How to Understand Alcoholism

Transcript Hello, my name’s Dr. Paul Rinaldi. I’m a clinical psychologist and an addiction specialist. I am the Director of the Addiction Institute of New York, which is the division of substance abuse treatment at Saint Lukes and Roosevelt hospitals which are members of the Mount Sinai Health Network in New York City. I’ve been …

Transcript People are often curious and ask the question as to why alcohol seems to make some people really emotional. Well, alcohol doesn’t really cause the emotions. What alcohol does is alcohol lowers people’s inhibitions and often allows people to express things that they may not otherwise express. So, for instance, someone may be feeling …

Transcript The question that has been posed is what is alcoholism. The good news for people is that alcoholism is a term that doesn’t exist anymore and that seems very curious to people. We used to diagnose alcohol in two categories: alcohol abuse or alcohol dependence. Now, with the publication of DSM5, which is the …

Transcript People are often curious about what constitutes a standard drink. People who have trouble with alcohol will often talk about how many drinks they had per night or per week. But you have to ask people what they consider a regular drink for them. What’s considered a standard drink is different, depending on the …

Transcript I’m sometimes asked by people what would be considered a safe level of drinking. That can be very different, depending on the individual. Generally, a safe level for any individual is a level at which one’s not inebriated. Because when people are inebriated they often do things that they wouldn’t normally do that could …

Transcript People are very curious about what causes hangovers and if hangovers really are real, if they exist. The answer is that yes, hangovers do exist. What causes hangovers is very simple – it’s excessive alcohol ingestion along with dehydration. The way to avoid a hangover generally is to not drink too much and also …

Transcript Often, people are concerned about a loved one and they may have been trying to get that loved on into some kind of treatment for their alcohol problems and the person refuses to do so. So then what they want to do is stage what’s called an intervention. An intervention should be staged. Often, …

Transcript People often are curious about if there are myths about alcoholism and there are. One myth is that alcoholics are drunks forever. Once an alcoholic, always an alcoholic. And that may be true, but that doesn’t mean that people are drunk forever. People stop. People are very successful with different ways of treating their …

Transcript A question that I frequently get from people who are working on their alcohol use is around triggers and the avoidance of the triggers. What’s important to do first is to identify what does trigger you to want to drink. People are triggered for different reasons. In the 12 step traditions in AA for …

Transcript I’m often asked by parents, what are the signs that their child is using or particularly abusing alcohol. In this area, we have to really be careful because there are some normal developmental issues with kids and kids often do experiment with different things and that doesn’t necessarily mean that there’s a problem, although …

Transcript People frequently ask about the Sinclair Method. The Sinclair Method is a treatment for alcohol use that involves pharmacological intervention. What it involves is something called pharmacological extinction where an opiate agonist, such as Naltrexone, is given to patients who are abusing alcohol. And patients are told really to continue their normal drinking. And …

Transcript A question that’s frequently posed is whether people can be high functioning alcoholics and that’s a tricky question because there’s no clear criteria that we use to say someone’s high functioning versus low functioning. Often, people have stereotypes of what an alcoholic is and I think when people think of a high functioning alcoholic, …

Transcript There’s been a lot of focus in the media on what’s called binge drinking. A lot of binge drinkers are younger people, at least that’s what gets put in the media. We hear a lot of about binge drinkers in college and there is a great deal. We know from research, there’s a great …

Transcript I sometimes get asked from people whether they should and how to stop drinking cold turkey. In other words, just one day I’m drinking the next day I don’t drink. My answer to that is well, I have two answers. I start with a question. How much are you drinking? So if you’re drinking …

Transcript I’m often asked by people, what are the risk factors for alcohol problems and there’s many risk factors that could come about for people. One major risk factor is looking at one’s family and looking at whether there’s been alcohol or other substance abuse problems in the family. There often is a generational or …

