,” a term used ubiquitously within common language and lay discussion, actually does not have a specific clinical definition.  There is a non-precise definition for “alcohol abuse” – use of alcohol that is “excessive” to the point of causing problems; and there is a definitive definition for alcohol dependency/addiction – use of alcohol to the point that abstinence causes a physiological withdrawal syndrome (addiction) and/or psychological withdrawal syndrome (dependence).

The diagnosis of alcohol dependence or addiction is important for medical and psychological reasons:  if abstinence causes physiological withdrawal, which may range from discomfort to dangerous or even fatal medical complications (such as untreated delirium tremens); psychological withdrawal can lead to depression, anxiety, irritability etc.  Both encourage a return to alcohol use in order to end the withdrawal syndrome, and therefore, abstinence/recovery is more difficult in persons who are physiologically addicted or psychologically dependent.

However, apart from specific medical issues, in applying the term “substance abuser” or “alcoholic,” my over 25 years of clinical experience is completely consistent to what I was taught during my residency by renowned alcohol researcher and expert at U.C. San Diego Marc Shuckit, M.D:  it doesn’t matter how much or how little (volume) is consumed drink, or the frequency of use;  if the use of alcohol problems: medically, socially, legally, in personal/family relationships, etc. – then you have a substance abuse problem, you are an alcoholic. It is as simple as that.  

 If a half a beer once a week causes you to “go off” on your kid or significant other, drive in an impaired manner, become emotionally unstable, spend money irresponsibly, etc. – then you are alcoholic.  However, if you can have a few drinks per night with absolutely no negative impact medically (e.g., liver function), interpersonally or socially, C'est La Vie!

On the average, there are significant cultural differences in what is generally considered an “excessive” intake of alcohol.  Further, there is no doubt (supported by research) that in cultures where children are taught to drink responsibly from an early age, in general, there is less destructive alcoholism than in societies where alcohol abuse is encouraged, or where alcohol use is considered a taboo or a “rite of passage.”  Of course, that is a very general statement, and does not necessarily apply to any specific individual in any specific culture.

At a certain level of alcohol consumption (which will be different depending upon personal genetics and biological metabolism), no matter what the social circumstances, there may be destructive physiological effects (upon the brain, liver, carcinogenesis, etc.)  For example, drinking frequently to the point of gross intoxication, or “black out” – even if not leading to other psychosocial problems - will inevitably cause medical difficulties, injuring the brain and the liver.  Also, consumption of alcohol can interfere with the effectiveness of many different types of medications (and is dangerous in combination with certain medications) – alcohol most problematically and dangerously interacts with psychotropic medications (medications prescribed for psychiatric reasons) and psychoactive agents (anti-histamines, asthma medications that can be stimulating, pain medications, etc.), but may also interact negatively with other classes of medications.  It also must be recognized that despite the initial euphoric effect, alcohol is a chemical depressant that may contribute to or hasten the development of clinical depression in susceptible individuals even if not causing other overt problems.  However, low levels of consumption, without concomitant use of other drugs or psychoactive agents, if otherwise tolerated, may be medically “healthy” or even beneficial in some ways.

If the medically-dangerous/detrimental threshold is not met, the key to defining alcoholism is, very simply: “The presence of problems caused by alcohol consumption” – really a very easy concept to grasp.  However, especially in the United States, the prevalence of denial leads many people look for "objective measures” to define the problem/disorder, i.e., "If I'm not drinking ‘X’ amount; if I don't have withdrawal symptoms; if I haven’t received a DUI – then I can't be considered alcoholic."  If media, schools, etc. pick up on those “objective measurements” of volume and frequency of consumption (which are actually arbitrary), that can be destructive and can result in denial of problematic alcoholism (or less frequently, over-diagnosis of benign alcohol use).

Relying purely on a specific volume or frequency of consumption is not logical and is a clinically dangerous way of thinking of and conceptualizing alcoholism.  Conversely, in other cultures, if large volumes of consumption are considered “normal” and presumably not excessive, that leads to a different form of denial and under-identification of alcoholism.

Simply put, “If honestly, without invoking denial, you can definitively state that alcohol has no negative effect upon your health, life or relationships – then clinically, alcohol use is not a problem.  However, if any of those areas are negatively impacted by alcohol use, you are alcoholic and should seek some form of treatment or intervention, regardless of the volume or frequency of consumption – and any other conclusion is purely denial.

wwww.dmrdynamics.com


Thanks Dr. Reiss!


