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In the final months of my active alcoholism I was living in the attic room of my house. About alcoholism.

I drank about 6 bottles of cheap Spanish wine plus a dozen cans of strong German beer every day.

The alcohol had little effect on me by this stage. I only drank to dampen the delirium tremens, the violent shakes. I often could not control my hand enough to get alcohol into my mouth, holding my wrist steady with my other hand to raise the drink to my mouth.

Usually  cracking the bottle or tin can against my teeth.

I was no longer getting drunk anymore.

You know you are fully addicted to alcohol when it does nothing intoxicating any more.

I slept in 5-10 minute fits and busts. I did not eat for months. The television told me to kill myself and voices not belonging to me talked insistently in my head.

No one told me this would happen when I bought my first alcoholic drink when I was fourteen years old. There was no health or warning label saying “Could lead to Psychosis and Premature Death!”

Maybe there should be.  Or at least alcohol can be addictive for some.

Anyway there is more to alcoholism than alcohol.

In the depths of this alcohol induced madness, I rarely saw my wife, who could not bring herself to look at me and what I had become.

If I could have got it together I might have killed myself.

But I couldn’t get it together. Psychosis is all involving, doesn’t leave much time for planning anything.

So I staggered on. When I say staggered, I could not actually walk more than a few yards or climb more than a few stairs.

By  the time I reached my first AA meeting

1. the alcohol had stopped “working”.

Regardless of these two factors, I could not admit I was alcoholic. My pride and it’s best friend shame were still talking away to me.

I was willing to admit I was addicted to alcohol and that I was about to die from it.

We often wonder why some people don’t accept their alcoholism?

How did I start my journey to acceptance?

My wife came to my first meeting of AA, she practically carried me in!

The Chair of the meeting was a person I had drank with before – I though how come he is here?

I spilled more drink than he ever drank?

Then it dawned on me that maybe I should have come here before?

Especially when he shared that he had been trying to get sober and recovered for ten years!?

I then listened to the other alcoholics sharing their stories.

The stories mentioned the progression of the alcoholism, which I obviously identified with.

They also mentioned how they, even now in recovery, struggled with their emotions and anxieties, how they found living life difficult.

They talked about issues which had bedevilled them and me since childhood, this  spiritual malady they talked of was like the emotional disease I had  suffered from all my life, whether it was depression, panic attacks, anxiety disorders, PTSD, etc.

They had used alcohol to self medicate these conditions, especially as alcohol for them had felt like an elixir for them as it had for me.  We all had all dealt with our negative emotions since adolescence in the same way.

Now a new way had to be found.

When we left the meeting my wife had a psychic change similar to the one I had.

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She said these people are just like you. They can help you, I can’t.

A week before I had heard a voice in my heart, through the psychosis, saying  to go down stairs to my wife and ask her for help. I asked her for help in that round about alcoholic way of “do you think I look a bit jaundice (I actually looked like Homer Simpson with a heavy sun tan!)?

The help I asked for was not to come directly from my wife but she led me to where I could get it. In a room, full of people just like me, suffering the same illness as me.

I will be forever eternally grateful for it being there for me. For them being there.

We will be there for you too!

The main reason I am alive today, sober and have recovered from a seemingly hopeless condition of alcoholism is simple!

Or rather the first step can be simple.

The first step on my recovery journey was to identify with the life stories of other recovering alcoholics.

Not necessarily with where they grew up, or the damage alcoholism had inflicted on their lives. Although many alcoholics talk themselves, or their illness talks them, out of the possibility of recovery by saying I am not as bad as that guy, or that woman.

You may not be as bad “YET!” – the “yets” are often talked about in AA – you may not have done the damage others have, yet? Keep drinking and you are bound to. You, like them, will have no choice.

Alcoholism increasingly takes away choice.

It takes over your self will.

Your self will, your self regulation, is a combination of your emotional, attentional, memory and reward/survival/motivation networks.

Alcoholism takes over these networks, progressively, over time.

Neuroscience has shown this, over the last twenty odd years.

A superb longitudinal study, “ The Natural History of Alcoholism ” by George Vaillant  clearly showed this progression in six hundred alcoholics over a 60 year period!

In my own research and in articles, with two highly respected Professors at a UK University, I have shown how the alcoholic brain progressively “collapses inwards” to subcortical responding.

In other words, we end up with a near constant “fight or flight” reaction to the world,  with alcoholism causing distress based compulsion at the endpoint of this addiction.

All the above neural circuits become governed by a region of the brain which deals with automatic,  compulsive behaviour. All the self regulation parts of the brain progress to an automatic compulsive behaviour called alcoholism and we are then often without mental defence against the next drink!

