SUNDAY SNIPPET, April 28

For this week's excerpt, I'm sharing part of an early chapter of Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety. Alcoholics drink that first drink for many of the same reasons non-alcoholics do: among the reasons is to relieve stress. Non-alcoholics can stop, alcoholics cannot, after the first drink. Chapter Two covers stress and cortisol and their relation to relapse, plus the new research revealing how the stress hormone alters the perception of and reaction to stress in those with the disease of alcoholism.


"The stressors Alcoholics pile up over periods of sobriety aren’t the small day-by-day stressors like coffee spills on new carpet. They’re the four major category stressors covered in chapters four through seven.  The longer you spend in prolonged stress with the cortisol rioting through you, the more intense your feelings of helplessness and, sometimes, emotional numbness. You at times feel like you’re just going through the motions. Things “normal” people drink to forget. 

 

Adrenals, like the rest of the body, are not designed for prolonged stress according to Dr. Aphrodite Matsakis (I Can’t Get Over It, New Harbinger Publications, Oakland, CA 1992). “The adrenals can be permanently damaged leading to overfunctioning during subsequent stress. If you were subjected to repeated or intense trauma or stress, certain biochemicals may have been depleted.”

 

In a famous series of experiments conducted by Martin Seligman in the 1970s, animals were subjected to electrical shocks they could not flee no matter what they did or did not do (Helplessness: On Depression, Development and Death, W.H. Freeman, San Francisco, CA 1975). They fought at first. Later the animals became listless when shocked. This was phase one. In Seligman’s second phase, the animals were shocked again but could prevent the zap by pressing a button. They didn’t. They were too changed biochemically to take a simple action to end their suffering. Bessel van der Kolk (in Journal of Traumatic Stress, Vol. 1, 1988) followed up the Seligman work and concluded the shocked creatures had the same biochemical imbalances as humans enduring prolonged exposure to stressors. With people though, human nature dictates that we try to avoid or escape anything to do with the stressor. Someone might, for example, avoid driving a car after the stress of a car wreck. That is a single, short-duration stressor. An Alcoholic, like Seligman’s experiment subjects, has multiple stressors of long duration. And you can’t run from them all. Like the two experiments convincingly demonstrated, there’s a point at which we don’t even save ourselves. Alcohol becomes an efficient escape.

 

Initially as we begin abstinence, we’re told to save ourselves from triggers. People. Places. Things. And the things in slogan-happy and acronym-rich rehab we call HALT: being Hungry, Angry, Lonely or Tired. Research demonstrates that those triggers lead to lapse because you are not thinking your clearest thoughts. When your stomach growls the oldest parts of the brain focus your body’s resources on food. If you’re focused on food, you’re not focused on sobriety, the thinking goes. You’re juggling sobriety’s apples and hunger throws you a chainsaw. When you’re tired, your thinking is blunted by your need for sleep. When you’re angry or lonely, you may prioritize resolving those emotions rather than concentrating on sobriety. HALT is a good starting point. The objective is to stay out of harm’s way. Avoid. But the four major stressors knocking our cortisol out of whack and leading to lapse, you cannot avoid. We need to instead alter our reactions to them.”

– from Every Silver Lining Has a Cloud, pages 29-30, FIVE STARS on amazon.com 

 

The first drink is the ESC key for the big stressors in the book, even for infrequent drinkers.  Alcohol has managed to remain popular for millennia for that reason despite troubling social or physical outcomes from alcohol misuse. For non-alcoholics, stopping after that first drink, after hitting the ESC key, isn't an issue.  All bets are off for the Alcoholic after the first drink to break the stress.  That isn't to say violence or illness is inevitable for that episode, just that stopping at one is not an option.  Many drinkers have tried and failed that simple test.  After the first one, it's like trying to slam a revolving door.
www.alcohologist.com 

 

SATURDAY REWIND: Alcohol is, and isn't, a sleep aid

Alcohol is a fairly efficient, cheap and readily accessible central nervous system depressant.  Even though some people react with euphoria or aggression while under the influence, alcohol is a sedative.  It does help put a person to sleep. But as this January article from my archive points out, alcohol does nothing for the quality of sleep, potentially leading to health problems, even for non-alcoholics.

A review of several sleep studies, including one reported on examiner.com last December, bashes myths about alcohol aiding sleep. Results will be published in the April 2013 issue of Alcoholism: Clinical & Experimental Research but were released January 22 online.

"Certainly a mythology seems to have developed around the impact of alcohol on sleep," said Chris Idzikowski, director of the Edinburgh Sleep Centre. "It is a good time to review the research as the mythology seems to be flourishing more rapidly than the research itself."

The study confirms that people do fall asleep quicker under the influence and alcohol increases deep sleep in the first half of the night, but has a major impact on rapid eye movement (REM) sleep. REM sleep is important to physical health, metabolism and mental health.  Lead researcher Dr. Irshaad Ebrahim concluded. "The higher the dose, the greater the impact on increasing early sleep. This effect on the first half of sleep may be partly the reason some people with insomnia use alcohol as a sleep aid. However, the effect of consolidating sleep in the first half of the night is offset by having more disrupted sleep in the second half of the night."

Both Ebrahim and Idzikowski hope this review will improve understanding that short-term alcohol use only gives the impression of improving sleep, and it should not be used as a sleep aid. “Alcohol on the whole is not useful for improving a whole night's sleep. Sleep may be deeper to start with, but then becomes disrupted. Additionally, that deeper sleep will probably promote snoring and poorer breathing. So, one shouldn't expect better sleep with alcohol."

