Care to Join Me in a Month Off from Alcohol in January?

Want to join me in a month off from alcohol?

Beautiful but empty champagne glassI asked the same question last year, and was delighted to hear privately from several people that they gave Dry January a try and were both enlightened and pleased by the results.

I’ve included excerpts from last year’s post, plus updates.

Here’s a helpful article published 12/21/16 by Medical News Today on the physical benefits of a month off from alcohol. A debate in The BMJ questioned the potential good vs. potential harm of Dry January, but a recent study states, “The findings suggest that participation in abstinence challenges such as Dry January may be associated with changes toward healthier drinking.”

The HBO film Risky Drinking was released in December 2016 (which I recommended viewing, with these caveats). The film’s home page links to this brief and straightforward drinking self-assessment from the NIH.

In Do You Think I Have a Drinking Problem?, I wrote of my relief that people feel comfortable and free to ask me about drinking, both for themselves and for loved ones. “How do you feel when you don’t drink?” is a key question to ask. Taking some time off from drinking can help provide the answer.

I was abstinent from alcohol for 4 years on December 28, 2016. I am abstinent today, I will join you in abstinence during Dry January, but I’ll keep going in February and March and… As a result of the still unknown brain malfunctions that shift voluntary sipping to involuntary drinking, I developed an alcohol use disorder and, for my particular case, need to abstain, well, forever.

I absolutely loved champagne. If you’re still drinking, savor just a sip for me on New Year’s Eve. (Just a sip. There’s actually no cure for a hangover and it is, according to Dr. Laura Veach, “a form of alcohol withdrawal at its most benign.”) Then on January 1, I’d love to join you in being abstinent together and seeing what insights unfold!

. . . . .

Note: If you experience any physical, mental or emotional changes when you delay or do without alcohol, see a health care provider ASAP. Alcohol dependence and alcohol use disorders are serious health conditions for which treatment is available. The NIAA recommends the first step is consulting with a primary care physician.

And a grim but potentially motivating statistic to help us all help each other get help when we need it, from page 30 of the Surgeon General’s report: “1 in 10 deaths among working adults are due to alcohol misuse.”

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Last updated 1/13/17

What I Know After 4 Years of Sobriety

Four years ago today, I did something I hadn’t done in the preceding 6 years. I did not take a drink of wine or beer or any other type of alcohol.

Early December 2012I didn’t know at the time – but it is known definitively today thanks to the newly released Surgeon General’s report on addiction – that I had developed a brain disorder that manifests as an inability to stop a behavior despite negative consequences. The negative consequences I am open to sharing that I experienced from drinking alcohol are injuring myself from falls and saying things to beloved others that I still profoundly regret. After each incident of harm to myself or others, I continued to drink alcohol.

Unfortunately, I cannot tell you specifically what made December 27, 2012 the day I finished all the wine in the house, then had none the next day. In common parlance, I had no “bottom.” I can’t explain how I was able to override the neurobiology of addiction one day – now numbering 4 years worth of days – but not in the previous days. I cannot identify which, if any, of the probably 100 strategies that I attempted continuously, actually did help me abstain from alcohol. Not knowing is a precarious position to be in because I neither know what exactly to do to help myself today or tomorrow, or exactly what to advise others to do to help themselves.

Here are some things I do know:

I am not an alcoholic. I am a person who has developed a grave brain illness, a medical condition termed a substance use disorder. According to the Surgeon General’s report, the three components of evidence-based treatment for substance use disorders, named in order in the report, are medications and medication-assisted treatment, behavioral therapies, and recovery support services. I do not need to change my identity to the name of an illness.  If I suspect I have a substance use disorder, I need to get myself to a doctor.

