In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
When we realize that our drinking becomes dangerous, then we throw ourselves into the whirlwind of professional work, often on the verge of workaholism. We prove to ourselves and to others that we control everything – says psychologist Tadeusz Wieszczyk who has been working with addicts for 19 years.
– How is today’s alcoholic different from that of a dozen or so years ago?
– What I observe from the perspective of almost 20 years of practice is a change in the style of drinking, especially in men who drink lighter alcohol (beer, wine), drink less socially, and more alone, in secret, and treat their drinking as a relaxation after hard day or week of work. Some, the so-called quiet alcoholics try to convince me that drinking them is in no way dangerous. They come to hear that they have no alcohol problem. They say: “I drink, but I still control, I know when to quit”; “I don’t really have an alcohol problem, because I only drink in the evenings, after work, and alcohol from the top shelves”; “After alcohol, I do not behave loudly, I take care of my home and family, they do not lack anything”; “I only drink on weekends”; “Maybe I drink too much sometimes, but no one sees me like that,” etc. When I ask for details, it turns out that this quiet drinking is not safe at all. And you can see that for some time the patient not only drinks a bottle of wine in the evening, but has to open another one; he becomes more and more impatient when his wife “bothers him” with household matters, when he is just thinking about relaxing with a drink or on weekends instead of being with his family after the work week, he is drunk all the time from Friday night to Sunday noon. Apparently, it does not hurt anyone, but still he is more in a relationship with alcohol than with other people and he is completely not interested in any other way of spending his free time. It is comforting that today’s alcoholics seek treatment earlier. Most of my patients are between the ages of 26 and 35.
– Does this also apply to women?
There has been a marked increase in the number of women drinking. They are often ambitious successful women who have achieved a good professional position and made a career. It is often not easy for them to remain in the constant tension of professional competition, especially with men, and to reconcile the role of a businesswoman with family and home responsibilities. In order to maintain their professional position and function socially, they have to put in much more effort and energy than men. And that is emotionally costly! It creates a lot of anxiety, frustration and exhaustion. Most women drank and still drink in the privacy of their homes. Together with alcohol, they create a magical world of their independence, an escape from unsuccessful relationships with men, from a painful feeling of being exhausted and often used, and sometimes simply excessive duties and the lack of sufficient gratification in their personal lives. It is still more difficult for women to admit their alcoholism and go to treatment because of the great shame and fear of condemnation.
Many men and women hide their drinking from others, ashamed that it might come out and expose their addiction. Paradoxically, the family sometimes helps in this hiding by ignoring and not noticing the facts that are symptoms of the disease; denying the problem (“He cannot be an alcoholic”), minimizing (“nothing happened”); justifying his drinking (“He had a reason to drink – he has been working hard lately”); taking responsibility for oneself in connection with the partner’s alcohol indispositions; hiding the problem from other family members, the boss, etc.
– Can you be a good worker or a drinking boss?
Among people with an alcohol problem, I often meet those who treat their work in an extremely ambitious and serious way. They try at all costs to show themselves and others that as long as they work efficiently, their drinking is not dangerous. Often it is their work that they create a bastion that protects them from realizing that drinking them is not good. Many of my patients show a certain dependence: the more it penetrates into their awareness that drinking is becoming dangerous, the more they prove to themselves and to others – precisely through professional activity, often on the verge of workaholism – that they are in control of everything. Of course, with time, when addiction progresses, it is impossible to reconcile meaningful professional activity (as an employee or a boss) with drinking alcohol. Sooner or later there must be a crisis. I know many alcoholics who, after many years of drinking and remaining in prominent positions, immediately lost their jobs and only then came for treatment.
– Workaholism can also cause alcoholism?
In many stories of addicts, one can also see a certain relationship between the high level of ambition and expectations related to functioning at high speed at work, where only the best ones count, and reaching for alcohol as a means of relieving emotions against the background of experienced stress. Alcohol becomes an easy, quick and reliable means to calm down, to calm down, to return to full control over one’s own internal states after a huge effort at work. This way of regulating emotions, especially in the absence of other coping skills, is an unusual temptation to repeat and, with some training, can lead to addiction. What characterizes the majority of people with an alcohol problem, i.e. the inadequate ability to rest without alcohol.
– How difficult is it to realize that you have an alcohol problem?