I identified with this one simple fact – the progression of this neurobiological, emotional, and spiritual disease state called alcoholism. I saw it in my own life, this progression over years of drinking.

The “invisible line” that is crossed, according to AA members, can be viewed on a brain image, I believe.

Can you see it in your life?

Like these recovering alcoholics I had not taken my first drink hoping to end up an alcoholic

It was something that had happened to me,  happened despite my very strong will not because my will is weak. I am as wilful a person as you would hope to me. How come I became an alcoholic then?

I did also relate to other things these people shared.

I identified with the damage caused by alcoholism  in their lives and the lives of their family.  How this illness affects everyone in the immediate and even extended family.

I had never considered the effect on others, apart from me?

I listened and identified with how they talked about a “hole in the soul”, how they never felt part of, felt different from others, detached. I related to this. That was me too.

Alcohol made me feel more me! I became attached to it and grew to love it like someone would love another person, more so perhaps? Alcohol came first, loved ones second.

Alcoholism takes away all the good things in life and then your life too.

All of this was the case with me too.

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I identified with all this.

I identified too with their solution.

I identified with and wanted what these now happy people in recovery had.

I decided to take the same steps as they had towards this happiness.

For those reading who feel they may a problem with alcoholism I will attempt to help you self diagnose.

I personally came into recovery via AA after my local doctor/GP, stated quite unequivocally that he thought I was an alcoholic. I was with my wife at the time.  The scales fell from our respective eyes.

Oh that’s it!? It wasn’t my troubled childhood, the premature death of my parents, my various difficulties with anxiety, depression, panic attacks, etc etc. It was because I was an alcoholic!

I have no doubt that the above factors contributed to the severity of my alcoholism but the other psychiatric issues I now consider to have been substance induced disorders which have either dissipated in recovery or have been treated in some way by a 12 step recovery?

Regardless of GP’s diagnosis of alcoholism I still need to self diagnosis.  I could not recover from alcoholism based on someone else’s diagnosis, however helpful. I had to identify myself as an alcoholic. Acceptance of this condition was the first step in recovery for me and countless others.

In the early days acceptance is based on acceptance of a destructive relationship with alcohol.

How do we define this relationship, this alcoholism?

There are various definitions of alcoholism mainly centring on  continued use of alcohol despite negative consequences. The Big Book of Alcoholics Anonymmous (1) simply states  “If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.  “.

This useful useful article (2) discusses the “loss of control over drinking” concept, which academic studies have failed to prove or disprove in laboratory settings.

I believe this loss of control can occur spontaneously or over several drinking episodes. It is not an all or nothing phenomenon like the “allergy” concept of the Doctor’s Opinion in the Big Book. It is variable.

The return to uncontrolled drinking can take one drinking session for some or a number of drinking sessions for others.

“The loss-of-control phenomenon is the essence of any addiction and certainly of AD.

This refers to the inability of the AD person to predict with any degree of certainty how much he or she will imbibe from one drinking episode to the next.

Clinically, once the drinking episode starts, the AD person will be unable to stop in the middle of the episode without a very great struggle. Useful questions at interview include asking 1) whether patients feel compelled to continue drinking or find it very hard to stop drinking; 2) once they start, whether they find themselves drinking more than they wanted to or had planned to; and 3) whether they make rules to attempt to control their drinking through external means.

It is important to distinguish the loss-of-control phenomenon from craving. The former has to do with the inability to stop drinking once started.

The loss-of-control phenomenon occurs within a drinking episode. Forms of craving occur between drinking episodes. The loss-of-control phenomenon continues to be a scientific puzzle.

Despite ongoing research inquiry over many years, neuroscience has yet to define the CNS changes underlying the loss-of-control phenomenon that characterizes dependence.

Clinically, however, longitudinal studies of abstinence make it clear that once the control of drinking behavior departs, it does not return in most cases (3).

It cannot be relearned or reconstituted. In this sense, a diagnosis of dependence signals a permanent condition—including a permanent risk of uncontrolled drinking. “

Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

Beresford, T. P. (2007). What is addiction, what is alcoholism?. Liver Transplantation13(S2), S55-S58.

Vaillant GE. The Natural History of Alcoholism, Revisited. Cambridge, MA: Harvard University Press; 1995.

In a recent blog a few days ago I challenged some of Gabrielle Glaser’s “evidence” in her article   “The Irrationality of Alcoholics Anonymous “, which purported to demonstrate the so-called effectiveness of “controlling drinking”.

Glaser cited the following in her article

“ To many, though, the idea of non-abstinent recovery is anathema. No one knows that better than Mark and Linda Sobell, who are both psychologists. In the 1970s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence.

Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely.”

