Defining Addiction and Alcoholism, When Is It A Problem?

Wednesday, May 20, 2009 12:00
Posted in category Ask Rickhead
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Post written by Rick Doyle

Defining Addiction and Alcoholism, When Is It A Problem?

Dear Rickhead:  I am getting a really worried about my brother I think he has a drinking problem.  He won’t admit he has a problem and no matter what trouble he gets in he thinks he has it under control.  How do I know if he is an alcoholic?

                                              – Michelle

Dear Michelle: I want to give you a basic definition and description but inevitably he either needs to admit he has a problem and seek help or intervention by family, friends or courts will have to occur with an assessment by a trained therapist.

There is recent debate about changing the legal drinking age from 21 to 18 years of age and to add insult to injury the debate on the legalization of marijuana. The following are basic definitions of addiction and alcoholism that doesn’t require complex analysis that should help anyone in defining whether there is a problem or not.

If usage of any substance or behavior causes you problems and you keep using or engaging in that behavior DESPITE the problems it causes, IT’S A PROBLEM.

Defining a problem isn’t too tough either.  Some examples of those problems would be getting an OVI (Operating a Vehicle under the Influence), DUI (Driving Under the Influence), waking up outside naked when you didn’t intend to be naked, divorce number 5 (and the previous 4 all blame your drinking), vomiting publicly (a lot), falling asleep after using (like while driving a vehicle or during an event that you should be awake for, like sporting events or weddings, blackouts (walking, talking, functioning like the lights are on and yet no one is home with zero memory of what, how, who, etc.), when your last dime and all debts are directly traceable to your usage and it adds up to more than your basic necessities like home, food, transportation, when you party to live and you live to party, when employment becomes secondary because you either can’t work and party or you get fired for partying at work, having sex with people you don’t want to have sex with (coyote dates), inability to have sex because of your usage (you’re not up for it or awake), when your family or friends tell you it’s a problem and they don’t want to be your friends or have you over because of your usage, when the judge says you have a problem while giving you shiny chrome bracelets (for the 3rd time or more) and a final example is when you are sick and tired of being sick and tired and your usage has beat you up so much you have to look up to see down.

This is just a sample but defining what is an addiction or alcoholism within this simple definition is the premise, “If you keep drinking or using and it causes you problems yet despite those problems you keep drinking or using, it is a problem or addiction.”  The definition of insanity is basically the same, “You continue to do something the same way over and over yet expect different results.”  If you grab the edge of the door the same way 20 times in a row and mash your fingers every time you close it, yet expect to not mash your fingers is insane.  There is always the guy who says, “I don’t have a problem, I can quit whenever I want to, I just don’t want to quit.  I don’t have a problem”.  Okay folks, I have never met anyone on the way, in need of or in treatment that ever asked themselves the question, “Do I have a problem with this?”, that didn’t already have a problem!  Only a person who has had consequences from their usage would ever have that question enter their mind.  People who haven’t had any problems from their usage would ever entertain that idea or question.  Here’s another example, if eating sardines hasn’t ever caused any problems, then asking yourself if it’s a problem would probably never happen.  Only an addict or alcoholic would ever have that question pop into their head since ordinary usage doesn’t cause enough problems to consider that train of thought.

So without doing an extensive 10 page assessment you can apply the basics above to get a good sense of when addiction is present or alcoholism should be a concern.  This is also a decent generic gauge for food addiction, sex addiction, gambling addiction virtually anything that drives a person to keep doing something that is not good for them and causes problems yet they keep doing it. THIS IS ADDICTION.

The good news is there is help everywhere, but it will only start with admission.  Once a person admits to their addiction they have just about ruined their usage.  Getting help is a little harder.  I have seen literally thousands of alcoholics and addicts go in front of a judge or jury, lose everything they have including their family, friends, freedom, cars, job, house, even their children and still won’t admit that they have a problem.  There are four different ‘bottoms’; spiritual, psychological, emotional and physical.  Some people will die before they will ever hit bottom and surrender.  For others they only need to hit one or two bottoms to get through the door to help.  Inevitably when the pain outweighs the pain of change you’ll change. At that point, walking through the door of a 12 step program, going to a therapist or even seeking out a program becomes the lesser of evils.  Others have great enablers and codependents to keep the addiction going for years longer than if they had let, or even aided, the person hit bottom faster by not enabling them or covering for them.  Let them experience the consequences of their usage completely and fully and they will likely hit bottom faster.  Do you know why a guy gets his 8th OVI or DUI?  Because somebody covered for him and he didn’t suffer the consequences of his actions the first 7 times.  Why should he quit or even look at the problem if he can get you to bail him out, time and time again?  There are a thousand clichés in recovery but few things strike home to the addict or alcoholic like, “If you have it so together how did you end up in my chair?” (i.e., court, jail, treatment, therapist).  “Sobriety is an ongoing process of learning something else I was wrong about.” and finally “But for the grace of god there go I.” (referencing the man or woman who is in a worse place than where they got off the crazy train). 

The key to a problem with addiction or alcoholism recovery then is not surrender or admission once they have raised their hand and said, “Hi, my name is _______ and I’m an addict or alcoholic” but rather what will keep them in recovery and what will keep them from relapse.  Please remember that 12 step programs are NOT designed to make anyone stop anything. They are not designed to fix anyone and no therapy or honest therapist will either! Having an addiction or alcoholism is like being a horse thief.  The problem is NOT stealing horses!  The root problem is the person is a thief.  Stealing horses is just a symptom.  If there’s no horses to steal you still have a thief at the core.  They would just steal other things like purses, watches, money, whatever.  If you have an addict or alcoholic and you take away the drugs or alcohol, you still have an alcoholic and addict while drinking or usage is just a symptom.  What recovery is designed to do is teach you how to live clean and sober.

