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
have their own suffering to bear.
of this suffering is bound to relationships, as well, but alcoholism
other aspects of life-functioning.
all of us have some
experience with alcoholism, whether through personal involvement or
grief and strife of others who are close to us.
Alcoholism and alcoholic behaviors are
difficult problems to comprehend,
from either perspective.
article is written to help
people understand some of the complexities of alcoholism and what is
in recovering from its devastating effects.
research related to
alcoholism has contributed much to theories about its causes, the
of various treatment modalities, obstacles to recovery, and the impact
alcoholism on families and society.
is a wide range of alternatives for managing alcoholism. There are
programs and “treatment” programs, both residential and outpatient.
programs prescribe specific steps one must take, while others use
individualized approaches to controlling alcohol abuse.
article neither advocates for
nor disputes any methods or programs for maintaining abstinence from
path one chooses to control
his or her drinking, it is important to understand that without
there is little chance that any serious work can be done to truly heal
many aspects to
wellness. Some of
these are more obvious
than others. Of
course, there is
physically health. Alcohol
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
dietary, or fitness consultations might be considerations for the
social, and relationship aspects of wellness to consider. These are
that don’t always get enough attention during addiction recovery. Often, maintaining sobriety
is in the
forefront of the alcoholic’s mind.
is important to understand that managing the mental, emotional, and
deficits caused by alcohol abuse is nearly as important as managing
any of these, and the
chances of relapse increase.
article is about some of the
deficits in personal functioning caused by alcoholism and their
for wellness. It
provides an overview of
the ways in which alcoholism presents challenges to living well with
and others. It also
talks about how alcohol
abuse affects the brain and personal development and vice versa.
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
essential language for talking and thinking about alcoholism.
this article presents
concepts that stimulate thinking about one’s personal journey toward
Dry Drunk Syndrome
I have heard the term
“dry drunk” or “dry alcoholic.” These,
somewhat derogatory, descriptions refer to a person who has abstained
alcohol consumption for an unspecified period of time, yet retains or
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
has changed, but little else about the person has changed.
alcoholics have learned how to
abstain from alcohol usage, but they retain or slip into the same
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
continue. Anxiety, depression, low self-esteem, and other destructive
are part of the unhealthy mix. Relationships continue to be
troubled, or irreparably damaged as a result of the aforementioned
emotions and inappropriate behavior patterns of the recovering
perspective of a dry
alcoholic, there is often limited insight into what are normal, healthy
emotions and behaviors. Having
mostly with unhealthy thought and behavior patterns, the alcoholic
recognize when he or she is slipping into dysfunctional ways of dealing
stress, feelings, or other people.
behaviors may feel normal or familiar, while healthy behaviors feel,
wrong or uncomfortable.
also easy for the alcoholic
to get caught-up in his or her personal program for controlling alcohol
neglecting work toward developing healthy patterns of living in
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
Later, however, it is equally important to consider the role that
and interpersonal growth play in recovery.
to understand why
alcoholics behave the way they do, one must think about how their
behavior and relationship patterns have evolved. The next section of
article is about some of the contributors to alcoholism and alcoholic
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
behavior patterns. Emotional
development is dependent upon the experience of moving through
adolescence toward becoming an adult.
For the budding alcoholic, development in
these areas comes to a near
adults, many alcoholics, including
dry alcoholics, are viewed as child-like or immature, exemplifying
personal growth. This
is often seen in the
alcoholic’s need for recognition, approval, and attention. Those who interact with
similar experiences to when they interact with pre-teens, who require
acknowledgement and accolades for the smallest accomplishments or
Some experts refer to this considerable need for attention and praise
narcissistic or ego-centric personality.
recovering alcoholic is a developmentally
delayed individual who must find another pathway to learning
behavior patterns for living in society and maintaining meaningful and
learning cannot be
done alone, nor can it be done easily.
requires teaching, guidance and support from others.
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
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.
