This is actually a very important topic and something I need to revisit every day or I will undoubtedly listen to the voice that tells me (at least several times a day, sometimes in a whisper, sometimes a deafening scream) that I am not…And that I can, in fact, drink or use in moderation.
Over the past several months, as a consequence of starting on Campral (which is a medication designed to curb cravings for alcohol, and I’ve found works similarly for other cravings, like food binging), it has been increasingly difficult to convince myself I am an alcoholic. Why? Because when I slip and drink now, I actually AM able to stop after “only a couple.” Campral appears to help with preventing my ‘MORE MORE MORE’ switch from getting flipped as soon as I have ‘just one.’ It’s not a cure and it certainly doesn’t stop me from making other poor choices as being under the influence to any degree causes disinhibition, but it does temper my prior need to satisfy the ‘ALL’ on my all-or-nothing spectrum.
So, as you can imagine, my disease really enjoys this newfound ‘manageability’ and focuses on how because I am able to drink more moderately, I can’t be an alcoholic. Right? Well…, if I force myself to remember the not-at-all distant past and am honest with myself (and others), I am quickly reminded of what makes me an alcoholic. For starters, the fact that I’m f’ing taking Campral. Non-alcoholics don’t usually end up getting prescribed this medication. Oh, um, right. Things got bad enough that I couldn’t control myself on my own, so in addition to therapy, meetings, other psychiatric medication (Prozac), and err, inpatient rehab and intensive outpatient treatment, it was suggested I give Campral a try.
What was that, self? Rehab? Yeah, that’s another thing people who aren’t alcoholics/addicts don’t end up including in their “30 things to do before I turn 30” lists. And if that wasn’t enough, let’s consider in detail some of the additional ways I can be sure, I am in fact, an alcoholic and an addict.
There’s the Diagnostic and Statistical Manual of Mental Disorders IV-TR criteria for alcohol dependence I just happen to fit perfectly (I know, I say I/we can’t do anything PERFECTLY, but this time I’d say I come pretty damn close)…It classifies dependence as:
A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
(1) tolerance, as defined by either of the following: (Check)
(a) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect (Check)
(b) markedly diminished effect with continued use of the same amount of alcohol
(2) Withdrawal, as manifested by either of the following: (Check)
(a) the characteristic withdrawal syndrome for alcohol (Check)
(b) alcohol (or a closely related drug such as valium) is used to relieve or avoid withdrawal symptoms (Check)
(3) alcohol is often used in larger amounts or over a longer period than was intended (Check)
(4) there is a persistent desire or unsuccessful efforts to cut down or control alcohol use (Check)
(5) a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects (Check)
(6) important social, occupational, or recreational activities are given up or reduced because of alcohol use (Check)
(7) alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption) (Check)
Then there’s the nice little CAGE questionnaire I can reference to be extra, extra sure I don’t try to find a loophole…
Two “yes” responses indicate that the possibility of alcoholism should be investigated further. The questionnaire asks the following questions:
1. Have you ever felt you needed to Cut down on your drinking? Yes
2. Have people Annoyed you by criticizing your drinking? Yes
3. Have you ever felt Guilty about drinking? Yes
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? Um well, yes, I’ve done that too.
I would actually classify myself as Polysubstance Dependent. In addition to alcohol, over the course of my life (and often at the same times), I have been actively dependent (according to the above criteria) on several other drugs…benzo’s (Xanax, Ativan), amphetamines (Ritalin), opiates (Hydrocodone/Oxycontin), and dextromethorphan (mood-altering ingredient in OTC cough medicines like Robotussin). GO ME.
And now, some personally relevant points to really drive it home.
Note: I am going to use ‘addict’ as an all-inclusive term here, pertaining to those whose substance of choice is chemical (drug/alcohol) as well as non-chemical (food/exercise, people/relationships). It is good for me to conceptualize it in this way because, as I have struggled with all of the above, such a view helps me not to compartmentalize my addictions.
Compartmentalization is a wonderful rationalization tool that anyone with multiple ‘substances of choice’ is apt to use throughout the recovery process …For example, I’m just out of control with food, or THIS particular drug, but THAT one, THAT I can use in moderation…Thinking in these terms only results in substitution and gives me permission to ‘just’ work on my addiction to THIS while in the meantime, THAT is spiraling out of control to become my next THIS. I hope that made sense.
Ok, moving on to a few examples that help me keep my powerlessness ‘up front.’
1. Non-addicts do not feel compelled to keep using until their substance is gone, even after they feel physically and mentally sick from it.
2. Non-addicts do not go to bed at night swearing on everything they love that they will not use the next day and then not even make it halfway through the day before they break their promises and end up using.
3. Non-addicts do not use (to the point of impairment) and drive.
4. Non-addicts don’t seriously consider injuring/killing themselves in an effort to end the cycle (and they don’t steer their car into a guardrail so they don’t have to go to work because they feel so out of control).
5. Non-addicts do not go from store to store, sometimes completely out of the way, in order to prevent store proprietors from thinking they might have a problem (SO many people I’ve seen in liquor stores appear to be alcoholics that I have often wondered what owners/employees think when they see how their business is so obviously contributing to the destruction of lives…no, I’m not saying they are to blame for our use as we have the choice to recover and all of that, but I imagine they have to think about it)…This one also applies to my history of frequenting multiple fast food drive-thrus and convenient/grocery stores to stock up on binge foods.
6. Non-addicts don’t hide bottles (empty or opened) or leftover pills around the house for their next use.
7. Non-addicts don’t use in the morning or in excess, alone.
8. Non-addicts stop using when they experience significant medical issues that are likely the direct result of their use. They don’t, while being fully conscious of the relationship between using and health problems/risks, continue to (frequently) use dangerous amounts.
9. Non-addicts don’t lie ALL-THE-FREAKING-TIME to protect their addiction(s).
10. Non-addicts don’t sneak off from whatever activity they are doing at various points throughout the day to use.
11. Non-addicts don’t use at work.
12. Non-addicts don’t go through people’s medicine cabinets and steal their pills.
13. Non-addicts don’t put their substance before everything else they value and end up losing (or come incredibly close to losing) relationships, jobs, homes, and ultimately lives because they continue to use despite experiencing or facing these losses.
I could go on. And on. But I’m tired and it’s pretty damn clear to me that I am an addict. Well, I said I was going to be honest. Does it make sense why I might have some guilt and shame to work through?…Oh, I guess for those who don’t know, I should add I was doing these things, at times, while working with people struggling to recover from their own addictions…This hypocrisy ate me alive and kept me sick for far longer than if I hadn’t been a professional ‘in the field.’ Because I just couldn’t tell…how could I tell?