Here’s how to address the rest of the disease.  The disease is spiritual, emotional, physical and psychological.  Drinking and using is just a symptom. Take away the drugs and the alcohol you still have an alcoholic or an addict.  They still think, feel and act like an addict or alcoholic until you address the rest of the disease.  Recovery is supposed to introduce a person to others success and implementation of recovery tools such as 12 steps, sponsorship, discussion and integration back into relationships, families, jobs and other changes that the recovering person will need to learn or re-learn.  You cannot re-habilitate someone who has never been habilitated in the first place.  However it all hinges on the person who wants to be there, be clean, be sober and make changes.  They have to want it for themselves.  Recovery for others does not work.  If it did the words, “I promise and this time it will be different” wouldn’t be followed by continued usage.  Recovery is the exact opposite of usage.  Here’s another pair of old clichés; “First the man takes a drink. Then the drink takes a drink. Then the drink takes the man.”  And for those who really have a problem from the word go, “One drink is too many and a thousand isn’t enough”.  I used to tell many people when I was in practice, “If you’re sitting in my chair, you have a problem because nobody ever came to an addiction therapist because they were just fine.”

Please remember that recovery is a process and defining addiction or alcoholism in a brief article is somewhat oversimplifying it.  A good assessment will determine not only what the problem is but also to what degree and/or what course of treatment or intervention might best benefit that person.  There is also what we call differential diagnosis.  Fancy words for basically ‘you are an accident waiting to happen’.  A few examples are a Periodic abuser who uses (you guessed it) periodically and rarely gets into trouble but it’s starting to progress in severity of consequences.  A Situational abuser (you guessed it) uses to cope with feelings, events or situations.  Again, problems and/or consequences are rare but drugs or alcohol are being used too often for the wrong reasons and quantities are increasing. Then there is the Chronic abuser who uses large quantities daily but without problems…yet!  All of these people are on the borderline of 1st, 2nd or 3rd stage addiction but are not quite there yet. A lot of people don’t realize that it’s not how much or how often you use that defines addiction but rather it’s what happens to you when you use. It’s a problem when it’s a problem and you keep doing it anyway.

On a final note I have to mention my opinion on legalizing marijuana, pot, weed, herb, smoke, grass (ok, I’m showing my age) whatever you want to call it.  I don’t have that much of a problem with legalizing it except that the effects to the smoker’s health are drastically worse than one typically hears argued. I don’t mean the immediate effects like smelling like burnt leaves or having the IQ of a peanut because frankly, some folks are like that without smoking.  I’m not even talking about the short term memory loss because even drunks sometimes can’t find their car and I hate it when I lose my keys, especially when they’re in my pocket. I wouldn’t even worry about the fact that marijuana stores itself in the body fat and can test positive for up to 3 years after last ingestion.  This is because much of your brain’s tissue is composed of fat and contains the most concentrated area of fat in your body.  What really worries me is that the average sample of pot has 7 to 20 times the amount of tar of an unfiltered cigarette so each joint smoked is like smoking 7 to 20 unfiltered cigarettes. Then there is the THC issue.  Not the fact that it has THC which is the only reason why people smoke it.  It’s the 291 known carcinogens in the THC in an average sample.  Cigarettes have 1-20 chemicals that are known health risks so imagine how many you could smoke before even coming close to the risks of smoking one marijuana cigarette.  People are always going to drink, get stoned and some will have a problem others will not.  What bothers me, is when it hurts others OR costs others money.  When I have to pay for your self-induced stupidity or cancer or crime, then I have a problem with it.  I have no problem with legalizing it or even lowering the drinking age.  I think as a society if a few idiots want to stick their finger in the light socket, have at it. However, if we go that route I think a few easy compromises are only fair.  Any alcohol or drug related offense will have ten times the current punishment with mandatory 1 year treatment and very strict guidelines.  Make every offender pay ALL costs in full with a strict no pay, no play policy.  Make ALL health care costs for any tested or convicted user of marijuana uninsurable and completely responsible for ALL their health issues and payments for any medical treatment of any kind.  Many foreign countries allow all kinds of usage for everything including hash, marijuana, cocaine and even heroine.  However the penalties are so severe that they are effective in all but eliminating usage. Imagine getting a DUI or OVI and instead of throwing the offender in jail the entire immediate family goes to jail.  Imagine what the DUI rate would be if execution were the punishment a first offense as it is in some countries.  A few folks might even look at themselves and say, “Maybe it’s time to get help before I hurt myself or others anymore.”  This sounds extreme but I don’t imagine it sounds extreme to a parent who has lost a child to a drunk driver.  I am all for treatment, all for users hitting their bottom and even for some people bottoms up is just fine but not if it’s a problem.  But I really can’t understand why anyone would want to provide easier access to what is likely going to exponentially increase the current problems and numbers of people who have a problem.  Like many families and friends of those who might have a problem, just getting it out in the open, talking about it, asking the person if they want help or even seeking the help of a trained addiction therapist for a possible intervention might be a good place to start. What do you think?

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