Breast Cancer Awareness Month: Decipher mixed messages about alcohol and breast cancer

Research reported June 2013 in the Journal of Clinical Oncology (JCO) finds alcohol does not reduce survivability from breast cancer. The study is encouraging Breast Cancer Awareness Month news for women who prefer to drink, but the encouragement fades quickly because there remains a higher cancer risk associated with drinking.

Previous research has linked alcohol consumption to an increased risk of developing breast cancer, and the JCO study does not contradict those findings. (See the Oct. 2012 examiner article on the breast cancer/alcohol link) Alcohol consumption is believed to influence breast cancer risk through increases in estrogen production and also by altering breast tissue in developmental years. An August 28 Journal of the National Cancer Institute report showed a double-digit increase in breast cancer risk for women who drank as little as one drink daily between the first menstruation and the first pregnancy. The results were independent of drinking after first pregnancy.

"The risk increased by 11 percent for every 10 grams a day of intake, about six drinks per week," said study author Ying Liu, M.D., of Washington University School of Medicine in St. Louis. A drink, or 10 grams of alcohol, is a 12 oz. beer, a 4 oz. glass of wine or a1.5 oz. shot of hard liquor.

Liu's team also discovered an increase in benign breast disease, a non-cancerous condition which accounts for 80 percent of breast lumps. These benign lumps do increase the risk of breast cancer by 500 percent. The more alcohol consumed between the onset of the first menstrual period and the first pregnancy, the greater the risk for both benign breast disease and breast cancer, the study reported.

The results are a warning in favor of alcohol moderation – or abstinence – during adolescence and early adulthood when the breasts are developing new tissue. "Breast tissues are particularly susceptible to environmental exposures between [the onset of menstruation] and first pregnancy because they undergo rapid cellular proliferation," Liu said. "Our results suggest that alcohol intake before the first pregnancy consistently increases the risk.” The association between drinking before first pregnancy and breast cancer appeared to be stronger for women who had a greater interval of time between the first menstrual cycle and first pregnancy, which is to say that older first-time moms carry a higher risk if they were daily drinkers. (See full article.)

The JCO 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 already 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.

The JCO 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, Ph.D., said. “When it comes to cancer, there is no safe level of alcohol consumption."
--from my Oct. 1 news article (full report)
www.alcohologist.com

SUNDAY SNIPPET: September 29

Alcoholism is the only disease where successfully getting it into remission relies heavily on paraprofessionals outside the medical community.  When those resources come from within the criminal justice system, the results are statistically below average, as this excerpt from my previous book What the Early Worm Gets begins to point out.

"The professionals and paraprofessionals handling the treatment are critical to the success. And to build that success you need credibility, especially because there are so many paraprofessionals affiliated with recovery. It’s their duty to adhere to a code of ethics simply not embraced in a correctional environment. Knowledge and competence—not necessarily a degree—are required, and trust. Where do those with alcohol problems place their trust? Others who have walked a mile in their shoes. Because you really don't know how it feels to be alcoholic unless you are alcoholic.  A mechanic isn’t a metallurgist even though the material with which he works with is metal. You still need a multi-disciplinary team including medical doctors or psychotherapists, however having someone who is in recovery helping facilitate the recovery process gets better results.

The most important facet of good treatment is alleviating guilt, shame and grief. We look through life’s window which can get coated with a grime of guilt and shame and grief. Those are precisely the three features the criminal justice system uses in its programs to make sure you’re sorry, make sure you know you’re sorry and won’t do it again. Positivity and attitude are the window cleaner that can clean the window of the grimy shame. The criminal justice system doesn't do windows.  They put bars on them. They will work to make sure you don’t forget your shame.

Recovery can be spontaneous. It does happen. However, true rehabilitation is based on Opus Contra Naturam—working against what comes easily— and few people are successful working against what comes easily without help.  Few people are successful for long when that help comes from a corrections environment designed to warehouse people, not provide meaningful treatment."
--from What the Early Worm Gets, pg. 73

www.alcohologist.com

 

SATURDAY REWIND: Other organs risked by binge drinking, not just the liver

The following article from the alcohol research news archive takes a look at other organs at risk from episodes of heavy drinking.


Alcoholic liver disease (ALD) covers a range of diseases such as fatty liver, hepatitis and cirrhosis. All are commonly linked to alcohol abuse or the disease of alcoholism. A January 22 review of studies addressing the effects of binge drinking on the liver underscores the complex interactions among various damages done to the liver by binge drinking.

Results published in the April 2013 issue of Alcoholism: Clinical & Experimental Research and are part of the first review that highlights the changes at the molecular level that occur in the liver from excessive alcohol use.

Binge drinking is defined by the U.S. Centers for Disease Control and Prevention (CDC) as four or more drinks in an episode for women, five or more in an episode for men.

Binge drinking is on the rise worldwide, and is particularly common in the U.S. A recent study, reported on examiner.com in early 2012, shows it is a rising – and risky – problem for women, but men are statistically more prone to binge drinking and are also at risk. Teen and young adult binge drinking is also a statistical headache for those in the alcohol abuse prevention profession.