As a rule, it is very difficult, because we usually firmly believe that this problem affects others who drink more, more often and in a more destructive way. Stereotypes about drinking also hinder the awareness of one’s own problem, e.g. that alcoholism affects only people with weak will or that I will not become addicted because I have a strong head, or that drinking only beer or wine cannot become addicted, or that I have alcohol problems. only primitive people from social “pits”, etc. When thinking about the word “alcoholic”, we have bad associations and ideas – someone “bad”, “loser”, “weak”. After all, we don’t want to be like that! In addition, tremendous shame, remorse, and fear of degradation in the eyes of others or condemnation keep us from the truth about ourselves and our own drinking. There are also specific mechanisms of developing alcoholism, which focus our attention on problems other than drinking itself, i.e. we do not mind drinking, only the problems arising from it, which must be quickly mastered and hidden. Besides, we want to believe that these problems are not caused by drinking. There are people who manage to reconcile their evening drinking with active work the next day, they rather keep their commitments and promises, and function relatively well in family or social relationships. They also have remarkable ability to soothe and quickly “sweep up” their drinking “mishaps”. These can be people in the early stages of addiction.
Can an addicted mind trick the “owner” just to get another dose of alcohol?
You could say so. Thinking, reasoning, imagining – that is, important cognitive processes are in the service of alcoholism. Unconsciously the addicted person develops submissiveness of the mind to alcohol. A specific mechanism is created, which we specialists call the system of illusion and denial. Its task is to cut the drinker away from reality, from facts and from awareness of the devastating effects of drinking alcohol. This makes it easier for the alcoholic to hide his own addiction from himself and other people. It also allows you to continue drinking without taking responsibility for the consequences of it.
– How is an alcohol addiction diagnosed?
The basic symptoms of alcoholism, which are used to diagnose addiction, are: subjective feeling of having to drink alcohol, the so-called craving alcohol, having to continue drinking with small doses of alcohol, obsessive thinking about drinking, uncontrolled drinking and behavior after alcohol; alcohol withdrawal symptoms – malaise, internal breakdown, inability to recover for a few days after drinking, change in alcohol tolerance, drinking despite increasing problems in life, relapse of drinking after periods of abstinence.
The simplest CAGE alcohol test for self-diagnosis of an alcohol problem consists of 4 questions.
1. Have there been times in your life when you felt the need to cut back on your drinking?
2. Has it ever happened that people close to you have upset you with comments about your drinking?
3. Have you ever felt remorse, guilty or ashamed about your drinking?
4. Have you ever had alcohol when you wake up in the morning to “calm your nerves” or “get you on your feet”?
Obtaining at least two affirmative answers to the above questions indicates a significant likelihood of alcohol dependence.
It is worth emphasizing that many of the basic symptoms of alcoholism may be vague or masked. Despite the general model of the development of alcoholism, we can deal with atypical symptoms of addiction, when a person remains within the limits of normal drinking for many years, but is de facto addicted. A characteristic feature of alcoholism is that the addicted person distorts the truth about his own drinking, denying the obvious facts related to drinking and the consequences of drinking (losses, harms). These losses may seem much smaller to an addicted person and not as dangerous as they actually look.
– How is the disease going?
Usually innocent at the beginning as a pleasant experience of coloring and making your life more pleasant. Alcohol improves your mood, relaxes you, gives you self-confidence, takes care of certain problems for you, related to a deficit of skills, and turns the impossible into possible. It gives the illusion that it generally helps in life and such a discovery is the beginning of a deadly friendship with alcohol. Most people who become addicted to alcohol have a fairly high tolerance, the so-called strong head. They need more alcohol to achieve the desired effect. Therefore, in the group of people with whom they drink, they become the “locomotives” of drinking, they initiate the next rounds and look for more frequent drinking opportunities. If such drinking is not social, they begin to drink alone and try to drink covertly. A characteristic feature of this initial phase of addiction are also the so-called broken movies “.
As it becomes more and more difficult to recover from night drinking, many start their day with a so-called with a wedge, that is, drinking a small dose of alcohol in the morning, for example one beer, or treated with psychotropic drugs, aimed at extinguishing the malaise, but also remaining in a state of a slight “excitement”. As the disease develops, it becomes more and more difficult to hide the effects of drinking, e.g. health problems, family and professional neglect, absences from work, failure to keep contracts and promises, difficulties in coping with emotions, sometimes impulsive reactions inadequate to the situation, conflicts with others, remorse, the so-called moral hangovers and other harms and losses that the alcoholic tries to minimize, explain to himself and others rationally, distract from them. A very tight system of self-defense mechanisms develops against the awareness that drinking alcohol destroys my life and that of others. Some people swear to improve, do try to refrain from drinking for a while, but without help it is very difficult. As a rule, addicts drink in strings after a while. In the chronic (chronic) phase of addiction, alcohol tolerance decreases. Alcohol becomes the only goal in life, it has serious consequences in family, professional and personal life. Important relationships with people break down, somatic and mental problems appear – cirrhosis of the liver, polyneuropathies, alcohol psychoses.
