Going Public With Alcoholism

(This first appeared on Huffington Post)

Bottles

I am, among other things, an alcoholic.

When describing myself list-wise, alcoholic would probably come after writer, wife, activist, mom etc; but I am still, and in a very public way, an alcoholic. It’s the business of being public that puts me at odds with a lot of my fellow alcoholics. But I haven’t had anyone complain, and I am increasingly certain that going public isn’t such a bad idea.

Most alcoholics have very good reasons for keeping their anonymity. Outside of AA meetings their addiction — conquered or not — could cost them jobs, friendships, reputations. I lost some of all the above in my drinking days, but letting people know that those days are behind me poses no identifiable risks.

At six years alcohol-free, I moved to San Francisco in 1992 to marry the old friend known ever since as my Final Husband. I had to make a choice: Spend the rest of my life saying “No, thanks, I don’t care for one right now,” or, “You know, I’m an alcoholic. I can’t handle the stuff.” If I chose the latter, I figured I would soon not have to say it very often, if at all. I chose the latter, and never looked back.

The Final Husband, a man who does love his cocktail hour martini (gin, of course, up with a twist) and a good wine with dinner, bought into the plan. He would have far preferred a wife who would join him in wine appreciation, but took my word for the fact that I am an addict and vowed to support me. For the first several years of our alcohol-bifurcated union, he quietly took a bottle of non-alcoholic wine to cocktail parties so I could be comfortably unobtrusive. (This led to one rather hilarious episode that has become a favorite family story: From across the room in a crowded party thrown by one of San Francisco’s impeccably elegant hostesses, I once spotted a gentleman filling his lady friend’s glass from my non-alcoholic wine bottle. Unable to dive over the crowd to intercept, I watched as her pleasant smile turned to a disbelieving grimace and she set the glass down rather abruptly on a nearby table. We have imagined all manner of repercussions from this incident, but thought better of telling the hostess.)

From the beginning, I worked hard to craft comments that would not come across as judgmental or argumentative. Those were mild-mannered remarks like “I was a ‘social drinker’ for a long time but my drinking changed and became very bad for me.” Or, “Some of us can handle alcohol and some can’t. I really can’t.”

But I also fought hard against the common, almost reflexive attitude that being alcohol-free must leave my life barren and deprived, supremely dull. So I tried to say things like, “Whoa. I hated feeling like my words and thoughts were not super-sharp.” Or, “I really love waking up in the morning without feeling blurry, let alone hung over.” In the land of perpetual cocktail events, wine etiquette and Nectar-of-the-Gods believers, living outside that culture is generally assumed to be the worst of all worlds. I took the attitude that I’m delighted to see others enjoy themselves with alcohol, but for me, being without it is far more of a delight. Unadulterated joy, as a matter of fact. My comments at least carried the weight of demonstrated truth.

After the first few responses of shock and disbelief, my new friends on the Left Coast fairly quickly adapted to this strange situation and joined me in laughing about it all… or soon, ignoring the issue completely. I never imagined that it mattered to anyone but me. But here is why I suspect being public about being alcohol-free does indeed matter, and perhaps more of us should consider doing that.

One day I received a Valentine that reinforced my conviction about having taken the right course. It was from a woman I had known, though not intimately, for several years; we had frequently been together at concerts and parties. She is bright, pretty, accomplished in many areas, widely admired and respected. If anyone had ever suggested to me that she had an issue with alcohol I would have scoffed in utter disbelief.

The Valentine included several brief lines. She said she was sober now. She said I had influenced her to try that route to new life. Over the years I’ve gotten several other notes, like the email that just came, wanting to make sure I saw John Skoyles’ essay in the New York Times Sunday Review “about his coming of age with the bottle. I am 14 years plus now,” she wrote. “I have you to thank.”

It may be mid-summer, but that’s the best Valentine’s gift I’ve ever received.

 

Medicinal pot, Yes. Legal pot, bad idea

Wafting around California these days is a lot of rhetoric about legalizing marijuana, a proposition (#19) that will be on the ballot in November. Californians being Californians — I’m one; I know — and pot being pot, there is no shortage of heated opinion. Here is one more.

Countless Americans suffer from chronic or short-term conditions which could be relieved by marijuana. To deny them such relief simply makes no sense at all. The sooner everyone wakes up to the logic of marijuana as comfort care, and it becomes universally legal and available, the better.

Legalizing the weed for recreational delight, though — essentially making it available to all comers — makes very little sense at all. It’s an addictive substance, folks. It messes with your mind. All we need is a whole new population of messed-up folks to add to the messes we already have.

This is just one addict’s opinion. But if one addict’s opinion is only anecdotal, some others, below, are worthy of serious consideration. They were offered by the California Society of Addiction Medicine in an op ed piece by the Society’s president, Dr. Timmen Cermak, in the San Francisco Chronicle, August 22. The Society is taking no position on Prop. 19, Cermak explains, “but we wish Californians would look at the research before they make up their minds on how to vote.” This space applauds that suggestion.

The Society of Addiction Medicine is made up of “the doctors who specialize in the treatment of drug abuse; we work every day with people addicted to drugs, including alcohol,” Cermak writes. “We are a diverse group of doctors committed to combining science and compassion to treat our patients, support their families and educate public policy makers.”