"The liver is the main metabolic site in the body," said Shivendra D. Shukla, Margaret Proctor Mulligan Professor at the University of Missouri, School of Medicine and lead author for the study. "It is involved in the physiological functions of organs such as the heart, kidney, blood vessels and brain. ALD-affected liver chemicals can also influence immunity, cardiovascular health and coagulation. Thus, ALD can have a 'domino effect' on many organs."

The liver is also the major organ for alcohol metabolism, and as such, is the first line of defense against excessive alcohol consumption.

New studies from both experimental animals and humans indicate that binge drinking has profound effects on the liver. This is in addition to the known dangers of acute levels of alcohol. "Chronic alcohol consumption renders the liver highly susceptible to binge-induced liver damage," said Shukla. "Binge-induced liver injury impacts other organs as well, a view rather poorly appreciated by the public."

Shukla said, "This review also sets the stage for additional investigations in this field. The cross-organ implications of binge-induced liver damage must be explored."

Binge drinking can cause changes at the cellular level, in the mitochondria – the power-plant of all living cells. It can result in cell death as a result, and otherwise has a snowball effect in other organs because of the liver’s role in removing toxins from the body. Added Zakhari. "Therefore, people should not binge drink, especially on an empty stomach, and if they are chronic heavy drinkers, binge drinking will exacerbate liver injury, especially if (conditions) such as obesity, Hepatitis C or HIV infection exist."

"We hope this will encourage research and development of newer approaches and tools to control and ameliorate binge-induced health effects,” said the researchers.

The alcohol user is eight times more likely to get cirrhosis, which is irreversible, incurable and fatal. Not all Alcoholics will get it. Only one in 10 develops cirrhosis. However, it is not the only liver disease cause by alcohol. A fatty liver occurs when alcohol consumption disrupts how the body chooses its fuel. Cell mitochondria – our body power plants – normally use fat to produce energy. As acetaldehyde breaks down in the body it releases hydrogen, which mitochondria use before fat as fuel. The unused fat then accumulates around the liver. Even in someone who doesn’t look fat in their extremities or midsection, fat deposits choke the liver.

Alcoholic hepatitis is a third type of liver injury connected to alcohol misuse. It is a condition similar to the other hepatitis diseases, but is not the same as A, B or C hepatitis.

“Lest you think these three liver problems are the realm of only the hard drinker, they can be stimulated by amounts of alcohol between seven and 13 ounces of whiskey – five to nine shots or mixed drinks – in 24 hours,” according to the book, Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety. “There are very few symptoms of liver injury until it becomes chronic because the liver has no pain nerves to tell you when it is hurt. If the liver had nerve endings, you’d never make it to the second drink.”
-- from examiner.com (full article)

www.alcohologist.com

The 12 steps unchanged after 74 years

September 30, 1939, the popular weekly magazine, Liberty, gave many Americans a first taste of the now famous 12 steps. Many self-help groups today employ the 12 steps that originated in the book, Alcoholics Anonymous, published five months earlier. The group named after the book remains the most successful organization in handling the disease of alcoholism today.

The Substance Abuse and Mental Health Services Administration (SAMHSA) in 2008 reported an annual average of five million people 12 and older attended a group self-help meeting in the prior 12 months. One third also went for one-to-one counseling or group therapy. Because 12-step groups are so widespread, most one-to-one counseling and group therapy is based on the 12-steps and those counselors encourage participating in 12-step group self-help to boost sobriety. In fact, the National Treatment Center Study Summary Report from the University of Georgia found 90 percent of 450 treatment centers are based on the 12 steps, while 10 percent rely on “Behavior Therapy.”

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) seems to endorse the 12-step approach in group therapy as well. In 2008, it found Behavioral Therapy less successful than 12-step methods. “Individuals in 12-step oriented therapy have increased subsequent AA participation and it is the AA involvement that leads to better outcomes by buffering the effects of social pressures to drink. AA exposes a person to a network of people who have a goal of sobriety and support one another in achieving that goal.”

Group therapy requires signing up and showing up. Group self-help like AA requires only showing up. One thing to note though, if it is confidentiality you seek, one-to-one counseling is the only route 100 percent confidential. Anonymous is not a synonym for confidential. Ask yourself, though, does recovery really need to be confidential? Far too many get ticklish about talking “publicly” about their shame and other stressors. The alternative is not talking. And that leads to relapse. A twelve-step meeting is not the town newspaper. Even if it was, some alcoholics’ under-the-influence feats were more public than anything they’d say in a group self-help meeting ever would be.

These are safe venues in which to communicate. They consist of people who share the exact same struggles. Talking things out among them is cathartic. You don’t need to talk about every confession you have. You don’t get style points for deeper traumas. You do get style points for creating a climate of trust by putting on the table the things that are giving you challenges in sobriety. Those with drinking problems risk reaching out because they need a new label, a new place to belong, and there is safety among others who are also trying to shed old labels and stressors. If You’re Not Normal is the three-word death sentence to recovery, Me Too is the two-word pardon alcoholics get at 12-step meetings.

