July 15, 2007

Alcohol Addiction and Alcohol Dependence

Brian: Good Morning Atlanta, welcome to the Breakthrough Addiction Addiction recovery Hour, last week we were talking about the disease of alcoholism taking our country by storm, and today, my name is Brian Fujii, good morning to my co-host Jill Mattingly, good morning Jill!

Jill: Today your name is Brian Fujii, that is good to know (laugh) Another rainy Sunday in Atlanta, a good day to turn your radio on and tune in to AM920.

Brian: We have been talking about alcoholism and getting help for our loved ones. Most families recognize the alcohol problem with their loved one and we can help them take a look and see if they really have a problem. Screening issues, we will look at those.

Jill: There was a terrible event this week here, a young man driving the wrong way on the highway, and the part that caught my attention was the interview of the witnesses. This young man, as he was described, this man got on the wrong way at Interstate 20 and people were honking at him and he was watching a dvd in his car while driving going the wrong way and then a head on collision, took someone’s life and once again, the destruction

Brian: Again, people really understand the impact that alcohol. You know I was noticing that we had about 100,000 alcohol related deaths this year, whether it is physical or accidents, this is a major problem in our country and people don’t realize that there is help out there.

Jill: We talked last week about the differences between use, addiction and dependency, moving into each stage there is not a red flag to tell you where you are moving. And we went over the details about that but today as we talk about you know people getting into alcohol addiction treatment I was reading on the National Institute of Health news website where they were talking about the difference between the age of onset of addiction and dependency and the age where they seek alcohol addiction treatment and it was amazing. The average age of onset of dependency which we should go over one more time, is 22 years old and the average age of seeking alcohol addiction treatment for dependency is 29, that is eight years.

Brian: That is a good point, we see this in alcohol addiction treatment when you see dependence and what we see is denial and until there are major life issues that come up but inspite of some of the consequences people won’t stop.

Jill: I know that it does effect a lot of lives in a negative way and this is a call in show, so please call us with questions or comments, if you are listening outside of Atlanta, 1-888-920-2665, if you have had alcoholism touch your life in some way we want to hear from you, you could not only get help for yourself but for someone else. , if you have had alcoholism touch your life in some way we want to hear from you, you could not only get help for yourself but for someone else. You know Brian when you were talking about addiction and dependence and those characteristics, were you saying that the problems with legal issues or work, was that just dependence.

Brian: No in fact that is when you see the addiction. Let’s review uh, the three different levels. People use alcohol and use it responsibility and have no problem and yet we know that people can move into the area of addiction and some of the qualifications are using in hazardous situations, driving under the influence, getting in trouble at work, and we also find getting into interpersonal or social issues where people are saying hey, you don’t act the same, what is wrong. We see this among family members too. These are indications that people are experiencing difficulty with their alcohol drinking.

Jill: Well going back to the lag time between agbuse and dependency and then the time that it takes before a person seeks alcohol addiction treatment, now I think in the article it said that seeking alcohol addiction treatment could be broadly defined, either from physician or by just attending a 12 step program crisis center, maybe even employee assistance program.

Brian: Employee assistance programs can be very helpful as they identify issues by drinking, supervisors can be a tremendous asset. Looking at work performance we try to help people, understand there is help. They can help through various counseling sessions but if that continues to be a problem they can make referrals to other sources.

Jill: We are giving out the number again, 770-226-0920 and 1-888-920-2665. Call us with comments or questions. I am going to state also that that lag time study did talk about addiction being a longer lag time between the age of onset and the age of getting alcohol addiction treatment as being 10 years. So, Brian, you know, I am a health professional and I know that that person saw a doctor or some type of health professional in that 10 years

Brian: I am sure they have, but so many times the difference between addiction and dependence, once they reach that level it becomes worse and they realize the negative impact that their drinking is having and they may seek out alcohol addiction treatment a bit sooner because the pressure is on.

Jill: coming into a doctor’s office is usually the last thing they want to talk about is their alcohol use and some of the problems it causes.

Brian: In fact studies show that only 1/3 of healthcare practitioners actually ask questions about alcohol and alcoholism. What a great place to get that information and yet some don’t

Jill: I am on the other side of that because I know that when we are told by managed care how many patients we can see in one hour we have maybe five or ten minutes so the high blood pressure and diabetes is more important to handle than whether or not they are drinking two or four glasses of wine a night.

