Answer:  Donald W. Goodwin, MD, professor of psychiatry, noted in an article he wrote for the American Journal of Psychotherapy (Vol. XLVI, No. 3, July 1992) that there was a “veritable epidemic of alcoholism among American writers” in the first half of the 20^th century. He said that over 70 percent of the American writers who have won the Nobel Prize in Literature were alcoholics, including Sinclair Lewis, Eugene O’Neill, William Faulkner and John Steinbeck.

 Upton Sinclair’s “15 Leading Heavy Drinkers of the 20^th Century” (The Book of Lists, Wallechinsky, Wallace, et.al, Wm Morrow and Co., Inc. New York, 1977) includes Edna St. Vincent Millay, poet; Ambrose Bierce, journalist; Maxwell Bodenheim, writer; and Sherwood Anderson, writer.

 “The Peoples Almanac” (Doubleday and Company, Inc., New York, 1975; Wallechinsky and Wallace) lists even more literary greats who were alcoholics, including Edgar Allen Poe, Jack London, O.Henry and F. Scott Fitzgerald.

 Why this seeming preference of the disease for these kinds of gifted people is an ongoing study. However, besides alcoholism, these famous writers also had high prevalence for affective conditions (depression) and were loners.

 Answer:  Alcoholics take very seriously reports of experience.

 They have heard and believe that when an alcoholic starts to drink after many years of continuous abstinence the pattern of drinking reverts very rapidly to the same compulsive, loss-of-control drinking that existed before becoming sober.

 There is a neurobiological reason for this.  Special nerve pathways in the brain were highly and permanently sensitized to alcohol by earlier heavy drinking.  Even the smallest amount of alcohol after many sober years will inevitably set into motion an irreversible cascade of mental and physical events.

 The first is euphoric recall, that vivid expectation of “how good a few drinks” can be. The second is obsession, or being unable to think about anything else but drinking. The third is compulsion, an overpowering, irresistible urge to “go ahead and drink.” The fourth is physical craving a need, beyond desire, to drink alcohol.  All of these events take place in the brain.

 Many persons who had long-term sobriety and relapse are elderly.  Because experience has shown it is so hard to reestablish abstinence in the late relapse, many quietly drink themselves to death.

 Although a person in recovery may have gotten used to being a “non-drinker” for years, there lays beneath the surface of his or her consciousness what neuro-scientists now call Chronic Relapsing Brain Disease.

 We do know that those who respect the power of the disease continue to go to AA meetings for as long as they have the disease.  The disease is lifelong, but so is sobriety for those who remember that reality.

Answer:  Alcoholics who drink every day avoid craving because they keep the blood alcohol level high enough to prevent the symptoms of withdrawal. The only times you could have experienced craving was in the hospital and treatment center when you were given medication to prevent severe withdrawal symptoms. Craving, however, can occur without withdrawal symptoms or long after the last drink or drug use, especially if the memory of the effects of the alcohol or drugs are evoked by strong reminders, called cues.

 A report in the Journal of Clinical and Experimental Research (Modell JG et al, 1992) indicates that many of the symptoms of craving in the dependent individual are similar to the thought patterns and behaviors of persons with obsessive-compulsive disorder, including recurrent and persistent thoughts about alcohol and the inability of the individual to resist these thoughts and a compulsive drive to consume alcohol and loss of control over that drive. 

Recently, the National Institute of Drug Abuse used PET scans to demonstrate how an area in the left frontal lobe of the brain “lights up” when a sober alcoholic is shown drinking scenes. This brain activity is accompanied by intense craving.

Answer:   Help is here. Listen carefully! Call an alcohol or drug rehabilitation center in your city.  There are several of them. You need the direct medical care of an inpatient program to get you through the rather extensive detoxification process necessitated by your long-term heavy use of the particular sedative /tranquilizer you have been taking. You are not alone in this addiction. The National Center on Addiction and Substance Abuse reports that 2.8 million (11 percent) of women over the age of 59 abuse prescription psycho-active drugs. (There are 25.6 million American women over the age of 59).

Not only are mature women at higher risk to become addicted faster, but doctors are slow to even consider a substance abuse diagnosis when treating these women.

I also warn you not to try stopping the drug until you are under the care of a physician, and the nurses, of an inpatient program. Unfortunately, the drugs that are effective in alleviating anxiety are addicting. They were designed for short-term use only. Prolonged use not only robs them of their effectiveness, but as the body builds up tolerance to them, dependence (addiction) is the inevitable result. Intensive psycho-social therapy must follow detoxification. This therapy arms one to deal with the strong compulsion to relapse.

 Many of her country club friends are still following this routine.  In the past year she has been gradually getting back into the kind of social life she enjoyed before.  She has also started to drink again like most of her friends do.

 We were shocked a few weeks ago when a physician friend recommended that she abstain from alcohol.  He said her drinking might well have caused her stroke.  Is this possible?

 Answer:  It is not only possible, but also probable.