The majority of studies, across different alcohol dosages, ages and genders, confirm an increase in slow-wave sleep (SWS) in the first half of the night. "SWS or deep sleep generally promotes rest and restoration," said Ebrahim. "However, when alcohol increases SWS, this may also increase vulnerability to certain sleep problems such as sleepwalking or sleep apnea in those who are predisposed.

"With increasing doses, alcohol suppresses our breathing. It can turn non-snorers into snorers and snorers into people with sleep apnea - where the breathing's interrupted", said Ebrahim.

Alcohol's affect on REM sleep is dramatic. REM sleep typically accounts for 20 to 25 percent of the night. Total night REM sleep percentage is halved in the majority of studies at moderate and high doses in so-called “normal” people as well as those with alcohol use disorders, such as the disease of alcoholism.

Dreams generally occur in the REM stage of sleep. During REM sleep the brain is more active, and may be regarded as “defragmenting the drive,” according to Ebrahim. REM sleep is also important because it can influence memory and serve restorative functions. Conversely, lack of REM sleep can have a detrimental effect on concentration, motor skills, and memory.

"One consequence of a delayed onset of REM sleep would be less restful sleep," he adds. "There is also a linkage with depression."
– from examiner.com
      

 

The older archive article linked in the story's first paragraph takes you to a piece on lethargy and lack of alertness following a night when someone – alcoholic or non-alcoholic – has a nightcap or two or four before bed.

 

Sleep is a problem for those in recovery, a real struggle for the newly sober, and is often a trigger for a return to alcohol use. Getting a good night's sleep is essential, but isn't easy. Over-the-counter remedies are the last house on the block. (Most people in recovery avoid them like the plague.) Getting more, and better, sleep can be encouraged by:

Eliminating or greatly reducing caffeine intake, especially in the 4-6 hours before bedtime;

Getting aerobic exercise during the day, but not in the 4-6 hours before bedtime;

Eating foods that can help sleep such as tryptophan-rich nuts, seeds, honey, bananas. Warm milk sounds disgusting, but it works, too. And;

Abstaining from tobacco before bedtime (or completely). Nicotine is a stimulant, just like caffeine.

www.alcohologist.com

Press here please: Employers can check for alcohol use with a 10-second finger scan

Alcohol concentration tests take a measure of the alcohol in a person at that moment.  It doesn't tell if there is a lingering problem with an alcohol use disorder, but employers now have a passive detection tool that can tell in 10 seconds if an employee is impaired.  This is from my news article posted today.


Employers with zero tolerance of intoxication on the job are being marketed a new fingerprint scanner to take the place of breath tests. TruTouch Technologies, Inc. unveiled the TruTouch 2500 at a trade show last fall and has now begun pitching the product to employers in conjunction with Psychmedics Corporation.

The workplace-sobriety device is an optical sensor that can accurately read alcohol levels by placing a finger on the scanner and waiting as few as 10 seconds for results. The finger-touch system replaces more invasive and time-consuming tests, such as urine, blood or breath sampling. Employers set their own levels and those who take the finger test will get a red or green light.

In 2011, the U.S. Centers for Disease Control and Prevention (CDC) concluded that alcohol use disorders – alcohol abuse and the disease of alcoholism – accounted for $154 billion in lost productivity. Dr. Richard D. Gill, President & CEO of TruTouch, said the scanner helps employers reduce the alcohol-related downtime and keep the public safe. “The TruTouch measurement offers employers, individuals, and society in general the tools to intercept alcohol consumption before it does harm.”

Millions of workers face routine alcohol testing in high-risk jobs such as transportation and manufacturing, but more employers are incorporating zero-tolerance rules to improve healthcare costs to the company and/or to ensure employees with public contact are projecting a sober image.

The proposition of being scanned when an employee clocks in is stirring some controversy in the United Kingdom, where staff in local government and security, transport and leisure industries will be first to be targeted. Unions complained alcohol testing was heavy-handed while an employment lawyer said most workers had the right to refuse a test, according to U.K. News site Metro.

The publication reports Dave Prentis, general secretary Britain's biggest public sector trade union, condemns the move as ‘a sledgehammer to crack a nut’. "If workers have a problem with alcohol, their employers should not be relying on a gadget to entrap them but should be providing them with proper support."

Passive alcohol detection is not new. Skin tests date back to the 1930s and the method is backed by science and the courts. The TruTouch device is the world's first to measure alcohol concentration through the skin using optical technology. Presently in the U.S., many criminal justice offenders out on probation or bail are ordered to wear a continuous alcohol monitoring (CAM) ankle bracelet that monitors alcohol through the skin, but not optically. The optical scanner method is for instant readouts, and is the type of passive system the National Transportation Safety Board (NTSB) on Dec. 19 called for in all motor vehicles to eliminate intoxicated driving deaths. (See related examiner.com article)

Alcohol is processed by the body at a rate of approximately one drink (10 ounces of wine, 12 ounces of beer, one 1.5 ounce shot of spirits) per hour. At that rate, a person intoxicated at .20 BAC (two and a half times the legal limit for driving) at 2 a.m. Would show up for work at 9 a.m. with alcohol still in his or her system and would trip any measuring method, possibly without even feeling impaired.

As it passes through the body, one percent is removed through the skin without being metabolized. The percentage is consistent regardless of weight or gender, which is how all trans-dermal alcohol concentration (TAC) screens function.
-- from examiner.com




Employees concerned their off-premises, off-hours alcohol use might be subject to employer scrutiny through such devices might want to consider their consumption rather than the employer's tactics. The CAGE self-test is a reliable indicator:
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you about your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had an Eye-opener drink first thing in the morning to steady your nerves or get rid of a hangover?
 