Since very few of the Society of Addiction Medicine’s 400 physician members believe prison deters substance abuse, legalizing marijuana would have that small, back-handed benefit. “Most (of us) believe addiction can be remedied more effectively by the universal availability of treatment,” Cermak writes. “When, according to the FBI, nearly half – 750,000 – of all drug arrests in 2008 in the United States were for marijuana possession, not sales or trafficking, we risk inflicting more harm on society than benefit. Prop. 19 does offer a way out of these ineffective drug policies.”

But other research should raise alarm bells. Cermak’s essay is excerpted below, with a few points worth pondering bold-faced:

“Two-thirds of our members believe legalizing marijuana would increase addiction and increase marijuana’s availability to adolescents and children. A recent Rand Corp. study estimates that Prop. 19 would produce a 58 percent increase in annual marijuana consumption in California, raising the number of individuals meeting clinical criteria for marijuana abuse or dependence by 305,000, to a total of 830,000.

“The question of legalizing marijuana creates a conflict between protecting civil liberties and promoting public health… between current de facto legalization in cannabis clubs and revenue-generating retail marijuana sales… The society wants to make sure voters understand three basic facts about how marijuana affects the brain:

“– The brain has a natural cannabinoid system that regulates human physiology. The flood of cannabinoids in marijuana smoke alters the brain’s delicate balance by mimicking its chemistry, producing a characteristic “high” along with a host of potential side effects.

“– Marijuana is addicting to 9 percent of people who begin smoking at 18 years or older. Withdrawal symptoms – irritability, anxiety, sleep disturbances – often contribute to relapse.

“– Because adolescent brains are still developing, marijuana use before 18 results in higher rates of addiction – up to 17 percent within two years – and disruption to an individual’s life. The younger the use, the greater the risk.

“Marijuana is a mood-altering drug that causes dependency when used frequently in high doses, especially in children and adolescents. It’s important that prevention measures focus on discouraging young people from using marijuana.

“Prop. 19 erroneously states that marijuana “is not physically addictive.” This myth has been scientifically proven to be untrue. Prop. 19 asks Californians to officially accept this myth. Public health policy already permits some addictive substances to be legal – for instance, alcohol, nicotine and caffeine. But good policy can never be made on a foundation of ignorance. Multiple lines of scientific evidence all prove that chronic marijuana use causes addiction in a significant minority of people. No one should deny this scientific evidence.”

So we could use the tax revenues from legalized pot. But it may surely be worth thinking twice about what the concurrent costs will be, in illness and crime and human lives.

A once-a-month alcoholism shot? An anti-cigarette pill? Could happen

addiction
Image by alancleaver_2000 via Flickr

For those of us who got off addictions the old-fashioned way, reports from the recent American Psychiatric Association‘s annual meeting sound like good news, even if it’s a little late in coming. AP Medical writer Lauran Neergaard summed up the latest:

“This is the next frontier in substance abuse: Better understanding of how addiction overlaps with other brain diseases is sparking a hunt to see if a treatment for one might also help another.

We’re not talking about attempts just to temporarily block an addict’s high. Today’s goal is to change the underlying brain circuitry that leaves substance abusers prone to relapse.

It’s “a different way of looking at mental illnesses, including substance abuse disorders,” says National Institute on Drug Abuse Director Dr. Nora Volkow, who on Monday urged researchers at the American Psychiatric Association’s annual meeting to get more creative in the quest for brain-changing therapies for addiction.

Rather than a problem in a single brain region, scientists increasingly believe that psychiatric diseases are a result of dysfunctioning circuits spread over multiple regions, leaving them unable to properly communicate and work together. That disrupts, for example, the balance between impulsivity and self-control that plays a crucial role in addiction.

Addiction is a strange phenomenon, and we who know a lot about it (this writer kicked cigarettes in the 60s, alcohol in the 80s, crunching ice — you haven’t ever met an ice-crunching addict? Believe it. — five or six years ago) say it’s about time we got our own dysfunctional circuitry studies.

Think of it as if the brain were an orchestra, its circuits the violins and the piano and the brass section, all smoothly starting and stopping their parts on cue, Volkow told The Associated Press.

“That orchestration is disrupted in psychiatric illness,” she explains. “There’s not a psychiatric disease that owns one particular circuit.”

So NIDA, part of the National Institutes of Health, is calling for more research into treatments that could target circuits involved with cognitive control, better decision-making and resistance to impulses.

Addictive behavior has drawn attention from researchers and writers for years. A 1983 study done for the National Academy of Sciences by Alan R. Lang, Professor of Psychology at Florida State University reported that “some mental health experts find it useful to view addiction as including all self-destructive, compulsive behaviors”  and cited references to addictions as wide-ranging as caffeine (guilty), chocolate (definitely) and gambling (not on your life.)

Changing behaviors to conquer addictions, with a little help from therapies and therapists of all sorts, has been plugging along as a solution for decades. Takes a lot of work. Wouldn’t a magic pill be lovely?

Targeting brain circuits for addiction, relapse.