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alcohol use disorder

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The Difference Between a Bad Habit and an Addiction

Is stopping by the bar after work every evening for two martinis a bad habit, or an addiction? Read on.

Is stopping by the bar after work every evening for two martinis a bad habit, or an addiction? Read on.

A new study suggests that drinking a bottle of wine a week increases the risk of cancer in women as much as smoking ten cigarettes, and that drinking three bottles of wine a week means that an extra thirty six women out of a thousand will develop cancer. Research over the past few years has turned the purported health benefits of alcohol on its head, particularly when it’s women who are drinking.

Nearly half of the clients I work with have a goal of cutting back on drinking, or quitting altogether. But, it can get tricky to discern between a bad habit and an addiction. Each require different paths of treatment, and impact the person in very unique ways. By the way, this does not only apply to alcohol, but to food, exercise, smoking, prescription drugs, and even sex and love. So, how are you supposed to know if you’ve got a bad habit or an addiction? Can someone who drinks “only” two glasses of wine every night be addicted?

A bad habit is an ingrained, learned pattern of behavior propelled by a stimulus and a response. It’s got a straightforward, routine quality to it, and a complete change can be made to break it within a period of a few months. An addiction is a complex and inflexible repeated behavior influenced by psychological, physiological and social factors. It’s often a coping mechanism for dealing with trauma or stressful emotions, and serves as both a distraction and a container that becomes increasingly necessary to function over time… until that coping mechanism caves in on itself. 

Whereas a bad habit can often be viewed as a nuisance or thoughtless behavioral pattern, an addiction is all-consuming, and will eventually erode your career, health, primary relationships, and self-esteem.

An addiction has an enticing quality, not unlike a secret lover—you’ll find yourself hiding, sneaking around, compromising, and making excuses over and over again.

Addictions and disorders — like an alcohol use disorder — trample over willpower and thrive on self-deception. As much as you say that you’re not going to drink for a week or a month, it may be all you can think about until finally, you rationalize caving in by telling yourself that you never really had a problem to begin with. Changing a habit can be hard work, but going to battle with an addiction often requires giving it everything you’ve got while altering your life constructs in the process.

So, to answer the question, “can someone who drinks only two glasses of wine every night be addicted?” YES. It is not the quantity that matters, but the consequences of that behavior and the difficulty in changing. 

For me, I knew that my relationship with alcohol had become an addiction when I could not stop drinking on my own, even though I’d given myself little challenges for years (Drynuary, “cleansing,” etc.). There were multiple consequences from my drinking which had started to impact my health, my relationships and my personal integrity. Alcohol had become my potion to suppress painful emotions and trauma. It took asking for help, and committing to addiction-focused treatment, to finally quit drinking (this year, I celebrate a decade of freedom from alcohol and cigarettes).

Action:

On the top of a sheet of paper, write down one behavior that is keeping you from living the life you desire. Fold it into two columns. In the first column, list all the consequences of that behavior. In the second column, write down all the potential positive aspects of changing that behavior. 

Power Question: 

In what ways is a bad habit or an addiction impacting your life? How might you be able to discern between whether it’s a habit or an addiction?

Thanks for reading! Have you struggled to discern between a bad habit or an addiction? Did something in this post resonate with you? Leave your thoughts in the comments section.

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The Conversation: What Does An Addict Look Like?

“I don’t think you are really an alcoholic,” someone close to me remarked quite unexpectedly as we shuffled past a neighborhood bar, making our way through the cool dark to a restaurant by the sea. It wasn’t a conversation I welcomed chewing into at that time. I was hungry and I didn’t have the patience to get into how the term “alcoholic” is both dated and inaccurate, or what “alcoholic” even means anymore.

“Why do you say that?” I asked. My throat tightened.

“Because you’re not that weak,” he replied. The weight of those five words sunk to the pit of my gut and anchored there as carelessness and ignorance. This, from someone so intelligent, someone who knew me so well. “Well, that’s your opinion,” I said, having nothing more to offer on the matter and sensing that any further explanation would just be wood chips for the fire. I have since realized that those many cutting statements delivered to people in recovery are not only sprung from 
naiveté, but also from a desire for control. It is “Human Nature 3.0”- we like things to be predictable and we want to have the upper hand (more on this in a future “Conversation”).

