While not everyone who consumes alcohol will become an alcoholic, it is important to bring to light that with habitual use of alcohol, a person can develop a dependency that can spiral into a very serious health condition.
Unfortunately, many people are not aware of the early signs that can lead to alcoholism. Alcoholism is a chronic progressive disease, just like diabetes or high blood pressure. Alcoholism, if left untreated, can progress until it causes death due to excessive use or alcohol-related illnesses.
Today with the help of Army National Guard veteran, Michael Coffman Jr., Lejeune-New River Behavioral Health clinical and prevention supervisor, we are going to talk about ways to help you identify some of the common indicators of alcohol abuse, risk factors and how you can help veterans and active-duty service members who may be struggling with alcoholism.
According to Coffman, many people initially drink for the relaxation effects of alcohol or because it is part of the environment they are in. The danger comes when alcohol is used as a way to deal with problems.
“Early intervention and treatment are very important,” said Coffman. “The longer (the problem) is left untreated, the greater the potential for adverse medical and life-altering consequences.”
Alcoholism disguises itself in many ways, making it easy to dismiss abnormal behaviors, however, there are signs that can help a person determine if something is not right. The signs that mark the beginning of an alcoholic’s struggle with addiction are broken down into three phases in the Jellinek Curve.
During phase one, the person drinks to seek relief. As their drinking increases in regularity, so does their alcohol tolerance, putting the person at higher risk because they don’t feel impaired — this is a major red flag of an underlying problem. At this stage,
you will notice the person becoming more preoccupied with drinking. Common actions reported by recovering alcoholics are finishing their friends’ drinks or “casually stealing a few sips.”
“One of the warning signs people need to be mindful and watch for is increased tolerance — needing more to get the same effect,” said Coffman. “Tolerance is a really big one that we try to teach about.”
It is at this stage where the onset of memory lapses start occurring and blackouts start happening. The person becomes secretive about their habit and starts hiding alcohol, oftentimes masking their drinking so others don’t notice how much alcohol they are consuming. Alcoholics tend to deflect attention with arguments when they feel that others start noticing their increased use of alcohol and start to isolate themselves so they can drink alone. They have a cognizance that something is way off even though many of their experiences may be in a blackout state.
“From the standpoint of treatment and prevention education, we look into educating people on the different risk factors that play into that,” said Coffman as he explained how they explore social influences, psychological attitudes and belief systems. “If they have a biological parent’s history, they are four times more likely to become alcohol or drug dependent.”
When the person’s dependence increases, he or she starts experiencing an urgency for the first drink. The disease starts wreaking havoc in a person’s sense of well-being and they start to feel guilt and shame. But because of the dynamics of the disease and how it affects the processes in the brain’s limbic system, the person starts to rationalize that they are not as bad as other people and continue to drink.
“A lot of times, people define whether they have a problem or not based on what types of consequences they have associated with that behavior. So if somebody is partying, drinking and they do it all the time, but they haven’t had a DUI or any perceived consequences, then they are not going to see that as an issue,” said Coffman. “Therefore it is going to continue to progress until something does happen that kind of gets their attention. They don’t have the ability to recognize danger or make important decisions (due to) the chemical changes in their brain.”
“A lot of people think that drinking is a choice. It may start as that, but after they are manipulating their brain and the chemicals associated within, it becomes something they can’t stop without intervention and treatment. That is what makes it a disease — it rewires your brain.”
From a scientific standpoint, what is happening is that alcohol alters the neurotransmitters in the brain. One of the main neurotransmitters, which influences the development of alcohol dependency and can cause relapses, is dopamine, according to the U.S. National Library of Medicine.
Alcohol temporarily elevates the levels of dopamine that are naturally released in the brain. As the person increases their use of alcohol, the body starts producing less dopamine to regulate the levels. Dependency occurs when the body is not producing enough and the brain needs to restore the levels causing the person to feel the need to drink more to feel ok. Serotonin, y-aminobutyric acid and glutamate also are affected and play a big role in the pattern of addiction as the brain chemistry begins to change.
During phase two, the person’s memory starts to fail and blackouts start to increase. The person will seek excuses to drink and try geographical escapes to justify their drinking. Another big red flag during this stage is that the person will isolate more and more and binge drink. The person starts losing interests in things they used to enjoy and relationships start to take a toll. As the person’s ability to stop drinking decreases, persistent remorse becomes a common factor when resolutions to stop drinking fail. The alcoholic will begin to neglect their nutrition. It is also during this phase when the person will start experiencing money troubles.