I understand why people believe I have a moral, mental, or psychological problem – even a spiritual one – rather than a medical condition. My words and actions may well be immoral. Tragically, substance use disorders compromise networks involving the brain’s basal ganglia, extended amygdala, and prefrontal cortex, areas directly responsible for decision-making and impulse control. Many people who love those with substance use disorders find themselves appalled and anguished by the Dr. Jekyll and Mr. Hyde transformations that occur in their good-natured, delightful loved ones. Neuroscience will continue to further explain the cause-and-effect relationships between brain malfunctions and behavior, as well as specific brain structures to target for addictions treatment.

I have an illness which is not curable but is considered to be, according to the Surgeon General’s report, in remission after 4 to 5 years. If I can abstain from substances problematic for me, or in some cases and for some substances, take them as prescribed or, take them as I – in consultation with my treatment team – have concluded works best for me, my odds of a return to problematic use decline dramatically. Personally, I feel better now than I have in 4 years. Perhaps that is due, not to anything I have done, but to the time my particular brain has needed to heal in the absence of the neurotoxin of alcohol. But I don’t know and can’t know for sure.

Brain impairments resulting from substance use disorders are not repaired automatically and immediately by abstinence. Therefore, even if I am abstinent or following my physician’s orders with regard to substances, my words, actions and thinking may confuse me and you. With time, my brain may repair itself or find alternate paths for connections. Expecting myself to return to my pre-use functioning, especially early on, may be frustratingly disappointing to others and dangerously disappointing to me.

I used alcohol for reasons, some of which were unknown to me. When I stopped using alcohol, those banked reasons came back as dragon heads roaring flames. I have no idea how I survived the fire, nor how I kept from returning to alcohol for blessed relief from the burning.

I will never again have the inner experience of oneness with love, comfort and relief I had while I was drinking. Nothing I have done or tried in the past 4 years has even approached generating the feeling alcohol gave me. That makes perfect sense. Alcohol is a substance that chemically takes the brain where it can’t go on its own. My inner experience while drinking was a chemically induced illusion. Every day I don’t drink is a day I deny myself the best feeling I have ever, ever had. So far, I have been able to live without it. In this post, I have included a photo of me intoxicated in early December of 2012. I hope we will never see again that wine-magnified look of joy on my face. Painful. But I get it, and I’m mostly okay with it.

I have more than my share of resources to try anything and everything not to take a drink. I have income and savings, a home, a car, health insurance, and emotional and financial support from my family. I can pay to consult with doctors, psychologists, psychiatrists and other health care professionals to help me.

During one near-relapse, when nothing I could think of to do was helping – and I still believed I had a moral condition instead of a medical one – I had a last-ditch, desperate, radical idea to call my primary care physician’s office for an emergency appointment. The sympathetic assistant squeezed me in, I drove myself to the office, paid the co-pay, and sat on my doctor’s exam table and just cried. I have no idea why or how seeing my doctor helped, but it did. Looking back, the extensive resources, infrastructure and network of connections required to get same-day personal support from a medical professional are available, frankly, only to the privileged. Addiction, however, is over-represented among the poor.

I committed malpractice against myself by attending support groups as treatment for alcoholism instead of getting medical and professional care. As well-meaning and helpful as volunteers at support groups such as Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery might be (these are the substance use disorder support groups available in my town), layperson survivors are not qualified to provide treatment for the brain illness of addiction, for the co-occurring mental and physical illnesses that usually accompany it, nor for the danger and distress of abstinence. According to the Surgeon General’s report, and in my personal experience, support groups can certainly provide the social support beneficial to recovery from addiction, but they’re not treatment. (This guide for treating alcoholism has been available from NIAA since 2014 and advises beginning with a visit to one’s primary care physician.)

“Little is known about the factors that facilitate or inhibit long-term recovery from substance use disorders or how the brain changes over the course of recovery.”
– Page 2-25, “Chapter 2. The Neurobiology of Substance Use, Misuse, and Addiction,” Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health

I know what I don’t know. If you ask me for help with a suspected drinking problem, overuse of painkillers, or worries about any other substances – or with activities such as gambling, gaming, shopping or porn – the first words you won’t hear from me are, “What you should do is ____.” Not only do I not know what you should do, even the Surgeon General doesn’t know.

