Doctor Mickey Greenfield will be discussing alcohol abuse and the 5 signs of alcoholism below.
Denial is a major symptom of addiction and is a fatal aspect of alcoholism. It impairs the judgment of affected individuals, resulting in self-delusion which keeps them locked into an increasingly destructive pattern.
Globally, alcohol misuse is the fifth leading risk factor for premature death and disability. It is estimated that in the United States nearly 18 million men, women and children have an alcohol drinking problem.(1.)
The signs of an alcoholic are:
The following is a presentation that is given to other professionals dealing with alcohol abuse.
Hi, my name is Dr. Mickey Greenfield, and today we are going to discuss the 5 SIGNS FOR IDENTIFYING YOUR ALCOHOLIC CLIENTS.
Why is this important to you?
Alcohol effects 1 in every 5 people. This means on average that each family you treat has an alcoholic member.
Now, as a Ph.D. in Psychology, I know that alcoholism can easily mask itself as many different conditions. And, with 26 years of clinical experience, I can tell you that your alcoholic clients will be your most difficult problematic cases.
These 5 Points are the most important tools in your arsenal for identifying these clients. The best thing you can do for them is to first identify them, because this will change your entire treatment approach!
Your first tool for identifying your alcoholic client is ABSENTEEISM. This can take the form of missed school, work, family gatherings, and on-and-on. You won’t get this information from the alcoholic. It will come from questioning family members. The questions will explore such areas as does he/she miss planned family gatherings without feasible explanations — “Did he miss Junior’s graduation???” Frequent excuses are “I had to work late again Honey,” but when he comes home he reeks of alcohol. He/she might be missing dinner frequently using the same excuse.
Another form the absenteeism might take is frequently staying home from work because he’s “sick” in the morning and can’t get up – but he can go out again in the evening to meet his buddies “for a business conference.”
I could go on with examples, but I’m certain you have heard most of these before. Remember, FREQUENT ABSENTEEISM IS A SYMPTOM YOU DO NOT WANT TO OVERLOOK.
The second tool for identifying your alcoholic client is, IS HE/SHE PRONE TO ACCIDENTS? Does he or she suffer from frequent, unexplained injuries? Are their clothes often torn or dirtied as though they fell? Are their shoes scoffed, especially on the sides? Does their car have dents that only happened “when the car was parked?” And, of course, there are the work injuries. Each of these can be a clue that they were drunk and injured themselves or their clothes or their car while they were under the influence.
Recently, an in-house EAP sent us a young man who had his right index finger severed from his hand by a paper-making machine. It seems that the machine got jammed and he put his finger in the jam to try to pry it loose, but he forgot to put the machine in neutral. He un-jammed it all right, but it cost him his finger. His company is a drug free work place, and whenever there is an accident at work the employee must take a drug test. Well, this company not only tests for illegal drugs, they also test for alcohol. He was positive for alcohol.
Another incident occurred when a patient who worked in the yard at a railroad station forgot to move his foot off the track while signaling the train to back up. This resulted in a crushed foot. He, too, tested positive for alcohol.
Another incident involved a housewife trying to disjoint a frozen chicken in her kitchen with a carving knife while sipping wine. This resulted in 48 stitches in her left hand.
The list goes on-and-on, but I think you get the picture.
The third tool for identifying your alcoholic client is DOES HE OR SHE HAVE MONEY PROBLEMS. Is there adequate income, but there are frequent or continued financial difficulties? If the answer is “yes,” then you need to explore further.
Recently I treated an alcoholic who also fell in love with cocaine. It gave him the “energy he needed to close the big ones.” He was a hotshot salesman who made over $100,000 per year, but his family was always robbing Peter to pay Paul. There were four children, and they lived in a doublewide trailer. They were always stepping over each other. His wife barely had enough money to feed and clothe the family, but he played golf twice a week at a fashionable golf club.
