Despite the common acceptance of drinking in our culture, the destructiveness of alcohol cannot be ignored. In 1956 the American Medical Association recognized alcoholism as a disease. Prior to this, in 1944, the U.S. Public Health Service labeled alcoholism the nation’s fourth largest public health problem. In 1952, E.M. Jellinek supported the view of alcoholism as a disease with “a symptomatic progression of phases leading eventually from psychological to physical addiction.”
Facts About Alcoholism (Goodwin)
The alcoholic is commonly addicted to alcohol as well as caffeine,
tobacco and other drugs, thus we hear the phrase the “addictive
personality”.
The alcoholics tolerance for drinking builds over time, and requires
more alcohol to feel the same effect.
Alcoholics sometimes experience “blackouts” — time gaps with no memory
which occur for hours or days while intoxicated.
Alcoholics are three times more likely to be divorced than
non-alcoholics, and have a death rate three to four times higher than
non-alcoholics.
“Without exception, every family study of alcoholism has shown much
higher rates of alcoholism among the relatives of alcoholics than
occur in the general population.”
Alcoholism is a deceptive disease and a long term progressive
disorder. Although there are no exact patterns to the illness, it
varies for the individual in patterns of psychological and social
dysfunction, and medical complications, and it some situations can
lead to death. There is a subtle progressive aspect that makes it
difficult to judge the onset of addiction. When does acceptable
drinking change to uncontrolled drinking? Denial, a significant
symptom of the disease makes diagnosis more difficult.
The National Council on Alcoholism defines alcoholism as:
“A chronic, progressive and potentially fatal disease characterized
by tolerance and physical dependency or organ changes, or both.
Generally, alcoholism is repeated drinking that causes trouble in the
drinker’s personal, professional, or family life. When they drink,
alcoholics can’t always predict when they’ll stop, how much they’ll
drink, or what the consequences of their drinking will be. Denial of
the negative effects alcohol has in their lives is common in
alcoholics and those close to them.
The disease of alcoholism is widespread in its nature, and we now know
that alcoholism affects people of all ages, genders, ethnic and social
backgrounds. Because of the social stigma, embarrassment and denial,
families tend to keep the alcoholic’s drinking a secret. Alcoholism is
a disease that cannot be cured, hence the term” recovering alcoholic.”
The addictive personality remains after the drinking stops. The
potential for relapse is always there, and once a person decides to
take a drink, the obsession returns, and it’s hard to stop. Relapses
are intense, they bring the alcoholic back to their last stage of
active drinking.
Alcoholism cannot be cured, only arrested. Treatment is not always
successful, and relies on the alcoholic’s ability to control their
addiction. Now days, alcoholism is viewed as a family disease. The
family becomes co-dependent, by engaging in an unhealthy pattern of
enabling. Co-dependency is accepted as a disease separate from
alcoholism, but with similar characteristics.
Addict |
Family |
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The family member affected by the family illness which is alcoholism, tends to display these behaviors:
• Obsession with the addict
• Attempts to control
• Hope /Wishful thinking: “if only”
• Enabling/caretaking/guilt
• Unable to hold the addict accountable
• No or limited healthy boundaries
• Give money, time, energy
• Unable to say “no”
• Poor self-care
To help with the family disease, Alcoholics Anonymous (AA) was formed
in 1935. Al-Anon, for families of alcoholics, formed in 1951 and
Ala-Teen, for teenagers of alcoholic families, followed in 1957.
Children of Alcoholics groups started in the early 1980s. These groups
are recommended by professionals today.
Bradshaw states that all families are dysfunctional to some extent,
some of the time. The problem occurs when this pattern of dysfunction
exists over time and the family gets stuck and does not deal with the
issues. Some factors contributing to this are: denial by the family,
the behavior and personality of the alcoholic (may function, go to
work, and be non-violent). Bradshaw states that denial is partly
unconscious and is a defense mechanism that protects the self. It
maintains the status quo and keeps us from recognizing the truth and
contributes to keeping secrets. Bradshaw in his videotape series
Family Secrets emphasizes that the family is a dynamic system. When
there is a problem, the whole system is affected, not just the
individual.
RD Laing discusses the psychological “catch 22” of the disease of
alcoholism. He talks about getting caught up in verifying ones own
doubts and trying to confront denial in this poem from his book Knots:
“There must be something the matter with him because he would not be acting as he does unless there was therefore he is acting as he is because there is something the matter with him.
He does not think there is anything the matter with him because one of the things that is the matter with him is that he does not think there is anything the matter with him therefore we have to help him realize that, the fact that he does not think there is anything the matter with him is one of the things that is the matter with him” - Lang
It is through Al-Anon and/or Children of Alcoholics that a family can begin to recognize their own set of dysfunctional behaviors.
Advanced Progression of Alcoholism
Goodwin typifies the progression of the disease as follows:
“The ‘typical’ white male American alcoholic begins drinking heavily
in his late teens or early twenties, drinks more and more through his
twenties, starts having serious problems in his thirties, is
hospitalized for drinking (if ever) in his mid or late thirties, and
is clearly identified by himself and others as alcoholic—a man who
cannot drink without trouble—between age 40 and 50.”
“But a small minority of alcoholics do suffer brain damage due to
deficiency of thiamine, a B vitamin. The malnourished alcoholic gets
too little thiamine, and if the deprivation persists and is severe,
certain well-demarcated areas of the brain are destroyed. These areas
are, among other things, involved in memory storage, resulting in
severe memory impairment. A German named Wernicke and a Russian named
Korsakoff first described the disease as directly caused by a thiamin
deficiency, and is linked to long-term (chronic) alcohol consumption -
however, some patients who do not abuse alcohol may also develop this
syndrome. Wernicke-Korsakoff syndrome is also known as wet brain.
Most commonly, Wenicke-Korsakoff syndrome is seen in alcoholics
because heavy drinkers typically are poor eaters. Alcohol also
interferes with the proper absorption of nutrients from the digestive
system. Thiamin is essential for energy production for proper neuron
function. If thiamin levels are very low, the neurons may either
become damaged or die. Wernickes encephalopathy - this is a type of
brain damage in which the initial symptoms appear. The individual has
abnormal gait and eye movements.Korsakoff syndrome - if Wernickes
encephalopathy is left untreated the patient will start developing
this psychiatric disorder, which includes dementia and psychosis.
Individuals with Wernicke-Korsakoff syndrome are often thought of as
drunk when they are not. This is due to the symptoms of confusion, as
well as wobbliness, unsteadiness, and lack of coordination. As there
is some memory loss, they may confabulate - replace the gaps with
imaginary remembered experiences consistently believed to be true.
These expressed imaginary experiences are not attempts at deceiving.
The patient may also have hallucinations and vision problems, and they
may seem malnourished.
The condition is devastating, and the chronic Wernicke-Korsakoff
patient needs custodial care for the rest of his life.”
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