Alcoholism usually develops over several years of drinking, but young people can become addicted within a few months.
– Maybe the salvation from addiction is to train willpower?
Proving a “strong will” in a situation when a person is already in alcoholic bondage does not make sense and is very exhausting. It leads to feelings of helplessness, self-anger, shame and a feeling of emptiness. Since drinking control is impaired in alcoholism, and it is lost over time, a person consuming alcohol is less and less likely to predict what the drinking will end up with. He manages his own life less and less, not only under the influence of alcohol, also when he does not drink, but fights with himself with this willpower. Instead of training willpower, it’s better to talk to a specialist about what’s bothering me about drinking and look for strategies other than willpower to improve your life.
– There is a cure for alcoholism?
For at least several decades, the search for a golden pharmacological agent, probably matching the Nobel Prize, has been going on, with the help of which a person addicted to alcohol will free himself from the compulsion to drink. At the current level of knowledge and research, no one has developed such a medicine. The drugs currently available on the market can at best help cure a hangover, relieve withdrawal symptoms or act as a bogey before drinking. Disulfiram (orally under the name of Anticol and in the form of the so-called insert under the skin under the name Esperal) is such a remedy that has been known for years, though almost unused today. Obviously, this is not a remedy for treating alcoholism, but it helps to maintain abstinence through the painful awareness that drinking even the smallest dose of alcohol can end up with very unpleasant health consequences. I know cases that ended in a collapse and the need for resuscitation.
It is also worth emphasizing that some people with an alcohol problem manage to trick general practitioners or sometimes even neurologists or psychiatrists that the reported fears, symptoms of neurosis or depression do not result from drinking alcohol. And then the person who has an alcohol problem tries to heal himself with the consent of the doctors with the use of tranquilizers, anti-depressants, believing that this will generally help with their problems. Meanwhile, it turns out that such therapy becomes a lethal weapon and increases the risk of developing cross-addictions – alcohol and drugs, which are even more difficult to treat.
– Can you deal with an addiction without the help of a psychotherapist?
I know many people who, before seeking help, read almost all the literature on addiction available on our market, and even acted as experts in the field of counteracting addiction and, despite their knowledge, continued to drink destructively. Many of my patients did not seek help before, because he had exhausted his repertoire of ideas for fighting the addiction on his own, he often tried to reduce drinking, change the type of alcohol, drinking times, place and people with whom he drank before, and it did not help. Still others sought help from the so-called paraprofessionals in addiction cases, incl. among people dealing with acupuncture, coding, hypnosis, herbal medicine, electrostimulation or finally decided to implant Esperal. Some even managed to keep them from drinking for a while, but sooner or later they would relapse.
I know from my practice that it is very difficult to cope without outside help and it is best if it is the help of addiction professionals in places that provide specialist help. Of course, you can also use the support of Alcoholics Anonymous self-help groups, which operate in almost every corner of our country and abroad.
– How is the therapy more effective: group or individual?
Group therapy is the basic method of helping people with alcohol addiction problem. Its advantage over the individual relates to the greater, because group strength of confrontation and identification with the problem, which is usually minimized by the drinker and presented in convenient versions. Secondly, participation in a group helps to overcome the alienation, loneliness and isolation that many alcoholics have been stuck in for a long time. And thirdly, the group allows you to get rid of the feeling of uniqueness and extraordinary nature of your own problem, which turns out to be very similar in its course and mechanisms to the problem of other people. In a group, you can discover that alcoholism is a democratic disease, because an alcoholic can be a very light person, with a great intellectual potential, comprehensively educated, wealthy, professionally very efficient and creative, as well as a person who has received fewer material goods or intellectual resources. However, there are special cases when, for some time, individual therapy may be offered to a person with an alcohol problem. However, it should be remembered that if we come across the proposition of individual therapy as the basic one among the therapeutic offers – then it should be suspected that we are not dealing with professional help.
Text: Halina Pilonis
Consultation: Tadeusz Wieszczyk – director of the Warsaw Center for Victims of Domestic Violence, addiction therapist at the AKMED Center and lecturer at the Postgraduate Study of Interpersonal Relations and Addiction Prevention at the UKSW