February 23, 2024 • 15 mins
Description: Alcohol consumption is widely accepted and often expected in several social environments. However, addiction is just as prevalent with alcohol as it is with illicit substances. From mild to severe diagnoses, to binge drinking, to life-threatening effects, alcohol misuse needs to be acknowledged. Dr. Julia D’Alo, Chief Medical Officer, and Carin Fraioli, Vice President of Recovery Services, at Gateway Rehab, help to explain alcohol use disorder, how to address concerns of dependency, and fighting back against stigma.
Not all participants in this podcast are medical or clinical professionals. Always consult with a qualified health care provider.
Host: Jonny Hartwell.
Not all participants in this podcast are medical or clinical professionals. Always consult with a qualified health care provider.
Host: Jonny Hartwell.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Making a difference in the lives ofthe people that we love. Addiction is
a treatable disease, so I thinkit's more about bringing their guard down and
having them understand that we are tryingto assist them in any way, shape
or form that we can. AndI was like, oh, I just,
oh my god, I never wantto feel this way again. This
is Gateway Rehabs Recovery Roll Call andWelcome back. This is Gateway Rehabs Recovery
(00:24):
Roll Call. I'm your host,Johnny Hartwell, and I'd say hello too,
Julie Diello, Karen Frehley. Ourtoday's topic is alcohol use disorder.
What exactly is that? So alcoholuse disorder typically involves dependence on alcohol and
sort of cravings for alcohol and generallydysfunction in the person's life. I mean
(00:48):
that's like simply put. But itusually involves also just a lot of problems
with relationships and behaviors, and youknow, essentially it encompasses all that all.
Right, So there's probably the kindof the topic that just about every
one of our segments has something todo with stigma, and there's so many
stigmas when to come. So wecall it alcohol abuse disorder. But you
(01:14):
know, how's that different than callingsomebody an alcoholic or you know, and
there's so many other boozer and allthose kind of you know, disparaging terms.
You want to get away from that. Is that why it's called that,
right, I mean, alcohol usedisorder is the disease that the person
has and that is not their identityor you know, just we try to
(01:34):
stay away from labeling a person andsort of separating the disease from the person.
So if you're talking to somebody,maybe somebody who's listening to this podcast
and they have a friend or afamily member who is is going through this,
it's almost a softer landing point whenyou refer to them, and when
you talk to them and say,hey, maybe you need some help.
(01:56):
You know, you don't want touse those terms like you know, like
we just referred to and this isthis is a disorder. This is something
that and you need help and we'rewilling to help you get that help.
And of course Gateway is there tohelp as well. Of course. Yeah,
I mean language matters, like we'veI think we've talked about that in
some other segments, but I meanthis has actually been studied where people who
(02:16):
are labeled like alcoholics or junkies,they're actually treated differently by healthcare workers and
just people in the general society.So it's important that we, you know,
that we treat this and talk aboutthis disease just like we would talk
about any other disease. I thinkthe thing that I'd like to bring up
(02:37):
just about alcohol use disorder is thereare different different ways to label that as
well, meaning that it can gofrom mild to severe, and those can
be very different. You know,someone that's in the in the severe place,
and you know, Julie can eventalk more about this, but it
is really it is affecting all partsof their life and physically they're dependent on
(03:00):
alcohol. They can't function or getthrough the day without it. But then
you have your people that maybe wewould call binge drink, and binge drinking
is generally defined as five or moredrinks in a setting, but maybe they
don't do that that often, butthat's still if it causes them, consequences
(03:21):
still can be you know, analcohol use disorder, but more on the
mild side, So there there arevarying degrees of that. I also think
we point out that if you're inthat severe category. It's very dangerous.
It can be very dangerous for you, and you know, Julie may want
to talk about the physiological and thephysical parts of that, but it's it's
(03:43):
a very dangerous thing and needs tobe treated appropriately well. Alcohol is accepted
generally in society. That that makesyour that makes you solving that that disorder
even harder, very difficult, becauseit is accepted, so people don't see
it the same way they would seean illicit substance. And you can get
(04:08):
alcohol anywhere, so it's easy accessible, and it is accepted and a lot
of it's even advertised by the state. Even though you know, in Pennsylvania
it's controlled by the Pennsylvania Liquor ControlBoard, they still advertise the stores.
Yeah, I mean it's expected.You go to a sporting event or a
(04:29):
party and people look at you funnyif you're not drinking. Right. So,
I think, like espentially, Ithink the binge drinking thing is really
an important topic to talk about becauseit is actually the problem that affects more
Americans. You know, they askedme about twenty four percent of the US
population has you know, reports havingparticipated in binge drinking in the last month.
