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Abstinence Is Not Enough

An Introduction to Alcoholism

 by Sherwood Stauffer


“Unpleasant” is not adequate in describing the the experience of living with an alcoholic.  Neither, is it a good descriptor of any kind of significant relationship with an alcoholic.  Of course, alcoholics have their own suffering to bear.  Much of this suffering is bound to relationships, as well, but alcoholism also impacts other aspects of life-functioning.

Almost all of us have some experience with alcoholism, whether through personal involvement or through the grief and strife of others who are close to us.  Alcoholism and alcoholic behaviors are difficult problems to comprehend, from either perspective.

This article is written to help people understand some of the complexities of alcoholism and what is involved in recovering from its devastating effects.

Introduction

Extensive research related to alcoholism has contributed much to theories about its causes, the effectiveness of various treatment modalities, obstacles to recovery, and the impact of alcoholism on families and society.  There is a wide range of alternatives for managing alcoholism. There are “support” programs and “treatment” programs, both residential and outpatient. Some programs prescribe specific steps one must take, while others use multimodal or individualized approaches to controlling alcohol abuse. 

This article neither advocates for nor disputes any methods or programs for maintaining abstinence from alcohol usage.  Whichever path one chooses to control his or her drinking, it is important to understand that without sustained sobriety there is little chance that any serious work can be done to truly heal oneself.

There are many aspects to wellness.  Some of these are more obvious than others.  Of course, there is physically health.  Alcohol abuse takes its toll on the body.  There is a lot that must be done to regain physical wellness.  Each person should think about what he or she needs to do to become healthy. Diet, rest, and exercise are all important elements of wellness.    Medical, dietary, or fitness consultations might be considerations for the recovering alcoholic.

There are mental, emotional, social, and relationship aspects of wellness to consider. These are essential components that don’t always get enough attention during addiction recovery.  Often, maintaining sobriety is in the forefront of the alcoholic’s mind.   It is important to understand that managing the mental, emotional, and social deficits caused by alcohol abuse is nearly as important as managing alcohol consumption.  Neglect any of these, and the chances of relapse increase.

This article is about some of the deficits in personal functioning caused by alcoholism and their implications for wellness.  It provides an overview of the ways in which alcoholism presents challenges to living well with one’s self and others.  It also talks about how alcohol abuse affects the brain and personal development and vice versa.   

My language in this article is not likely to match that used by some alcohol treatment and support groups.  I have concerned myself with the content of my writing, rather than incorporating what some might consider essential language for talking and thinking about alcoholism.  

I hope this article presents concepts that stimulate thinking about one’s personal journey toward recovery from alcoholism.

Dry Drunk Syndrome

Frequently, I have heard the term “dry drunk” or “dry alcoholic.”  These, somewhat derogatory, descriptions refer to a person who has abstained from alcohol consumption for an unspecified period of time, yet retains or exhibits similar behavior patterns to when he or she was drinking.  These behaviors emanate from the same maladaptive thoughts and feelings experienced prior to giving-up drinking.  Put simply, the person’s alcohol consumption has changed, but little else about the person has changed.

Many alcoholics have learned how to abstain from alcohol usage, but they retain or slip into the same behavior patterns that were active during their addiction. Impulsiveness and low frustration tolerance remain.  Intolerance of others and judgmentalism is still prevalent. Grandiosity and self-centeredness, defensiveness and rationalization, and indecisiveness continue. Anxiety, depression, low self-esteem, and other destructive feelings are part of the unhealthy mix. Relationships continue to be superficial, troubled, or irreparably damaged as a result of the aforementioned negative emotions and inappropriate behavior patterns of the recovering alcoholic.

From the perspective of a dry alcoholic, there is often limited insight into what are normal, healthy emotions and behaviors.  Having lived mostly with unhealthy thought and behavior patterns, the alcoholic cannot recognize when he or she is slipping into dysfunctional ways of dealing with stress, feelings, or other people.  Unhealthy behaviors may feel normal or familiar, while healthy behaviors feel, somehow, wrong or uncomfortable.

It is also easy for the alcoholic to get caught-up in his or her personal program for controlling alcohol consumption, neglecting work toward developing healthy patterns of living in relation to others. In other words, he or she becomes a program enthusiast.  I don’t say this with negative tone. In the early days of sobriety, being an enthusiast is fine – important, in fact. Later, however, it is equally important to consider the role that ongoing personal and interpersonal growth play in recovery.

In order to understand why alcoholics behave the way they do, one must think about how their dysfunctional behavior and relationship patterns have evolved. The next section of this article is about some of the contributors to alcoholism and alcoholic behavior patterns.

Developmental Issues 

Alcohol abuse usually begins at an early age, the teen-years or early twenties, and continues long into adulthood.  There is an enormous amount of personal and social learning that takes place as we grow-up.  Some of the most unfortunate side-effects of alcohol abuse are stunted emotional growth and underdeveloped relationship and behavior patterns.  Emotional and social development is dependent upon the experience of moving through childhood and adolescence toward becoming an adult.  For the budding alcoholic, development in these areas comes to a near standstill. 