His company sent him to Cuba to sell the Navy some heavy equipment, and he sold them over $100,000 of new equipment. He is one heck of a salesman. His net commission was well over $10,000 for that one week of work, but he was having difficulty paying his counseling bill. His counselor became suspicious and called me. I suggested she ask the wife if he drinks or drugs. The wife confirmed this suspicion, and the husband was referred to me for an evaluation. His tests were positive for alcohol and drug dependence. He entered treatment and the family also continued seeing their counselor — we worked together. After his drinking and drugging was arrested, the counselor was able to help this family get back onto their feet. Money problems are always a sign not to be over looked.
The fourth tool for identifying your alcoholic client is FREQUENT ILLNESS. Alcohol is a toxic, mind altering drug. Over one hundred million Americans drink alcohol. Sixty percent of all automobile accidents are caused by drivers who were drinking alcohol. Seventy percent of all homicides are committed by someone who was drinking alcohol.
I’d like to tell you what alcohol does to the body. First let me dispel the myth that alcohol is a stimulant — It is just the opposite. How it effects the body depends on how much you drink, the contents of your stomach, and what other drugs you might have taken.
Absorption starts in the mouth, and if you have a small sore in the mouth the constant irritation caused by the alcohol can cause cancer. When we inhale the fumes from the alcohol it causes irritation of the bronchi and lungs. If you smoke and drink alcohol you are fifteen times greater at risk for developing cancer of the bronchi or lungs. When alcohol enters the stomach the irritation it causes, causes the stomach to overproduce hydrochloric acid which can injure the delicate lining. This can cause alcoholic gastritis. In the small intestine it can cause duodenal ulcers.
But alcohol takes its greatest toll on the liver. The liver produces the chemicals that cause the blood to clot; it stores glucose; it produces bile which is deposited in the small intestine and aids in digestion; it neutralizes toxic substances in the body, and when damaged by alcohol these functions are inhibited. When the liver is damaged by alcohol it can no longer properly filter the blood and begins storing fatty substances. These fatty substances soon replace healthy liver tissue, scarring occurs, and a condition called cirrhosis develops. When the liver breaks down from drinking you can develop alcoholic hepatitis or jaundice. Jaundice results from the flow of bile from the liver into the blood stream instead of into the small intestine, and this causes discoloration of the skin and eyes due to this bile pigment in the blood. This is a very serious condition.
Alcohol also damages the esophagus. It causes blood vessels in the espohagus that are near the stomach to enlarge. These are called esophageal varices, and if they rupture death can occur.
The pancreas is the organ responsible for the production of insulin. It can also be damaged by alcohol. When this occurs you can develop alcoholic pancreatitis. This most often develops in younger males. If the pancreas becomes damaged you can have incomplete digestion, undigested food is passed through the stool, and malnutrition can occur. You can also develop alcoholic diabetes. Pancreatitis can be fatal.
In the circulatory system alcohol can cause heart problems, high blood pressure, strokes, arteriosclerosis (hardening of the arteries), weaken heart wall muscles known as cardiomyopathy, and damage to the nerve system of the heart which can cause irregular heart rhythms.
If you are a pregnant woman and you drink, alcohol can cause irreversible abnormalities to the unborn baby. Even a small amount of alcohol can be damaging because the unborn child is still developing and is effected more by the alcohol. Drinking during pregnancy can cause fetal alcohol syndrome. The safest choice is not to drink. Alcohol also inhibits the production of a hormone that aids in contractions, and can cause more difficult labor. Alcohol can also cause spontaneous abortions, and if the mother is drinking and nursing her baby she passes alcohol directly on to her baby through her breast milk.
Alcohol can cause our muscles to lose their tone, our hands to shake, and cramps in our arms and legs are common.
Our bones become depleted of calcium due to alcohol and our bones become porous. We have frequent back aches, and back operations are more common among users of alcohol. It inhibits the manufacture of blood cells in our bone marrow. I will discuss this later.
The genitourological system is adversely effected by alcohol. It can cause the kidneys to become inflamed and they will begin to accumulate fat. Sexual functioning is adversely effected, especially in the male. Testicular atrophy can develop. Ovaries, too, can atrophy. On top of each kidney is a small gland known as the adrenal gland. It is responsible for the production of female hormones in both the male and female. If the liver is damaged the male cannot filter out this hormone, and he will begin to develop female physical characteristics such as enlarged breast and reduced facial hair.