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
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
a pattern of hurt.
alcoholic’s options for
learning healthy functioning becomes more limited as the time spent
addiction increases. Often the recovering alcoholic is left to his or
devices when it comes to acquiring knowledge and experience that should
place while growing-up.
abuse prevents people
from thinking-out and understanding how to function in socially and
appropriate ways. In
fact, it prevents
people from thinking introspectively or logically about themselves and
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
difficult for them to find their way to wellness without help from
Alcohol Abuse and the Brain
people, including physicians
and other treating professionals, view alcoholism as a physiological
problem. Often, the
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.
particular, brain functioning plays a significant part in alcoholism.
is a complex syndrome
of addictive patterns, inappropriate behaviors, emotional problems, and
relationship issues. We know that personal problems in these areas can
related to brain functioning. The
question becomes whether impaired functioning in specific parts of the
increases the risk of developing alcoholism or if extensive alcohol
results in either temporary or permanent brain dysfunction. Regardless of which comes
first, the significant
factor is the relationship between alcohol, the individual’s
research substantiating that
alcoholism significantly impacts the brain.
This means there are definite changes in the
brain following long periods
of alcohol abuse. In
are changes in the functioning of the frontal lobe (prefrontal cortex)
linked to our executive functions.
planning and regulating behavior, inhibiting the occurrence of
unwanted behaviors, supporting goal directed behaviors and good
judgment, and facilitating
problem-solving ability. Disruptions
prefrontal cortex functioning (executive functioning), therefore,
reduced impulse control and interpersonal interaction problems. Alcoholics frequently have
and following through with goals, problem solving, and making decisions
are in the best interest of themselves or others.
alcohol abuse also
affects the limbic system of the brain, which is important in emotional
may be why alcoholics
have a tendency toward “emotional reasoning” or making decisions based
they “feel” at the time. High
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
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
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
emotions trigger extreme impulsive behaviors.
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
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
talked about how extensive
alcohol abuse has been shown to cause dysfunctions in various parts of
brain, thus contributing to some emotional, behavioral, and social
alcoholics. There is new research indicating that some people with
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
It may be
that both situations
people may have a
vulnerability to developing alcoholism because of a pre-existing brain
others, alcohol abuse may
cause or exacerbate existing brain related functional problems, such as
control, low frustration tolerance, and emotional disturbances.
mean there is an
alcoholic gene? Even
can occur in multiple family members and span generations, no alcoholic
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
functional characteristics are passed on through generations. A family history of
alcoholism should be
taken very seriously, considering recent findings that pre-existing
lobe dysfunction may predispose individuals to reduced impulse control
Next Steps toward Recovery
does this leave the
recovering alcoholic? There
is no simple
immerse themselves in support groups or utilize peer supports to
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
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.
addition to achieving and
maintaining abstinence from alcohol, psychotherapy is important for
emotional, and interpersonal growth.
recovering from alcoholism must learn from an objective therapist, who
put in a position of teaching new behaviors and ways of thinking or
old, dysfunctional behaviors and thought patterns.
The alcoholic must practice healthy social
and emotional skills in the real world, using therapy sessions as a
where he or she can process thoughts and feelings related to personal
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
other alcoholics. This
isn’t always the
best scenario for therapy.
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
or not a therapist will meet your personal needs.
therapist should be a
clinician who is skilled in helping people intervene in their
patterns and helping them develop new coping skills, while supporting
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
behavior is not easy to
isn’t simply the
consumption of alcohol, but rather a plethora of emotional disturbances
behavioral problems affecting the alcoholic’s interpersonal
are contributing factors related to
brain functioning, as well deficits in learning that would normally
during certain developmental periods of youth.
There are almost always underdeveloped or
ineffective social and
relationship skills to be considered in the recovery process.
addition to missing
significant positive learning opportunities, most alcoholics have
unhealthy interpersonal behaviors.
of these are aggressive (even violent) behaviors, passive-aggressive
behaviors, or other means of controlling others to their benefit.
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
experience-based advice for managing alcoholism.
These are tried and true methods that work
for many alcoholics. Participation
support groups, such as Alcoholics Anonymous (AA) is essential to
maintaining abstinence from alcohol usage. Support groups, however,
of being able to help the alcoholic negotiate the broad spectrum of
with which he or she is living.
a multitude of
developmental, emotional, and physiological issues that require
the path to recovery from alcoholism.
this article I propose going beyond abstinence by engaging in what may
therapy with a trained and skilled professional.
Within the therapeutic environment, the
can work toward developing new, more effective patterns of behavior and
ways of relating to others. Therapy
sessions are excellent workshops for a person to learn and practice new
develop healthy thinking patterns, and continually assess where he or
she is in
relation to established goals.
alcoholic does not usually know
there are things he doesn’t know about himself and his relationship to
helps us learn that which we don’t
know about ourselves and change accordingly.