A score of just two yes answers suggests a significant risk of problem drinking that should be discussed with a doctor.
www.alcohologist.com

New socializing mobile app is the latest of three aimed at sober living

Another new application for mobile users, the third alcohol-abstinence-related app this year, helps the sober connect with other non-drinkers. The new app and the other two are in this new examiner.com article.


A small Irish startup, notmyround, Ltd., released the world's first social app designed exclusively for non-drinkers looking to enjoy the social scene without booze. Notmyround, introduced April 14, taps into the phone's GPS to locate other sober people for chatting, sending photos or meeting up with other people for socializing without alcohol.

The company's founder noticed it is easier for people who drink to meet up for a night out, but it wasn't so easy for abstainers and people fighting alcohol use disorders – alcohol abuse and the disease of alcoholism – to connect with other people who chose to socialize sober. "My non-drinker friends, who usually don't hang out in pubs and bars, keep telling me the same thing: 'I want a better social life. I need to get out more. I want to meet some new people'," said Jean McElvaney, founder of notmyround.

There are no passwords for the app to make the tool more immediate and accessible. Sober people can just send out free texts and maps to other like-minded people anywhere, anytime.

“Instead of getting out there sober people found themselves, as did I, having yet another quiet night in,” McElvaney remarked. “I think it's very important as social beings that we get out there and have some fun. I thought the best approach would be to have an app that could connect non-drinkers on demand.”

The free app is only for iPhones presently.

Notmyround is the third of the new 2013 apps aimed at sober living. A popular Scottish app was introduced Jan. 9 to demonstrate how alcohol will age your face. (See related examiner.com article) It's for Android platforms. Later in January, The Doctor Says, Inc. rolled out the Alcohol Abuse Predictor, which uses a research-based questionnaire to help mobile users determine if they are at risk from alcohol use disorders, help them get information and seek medical treatment when needed. It's not available for iPhone, but is free for Blackberry 10 and Android devices.
-- from examiner.com


The Scottish app is called The Drinking Mirror and was wildly popular earlier this year for amusement.  That got people to use it while getting across the Scottish government's point that alcohol misuse does a lot of damage over time, not just to your looks but to your tissues and organs as well.  The Alcohol Abuse Predictor was developed in Canada.
www.alcohologist.com

SUNDAY SNIPPET, April 21

For this week's excerpt, I'm introducing one of the four stressors related to relapse emphasized in Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety. Shame. The book leans heavily toward the neuroscience and endocrinology fields in parts of the first portion of the book. In this middle section, in addition to being bluntly personal, I turn to many of the established pros in addictions and psychology... men and women who know the stigma the word "alcoholism" carries.


"...That’s just one example of stigma or ignorance leading to the insensitivity behind shame other people bring to our doorsteps or the shame we find when we stand on their doorsteps. In a lot of ways the shame is as pain-provoking as the disease itself, especially when we’re treated this way by People Who Should Know Better. I once thought I had a huge fund of tolerance for people but realized it could be quickly drained once I began dealing with otherwise smart people who say dumb things about Alcoholism.

The shamer may not want me to go to heaven because I’ve got this thing, but I want to go anyway, so who’s the one with the problem? The Person Who Should Know Better. You do not expect them to build a shrine to your sobriety, but it isn’t too much to expect them to let you try to succeed. They are simply not strong enough to accept that negative things can happen in life randomly. It is a part of nature they have chosen to deny. They have a “conflict of visions of reality” to steal from Zen and the Art of Motorcycle Maintenance. (Robert M. Pirsig, HarperCollins, New York 1974) It’s the way people choose to see the world regardless of scientific discoveries.

Stigma is the shadow cast by ignorance, and ignorance about Alcoholism remains very strong in society. A poll cited in HBO’s 2007 series, Addiction: Why Can’t They Just Quit? reported that one half of the public believes Alcoholism is a “personal weakness.” In the face of 56 years passing since the American Medical Association deemed Alcoholism a disease, HALF the population still refuses to believe it is one, and are wed to a 3000-year-old notion that it is a bad person rather than a bad medical condition. Call it lack of training or education to be more diplomatic, but it isn’t going to change by the time you finish this book. According to a truly common way of thinking called the “just world philosophy,” you’ve gotten what you deserved. In a just world, if you are careful, smart and moral you can avoid misfortune; and if you don’t avoid misfortune, you are misfortune. Shame on you.

In 1957 Dr. Jellinek’s disease model of Alcoholism authoritatively ended centuries of false conclusions about Alcoholism being tied to careful, smart and moral. People still have a hard time giving up the idea that it is some sort of problem that can be stopped by just walking in a different direction. They don’t isolate the science from the myth and rhetoric. The prevalence of shaming is a natural human tendency to be subjective rather than objective and that the untrained and closed mind will follow the path of least resistance. The American society shames the Alcoholic, so too must they.”

--- condensed from Every Silver Lining Has a Cloud, pages 53-54, FIVE STARS on amazon.com 

 

It's unicorns-and-rainbows thinking for those in recovery to try to overturn the stigma that is rooted so deeply in our culture. What we can do is learn to live, live well and live sober around it. It's a key to long-term recovery.

www.alcohologist.com

SATURDAY REWIND: Confusing messages about alcohol and pregnancy

There's been a lot of good science coming out of universities lately on the causes of alcohol use disorders and the health consequences of drinking. I try to report on most of it, even when it comes in direct conflict with previous research. Who's to say the old research isn't... well... old?