Even if an alcoholic does not ever buy into the 12 steps as a design for living, they are suggested, not required, for membership. “The only requirement is a desire to stop drinking,” the literature says. Twelve-step meetings are places to be among others who feel the same, wore the same masks, suffer the same struggles and have a desire to communicate rather than drink over them. “The most desperate need of mankind today is not a new vaccine for any disease or a new religion or a new way of life,” wrote Taylor Caldwell in the novel The Listener. “His real need, his most terrible need, is for someone to listen to him, not as a patient but as a human soul.”

Everyone, no matter how gifted, healthy or wealthy, encounters an issue that baffles them or breaks the spirit. Twelve-step groups are where alcoholics can communicate the baffling and the spirit-breaking. What all are trying to do together is acquire back self-esteem.

There are alternatives to 12-step groups, such as Self-Management and Recovery Training (SMART) and Women For Sobriety (WFS), however none have the track record of success AA boasts, and none are as widely available.

The Higher Power thing is tough for some people to swallow. The 1939 Liberty article had the title “Alcoholics and God,” which AA founder Bill Wilson disliked because he knew some people would object to the still-new program when positioned that way. And some still reject the program's spiritual bent.

Some people stay away from 12-step meetings because they don’t see themselves in the people around the tables or hear their stories told in the tragic stories of others. That is the point in going: To make sure you’re communicating what is stressing you before you go back to the drinking and become those tragic stories.

From a strictly medical standpoint, alcoholism is remarkably easy to arrest. It’s a lot less complicated than arresting cancer or diabetes. Abandon the bottle long enough and detox and biological functioning returns to something close to normal in a few weeks or months. From that point on, it is a matter of not going backward. That’s the drawback to having a disease that can be arrested but not cured: While it is under control it’s all too easy to forget what life was like when it wasn’t. Twelve-step groups remind alcoholics what it was like. Without the stigma.

One of the most treasured AA stories in print says, “Above all, AA taught me how to handle sobriety. I have learned how to relate to people… deal with disappointments and problems that once would have sent me right to the bottle. How do we do it? By sharing at meetings.”
-- Adapted from Every Silver Lining Has a Cloud.

-- From examiner.com (full article)
www.alcohologist.com

SUNDAY SNIPPET: September 22

The stigma of the disease of alcoholism stems from faulty beliefs generally accepted by the public. This Every Silver Lining Has a Cloud excerpt looks at misinformed manipulation from people who think in outdated stereotypes.

"Of all the characters who march across the stage of your recovery, misinformed manipulators are the most potentially harmful.

A manipulator demanding an apology is almost without fail a person who has a belief system that tells them the logical explanation for Alcoholism is that it is a choice. As a result, their injury is that they feel you chose the disease. There are millions of sometimes goofy bits of misinformation that find their way from being comforting thoughts to becoming “logical explanations.” If you get cancer, you ate too much red meat. If your husband left, you drove him to it. If an infant dies, it was God’s will. If you get Alcoholism, you chose to get Alcoholism. Faulty belief systems aren’t your hang-ups to solve. Logic is what other people try to use to prove you are wrong. Their logic is not logical.

Alcoholism isn’t logical. Period.

A lethal disease that kills with an undeniable need to consume a toxic substance yet still kills when you deny it the toxic substance is not logical. You can see how that won’t be logical to most people, however, because non-Alcoholics unchallenged by alcohol have no idea how it feels to have to keep drinking once started. Nine out of 11 people who are not in the counseling or medical professions still have belief systems that Alcoholism is a problem of willpower. To them it is far from logical to think it is a biochemical problem, not a moral one.

I’m fond of pointing out that mice don’t even like the smell or flavor or alcohol. It repels them actually. They don’t have morals, either. So how do scientists gather up alcoholic mice for alcohol research if Alcoholism is a moral problem? They breed them. The Alcoholic mice are Not Normal. The genes are tweaked. The mouse morals aren’t tweaked, and the alcohol is not altered to trick them into tasting it. They are bred with a biological condition, not a psychological condition. Dr. James Milian and Katherine Ketcham point out, “Psychological factors play no stronger role in Alcoholism than they play in causing any other chronic illness.” (Under the Influence, Madrona Publishers, Seattle, WA 1981) And that is a leap of logic many people are unwilling to take. Despite the weight of medical evidence, there will be those in the path of your recovery who have a belief system which simply will not permit them to accept a biological explanation. It’s something you did and they want an apology."

--from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pgs. 65-65

www.alcohologist.com

 

SATURDAY REWIND: Impaired driving, what 53 feet means

There will be increased enforcement of drunk driving laws this month and through the remainder of the year. It is an act of courage on behalf of law enforcement, with many officers waging a never-ending and usually dangerous battle of tagging intoxicated drivers.  The following article from the alcohol research news archive demonstrates what a couple of drinks means to avoiding collisions.