(04:50):
That's a lot of people, rightwho are you know, on a
Friday night or Saturday night are drinkingyou know, like ten twelve beers or
it's great, it's it's defined asgreater than five drinks in a male and
greater than four drinks and a femalein a short period of time, a
couple of hours or you know,in a period of time. If somebody
(05:12):
is listening to this podcast, they'reobviously either facing their own addiction to alcohol
or they have a family member.So if you're if you're addressing alcohol use
disorder, what's the first step?So, I mean a first step I
think with anything when you are whenyou love someone who you think has a
problem, is telling them what yousee, what you observe. I can
(05:36):
tell you a lot of things thatdon't work generally, like nagging, you
know, labeling them, throwing awaythe alcohol, driving them to meetings or
dropping them off at rehab, yeah, picking them up, picking up after
them, you know, driving themto work and things like that. So
(05:56):
those those things actually don't work.Well. People are listening to this problem
have tried a number of those things. Oh yeah, I mean that's I
mean, any person would try thosethings, but they're just not generally effective.
This isn't something that would be differentthan any of the things that we
talked about with our listed substances.It's being concrete. It is saying what
you're seeing and how it's affecting themin those specific areas of their life or
(06:21):
or your life. Is the familyAgain, I say this over and over.
Addiction is a family disease. Sowe need to point those things out
and then we need to have healthyboundaries. It's very difficult. It's very
difficult again because alcohol is very muchaccepted in our culture, so it is
difficult, but the same pieces apply, you know, setting those boundaries and
(06:43):
unlabeling the consequence if things don't change, but pointing out the behaviors because sometimes
when you're in the midst of it, you can't see the behaviors. So
if you're pointing that out, isthe next step rehab or what is an
effective way of addressing that problem?Because probably deep down, who's somebody who
is suffering from alcohol use disorder,they probably deep down know something is going
(07:09):
on, or they maybe they they'renot they're denying it, but they know
something is not right in their life. Yeah, I know, things are
spending a little bit about of controland there may be a problem. So
what is the effective way of addressingthat to somebody. I think everybody has
a different path on that. Mypersonal opinion, and I think it goes
along with harm reduction, which we'vetalked about as well, is if we
(07:30):
can get them to do something,it's better than nothing, So meaning if
it has to start at a lowerlevel where you know, we're asking them
maybe to participate in a support group, which which folks, that's not generally
a first step. But maybe they'renot willing to go to rehab, but
they're willing to talk with an individualtherapist. Okay, let's do that and
(07:50):
then maybe with that other person.The other people that are involved in that
situation participate in their own therapy orthey do it as a group. I
think that's great. I mean thatcould be the first step. Could the
first step be rehab? Absolutely?Now I'd like to point out, and
Julie may want to comment more aboutthis from a physician's point of view,
(08:11):
but you know, you have tobe very careful when you're in a severe
state of alcohol use disorder because itcan be lethal to come off of alcohol
and not drink it if you arein that state. We have to be
very careful with those folks, andthat's not something that we encourage people to.
If they're drinking on a daily basisand can't function without drinking, they
(08:33):
need to be getting medical care inorder to stop drinking. So that is
what we call withdrawal management or detox. That's we generally do that in an
inpatient unit where we can monitor theperson and we do give them, usually
benzodiazepines if people are familiar with that, like I mean, I think the
(08:54):
name on the street would be likexanax or klonopin or adavan, but generally
we use adavan or librium and wegive those in lessening amounts over decreasing amounts
over the course of several days,and we use other medications as well to
keep them comfortable and to keep themsafe, and then we monitor them very
(09:16):
very closely for withdrawal symptoms. Andwhat if somebody is reluctant to address their
problem, or you're talking to afamily member who's reluctant to if you brought
up the topic, that that wouldbe the you know, we're not nagging,
we're bringing up Hey, you mightwant to see somebody. If they're
reluctant, what do you do.That's where you have to set your boundaries
(09:37):
and the consequences for those boundaries,and you know, for the health of
the rest of the people in thefamily. Obviously you're always going to be
concerned about that person. But ifthey're unwilling to listen to you, obviously
it's affecting you if you're bringing itup as well. And so the advice
we generally would give is, Okay, set your boundaries. If this,
then that, and but you've gotto stick with them. And the one
(10:00):
thing I caution people on when youset boundaries or healthy boundaries is don't go
to the extreme. If you don'tgo to rehab, we're getting divorced,
if I'm taking the kids away,whatever it may be, because that extreme
is not the start off point.Let's have something that's in between. We
can't tell people what those consequences are. Necessarily, sometimes we can bring up
things that we know other folks havebrought up, but you know it might
(10:24):
be if you continue to do thisand drink and drive and you have my
children, I'm going to call thepolice and let them know it's a very
hard step to take, but it'sa consequence. It's an unfortunate consequence,
but it is and it's a safetyissue. Yeah, I mean, I
think it's important for the individual whoidentifies the problem. You know, if
(10:45):
your loved one has a drinking problem, you think and they're not responding to
you, the most important thing foryou to do is to really get yourself
help because addiction destabilizes everybody and everybodyand everything exactly. So in getting your
self help and basically finding you know, that will help you develop these healthy
(11:11):
boundaries and you will still participate inself care and you will still be able
to function in your everyday life withouthaving this other person completely bring you down
in the process. And you know, still it's the same things that we
talk about. You want to treatthat person with compassion. You want to
kind of separate the disease from theperson. You know, when a person
(11:31):
drinks, they can be pretty awfuland then they can be really great when
they're sober. But you know,there are really some steps that a person
can take that are very healthy forthat individual. If the person that they
love isn't ready, why get help? Why are some people reluctant to get
help if I had, let's saycancer, I was diagnosed with cancer,
(11:52):
Obviously, I'm going to seek outhelp to get rid of the cancer.