Psychoses are more frequent in alcoholics. Approximately fifty percent of all admissions to state mental hospitals are alcoholics as is one third of the admissions to general hospitals. Ultimately, alcoholism is fatal.
Earlier I mentioned that alcohol inhibits the manufacture of blood cells in the bone marrow. This is where we manufacture both red and white blood cells. One of the primary jobs of the red blood cells is to carry oxygen and food to the cells of our body, and to remove carbon dioxide and other waste materials from every cell in our body. Alcohol adversely effects the manufacturing of these blood cells. When the number of the red blood cells is reduced, or when these cells are unhealthy, they cannot function properly. This causes the oxygen and food supply to be reduced throughout our body, and allows carbon dioxide and waste materials to buildup, and we become sick.
White blood cells, the cells that attack foreign bacteria that invade our body, are also manufactured in the bone marrow. Alcohol also adversely effects this process.
So we end up with unhealthy cells throughout our body and a less than adequate immune system to fight off disease causing bacteria. Is it any wonder that frequent illness is a tool for identifying alcoholic clients.
The fifth tool is FAMILY PROBLEMS. The problems I see most often are between spouses; however, I also see problems involving parent and child. One of my recent cases involved Paul.
Paul and his wife were seeing his EAP because “they were not able to resolve simple every-day problems.” The EAP worked with them for a while and was at her wits end. She asked me to evaluate Paul. His tests, family history, and personal history were all positive for alcohol dependence.
He entered treatment but was not yet committed. I asked him to go to his personal physician for Antabuse, a drug that will make you very ill if you drink alcohol, but he talked his physician into giving him ReVia, a drug that reduces craving. The ReVia was not enough for his condition and he continued to drink. He was still in denial about his alcohol dependence.
One Friday night he got drunk and became physically abusive to his wife. She called and asked what to do. I advised her to call the police and have him kicked out of the house, and to keep him out of the house until he was in good recovery. She did just that!
Since then, Paul has gotten his physician to prescribe Antabuse, and I supervise him taking the Antabuse each night during treatment. They are still separated, the wife attends Al-Anon and our family group sessions, and he has become a model patient.
Treating family problems without dealing with the alcohol would remain fruitless. Now, this family has a chance to begin a successful life.
FACTS ABOUT ALCOHOLISM
Alcoholism is an equal opportunity disease; however, females are typically under-treated.
Ninety-seven percent of alcoholics are working members of society who are in good standing — only three percent are “sleeping under the bridge.” So . . . unless your treatment population is homeless, which it probably is not, 100% of your clients are susceptible to this disease.
Now I just called alcoholism a disease. Why did I say this? Before I can answer that I must first define “disease.” The best working definition I ever heard came from David L. Ohlms, MD. He said, “To be a disease it must be a morbid process with definite signs and symptoms that are reliable from case to case.” I believe it can safely be said that alcoholism is a morbid process — a process that gets worse and worse if left untreated. The definite signs and symptoms that are reliable from case to case will take a little more time to explain.
To begin, there are three stages of alcoholism: EARLY, MIDDLE, AND LATE, and each stage has it own signs and symptoms. In fact, there are over 100 confirmed signs and symptoms of alcoholism.
The early stage is where the client begins drinking for relief, or repeatedly drives under the influence, or has black outs, etc. However, this stage is most characterized by a loss of control over one’s drinking. This is where the client cannot predict when he or she will have a couple with the gang and then go home, or when it will become a binge.
The middle stage is characterized by social problems such as job or school trouble, family and friend problems, lying and cheating, money problems and any other societal problems in general.
The late stage does not require a genius for diagnosis. This is where the alcoholic has developed physical problems from his or her drinking. We refer to this stage as “body rot.” By this time no one except the alcoholic has any doubt about his or her problem. The trick is to learn to recognize this disease in the early or middle stage where it is easier to treat and the client is not yet suffering from the physical problems that are caused by alcoholism.
Final thoughts on the disease of alcoholism.