Most alcohologists prefer the term “Operating While Impaired” over “Drunk Driving” because often drinkers don’t feel drunk, but they are impaired. No distinction is ever assessed whether the driver is an alcohol abuser or has the disease of alcoholism: If you are impaired, you are under arrest.

 

Drunk or buzzed driving is the act of operating or driving a motor vehicle while under the influence of alcohol or drugs while motor skills are impaired. In the United States, the point of impairment is pegged at .08 Blood Alcohol Concentration (BAC). However, studies have demonstrated that motor-skill impairment begins at much lower BACs. Reaction time is 1/5 of a second for an unimpaired driver. With alcohol in the system, reaction time is slowed to 4/5 of a second at .06 BAC. At 60 mph, a second means 88 feet. A fifth of a second is 17.5 feet, 4/5 of a second is 70.4 feet. The Jetta slamming on the brakes in front of an impaired driver is 53 feet closer, reaction-time wise, compared to an unimpaired driver.

 

The specific criminal offense is usually called driving under the influence (DUI), and in some states driving while intoxicated (DWI), operating while impaired (OWI), or operating a vehicle under the influence (OVI). In the United States the National Highway Traffic Safety Administration (NHTSA) estimates that 10,000 people died last year in alcohol-related collisions, representing 40 percent of total traffic deaths. One out of every 10 arrests for all crimes in the U.S. were for OWI, compared to 1.9 million such arrests during the peak year in 1983, accounting for 1 out of every 80 licensed drivers in the U.S. NHTSA is a sponsor of National Drunk and Buzzed Driving Awareness Month along with Mothers Against Drunk Drivers (MADD) and the Governors’ Highway Safety Association.

 

The first jurisdiction in the U.S.to adopt laws against drunk driving was New York in 1910, with California and others following. Early laws simply prohibited driving while intoxicated, requiring proof of a state of intoxication with no specific definition of what level of intoxication qualified. The first generally-accepted legal BAC limit was .15. In 1938, the American Medical Association created a "Committee to Study Problems of Motor Vehicle Accidents". At the same time, the National Safety Council set up a "Committee on Tests for Intoxication". In the US, most of the laws and penalties were greatly enhanced starting in the late 1970s, and through the 1990s, largely due to pressure from groups like MADD, leading to a national standard of .08 as the definition of impairment.
-- from examiner.com

Among recommendations from the National Transportation Safety Board earlier this year:  An even LOWER BAC threshold of .05.  While it has met some resistance, the NTSB this week reinforced its commitment to a lower limit for U.S. drivers.  Keep in mind, it took two decades to lower the BAC limit to .08 from .10.
www.alcohologist.com

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at alcohologist.com... and please read the new interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK.

 

SUNDAY SNIPPET: September 15

Guilt and shame are two of the four stressors behind the Symptoms of Sobriety. Every Silver Lining Has a Cloud, compares the two in the segue between chapters dedicated to each.  Here's a brief excerpt.

"One of the first TV newsrooms in which I worked had an old-school assignment editor who had above his desk a framed photo from his reporter days. He was on the Patty Hearst story in California. In the 1970s, the newspaper heiress was kidnapped by a violent left-wing activist group that forced the 19-year-old into a role in a series of crimes for which she was put on trial in ’79. The photo shows her outside the court in a t-shirt that read, “Being kidnapped is always having to say you’re sorry.” Drop kidnapped and insert Alcoholic and that shirt could communicate how it sometimes feels when you’re working toward recovery. First, a violent abduction from your day-to-day life makes you a hostage, then your guilt and shame subject you to years of feeling as though you won’t ever be able to atone for it.

Guilt and shame are different. Psychiatrist Helen Block Lewis points out, “Shame and guilt often occur together. They’re frequently fused and therefore confused with each other.” (The Role of Shame in Symptom Formation, Lawrence Erlbaum Inc., Hillside, NJ 1987) Shame is the feeling we get from others that we are wrong . . . guilt is the feeling we give ourselves when we do wrong. In guilt, you’re reviewing your own irrational beliefs and telling yourself you didn’t do enough and you punish yourself for it . . . in shame, someone else is saying you didn’t do enough based on their own irrational beliefs. The former is caused by your values . . . the latter is caused by others imposing their values on you. The gap between your performance and your expectations of yourself is guilt . . . the gap between your performance and others’ expectations of you is shame. When you feel guilt over being Alcoholic, you feel the disease has made you a monster . . . when you feel shame, other people behave as if you are a monster.

As for their impact on cortisol, guilt and shame have the same outcome even though their origins are so different. The cortisol doesn’t make a distinction between whether others are judging you or you are judging yourself. The judgment is that Alcoholism is not “normal.”

These words that can derail sobriety more than any others are: You’re Not Normal. Shame carries that kind of whallop."