If you have any suggestions for show topics please send us an email at outreachtodayradio@yahoo.com.  You can listen to our show live Wednesday's 10am Pacific.  You can also see past shows in our archives. Just click here. http://voiceamerica.com/show/1955/outreach-today


Thanks for being a part of our Outreach Today family. Have a great day!
Eva Bowen
Exec. Producer
Outreach Today

Tips for Caring for your Aging Parents

Wow what a wonderful show about Caring for your Aging Parent.  We asked one of our guests to provide more information for you.  Who best then someone who has been through it...to help you get through it!

Caring for Aging Parents: Elder Rage & Alzheimer’s
By Jacqueline Marcell, Author of ‘Elder Rage’ www.Elderrage.com 

For eleven years I pleaded with my obstinate elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other he adamantly insisted on taking care of her himself. Every caregiver I hired to help him called in exasperation, "Jacqueline, I just can't work with your father–his temper is impossible to handle. I don't think he’ll accept help until he's on his knees himself."

My father had always been 90% great, but boy-oh-boy that temper was a doozy. He’d never turned it on me before, but I'd never gone against his wishes either. When my mother nearly died from his inability to continue to care for her, I flew from southern California to San Francisco determined to save her life–having no idea that it would nearly cost me my own.

EARLY SIGNS OF DEMENTIA?I spent three months in the hospital nursing my 82-pound mother back to relative health, while my father went from being loving one minute to calling me horrible nasty names and throwing me out of the house the next. I walked on egg shells trying not to upset him, even running the washing machine could cause a tizzy, and there was no way to reason with him. It was heart wrenching to have my once-adoring father turn against me.

I immediately took my father to his doctor, only to be flabbergasted he could act normal when he needed to. I could not believe it when the doctor looked at me as if I was lying. She didn’t even take me seriously when I reported that my father had nearly electrocuted my mother, but fortunately I walked into the bathroom just three seconds before he plugged in a power strip that was soaking in a tub of water–along with my mother’s feet! Much later, I was furious to find out my father had instructed his doctor (and everyone) not to listen to anything I said because I was just a (bleep) liar—and all I wanted was his money! (I wish he had some.)

Then things got serious. My father had never laid a hand on me my whole life, but one day nearly choked me to death for adding HBO to his television, even though he had eagerly consented to it a few days before. Terrified, I call the police for the first time in my life who took him to a psychiatric hospital for evaluation. I could not believe it when they released him right away, saying they couldn't find anything wrong with him. What is even more astonishing is that similar incidents occurred three more times.

CAREGIVER CATCH 22After three months I was finally able to bring my frail mother home from the hospital, but furious to find myself trapped. I couldn't fly home and leave her alone with my father–she'd surely die from his inability to care for her. I couldn't get my father to accept a caregiver, and even when I did—no one would put up with his raging very long. I couldn't get healthcare professionals to help–my father was always so darling in front of them. I couldn't get medication to calm him, and even when I finally did—he refused to take it and flushed it down the toilet. I couldn't place my mother in a nursing home–he'd take her out. I couldn't put him in a home–he didn't qualify. They both refused Assisted Living—legally I couldn't force them. I became a prisoner in my parents' home for nearly a year trying to solve crisis after crisis, begging for professional help—and infuriated with a medical system that wasn't helping me appropriately.

GERIATRIC DEMENTIA SPECIALIST MAKES DIAGNOSIS You don't need a medical degree to know something is wrong, but you do need the right doctor who can diagnose and treat dementia properly. Finally, a friend suggested I call the Alzheimer’s Association who directed me to the best neurologist in the area who specialized in dementia. He performed a battery of blood, neurological, memory tests and CT & P.E.T. scans. After reviewing my parents’ many medications and ruling out numerous reversible dementias such as a B-12 and thyroid deficiency, you should have seen my face drop when he diagnosed Stage One Alzheimer's in both of my parents–something all their other healthcare professionals missed entirely.

TRAPPED IN OLD HABITSWhat I'd been coping with was the beginning of Alzheimer’s (just one type of dementia), which begins very intermittently and appears to come and go. I didn't understand that my father was addicted and trapped in his own bad behavior of a lifetime and his habit of yelling to get his way was coming out over things that were illogical... at times. I also didn't understand that demented does not mean dumb (a concept not widely appreciated) and that he was still socially adjusted never to show his ‘Hyde’ side to anyone outside the family. Even with the onset of dementia, it was astonishing he could still be so manipulative. On the other hand, my mother was as sweet and lovely as she’d always been.