Transcript I’m often asked if there are medical consequences to alcohol use. The answer is that if alcohol is used in a normal, meaning non-abusive way, no, there’s rarely any medical consequences to alcohol use. However, when people use alcohol problematically, meaning that they use alcohol for an extended period of time throughout their life …

Transcript People are often wondering whether if there’s other things they can do for treatment besides AA. In fact, there are many. AA is one treatment option, however it’s not the only one. There are many ways to get treatment and get effective treatment for problematic alcohol use. AA is one of them, then there’s …

Transcript People often wonder about elderly people and alcohol use. In fact, there are elderly people who use alcohol problematically. And often people assume that those are people who always drank problematically. And certainly it’s sometimes the case where people just continue their patterns, but what often happens is that there’s some elderly people who’ve …

Transcript I’m frequently asked by people whether alcoholism and depression are related. Alcoholism and alcohol problems can often cause people to feel depressed. Alcohol is a depressant. When people start drinking, at first when they start drinking alcohol elevates one’s mood. And then your mood decreases with more alcohol. So it is actually a depressant, …

Transcript When people are drinking heavily, they’re often concerned that if they stop drinking, will they have withdrawal symptoms from alcohol. It’s not necessarily predictable if they’ll have symptoms and if so, what those symptoms will be and what the severity will be. However, alcohol withdrawal can be very serious and potentially life threatening. Alcohol …

Transcript People sometimes wonder how people die from alcohol. What may be surprising to some people is that the main cause of death from alcohol is through accidental death, often auto accidents or pedestrian accidents when drunk. There’s also medical reasons that people die from alcohol. Those medical reasons can include dying from cirrhosis of …

Transcript I’ve been asked about the phrase, alcohol dementia, and what is alcohol dementia. Alcohol dementia refers to a brain disorder that can occur through long exposure to alcohol. Alcohol dementia, you generally see in people who have been abusing alcohol at high levels for a very long time. People don’t get alcohol dementia early …

Transcript Folks are often curious about what the difference is between alcohol abuse and alcoholism. We used to use those terms, diagnostically, as professionals. We use a diagnostic manual for diagnoses of psychological disorders and substance abuse disorders. And in the old diagnostic manual, which was called “DSM-IV-R”, there was a category of alcohol abuse …

Transcript I’m often asked by people who are in treatment for alcohol problems if they should have acupuncture to help with their alcohol treatment. Well, acupuncture has been widely used in the field of substance abuse disorders. And in that, acupuncture has been used for many years, however in research there’s not a good research …

Transcript In the addiction field we’re often asked what the medical criteria is for alcohol problems. Most people want to know if there’s medical criteria for alcoholism. We don’t use the term alcoholism any longer, we use the term alcohol use disorder. In terms of medical criteria, there’s psychological and medical consequences of alcohol problems. …

Transcript People sometimes ask, “What’s the best way to stop drinking?” There’s no clear answer to that question. There’s different ways to stop drinking and different ways work for different people. So, among those different ways, is to go to Alcoholics Anonymous. You start going to Alcoholics Anonymous, you’re putting yourself in a situation where …

Transcript People are often curious to know whether it’s bad to drink alcohol on an empty stomach. In fact, when you drink on an empty stomach, you have nothing in your stomach to absorb the alcohol. So what happens is that your blood stream absorbs the alcohol much more quickly. If you have a full …

Transcript People are often concerned about whether they can inherit alcohol disorders or other substance disorders. What we do know now from research, is that there is a genetic predisposition to developing alcohol problems. There are genes that we know could be passed on from generation to generation, that can determine the potential for an …

Transcript There’s been an age old question about whether alcohol problems are a disease. We don’t use the term alcoholism anymore. We use the term alcohol use disorder and there’s been controversy and questions for a long time about whether it’s actually disease or whether it’s just a behavioral issue and perhaps some people view …

