Is my husband or wife an alcoholic?
What Does Problem Drinking Look Like?
Problem drinking looks different for different people -- and is easy to deny. In the same setting, two people of similar stature, drinking the same type of alcohol, in the same amount, can have dramatically different experiences. One might doze off while the other goes off in an abusive rampage, despite virtually identical blood alcohol levels. Ironically, in the above example, both can be problem drinkers -- the former just as likely as the latter--with perhaps neither being alcoholics because, among other criterion, alcoholism is about patterns of choices and behaviors.
If the former dozes off three times a week and can’t function at their job, a problem might exist. The latter might have anger issues that will arise whether they drink or not. Appearances can be deceiving. Perhaps just as importantly, no pathologies exist as a precise measuring stick for alcoholism.
So, what does alcoholism look like? It looks like a pile of jigsaw puzzle pieces that, when put together carefully, paint a picture of a problem that nobody wants to look at--spouses, family, friends, colleagues.
Is there a checklist for alcoholism?
Obvious signs of intoxication may be different for an alcoholic
There are unmistakable symptoms of intoxication: slurred speech, confusion, disorientation. But the chronic problem drinker who, over a course of several months or years, sustains behavior that results in negative effects on their lives when they are not drinking, is presented with one very large piece of the puzzle.
Commons signs of a drinking problem
Other common indicators exist. Alcoholics can develop a resistance that requires greater quantities to achieve the same results. Many hide their drinking and their bottles. Some only drink at home, alone. Others keep their activities as far from home as possible. The homebodies stash their alcohol on high shelves in the garage, in the toilet, buried in planters and in heating ducts. Others hide it in their office desk drawers. More than the behavior while drinking, the choice to hide the alcohol is a huge red flag and, despite likely vehement defiance when confronted with the choice to hide, the choice is a significant indicator. And, while the defiance may not be an outright lie-- be assured that lying is taking place. Lies of omission. Lies of commission. Lies told to oneself. Lies to to the ones we love.
Ten potential indicators of alcoholism
Unfortunately, there is no checklist that will allow a user to unilaterally--and unequivocally--conclude a diagnosis of alcoholism. Perhaps more to the point is the fact that alcoholism cannot be diagnosed like other diseases. Symptoms can seem obvious but there is no blood test and there is little in the way of long term medical intervention except discontinuing the use of alcohol. An abridged list of things to look for follows.
High tolerance
Hiding alcohol
Drinking to prepare for more drinking -- at parties, events and socially
Injuries that can’t be explained
Physical problems: weight gain/loss, sleep disturbances, trouble eating without drinking alcohol and substituting alcohol for meals
Lying about whereabouts, volume, driving, relationships
Psychological struggles - depression, paranoia and others
Gaslighting discussions with spouses to manipulate circumstances and avoid accountability
Strained/abusive relationships with spouse, parents, children, friends, co-workers, bosses
Legal problems related to poor decision-making while intoxicated
Dealing with the issues of a high-functioning alcoholic
A chronic drinker may be able to hide the symptoms from even those closest to them--and, when discovered, have the uncanny ability to convince those with the concerns that the problem is theirs. I had been an active alcoholic, at times able to get drunk twice a day for over a decade, and my live-in girlfriend and colleagues had no idea. I was an expert in avoiding detection. Most alcoholics are.
What’s the difference between a problem drinker and an alcoholic?
Semantics, mostly--if the results of the drinking are compromising the life and health of the person. The question, however, can be hotly debated in online reference resources and by those involved. The answer will always be qualified by defining the motivation behind the person who is asking and the person who is answering. A case in point is binge drinking. Binge drinkers can go days--or weeks--without physically needing alcohol but, when they drink, they often blackout. Few people who blackout from drinking more than once or twice aren’t problem drinkers.
The former title, for most people, often seems more palatable. In our culture, the ugliness and fear associated with the “A” word is sometimes enough to keep people from getting help so, if the patient or their circle needs to use a kinder term, do so. That said, if the results are the same, the name is just a name. Alcoholism does not require a physical reliance on the substance.
How Long Does It Take To Become An Alcoholic?
Problem drinking may go on for years or decades. An alcoholic may drink excessively--and compulsively-- for 30 years without interruption. Despite this fact, different people have different risk profiles. Binge drinking, for example, is a rising problem among many young people who have only begun drinking.
Conversely, over that course of decades of non-binge drinking, we can develop a tolerance that results in the need to drink as much as 10 times more than normal drinkers, without showing as many signs of being drunk. A strong case can be made that the correlation between alcoholism and the length of one’s drinking career can vary dramatically.
What If My Spouse Has A Problem With Both Alcohol and Drugs?
Many people mix alcohol and drugs. The drugs may include both prescription drugs (like opiates) and illegal drugs. It should be noted, too, that other comorbid compulsive behaviors are common, like gambling, sex, food and more.
