Do you or someone you know drink excessively? Are you unsure on what type of help is available for someone who drinks excessively? To help understand where excessive drinking stems from in the first place and how someone can overcome excessive drinking, I have interviewed psychologist Melanie Wilson, PsyD.
Tell me a little bit about yourself
“I am a clinical health psychologist with a Doctor of Psychology (Psy.D., Hahnemann University, 1987) degree in Clinical Psychology. My training and experience have been in a variety of settings with a variety of people. I’ve worked in hospitals, schools, and corporate settings, with all age groups, including individuals, couples, families, groups, executives and teams. Currently I am in private practice in Bryn Mawr, PA, 12 miles west of Philadelphia.”
Where does excessive drinking stem from?
“Excessive drinking stems from a combination of factors – biological/genetic, psychological, and social/cultural. In the behavioral health care field, we refer to this as the biopsychosocial model of behavior. We do know that it runs in families. But while there is often a genetic predisposition, it’s not possible to separate this from the environmental experiences, which also shape the behavior. It is a complex, multidimensional pattern of behavior that is also influenced by cultural and environmental factors, socioeconomic group, educational level, peer groups and stress levels.”
“Even if someone has a genetic predisposition, epigenetic research is showing that environmental experiences can actually alter our DNA. So in no way is someone doomed to a destiny of “alcoholism,” excessive drinking, or an alcohol use disorder, regardless of your inherited genetics.”
“We are bombarded with media marketing, linking alcohol with sports, sex, freedom, and carefree fun. There are peer influences and the allure of the forbidden in adolescence. In college alcohol is a big part of social life, and getting drunk on your 21st birthday with your friends has become an American rite of passage. Drinking with friends at bars is also a stand-alone social activity for many single twenty-something adults.”
“So the context of our culture is ripe for those with a genetic predisposition to slide into a harmful pattern of excessive drinking. And who doesn’t also have a certain amount of stress and emotional pain, which can tip the balance even further.”
“It can start with a “perfect storm” of genetic, environmental, and cultural forces, which can then develop into a habitual pattern of behavior. And ultimately, people ‘”even when they’ve become aware that it has gotten out of hand ‘” continue the behavior because it has become their conditioned, default behavior.”
“Alcohol is easy, plentiful, and legal. It offers a quick and soothing elixir for dealing with unpleasant thoughts and feelings such as anxiety, boredom, and loneliness ‘”at least temporarily. Of course, it makes all these things worse over time.”
What type of impact can excessive drinking have on someone’s overall life?
“First, let’s define what constitutes this broad category of excessive drinking, because very few people are aware of the limits for keeping within the low-risk range. So here they are:
Drinking more than four units of alcohol a day (a 12-ounce can of beer, 5 ounces of wine, 1.5 ounces ‘” a shot – of liquor) for men, or more than three for women, even once or twice during a year’s time, puts you at higher risk for meeting the criteria for the official diagnoses of Alcohol Abuse or Alcohol Dependence. Alcohol Dependence, the more serious of the two, is roughly equivalent to the imprecise folk term, “Alcoholism.”
Staying under these limits ‘” 4 for men, 3 for women ‘” puts you at lower risk, but only when you also adhere to weekly limits. Men need to stay under 14 drinks per week. The weekly limit for women is 7.”
“Excessive or harmful patterns of drinking increase your risk of developing alcohol-related health problems such as liver and heart disease, sleep disorders, depression, stroke, diabetes, and a number of cancers over the long run.”
“Excessive drinking in the family is associated with varying degrees of stress and trauma, for example, emotional and physical abuse; intense, unrestrained expression of emotions; unpredictable and inconsistent parenting behavior, and prolonged chaos.”
“Unpredictable behavior in the home is very hard on kids, who are basically at the mercy of their parents. Kids do the best they can to adapt, but the stress takes its toll, frequently in the form of anxiety, depression, and low self-esteem. They learn to be on their guard, and expend a great deal of energy trying to “read” the unpredictable parent. They may find it difficult to trust others, which can lead to intimacy problems in their adult relationships.”