As adults, many alcoholics, including dry alcoholics, are viewed as child-like or immature, exemplifying stunted personal growth.  This is often seen in the alcoholic’s need for recognition, approval, and attention.  Those who interact with alcoholics report similar experiences to when they interact with pre-teens, who require acknowledgement and accolades for the smallest accomplishments or expectations. Some experts refer to this considerable need for attention and praise as a narcissistic or ego-centric personality.

The recovering alcoholic is a developmentally delayed individual who must find another pathway to learning appropriate behavior patterns for living in society and maintaining meaningful and healthy relationships.  This learning cannot be done alone, nor can it be done easily.  It requires teaching, guidance and support from others.

Learning Challenges

Some things are best learned during particular stages of human growth and development.  For example, it is much easier for a person to learn a second or 3rd language during childhood than it is for an adult to learn a new language.  The same might be said for mathematics and music.  That’s not to say that these cannot be learned as an adult.  Learning may just be slower, more challenging, and require a different approach.

In the case of adult alcoholics trying to learn social and relationship skills or how to control impulses and intolerance, the best opportunities may be in the past; childhood and adolescence are the prime learning years for these skills.  Parents and siblings may no longer be available to help with the adult alcoholic’s mental and emotional growth issues.  Spouses and significant others may have already spent their energy in dealing with a myriad of alcoholic problems and are not interested in repeating a pattern of hurt. 

The alcoholic’s options for learning healthy functioning becomes more limited as the time spent wallowing in addiction increases. Often the recovering alcoholic is left to his or her own devices when it comes to acquiring knowledge and experience that should have taken place while growing-up.

Alcohol abuse prevents people from thinking-out and understanding how to function in socially and emotionally appropriate ways.  In fact, it prevents people from thinking introspectively or logically about themselves and their behaviors in relation to others.  The point is that alcoholics miss-out on some essential personal growth, contributing to problems with insight and reasoning. This makes it extremely difficult for them to find their way to wellness without help from peers and professionals.

 Alcohol Abuse and the Brain

Many people, including physicians and other treating professionals, view alcoholism as a physiological problem.  Often, the alcoholic is described as a person with an allergy to alcohol.  Normal drinkers do not have the same allergy and respond differently to alcohol consumption.  Although the allergy concept may seem reasonable, in view of the alcoholic’s reaction and response to alcohol, there are some specific physiological factors to consider.  In particular, brain functioning plays a significant part in alcoholism.

Alcoholism is a complex syndrome of addictive patterns, inappropriate behaviors, emotional problems, and relationship issues. We know that personal problems in these areas can be related to brain functioning.  The question becomes whether impaired functioning in specific parts of the brain increases the risk of developing alcoholism or if extensive alcohol usage results in either temporary or permanent brain dysfunction.  Regardless of which comes first, the significant factor is the relationship between alcohol, the individual’s functioning, and the brain.

There is research substantiating that alcoholism significantly impacts the brain.  This means there are definite changes in the brain following long periods of alcohol abuse.  In particular, there are changes in the functioning of the frontal lobe (prefrontal cortex) which is linked to our executive functions.

Executive functions include planning and regulating behavior, inhibiting the occurrence of unnecessary or unwanted behaviors, supporting goal directed behaviors and good judgment, and facilitating problem-solving ability.  Disruptions in prefrontal cortex functioning (executive functioning), therefore, result in reduced impulse control and interpersonal interaction problems.  Alcoholics frequently have problems setting and following through with goals, problem solving, and making decisions that are in the best interest of themselves or others.

Sustained alcohol abuse also affects the limbic system of the brain, which is important in emotional processing.  This may be why alcoholics have a tendency toward “emotional reasoning” or making decisions based on how they “feel” at the time.  High intensity of emotions is common in alcoholics.  When volatile emotions are coupled with poor impulse control, there can be disastrous results. 

Here is a rather benign scenario describing how a person with limbic and prefrontal cortex dysfunction may respond inappropriately to a simple stimulus.  Let’s suppose the person eats a piece of apple pie.  The delicious quality produces exceptionally strong feelings about consuming the pie: “I love apple pie!  Apple Pie is the best food on earth!”  Coupled with limited impulse control, due to some prefrontal cortex dysfunction, the individual might consume another piece of pie…and another…and more, until uncomfortably full.  Most likely, he or she will do this without consideration of others, who may also want a piece of the pie.  It is also likely that this scenario will occur in other instances where the person’s exaggerated positive or negative emotions trigger extreme impulsive behaviors.

Many other brain functions have been shown to be affected by alcoholism.  These are beyond the scope of this article.  As an easy starting point toward more information, I refer the reader to Alcoholism and the Brain: An Overview by Marlene Oscar-Berman, Ph.D., and Ksenija Marinkovic, Ph.D.  In addition, a wealth of credible information is free to explore on the internet. 