"Because you're not that weak." 

Stereotypes imprison the addicted and block our collective consciousness from seeing that this crisis is perhaps the largest societal challenge we face today. After all, the vast majority of us are addicts in action; our poisons are the differentiator. Food. Sex. Gambling. Money. Shopping. Booze. Drugs. Pills. Work. “Perfection.” Love. Prestige. Exercise. Religion. Facebook. Beauty. Power. And yet, when people conceptualize the image of an “addict” in their minds, their own reflection is rarely conjured.

"Getting sober just exploded my life. Now I have a much clearer sense of myself and what I can and can't do. I am more successful than I have ever been. I feel positive where I never did before, and I think that's all a direct result of getting sober." - Jamie Lee Curtis

"Getting sober just exploded my life. Now I have a much clearer sense of myself and what I can and can't do. I am more successful than I have ever been. I feel positive where I never did before, and I think that's all a direct result of getting sober." - Jamie Lee Curtis

Imagined instead are: 

  • A drink upon waking
  • Homelessness and squalor 
  • Trembling hands, “the shakes”
  • Messy hair, body odor, bad teeth
  • Joblessness & living on the dole
  • School dropouts, lack of education
  • Marital and financial trouble
  • Piercings & tattoos
  • Drink or use every day 
  • Foolishness, weak-willed  

Maybe so many people have chosen to frame addicts this way because it’s easier, because the reality is far too close and unearths unacceptably discomforting levels of fear. Consider that over 7% of the US population and just under 4% of Singapore’s population fit the criteria for having an alcohol use disorder, according to population-based surveys (estimates should be considered extremely conservative, given self-reporting methods and the shame associated with admission). Millions of these people are educated, hold down jobs, and have family and friends to answer to. In fact, around 20 percent of individuals with an alcohol use disorder are considered “high functioning”- in other words, highly intelligent achievers who are able to maintain the façade of an accomplished and even enviable life despite their dependence on alcohol. Gabrielle Glaser, author of “Her Best Kept Secret: Why Women Drink,” writes that the more educated and well off a woman is, the more likely she is to consume booze, and that white women are more likely to drink than women of other ethnicities. And, according to a new survey by Protecting.co.uk, a third of workers in the UK have admitted to using drugs at work while nearly every respondent said they had gone to work drunk at least once.

                                                                                    "What made me stop [drinking]? I realized it was not going to end well." - Kristin Davis 

                                                                                    "What made me stop [drinking]? I realized it was not going to end well." - Kristin Davis 

In an age where nearly everything seems to revolve around cocktails- from bonding with friends to making important business decisions and even having sex (yes, many people admit that drinking is often a prerequisite requirement to doing the deed), what does addiction actually mean and how can someone tell whether or not they’ve crossed the line? Perhaps it is first crucial to accept that no one definition of addiction exists, as it is viewed from diverse perspectives.

Many scholars and doctors define addiction as a “brain disease,” which in my view is a simplistic and even dangerous way to categorize a many-tentacled beast that sucks its existence from complex social, cultural, biological, psychological and spiritual forces. Other addiction experts say that addiction is a chronic neurobiological disease characterized by impaired control, compulsion, continued use or behavior despite harm, and craving. This perspective to some extent minimizes the outcomes while focusing on the actions. Is an addict still an addict if she is no longer engaged in her addiction? SMART Recovery describes “addiction as an impulse disorder, favoring momentary satisfaction over the long term view,” while other programs consider addiction a “spiritual bankruptcy.” The origin of the word “addiction” perhaps gives us a clearer meaning; it is derived from a Latin term that means “bound to,” or “enslaved by.” This notion, “an enslavement,” resonates most with me; when you have an alcohol use disorder- or any kind of addiction- you must tie yourself to some external actor in order to feel ok; that desired sense of belonging or normalcy exists at the other end of the craving. Addicts without their fix- be it cocktails, cakes or cocaine- find it impossible to inhabit themselves.

