Science is learning more and more about the biological damage to the brain caused by alcoholism, and there are more and more medical treatments to help ameliorate the damage. The biological damage is the easiest to understand. The alcoholic mind is harder to understand. What’s difficult to deal with is the lingering psychological damage caused by alcoholism and past behaviors under the influence. This post is about alcoholism, but most of it pertains to addiction to other drugs such as opiates, cocaine, benzos, etc.
Once an alcoholic has been abstinent from alcohol for a period of time, the psychological damage is easier to assess. During active alcoholism and early withdrawal, alcoholics are often misdiagnosed psychologically. Alcoholism causes strange, irrational behavior (rational to the alcoholic, but irrational to others), and most alcoholics are anxious or depressed due to the consequences of alcoholism. The depression is also due to the fact that alcohol itself is a depressant.
The recovering alcoholic can experience intense, painful and persistent feelings of shame, fear, anger, depression, and any other feeling known to man. If these persistent emotions and states of mind are not dealt with, sobriety becomes an unbearable experience. If the painful, confusing, disorienting emotions and the uncomfortable states of mind are not dealt with, the recovering alcoholic is at risk for relapse. Most often, group therapy, counseling, support groups and behavior changes are enough for the painful emotions to subside, but if the depression or anxiety continues, a doctor who understands addiction should make appropriate recommendations — there might be a dual problem of alcoholism and depression or alcoholism and anxiety or alcoholism and some other mental health problem.
In treatment we help clients deal with their emotions and states of mind as they relate to alcoholism. Once the alcoholic (the drug addict of any sort) accepts their condition and understands that changes are necessary, the combination of talking therapy and a plan of action enables the person in recovery to perceive his/her reality as it is, and to begin changing that reality. If a person is going to change they must first acknowledge the starting point.
Often, the starting place is not pleasant, to say the least. The person in recovery doesn’t like admitting that they’ve hurt and alienated loved ones, wasted their savings, lost another job, have a DUI on their record, but reality is reality and nothing much can change if the person denies reality or blames other people, places or things. There’s a misunderstanding among much of the public regarding the disease concept of alcoholism — many people think that calling alcoholism a disease, which it is regardless of what the public thinks, is a cop-out and that it lets the alcoholic off the hook for responsibility. I hear non-alcoholics say all the time that no one poured the alcohol down the alcoholics throat. This is a simplistic way to perceive the problem.
What we do in treatment is educate our clients about the chronic brain disease of addiction, then the clients are responsible to do something about the problem and to answer for past behaviors. No one is getting off any hooks — in fact, it’s quite a rigorous and emotionally exhausting process dealing with past actions and the present consequences from years of irrational behavior and impaired judgement.
When the alcoholic understands the condition of alcoholism, then they can do something about the condition. If the alcoholic is simply condemned, berated and shamed, the problem only gets worse – if the person doesn’t understand that alcohol, and how alcohol affects their brain, is the main problem, they might try to do the right thing but continue to lose control of the alcohol and create more problems for themselves and others. The alcoholic who doesn’t understand his/her condition might stop drinking for awhile, start feeling better, straighten out problems, then think that they can drink responsibly again because they’ve become responsible and clear-headed. In fact, when family and friends tell someone in treatment that the disease concept is a cop-out and that the person only has to tighten up and control their drinking, they’re setting the person up to drink more and to continue the progression of alcoholism.
Recovering from alcoholism is difficult, but it’s worth the effort. Recovery requires abstinence, first of all. A recovering alcoholic has to understand their condition regardless of whether others understand or not. The reason Alcoholics Anonymous is so effective for long term treatment of alcoholism is that other recovering alcoholics understand what alcoholism and recovery are about. The average person, although they might have good intentions, doesn’t fully understand. The family member or friend can help, though, just by understanding they don’t understand.