“And they are at increased risk for developing their own alcohol problems, and for getting involved romantically with a partner who drinks excessively. They may have an unconscious fantasy of “fixing” their own family by fixing their alcohol-abusing partner by loving and understanding them enough.”
“Kids tend to blame themselves for family problems, and can feel deeply ashamed and guilty. Many children must learn to fend for themselves, and they become “parentified” in the process. These “miniature adults” get their siblings off to school in the morning, take mom her coffee, and order pizza for dinner. Low self-esteem and “people-pleasing” tendencies often follow them into adulthood. They become overachievers, fantastic success stories in their career life, but they frequently have insecurities and low self-esteem when it comes to family and personal relationships.”
“Adolescence is a time of omnipotent illusions, identity formation, and striving for autonomy. An adolescent can appear “5 years old, going on 40,” which is fertile ground for alcohol abuse. One hallmark of excessive drinking is disinhibition, which results in all kinds of risky behaviors, such as sexual promiscuity, date-rape, STDs, DUIs, and violence.”
“Unfortunately, high school and college students learn their early drinking habits from their each other, which typically involves binge-drinking. This is akin to “the drunk leading the drunk.” Binge-drinking is never a good thing, but it can be especially harmful before the age of 25, which is when the planning and executive parts of the brain (prefrontal cortex) are fully developed. About one third of the people who develop alcohol dependence (i.e., the folk term “alcoholism”) do so in their late teens and early twenties.”
“Most of my private clients with alcohol-related problems are “baby boomers,” at the top of their careers. They function at an extremely high level of competence and success. In their mid-forties and early fifties, they’re questioning the meaning and purpose of their lives. Many are divorced, or in unhappy marriages. They may have put on a bit of extra weight. Their children are growing up, and they may have lost one or both of their own parents.”
“They feel as though they’ve lost their way. They may have lost a sense of purpose, of what’s really important to them. They may wonder, “Is this all there is?” They frequently drink alone, in secret, out of habit, boredom, stress, or to self-medicate their anxiety, depression, loneliness, or a sense of emptiness or overwhelm.”
“There’s an inner sense of unease, as they realize they want more meaning and happiness in their lives. Their pattern of drinking is incompatible with creating such a life, and by now, the illusion of having plenty of time is no longer sustainable. They know they’re not happy, that they want more out of life, and suddenly the “if not now, when?” cliché takes on an undeniable urgency.”
“Excessive drinking steals precious hours, days, and years from your life. It creeps up insidiously, until one day you realize that you feel as though you are at the mercy of a life-sapping habit.”
“You wonder, “When did this happen? How did this happen?” At some level you know that this is not who you really are. I’ve had more than one client say to me, “What happened to that person?” as if they were talking about someone other than themselves.
Ultimately, the impact of repeated excessive drinking is the absence of a wonderful life ‘” a life filled with meaningful engagement, great relationships, and happiness.
That’s why I ask my clients two key questions: (1) “What’s really important to you in your life?” and (2) “How is your relationship with alcohol affecting that?””
How can someone overcome excessive drinking?
“To change any habit, including excessive drinking, you need to decide to change the behavior, believe you can do it, and really want to do it. In other words, you need to have a combination of commitment, belief, and motivation. You can try a self-help approach, join a support group, or work with a licensed professional.”
“Start where you are. Everyone, including non-drinkers and low-risk drinkers, should know the risks and limits to ensure prevention in the first place. If your drinking is already excessive, or on the way to getting there, change the pattern as soon as you can. That is, cut down or stop altogether. Many people can cut down to low-risk levels once they know what these limits are. For those who have difficulty moderating or regulating their drinking, then a goal of abstinence will be easier to achieve and sustain.”