I think everyone agrees that alcoholism is a morbid process, and I have just given you some of the over 100 signs and symptoms for diagnosing alcoholism. Thus, you have the criteria that establish alcoholism as a disease. Want more? Well, the AMA called alcoholism a disease in the early 1950’s, and in 1958 they said it is a primary disease. It stands alone and is not the result of some underlying situation, and yet in the mental health field there are still those who search, usually in vain, for underlying causes.
We have long known alcoholism tends to run in families. When I was growing up it was common to hear “Tommy is a drunk just like his dad.” Researchers spent years determining whether it was the result of environment or heredity — was it nature or nurture. Twin studies conducted in the Scandinavian countries explored this. They separated identical twins born to alcoholic parents at birth. One twin stayed with the alcoholic parents and the other twin was placed in a family where alcohol was never used. At a given age the twins were examined to see what their drinking was like. Scientist found that they were each drinking at the same level. This was replicated many time with the same results. Today, few disagree with the finding that it most definitely can be passed on genetically. The question then becomes “what is being passed on?” Scientists believe that an abnormal biochemistry is being passed on that causes the alcoholic to react differently to the drug alcohol.
Most experts agree that there are two types of alcoholics — type one and type two. (I just love living in the post-Latin era. Can you imagine what terms would be used for early, middle and late stages and for type one and type two alcoholics? Obscure, hard to remember Latin that means nothing to the public.)
Type one alcoholics have a slight genetic predisposition. They can inherit this predisposition form either their mother or their father or both. Onset of the alcoholism is in the very late teens or early twenties, and the progression of the disease is usually not very rapid. They have a four times greater chance of becoming alcoholics than does someone born to parents with no alcoholic history.
Type two alcoholics are always males, have an early onset of the disease which has a very rapid progression, and they usually have acting-out problems that get them involved with the law. They are nine time more likely to develop the disease if their father was a type 2 alcoholic.
Now that you have learned more about alcoholism, how it effects the body, and how to recognize it, you need to know something about denial.
Denial is the psychological process by which human beings protect themselves from something threatening to them by blocking knowledge of that thing from their awareness. It is a buffer against unaccepted reality.
The denial of alcoholism is the lack of awareness of their excessive and/or inappropriate use of alcohol and the resulting harmful consequences.
Denial is a major symptom of addiction and is a fatal aspect of alcoholism. It impairs the judgment of affected individuals, resulting in self-delusion which keeps them locked into an increasingly destructive pattern.
A few months back I was asked to see a patient in the hospital. He was the administrator of a small hospital in a nearby community. His daughter was a physician. When I entered his room it smelled like a locker-room toilet that had not been cleaned or flushed in weeks. He was so yellow that he looked like a Disney cartoon. He was suffering from severe liver damage and jaundice, and he was dying. His daughter, the physician, and his personal physician were pleading with him to stop drinking. When I took his history he stated he only drank one or two beers a week. His denial cost him his life.
I never cease to be amazed at how alcoholics deny their drinking problems in the face of total disaster.
Well, what do you do to overcome this denial? I know you have heard that an alcoholic cannot be helped until he or she hits bottom. This saying has caused many alcoholics to die needlessly — and it just isn’t true.
Change is easy to achieve during a crisis. The problem is that frequently crises can be fatal if left to happen on their own. We, as therapists, can create a controlled crisis, and thus set the stage for change. How do we do this? And, how do we help someone who doesn’t want help?
Vernon E. Johnson, the founder of the Johnson Institute in Minneapolis, has been doing just this for years. In fact, he published a book in 1986 entitled INTERVENTION. He defines intervention as “presenting reality to a person out of touch with it in a receivable way.”
First, to do this, he assembles an intervention team consisting of meaningful persons in the alcoholics life. This could be family, friends, co-workers, professionals, and others who might be significant. He then forms the team. He states, “the best team members are those who know something about alcoholism, are willing to risk their relationship with the alcoholic, and are emotionally adequate to be interveners.”
