Why It’s So Easy for People with Alcoholism to Live in Denial
Apr 10, 2019
This is part of CleanSlate’s special “Spotlight on Alcoholism” discussion during Alcohol Awareness Month.
April is Alcohol Awareness Month, a time when we should acknowledge the third leading cause of preventable deaths in the U.S. (after tobacco and poor diet/ sedentary lifestyle.) The national focus may be on the opioid epidemic, but the epidemic of alcoholism is far greater and deadlier. Approximately 88,000 people from every walk of life die each year from alcohol-related causes.
Too often, people with Alcohol Use Disorder (AUD) stay mired in denial about the extent of their problem until the very end. Some of that denial may even be connected to the attention on the opioid epidemic.
I have a house, I have a great job, I pay the bills, they tell themselves. Sure, I may overdo it with my wine, but I don’t have a problem. Those people on TV with the opioid addictions, the ones who are homeless and unemployed – they have problems. I’m fine.
High-functioning people with AUD live in a world where they seem normal. People drink for fun at every turn; at sporting events, business events, celebrations, in the movies and on TV – the list is endless. It’s hard to find a situation where alcohol isn’t a part of the social fabric.
Alcohol is such a widely accepted part of our culture that it can be difficult to distinguish when someone has a problem.
And that is a problem.
Generational differences around alcohol
Remember when you snuck a beer out of your parents fridge? Siphoned a little whiskey out of their liquor cabinet?
If you answered yes, you might be older than Generation Z.
Teenage experimentation with substance use once commonly started with alcohol. Today, the first taste of rebellion for kids often comes in the form of weed. Or, far worse, opioids.
When kids do start drinking, it’s sometimes in combination with other substances and done as a binge activity. According to the Center for Disease Control and Prevention (CDC), teen alcohol use kills 4,700 people each year, more than all illegal drugs combined.
That said, in my personal experience, I see a lot of young people who are focused on weed, vaping, and opioids as their substances of choice. When it comes to alcoholism, I see the older generations as the most difficult people to help. That’s because high-functioning adults with alcoholism can do a great job of blending in with social drinkers, amidst a culture that continues to glamorize and normalize alcohol.
Consider this: when some of our physicians attend medical conferences for liver doctors, the wine is flowing like water.
When is alcohol a problem?
As a society, we’re not well equipped to help people identify themselves as problematic drinkers. Some of the reluctance amongst physicians to flag problematic alcohol use by patients may be because doctors drink, too. The distinction between social drinking and AUD can be a blurry line, making it easy for patients to remain in denial and doctors and others to overlook warning signs.
So what does AUD look like? In short, drinking to survive. The person with AUD doesn’t feel normal without alcohol. He needs alcohol throughout the day; if too much time passes without a drink, he begins to experience withdrawal symptoms, such as shaking.
But AUD can also look like a weekend warrior, someone who starts drinking on a Thursday and doesn’t stop until Monday. Alcohol is such a big factor in her weekends that it creates a problem with the other parts of her life.
What role does alcohol play in your life? Are you drinking excessively with friends every weekend? How is it affecting the rest of your life? The consistency of your alcohol use plays a role in determining whether you have AUD.
If you do determine that you or someone you love has a problem, then what?
Medication can treat alcoholism. Why is this a secret?
When I’m out in the community talking about medication-assisted treatment (MAT), I find that there’s shockingly little awareness that Vivitrol (naltrexone) can treat AUD. Alcoholics Anonymous and similar programs have done a great job of creating community around alcoholism, but they have also marginalized the use of medications to treat addiction.
Related blog: AA And NA Won’t Accept Them, So People In Medication-Assisted Treatment Are Starting Their Own Addiction Support Groups
One of CleanSlate’s medical leaders, Phyllis Losikoff, M.D., recently treated a 36-year-old alcohol dependent patient. She told me that by the time he arrived at CleanSlate, he was in complete liver failure, showing the kind of damage that you don’t usually see until someone is in their 50’s.
“To be honest, his health was so dire that it was a tough decision to even accept him as a patient, since Vivitrol can be harmful to the liver,” Losikoff said.
The patient needed a liver transplant, and his health was so critical that he had to get the fluid taken off of his abdomen. And yet nobody – not even his GI specialist – had previously encouraged him to seek MAT to abstain from alcohol.
Over the past eight months of MAT with Vivitrol in our center, this patient has made remarkable strides. He is a changed man, he has not needed to have the fluid taken off of his abdomen since we began seeing him, and his prognosis has improved significantly.
I share these kinds of patient stories with the medical community to try to increase the education around MAT for alcoholism, Losikoff told me. If physicians would refer patients earlier on for MAT treatment, the long-term prognosis of patients could be vastly improved.
As awareness around opioid use, prevention, and treatment continues to increase, we mustn’t lose sight of the mother of all addictions – alcoholism. People with AUD need to be better advised and supported around identifying their disease, and better informed that MAT is an excellent course of action to get help.
With the cultural enthusiasm towards alcohol, it’s easy for all of us to live in denial about alcohol addiction. If we as a society are to substantially combat this grave health threat, we must all become far more engaged in preventing, recognizing, and medically treating this deadly disease.
CleanSlate treats patients suffering from opioid or alcohol addiction with medications and a continuum of care to support each individual’s journey to recovery. If you or someone you love needs help, contact us at 833-505-4673, or visit our website at www.cleanslatecenters.com to find the center nearest you.