Brian: I believe it is really something to look at, all of us in the healthcare profession and I agree time is a major issue, and that is great about Breakthrough we can use the screening tool and expedite the process. The “cage” have you used it?

Jill: Of course, it is a great screening tool, tell the audience where that information has come from that you are holding there. That is very important for people to know that there are free materials out there.

Commercial Break

Brian: We are back and my name is Brian Fujii and my co-host is Jill Mattingly, at Breakthrough Addiction Addiction recovery, a drug alcohol addiction treatment program in Tucker, Georgia. And we were back on the topic of talking about the screening tool called the “cage” to give you information for quick screening for health care practitioners as well as counselors,

Jill: Even if you are not in medicine, to know that there is a tool out there. If you are in the doctor’s office with your husband and they see an enlarged liver and don’t ask questions, you need a screening tool for the liver to see if alcohol is effecting their physical health. It is so good for lay people to arm themselves with knowledge.

Brian: These are very bask and easy questions, it becomes less invasive and seen by observation, for example the letter C, it says have you ever felt that you need to cut down on your drinking? I am sure many who struggle have said, tomorrow I am going to quit and somehow the tomorrow never comes and they feel the frustration as to why they can not quit. We spoke earlier that people don’t understand that alcoholism is a disease of the brain and not something that means weak willpower.

Jill: I think people believe that when they come in, ok I like the A. Have people been annoyed or annoyed you by criticizing your drinking. Very interesting (laugh) you tell someone to cut down and they respond by being annoyed with you, hmmm that is a sign something is going on.

Brian: I think the defensive mechanisms do come about when someone is confronted or asked, that is something too that we don’t want to be so confrontational so that they become alienated. But we do understand that as they use it will become problematic and they will have problems with communications or problems with other areas and that is annoying

Jill: What is the G

Brian: Have you ever felt guilty about drinking.

Jill: The big G

Brian: That is one of the key factors in addiction and we feel the sense of guilt and shame and then again guilt is feeling bad about what we have done as far as our behavior and people see that and usually what I find with people I work with is that when they are drinking and feel no control, they feel their lives are unmanageable and feel a lot of guilt about that. And they feel embarrassed and that is also what motivates them to get through the denial and get the help, ok, that brings us to

Jill: Brings us to E, have you ever had to drink early in the morning to get rid of the hangover and we call this the E for the eyeopener. This tells me as a health care practitioner that this falls on the side of dependency and if you are waking up with tremors and feeling anxiety maybe even sweats, uh you just feel like you can’t be yourself and then you take a few swigs of vodka or you know looking for a reason to go out and have a bloody mary in the morning there probably could be something going on with dependency and it is having to drink to feel normal.

Brian: That is the key right there Jill, a lot of times people use drugs to feel an extra Zing or an extra High, but typically for alcoholics the drink is to just feel normal or ok. Of course one of the key factors too is that people who drink in order to avoid the pain of withdrawal is a big one too, so if they have been drinking the night before and they are really into having that cellular addiction they are drinking to avoid the uncomfortable feeling of not having the alcohol.

Jill: That is interesting for someone to be in this place and walking into a doctor’s office and asked these questions, I am sure the shame just goes into overdrive when they have to start talking about his and yet when the professional starts to get the conversation going there is a sense of relief from the patience that finally you know I have a private safe place to talk about this and a lot of times that could be the place where someone starts to get the help.

Brian: Confidentiality and feeling safe, if we have anyone out there that may want to know something about an issue that they are struggling with and don’t want anyone to know please feel free to call us at our number 770-226-0920 and just let the engineer know that you don’t want to talk on the air. You just want to ask the question and he will write it down and we can answer on the air. We want to encourage you if you are struggling and not wanting to get on the air but want the information please call us again the number is 770-226-0920 we would be delighted to answer.

Jill: Objective data carries a whole lot of weight. If I get lab work back and it shows clear signs of alcohol taking it’s toll, the actual laying on of hands to feel possibly an enlarged liver to look in the throat and see things happening or erosions uh, there are many different things that if a practitioner really does all of the things that are needed in a screening or health history and physical there can be powerful information

Brian: You can feel the enlarging of the liver

Jill: Yes, and the patient can’t deny this and of course they can deny it is because of the drinking and you can encourage them to start seeking alcohol addiction treatment. Years ago doing internal medicine, I would say that they only thing I could tell them is to go to ALCOHOLICS ANONYMOUS meetings and there is a world of alcohol addiction treatment options out there and I think that being well versed on that is very important by the practitioner.

