I am back working in Colorado and a recurring theme this month is alcohol and alcohol myths.
Myth: If I only drink on my days off, I am not an alcoholic. Nope. People can binge one day a week and still be an alcoholic. A standard “dose” of alcohol is 12 ounces of 5% beer, 5 ounces of standard wine or 1.5 ounces of liquor. But what if someone drinks 8% beer, 12 ounces? Well, that’s 1.6 standard drinks. An 8% 16 ounce beer? That is 1.6 times 1.3, so 2.08 drinks. Perhaps we should have an app that calculates this. And locks the car ignition when we are over the limit.
How much alcohol means that we are an alcoholic? The guidelines right now in the US say 7 drinks per week maximum for women, 14 for men, no more than one in 24 hours for women, no more than 2 in 24 hours for men and no saving it up for the weekend. Here: https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/basics-defining-how-much-alcohol-too-much#pub-toc3. However, alcohol is bad for the liver, bad for the heart, bad for the brain, and increases cancer risk. There is not a “safe” amount.
What is binging or heavy drinking? For women—4 or more drinks on any day or 8 or more per week, For men—5 or more drinks on any day or 15 or more per week. The rate at which people drink is also part of this.
MYTH: If I don’t throw up, I’m not an alcoholic. Now that’s an interesting one. When we drink, alcohol is absorbed into the blood and goes through the liver. The liver has enzymes which break alcohol down into aldehyde. Aldehyde is a carcinogen, causes cancer. Aldehyde is broken down by other enzymes into acetate and then to carbon dioxide and water. Some people break down the aldehyde quickly, fast metabolizers. They can drink a lot and not throw up because they break the aldehyde down fast. However, the process inflames and kills liver cells. If they keep drinking, the liver slowly dies, and this is cirrhosis. Eventually they will not be able to break down alcohol fast because the liver makes the enzymes. Then they will start throwing up.
Other people make enzymes that are slower or make less, and they get sick and have alcohol poisoning more quickly. The fast metabolizers are at higher risk for cirrhosis and the slow ones for liver cancer, but they can get either.
MYTH: “My blood pressure is fine.” I spoke to a person who stated that their blood pressure was ok during pregnancy so they did not have high blood pressure. The chart shows very high blood pressure for the last three years and I didn’t look back further. I ask, “Did you stop drinking alcohol while pregnant?” “Of course.” When NOT pregnant, this person admits to 4-5 drinks a day. Also, the history in the chart states that they had blood pressure complications in pregnancy. I did not have time to go through the chart and look at that, but this person is in denial. I think of denial as the addiction taking over and the addiction lies. It lies to me but it also lies to the person. They want to believe what they say. They want everyone else to believe what they say even if it is patently a lie and ridiculous. A woman who says a friend gave her something, she didn’t know what it was, for a headache. “How did you take it?” I asked, looking at the urine dip results. “I snorted it.” “So what things do you snort for a headache?” She was positive for cocaine and pleading ignorance was ludicrous. Another person has a positive urine drug screen for multiple things. “Can I try again?” Pause. “Sure.” I say. The first one is a false sample and I am very curious to see what the real sample will have. It has nothing. He is then surprised that I won’t fill his prescription and offer inpatient drug rehabilitation. Come now, sir, you got a urine sample from a dealer when you sold the medicine I gave you for something else. Your dealer must have been annoyed or gave you the wrong sample. When someone is really out of control, they do not have convincing lies and the only person they can convince is themselves. It is interesting to watch someone be all outraged that I do not buy the story, accusing me of discrimination or hating them or hating their race or whatever. They attempt to accuse and distract. It is harder for families because they desperately want to believe their loved one, even when the evidence shouts the opposite.