 

Sometimes the confusion is the result of careless reporting not the studies themselves. Take for example the breast cancer research announced April 8 (see “Report clouds alcohol, breast cancer connection”). The study concluded that moderate alcohol use doesn't make breast cancer less survivable after diagnosis. Several media outlets interpreted the findings to mean alcohol doesn't increase breast cancer, which was not the study's focus. In fact, alcohol consumption remains the only dietary factor shown to increase breast cancer risk. The new research confirmed that point, but said it didn't make the breast cancer drinkers get more fatal than non-drinker's breast cancer.

 

This week, a new study was released on alcohol consumption during pregnancy. Headlines from the study claimed “Light drinking during pregnancy may not harm baby” based on observations of children born to mothers who reported drinking one or two drinks a week during pregnancy.

 

Here are excerpts from two other studies from my archive that suggest otherwise.

Alcohol causes low birth weight even when a mother has treatment 12 months prior

A study of 1,107 first-time mothers released April 15 by Australia's University of New South Wales found an increased risk of low birth weight even if the mother was treated for an alcohol use disorder 12 months before conception. Fetal alcohol spectrum disorders (FAS) have often been connected with drinking after conception. This is the first study connecting problems with newborns with drinking alcohol prior to conception.

 

The results of the study were outlined at the annual congress of the Perinatal Society of Australia and New Zealand in Adelaide. The researchers found women with drug or alcohol problems, even problems that were addressed, are up to four times more likely to have a low-birth-weight baby. -- (article continues here)

 

 

Drinking during pregnancy drops the child's IQ by age eight

 

The physical deformities resulting from alcohol use during pregnancy have been well known for years, but a study released November 15 in Britain proves the drinking impairs mental performance in elementary school. Researchers found an eight point drop in Intelligence Quotient (IQ) scores among third-graders whose mothers drank during pregnancy. The point is not the eight points, it is that there was a measurable difference between kids who had mothers who drank during pregnancy versus kids whose mothers abstained.

 

The study is one of the first of its kind to track the genetic changes brought about by prenatal alcohol use. It did not include heavy drinkers, but rather focused on alcohol consumption that ordinarily would be considered “moderate.” The moderate drinking caused changes in four specific genes in the children and later resulted in the lower IQ scores.  (article continues here)



The Centers for Disease Control and Prevention (CDC) states that drinking alcohol during pregnancy can lead to FAS:  Birth defects, cognitive problems and disabilities. They are some of the most preventable birth defects and developmental disabilities. The CDC also points out that there is no amount of alcohol that is safe to drink while pregnant, and all drinks with alcohol can hurt a fetus.

Responsible parenting – and common sense – tend to side with the CDC on this one. Who wants to find out nine months later that the study or the headlines about moderate drinking being ok were wrong?

www.alcoholgist.com

Alcohol advertising in sports blasted for 'grooming child drinkers,' bans becoming popular internationally

From my news article posted this morning, here's a look at the growing distaste over sports advertising and sponsorships by the alcohol industry.  The list is by no means all-inclusive.  For example, Malaysia and Israel have current bans in place for sports events to prevent teen exposure to the ads and/or reduce domestic violence.

Doctors in Ireland are demanding a ban on alcohol sponsorship of sporting events, warning the beverage alcohol industry is “grooming child drinkers.” Sporting bodies are “very much in the alcohol industry’s pocket,” a communications regulatory committee was told April 17 by representatives of the College of Psychiatrists of Ireland (CPI).

The proposed ban is similar to smoking advertising bans in the United States, which forced a sponsorship change for NASCAR's top racing series from the Winston Cup to the Sprint Cup.

Dr. William Flannery of the CPI said the alcohol industry was targeting adolescent children and advertising was linked to the early onset of alcohol use disorders – alcohol abuse and the disease of alcoholism. Medical and youth advocacy groups in the U.S., where one in four minors are drinking (see related examiner article), are watching developments in Ireland and other countries while pushing for similar sports advertising bans in the U.S.

Alcohol companies spent more than $1 billion on U.S. sports sponsorships and advertising in 2012, from local events to the Super Bowl. If such a ban is successful in the U.S., it would challenge how professional sports and broadcasters generate revenue. For example, Chicago's Rock and Roll half marathon would have to replace official sponsor Michelob Ultra. Nearby, Milwaukee's Miller Park may need to seek a new naming-rights partner other than the Miller-Coors brewery a half mile away in the cradle of America's beer industry.

U.S. alcohol industry watchdog Alcohol Justice has sports advertising in its crosshairs. Their Free Our Sports Youth Film Festival project, which honored it's winners this month, is a call to eliminate alcohol advertising, sponsorships, branding and promotions from every sport. Each entry from youth aged 10-20 generated letters targeting the CEOs of the three top alcohol producers, demanding that they stop using sports events to promote alcohol consumption.

According to the group, “As alcohol-marketing tactics increase in complexity and frequency, they significantly influence youth expectations and attitudes, creating an environment that promotes underage drinking.” Alcohol Justice points to a 2004 survey showed that 75 percent of adults back a ban of alcohol advertising in youth-oriented media, including sports broadcasts.

“There is no product on the planet that could cause children more harm,” CPI's Flannery said. "They are the real targets of alcohol sponsorship."

The CPI noted that organizations such as the World Health Organization have shown the major effects alcohol marketing and advertising can have on young people in terms of when they begin drinking and how much they consume. "Teenagers' brains are still developing so drinking alcohol at this crucial stage interferes with that development and slows it down,” explained Flannery. "The teen years are crucial stages for developing skills and confidence in how to deal with social situations and various problems that life throws at us. If they are consuming alcohol in these years then their ability to deal with life's challenges in their twenties is impaired as they may only have coped in these circumstances by using alcohol."