Brian: We are coming up to our next break. The number is 770-226-0920 or out of the Atlanta area, 1-888-920-2665. We will be right back after this break. Stay with us.

Commercial Break

Jill: We are back my name is Jill Mattingly with Brian Fujii, we are discussing alcohol and alcoholism, we are covering a lot of information call us, 770-226-0920 and outside of the area, 1-888-920-2665 even down in Macon. We also because of the nature of what we are discussing and the confidentiality that many people like to stay with, you can call the station and our engineer will take down the questions and we will answer for you on the air. Don’t be shy, call in if you can. We have been talking about healthcare professionals and the importance that they have in being kind of a gatekeeper in getting people into alcohol addiction treatment and also pointing out the problem with use, addiction or dependency. There is a lag time between the onset of addiction and dependency and the actual time where this person may seek alcohol addiction treatment. So, the average onset is usually around 22 and they don’t seek alcohol addiction treatment for at least l8 to 10 years after that. What is going on Brian?

Brian: Well, this thing about 22 is that it is young, college, looking at various activities on campus which usually involve alcohol and a rite of passage and you know one of the key things we talked about last week is some of the genetic related issues and also familiar issues, if a family history a grandmother, aunts or uncles with alcoholism then you have a greater propensity to fall into that same trap or realm and also too when you start taking a look at family environments like dinner time or evening hours where alcohol is used with great prevalence. You need to find ways to either avoid those or to just change the behavior that takes place. So for example if you are drinking wine at every dinner and some do it responsibly then you realize that you can’t and now you have to address the issue.

Jill: The college years, a lot of people graduate college around 21 or 22 and yah there was probably a lot of partying in college but if you continue the behaviors to such a level that may be something going on that you are still partying like you have class in the morning and not a 9 to 5 job.

Brian: Those behaviors carry on into the workplace. Usually things are not changing until there becomes the actual negative implications. So, you know going back to the way to get people into alcohol addiction treatment or going back to your work in the medical area, uh, we find out that not only time but this brief intervention and using the cage can take fifteen minutes or one or two visits so it really benefits a healthcare practitioner to do the screening and there is physical problems that occur as a result of alcohol. Jill tell us how it effects the liver, the brain or cancer.

Jill: All of the above, one thing that happens if there is severe dependency usually the result is death. Death occurs a lot earlier than it should have if there is continued addiction so it is important for health care providers who want to prolong life that they do the screening and one of the things we look for or course is liver disease, and liver disease takes on a few different types of looks. The first look could be that you have something on your labs that makes it seem like maybe the liver is not doing so well,

Brian: Why is the liver so important?

Jill: We can’t live without a liver and for the alcohol detoxification of our body, um without it you either pass away or you get a new one, so um, but liver disease actually up to a point is reversible and uh, if it is caught at the right time and defending agents are taken away the person can actually do much better and return to normal liver function which is very important to tell people.

Brian: Actually from abstinence you can heal the liver?

Jill: Absolutely, and once you pass a certain place though, you will go into a disease that most have heard of called cirrhosis of the liver which is when the liver is barely functioning and ready to shut down and have one to two years left before needing a transplant or making their final plans. Of course cancers are very much involved with uh, end stages of alcohol addiction and dependency and those cancers can be all over the body.

Brian: I think before you have said that the liver is not working well can produce something like a problem of bile backing up into the

Jill: We might not want to get too technical and gross, ok, so let’s take a break and let the audience get over that comment. Call us at 770-226-0920. We are waiting for your call.

Commercial Break

Brian: Welcome back this morning we are talking about alcohol and alcoholism and getting alcohol addiction treatment. We were discussing how alcohol impacts the body and for instance cancer.

Jill: I didn’t want to interrupt brunch this morning with some of the toll the physical toll that alcohol takes when you are dependent. Cancer is a very real threat when someone is dependent on alcohol not only the liver but you can have problems with the esophagus and throat cancers along with immunity problems and one of the topics people forget about is pregnancy issues, a pregnant woman drinking and we have a lot of people getting pregnant later in life in their 30’s and 40’s and dependency has already set in, fetal alcohol syndrome is devastating to the family and the child. Also, brain damage, people don’t realize that neuron damage is very real with alcohol dependency, there can be dementia and sometimes it is tied to the liver failure not just out and out brain damage. So, we can have an alcoholic dementia and some out there may be dealing with that in their family. Since I am bringing up the physical if you would like to call and ask questions about this or comment or privately ask the engineer to write it down for us, you can call at 770-226-0920, or outside Atlanta, 1-888-920-2665.

