L. F. In 2003, one of my loved ones entered treatment for alcoholism, and I found myself plunged into a world with terms like addiction, alcoholism, adult children of alcoholics, codependency, dual-diagnosis, and on it went. [I soon admitted that I'd experienced decades coping/fighting with family members and friends' alcohol abuse and/or alcoholism.] To answer my questions — namely, “How could it possibly be a disease; they choose to drink?” and “Why have I put up with it for so long!?,” I immersed myself in research and my own recovery work (e.g., therapy and 12-step programs for family members) and found there was a whole new body of knowledge (much published in just this century) – thanks to new brain imaging technologies. It was this new research that I wanted to share in the hopes I could help other family members/friends who struggle with a family member’s drinking and to help all of us, as a society, end the stigma and shame that surrounds and perpetuates the disease.
G.S. In your book If You Loved Me You’d Stop: What You Really Need to Know When Your Loved One Drinks Too Much, you write how alcohol hijacks the brain. Please describe the most interesting thing you learned in your research about alcohol abuse and the brain?
L. F. I would say it’s the brain disease nature of addiction and that chemical and structural changes occur in the brain as a result of alcohol abuse and alcoholism. Given the brain controls everything we think, feel, say and do, brain changes caused by alcohol abuse or alcoholism cause people to behave in ways they normally would not behave, such as: arguing with family members or friends about the drinking, yelling at or hitting family members, missing work, carrying on rambling arguments, accusing family members or friends of doing things they haven’t done, driving while under the influence, being super nice, or continuing to use/drink after promising not to. We call these things drinking behaviors. Understanding that alcohol misuse (abuse or alcoholism) causes the drinking behaviors; that it is not a behavioral choice once the brain changes are activated, helps all concerned better appreciate that: 1) the alcohol misuse needs to stop in order to stop the drinking behaviors, and 2) the non-drinker has no control over the drinking behaviors caused by a person’s alcohol misuse-related brain changes.
To identify possible alcohol misuse (alcohol abuse or alcoholism), start with a single question. How many times in the past YEAR have you [male] had more than 5 drinks per day? [Insert 4 drinks, if female. Drink defined as 5 oz. of wine, 12 oz. of beer, 1.5 oz. of hard liquor.] If the answer is once or twice, that person is engaging in “at-risk” drinking – the type of drinking that can lead to alcohol abuse and/or alcohol dependence (alcoholism). By the way, “normal” or “moderate” drinking is defined as: no more than 7 standard drinks/week, with no more than 3 of the 7 in a day for women; and for men, it is no more than 14 standard drinks/week, with no more than 4 of the 14 in a day.
G. S. Many people married to an alcoholic typically develop stress related illnesses and emotional problems such as anxiety and depression. What have you discovered to be most helpful for those struggling in a relationship with an alcoholic?
L. F. First it is important to really understand the answers to the above questions. Secondly, it is to understand that coping with a person’s undiagnosed, untreated, not openly discussed drinking behaviors causes secondhand drinking/SHD (similar to the idea of secondhand smoke). SHD activates the fight-or-flight system in the body of the non-drinking family member. When the fight-or-flight system is chronically activated, a person experiences brain changes, changes that in turn can cause behavioral changes, such as unhealthy coping skills. This chronically activated system can cause emotional and physical ailments, such as depression, anxiety, headaches, backaches, and stomach problems. My most recent book, Loved One In Treatment? Now What!, helps family members understand this dynamic and how to stop it.
Thirdly, it’s understanding they are not alone. Over one-half of American adults have a loved one with a drinking problem, and one in four children will live with alcohol abuse or alcoholism or both before the age of 18.
SHD can be identified with a single question, as well: In the past year, has any male in your family had five drinks in a day (or any female had four)? If you answer, “Yes,” you’ll want to learn more.
G.S. On your website and in your book you refer to alcoholism as a disease. How do you answer those skeptics who believe alcoholism is merely a problem of self-control?
L. F. One of the most difficult aspects with regards to alcoholism is to understand that it is one of the diseases of addiction, which is defined as a chronic, often relapsing brain disease. To that end, it is helpful to realize that everything about our body – what we can see and what we cannot see – is made up of cells. Diseases change cells in our body — that’s what makes a disease a disease. A disease might change cells in body organs (like the heart or liver or eyes) or in body organ systems (meaning several organs working together), like metabolism or cardiovascular. For example, the disease of breast cancer attacks cells in the breast and the disease of diabetes, attacks cells in the metabolic system. The diseases of addiction (drug addiction or alcoholism) change cells in the brain, thereby changing how the brain works. Brain cells that control our emotions, memories, learning, motivation, and judgment are the most deeply affected. Additionally, alcoholism often change cells in several other body organs, as well, such as the liver, heart, and kidney. Like other diseases, if untreated or during a lapse in management of the disease, a person can die from alcoholism, just as people die from other diseases.
