Ending Addiction for Good

Can Alcoholics Ever Drink Moderately?

During April’s Alcohol Awareness Month, I hope you’ll join me in the real, inward-looking experience of discovering what kind of drinker you are. If the answer is “non-dependent” you may have the choice of moderation management. But if the answer is alcoholism, your best goal has been and remains abstinence. Read More

NIAAA data

The data doesn't lie.

in the case of alcohol use, a nationally representative survey of 43,000 adults (http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx, summarized at http://www.medscape.com/viewarticle/703483) funded by NIAAA concluded the following:

“Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.”

“About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.”

***

The norm is that problem drinkers stop on their own, and more than half of those who stop, drink at low-risk levels afterward. This should give big hope to many problem drinkers.

Spontaneous Recovery

I quit on my own. I had a spontaneous recovery a little over 3 years ago. It wasn't really spectacular, noting really happened. I just didn't drink. I did not make any public declaration of my intent to quit. I didn't go to a meeting. (I am a solitary person so social people may benefit from groups when looking for new things to do)

There is an NIAAA study that says approximately 24% of drinker quit this way. (It looks like they did another study, this study I mention was in 2005, I think).

I have not tried to drink moderately. But if I drank a someone else's soda that had alcohol in it by accident, I would not run to the nearest AA meeting or anywhere else. I also have not had a slip or a relapse.

Once I felt that alcohol was bad for me I was done. Knowing alcohol was bad for me didn't get me to stop. I had to feel it.

"The addicted brain is

"The addicted brain is addicted. And it’s not one or two drinks the addicted brain wants."

This statement suggests humans can't change and alcoholism is an incurable disease. All change ultimately occurs because of decisions (THINKING) people make for themselves. People change with they are HURT enough and HAVE to, or when the LEARN enough and WANT to.

People overcome addiction out of purpose-based motivation -- they quit when they recognize how their habit violates WHO they were, WHAT they want to be, WHERE they want to go in life. A person's purpose and values are the main navigational tools in recovery from any hurt, habit or hang-up.

People are not mindless experimental rats lacking free will (disease model).

Granted there are people who don't give a hoot (no purpose driven motivation) and will always drink to excess.

Complete abstinence for some is necessary but these folks can be filtered with motivational interviewing and psychotherapy that you won't find at AA backed dogma groups.

I know one who did...

Mid 30s drunk decided he was going nowhere and he was an ass while drunk. Got his life together, got a good just and drank still but never to the point of drunk.

I also know several that quit but are still addicts... they just drink insane amounts of coffee.

And by "addict" are we

And by "addict" are we talking about people who have had withdrawal symptoms? If not, were they ever addicts?

12 - Step model

I think that the heavy drinkers can definately be able to switch themselves to moderate drinking. With the help of 12 step model plan, the drinker should really try to heal themselves.

What is the Difference Between "Problem Drinking" and "Alcoholism"?

Thank you all for your comments.

The main thread is to find the difference between "problem drinking" and "alcoholism" -- which unfortunately in most studies are lumped together as "alcohol dependence." Many people are problem drinkers. Some of those might even "look" to the outsider like an alcoholic. Take the young man or woman in college who parties three or more days a week. S/he might find him/herself experiencing blackouts, unable to go to class at times because s/he is too hungover, shaking a little when s/he stops drinking, having sexual contacts that are regretted later, etc. We'd consider these the actions at least of a problem drinker, if not an alcoholic. Yet the greatest majority of these young people leave college and immediately clean up when they get a job and other forms of responsibility. On the alcohol use spectrum, we would consider these individuals heavy or problem drinkers. They may have some negative consequences to their drinking, but still have the ability to change their ways unaided. These individuals will likely be able to drink moderately if they choose to. These individuals also are not good candidates for treatment. If you can relatively easily make changes to your lifestyle on your own, changes that stick, I applaud you.

The true alcoholic, different from the heavy or problem drinker, has both a biochemical and a physical change to his/her brain. The consequences of their drinking become increasingly severe over time. They try to quit and are unable to do so without help. In these individuals, the brain is essentially co-opted by addiction to the point that the individual literally can no longer make good decisions for him/herself. There's some good research from McGill University on this phenomenon if you're interested.

No, the vast majority of people who fall into the category of alcoholic -- this second group -- never seek treatment. It is also true that while many addicts in recovery have a soft spot for 12 step programs, they have a very poor recovery rate when used on their own -- 10% or less at one year. Whereas addicts who go through an evidence-based treatment program for three to four months and then complete an aftercare program at home for another eight or nine months (which will likely include but not be limited to 12 step meetings), those individuals recover at a rate of about 70% or more...again, for those who do ALL the suggested work in their treatment and aftercare programs.