What you’ll get from me first is empathy, compassion and respect. Then, you’ll get help from me with access to evidence-based care. Given that we at least all know now what the Surgeon General does know – that medications and medication-assisted treatment, behavioral therapies, and recovery support services don’t cure but can assist with substance use problems – we’ll talk about what might be most helpful to do next for you.

. . . . .

The opinions expressed here are mine alone and do not necessarily reflect the positions of my associates, clients, employers or relatives.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Last updated 12/30/16

A Paradoxically Cautionary and Insistent Recommendation to Watch ‘Risky Drinking’

For society, sure, the central problem with alcoholism is alcohol and the behaviors that result when a person is using it or continues to use it. But for a person with alcoholism, the central problem isn’t alcohol. It’s abstinence. For a person with alcoholism or other substance use disorders, the anguish, enormity and complexity of the inner experience of abstinence is usually beyond bearing.

This inner experience is portrayed painfully and poignantly in HBO’s documentary, Risky Drinking, released December 19, 2016. The film follows the alcohol use of four people, considered “risky drinkers. Here’s a link to more about the film.

“People don’t drink because they’re crazy; they drink because it works in some way.”
– Carrie Wilkens, Ph.D., interviewed in Risky Drinking and quoted on the film’s site and interviewed for The Fix

The discussion guide for Risky Drinking includes this caution: “Before you watch, a note of caution: this film contains content and images that some – especially those struggling with an alcohol use disorder – may find disturbing.”

Results from RethinkingDrinking.com
I would extend that caution. Both those struggling with alcohol use disorder – and those who love them and have tried to help them – might find the film disturbing, even traumatizing. As someone in both categories, I had to take a break midway, and still found myself sobbing helplessly at the end.

With 4 years of abstinence from alcohol, I’m in the early part of the 4-5 year range named in the Surgeon General’s report on addiction to be considered in remission from alcohol use disorder, but I am determinedly trained in emotion regulation skills, primarily through dialectical behavior therapy, DBT, so I was able to do what I needed to do to handle images in the film. Top precursors for return to active use for those with substance use disorders are 1) stress/distress and 2) environmental cues. Film viewers will experience #1 and may experience #2. For some people, viewing Risky Drinking may be too risky. Those with less time abstinent or nascent self-soothing skills may want to wait to watch it.

If you can tolerate watching Risky Drinking, then it’s a must-watch. While I appreciate that over 2 million American are estimated to have opioid use disorder, over 18 million Americans are estimated to have alcohol use disorder. If the first number qualifies as a crisis, the second qualifies as an apocalypse. In Risky Drinking, you will see what I have seen in myself, what I have seen in and heard from others, and what plagues of Americans. I know all the people in this film, personally and professionally, just by different names.

And I am one of them.

I unequivocally recommend taking the drinking pattern self-assessment on the Rethinking Drinking site linked to from the Risky Drinking site, produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a part of the National Institutes of Health. It only has two questions. Yesterday, I entered numbers on the low side for my drinking pattern before I began abstaining nearly 4 years ago at the end of 2012. I’ve included a screenshot of my results.

The producers would like to thank the participants in this documentary for sharing their varying struggles with alcohol, in their desire to help others.

Their participation took great courage.
Risky Drinking

In early 2012, my individual counselor told me of this NPR story on a CDC report on women and drinking. I remember reading it, then looking for and taking online self-assessments, none as clear and definitive as the one offered on the Rethinking Drinking site, and feeling a growing sense of horror. Nor did I find such helpful, supportive suggestions as these. I did try harder to cut back and to stop, but abstinence itself induced the primary precursor to relapse: stress and distress.

If I realized I had a drinking problem today in 2016, I can’t know if I would have done things differently than I did in 2012. But I can’t have done worse. I told no one, including my counselor, physician,  family members or friends. I drank nearly the full amount I had been drinking every day prior, then, without detox, headed to a support group. While the people in support groups have been lovely, the Surgeon General’s report excludes support groups from the category of treatment and relegates them to the “recovery support services (RSS)” category.  I threw myself off a cliff into the torturous chasm of untreated abstinence and it took me years to recover my footing.