I responded to this as follows

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” What Glaser failed to mention was that in a subsequent study (4) 10-year follow-up of the original 20 experimental subjects showed that only one, who apparently had not experienced physical withdrawal symptoms (thus possibly not alcoholic), maintained a pattern of controlled drinking;

eight continued to drink excessively–regularly or intermittently–despite repeated damaging consequences;

six abandoned their efforts to engage in controlled drinking and became abstinent;

four died from alcohol-related causes;

and one, certified about a year after discharge from the research project as gravely disabled because of drinking, was missing.

Why did Glaser failed to mention this research, a follow up study to the one she mentions and cites?”

The authors attempted to justify this choice in a statement that seems to clearly demonstrate their bias: “we are addressing the question of whether controlled drinking is itself a desirable treatment goal, not the question of whether the patients directed towards that goal fared better or worse than a control group...” ( Pendery et al., 1982, 172-173 )

The interesting aspect about her article for me (and most worrying) was that it highlighted a controversy that goes back to the 1960s – can alcoholics ever control their drinking?

In this blog we will address the origins of this “controlled drinking debate” and demonstrated how it is a castle built on sand.

The original study which supposedly demonstrated so-called controlled drinking or asymptomatic drinking in it’s alcoholic participants did no such thing.

So we now have an ongoing debate about controlled drinking when it has continuously been based on dubious research, bogus findings and bad science.

It is the researchers that Glaser champions that could be accused of irrationality.

The methodological madness started way back in the 1960s.

 While scattered reports of controlled drinking outcomes had occasionally appeared in the scientific literature before 1962, most commentators date the beginning of the controlled drinking controversy to the publication that year of a paper entitled “Normal Drinking in Recovered Alcohol Addicts.” In this paper, D.L. Davies, a British psychiatrist, reports that, in the course of long-term follow-up of patients treated for “alcohol addiction” at Maudsley Hospital in London, 7 of the 93 patients investigated “have subsequently been able to drink normally for periods of 7 to 11 years after discharge from the hospital.” (Davies, 1962, p. 94).

At least two different studies have challenged the findings of Davies:-

“Evidence suggests that five subjects experienced significant drinking problems both during Davies’s original follow-up period and subsequently, that three of these five at some time also used psychotropic drugs heavily, and that the two remaining subjects (one of whom was never severely dependent on alcohol) engaged in trouble-free drinking over the total period”

“A subsequent follow-up of these cases suggested that Davies had been substantially mislead”

So four decades of research into controlled drinking were inspired by a study which did not actually demonstrate controlled drinking in the first place!

In addition to the Sobells, Glaser also mentioned the Rand Report of the 1970s.

“In 1976, for instance, the Rand Corporation released a study of more than 2,000 men who had been patients at 44 different NIAAA-funded treatment centers. The report noted that 18 months after treatment, 22 percent of the men were drinking moderately. The authors concluded that it was possible for some alcohol-dependent men to return to controlled drinking. Researchers at the National Council on Alcoholism charged that the news would lead alcoholics to falsely believe they could drink safely. The NIAAA, which had funded the research, repudiated it. Rand repeated the study, this time looking over a four-year period. The results were similar.”

The first Rand Report was attacked as being methodologically weak  – e.g  it suffered from sample bias (80% of subject dropped out).

The Rand Corporation did a follow up 4 years later.  This time they reported that a smaller figure of 14% of the sample  continued to drink in an unproblematic manner  but other researchers reanalyzing the data arrived at a corrected estimate of 3-4% of the sample were drinking in a nonproblematic manner.

3% is somewhat less than the 22% – why does Glaser not cite these other follow up studies again?  It is difficult to accept any of her arguments as  she picks only studies that support her biased arguments.

It was also noted that alcoholics can often be expected to drink in a non problematic manner for brief periods. In my own experience, I have often heard of alcoholics share about a relapse and state that they thought they had their alcoholic problem licked as they started off drinking in what appeared to be a controlled manner only to find in a matter of weeks that their alcoholism had progressed far beyond it’s original severity prior to the relapse. In other words it can take a relapse some weeks to kick start into even more profound alcoholism than previously.

Researchers need to spend more time around alcoholics to observe what we have learnt through very painful experience, instead of theorising about this reality from academic ivory towers.

As the Big Book of Alcoholics Anonymous states in Chapter 3  “Most of us have been unwilling to admit we were real alcoholics. No person likes to think he is bodily and mentally different from his fellows. Therefore, it is not surprising that our drinking careers have been characterized by countless vain attempts to prove we could drink like other people. The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death. We learned that we had to fully concede to our innermost selves that we were alcoholics. This is the first step in recovery. The delusion that we are like other people, or presently may be, has to be smashed. We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals –usually brief—were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.”

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