So, when does drinking become a problem; how do you know if you have an alcohol use disorder? Well, you can take a handy "Almost is Too Close to Always" quiz from Harvard, although I’m not sure its results are definitive, particularly since, again, the criteria varies. Or, you can go with a more traditional screening method like CAGE:
C
 Have you ever felt you should cut down on your drinking?
A Have people annoyed you by criticizing your drinking?
G Have you ever felt bad or guilty about your drinking?
E Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? 
According to a CAGE screening, two positive answers warrant further assessment. 

Be warned however, that most people severely underestimate how much they drink and count, on average, only one quarter to one half of the drinks they actually consume. I think, with many of these types of issues, we already hold the answers within. I knew years before I quit drinking that it was hollowing me out and stealing my spirit. But, if someone asked me about it, I wouldn't hesitate denying that knowledge.  

It is alcohol after all... cunning, baffling, powerful. 

So, if you suspect that your drinking may not be serving you well anymore, why not begin your exploration of that relationship by reflecting on these questions?

  • Is my alcohol use holding me back from my dreams?
  • Is my drinking negatively impacting my relationships or my health?
  • Do I actually enjoy drinking or has it just become something to do?
  • Am I drinking away boredom?
  • Would my life be better if I quit drinking? In what ways?

I quit booze when I realized that it was beginning to steal the life I was meant to lead- one with a sense of peace and confidence, a creative existence, a good marriage, a rewarding career, a spiritual belonging, the ability to accept myself as is. A few people might argue that I hit the bottom several times, while most others standing on the outside looking in could only see a woman who had it mostly together- top student, secure job at a great company, solid friends and marriage, and a rather exciting life in a "city so nice they named it twice." What I knew for sure was that I was deeply unhappy with who I’d become, and that if I chose sobriety, I’d at least have a chance to turn it around.

Best. Decision. Ever.

 Perhaps it will be the same for a few of you reading this today.

If you missed the first two installments of The Conversation, you can check them out here and here. Blogger EJ Austin-Jones also had some thought provoking things to write about this series, so check out her take here. I'd love to hear your thoughts, so please share them in the comments section. If you liked this post or think it might be interesting to someone else, please share! Stay tuned for next week's installment and if you have a question on addiction or would like me to cover a particular aspect, just send me a message. 

 

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The Conversation: "Total Alcoholic"- Is Our Language a Problem?


“The Conversation” is a weekly series on women and drinking. If you missed the introductory post, you can read it here. I am a health and addiction recovery coach and researcher who has firsthand experience with this topic; I am not a medical doctor, counselor or psychologist. All ideas proposed are up for discussion and debate- it's one of the best ways we can find new solutions and evolve. 

Tina* was the kind of girl you could always count on for a fun time. We met when we were both waitresses at the landmark Coffee Shop in Manhattan’s Union Square, and we immediately discovered that we had something else in common- we both relished getting blitzed toward the close of our work shift and were always smooth about not getting caught. After we'd punch out the clock, we’d race over to the East Village together and spend the rest of our evening drinking at a handful of dive bars until closing time- ones that would serve underage charmers like us. Our party came to an abrupt end when, after barely a few months at Coffee Shop, we were both dismissed. I didn’t see Tina again until a few years later, when I ran into her at the 24-hour diner where she worked as I was brunching with a friend. I surveyed her face- sunken cheeks spotted with acne, circles under her drowsy eyes, collar popped on a grubby shirt- while we exchanged an awkward acknowledgment, and I remember thinking to myself,

“Total alcoholic.”

What were our differences? She was a young black woman from the Bronx, I was a Connecticut-born WASP without the usual privileges attached. She was serving up eggs at a rundown greasy spoon, while I was racking up student loan debt at a fancy university. She was relatively honest in her presentation to the world, while I was a liar in a Betsey Johnson frock who spent money I didn’t have on dresses and martinis that I certainly didn’t need. She’d always been “balls to the wall.” I was measured, careful, rehearsed. And yet, we were both heading in a similar direction. 

“Total alcoholic.”

Have you ever had this thought cross your mind about a person you don’t truly understand while out at a friend’s party or a wedding or a company meeting? I know I have, at several points in my life. The colleague at work who’s always hungover, who’s always calling out sick. The melodramatic, co-dependent buddy who just can’t seem to keep it together. That Facebook friend who posts photos of cocktails several times a week, with hashtags like #roughday and #thirsty. The lover who stumbles home well past midnight after yet another business outing, who wakes you up by vomiting. It’s the easiest way to dismiss a behavior that unsettles us because that behavior hits too close to home, or because it looks like us, or because it confronts us with something that seems incomprehensible, alien, uncouth.

