Saturday, November 30, 2013

SATURDAY REWIND: Shaming leads to poor outcomes, relapse

Shaming someone with the disease of alcoholism or another substance abuse problem is a centuries-old practice that does nobody any good (except maybe the shamer, in a warped sort of way).  Science backs that up now, too, as this piece from the alcohol research news archive points out.

To predict whether an alcohol abuser or someone with the disease of alcoholism will hit the bottle again, ignore what they say and watch their body language for displays of shame, a University of British Columbia study finds. The University introduced its research in a news release February 4 in advance of publication in Clinical Psychological Science journal.

The study, which explored drinking and health outcomes in newly sober recovering alcoholics, is the first lab work to show that physical manifestations of shame – from slumped shoulders to narrow chests – can directly predict a relapse in people who struggle with substances.

“Our study finds that how much shame people display can strongly predict not only whether they will go on to relapse, but how bad that relapse will be – that is, how many drinks they will consume,” says UBC Psychology Prof. Jessica Tracy, who conducted the study with graduate student Daniel Randles.

Forty-six drinkers completed questionnaires about their physical and mental health while Tandy and Randles assessed their body language — finding unconscious physical mannerisms are a powerful sign of future relapse, while the written expressions of shame offer almost no clues. Tracy says the amount of shame displayed was directly tied to the number of drinks an alcoholic will have on that first binge after giving up sobriety.

The issue of shame is one of the four largest emotional situations tied to relapse. This may be the first scientific study to empirically link shame and drinking, however the concept has been around a long time, dating back to the work of psychologist John Bradshaw in the 1980s in his Healing the Shame that Binds You. According to the new relapse book, Every Silver Lining Has a Cloud, “The inability of an alcoholic to deal with the social stigma attached to the disease of alcoholism can be countered by group counseling and group self-help, e.g. Self-Management and Recovery Training (SMART) or 12-step groups, such as Alcoholics Anonymous. In any of those group environments, those attempting recovery see and accept they are not alone, that others feel the shame, too, and by talking through the emotional stressor they can stay sober.”

The UBC findings have important implications for people struggling with addictions, their friends and families, and researchers and clinicians who study emotion and addiction, the researchers say. “The research is also important in light of the fact that some policymakers and judges have argued for the use of public shaming as a punitive measure, or treatment, against crime. Our research suggests that shaming people for difficult-to-curb behaviors may be exactly the wrong approach to take,” Tracy and Randles argue. “Rather than prevent future occurrences of such behaviors, shaming may lead to an increase in these behaviors.”
-- from (see full article)

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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, November 24, 2013


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 some 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. 
Adrenal glands secrete the stress hormone cortisol and, 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 a cheap, fast, easy, available 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.”
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 drink 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. 

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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. 

Saturday, November 23, 2013

SATURDAY REWIND: Understand relapse, because it's not at all uncommon

A man I've come to admire in recovery, Bill, relapsed four times in 22 months. It's part of having a chronic disease as this article from the alcohol research news archive points out.  However, so is bouncing back from relapse part of having a chronic disease.  Bill relapsed four times, but gave sobriety a fifth try.  His name: Bill Wilson, one of the founders of the 12-step group Alcoholics Anonymous. Whether or not you subscribe to AA's methods, here is some of the science behind relapse.

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 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 (see full article)

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 stress—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?”

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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. 

Friday, November 22, 2013

Purple with a Purpose: Alcohol misuse ups pancreatic damage, especially in men

People wearing purple Nov. 22 are doing so in support of Pancreatic Cancer Awareness Month. One of the easiest ways to reduce the risk of pancreatic disease and cancer is to cut back on the alcohol or stop all together. Alcohol abusers and those with the disease of alcoholism are 1.6 times more likely to develop pancreatic cancer, the most fatal of cancers and one of the hardest to detect.

Pancreatic cancer is currently the fourth leading cause of cancer death in the United States, but is expect to become the second in 2020. According to the Pancreatic Cancer Action Network, 45,000 Americans will be diagnosed with the disease this year alone.

Pancreatic cancer is more common in men than women, however it has recently moved from the tenth to the ninth most common cancer in females. As an additional shot across the bow for men: University of Pittsburgh School of Medicine researchers isolated a gene variant in men that puts those who drink heavily at risk for pancreatitis. While painful and treatable, long-term pancreatitis has been linked to cancer of the pancreas.

The researcher’s report, online in the journal Nature Genetics, found the genetic defect in half the men with chronic pancreatitis.