Transcript When people are seeking treatment for alcohol disorders, they’ll often ask me if hypnosis is a good treatment for their alcohol problem. Well, we look at different kinds of treatments from the perspective of evidence through research. There is not a research base that shows us that hypnosis is effective in and of itself …

Transcript I’m often asked by people how can I get my loved one who’s abusing alcohol into treatment. Often people are very resistant to treatment. They often don’t want to see themselves as having a problem. I can take care of it. I can stop but even when the evidence is that they can’t. There’s …

Transcript I often get calls from people who would like to stop drinking, but really are afraid of having withdrawal symptoms. When that happens, my main recommendation to them is that they come in and they see an addiction specialist to be evaluated. But I often get calls from people who aren’t in my local …

Transcript People who are struggling with alcohol use and trying to stop drinking, often experience cravings. People need to remember that just because you have a craving, that doesn’t mean you’re going to drink or have to drink. There’s a couple of ways of trying to control cravings. One way is through medication. We have …

Transcript People often ask how many drinks it will take to reach a blood alcohol level of .08. They ask that because .08 is the legal limit for what’s considered driving under the influence, now in all 50 states. It’s difficult to answer that question because what takes one person to reach that limit will …

Transcript People often want to know, “What is the amount that one needs to drink to cause alcohol poisoning?” That’s a very difficult question, because there’s many things that could contribute to alcohol poisoning. What you see often, just like in terms of people getting inebriated, you could have two people drinking together who are …

Transcript People often want to know how long alcohol will remain in their body after they stop drinking. What’s interesting about this is that while people absorb alcohol in very different ways and at very different speeds, the excretion of alcohol occurs exactly the same from person to person. If you have a blood alcohol …

Transcript The question that has been asked of me is if alcoholism can lead to diabetes. And if so, how? The answer is chronic alcohol use can lead to diabetes. The way it leads to diabetes is that chronic alcohol use can cause inflammation of the pancreas, and chronic inflammation of the pancreas can affect …

Transcript People are often curious about the effects of alcohol on women vs. the effects of alcohol on men. In fact, alcohol does affect women differently than men for a couple of reasons. The first is that women actually in their body mass have less water than men have in their bodies. So when they …

Transcript I’m often asked about the differences in men versus women. That it seems like there’s more male alcoholics then there are women. Well, in fact from what we know, that is true, there are more men who are identified as having alcohol use disorders than women. However, there is a phenomenon with women of …

Transcript People often want to know what are the health risks of chronic heavy drinking. There can be several different kinds of health risks that people can experience. One of them can be hypertension where people’s blood pressure becomes chronically high requiring medical intervention. People also can experience changes in their esophagus and in their …

Transcript People will often ask us if there’s just a few things that they need to look at to see if they have actually some problem with alcohol, and there actually are. You can really ask yourself a few basic questions to see if you’re getting in some trouble with alcohol. A question might be, …

Transcript The question that comes up is around what’s called fetal alcohol syndrome. Fetal alcohol syndrome is a very serious problem that’s caused by mother’s drinking heavily while carrying a fetus. Alcohol goes through the placental barrier and actually affects the child while developing in the placenta. Children with fetal alcohol syndrome can have distinctive …

Transcript People are often curious about what kinds of treatment there is for alcohol problems. When people who are most interested in alcohol rehab, when people think of alcohol rehabilitation facilities, they are usually referring to inpatient rehab facilities. The standard alcoholism rehabs are what’s called 28 day facilities and they are one month treatments. …

Transcript I’m often asked what are the medical treatments that people can engage in for their alcohol problems. There are a couple of medications that can be used for people with alcohol use disorders. One of them is called Antabuse. Antabuse is a medication that people take each day. It comes in two different doses, …

Transcript Women often want to know when they’re pregnant if it’s safe to drink at all during pregnancy. This has been a controversial topic. There are some obstetricians who will recommend that women abstain from alcohol completely during their pregnancy. Other obstetricians will say that it’s okay for a woman to drink small amounts in …

