Most alcoholics don’t even know they have a problem. So what are the signs of alcoholism and when should you, as a family member, start worrying that you might have a problem?
Joining us to answer these questions is Dr. Sadaqat Ai. He is a graduate of Dow Medical College, Karachi, and is a recognized Addiction Psychiatrist with a background of training at “HAZELDEN” and Vitalsmarts USA. He is the project director of Willing Ways, Pakistan a state-of-the-art facility for alcoholism treatment.
Dr. Sadaqat Ali, a graduate of Dow Medical College, Karachi is a renowned professional in the field of addiction psychiatry. He has a background of getting trained at “HAZELDEN” and “Vital Smarts”, USA. Dr. Sadaqat Ali is the Project Director of Willing Ways (Pvt.) Limited and Sadaqat Clinic (Pvt.) limited. Dr. Sadaqat’s name was included in the international Who’s a Who directory of professionals which was the first-ever distinction of any Pakistani doctor.
Editor: Arman Ahmed
Q: 1 Dr. Sadaqat, what’s the difference between somebody who is an alcoholic and someone who just likes a drink or two?
A: Well, an alcoholic is someone who has a problem with his drinking. Either he is troubled it, or someone else bears the brunt. There are some specific criteria that we use to determine alcoholism. We have a CAGE questionnaire. If someone has made unsuccessful attempts to Cut Down, that It-leans there’s an issue about his drinking. The second (I am Annoyance. Actually, this ranges from irritability to rage. One should • be pleased alter drinking after all that is why one drinks. Instead, we see him changing in front of our very eyes. It goes from cranky and irritable to rude, obnoxious, or aggressive. He becomes louder and nothing seems right to him. The more he drinks the worse he grows. The third criterion is Guilt, which is saying, I think, I shouldn’t be doing this.
It is not a mind-set that is prone to alcoholism. It is a “body-set” which is vulnerable. Drinking requires a pro drinking mileu; whilst alcoholism requires a conducive genetic makeup.
Use of alcohol in the mornings. There is a rule of thumb: If somebody points a finger at your drinking, it’s alcoholism.
Q: 2 But someone who likes to take a drink at dinner, a glass of wine, that’s not a problem, is it?
A: It’s not a problem if it’s not a problem. If it doesn’t disturb his social and occupational functioning, if it doesn’t disturb his health, it’s not a problem. If it makes him more of a gentleman, then it is not a problem; rather it is a solution.
Q: 3 Dr. Sadaqat, could alcohol make you more of a gentleman???
A: It is supposed to make one more of a gentleman and it does if one’s body processes it in a normal fashion. It is supposed to make one sociable, relaxed, creative, and confident. People don’t drink alcohol to slur their speech, stagger their gate, throw up, repeat themselves over and over again or feel annoyed. They don’t become drunk or pass out by design. People become alcoholics by default. What’s more, alcohol-ism does not happen to everybody who drinks. Only 10% will ultimately cross that invisible at risk.
Q: 4 Is it a mindset that is prone to alcoholism?
A: No! The mindset may be prone to drinking only: but it is a “body-set” that requires a pro drinking environment: whilst alcoholism requires a conducive genetic makeup. Drinking is a matter of the body, the seat of drinking is in the mind, the seat of alcoholism in the body.
Q: 5 What is the disease model of alcoholism?
A: The disease model basically says that alcoholism is a bio-psycho-social and spiritual disease. It starts in biology and “encroaches” on psychology, sociology, and spirituality, in that order.
When he is a little tipsy and is kind of okay in the morning, but still harbours a little toxin, he is suffering from micro-alcoholism. This is very risky if he works in a sensitive profession.
It is a primary, chronic, and progressive illness; if untreated, it is Fatal. A person is not held responsible for his alcoholic just as a person is not held responsible [or diabetes and hypertension just because he made unhealthy choices leading to this dangerous duo. However, like a diabetic and hypertensive patient, he is responsible for his recovery from this deadly disease. Of course, he needs empowerment and support From the Family to seek help. His flesh is Willin concerned others to motivate him towards recovery.
Q: 6 Could you tell us more about the diseased part?
A: Of course… Alcohol once taken produces tranquility and is normally broken down to carbon dioxide and water. Both are harmless end products and are eliminated from the body as such. In alcoholism, the metabolism becomes erratic and an intermediate toxic substance accumulates, hence the Word “intoxicated”. This toxic substance is called acetaldehyde and it is quite similar to chloroform. This toxin makes the person numb and knocks him down when produced in abundance. The alcoholic may pass out and his body has to do a lot of restorative work.