Now the team begins to gather data. There are two types of data needed for the intervention: facts about the alcoholic’s drinking, and information about treatment options. With the drinking information, he has the intervention team make written lists of specific incidents or conditions related to the alcoholic’s drinking that legitimatize their concern. Each item should explicitly describe a particular incident, preferably one that the writer observed firsthand.
Next, the intervention team finds out about treatment options in the area. Johnson states, “You are not ready to do the intervention until you have performed this critical task.”
The intervention is now rehearsed. A chairperson is designated, and the team goes over each item on the written lists that each member has prepared. Following this, the order is set for each presenter to read their list during the intervention. Notice, I said read their lists. This prevents team members from becoming too emotional and losing sight of the goal of the intervention.
After this is done, someone from the team is elected to play the role of the alcoholic during the rehearsals. This will help the team determine how they will respond to the alcoholic’s reactions. The team can now set the order of speakers. Someone will be needed to open the intervention and someone will be needed to close.
It is strongly recommended that the intervention not be conducted on the alcoholic’s turf, if possible. This would give him or her the upper hand. Instead, choose a neutral location or one where you have the upper hand such as in the alcoholic’s employer’s office, therapist’s office, physician’s office, minister’s office, etc.
A few years ago someone from a local hospital came to me and asked, “can an intervention be done with a team of one.” I stated it probably could, but tell me more. It seemed that her father, who recently retired, let his drinking get out of control. I asked, “don’t you have family living in the area. She stated, “Yes, but they don’t think Dad has a problem.” After further discussion it was determined that they were in denial, and that we needed to do an intervention on them regarding the father’s drinking.
We began with the sister. First, my client made a list of events where her sister was present and the father’s drinking became a problem. We rehearsed the list and then had the sister meet us in my office. An actual intervention was performed, and the sister finally agreed that the father did, in fact, have an alcohol problem.
Next, the client, her sister and I discussed the mother who was in great denial. It was decided we either had to convert her or neutralize her where she would not defend the father during the intervention. The same process was followed, and the mother did admit that the father’s drinking was out of control. Thus far, we had completed two interventions to get ready for the main event.
After the preliminaries were completed, it was decided that the intervention would be held in my client’s home the following Sunday. I arrived early and was literally hidden from view on the patio until the father arrived.
The room where the intervention was held was arranged in such a way that the father could be boxed in on the sofa with a daughter on each side of him and the huge coffee table in from of him. The daughters thought this was important because, as they put it, he was a feisty Irishman who would rather fight than switch. The seating went as planned and I was signaled to come in. When this occurred there was polite tension throughout the room.
I signaled for the first daughter to begin immediately, and the intervention went off beautifully. They read their lists with the right amount of emotion and everyone in the room was crying. I did have to ask the daughter who was closing the process to tell the father what they wanted him to do.
It was earlier determined that he would need medical detoxification in the hospital, and arrangements were made to do this. His bag was also packed for a four day stay in the hospital and hidden from him.
When the daughter said we want you to enter the hospital to be detoxed and then to enter treatment, he stated, “I want to think about this.” I looked him right in the eye and said, “You’ve got five minutes.” He flushed with anger, but only stated, “You’re damn sneaky.” I thanked him and looked at my watch. After the pregnant pause, he said, “OK, but I need to go home and get a bag packed.” When his wife said, “No you don’t; I have everything you’ll need packed in the car.” Before he knew what had happened he was peacefully being driven to the hospital.
He died three years after getting sober, and I received a beautiful card from the family thanking me for giving them those three years.
You, too, can do this for your clients. If you don’t feel your client can pull this off alone, call a professional. Any treatment center can furnish you with the names of experts in the field.
I could go on and on about this exciting subject, but I’m running out of time. I want to leave you with these thoughts —
Alcoholism is a disease that effects 1 in 5 of your clients.
It can be inherited. This means that family histories are important.
Denial is a part of the disease, and you can help the alcoholic overcome this.
You do not have to wait for the alcoholic to hit bottom before receiving help.
And, you now have the 5 signs of alcoholism for easy reference.
FAMILY PROBLEMS (the symptom that frequently brings the client to your your office)
If you miss these signs you will miss the opportunity to help 1 in 5 of your clients.
Good luck and God bless you.