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.
