What Is Problem Drinking?

What is too much drinking? That depends on whom you ask. Some will say, “I drink every day, but I don’t drink during the day.” And, others say, “The only problem I have is that bars close at four, and I have to stop drinking.” Or, “Just as long as I am able to go to work/school and attend to my life, I can drink just as much as I want.” But, it’s difficult to admit that one feels that they do not have control over something outside themselves. So, until something concrete and negative happens, most people learn to live with the vague anxiety of feeling powerless.

I think many people, including myself, were surprised by this guideline from the National Institute on Alcohol and Alcohol Abuse on problem drinking. By their measure most people I know in New York City between the ages of 20 to 50 are problem or binge drinkers. But, most of these people are not alcoholics either. Personally I don’t know anyone who has been to detox or rehab*. I’ve worked as a social worker with many clients who have been in and out of inpatient and outpatient drug and alcohol treatment programs, and so I know what alcoholism and addiction looks like. Most of my peers would fall into the problem or habitual drinker category at some point in their lives, but they would not be classified as alcoholics.

So why is habitual, mindless, heavy or risky drinking a problem? With every behavior there is a consequence, and consequences of unchecked alcohol consumption are very real and can pervade every aspect of life. Common issues are: vague discontent and unhappiness (depression, maybe not in the clinical sense); poor health due to bad diet and excessive alcohol, smoking while drinking and lack of exercise; frequent hangovers; being late or missing work or school; regret over one’s behavior while drunk – being excessively emotional, aggressive or sexual; use of other drugs such as cocaine, further lowering inhibition leading to poor decision making; fighting with partners about drinking or other problems caused by drinking.

As a result of these and other reasons, problem drinkers try to cut back or stop but often without success. Because problem drinkers have difficulty controlling alcohol intake, they may intend to have just a drink or two, but after the two they find themselves not wanting or able to stop. And, happy hour becomes an all-night drinking session or binge. And for problem drinkers, drinking happens most nights of the week, although not heavily every time. 

To be continued…

*Detox takes place in a hospital or medical setting for the duration of a short week. For severe alcoholics medically supervised alcohol withdrawal is necessary as seizures and other serious complications may occur when a body, long immune to the presence of alcohol, is suddenly without it. For this reason, anti-anxiety medications, such as Xanax, Valium and Librium, are often prescribed. The singer Amy Winehouse’s death was probably a result of unsupervised withdrawal.

Rehabs are usually 28 days long, although depending on severity and finances stays can be longer. I’ve worked in a facility that wasn’t much different from jail; many of its clients, mostly former heroine addicts, were mandated to drug treatment in lieu of serving yet another stint in jail for drug-related charges. Most of these clients were Medicaid eligible and stayed anywhere between three months to two years. Private insurance does provide inpatient substance abuse treatment, but they ususally restrict the duration of treatment to 28 days. However, if you are financially able, treatment options are plentiful. After the initial medically supervised withdrawal (what happens in a detox) a treatment team addresses the psychological aspect of addiction. Through group and individual therapy long exploration into the how’s and why's of addiction, in addition to strategies to prevent relapse, are explored These programs are designed to prepare for maintaining abstinence – a life of sobriety. Ideally, this would be just the beginning of psychotherapy, which should continue post-rehab.

The Take Away From Sandy

http://www.nasa.gov/

I began this entry from my dark and chilly apartment, lit only with candles and a battery-run lamp. Myself, along with many, many others in the East Coast were in the dark for five days. It was the longest period I’ve gone without electricity.

This was how superstorm Sandy affected my life, which was significant, but for many others, it was a catastrophic natural disaster. The distinction between man-made and natural disasters becomes complicated due to the undeniable connection between climate change and extreme weather. You don’t need me to tell you about the extreme heat, drought and cold of recent years. More on that later.

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East River, the Hudson and New York Bay surround lower Manhattan. These three bodies of water eventually meet and merge with the Atlantic. Angrily churned by Sandy, they swept in quietly but relentlessly and did what water does, which is to obey gravity and make a bee line towards areas that are least elevated.

Damage it wrought was awe-inspiring. Plastics of every variety, bee hives and remnants of construction sites were strewn alongside large trees that had snapped as if they were toothpicks or cleanly uprooted from the saturated ground. Many homes and businesses in the East Village were badly damaged by the flood, and, even two weeks later, one can find cars that were submerged, which you can tell because of the condensation on the inside.

Peter Radley

So, how does this relate to mental health?