In alcoholism a chloroform like toxin, aldehyde accumulates in the blood; hence the term intoxicated. Presence of this substance in blood opens a whole lot of pendora’s box.
This cleansing process takes many hours and when he regains consciousness, he is hungover because of the residual toxin.
Q 7: So, drunkenness is the sin-qua-non or recognition point of alcoholism?
A: Drunkenness is only one side of alcoholism; the other side is consuming large quantities with significant behavioral changes. These two aspects together produce a whole range of alcoholisms. That is why we say, “Alcoholism includes alcoholisms.” quantities of alcohol consumption ultimately exhaust the liver. The toxin is produced in large quantity organs, especially the brain.
Q: 8 Can we safely assume that alcoholism does not exist if there is no intoxication or hangover?
A: No, we can never safely assume that alcoholism does not exist even when there is no intoxication. Let me explain… When a person gets visibly drunk. he passes out or goes into d seemingly deep but restless sleep…. Or when he regains consciousness or awareness in the morning with a heavy head or a hangover, he is suffering from macro-alcoholism; but if he looks just little tips after drinking and is kind of okay in the mornings, and may still be harboring a little toxin, he is probably suffering I mill what we call micro-alcoholism. Now, if his work requires precision; if lie happens to be an air-force pilot, he may jeopardize his life and his airplane. Similarly a neurosurgeon or a foreign office, negotiator would be risking a brain or his country’s claim. Whereas it person with macro-alcoholism may mess things up quite visibly, a person with micro-alcoholism may quietly play havoc With h delicate matters of great significance.
Drunkenness is only one side of the alcoholism; the other side is consuming large quantities. These two aspects of alcoholism together produce a variety of shades of the alcoholism.
However, a person who just consumes large quantities of alcohol and does not look drunk suffers because of other reasons. He is preoccupied with drinking all the time and neglects his responsibilities. He burdens his liver day in and day out. Drinking is never absolutely safe and when we choose to drink, we are taking at 0% risk with our lives. That is an enormous risk especially if we work in a significant and sensitive profession.
Q: 9 Dr. Sadaqat, some people are suffering from alcoholism, know there is a problem, their families know it… but they don’t seek help… Why is that?
A: Well, another hallmark of alcoholism is Denial. The alcoholic is not really aware of what’s going on. He may know that things are not quite right but the nature of his problem is not obvious to him. As the saying goes; ‘Fish discovers water last.’ An alcoholic’s life starts to revolve around his drinking. Drinking becomes a way to cope with problems. It becomes a way to ‘belong.’ It becomes a way to have fun. People aren’t so keen on giving that up. So they do not seek help until the consequences far outweigh the pleasures. And until one can accept a problem and discuss it at an appropriate forum one can’t solve it. The single most important factor that contributes to the survival of alcoholism and prevents an Alcoholic from seeing the light and getting treatment is, enabling.
You don’t have to play doctor. You just have to look into problems generated by his alcoholism and use them creatively to increase treatment seeking behaviors in your loved one.
Q: 10 What is enabling?
A: Enabling is done by the concerned others.’ It means finding short-term solutions for a long-term problem. many of I IS are inclined to protect the person who is drunk, high, or hungover. We clean up his mess, prevent potential accidents, “cover up” for him with lies, show sympathy, make excuses. or simply look the other way.
You need to show him that his drinking has turned into alcoholism. You need to be honest while expressing your concerns. You need to show compassion, because without it he won’t listen.
But in so doing, we lift the responsibility from that person onto our shoulders. We interfere with the logical consequences of the person’s behavior. If you are the one to take all the pain generated by alcoholism, while our loved one is buss extracting whatever pleasure is left in drinking, no wonder he is not bothered by this state. No wonder he does not listen to you when you tell him to reduce or stop drinking. The concerned others need to cork very seriously at getting rid of alcoholism; .just stepping in to advise From time to time, is not enough. They need to op enabling.
Q: 11 Tell me what kind of impact does alcoholism really have on families’? How bad is it?
Alcohol works from the top down. Alter bringing changes in the identified patient, it works on the near and dear ones. Alcoholism casts a dark shadow on the whole family much more than other chronic diseases. The family bears the brunt of the emotional repercussions of alcoholism. When a loved one messes up his life and one keeps on cleaning up the mess, this labor of love becomes a sickness. You see a lot of symptoms of codependence in such family members. It affects practically every aspect of family life in a variety of ways.