What does blood pressure have to do with alcohol? Alcohol drives blood pressure up and pulse, especially when it is wearing off. Severe alcohol withdrawal is delerium tremens and people can have such high blood pressure that they have a stroke or a heart attack or encephalopathy — a poisoned brain. They can hallucinate or have seizures and it is very dangerous. “Very dangerous” means they could die or have permanent disability. Tobacco, cocaine, methamphetamines, all raise blood pressure. The number one cause of death in the United States is the heart, but it’s not just from hypertension and weight and cholesterol and inactivity. Addictive drugs have a huge contribution.
There is nothing cheap about the cost of addiction in our country.
For the Ragtag Daily Prompt: cheap.
KO Rural Mad As Hell Blog 
From what I have seen around me, an alcoholic never admits to alcoholism but a few on the brink were able to step back. Thanks for sharing your detailed post.
We routinely drug tested employees if they had a work-related injury. One employee was so incensed that his drug screen came back positive that he asked for the written results. He wanted to get his money back on the ‘antidote’ that was supposed to guarantee a negative drug screen.
Snort.
I would define alcoholism less statistically — I would define it as a life that revolves around the drink regardless of quantitatively how much is in the glass or bottle. I would define it as a person who says, “I only drink XYZ so I’m not an alcoholic.” That’s an alcoholic. A person who needs booze in the house to feel “comfortable” is an alcoholic. In my (copious and direct though not personal to me) experience with alcoholics health concerns related to alcohol are not important. My alcoholic brother died of a stroke. My mom of alcoholism related brain degeneration. I think you can tell them all that and it’s totally irrelevant to them. I don’t know what I would tell them, but it wouldn’t be scientific or kind. It would be, “Come talk to me when you stop drinking.” Lou is right, though, and much “kinder” than I am and there might, indeed, be the one who hears.
I agree with you and still, numbers give me a place to work from in clinic.
l don’t know how I’d deal with this in your situation.
I think of clinic as some science education and then also saying, “I am concerned that if you keep doing whatever, then you will (have a stroke/heart attack/liver damage/die/whatever).” It is rather parent-like, but I try to point them towards evidence and also make it their choice and job.
That’s a good approach, I think. ❤️
The doctor who taught the addiction medicine suboxone course said, “If you are working harder than the patient, there is something wrong. You offer them the work and they do it or they don’t.” When someone would disappear from treatment, I would think, “Well, he/she can come back and try again, I hope they live long enough to do so.”
That doc was right. It’s awful. I did counseling with a former junky for a few years. He’d been sober as long as he’d been using, so there was that. One of the most amazing people I’ve ever known. He was helping addicts who wanted to go into a treatment center in Tijuana, Mexico.
I “talked” (via Facebook) in groups and individually with family members. I’d gotten good training from life but also a program. It’s so hard to say to a family, “You have to back off. Your life matters. You need to evaluate how much of your life is trying to fix the addict, help the addict, live the addict’s life for them”
Personally don’t even think it’s possible as long as the addict is using. And when you see that level of irresponsibility toward a life YOU value? That shouldn’t make sense. It’s crazy. It’s truly the saddest thing I know. And the “enabler” it’s part of their — ooops I mean our — nature.
We are awash with dependencies in this society. Thanks for this carefully laid out post. It’s important that the data be presented repeatedly. The human ability to ignore unpleasant truths is huge, but every once in a while you get someone in a receptive mood, and start a process of change.
I think people can change but there is sometimes a really big gap between can and will. Some will not do the work. Thank you for your comment!
Well-said. I once had an employee who was an alcoholic. He was a binge-drinker and would laughingly say he never had more than three drinks – because after three he stopped counting. He might go days or weeks between black-out drunks. He checked into inpatient rehab when he woke up in another city and didn’t know how he got there.
I had parents who drank daily. Not a lot, but as though it were another meal in the day. Addiction with different details.
I had a patient who claimed he didn’t drink but that his body converted sugars to alcohol and that’s why he always tested high for blood alcohol concentration. Funny, but he stopped testing positive when he was an inpatient.
The alcohol in control and lying again! And we want to say, “That isn’t true!” But we are afraid in social situations, all too often.