Those five days without electricity forced me into stillness, especially at night, which turned out to be an unexpected gift. I actually had to be okay with the discomfort of sitting in silence by myself. The three most reliable distractions of modern life – computer, smart phone and the television – were all unavailable. The simple act of checking email, making calls and sending texts could only be done during daylight, and in another part of the city requiring travel. This was in stunning contrast to my established relationship with electronic devices; not only were they tools to manage my social and professional life, they kept me away from myself by blocking access to quiet time and inner reflection. Often, these devices were used during other activities including the time I spent with friends. In other words, Sandy taught me that these “tools” were keeping me from life.

The direct experience of nature’s negative impact broadens the context of how we look at our lives; we are not isolated single points of misery but a part of a larger system. We tend to get myopic and forget that we are in fact inconsequential in the grand scheme of things. In other words, the universe couldn't care less about us. At the same time, this realization brings us to the awareness that we are inevitably connected to each other, in that as humans, we all share the same vulnerabilities.

And this brings a very important point: we now know that we have in fact contributed to the ferocity and the growing frequency of these natural disasters. Climate change is real, and rising sea level has set off a chain of events in the weather system with consequences we can’t yet predict. In response, many are collectively taking action. Arguably, this is one of the reasons why President Obama was reelected. Here in New York, people have volunteered in droves. Instinctually, people want to help others out of kindness, but it’s also an act of self-help. Helping others alleviates anxiety by externalizing fear into concern for others, an example of sublimation. Taking part in a collective effort, whether it’s helping a neighbor during a crisis, voting, or getting politically active to promote environmentalism, does amazing things for mental health. Contributing to one’s community makes us a part of it, and this is vital to mental health, especially in times of uncertainty.

Not So Jolly Holly Holidays

The dreaded season – the trifecta of joy: Thanksgiving, Christmas and New Year's – is just around the corner. For many of us this time period is fraught with anxiety, anticipation, excitement, joy and loneliness. We Americans tend to over eat, over drink, over party, and over spend, and over extend ourselves so that we become more susceptible to physical and emotional illness. We become emotionally more sensitive, partly due to the ever-present alcohol, which amplifies extreme (positive and negative) emotional states. Although I don't have proof, I suspect that many relationships come undone during this time, or couples experience more fights and disagreements, often fueled by effects of alcohol.

It is also the annual celebration of the family. And, at the center of many familial relationships (or, all relationships?) lies ambivalence: annoyance/solace, guilt/love, responsibility/guilt, thoughts of escape/desire to be closer to one's family, all of which can be very confusing. If you are fortunate enough to have a good relationship with your family and the family dynamic is mildly dysfunctional, it can be a wonderful time of reunion, eating together, catching up, and feeling the deep comfort that comes with being with your people. For others, holidays are reminders of the reasons you why you moved away from your people; long-simmering resentments and unspoken grudges come to a head, making family get-togethers an intense exercise of emotional control.

For many of us who are single in New York City, it can be a very trying time, punctuated with loneliness and sense of loss. Some of our families are too far away or too sparse for the annual convergence. And for others, temporary or permanent separation from family, by divorce, death or estrangement, make the holidays very blue. It can really pronounce one's singularity.

And, for those of us with predilection for substance use and depression this can be a challenging period. Over drinking can cause, or make worse, depressive symptoms, and increased alcohol consumption is a hallmark of this period, making it a dangerous season of excess. For this reason, many AA and NA groups are held on the hour, every hour, from late November through early January. The combination of lack of daylight, ubiquitous holiday parties, and mandatory merriment can also push some of us over the edge and into depression. And so a pattern can emerge and spiral out of control — feeling depressed; drinking or drugging to cope or to feel more social; the morning after or the post-weekend blues; feeling depressed...


What I am going to propose isn’t anything new. It’s common sense.


• Moderate your consumption of alcohol and drugs.
• Talk to your friends and family if you start to feel isolated and your mood darkens.
• Make phone calls and use of social media to stay connected.
• Get some exercise, go to the gym, take a yoga class, go for a walk, go run. Doing yoga can be cheap as finding a video on Youtube.
• If you don’t have plans for the holidays let your friends or even your colleagues know.
• Find a group online via Meetup.
• Volunteer at a homeless shelter; this needs to be planned ahead of time.
• Go to church, even if you are an atheist or agnostic, and enjoy the music and the peace.
• Go on vacation.


Any other ideas?