A common sign among people in this stage is that they will start experiencing tremors and crave early morning use. At this stage the person’s alcohol tolerance starts to decrease, he or she will start exhibiting a lack of good judgment, aggressiveness and depression. The alcoholic is no longer drinking to escape a problem or improve their mood, but to avoid the physical withdrawal symptoms like headaches and nausea.
As the disease progresses, the induced overproduction of serotonin causes the person to experience muscle stiffness, shivering and even seizures depending on how far the disease is advancing.
“The chemical imbalances make it really difficult to stop without intervention,” said Coffman. “Once you get to that point you can’t reverse the symptoms, you can only treat them. The mindfulness and awareness of risk factors is very important.”
Coffman places great emphasis on the importance of educating our military community about the risk factors so service members and veterans can seek help for themselves or help someone who may be in denial or who may think he or she can stop on his or her own.
According to a report by the National Institute of Alcohol Abuse and Alcoholism, stopping cold turkey can be extremely dangerous. One of the most severe and life-threatening complications are seizures due to alcohol withdrawal. Seizures affect one in 20 of untreated alcohol withdrawal cases with 90 percent occurring within 48 hours of the person stopping alcohol consumption without medical supervision.
“It can be medically unsafe to suddenly withdraw from prolonged alcohol use,” said Coffman. “Appropriate medical intervention and detoxification are necessary. People who are trying to help ultimately can become enablers without even knowing. You can support the person without supporting the behavior. Being consistent is important. If you have a concern, address the concern, but not in a confrontational way. It is important for them to understand the disease — not only for the person suffering from it but for the family members as well.”
According to Coffman, getting help in the early stages is the best form of prevention, as it is for family members to educate themselves about the disease. Providing positive encouragement to the person affected gives them a positive reason to want to seek help.
During phase three, the signs of alcoholism are the onset of lengthy intoxications, the person’s physical appearance starts to suffer and their health begins to deteriorate as their body becomes less able to clean toxins out of their blood. Their immune system is compromised along with the way their body processes medications and nutrients. The possibility of death becomes a reality as the alcoholic enters the end stage.
As the brain becomes more affected, the alcoholic will exhibit impaired thinking and will become obsessed with drinking. At this stage, they are not able to take action on their own and they must consume alcohol in order to function. Being a functional alcoholic is much less likely in the final stages of the disease. Alcoholics in this stage experience painful withdrawal symptoms and really bad depression, which can lead to suicide.
“In the late chronic stage of alcoholism, they are doing things despite the consequences because they can’t control it,” said Coffman. “The best way to help someone else is to take care of yourself and talk to others who can help provide support.”
Regardless of your circumstances, it’s never too late to seek help. While the disease may not be curable, it is treatable.
“Your present circumstances don’t determine your destiny, only your starting point,” said Coffman.
To conclude with this article, I’d like to share a story about a combat wounded veteran, who upon medical discharge, struggled with post-traumatic stress disorder and injuries that left him depressed. The veteran, whose name will be kept confidential for privacy reasons is a close friend of Coffman.
“He became heavily addicted to opiate pain medications and alcohol, and tried to take his own life on several occasions,” said Coffman. “He was involved in bad relationships that only propelled his addiction and deteriorated his mental health and self-confidence.”
According to Coffman, the veteran began his journey to recovery by seeking out treatment and made the decision to separate himself from the environments that contaminated his life. He built upon his bonds with family and fellow veterans and met a woman who is now his wife.
“He has a dedicated purpose and goals in his life again,” said Coffman. “His determination and will to respect himself as much as he does this great country is something to admire and be very proud of.”
“Change is possible to anyone who is willing to commit themselves to the process and understand that it’s a marathon, not a sprint,” said Coffman. “Treatment works and people do recover and whether or not we are successful at saving a life, it is never a waste to try.”
According to Coffman, the Substance Abuse Program Prevention team teaches the Prime for Life guidelines which allow someone without a diagnosed alcohol use disorder to consume alcohol at a low-risk level. Family history, current medications, mood state and situational circumstances should also be taken into consideration when consuming alcohol.
For information about Prime for Life visit, http://ireta.org.
Editor’s Note: Story by Ena Sellers.