Among several other countries regulating, or trying to regulate, alcohol in sports advertising are Australia, the United Kingdom and France. In Australia, where the alcohol industry has a voluntary ad regulation system, an Australian Alcohol Advertising Review Board (AARB) was formed in 2012 due to complaints of companies targeting young people through sport sponsorship. AARB chair professor Fiona Stanley says, "What reason can there be to expose young people and children to the association of alcohol with their sporting heroes or with behaviors such as driving fast cars and surfing?"

In the U.K., lawmakers are considering a total ban on sporting event alcohol advertising as part of sweeping reforms aimed at stemming the U.K.'s swell of alcohol use disorders and underage drinking. Currently there are complicated rules governing alcohol advertising saying that ads cannot be included around programs or films where more than 10 percent of the audience is under 18. (In the U.S. the voluntary standard is 28.4 percent, set by the Distilled Spirits Council of the U.S.)

France brought in a ban on alcohol sponsorship in sports in 2011. Rugby's Heineken cup is called the ‘H’ cup there.

Is such a ban possible in the U.S.? Alcohol Justice notes that in recent years, public health advocates and lawmakers have become reticent to enact new or enforce current restrictions on alcohol advertisements, citing court rulings backing free-speech rights. “However, with each ruling, courts have continued to clarify their position regarding the regulation of advertising. As a result, through careful drafting, state and local governments can still restrict alcohol advertising. Moreover, governments can look to crafting restrictions that effectively minimize youth exposure while addressing 21st-century advertising tactics. The scientific evidence is clear that the more ads kids see, the more likely they are to drink, and drink to excess.”

www.alcohologist.com

Scroll down for the replay of the Dr. Jeanette Gallagher show feature with Scott Stevens. Lucy Pireel's "All That's Written" included a feature on Every Silver Lining Has a Cloud called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud can be found on www.alcohologist.com, plus the interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK.  
 

SAVE THE DATE:  Scott Stevens will be part of the opening night symposium for the REEL Recovery Film Festival San Francisco.

Pat Summerall dies, both he and Roger Ebert had success after alcohol treatment

Sportscaster Pat Summerall died at age 82 April 16.  He's the second TV icon with an admitted alcohol problem to pass away this month.  Here's an article I produced this morning highlighting their successes in treatment and after.



Sportscaster Pat Summerall, who passed away April 16, and film critic Roger Ebert, who died April 4, both admitted having the disease of alcoholism. They both went to treatment and continued on to become two of the biggest names in their respective professions.

Journalist Ebert was a recovering alcoholic, having quit drinking in 1979. In an August 2009 blog post, he wrote about his recovery under the headline “My name is Roger and I'm an alcoholic.”  He wrote, “In August 1979, I took my last drink. It was about four o'clock on a Saturday afternoon, the hot sun streaming through the windows of my little carriage house on Dickens. I put a glass of scotch and soda down on the living room table, went to bed, and pulled the blankets over my head. I couldn't take it any more.”

He was a member of the 12-step group Alcoholics Anonymous after treatment. “The problem with using will power, for me, was that it lasted only until my will persuaded me I could take another drink. Since the first A.A. meeting I attended, I have never wanted to. I know from the comments on an earlier blog that there are some who have problems with Alcoholics Anonymous. They don't like the spiritual side, or they think it's a "cult," or they'll do fine on their own, thank you very much. Don't go if you don't want to. It's there if you need it.”

Summerall was a kicker in the National Football League for 10 years before his broadcasting career, which he began in 1975. Summerall battled alcoholism throughout much of his life and wrote about it in his 2006 autobiography, “Pat Summerall: On and Off the Air.”

In 1990 Summerall was hospitalized with a bleeding ulcer that was aggravated by a toxic combination of painkillers and alcohol. He vowed to give up drinking and did for seven months before a relapse. He confessed that drinking “was no longer fun” at that point. As an athlete and TV personality, he loved being the last guy at the bar, telling the best stories, having the grandest time, but by 1992, he had to hide the drinking and deny the problem. He went to the Betty Ford Center to begin his recovery. "I sat at meetings where you have to introduce yourself and say your problem," he said. "Some people never got the courage to say it. It was tough to say, 'I'm Pat and I'm an alcoholic.' "

Years into his recovery, the damage to his body from his drinking years required a liver transplant in early 2004.

Both men went on to the most successful years of their careers following treatment for the  alcohol use disorder.

Three years sober, Ebert rose to national celebrity in 1982 with the syndicated television show "At The Movies With Gene Siskel & Roger Ebert." A star on the Hollywood Walk of Fame came after sobriety, and Oprah Winfrey credits him with persuading her to syndicate "The Oprah Winfrey Show," which became the highest-rated talk show in American television history.

Summerall broadcast 16 Super Bowls on television with networks CBS and FOX, more than any other announcer and most came after sobriety in 1992. The National Sportscasters and Sportswriters Association inducted him into its Hall of Fame in 1994 and he was that year's recipient of the Pete Rozelle Radio-Television Award, bestowed by the Pro Football Hall of Fame "for exceptional contributions to radio and television in professional football." In 1999 he was inducted into the American Sportscasters Association Hall of Fame.

A theme in Ebert's blog on why he stopped drinking and took the step toward recovery is shared by Summerall and summarized in his book: "After a while I became more aware of what alcohol did to me and I wanted to live a hell of a lot longer." Summerall lived to age 82, 20 years into recovery. Ebert died at age 70, 32 years sober.