Drugs and alcohol present a particularly dangerous combination, for several reasons. Mixing alcohol and most mind-altering drugs can very easily result in deadly overdoses. Alcohol is a sedative, as are opiates and, when combined, can suppress breathing to point of death. In addition, if we choose to drive after taking a combination of alcohol and drugs, the risk to those sharing the road (and ourselves) is greatly increased.
Protecting the spouses of all active alcoholics
Concerned spouses are encouraged to seek the help of a licensed therapist if there is a concern about dealing with a potential alcoholic for four reasons: 1) To identify healthy and safe ways to discuss concerns, 2) To identify appropriate ways to ensure the alcoholic’s accountability with resolutions, 3) To maintain one’s own ability to navigate the difficult circumstances that result from a spouse’s alcoholism, 4) To receive guidance to other professionals whose services may be required if the situation continues to deteriorate--like attorneys, detectives, family counselors, women’s shelters, etc.
Treatment For Alcoholism
What Is An Intervention?
Taking the first step in treating your spouse’s alcoholism
Alcoholism eventually affects everyone with whom the alcoholic comes into regular contact. And, while observations and experiences can differ based on the relationship with the alcoholic, the problem will eventually become undeniable. When those within the alcoholic’s sphere of influence have a chance to compare notes, the ugly truth is usually identified and an intervention becomes the next appropriate step.
Is professional support important for an intervention?
Intervention is a process undertaken to address the shape of the group’s life when an alcoholic’s problem is unambiguous. It is usually a formal process that includes a professional in addiction treatment and a number of persons affected by the behavior of the alcoholic. The inclusion of an independent certified professional is strongly advised.
How do I prepare for my spouse’s intervention?
The process begins when a family member--often a spouse or significant other--requests help from a rehabilitation center or the family physician. An intervention professional meets with the family member, and possibly also with other members of the family and friends, to coach them on the intervention process. Family and friends are taught not to accuse the alcoholic. Instead, they are coached to share how the alcoholic’s alcoholism has affected them. For example, a wife may offer that “when you showed up drunk at our daughter’s Father/Daughter dance, it embarrassed our daughter and me”. The technique is designed to prevent the alcoholic from denying whether or not something happened and, just as importantly, the alcoholic cannot deny the feelings being expressed.
What happens during an intervention?
All of the family members and friends who wish to participate are gathered in a private room with the interventionist. Then, the alcoholic is brought to that room, often without warning, and confronted. The interventionist explains that the alcoholic’s family and friends have gathered to explain the impact of the alcoholism on each of the participants. Then, one by one, each of the family and friends take a few minutes to share how they have been affected by the behavior of the alcoholic. The alcoholic is asked to listen to the feedback, without commenting, until the end of the intervention.
Is an intervention a structured event?
Yes and no. Experienced interventionists always have a firm yet adaptable game plan that allows for adjustment based on the number of participants, their temperaments, the personality of the alcoholic and other factors unique to a given situation.
The interventionist often coaches the participants to describe consequences, if the alcoholic chooses to continue drinking. For example, in my situation, my boss was part of the process. He explained to me that I could participate in a formal, inpatient rehabilitation process and, at the completion of the process, my job would be waiting for me. If I chose not to participate, he told me that I would he would terminate my employment immediately. I accepted treatment.
Prior to most interventions, arrangements are made for inpatient rehabilitation, if the alcoholic chooses to receive help. In some cases, the alcoholic is taken directly to a rehabilitation facility. Unfortunately, many alcoholics refuse treatment. Some refuse to participate in the intervention, choosing to leave the intervention and continue their alcoholism.
The goal of an intervention, in almost all cases, is to get the alcoholic to accept the fact that a life-endangering problem exists, to offer a concrete solution (rehab) and to immediately move toward resolution of the problem (attending rehab).
What is The Difference Between Rehab and Detox?
Family members seeking help for the alcoholic are often confronted with new language and jargon. Among the most commonly misunderstood are “detox” and “rehab”. Often, people use the two interchangeably despite each being very different.
Detoxification (or “detox” for short):
A medical process of weaning the alcoholic off of alcohol. This process usually involves a short hospital stay (2-3 days), where the alcoholic is observed closely, receives around-the-clock medical support, and medication (if needed), to alleviate the symptoms of withdrawal.
Alcoholics usually experience significant withdrawal symptoms when we stop drinking. The consequences of those withdrawal symptoms can be severe, including seizures, psychiatric symptoms, and in rare cases, a syndrome called Delirium Tremens, which may be fatal. Also, withdrawal symptoms produce an intense craving for alcohol in order to stop the withdrawal, which makes the alcoholic/addict much more susceptible to relapse.
Rehabilitation (or “rehab” for short):
Rehab takes place over a longer period of time. Usually 28 days. Medical support is often included (although not as intensive as in detox). Additionally, psychological/psychiatric support, counseling, and group therapy take place. Beyond the described supports a reorientation to a healthier, more organized everyday life is stressed. The patient makes their bed, arrives on time for scheduled events, maintains hygiene, is encouraged to build relationships and performs chores common to most healthy people.