In terms of drinking heart disease can be there. A stroke sudden death from alcohol use, and think about the caloric intake and increasing blood pressure and no nutrition. At our program I spend a lot of time with my patients talking to them about changes in their nutrition and they are coming to us where alcohol has been their main food group and it does take some teaching of what needs to be added back into their diet.

Brian: That point brings us back to this piece of how to get people to recognize the need for alcohol addiction treatment and one of the other ways besides the brief intervention is if they are willing to be linked up with a therapist and then the physician following up and making sure the alcohol addiction treatment is effective and the second would be motivational interviewing developed by William Miller a therapist and some of his colleagues. This approach is um, new and it is fundamentally empathetic and um,. Spiritual approach to human suffering and it is a non-confrontational approach. We help to educate and give skills and training for our clients to help them understand that alcohol addiction treatment works.

Jill: An example of motivational interview is encouragement and compassion and helping along the road? That is interesting because the confrontation it is usually very ugly and you know so this is motivational interviewing. You mentioned cognitive behavioral therapy talk about that.

Brian: A method by which we therapists use to get education and help a person to help the way they think and by changing the way they think they actually change the way they behave. This brings me to a point of how people change and in fact there are studies that have been done and they actually identify that there are various stages that people go through before they even seek help. For example if someone is pre-contemplative, they are not thinking about it. When you bring it up they say, what are you talking about? Many can identify with that and so they are not thinking about it. It becomes a very difficult time to help them when they are at this stage, it is hard to get them into alcohol addiction treatment so the family needs more information and help. The next one is really what they call contemplative they have actually felt that what you are saying is sinking in, they many not verbalize it but they are thinking that there is possibly some validity. There may be those in our audience that are struggling with this, so please give us a call at 770-226-0920 or 1-888-920-2665 we would be delighted to answer your questions.

Jill: Over the past few days I have been looking at the movie “My Name is Bill W” about the man that started Alcoholics Anonymous and it basically was the first half of the movie him in pre-contemplative state of Bill W and when he got to the place where he realized something was happening and in terms of his alcohol dependency it was an excellent movie and it really shows the struggle of the alcoholic and how brilliant it was of Bill W to start up a program when there was nothing out there in the 1920s and 30s.

Brian: He was a real pioneer in addiction recovery and developed a strong program to help people with the information that they need.

Jill: His best bud was a doc and I liked that (laugh) I am really encouraging you out there that we want your calls and questions even after the program if you would like to contact us at our office we will give the number at the end of the program. 770-226-0920 is the number to call today. We will be right back.

Commercial Break

Brian: Welcome back I am Brian Fujii and my co-host here is Jill Mattingly and we just had a message come in and it is very good. The question was, I thought if someone was a raging alcoholic they were the type to lay in the street drunk, but what if they are a loved one and a functional alcoholic. Someone that is drinking too much

Jill: Functional alcoholic

Brian: One who can keep appointments and is just drinking too much each day, are they experiencing any negative consequences that is the key, so are they having problems at work, at home or with the law. These are the indicators that can be signs that there is a need for help at this point.

Jill: Taking them to a doctor and getting a physical, hopefully the doctor would do the cage and find out that the first drink is before noon and that with blood work that there is a problem. The reason they need to find out what is going on, peel back the layers is to find out why they are drinking every day

Brian: Good point Jill, they may not feel that there is anything wrong until that blood work is done that there may actually be a reason to quit drinking so much.

Jill: Healthcare professionals need to be the gatekeepers. The lag time we spoke of earlier, professionals screening for alcohol addiction, you know, I realize there are many other addictions that are going on in peoples lives um, and we are going to approach those in the coming shows, but you know in terms of alcohol it is such a social uh, you know situation that people usually are in and they don’t see a problem until it is too late.

Brian: Studies have definitely indicated that if you are taking a medication such as Naltrexone and combining it with a solid psycho social alcohol addiction treatment program where they are learning how to change the behavior by developing new coping skills and individual counseling then they are able to truly link together all of these components and we find that the efficacy of that program really is far more successful

Jill: That is all across the board, medication, nutrition and counseling

Brian: Yes, it is rarely seen that any one program would work fully, so that completes our show for today and we hope that this has been helpful and visit our website at www.breakthroughaddictionaddiction recovery.com and if you or a loved one needs help with anything related to alcohol or alcoholism please call us at 678-534-1715. Thanks for listening.