In 2012, I thought I had contracted a moral problem and hid my secret in shame. In 2016, thanks to Facing Addiction, Maia Szalavitz, the Surgeon General, and other pioneers, I would know I had developed a medical problem – malfunctions identifiable in specific brain structures – and I would take myself to a doctor.

Perhaps those who watch Risky Drinking and take the assessment can help themselves on their own, get early, good help, or do whatever it takes to get help in their locale,  and feel better and do better faster than the people in the film – and than I did – and we can all get on with fully living our beautiful, precious lives.

My Involuntary Relapse

I quarantined myself from friends’ homes, restaurants, public festivals, business networking events, anywhere alcohol was seen or served. After nearly 4 years of abstinence from alcohol, I began to realize that I had had drinks with nearly every person I saw and in nearly every place I went in my small town.  My entire world triggered me. I became increasingly relegated to solitary confinement.

Anne having tea at Smithfield PlantationI am a person with alcohol use disorder with the very human need and longing to be with people. A holiday afternoon, alcohol-free party at a place I had rarely frequented seemed safe. The usual descriptive paper tents describing the food were missing, but I enjoyed the luscious main dishes and the conversation with my table companions.  I had carefully saved room for the steaming bread pudding on the back table. In front of the serving dish were two bowls of sauce. I’m right-handed so I ladled on sauce from the right-hand bowl. I sat down, took a small spoonful of pudding and sauce, then took another one. I felt the burn on my tongue and that shimmer in my mouth and that rise of heat into my nasal passages.

After nearly four years of fleeing it, alcohol had caught me.

. . . . .

The trouble with alcohol for me is that once I start, I can’t stop. I can’t stop drinking too much at one sitting, even though I set a personal limit, and I can’t stop drinking day after day, even when I commit to not drinking that day or the next. Drinking a lot of alcohol day after day is hard on the brain and the body but if I wanted to continue doing that, I would support my personal freedom and choice to do so – with one huge exception. If I say or do mean or dangerous things when I’m with you or others while I’m drinking, well, I’ve violated your right to be safe in my company.

Addiction is defined as persistence despite negative consequences. My drinking provided me great pleasure, great relief, and inexpressible benefits, small and large. In old school terms, I neither “abused” alcohol nor, in the new Surgeon General’s lingo, did I “misuse” it. We all know what alcohol’s purpose is and I used it intentionally for just that. But my drinking also resulted in negative consequences for others. Scaring people when I fell down staircases was one negative consequence I have shared publicly. I had to stop.

. . . . .

Nearly instantly, when I felt the alcohol in the bread pudding sauce take over my senses, an image of a lighted Christmas tree came to me, my father seated beside it wearing a shirt, tie and sweater vest and letting me, his little girl, have a sip of his holiday drink. My father smiled in a circle of green and red and blue Christmas tree lights lights. Oh, another taste of bread pudding would mean a bit more time with that treasured memory!

I looked up at the lady across the table from me and said, “This has alcohol in it.” I felt tears come into my eyes. The lady seemed confused, but looked at me kindly.

I stopped eating. I stood up. I walked across the room to the waitress and asked her to please take my plate away from my seat. I told her I couldn’t have alcohol. I filled a coffee cup with decaf. The waitress returned. She said, “Our bad. We usually have labels. The sauce on the right has bourbon. The one on the left doesn’t. So you could have the one on the left.”

I was able to stay a few more minutes, even to taste the plain sauce, very plain if I recall correctly. But shock was passing and panic starting. Once I start, I can’t stop. Was this the beginning of my end?

In the parking lot, four years of experience with what the Surgeon General terms recovery support services, or RSS, kicked in. I knew I needed to call someone with tough, long-term abstinence for help. As well-meaning as the lady across from me was, she had no idea – as I had no idea before I developed it myself  – of the ghastly rip in selfhood made by addiction to a substance. I needed to survive it so I needed to talk to someone who had.