--from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pgs. 49-50

www.alcohologist.com

 

SATURDAY REWIND: Young adults getting drunk before going out to get drunk

Every September, alarmed parents are clobbered with news of campus alcohol-related arrests at the universities attended by their sons and daughters.  This year, the numbers have been quite staggering.  For example, reports out of Tempe, Ariz. had more than 1,367 alcohol-related arrests just in the first three weekends of school at Arizona State University.

The following article from the alcohol research news archive demonstrates how as many as three-fourths of college students "pre-funk" or "pre-drink," ramping up their alcohol consumption before they even head out for the evening.

The alcohologists call it pre-drinking: Getting a buzz on before going to parties to get more intoxicated. A study released Tuesday which will be cited in the February 2013 issue of Alcoholism: Clinical & Experimental Research, reports that 65-75 percent of college-age students drink up before heading out rather than waiting to arrive at their destinations before starting to drink alcohol.

The pre-drinking leads to absence from school or work, hangovers, Operating While Intoxicated (OWI), violent behavior, risky sex and other drug use more than just drinking at the event would, according to researchers. Not earth-shattering news for many young adults who came to with a little regret the next day, but for the first time scientists have quantified the differences in alcohol consumption between pre-drinkers and those who waited until they got out.

Researchers found that when students drank prior to going to a bar or club, they consumed seven drinks, and students who drank only at a bar or event consumed just more than four drinks. This led to 24 percent of those who pre-partied getting involved in something that had consequences, versus just 18 percent of those who waited until going out to begin drinking.

Pre-drinking does not automatically mean a young adult has the disease of alcoholism. It seems to be part of the rite-of-passage for college-age people, more so in the United States where the drinking age is 21 compared to Switzerland, where the study was conducted. The drinking age in Switzerland is 16. What the study points to is one of the warning signs of alcohol use disorders: Alcohol use prior to use in a social setting.
-- from examiner.com

To put the pre-drinking into context... a male weighing 180 lbs. drinking seven drinks over three hours would be at a blood alcohol concentration (BAC) of .107 and over the legal limit for driving.  If the same guy went out without pre-drinking, four drinks over three hours would instead put the BAC at around .039, well below the .08 legal standard.  A 120 lb. female, using the averages from the study, would have a BAC of  .214 with seven drinks in three hours and .10 with four drinks in three hours.  (A drink being a 4 oz. wine, a 12 oz. beer or a 1.5 oz. shot.)
www.alcohologist.com

 

Wine can help with depression. Or make it worse. Or kill you.

Research published Aug. 30 noted lower levels of depression with drinking “two to seven small glasses of wine per week.” I found it in – wait for it – Wine Spectator. The Spanish study also was reported on other medical news sites, however. And the report could be the loophole a drinker may use to avoid quitting, or the justification an ex-drinker may use to slip out of sobriety.

First, to credit the authors of the study, the research followed more than 5,500 men and women over age 55 for seven years, specifically looking at amount and type of drink and level of depression. “Moderate” drinkers of wine were found to have lower levels of depression than either abstainers or problematic drinkers. Lead author of the study, Miguel A. Martínez-Gonzále of the University of Navarra in Spain explained, “Problematic alcohol intake may be associated with depression not only because of increased intake of ethanol but also because of other alcohol-related unhealthy lifestyles or because of the social environment surrounding problematic drinkers (job loss, family problems, financial problems or other addictions). Any of these circumstances may be a potential trigger for depression, even in the absence of a specific detrimental role for ethanol.” (This link connects to the university's news release.)

Other research from February this year contradicts that message somewhat, noting that a third of depressive episodes are tied to alcohol abuse of the disease of alcoholism and the periods of depression are “different from depressive episodes caused by other life events.” (See full article.) The February study, lead by noted alcohologist Marc Schuckit of the University of California, San Diego, focused on the problematic drinkers avoided in the University of Navarra study.

Heavy drinking causes depression. Light drinking alleviates depression. That seems to be the message. The question on the table is how to distinguish between heavy and light, and whether the individual can drink at all. Physicians define light as 1.2 drinks per day, moderate as 2.2 drinks a day, heavy as 3.5 drinks daily and abusive drinking was defined as 5.4 drinks a day.

Those with the disease of alcoholism have one choice: Zero drinks per day. Total abstinence is the only way to keep the disease in remission.

Experts have long known that heavy drinking can spur temporary episodes of depression while many with alcohol use disorders use alcohol to relieve depression. They self-medicate. "I don't know that the average person realizes that heavy drinking can induce mood problems," said Schuckit.

There is one additional consideration, stemming from a Norwegian study, also from February. “The evidence of the harmful effects of alcohol outweighs data on the benefits of drinking,” a physician wrote in an 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.”  (Full article.)

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 diseases demonstrate increased health risks with alcohol consumption. For example, Boston University's study earlier this year (see related article) concluded when it comes to cancer, “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.

Don't drink the Kool-Aid … or in this case, the wine.  Consider other possible consequences of the "cure" for depression.
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.