When a person gets visibly drunk, passes out and regains his awareness in the morning with a heavy head or a hangover, he is suffering from macro-alcoholism.
Family members go through paradigm-shifting experiences. They start seeing life differently. They start making molehills out of the mountains. Their children learn not to look to their father in times of difficulty. There are widows with living husbands. There is verbal abuse. There is domestic violence. You name an emotional pain, family dysfunction and it is to be found in the family of an alcoholic! That’s how it affects the family.
Q: 12 What about keeping a watch on him? Checking to make sure he does not keep large quantities of alcohol.
A: Alcoholics are usually much smarter than the people keeping watch over them; the concerned others. They hide the bottles in places one wouldn’t even dream of. Acting the watchdog is an exercise in futility and a recipe for frustration. You see, it does not work. You are asking him to control his drinking which he can’t. He can call it quits or keep drinking the same way. You need to motivate him. You need to promote treatment-seeking behaviors in your loved one. If you press the wrong end of a drinking problem. He is a magician; literally. He distorts reality; he will distract your attraction. He will make sure that his drinking continues.
Q: 13 What are the options family is left with?
A: The family is really caught in a trap. On the one hand, they’re upset, angry, and hurt by the behavior of the alcoholic. On the other hand, they love that person. Whether it’s a husband, son, brother, or some other dearly loved one. They can’t lust throw him out of the window, especially when chi, a person has cloned a lot for them in the past. The families often want him to get help. That becomes a whole bone of contention.
Family Intervention is a beautiful intellectual exercise, when the sanity of the patient is intact. The family goes through elaborate training and persuades him into treatment.
They need professional help so as to learn how to enhance the treatment-seeking behaviors in the identified patient.
Q: 14 And they shouldn’t give up on him…?
A: Exactly. The truth is that they cannot give up on him for long, but there is a very delicate balance between helping him and getting in the way of his recovery. They use common-sense tactics; they beg, plead or confront whenever moved by desperation to do so… at the spur of the moment. These don’t work. They try being nice; they try being nasty. They keep doing the same things again and again and each time expect a different result. So they become codependent; sick and tired of being sick and tired. Codependence is shadow-alcoholism. It’s an illness in itself.
Q: 15 What are the dos and dont’s for the families? How do they go about finding the right balance?
A: Well, seeking professional help is the key.
When he is paranoid, aggressive and violent with a lot of risky behaviors, a trained team moves into the “lion’s den”, after he is passed out and takes him to the hospital. This is Crises Intervention.
The sooner, the better. To begin with, they can do the following:
- Never talk to an alcoholic about reducing or stopping alcohol when he is drinking and intoxicated.
- Prepare well I not Milk to him alone, get the support of people meaningful to him.
- Pick a suitable time and place.
- Make sure you are “yell rested and have leisurely time at your disposal when you do this.
- Never be judgmental and attacking. Talk with care and concern.
- Don’t vent anger.
- Talk about our observations regarding his behavior when he is under the influence, and express your feelings about his drinking behavior. This is what happened…. give a short pause I felt embarrassed, hurt, helpless…
- Direct him towards getting help.
- You don’t want to extract a promise. It’s often very helpful to suggest getting help from the various options available.
Q: 16 The bottom line is that families should talk to a professional before they take any actions, correct?
A: I agree with that 100%. That’s right.
Q: 17 What is an Intervention when it comes to alcoholism?
A: Intervention is mane things; however, there is no such thing as one-size-fits-all. It can be carried out as a beautiful intellectual exercise when the sanity of the patient is intact. The family goes into elaborate training and persuades the patient into treatment. This will be termed as Therapeutic Structured Family Intervention. But, if the patient is paranoid, aggressive, there is verbal abuse and domestic violence, then intervention may comprise of a trained team moving into the “lion’s den” when he is drunk and has passed out he can be taken to the hospital. This is Crises Intervention. And, there is a whole spectrum of interventions in between. I mean you need to choose the path for your loved one. You need to develop a plan most suited to your loved one. However, there are three keys to success when it comes to any Intervention plan. However, you need to show the person that his drinking has turned into alcoholism because he can’t see it for himself. You need to be brutally honest while expressing love and maintaining a high level of respect. And compassion, because without a sincere desire to help, Intervention may not work. You don’t have to play doctor. You just have to look into problems generated by his alcoholism and use them creatively to construct a road map to his recovery.
Q: 18 So they should take some action?
A: Yes! ‘Life Rewards Action.’ Professionals can empower you and you can, in turn, empower the patient.