-- from examiner.com


Ebert's blog post (linked in the article) is pretty specific about his AA experience and is a good, quick read.  Success on the scale these two men enjoyed is not guaranteed after treatment... but at least they lived long enough to create and leave legacies.  AA isn't for everyone, nor is it the only choice for recovery, but many people find long-term sobriety more comfortable when AA is part of their regimen following in-patient or out-patient treatment.  The consensus among alcohol professionals is that no one can do it alone.
www.alcohologist.com

Rock legend Ozzy relapsed: It is part of having a chronic disease

Nine of 10 sober alcoholics relapse at LEAST once during recovery.  Even celebrities, with the best treatment resources at their disposal are not exempt.  Here's an excerpt from my examiner.com article today with some relapse stats.  I have additional commentary at the end.



Ozzy Osbourne recently suffered a relapse and has admitted to drinking alcohol and taking drugs in the last 18 months. The solo artist and Black Sabbath frontman confessed on his Facebook page April 15 that he was “in a very dark place” and has apologized to his family for his “insane behavior.” He reports he has now been sober 44 days since ending his relapse.

Relapse – a return to a pattern of drinking – is very common among those with the disease of alcoholism. Relapse is considered by most counselors to be part of the recovery process, yet some cynically state that relapse isn’t part of recovery it’s part of drinking.

Terence Gorski, author of Staying Sober, notes “you cannot experience recovery without experiencing a tendency toward relapse.” Louise Bailey Burgess, author of Alcohol and Your Health adds, “Unfortunately, despite desperate determination, the depressing fact remains that not more than 50 percent of those who decide to quit, manage to attain sobriety for the rest of their lives.” Neuroscientist George Koob of the Scripps Research Institute, in the public TV special "Close to Home: Moyers on Addiction," puts the number at 80 percent of those who have detoxed relapsing within the first year. Yet another expert, Michael Dennis of Chestnut Health Systems says in HBO's, "Addiction: Why Can’t They Just Quit?" “Seventy percent of patients relapse after the first time getting help. It’s not like fixing a broken bone.”

The 2013 book Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety puts the number at nine of 10 sober alcoholics returning to alcohol at least once, noting relapse isn’t even unique to alcoholics. "People with chronic depression have a relapse rate also at 50-80 percent. High blood pressure patients only have to keep taking their meds—a really simple task compared to staying clear of alcohol—and their rate of non-compliance is as high. Patients with seizure disorders: Same thing. Diabetics? Ditto . . . high rate of relapse/non-compliance. Asthmatics are even worse. Relapse is a part of having a chronic disease."

-- from examiner.com


Studies completed in 2012 and reported in my book point to an elevated level of the stress hormone cortisol in practicing and recovering alcoholics are a key part in relapse.  Too much cortisol creates an exaggerated startle response, confusion and mood changes like irritability. These non-physiological reactions to cortisol have a direct connection to lapse/relapse and are to what I’m referring when I use the term Symptoms of Sobriety.

Ironically, research from the University of Chicago showed conclusively what does block cortisol. Alcohol. “Alcohol can decrease the cortisol the body releases to respond to stress,” says Emma Childs, a research associate at the university quoted in Alcoholism: Clinical and Experimental Research, October 2011. That’s one of the many paradoxes of alcohol and the Alcoholic: The quick, easy solution to cortisol giving you the Symptoms is to drink. After all, relieving stress is the number one or two reason most people, including non-Alcoholics, drink. Lapse or relapse is, obviously, a ridiculous alternative that only makes the tress—and the cortisol—worse in the long term. In the hand of an Alcoholic alcohol is no answer, it is a question: “What do you feel like losing today?”
www.alcohologist.com

SUNDAY SNIPPET, April 14

For this week's excerpt, I'm going back to my 2010 book, What the Early Worm Gets, for an excerpt on the differences between the disease of Alcoholism and behavior disorder Alcohol Abuse, a main theme of that book.  This isn't an all-inclusive summary of the differences, but begins a lengthy chapter on how to distinguish the distinctly different alcohol use disorders from one another.

 

 

 "One of the top researchers, Don Cahalan wrote Problem Drinkers: A national survey (Jossey-Bass) based on four studies he authored or co-authored. He said, “Comparing estimates of Alcoholics and problem drinkers [Alcohol Abusers] is a rather futile exercise because the concepts of Alcoholism and problem drinking are not very similar, do not necessarily apply to the same people and have quite different implications for prevention measures and treatment.”

If Alcoholism was a behavioral or emotional or psychological or moral or social or spiritual failing, lab rats would not get Alcoholism, the physiological disease. Rats do not even like alcohol to begin with—so they are incapable of Alcohol Abuse—and haven’t the capacity of all of those psychological expressions commonly given as causes for Alcoholism. They are biochemically different when Alcoholism is present not morally deficient.

Cahalan and others saw the difference between the Alcoholics and Alcohol Abusers in studies of drinking behavior in the armed services. There’s a lot of heavy drinking in the military. You’d expect it in a population consisting largely of young males away from their families and in a stressful environment. Many drank so much that they were at a high risk of developing Alcoholism. Most however only had disciplinary problems, not telltale changes in body tissues. The medical risks and physiology of Alcoholism weren’t there.

That’s why many people leave Alcoholics Anonymous, the mother of all 12-step programs, in their first year. They walk away saying, “That isn’t me.” They could be right, too. They could be Alcohol Abusers not Alcoholics.