“So know what constitutes a standard drink or unit of alcohol, and know the limits for keeping your drinking below risky levels (Men: 4 units daily, 14 weekly; Women: 3 daily, 7 weekly. A unit is 12 ounces of beer, 5 ounces of wine, and 1.5 ounces of hard liquor).”
“Whether you change your behavior on your own or with the help of an experienced and knowledgeable therapist, it is important for you to do a bit of self-education. Go to the National Institute of Alcoholism and Alcohol Abuse (NIAAA) website for some great information and resources (www.niaaa.nih.gov).”
“The NIAAA is conducting the National Epidemiologic Study on Alcohol and Related Conditions (NESARC), the largest study ever conducted on alcohol use and abuse in the US. NESARC has been following the alcohol use patterns of a large, representative sample of the American population (43,000 adults, 18 and older) since 2001.”
“The NESARC revealed some astounding new information that will dramatically change the way people view and treat alcohol use disorders at all levels of the spectrum. But this won’t happen overnight. Historically, it has taken about 20 years (a generation!) before research findings get integrated into clinical practice, and thereby become more widely-known and available to the general public.”
“NESARC found that 72% of people who develop alcohol dependence (AKA “alcoholism”) at some point in their lives have a single episode, lasting about four years on average. They don’t seek any help or treatment. That’s right. They recover on their own. And they never relapse.”
“A word of caution here: Any level of alcohol abuse is accompanied by human suffering, and takes its toll in physical, social, emotional, and psychological damage. And the incidence of alcohol abuse and alcohol dependence continues to rise. So why keep your fingers crossed, hoping that you are one of the “lucky” 72% who eventually recover on their own? Incidentally, it’s typical for about ten years of abuse to precede dependence. There’s not a clear-cut line of demarcation between abuse and dependence.”
“The idea that you have to “hit bottom,” before you can change harmful alcohol use is a total myth. People can and should get help long before they’re forced to. In fact, the earlier someone does something about their alcohol-related problem, the better. There are effective treatments out there. They just aren’t being widely used yet. I doubt whether many professionals are even aware of the groundbreaking NESARC findings.
Some of the newer, research-supported treatments include brief intervention, cognitive behavioral therapy, motivational enhancement, behavior marital therapy, innovative coping skills strategies, and anti-cravings medications, such as Naltrexone and Topiramate. Clinical hypnosis has been found to enhance almost any cognitive therapy technique, and I have found it to be extremely helpful in my work with clients.
If you would like to try a support group for help with a goal of abstinence, you can look into AA, Women for Sobriety (WFS), and Smart Recovery. AA groups are everywhere, and pretty easy to find locally. However, Smart Recovery and WFS are not so plentiful. If there’s not one near you, can get their materials on-line and maybe even join an on-line group.”
“Each of these support groups is different, so do your research. Although AA groups abound, their one-size-fits-all approach may actually fit only the most severe, recurrent, and chronic cases of alcohol-dependence (about 1% of people with alcohol dependence).”
“I prefer Smart Recovery, which uses a social learning, cognitive-behavioral approach, supported by the research for mild to moderate conditions. Smart Recovery does not subscribe to the disease model, nor does it view the individual as “powerless over alcohol.””
“Women for Sobriety, has modified the AA model to be more suitable for women, and uses its own 13 Affirmations in place of the 12 Steps. WFS does not focus on disease, helplessness or powerlessness. You can get their materials on-line, however, and maybe even join an on-line group.”
“If you decide to work with a therapist, I recommend a licensed mental health professional who is up to date and experienced in what the research shows about what’s effective in alcohol treatment. A licensed psychiatrist, psychologist, clinical social worker, can also recognize and help you with any anxiety, depression, or trauma conditions that frequently co-exist with excessive alcohol use.”
Thank you Dr. Wilson for doing the interview on how someone can overcome excessive drinking. For more information on Dr. Wilson or her work you can check out her website on www.DrMelanieWilson.com.
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