Transcript People are often curious about whether mixing different kinds of alcohol in one drinking episode will be more likely to make you sick than if you stick to one kind of liquor. It’s interesting because actually science tells us that no, that’s not really true. There is some evidence that if you drink something, …

Transcript A frequent question is whether drinking too much will raise your tolerance to alcohol. It depends on what kinds of drinking you do. When people drink too much every once in a while or another way of saying that is binge drinking, that won’t necessarily change one’s tolerance. What changes one’s tolerance is drinking …

Transcript People are frequently curious to know if coffee is a good thing to have to help one sober up after excessive drinking. As we see, people are always offered coffee at the end of an evening. They often have coffee stations, you see that on New Year’s Eve. There’s free coffee at rest stops. …

Transcript A question that’s frequently posed is whether alcohol actually lowers people’s inhibitions. The answer is yes. When people drink alcohol, it does lower inhibitions, and it changes people’s judgment. Often people will report that they do things that they wouldn’t normally do. They may drive when they’ve been drinking, when they really would not …

Transcript People are often concerned about how alcohol use can affect their bodies. Well, alcohol can affect your body in several ways. Even people who don’t drink problematically can have some physical changes based on regular alcohol use. The typical change that people will usually think of is the beer gut, will be gaining weight. …

Transcript People often wonder about the medical effects of chronic alcohol use, particularly the effects on the liver. There’s really three types of liver disease that can result from heavy alcohol use. The mildest form is called fatty liver disease. In that case, what happens with the chronic alcohol use is that the liver develops …

Transcript In my practice I’m frequently called by the spouse or the partner of someone who has an alcohol problem, and they are usually calling to ask me what they should do. Usually they’re calling me to say, “How do I get my partner into treatment with you or into treatment with someone else?” When …

Transcript I’m often asked about how a child can cope with a parent’s alcohol problems. Well, that depends on the age of the child. If we’re talking about younger children or teenagers, really often what really is required in most often is that another adult becomes involved to help that child, whether that be a …

Transcript I’m often called by parents who are concerned about their child’s alcohol use. Sometimes those children are teenagers, sometimes those children are adults. But no matter the age of the child, parents are always parents and always feel responsible and concerned about their child. Anyone who’s a parent can relate to that. Even if …

Transcript There have been questions recently in the media about bariatric surgery and their relationship to alcohol abuse or alcohol issues. Bariatric surgery is when people have surgery to make their stomach smaller essentially, to lose weight. There has been some evidence now, showing that there is new onset alcohol problems after bariatric surgery. We …

Transcript People are often curious about what causes alcoholism or alcohol problems. We don’t really use the term alcoholism anymore. We use the term, alcohol use disorder but people often want to know why does one person fall into trouble with alcohol and the next person doesn’t. And you see this a lot when you …

Transcript People sometimes would like to know if they can force someone into treatment for alcohol. Well, the answer is generally no. You can’t really force someone into treatment. The only way you can force someone is through some coercion. And coercion meaning, if you’re a loved one you can certainly threaten to, if you’re …

Transcript I’m frequently asked by people if those with alcohol issues can learn how to drink moderately. There is an organization that’s called Moderation Management. The evidence suggests that those people who have severe alcohol use disorder cannot learn how to drink moderately, that those are people who really need to practice abstinence and maintain …

Transcript We often are asked by people what kinds of treatments are available for alcohol problems. The standard treatments are either in rehab facilities or 12 step, meaning Alcoholics Anonymous or Narcotics Anonymous for people who use other drugs. Alcoholics Anonymous is widely known but people often want to know what else can they do? …

Transcript People are often curious about why some people, when they drink, get really angry and people refer to it as the angry drunk. Well, alcohol doesn’t cause anger. Alcohol doesn’t cause emotions. What happens for a lot of people who get angry when they get drunk is that they have anger within them that …