What happens in treatment and aftercare that makes these individuals successful? In essence, we are able to rewire or retrain the brain to allow recovery to occur. Think of it this way -- if addiction is a feedback loop that prevents good decision making, in recovery, we create a new feedback loop that circumvents the damaged parts of the brain and allows a new lifestyle to develop. The old addiction feedback loop is still there, hence the reason for abstaining from drinking for these individuals -- but a new life...and in some ways, a new brain -- a new vision for seeing the world -- comes from treatment.

Two questions

1. Why is a problem drinker not a good candidate for your treatment, but an actual alcoholic is one?

2. Are you really saying that if you opened up the brains of a problem drinker at the three year mark of problem drinking, and the brains of an alcoholic at the three year mark of alcoholism, those brains would look different? Any studies to back this up? I can accept that you can retrain a brain to allow recovery to occur. That's what the CBT and DBT therapists do. But "rewire?" That would require the brains to look different even while the drinking is going on, and I have seen nothing to support that.

The entire disease model is

The entire disease model is primarily based on mammalian rat studies that are extrapolated to human beings. I'm not saying this is bad or unworthy, but just realize the profound limitations in variable control.

Then again, I may be ignorant of a special breed of rats, with free will, choice and reason.

I like to apply neuroplasticity to addiction

I believe our brain changes, but I believe my brain was also changed by reading this article. Dendrites proliferate whenever we learn something.
If the area that is creating the addiction for us is larger or better wired or more dense; what other functions might the area perform. Instead of trying to get rid of it can it be re-purposed.
What areas are affected most significantly.

I have had lifelong depression. Can I now use the no longer needed drunk part of my brain and use it to be happy?

Imaging studies of alcoholic brains

In fact, there are many studies showing that the brains of "problem drinkers" are different than the brains of "alcoholics" or at least showing that the more you drink, the more the structure of your brain is affected. For example:

http://psycnet.apa.org/psycinfo/1983-32942-001 -- "Alcoholics had larger ventricles, wider cerebral sulci, and wider Sylvian and interhemispheric fissures. Subjects whose scans had improved at follow-up differed from the rest with regard to length of abstinence prior to rescanning."
http://psycnet.apa.org/psycinfo/2004-10881-018 -- "This study suggests, as did our earlier study, that alcoholics and not heavy social drinkers, when exposed to alcohol cues, have increased brain activity in areas that reportedly subserve craving for other addictive substances.
http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.1988.tb00137.x/ab... -- "Across the entire group, alcoholics had significantly enlarged ventricles and sulci for their age. Enlargement at both sites correlated significantly with lifetime alcohol consumption."

These and many more show that if you opened up the brain of a problem drinker and an alcoholic at the three-year mark, the brains would look different. Interestingly, a couple of the studies cited above show the results of follow-up scanning in which after a period of abstinence, the brain does literally "rewire" itself back toward normal structures.

Response to Two Questions

These are excellent questions. Allow me to address each in turn.

1. Problem drinkers, individuals who drink to excess once in awhile or even reasonably frequently, but who are not alcoholic are not good candidates for any treatment center. Any problem should be addressed with the lowest level of care we can reasonably expect to work. Someone who overindulges now and again will do well in psychotherapy or out-patient treatment. Alcoholics, individuals who literally cannot go without drinking for more than a very brief period of time first of all need a supervised medical detox, because a person can die from alcohol withdrawal. Second, they need a higher level of care in which they are able to get a foundation for recovery before they are returned to an environment in which temptation to relapse abounds. There are not enough treatment beds even for those who need them. Let's be sure that those beds go to those who are most in need. Those who can reasonably be expected to be able to change their habits without residential treatment should be encouraged to do so.

This is different than expecting someone to fail out of treatment in order to "earn" a place in a higher level of care. Treatment professionals are adept at discerning what level of care is best suited to an individual he/she is working with. A trusted professional should be able to tell you honestly what level of care you or your loved one requires.

2. Your second question is about neuroscience research. For this, I defer to my full time addiction researcher, Dr. Constance Scharff. Over the course of the last year, Dr. Scharff has shared with me numerous studies coming out of universities in Canada, the United States and across Europe indicating that yes, not only does the biochemistry of the brain change in response to both addiction and recovery, but so too does the physical structure of the brain. As she explains it, the brain is far more dynamic than we previously thought and yes, it changes its structure in addition to its chemistry based on behaviors we do over and over again. This is very leading edge stuff, but yes, the science now seems to indicate that the brain changes are physical. Fascinating stuff!

How do you explain me?