FASD Awareness Day 9/ 9: Fetal alcohol syndrome more common than autism

The date 9/9 is a reminder to women who are or may be pregnant that during the nine months of pregnancy, there are significant and life-long risks due to alcohol for the child they carry. The Substance Abuse and Mental Health Services Administration (SAMHSA) has enhanced its message about Fetal Alcohol Spectrum Disorders (FASD) each year since the 9/9/99 observance of FASD Awareness Day.

Fetal Alcohol Syndrome (FAS), the most recognized condition in the spectrum, now outranks Down syndrome and autism in prevalence. A child is born with FASD every 4 1/2 minutes.

According to SAMHSA, women with the disease of alcoholism are not the only ones risking fetal development: Even infrequent social drinking is dangerous. "There is no known safe level of alcohol use in pregnancy." 

When an expecting mother drinks, the alcohol is passed directly to the fetus. The unborn will have the same blood alcohol concentration (BAC) as the mother, but lacks the ability to process the alcohol the way an adult does, so the BAC remains high for a long time. The alcohol causes a number of physical, cognitive, social and neurological problems in the infant that are permanent and irreversible. Alcohol also can kill a fetus.

FASD is a broad category conditions including FAS, alcohol-related neurodevelopmental disorder and alcohol-related birth defects. In the United States, about 130,000 pregnant women each year drink at levels shown to increase the risk of having a child with an FASD, according to the Center for Disease Control and Prevention (CDC). As many as 40,000 babies are born with an FASD annually, costing the U.S. up to $6 billion annually in institutional and medical costs. Costs of FAS alone are estimated at between 1 and 5 million dollars per child. This estimate does not include cost to society, such as lost productivity or incarceration, nor does it factor in the burden on families and poor quality of life.

Physical deformities (facial abnormalities, fused joints, organ problems) are one of the more obvious consequences of prenatal exposure to alcohol. However, the development of the brain is of particular concern. The brains of FASD babies are measurably smaller than otherwise healthy babies. Resulting impairments may include:
• Mental retardation
• Learning disabilities
• Attention deficits
• Hyperactivity
• Problems with impulse control, language, memory, and social skills

The brain and nervous system are among the first to develop, beginning around week three of pregnancy when some women may not even realize they're expecting. In the U.S. 1 in 2 adult women reports any alcohol use in the past month: Some women might not even know if they're pregnant 30 days after conception. For those who know they're pregnant, SAMHSA's stats are cause for concern. One in 30 pregnant women drinks at levels shown to increase the risk of FASD and more than 20 percent of pregnant women report alcohol use in the first trimester. The latter number drops to five percent in the third trimester.

A 2004 University of Washington study found that children born with FASD have a lifetime of difficulties. More than 90 percent had mental health problems, 83 percent experienced dependent living into adulthood, 80 percent had employment problems as adults., 6 in ten of those age 12 and older had trouble with the law and more than a third had had alcohol and drug problems.
SAMHSA notes that protecting babies from alcohol goes beyond pregnancy. "When a woman uses alcohol, her baby does, too. That’s why abstaining from drinking throughout pregnancy and during breastfeeding is the best gift a mother can give her child—it’s a gift that lasts a lifetime."

FAS, a diagnosis that first gained national attention in 1973, has four major components:
• A characteristic pattern of facial abnormalities (small eye openings, indistinct or flat philtrum between nose and mouth, thin upper lip)
• Growth deficiencies, such as low birth weight
• Brain damage, such as small skull at birth, structural defects and neurologic signs, including impaired fine motor skills, poor eye-hand coordination and tremors
• Maternal alcohol use during pregnancy

The SAMSHA message is abrupt, but clear. "FASD is 100 percent preventable. If you get pregnant, don't drink. If you drink, don't get pregnant."
-- from examiner.com 9/7
www.alcohologist.com

SUNDAY SNIPPET: September 8

In the early chapters of Every Silver Lining Has a Cloud, comparisons are made with other chronic illnesses... ones who's symptoms are seldom ignored the way those in recovery ignore the Symptoms of Sobriety.


"One of the differences between this disease and most other chronic ones that is so difficult to communicate is that with Alcoholism, when you are the sickest and most acute, you don’t feel sick because you’re getting alcohol. When you arrest the disease by treating it, that’s when you feel sick: In remission. First from withdrawal symptoms, naturally, but more so from cortisol and the Symptoms of Sobriety. With cancer, for example, you don’t feel sickest when you’ve stopped the spread and gotten that disease into remission. You feel sickest when the cancer is most acute. Lyme disease or even the flu is the same way. An Alcoholic can feel the sick from the Symptoms well into remission, even eight to ten years after stopping the drinking, according to 1985 research from Clinton DeSoto, William O’Donnell, Linda Alfred and Charles Lopes (“Symptomology in Alcoholics at Various Stages of Abstinence” in Alcoholism: Clinical and Experimental Research, vol. 9 1985).

That seems crazy: Other diseases don’t behave this way in remission.