Pancreatitis is a disease in which the pancreas becomes inflamed. Acute pancreatitis occurs suddenly, with severe upper abdominal pain and can be a serious, life-threatening illness if not treated. The most common symptoms of pancreatitis acute abdominal pain, pain radiating into the back, nausea, vomiting and fever. The symptoms may last for a few days then disappear off and on.

Alcohol abuse and alcoholism are risk factors for developing the disease of pancreatitis, but the new research shows men with a flaw on the X chromosome are more likely to have pancreatic troubles if they drink heavily. Women with the same flaw were not as likely to get the disease. The study suggests the second X chromosome in women protects them, while men have only one X chromosome and a Y.

The gene doesn’t cause pancreatitis but increases the risk in drinkers.

“The discovery that chronic pancreatitis has a genetic basis solves a major mystery about why some people develop chronic pancreatitis and others do not,” study lead author Dr. David Whitcomb, professor of medicine, cell biology and physiology, and human genetics, said in a university news release.

“We also knew there was an unexpected higher risk of men developing pancreatitis with alcohol consumption, but until now we weren’t sure why,” he said. “Our discovery of this new genetic variant on chromosome X helps explain this mystery as well.”
(from -- see full article)

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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.

Thursday, November 21, 2013

Five considerations about alcohol and the holidays

For those in recovery, sober is the only way to do the holidays.  For non-alcoholics, here's some food for thought...

Nearly half of annual domestic sales of wine and roughly 40 percent of higher-priced spirits are sold in the final three months of the year as consumers tend to drink more and buy alcoholic beverages as gifts or to bring to holiday parties and other special occasions. Then there are the office parties and gatherings of family and friends.

For many, abstinence is a year-round plan, and for those who may be concerned about their drinking, here are five fast facts about the season of drinking that demonstrate the value or moderation or abstinence.

Parents, not peers, set drinking examples. Much of parental alcohol abuse or the disease of alcoholism is only occasionally visible to the world outside the family. However, children get their attitudes toward alcohol by observing how the adults around them behave while drinking. Christmas can be stressful. Getting home, complaining to our partner and having a drink seems normal. But stop and think what that might be teaching your children – that alcohol is a coping mechanism.

Drink responsibly – you don’t have to finish the bottle just because it’s open, or even drain your glass. Know your limit. Once you’ve reached it, set the example. Also, when planning a family celebration where teens might be present, try to reach an agreement on rules for them beforehand. Don’t feel pressured to let your teen drink if you’ve already decided they shouldn’t drink before a certain age. And don’t feel hypocritical for drinking when you’ve told your kids they can’t. Explain that alcohol is for adults because their bodies have finished growing, and even then, there are laws about drinking and driving. (See nine more alcohol tips for holiday parenting.)

Alcohol adds calories. Many Americans worry about the extra calories from that green Jello stuff or slab of pumpkin pie. Put down the extra glass of wine and save yourself about 200 calories. If you drink a glass of wine before dinner, another glass with dinner and a sweet wine for dessert, that’s more than 400 calories in addition to the meal. If three beers help that dry turkey seem more palatable, that will add an extra 450 calories. (See more in this related article.)

Company parties are back. A recent survey by executive search firm Battalia Wilson found that 91 percent of the companies polled will have holiday parties this year, a significant increase from last year’s low of just 74 percent. If you’re a business owner hosting a party, you have liability. For a former drinker struggling with sobriety, there is no shame in skipping a bash. Otherwise, if you’re an attendee, ginger ale looks just like a cocktail and may keep you from legal trouble on the roads, because…

More people get in collisions during the holidays. Twenty-five people die on an average day in alcohol-related crashes. Between Thanksgiving and New Year’s, the average spikes to 45 alcohol-involved traffic deaths daily. December is Drunk and Buzzed Driving Month to emphasize the dangers of drinking and driving during the travel- and celebration-intensive season. Motor vehicle violations involving alcohol increase an average of 54 percent after Thanksgiving. Twelve hundred Americans will die on the roads this month from intoxicated driving crashes. The numbers are higher in years when Christmas and New Year's land on a weekend, which they won’t this year.