Controlled drinking may be a treatment goal for an Abuser. A treatment goal for an Alcoholic though is abstinence. Only abstinence. Success factors in dealing with either are variables like the client’s motivation, severity of drinking, socioeconomic stability and coercion. The largest predictor of success though is an appropriate match between problem and solution. Dr. Marc Schuckit, author of "Alcohol & Sociopathy: Diagnostic Confusion", in the 1973 “Quarterly Journal of Studies on Alcohol,” put it this way. “It is necessary to distinguish between the Alcoholic who engages in a limited sphere of antisocial behavior and of the antisocial who abuses alcohol as part of his behavior. The process and prognosis of these different varieties are distinct."

To put it another way, an Alcoholic says, “never again” and they mean it but cannot stick to it and when an Abuser says, “never again” they usually don’t mean it and will stick to "never again" only as long as they choose. Alcohol Abusers actually have three choices. They can choose not to drink. They can choose to drink moderately. They can choose to get bombed. Alcoholism is about lack of choice: Once they take the first drink of alcohol, stopping isn't a choice, and they can no longer choose the amount. And an Alcoholic certainly didn't choose the genetics that contribute to their disease."

-- condensed from What the Early Worm Gets, pages 33-35, FIVE STARS on amazon.com

This summer, the diagnostic manual clinicians use – called the Diagnostic and Statistical Manual or DSM IV – was replaced by an updated DSM 5. The update puts both Alcoholism and Alcohol Abuse under the same "code," however, there will always remain a distinction between the two and in how the two conditions are best treated.

SATURDAY REWIND: Alcohol and stroke risk

With the BMJ (formerly British Medical Journal) yesterday recommending more potassium and less salt to cut stroke risk, I retrieved this article from my archive on another stroke risk factor: Alcohol consumption. (The link to all archived examiner alcohol articles is here.)

Not “old enough” for a stroke? If you’re a drinker, guess again. It might be the booze. The University of California at San Francisco has now linked stroke among younger adults to alcohol use disorders. "When a young person has a stroke, it is probably much more likely that the cause of their stroke is something other than traditional risk factors," according to one of the lead researchers in the study reported this week in the journal Stroke.
 
When you think of stroke, you think of older people in walkers, but researchers said long-term changes in the heart as a result of alcohol abuse or the disease of alcoholism may put younger users at higher-than-average risk earlier in life.

Stroke disables more people in the United States than breast cancer or the war in Afghanistan. According to the Centers for Disease Control and Prevention (CDC), nearly 800,000 people in the United States have a stroke every year. Strokes (either ischemic or hemorrhagic) are the most common causes of serious long-term disability. One study of 2007 data found that almost five percent of people who had a stroke that year were between ages 18 and 44.

"Substance abuse is common in young adults experiencing a stroke,” according to the research team. "Patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse. One in five of strokes last year involved drinking.”

The study can't prove that patients' drug or alcohol use directly contributed to their strokes. It's possible, for example, that people who abuse alcohol also see their doctors less often or engage in other risky behaviors that increase the chance of strokes. 

Researchers emphasize the importance of seeing a physician regularly and quickly recognizing the signs of a stroke - such as weakness on one side of the body and dizziness - even for young people. Some treatments can only be used during a short "window of opportunity" after the stroke, just like has been commonly accepted as a window of opportunity for getting help to someone who’s had a heart attack.

-- from examiner.com


When initially researching this story on strokes and alcohol, I pulled the following facts from the CDC and the National Stroke Association.

• Stroke kills almost 130,000 Americans each year—that’s 1 in every 19 deaths.
• On average, one American dies from stroke every 4 minutes.
• Fewer than 20 percent of hospitals are stroke certified.
• Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes. One fourth are recurrent strokes.
• Nearly 90 percent of strokes are ischemic strokes, when a blood clot blocks the blood vessels to the brain.
• Stroke costs the United States an estimated $38.6 billion each year.

 

Alcohol's health benefits 'wishful thinking,' not evidence-based

The evidence of the harmful effects of alcohol outweighs data on the benefits of drinking, a physician writes in the current online issue of the journal Addiction. In a critical analysis of the health-boosting, disease-preventing characteristics of alcohol, Norwegian psychiatrist and addiction researcher, Hans Olav Fekjær, notes in the journal, “Altogether, the evidence for alcohol's ability to prevent diseases is considerably weaker than that for alcohol causing several kinds of harm.”

According to Fekjær, claims that alcohol has health benefits are observational, not evidence-based considering all the characteristics of the drinkers. This means that the claims do not take into account other lifestyle choices such as diet, nor do they consider the “dosage” of alcohol or pre-existing conditions, not the least of which is the disease of alcoholism.

Various observational studies have concluded that drinking moderate amounts of alcohol may help prevent:
Alzheimer's disease/dementia
Asthma
Colorectal cancer
Common cold
Coronary heart disease
Diabetes (type 2)
Gallstones
Hearing loss
Low birth weight, prematurity
Lower urinary tract symptoms (in men)
Osteoporosis
Overweight
Psychiatric disorders
Renal cell cancer
Rheumatoid arthritis
Stroke (ischaemic)
And total mortality

According to the journal, these studies all vary widely on the lifestyle factors taken into account. “Altogether, there is ample evidence that groups with different drinking habits differ in several other ways than their drinking, making it difficult to separate the effects of drinking habits from other factors” contributing to illness. For example, people who don't drink at all, as a group, "have a less healthy diet and exercise less than moderate drinkers to begin with," Fekjær said. An earlier study also concluded that abstainers have more of several other risk factors tied to the same diseases, such as having low education and passive lifestyles or being unmarried, disabled or depressed.

Fekjær also noted claims that moderate wine drinking has health benefits. “Wine drinkers generally had more formal education, better dietary and exercise habits and more favorable health status indicators. Altogether, there is ample evidence that groups with different drinking habits differ in several other ways than their drinking, making it difficult to separate the effects of drinking habits from other factors.”