In short, Detox focuses on the medical management of the patient. Rehab, on the other hand, focuses on why the patient became an alcoholic, in an attempt to prevent relapse.
Does Every Alcoholic Need to Go to Rehab?
Every alcoholic should have a medical evaluation by a physician who understands alcoholism. Admittedly, this suggestion often isn’t possible until the alcoholic is literally inside the rehabilitation facility and, sometimes, the physician may find that alternative medical tactics should be undertaken and/or replace rehab altogether. It should be noted, too, that most physicians, with an emphasis on family practitioners, receive almost no training on alcoholism in medical school.
What Is the Difference Between Inpatient and Outpatient Rehab?
Inpatient rehabilitation is a process that occurs when the alcoholic remains at a specialized facility 24 hours/day. Stays as short as three days take place. Some last as long as three months.
Intensive support is necessary for many alcoholics. Very poor health is common, as is homeless, malnourishment, broken families and evaporated personal infrastructure. Full time treatment gives an alcoholic the time and the place to work on their recovery, and to receive all of the required support under one roof. Another advantage to inpatient rehabilitation is the safety and security provided, keeping unnecessary life stressors and the temptation of friends who are drinking and taking drugs at arm’s length.
However, some people choose not to receive inpatient care due to lack of insurance, time or money and, instead, participate in outpatient rehabilitation. Outpatient rehab generally involves meeting with a counselor, and possibly a small group of other alcoholics, several evenings a week for several weeks. Some outpatient rehabilitation is called “intensive outpatient”, and may meet as many as seven times per week.
The advantages of outpatient rehab include lesser cost and also the possibility that the alcoholic can continue living at home and working, if they still have a job.
How Do I Find A Good Rehab?
Your family physician can help identify a good rehab. As described above, many physicians don’t have substantial training in addiction, but almost all family physicians have a long list of patients experiencing alcoholism and have had to help each take the first step toward a healthier life -- beginning with rehab.
In addition, if you have health insurance, your insurance company has data on rehabs with good (and bad) results. Although I am not a big fan of insurance companies, they do have a vested interest in ensuring the best treatment possible. It is good for them if you receive treatment that works.
Is Rehab Expensive?
Most facilities cost $500-$1,000 per day, with some charging significantly more. Sometimes treatment may be required for one month or more. That means treatment can cost $20,000-$30,000, or more.
Some insurance companies cover the cost of a rehab stay for the treatment of alcoholism. If you or a loved one is considering rehab, call your insurance company to see discuss costs. Even with health insurance, however, there may be significant out-of-pocket costs.
Can AA Help A Problem Drinker? Can I Just Go To AA and Do This Myself?
Alcoholics Anonymous (AA) can indeed help a problem drinker. AA is the only place that alcoholics can go where they can speak directly with other people who have had the same experiences--the good, the bad and the ugly. The people in AA do not lecture, they do not charge any money for their time, they do not set or enforce rules. They offer their time and their experience in the hope that doing so will help themselves stay sober. In this context, even alcoholics who choose to go their own way are not alone in their struggle. Almost every rehab program will encourage the alcoholic to embrace AA.
There are some limitations to the do-it-yourself approach, however.
No one in AA acts as a healthcare professional. Nobody directs another member’s recovery. Nobody tracks a participant’s progress. Everyone is free to come and go as they please and, for those alcoholics whose early sobriety requires structure, organization and accountability, the flexibility can offer another place to hide behavior. The problem with the DIY approach is that the person in charge of my recovery is me -- and I came into recovery with some serious medical and mental issues. I received professional help for those issues, and you may need professional help too.
Despite the success stories associated with AA, the grim reality is that the recovery rates for someone who walks into their first AA meeting are shockingly low. Most people don’t recover from alcoholism. (For more detail, read later on “Alcoholic Data and Progress”).
What Happens After Rehab?
The importance of aftercare -- including AA meetings, group therapy, participation in support groups, family counseling, and medical checkups -- cannot be overstated. A lifetime commitment is often required.
Alcoholic Data and Progress
Sadly, solid statistics on recovery do not exist because the necessary data is hard to compile, for several reasons:
There is no central repository for this information. Rehabs don’t have to report outcomes to a central authority.
Twelve step programs (e.g. AA, NA) do collect estimates on the number of members that they have, but they do not track or record the progress that individual members make in their recovery.
There is a lot of shame associated with alcoholism. As a result, individuals (and their physicians) are reluctant to record honest diagnoses on hospital admission and discharge notes.
When people die of alcoholism, the cause of death is often described as something else: for example, as accidental injury, exposure, pneumonia, infection, or suicide.
With all of this in mind, there are at least two recent publications that discussed the mortality associated with alcoholism. You can read about those publications in my essay “This Is Our Plague”.
Briefly, the Center for Disease Control (CDC) published a report estimating that 632,000 Americans die every year from tobacco, alcohol and drug addictions. The World Health Organization published a report that estimates that 3 million people die worldwide from alcohol abuse.
With love,
The Recovering Urchin
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