Alcohol-related violent crime increases in December. The Department of Justice reports alcohol-related violent crime is highest in December compared to the rest of the year except July – which is a statistical tie. One-third of state prisoners and one-fifth of federal prisoners report alcohol use at the time of the offense. Twenty-one percent of federal prisoners serving time for a violent offense reported alcohol use at the time of the offense. An earlier study in 2008 by Pew Research revealed that 25 percent of state prisoners given a standard questionnaire to screen for the disease of alcoholism tested positive.
--from (see full article)

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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, November 17, 2013


Grieving is something in which few aspire to be experts.  Even non-alcoholics are poor performers in accepting and grieving their losses... but an Alcoholic in recovery had better not skip over the grief process. This excerpt from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety shows the vital connection between successful long-term recovery and transcending loss.

You will not find recovery without the process of mourning. Most of us try to pull that off, but we can’t. Period. There is no conceivable scenario to avoid mourning in sobriety. You cannot go from drinking to recovery by skipping the pain of grief any more than you can go directly from Kindergarten to college. “After all, if our life is altered so dramatically by our trauma that we can hardly recognize it as our own, we might think it as a death,” says Kathryn Cramer. (Staying on Top When Your World Turns Upside Down, Penguin Books, New York 1990) “In a small but real way our life as we once knew it has died.” Death and grief go hand in hand.

You have a grievable loss. Failure to grieve, failure to grieve appropriately (e.g. without booze), or failing to even identify our losses as losses, sacks more attempts at long-term recovery than any other stressor. One thing few people respect or even notice about Alcoholics is the upheaval and loss we go through. Instead people seem more interested in the upheaval and loss we create.

Attention in group therapy is showered on abstinence. But look to those who have the most experience in their own recoveries and you’ll see people who have identified their losses, grieved them and transcended them. Every single one of them knows fully what he or she lost and is over it. Grief—the process, not the noun—belongs in treatment for Alcoholism. A full, real grief process. Not the infomercial version. It doesn’t happen in a series of handouts or a couple of DVDs. There are no shortcuts, and because there aren’t it is often overlooked in short-term treatment efforts. Mourning has to be an essential part of recovery’s curriculum. The carnage Alcoholism causes in our lives needs to be seen in the same light as grief counselors view a loss such as a natural disaster or untimely death.
--  Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pg. 72

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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. 

Saturday, November 16, 2013

SATURDAY REWIND: Meds boost outcomes, but no silver bullet for alcoholism

Recent news about the effective use of anti-seizure drug Gabapentin in the treatment of the symptoms of alcoholism and the growing list of approvals for the new drug Selincro (see article) draw attention to science's search for the elusive cure for the disease of alcoholism.  This article from the alcohol research news archive looks at two pharmaceutical solutions for early recovery woes, but notes there is no pill today to cure alcoholism. Period.

New research released by the Society for the Study of Addiction produced positive news about two prescription drugs used to help prevent lapse in alcoholics in treatment trying to stay sober. The drugs, acamprosate (marketing name: Campral) and naltrexone (ReVia) were found to help those struggling in different phases of recovery. Acamprosate helped manage emotional triggers in people who had already stopped drinking, naltrexone helped manage cravings in heavy drinkers who are trying to stop drinking or recently quit.

The study findings are encouraging but the medications still fall short of being a silver bullet. There is no alcoholism pill.

The slight increase in abstinence in the 2012 treatment study shows progress is being made as science looks for that alcoholism pill. Emphasis in treating alcoholism and alcohol use disorders instead remains focused on therapies such as group or one-on-one counseling and 12-step meetings or their alternatives.

The course of recovery, even for those taking the medications, centers more on talk and less on pills because while drugs like acamprosate and naltrexone help change brain chemistry, they don’t change minds. Once you take away the alcohol, sometimes with the successful use of prescribed medicine, the minds still need work. Alcoholics who slip in recovery and non-alcoholics drink for essentially the same reason: It relieves social/physical/emotional tension. With alcoholics however, their bodies are programmed differently genetically and respond to drinking with more drinking. So counseling or a 12-step meeting helps those abstinent keep from taking the first drink. Recovery has very little to do with stopping the drinking and those successful in recovery admit they’re success is based on learning or relearning how to manage life’s tensions.

Generics of both pills can be found at most pharmacies when doctor and patient agree that medication can help maintain abstinence as part of, not instead of, a sobriety plan. The generics are not currently on the lists of deeply discounted prescriptions at the three largest retail pharmacies.
-- from (see full article)

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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. 