Something else for skeptics to understand is that while brain changes occur with both alcohol abuse and alcoholism, one of the characteristics of the disease of alcoholism (or an addiction to another drug, for that matter) is cravings. An addiction craving can be five times stronger than our instinctual, hardwired drive to eat food when hungry because of the neural networks that are compromised. These powerful cravings override all other “thought” and are what cause an alcoholic to lie and steal and do whatever it takes to drink. The other three characteristics of the disease are tolerance, loss of control, and physical dependence.
It is helpful to understand the key risk factors that contribute to a person “crossing the line” from alcohol abuse to alcohol dependence (alcoholism). These risk factors include: genetics (if it runs in the family, genetic predisposition); social environment (where heavy drinking is viewed as “normal” and encouraged); childhood trauma (verbal, physical, emotional abuse – which “wires” unhealthy coping skills and brain changes); early use (critical brain development ages 12-25 makes the brain especially vulnerable to brain changes caused by alcohol misuse), mental illness (e.g., depression, anxiety, ADHD, PTSD, bipolar – which also cause brain changes and the potential to “self medicate” with alcohol). The more risk factors, the more susceptible a person’s brain is to the chemical and structural brain changes caused by alcohol abuse and the possibility of “crossing the line” to alcoholism.
G. S. Many of the couples I counsel have fights about alcohol because of the safety issues involved, e.g., the spouse worries that the children might be put at risk if they get in the car with the intoxicated other parent. What tips can you give spouses to address this important safety concern?
L. F. It is a critically important concern. Once a spouse understands the brain has been changed, they can appreciate that sticking to the terms of any kind of deal making (such as not having more than one drink if you’re going to drive with the children) is likely not possible if the person is an alcoholic — you just never know. Therefore, the non-drinking spouse needs to set up safety plans and explain those to the children and to the drinking spouse (when he/she is sober).
In both of my books, I have a chapter on what to tell children, but basically, it involves an age appropriate description of alcoholism. It is also important to separate the drinking behaviors from the “person.” Helping a child understands that alcohol changes how the parent’s brain works can help that child understand that it is those brain changes that makes their parent act differently or seem not to love them. Children need to understand this and that it is not “them” (the child), nor anything they’ve said or done.
But, back to the safety plans… one safety plan is that the child will not be driven (ever) by the drinking parent until the parent gets demonstrated help with their drinking — “demonstrated help” is a whole other topic, unfortunately.
L. F. The effects are extensive, as described above, and they can set a child up for several of the risk factors I described when the drinking is not openly, honestly acknowledge, discussed and productively dealt with. The latter refers to the notion that denial, secrecy, blaming, shaming, nagging do not work when trying to cope with a loved one’s drinking and subsequent drinking behaviors.
Another part of this is to understand what happens to the non-drinking parent. Their behavior changes, too, as a result of brain changes caused by the chronically activated fight-or-flight system; behavioral changes that can also be confusing to children. For example, a mom feeling anxious when dad is late (fearing he’s out drinking), may start to snap at her children — something she would not do were it not for her anxiety over whether her husband stopped for a drink on the way home from work. So parents need to understand SHD and how to treat/prevent it, which is one of the key subjects in my second book, Loved One In Treatment? Now What!
– Of further note, all alcoholics go through a period of alcohol abuse, but not all alcohol abusers become alcoholics.
– A person does not have to “hit bottom” to get and/or to be encouraged to seek help. In fact, the sooner the drinking pattern is interrupted, the better for all concerned. Nagging, shaming, blaming DO NOT work, however, which is why it is so important to learn about alcohol abuse and alcoholism.
– To better understand alcoholism (or any addiction), visit www.hbo.com/addiciton. It is an EXCELLENT resource and is produced by HBO in collaboration with NIAAA, NIDA and the Robert Wood Johnson Foundation.
G. S. Thank you, Lisa, for this interview, and for sharing this helpful information. I provided you readers with links throughout this interview if you wish to read some research supporting Lisa’s work. If you find yourself in a relationship where drinking becomes a problem, get help as soon as you can. You can find help from Al-Anon family groups, and your teens can find support from Alateen. These groups, in addition to counseling, can help prevent the damage Lisa described from “Second hand drinking.”
Photos courtesy of Seegul and Rikmoran.