And you are not crazy. You just need some adjustments. A diabetic, by comparison, would address the condition, not just symptoms, with small lifestyle adjustments. A severe diabetic would require more extensive life changes as well as professional help. He’d have an expert evaluate the meaning of his diabetic symptoms, wouldn’t he? Here’s another medical comparison. If migraine sufferers had the luxury of such clear warning signs as the Symptoms of Sobriety before the onset of a migraine, they’d take heed. Why should the Symptoms of Sobriety be evaluated any less thoroughly than the symptoms of diabetes or heeded less than the warning signs preceding a migraine? Neither diabetes nor migraines are as lethal as snapping Alcoholism out of remission.

The Symptoms aren’t some tabloid fad or syndrome-of-the-week; they are real. You feel like crap. It’s not imaginary. Not everyone will suffer from them though. For me, the third Symptom—the clarity—was my most pronounced and created the most havoc. I was so accustomed to thinking quickly on my feet. I believed the sharpness of the training as a journalist never dulled. At times though, even well after I stopped my two-liters-a-day drinking ordeal, I could not focus for more than 20 minutes at a time, couldn’t remember things I didn’t write down and had to re-read stuff to get the point. The cortisol was doing what the alcohol couldn’t: Singeing my brain, messing with my sharpness and my mental function. (Of course drinking that much blunted my judgment but at least I could make bad decisions more quickly.) I know this as a Symptom now. And now the Symptom is my own primary warning sign that there is something wrong and I need to address it and fix one or more of the sources listed at the end of the chapter, not just the Symptom itself."
 

--from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pgs. 27-28

www.alcohologist.com

 

SATURDAY REWIND: Nicotine vs. Alcohol, which one is worse?

This story from the alcohol research news archive demonstrates that while neither smoking or drinking are good health choices, there's a body of evidence that says alcohol is responsible for more harm than smoking. 

When a person recognizes there’s a problem with his or her drinking, quitting or cutting back can be as life-changing as pledges to work out more or promises to get a new job. Here are additional considerations about alcohol use disorders, quitting and staying sober.

Alcohol is a mass killer in the United States and is the defining public health issue for the 21st century. Driving under the influence has statistically little to do with those conclusions. Just under 10,000 motor vehicle deaths, 40 percent of the total, stem from alcohol-related crashes. To put that into context with other preventable deaths:
157,000 lung cancer deaths annually
50,000 people are killed in gun violence
39,520 breast cancer deaths
37,000 fatal overdoses from prescription drugs
34,000 suicides
30,000 Americans still die of the flu
18,000 people are killed in our hospitals by staph infections

Every alcohol-related car crash death is heartbreaking, but by the numbers, those deaths make up very little of the death toll from alcohol use. Even if you ended drinking and driving, alcohol is still our nation’s number one killer:
89,000 other deaths (not in cars) are directly attributed to alcohol; and,
1,000,000 more fatalities from diseases are indirectly attributed to alcohol (e.g. alcohol causes a condition leading to death).

It’s easy to be offended by drinking and driving. What’s even more offensive is the underreporting of the health effects of alcohol that prove alcohol is our defining health issue. Tobacco has at times held that mantle, but by comparison, only 473,000 die annually of smoking-related illness. Beverage alcohol kills more than a million. A 2012 study by the German University Medicine Greifswald found that heavy drinkers are at more risk of death than those who smoke.

The way America has responded to tobacco awareness campaigns holds promise for alcohol awareness campaigns, should one be mounted. In 1967, smoking was “in.” Seventy-six percent of adult men smoked. Today smoking is “out” and health officials at the Food and Drug Administration believe by 2020 smoking will be banned in all states. This is happening within just a generation and a half because smoking’s health effects are no longer underreported or reported only in obscure medical publications. With alcohol, as with smoking, people are entitled to their own opinions, but they are not entitled to their own facts.
-- Entire story appears on examiner.com

As a side note on a possible smoking/drinking link, a study from Baylor this summer found that smoking can increase the likelihood of a person becoming an alcohol abuser. Researchers discovered that even a small amount of nicotine can increase the likelihood because nicotine is powerful enough to change how the brain perceives alcohol as a reward it craves.
www.alcohologist.com

National Recovery Month: Five things to know about quitting alcohol

When a person recognizes there’s a problem with his or her drinking, it's usually followed by promises (often broken) to quit or cut back. Quitting or cutting back can be as life-changing as pledges to lose weight or goals for getting a new job. Here are five things to know about drinking, quitting and staying sober during Recovery Month, a national observance throughout September to educate Americans on how treatment can enable those with an alcohol use disorder to live a healthy and rewarding life.

1. Alcohol abuse and alcoholism are not the same thing, though are often treated as such. The newest version of the Diagnostic and Statistical Manual (DSM 5), the clinicians' diagnostic guide for related disorders, categorizes them together, but the conditions are different. Cutting back on alcohol consumption may be a practical outcome for an alcohol abuser. If a person has the disease of alcoholism, total abstinence is the only way to put the disease into remission. (Know the difference between alcohol abuse and alcoholism?)