So, what’s an “alcoholic?” This often misused and outdated term came into our lexicon way back in 1852 to describe a person who was addicted to alcohol and who could no longer control their consumption, nor the harmful outcomes resulting from it. Much like the designations  “lunatic asylum” or “mentally retarded,” “alcoholic” was retired quite a while ago and is no longer found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which sets the standard for criteria and language to be used by mental health professionals, researchers, insurance providers and pharmaceutical companies. “Alcoholism” has been replaced instead with “Alcohol Use Disorder,” a phrase implying an issue that flows along a spectrum (your experience and mileage may vary), rather than a disease (you either have it or you don’t). Unfortunately, journalists, recovery programs, and the general public have not received the memo- labeling someone an “alcoholic” may be as inaccurate, inappropriate and backwards as placing the “R” word on a child with dyslexia or ADHD- or any other challenge, for that matter.  Compounding this issue in our language and, of course, our thinking- as one shapes the other- is the fact that the primary method of treatment prescribed by hospitals, doctors and courts is Alcoholics Anonymous, which more or less encourages its participants to pat a label on themselves like a gold-foil badge: “my name is so-and-so and I’m an alcoholic.” 

I know the drill well because I’ve said that sentence myself at least a few hundred times over the years, which has created just as much peace within me as it has turmoil. When we are labeled, that mark initially makes it a lot easier to find our place in the world, even if that place costs us, over time, our ability to flourish, transform and grow. Sadly, I still use the word on occasion- about myself and in describing the experiences of others- if only because it makes it so much easier to carry on with a conversation or get to the point, rather than delving into its history and myriad offenses. “Alcoholic” is what most people know. It’s what we’ve learned to get comfortable with. And, I owe a great deal to AA, just as millions of others do. In its context, saying, "I'm an alcoholic," becomes nearly as easy as, "my name's Aimee and I'm a Taurus." 

But, what would happen to the way we view, treat and discuss excessive or problem drinking if we changed the language we use in describing it, and in describing all the millions who are impacted by it? How would treatment for those with an ALCOHOL USE DISORDER evolve and improve if we honored the spectrum as well as each individual's unique experience, rather than framing it in black and white? By alleviating sufferers from the yoke of stigma- and I cannot help but think of Hester Prynne's scarlet red patch embroidered in gold with the big letter "A"- are we then finally encouraging them to heal and become healers themselves? Or, must we brand them in order to keep them humbled and in line? I don't have the answer, but what I do know is that I'm doing my absolute best to adopt this more progressive terminology as a way to acknowledge the dignity and POTENTIAL of those who are wishing to change their relationship with alcohol, those who have already changed it, and to also respect my own growth.

I stopped fully identifying with the term "alcoholic" a few years ago- a divorce that was actually quite conflicted. I remember saying it aloud following my name, and feeling my throat constrict. This constriction had happened again and again- it felt as though I was no longer telling the truth about who I was, and I had a lot more to discover about who I was to become. I needed to make room for that. In this shift- one that isn't yet complete and may never be- I've discovered a world of difference in living as a thriver, in comparison to existing as a survivor. 

So, I'll pose the question once again- what would happen if we released the term "alcoholic" from our world and all the ideas that go along with it, and instead began to work with and through the knowledge, language and discoveries of more recent times? Estimates show that only around 15 percent of people with an alcohol use disorder receive treatment and that most people who drink too much are not alcohol dependent. If we went about discussing it in a more accurate and progressive manner, how many more would finally get the help they need? 

Thank you for reading. I'd love to hear your thoughts on this topic, and as I mentioned earlier, all points are up for discussion or debate. I do not propose to have or offer all the answers, so if you disagree with me or feel that something needs more explanation, please say so. I'm here to learn as well! In the next installment of "The Conversation," I'll be exploring how one can identify an addiction or alcohol use disorder. What's the difference between someone who likes to party and someone who drinks too much? How and when does drinking become a problem?

*Names have been changed.






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