Quick background: I've been in 5 treatment centers in my life, suffered from an eating disorder and was physically addicted to benzodiazepines. I drank quite heavily and could never control it once I started. Fast forward - 27 years later - 18 spent in recovery with no relapses - and guess what? I can drink - quite normally I may add and have been doing so for years. I have never been 'drunk' during that time. I have never drank more than one drink and I have absolutely no desire to do so. I have taken benzodiazepines on occasion for back issues. I had one prescription of 20 - it's been four years and there are still pills in the bottle. I am free from any kind of obsession regarding alcohol or my medicinal use of drugs including pain killers which were required short term for two surgeries. My eating disorder has also remained in re-mission. I can eat any kind of food I please and I am a normal weight. The thing is, I don't think I'm special, I think that over the years my brain has rewired itself. Specifically, I rewired it without knowing I was doing so. Was I an addict and an alcoholic? Any of the treatment centers I entered would tell you yes. I had to be medically withdrawn from benzodiazepines and I would drink until I blacked out every time. I think the brain is quite plastic. I don't know of any other way to explain myself. I have not attended a 12 step meeting in ages and my life is quite normal.

>>I don't know of any other

>>I don't know of any other way to explain myself.<<

You sound like someone with purpose driven motivation!
All change ultimately occurs because of decisions (THINKING) people make for themselves. People change with they are HURT ENOUGH and HAVE TO, or when the LEARN ENOUGH AND WANT TO. You may not be able to turn the switch off in rats, but humans, despite their propensity to do the wrong thing, have free will and choice and can and do create new switches, new and better pathways by exercising and developing character. None of us our powerless if we have free will and the ability to make decisions.

Congrats!!

addiction

AS I asked Dr. Scharff. If the brain can change then why cannot those who were once addicted no moderate once recovered?

The Neuroscience

What the science is currently showing us is that once the brain has developed this addicted pattern, that is once it has changed its structure, that part of the brain never changes back. Even if the person stops drinking, the new neuron pathways have been made and that's that.

In recovery, and this research is still preliminary, it looks as if the brain rewires itself around the "addict" part, circumventing it.

If the addict does not go back to using, the addict neural pathways will remain dormant. If the addict returns to using, the brain will be triggered and the addict will pick up just where s/he left off, with tragic results -- consider Philip Seymour Hoffman as an example.

Like riding a bike

So it is like learning to ride a bike. The first time it takes awhile to get the hang of it but if you come back years later it will only an hour or so to get you riding wheelies and crashing again.

>>If the addict returns to

>>If the addict returns to using, the brain will be triggered and the addict will pick up just where s/he left off, with tragic results -- consider Philip Seymour Hoffman as an example.<<

I respectfully disagree with your, "Rat Theory."
In my view, Mr. Hoffman loved heroin more than he loved any human being and more than he loved himself and God. No disease or genetic anomaly can make a person text a dealer, withdraw a stack of bills from an ATM, pick up a supply of 70 bags of heroin, tie a tourniquet around his arm and inject the stuff into his vein. No quirk of neurochemistry can make you rate getting high as more important than getting your kids through life. Only a disorder of character (values and purpose) can do that. Sadly, Mr. Hoffman lost his global purpose in life or he never had one.

>>What the science is

>>What the science is currently showing us is that once the brain has developed this addicted pattern, that is once it has changed its structure, that part of the brain never changes back. Even if the person stops drinking, the new neuron pathways have been made and that's that. <<

Please source your evidence for that statement???

Even if you accept this premise, it does not explain why people quit on their own. Recall the Robins study on Vietnam Vets addicted to heroin. Far and away the majority quit on their own when their values and motivation changed; when the horror of war was gone, when family, values and character became paramount.

Missing the point

Mr. Taite, I think you're missing the point. When I ask about the difference in brains between a problem drinker and an alcoholic, I'm asking about those brains during a time when they are consuming the same amount of alcohol! Are you are seriously saying that a problem drinker after three years of daily eight drinks, and an alcoholic after three years of daily eight drinks, will have different-looking brains? Where's the study to support that? No one is doubting that a heavy drinker and a person who drinks twice a week will have different-looking brains. The doubt is about the difference in brains between alcoholics and problems drinkers in the midst of their drinking.

And how do you explains, "How do you explain me?" post above? Is addiction the one brain disease in the history of science where motivation alone can "rewire" the pathways? Really?

This is a thin line to walk.

This is a thin line to walk. I understand that research is being presented that recovering alcoholics may be able to return to moderate drinking, but that is something I am not sure individuals who are in recovery need to even consider. Willpower can only be so strong. It can be very difficult to determine how for you will go after just one drink. I would like to hear a testimony from an individual who has overcome their addiction and is able to moderately or socially drink. Thanks for the topic, very good discussion.

Moderation

Moderation is possible for many but not for all. It all depends on the individual relationship with their inner self, maturity, values and global purpose in life. The question becomes how do you respond to stress? Do you exercise a displaced behavior in order to regain control of your stressful situation or do you NOW have the ability to produce a healthy direct response in order to regain control of your circumstances and life.

You can read more here. http://christrecovery.discussioncommunity.com/

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Richard Taite is CEO and founder of the Cliffside Malibu Treatment Center in Malibu, California and co-author of the book Ending Addiction for Good.

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