2. Nine out of ten people who quit drinking fail to stay sober the first time they quit. More than half drink again within six months. Set your expectations accordingly. Lapse or relapse or slips are as likely with alcoholism than with any other disease. They are not the end of recovery. It just means you have another chance to quit. One man, who might be the most famous alcoholic ever, lapsed four times in 22 months. He quit a fifth time though. That’s Bill Wilson, one of the founders of Alcoholics Anonymous (AA).

3. AA is not the only game in town. There is rehab if you have the resources or insurance, either inpatient or intensive outpatient. There is counseling, either one-to-one or as part of a group… there are also several other self-help groups, such as Self-Management and Recovery Training (SMART), Secular Organizations for Sobriety (SOS) and Women for Sobriety (WFS). None of the latter enjoys the widespread availability of the 12-step program of AA however. Those who have success in sobriety acknowledge one common thing: No one gets sober and stays that way without help, whether through counseling or self-help groups or both.

4. A chronic, heavy drinker should never attempt to stop drinking on his or her own. Alcohol is the only drug aside from benzodiazepines (think Valium) in which the withdrawal can be fatal. Heroin withdrawal is not fatal. Cocaine withdrawal is not fatal. Alcohol withdrawal can be. Alcohol changes the body tissues. Once the tissues become dependent upon alcohol, it is possible that taking the alcohol away will cause cardiac arrest, stroke or seizures. Supervised detox means medical assistance is nearby and nearly all supervised detox involves medication to ease the physical discomfort of withdrawal, which increases the probability for success.

5. Changing a habit takes three to four weeks, which is one reason many inpatient rehabs have a 28-day program. But that isn’t nearly the end. More severe alcoholics are barely medically stable after just a month. It takes effort – some days more than others – for the first year of sobriety, and an acknowledgement that alcoholism is not curable so the change will mean making adjustments for the rest of one’s life. Alcoholics and non-alcoholics alike return to alcohol for the same reasons of stress, grief, guilt or shame. Getting sober and staying sober only begins with a desire to stop drinking and getting some help in the first part of abstinence. The rest of recovery is learning to live without alcohol for those stressors.

National Recovery Month, now in its 24th year, is an initiative started by the Substance Abuse and Mental Health Services Administration (SAMHSA).

SUNDAY SNIPPET September 1

Forgiveness has been romanticized for its powerful effect on wellbeing. But as seductive as getting well and being forgiven are, forgiveness isn’t all that simple to seek.  It is one of the stressors that hit hard the men and women with the disease of Alcoholism because, to recover, we need the healing forgiveness offers.  Every Silver Lining Has a Cloud notes forgiveness as one of four potential barriers to long-term sobriety.


While under the influence of the disease, we do wrong. A lot of wrongs. Mind you not everything was wrong, but our brilliant judgment was impaired, and we did some really inexcusable things while impaired. Alcohol works that way on normal people, too. It loosens lips or inhibitions, or both, even in the man or woman with the most sophistication and integrity or the highest standards. That’s no justification, just a fact, demonstrated at any black tie affair as abundantly as at bar time at the local meat-market bar. It’s also fact that alcohol-fueled interactions leave one or both sides feeling a need to seek forgiveness or a need to say, “I’m sorry.”

One of the greatest reminders of how complicated we tend to make things is right in Robert Fulghum’s All I Really Need to Know I Learned in Kindergarten. (Ballantine Books, New York 2004) It is among his basics: “Saying you’re sorry when you hurt somebody.” That’s the lesson practiced by every Alcoholic at some point in their sobriety. It’s the low-hanging fruit for every Alcoholic, even if they don’t hang around 12-step groups long enough to make amends in the ninth step. Saying “I’m sorry” is a good start but it only nicks the surface of seeking forgiveness.

You can’t seek forgiveness methodically the way you look for a book at Barnes and Noble or toothpaste in the grocery store or a lost sock. Fulghum’s right, apology is that easy . . . but forgiveness is far from being that easy.

Forgiveness isn’t organized. It’s a volatile mix of timing and personality and one critical ingredient: Forgiving yourself. Psychologists call it self-compassion. When an Alcoholic hasn’t started overcoming guilt and forgiven himself for stuff that was actually said or done, he cannot go looking for forgiveness from others. Not forgiving yourself is a sin of pride known as scrupulousity. Not sin as in biblical, capital-S, Sin but a sin as in an infraction against your own well-being.

By the way, when Alcoholics are jailed, this forgiveness-of-self process is stunted, increasing the probability of relapse upon release because self-forgiveness does not happen in that environment. “The experience undermines self-forgiveness on a daily basis,” says Casarjian. “Interaction after interaction fosters shame and reinforces the self-concept of the [Alcoholic] as an inferior person who has not been forgiven and never will be.”

Self-forgiveness is not redefining an offense as a non-offense, or condoning behavior that is hurtful/insensitive/abusive/lacking in maturity. It’s not excusing or overlooking actions or absolving yourself of responsibility. It’s simply not resenting yourself for your actions or your illness.

Think about it this way: If you can’t forgive you, can you realistically expect others to forgive you?

--from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pgs. 61-62

www.alcohologist.com