Other evidence-based studies on the same diseases listed above demonstrate increased risk with alcohol consumption. On the list, alcohol is claimed to help with low birth weight in observational studies, but in evidence-based studies, drinking has been proven to cause fetal alcohol spectrum disorder (FAS) and lower the child's IQ by age eight. Observational studies mention alcohol as reducing risk of some cancers, but evidence-based studies by Boston University earlier this year (see related examiner.com article) concluded “No amount of alcohol is safe."

While there is observational data that light or moderate drinkers have a reduced risk of several diseases which are influenced by lifestyle factors, whether or not the lower risk is due to alcohol is a more complicated issue. “Taken together, the existing evidence does not seem to meet the criteria for inferring causality. For almost all the diseases, we do not know of any plausible biological mechanism explaining a preventive role for alcohol. Alcohol's possible ability to prevent diseases should probably not be considered as an established fact.

“The absence of definite knowledge leaves plenty of room for wishful thinking, which we observe frequently on this topic,” Fekjær concluded.


There are 79,000 U.S. deaths annually attributed directly to alcohol use (accidents, cirrhosis, etc.) and as many as 900,000 additional deaths indirectly attributed to alcohol use (cancers, Alzheimer's, etc.).  While it may be comforting to justify alcohol use as "good for my heart" or by using some other observational data, the CDC reports alcohol as the nation's #3 cause of death.


Scroll down for the replay of the Dr. Jeanette Gallagher show feature with Scott Stevens. Lucy Pireel's "All That's Written" included a feature on Every Silver Lining Has a Cloud called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud can be found on www.alcohologist.com, plus the interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK.  

SAVE THE DATE:  Scott Stevens will be part of the opening night symposium for the REEL Recovery Film Festival San Francisco.

Report clouds connection between alcohol and breast cancer

Research reported April 8 online in advance of publication in the Journal of Clinical Oncology finds alcohol does not reduce survivability from breast cancer.

Previous research has linked alcohol consumption to an increased risk of developing breast cancer, and this study does not contradict those findings. (See the Oct. 25 examiner article on the breast cancer/alcohol link) Alcohol consumption is believed to influence breast cancer risk through increases in estrogen production.

The new study by Seattle's Fred Hutchinson Cancer Research Center indicates that once a patient has the disease, drinking before and after her diagnosis does not impact survival from the disease. In fact, some benefit was found in women who were “moderate” drinkers due to a reduced risk of dying from cardiovascular disease, a major cause of mortality among breast cancer survivors.

So alcohol can increase breast cancer risk, but may also improve outcomes once a patient has the disease.

Polly Newcomb, Ph.D.,led the study. "Our findings should be reassuring to women who have breast cancer because their past experience consuming alcohol will not impact their survival after diagnosis."

The study began in 1988 and was conducted in New Hampshire, Massachusetts and Wisconsin. Among study participants with a history of breast cancer, the authors found that the amount and type of alcohol a woman reported consuming in the years before her diagnosis was not associated with her likelihood from dying from the cancer. However, the authors also found that those who consumed a moderate level of alcohol (three to six drinks per week) in the years before their cancer diagnosis were 15 percent less likely to die from cardiovascular disease than non-drinkers.

Wine drinking, in moderation, was associated with a lower risk of dying from cardiovascular disease, while no such benefit was evident for consumption of beer or spirits, or for heavier levels of drinking.
The report does not recommend drinking alcohol. An accompanying editorial cites many other risks of drinking alcohol, including alcohol use disorders (alcohol abuse and the disease of alcoholism), and that “alcohol intake may be associated with accidental or violent death.” A separate report Feb. 14 from the U.S. Centers for Disease Control and Prevention (CDC) demonstrated other health risks specific to women drinkers, beyond increasing the chance for breast cancer, leading to 23,000 deaths annually.

Additionally, the American Journal of Public Health posted research from Boston University earlier this year on the connection between all cancers and alcohol consumption. (See related examiner story) That study determined that alcohol-related cancer death took away an average of 18 potential years from a person's life. Boston University's Timothy Naimi, PhD., said. “When it comes to cancer, there is no safe level of alcohol consumption."

--- from my examiner.com article posted this evening

SUNDAY SNIPPET, April 7

On the stat that 9 of 10 alcoholics relapse...

“The high rate of lapse (or relapse) isn’t unique to Alcoholics. People with chronic depression have a relapse rate also at 50-80 percent. High blood pressure patients only have to keep taking their meds—a really simple task compared to staying clear of alcohol—and their rate of non-compliance is as high. Patients with seizure disorders: Same thing. Diabetics? Ditto . . . high rate of relapse/non-compliance. Asthmatics are even worse. Relapse is a part of having a chronic disease. “Bill,” a man I’ve come to appreciate and respect over the years, relapsed four times in 20 months.

A lapse or relapse doesn’t mean the end of your recovery. Your life doesn’t return to the previous chaos just from one lapse or relapse. Recovery is stability, stable psychosocial status to which you can return even after a lapse if you promptly correct it and not let it turn to loss of control. You don’t go all the way back to the start just from a lapse once you begin recovery.  That’s the fatalistic thinking that dooms a thousand recoveries a day."

...from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, page 22-23.

“Bill,” by the way, relapsed four times, but tried for sobriety a fifth. He is Bill Wilson, who went on to co-found the 12-step giant, Alcoholics Anonymous. This isn't an AA book, but his relapse experience is worth noting.
www.alcohologist.com