The first person I called didn’t answer. The second person I called didn’t answer. I got in my car and tried to think. But neuroscience tells us what common sense does, too: emotionality and rationality can be inversely proportional. The more upset I get, the less I can think.

I felt bushwacked by the involuntary return of alcohol to my system. I felt tricked into relapse, defeated by my mightiest foe.

And then my phone rang. It was the first person returning my call. I was relieved but not surprised. When people who have what I have call each other, we know it’s urgent. We do our very best to call back.

Apparently, involuntary consumption of alcohol happens often. Alcohol is so pervasive that any food or beverage we didn’t make ourselves is suspect. Alcohol shows up in innocent-looking soft drinks and lemonade, poured into desserts and sauces. We’re advised to just spit it out and keep going.

“You’re all right,” the person said.

As the hours, then days have passed, and I have continued to be abstinent from alcohol, I have felt increasingly exultant. Alcohol has not made me return to it. I am not its captive, its slave, its gimp. I am not alcohol’s helpless, hopeless, powerless victim.

The next night, I attended a gathering at a restaurant. I invited someone who is abstinent to accompany me. Half sat at the bar and half sat at the table. I sat at the table. I may have some control over my use of alcohol, but I am not a fool. My newest RSS pal, the Surgeon General, says most people with alcohol use disorder aren’t in remission until 4 to 5 years of abstinence. With 3 and 11/12 years of abstinence, I accept 1 and 1/12 years more of constant vigilance to go.

While I was seated at the restaurant table, a woman stopped by to chat and stood with her glass of red wine right in my face. Involuntarily, I leaned towards her glass. Bourbon wasn’t my drink. Wine was.

Most of the past four years, I would have been sobbing in anguish as I wrote that. Today, I’m laughing. A near relapse one day, and the next day I’m sniffing someone else’s beverage? What a ridiculous disorder this is.

And then gravity returns. Addiction is despicable to the people who have it and to those who love them. And, for many, deadly.

This southern lady didn’t spit out her bourbon-laced bread pudding this time, but she will next time, albeit behind a napkin. I thought I had all the needed prepositions on the to-not list – don’t be “with,” “by,” or “around” alcohol. I will now watch out for alcohol getting “in” me – against my will, against my wishes.

I have felt bent double, waiting, wearing terror like layers of dark coats, trying to cushion myself from the wicked, arbitrary decision of alcoholism to drop its boot on me again. It dropped. With whatever shreds of self left after everything that’s gone down, I pushed myself out from under it. I stood up.

I feel free in a way I haven’t in nearly 4 years. For me – and my anecdotal experience cannot be generalized to others – a small amount of alcohol, involuntarily consumed, did not result in an involuntary return to active use. The next day, after I leaned into the wine, I felt a novel indifference. The disorder made made me lean in. But I had power over what I did next.

If I were sitting at a restaurant all by myself and the maître d’ sent me a complimentary glass of wine, perhaps chilled cabernet sauvignon, nose-tickling champagne, or merlot just cooler than room temperature, ooh, how I would ache to drink it! Days ago, I might have.

Not today. My little involuntary relapse took the edge off the mystery. Yep, that’s what alcohol tastes like. Yep, if I had more, as the Surgeon General reports on page 2-20, I’d feel that fantastic first “euphoria as well as the sedating, motor impairing, and anxiety reducing effects of alcohol intoxication.” Woo-hoo! Who cares about motorly impairment when I’m feeling this awesome?!

Yep, if I had a little more, I’d want a lot more. For days on end.

Nope, not today.

Today, as the person who has what I have assured me, I am fine.

In fact, I’m feeling the best I’ve felt in nearly four years.

Photo of me taken by a table companion during tea at Smithfield Plantation on 12/5/16, the day before my “relapse.”

A Grown Woman Might Need a Little Red Wagon

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