Sometimes the Chicken - Sometimes the Egg

I have talked about how extensive alcohol abuse has been shown to cause dysfunctions in various parts of the brain, thus contributing to some emotional, behavioral, and social problems in alcoholics. There is new research indicating that some people with alcoholism have pre-existing frontal lobe dysfunction.  The theory is that the frontal lobe dysfunction causes impulse control problems, leading to excessive drinking and eventual alcoholism.  Think of the apple pie scenario, above.

It may be that both situations occur.  Certain people may have a vulnerability to developing alcoholism because of a pre-existing brain condition.  For others, alcohol abuse may cause or exacerbate existing brain related functional problems, such as poor impulse control, low frustration tolerance, and emotional disturbances.

Does this mean there is an alcoholic gene?  Even though alcoholism can occur in multiple family members and span generations, no alcoholic gene has been identified.  It is important to note that, even with no identified alcoholic gene, physiological characteristics are hereditary. This means that our brain construction and its functional characteristics are passed on through generations.  A family history of alcoholism should be taken very seriously, considering recent findings that pre-existing frontal lobe dysfunction may predispose individuals to reduced impulse control and subsequent alcoholism.

Next Steps toward Recovery

Where does this leave the recovering alcoholic?  There is no simple answer.  Often, recovering alcoholics immerse themselves in support groups or utilize peer supports to maintain sobriety.  There are tremendous gains to be made though such resources, and they are absolutely essential.  There are, however, many facets to recovery, requiring multiple modes of treatment and support.  Recovering from developmental deficits affecting interpersonal skills, problem solving ability, and impulse control takes a long time – years of work…..perhaps the rest a person’s life.  It can’t be done without help, and a support group is not likely to be enough.

In addition to achieving and maintaining abstinence from alcohol, psychotherapy is important for personal, emotional, and interpersonal growth.  People recovering from alcoholism must learn from an objective therapist, who is often put in a position of teaching new behaviors and ways of thinking or confronting old, dysfunctional behaviors and thought patterns.  The alcoholic must practice healthy social and emotional skills in the real world, using therapy sessions as a workshop where he or she can process thoughts and feelings related to personal developmental experiences. 

Therapy should take place with the guidance of a trained therapist who is a healthy personality.  Not all therapists have resolved their own personal issues, and some are recovering alcoholics, themselves.  Personal experience as an alcoholic is of tremendous benefit in support groups where alcoholics are helped by talking to other alcoholics.  This isn’t always the best scenario for therapy. 

Some may argue my last point; however, alcoholics don’t know what they don’t know about normalcy.  The alcoholic should choose a therapist who knows what it is like to live healthily.  If the therapist is a recovering alcoholic, he or she should be near the end of the journey toward wellness, not at the beginning.  Referrals from others who are already in treatment or interviewing a candidate therapist can help in determining whether or not a therapist will meet your personal needs.

The therapist should be a clinician who is skilled in helping people intervene in their dysfunctional patterns and helping them develop new coping skills, while supporting their journey toward social and emotional health and wellbeing.  I emphasize, again, that peer support is essential; however, peers are not therapists, and peer support is not the same as therapy.

Conclusion

Alcoholic behavior is not easy to understand.  It isn’t simply the consumption of alcohol, but rather a plethora of emotional disturbances and behavioral problems affecting the alcoholic’s interpersonal relationships.  There are contributing factors related to brain functioning, as well deficits in learning that would normally occur during certain developmental periods of youth.  There are almost always underdeveloped or ineffective social and relationship skills to be considered in the recovery process.

In addition to missing significant positive learning opportunities, most alcoholics have learned unhealthy interpersonal behaviors.  Some of these are aggressive (even violent) behaviors, passive-aggressive and manipulative behaviors, or other means of controlling others to their benefit.

Support groups are excellent in helping alcoholics attain and maintain sobriety.  They offer support from those people who best understand the challenges to sobriety faced by alcoholics, and they provide experience-based advice for managing alcoholism.  These are tried and true methods that work for many alcoholics.  Participation in support groups, such as Alcoholics Anonymous (AA) is essential to achieving and maintaining abstinence from alcohol usage. Support groups, however, fall short of being able to help the alcoholic negotiate the broad spectrum of problems with which he or she is living. 

There are a multitude of developmental, emotional, and physiological issues that require attention along the path to recovery from alcoholism.  In this article I propose going beyond abstinence by engaging in what may be long-term therapy with a trained and skilled professional.  Within the therapeutic environment, the individual can work toward developing new, more effective patterns of behavior and healthy ways of relating to others.  Therapy sessions are excellent workshops for a person to learn and practice new skills, develop healthy thinking patterns, and continually assess where he or she is in relation to established goals.

The alcoholic does not usually know there are things he doesn’t know about himself and his relationship to others.  Therapy helps us learn that which we don’t know about ourselves and change accordingly.