Friday, November 15, 2013

USA Best Books Awards honors alcoholism recovery book Every Silver Lining Has a Cloud

Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety has been recognized as an Award-Winning Finalist in the Health: Addiction/Recovery category of the 2013 USA Best Book Awards, sponsored by USA Book News. Using startling statistics and fresh medical discoveries interwoven with his personal account of the disease of alcoholism, author Scott Stevens relays the symptoms of sobriety, key stressors that lead to relapse and success factors that help keep relapse at bay. The result is an award-winning non-fiction book with a unique, bold take on sobriety and is a must-read for alcoholics in any stage of recovery and their loved ones.
According to the National Institute on Alcohol Abuse and Alcoholism, 21.9 percent of women and 42.3 percent of men have three or more drinks on a “typical drinking day.” Every person with an alcohol use disorder affects, on average, another eight people. Alcohol is the leading drug of abuse in the United States and the third-leading cause of death. Nine of ten ex-drinkers relapse: Stevens answers 'Why would anyone return to the misery?'

Many recovery books are written either like clinical texts or they're by accredited experts, not alcoholics. Stevens is a health writer with more than 120 alcoholism articles, archived on his site, However, with Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, he admits he's had to “eat his own cooking.” A mutual fund executive by day, Stevens once had a two-liters-a-day whiskey problem. I wanted to tell how relapse feels. You don't need a Ph.D. to read it. I felt it was important to include real experience plus the clinical research. Using my own story let me say to alcoholics, 'I'm just like you. I have been through the emotions, from anger to joy, before and after quitting.' The message in the back third of the book gives compelling medical reasons to not drink in the first place and why non-alcoholics should care. The material leading up to it is research I wish I knew during my struggles.”
USA Book News, the premier magazine featuring mainstream and independent publishing houses, announced the 2013 USA Best Books Awards honorees Nov. 14. Jeffrey Keen, President and CEO of USA Book News, said the tenth annual contest yielded over 1,500 entries. “The results represent a phenomenal mix of books and traversed the publishing landscape: St. Martin’s Press, Random House, Simon & Schuster, Penguin, and hundreds of independents.” Stevens is an independent author. Keen adds, “Our success begins with the enthusiastic participation of authors and publishers and continues with our distinguished panel of industry judges with extensive editorial, PR, marketing, and design expertise.”

Sunday, November 10, 2013


For this week's excerpt, I'm going back to the 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.  With modifications over the summer to the practitioners' manual -- the DSM 5 -- and even bigger changes coming in healthcare coverage in U.S., it could be time for a reminder.
 "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."

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.

The new radio interview replay is available at 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. 

Saturday, November 9, 2013

SATURDAY REWIND: Connecting TV advertising to alcohol use disorders in youth

The U.S. Centers for Disease Control and Prevention Nov. 7 noted that alcohol commercials reached one in four children in the 25-largest TV markets.  This article from the alcohol research news archive looks at the impact of ads on young people and how the ads -- especially in sports broadcasts and events -- may contribute to underage drinking and other legal, social or health problems.

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.”
-- from (see complete article)

Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at 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. 

Friday, November 8, 2013

Affordable Care Act final parity rules expand coverage for alcoholism and mental health

The Obama administration Nov. 8 released long-awaited rules that require health plans to treat alcoholism, addictions and mental illness on par with other physical ailments.  According to the U.S. Department of Health and Human Services (HHS) brief on the Affordable Care Act – slangily called ObamaCare – the nation is poised for the “largest expansion in substance use disorder coverage in a generation.” Under the new law, next year all new small group and individual health plans are required to cover treatment for alcohol abuse and the disease of alcoholism and do so at parity with other medical and surgical benefits.

In commenting on new final rules for the expansion of healthcare coverage, HHS noted one in three of those currently covered in the individual health plan market has no coverage for alcohol use or other substance use disorders. Nearly one in five presently has no coverage for mental health services.

Individuals with the coverages today may have gaps compared to coverage for medical or surgical procedures. HHS estimates that 3.9 million individual plan participants today will gain either mental health or substance use coverage or both. “We also estimate that 1.2 million in small group plans will receive (benefits) under the Affordable Care Act.” Further, the agency added that one in four Americans who lack health insurance coverage altogether today have a mental health condition, a substance use disorder, or both.

Expansion of coverage in general, as well as to those who presently have no alcohol or drug treatment access at all today, is expected to bring about a dramatic shift in the delivery of services. With as much as eight percent of the population alcoholic, and three times as many abusing alcohol, the new law forces an evaluation of the type of services delivered, the venues where they are delivered, the individuals who will receive the services, the work force that delivers the services and how services are measured/evaluated.