 Having four or five drinks a day, no matter how socially graceful and acceptable at the Country Club, or any other social setting, is heavy drinking.

 The risk of high blood pressure is 50 percent higher in persons drinking three or four drinks a day than in non-drinkers.  Hypertension is a major risk factor for cerebro-vascular hemorrhage (stroke), as well as myocardial infarction (heart attack). 

The four or five drinks your mother consumed are associated with a fourfold increase in the risk of a hemorrhagic stroke.

This kind of commonly fatal, or always disabling stroke, is much more common in female heavy drinkers than in men who drink an equal amount.

As she now re-enters her world of social functioning it is imperative that she refrain from alcohol.  Her risk of suffering another alcohol-related stroke is the same, or maybe even greater, than before.

Answer:  There is still lots of stigma out here in the public arena about alcoholics. Webster defines stigma as “something that detracts from the character or reputation of a person; a mark of disgrace or reproach.”

When a group of professionals and employers was asked “Is there a social stigma associated with alcoholism?” 83 percent of psychiatrists said there was a strong stigma, 70 percent of doctors stated there was a strong stigma, 51 percent of employers said there was a strong stigma, 47 percent of clergy stated there was a strong stigma, and 56 percent of counselors opined that there was still a strong stigma associated with being an alcoholic.

According to the Recovery Institute and Peter D. Hart Research Institute, from which this data is reported, “Most people see alcoholism as having elements of both a disease and a moral weakness. Given 100 percent to allocate in any proportion of the two models, fewer than one in four say alcoholism is 100 percent disease, and majorities of nearly every group say it is at least 25 percent due to the moral or personal weakness of the alcoholic.” Whether there is stigma or not, the important thing is that the person suffering from the disease of alcoholism gets treatment, and maintain recovery through Alcoholics Anonymous.

One day society will catch up with the science of addiction medicine, which with AA has been responsible, through teaching research, for bringing knowledge about alcoholism to its present level of understanding. Obviously there is a long way to go.

Answer:  It would be a pity if that were true. Take heart – many others have gone through this same relapse history and have made it. I suggest that you read the beginning of Chapter 5 in the Big Book of A.A., which starts by saying that “Rarely have we seen a person fail who has thoroughly followed our path”. The emphasis throughout this first paragraph is rigorous honesty. If, with courage and with total truth, you take the steps with absolutely no reservation, and eliminate those things from your life which, in good conscience, can’t be reconciled with living the steps, you will stay sober. Also remember, “You alone must do it, but you can’t do it alone!”

Answer:  I sure can! I know just the kind of emergency setting you are talking about. While you are assessing the patient, you can weave into your initial triage history from the patient four specific questions. These have sensitivity for identifying alcoholics up to 95 percent of the time:  The questions are as follows:

• Have you ever felt a need to cut down on your drinking?
• Has anyone commented on your drinking, and does it annoy you?
• Have you ever felt guilty about your drinking?
• Do you ever have an “eye-opener” in the morning to settle your nerves?

 If a person answers “yes” to two or more of these questions, chances are that he or she is an alcoholic. Referral to Alcoholics Anonymous would be good medical practice. It would be a prudent idea to have some AA brochures in the emergency room to give to those persons who “qualify” for a possible alcohol problem.

Answer:  This unhappy man was, like many others, unprepared for retirement.  He is one of those many persons whose drinking is most likely driven by environment, rather than any genetic predisposition to alcoholism.
 Under these circumstances the liability for relapse to drinking as an alternative to a very unhappy and depressed abstinence is almost inevitable unless there is a quick and effective intervention to get him into an alcohol rehabilitation center.  This should be inpatient treatment so that he will necessarily be with lots of other recovering people all the time.  His anticipated depression-related reluctance to go to treatment must be overcome.  Professional interventionists would be best for this.
 While in the inpatient program a psychological assessment will be made for depression and possibly some brain effects of heavy drinking in an older person.  Alcoholics Anonymous as a follow-up to treatment is the most effective form of therapy we know of today.  For a lonely depressed person, there will be many successfully retired persons to relate to after he completes a month or so of inpatient treatment.

 Answer:  An ex-marine officer who provides therapy for Vietnam veterans with post-traumatic stress disorder (PTSD) reports that many of those he has treated also have an alcohol abuse problem. PTSD refers to the cluster of pathological symptoms characterized by the painful mental and emotional response initiated by the recall of a deeply imprinted traumatic memory. These painful memories can intrude on a person’s consciousness with or without cues, and in some persons they seem to grow more vivid and stronger with time. Research has shown that when these memories are deliberately evoked, the subjects experience physiological changes, including a rapid heartbeat, sweating, overall weakness, shakiness, and a feeling of hyper-alertness. There doesn’t appear to be a direct connection between PTSD and alcoholism except that a person who is a victim of this often disabling disorder may drink excessively to dull the pain and anguish of these persistent and obtrusive disturbing memories. However, drinking not only does not help, but it interferes with the specific psychotherapy necessary for dealing with PTSD – the two conditions require separate treatment.