KEY: BALANCE BRAIN CHEMISTRY!I learned that Alzheimer's makes up 60-80% of all dementias and there's no stopping the progression nor is there yet a cure. However, if identified EARLY there are four FDA approved medications that can mask/slow symptoms, keeping a person in the early independent stage longer, delaying the need for part to full-time care. The medications are Aricept, Exelon, Razadyne and Namenda, with many more in clinical trials. In combination with optimal lifestyle changes (proper nutrition, weight, exercise, socialization), a one month delay in nursing home placement of Alzheimer’s patients could save the U.S. $1 BILLION annually. A five year delay in the onset could save $50 BILLION in annual healthcare costs. Public awareness, education, and more research dollars are needed!

After the neurologist slowed/masked the symptoms of Alzheimer’s in my parents, and also treated their depression (often present in AD patients), he prescribed a small dose of an anti-aggression medication for my father, which helped smooth out is his volatile temper without making him sleep all day. (Ohhh, if we’d only had that fifty years ago!) It wasn’t easy to get the dosages right and it took a lot of time and patience (and no, he wasn’t suddenly turned into an angel), but at least we didn’t need police intervention any longer!

CREATIVE BEHAVIORAL TECHNIQUESOnce my parents’ brain chemistries were better balanced, I was able to optimize nutrition, fluids, medication, treatments, and exercise with much less resistance. I was also able to implement techniques to cope with the intermittent bizarre behaviors. Instead of logic and reason–I used distraction and redirection to things they were interested in. I learned to use reminiscence and talk about the old days, capitalizing on their long-term memories which were still quite good. Instead of arguing the facts–I agreed, validated frustrated feelings, and lived in their realities of the moment. I finally learned to just ‘go with the flow’ and let any nasty comments roll off.

And if none of that worked, a bribe of ice cream worked the best to cajole my father into the shower, even as he swore a blue streak at me that he’d just taken one yesterday (over a week ago). I was also finally able to get my father to accept two caregivers (he’d only alienated 40 that year–most only there for about ten minutes), and then with the benefit of Adult Day Health Care five days a week for my parents and a support group for me, everything finally started to fall into place.

IF ONLY WE HAD LONG TERM CARE INSURANCE!Before long my parents’ life savings was gone and we were well into mine. I was advised to apply for Medicaid and after months of paperwork, aggravation, and evaluation they were approved for financial help from the government. I was so relieved, until I learned it would only pay to put my parents in a nursing home, not keep them at home with 24/7 care. And, since my mother needed much more skilled care than my father, they’d be separated, something they would never consent to—nor did I want to do after all this work to keep them together.

I could not believe it—I finally had everything figured out medically, behaviorally, socially, legally, emotionally, two wonderful caregivers in place, the house elder-proofed, and all I needed was financial help to keep them at home. If I’d only made sure my parents bought Long Term Care Insurance (or I bought it for them) years ago while they were healthy and before any diagnosis of dementia, it would have covered the cost of their care at home. Instead, I paid for it, which nearly wiped me out in every way. After five years of managing 24/7 care for my parents, I then survived invasive Brst. Cancer.

ALZHEIMER’S / DEMENTIA OFTEN OVERLOOKED
What is so unsettling is that not one healthcare professional discussed the possibility of the beginning of Alzheimer’s Disease (or any type of dementia) in my parents with me that first year, which happens far too often to families. Alzheimer's afflicts more than 5.4 million Americans, but millions go undiagnosed for many years because intermittent subtle warning signs are chalked up to stress and a ‘normal’ part of aging. Since one out of eight by age 65, and nearly half by age 85 get AD, healthcare professionals of every specialty should know the ‘Ten Warning Signs of Alzheimer's’ and educate their patients and families early on so everyone can save time, money—and a fortune in Kleenex!

TEN WARNING SIGNS OF ALZHEIMER'S
(Reprinted with permission of the Alzheimer’s Association)
1.   Memory loss
2.   Difficulty performing familiar tasks
3.   Problems with language
4.   Disorientation of time and place
5.   Poor or decreased judgment
6.   Problems with abstract thinking
7.   Misplacing things
8.   Changes in mood or behavior
9.   Changes in personality
10. Loss of initiative
www.ElderRage.com/Alzheimers.asp

Thanks Jacqueline...wonderful information!


If you have any suggestions for show topics please send us an email at outreachtodayradio@yahoo.com.  You can listen to our show live Wednesdays 10am Pacific. You can also see past shows in our archives.  Just click here. http://www.voiceamerica.com/show/1955/outreach-today


Thanks for being a part of our Outreach Today family.  Have a great day!
Eva


Eva Bowen
Executive Producer
Outreach Today