The new statute’s expanded coverage could also mean more is put into drug and alcohol misuse prevention. Today, almost $223 billion is lost to the U.S. economy from alcohol use disorders alone. The figure includes lost productivity and corrections as well as health and other social costs.
Beginning January 1, 2014, all plans are required to view substance use disorder treatment as an Essential Health Benefit according to the final rule. Essential Health Benefits also will be extended to the previously uninsured.

The final rule also closes gaps in parity rules for 30.4 million insured Americans, meaning their older plans will cover benefits for substance use disorders to the same level of general medical and surgical coverages.

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, November 3, 2013


Last weekend's excerpt from Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety and this weekend's both lead into the chapter on communication, a vital part of getting into and stay in recovery.

We need five things to shelter a recovery (aside from the obvious don't-take-the-first-drink mandate). The five basics to keep us on the path moving from abstinence to sobriety to recovery and navigating that path without the relapse detours:
And Responsibility.

We can have none of those five without people on whom we can rely and the communication we share with them. Several studies bear this out: The most recent (June 2010) is from the Center for the Study of Addiction and Recovery at Texas Tech University. This work demonstrated that those who dealt with stress by avoiding it had twice the frequency of alcohol cravings compared to people who used communication strategies to confront and understand stress.

At life’s intersections, if we don’t communicate well with others and do it with specificity and substance, we’re going to get t-boned.

If communicating feels one-sided at first, you’re doing it right. It has to be one-sided and you may feel like you’re just taking. It is all about the Alcoholic. And it has to be, at least at first. AA and other recovery resources will point out that in early recovery anything you put ahead of your sobriety you will lose. Davis Prend adds, “In the beginning . . . a definite period of self-absorption is necessary. In some ways you have to be completely, narcissistically involved in order to activate the healing process.” You’re not really in a position to give to others until you give to yourself first.
--  Every Silver Lining Has a Cloud: Relapse and the Symptoms of Sobriety, pg. 87

The new radio interview replay is available at 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. 

Saturday, November 2, 2013

SATURDAY REWIND: Alcohol warning for prediabetes, type-2 diabetes during Diabetes Month

November is American Diabetes Month -- the 14th is World Diabetes Day -- and this article from the alcohol research news archive notes that among the many health risks associated with alcohol, a significant danger among them is developing type 2 diabetes.

The blood sugar disorder has reached near epidemic status in the United States and has largely been blamed on an increase in the percentage of the population considered overweight. However, alcohol abuse and the disease of alcoholism also contribute to the disease.

Heavy alcohol use (with moderate use being defined as one drink daily for women, two a day for men) damages the pancreas, the organ responsible for producing insulin naturally to regulate blood sugar. The more a person drinks, the more damage to that organ and the higher the risk of developing prediabetes, which can lead to type 2 diabetes.

According to the American Diabetes Association (ADA) , prediabetes is when a person's blood glucose levels are higher than normal but not high enough to be type 2 diabetes. Prediabetics are more likely to develop type 2 diabetes.

The risk of prediabetes may be even higher for people with high blood pressure, according to preliminary research introduced April 18 at the European Association for Cardiovascular Prevention and Rehabilitation's EuroPRevent meeting. Lucio Mos, of San Antonio Hospital at the University of Padova, Italy, found that patients with high blood pressure who drank more than 10 drinks a day had a six-times higher risk of developing a prediabetic condition.

Drinking alcohol, especially in large quantities, contributes to diabetes in three ways.
1. Heavy drinking can reduce the body’s sensitivity to insulin (according to the journal Alcohol and Alcoholism)
2.Diabetes is a common side effect of chronic pancreatitis, which is overwhelmingly caused by heavy drinking, especially in men. (See related article on the Y-chromosome and pancreatitis)
3.Alcohol contains a huge amount of calories. One beer can be equivalent to a slice of pizza. (see article on alcohol calories) The extra calories increase your chance of becoming overweight, another diabetes risk factor.

According to the U.S. Centers for Disease Control and Prevention (CDC), 26 million children and adults in the U.S. have diabetes and another 79 million Americans have prediabetes. Many people with alcohol use disorders already may be prediabetic and not know it, according to the ADA, “because the symptoms develop so gradually, people often don't recognize them. Some people have no symptoms at all.”
Signs of prediabetes include:
unusual thirst
frequent urination
blurred vision
extreme fatigue
frequent infections
cuts/bruises that are slow to heal
tingling/numbness in the hands/feet
recurring skin, gum or bladder infections

Diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults, and a major cause of heart disease and stroke. It's the seventh-leading cause of death.
--from (see full article)

The new radio interview replay is available at 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.