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
