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Symptoms of Alcohol Dependence

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This article was published in dr. rosiello's sedona times psychology column in 2009.

There are people in our community who drive their car when they're in an alcohol-induced black out.

For those individuals who drink excessively and there are many, many people in Arizona who do drink to extreme, it's not unusual to spend a few evenings a week, drinking for hours until the bar closes, and then drive home. There is a societal peer pressure in our area to get as drunk as you can; it's almost a romantic quality to macho drinking in the old west where you can belly up to the bar and drink a series of shots. However, in the old west you just got on your horse and it drove you home, maybe you fell off the horse if you blacked out, but that is a lot less dangerous than being effected by and driving in an intoxicated state.

There are different types of alcoholic symptoms, some that don't look like symptoms but just look like being social. There is the functional alcoholic, for example, who can drink too much in any given evening and still perform all their duties the next day.  One of my patients who is in a high-powered career, meets a colleague nearly every day for lunch and has one or two glasses of wine. After work, she often meets another colleague or goes out with friends, nearly every evening. She'll start with a few martinis at the bar and then order a bottle of wine with dinner. This usually extends to another bottle of wine to finish dinner and then an after dinner drink. Then she drives home. She gets up the next morning and goes to the gym and then to work for another ten-hour day, interspersed by lunch with a colleague and dinner out. She classifies herself as a heavy drinker, but not an alcoholic. It took nearly a year of working with her and many chaotic experiences, both drunk and the 'sober' chaotic interactions the next day, before she agreed that she could not control her drinking. That was the discussion between us: she said she could control her drinking and I asked if she could show me by going for a month just drinking two glasses of wine a night. She couldn't do it. It still took a while until she realized she had absolutely no control over the alcohol and that the alcohol control over her. She began attending Alcoholics Anonymous and has been sober for over ten years now.

Another classification of alcoholic are those people who binge drink. Binge drinking is more occasional, more sporadic, maybe just getting drunk once a week or once a month or once a year. But just because a binge drinker only drinks sometimes, when they do drink, it's usually until they feel drunk. The binge drinker's symptoms also qualify them as alcoholic because it's the amount of alcohol consumed that constitutes the drinking problem. For the binge drinker, it's the level of alcohol consumed, not the frequency or timeliness of drinking.

How about the drinker who has one glass of alcohol and it seems like their personality changes? For this type of drinker, it's not the amount; it's the chemical change in their system that makes them react in a manner that is out of character for them. This individual has, therefore, lost control of their personality as they become someone who morphs into anger, or tearfulness, or into someone who's behavior seems childlike or adolescent. If drinking makes you into someone other than your sober self, they this kind of behavior is also symptomatic of alcoholism.

Of course there are other alcoholics who pass out on the street, who slur their words, who begin drinking at breakfast and continue through the day. These people are definitely alcoholic, but so is the heavy drinker, the functional alcoholic, the binge drinker, and the drinker who loses control of their personality. The definition of 'who is an alcoholic' isn't what it used to be when it just referenced the Bowery bum.  Alcoholism is now more widely defined, both medically and psychologically because we have more information about how alcohol operates in our mind/body system, how it creates chemical and psychological dependence, and how it impacts on our level of functioning.

"She'd...pour herself a glass of scotch. She felt in control of her day...As the night went on, she continued to drink to maintain that sense of control of being protected or numbed from outside anxieties." ~FR

Why do people drink? One of my patients said it relaxed her after a stressful day. She'd come home and pour herself a glass of scotch. She felt in control of her day as she felt control over pouring her scotch and therefore in control of her relaxation process for that evening. As the night went on, she continued to drink to maintain that sense of control of being protected or numbed from outside anxieties. At some point in the evening, her emotions would shift from relaxation to feeling sad and depressed and then she'd begin crying and sob herself to sleep. When she did go out with friends, she would drink in moderation because she didn't want them to confront her drinking or her depression. In a sense, she had made companions of aloneness and isolation and she could emotionally count on both to show up each evening. She controlled what emotions arose in her, even though the emotions were painful. She trusted her intoxicated cocoon. When she did go out with friends, she drank in moderation. Then, she'd go home and drink until she fell asleep. If no one knows about you're drinking, then the tree hasn't made any noise falling in the forest.  

Here's the criteria for diagnosing alcohol dependence: 1) A need to drink more than the limit you set for yourself. A desire for more alcohol to achieve intoxication or a black out. A need for 'more' alcohol in order to achieve the desired level of intoxification over time. 2) Wishing to cut down on drinking but unable to do so.     3) Withdrawal symptoms, such as in inability to control anger or depression the next day.  Using alcohol to avoid withdrawal symptoms or to provoke feeling angry/depressed. 4) Spending too much time drinking and too much time trying to obtain alcohol and too much time thinking about drinking. 5) Having a hangover or disrupted sleep that interferes with business or social activities. 6) Drinking and driving. (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, 1994. American Psychiatric Association, Publishers. Washington, DC)

If you think you're at risk of being alcoholic, then you probably right. Drinking alcohol is a way of swallowing and numbing emotions, whether it's depression or anger or fear of happiness. If you don't drown your emotions with alcohol, you've got an opportunity to get your emotions out through talking about them. Talking in therapy or in AA or in a detox inpatient unit, is how the alcoholic begins to recover. It isn't shameful to talk about the difficult emotions you've experienced in life that make you want to feel numb through drinking…although it feels like it is.  If you really think about it, it's more shameful to swallow difficult emotions and then drive home.