And if I recognize that there's there'san alcohol abuse situation there, why are
people reluctant? Is that maybe becausethey're self medicating there and they're they're they're
realizing that this is how they copewith everything, and they're reluctant to give
up that mechanism. Sure, Imean that certainly can be a reason why.
(12:16):
I think with alcohol use disorder aswell, it's such a social part
of our culture that the thought ofparticipating in social activities without that if you're
using alcohol could alter it. Sometimesit's just like it's not my life's not
going to be fun anymore. Andthat's not true, that's not true,
(12:39):
but that's what you see it as. Now. We talked a lot about
the stigma of addiction, but isthere a stigma in going to rehab?
Sure? I mean, like there'sso much shame associated with addiction in general.
I mean the individuals that we thatwe care for, almost all of
them will say that they feel shamedof themselves, and it takes a tremendous
(13:03):
amount of courage to you know,ask for help or go to a meeting
or go into inpatient rehab. Imean, we're asking people to step away
from their families, their jobs,and and and get this. You know,
when you're talking about in patient rehab, it's a it's a pretty you
know, yeah, pretty involved process. So yeah, but I think the
(13:26):
shame of the disease itself definitely isa barrier for people. It's a deterrent.
One interesting topic is is is dailyalcohol use healthy? You know,
you know, there was a periodof time where we heard, oh,
like a glass of red wine aday is really really good for you.
Actually, the current the current recommendationsare no alcohol or you know, alcohol
(13:50):
in moderation because you know, weknow that even low amounts of alcohol can
increase your risk of cancer, youknow, liver disease, all you know,
all kinds of other diseases. Soyou know, the current recommendation now
is for a woman no more thanone drink a day and for a man
no more than two drinks a day. But there seems to be a movement
(14:13):
more towards the less the better somebodyhas is facing addiction alcohol addiction or a
family member or a friend or coworker. What's what's what do you recommend?
Recommend that they look into possible servicesthat the family members, they themselves get
help, possibly participate in their owntwelve step program as a support alan On
(14:35):
or narn On if it's not alcohol, and really ask that person and point
out to that person, these arethe things that are concerning me. What
can we do? Let me helpyou get the help that I think you
need. You're listening the Gateway RehabsRecovery roll Call
Making a difference in the lives ofthe people that we love. Addiction is
a treatable disease, so I thinkit's more about bringing their guard down and
having them understand that we are tryingto assist them in any way, shape
or form that we can. AndI was like, oh, I just,
oh my god, I never wantto feel this way again. This
is Gateway Rehabs Recovery Roll Call andWelcome back. This is Gateway Rehabs Recovery
(00:24):
Roll Call. I'm your host,Johnny Hartwell, and I'd say hello too,
Julie Diello, Karen Frehley. Ourtoday's topic is alcohol use disorder.
What exactly is that? So alcoholuse disorder typically involves dependence on alcohol and
sort of cravings for alcohol and generallydysfunction in the person's life. I mean
(00:48):
that's like simply put. But itusually involves also just a lot of problems
with relationships and behaviors, and youknow, essentially it encompasses all that all.
Right, So there's probably the kindof the topic that just about every
one of our segments has something todo with stigma, and there's so many
stigmas when to come. So wecall it alcohol abuse disorder. But you
(01:14):
know, how's that different than callingsomebody an alcoholic or you know, and
there's so many other boozer and allthose kind of you know, disparaging terms.
You want to get away from that. Is that why it's called that,
right, I mean, alcohol usedisorder is the disease that the person
has and that is not their identityor you know, just we try to
(01:34):
stay away from labeling a person andsort of separating the disease from the person.
So if you're talking to somebody,maybe somebody who's listening to this podcast
and they have a friend or afamily member who is is going through this,
it's almost a softer landing point whenyou refer to them, and when
you talk to them and say,hey, maybe you need some help.
(01:56):
You know, you don't want touse those terms like you know, like
we just referred to and this isthis is a disorder. This is something
that and you need help and we'rewilling to help you get that help.
And of course Gateway is there tohelp as well. Of course. Yeah,
I mean language matters, like we'veI think we've talked about that in
some other segments, but I meanthis has actually been studied where people who
(02:16):
are labeled like alcoholics or junkies,they're actually treated differently by healthcare workers and
just people in the general society.So it's important that we, you know,
that we treat this and talk aboutthis disease just like we would talk
about any other disease. I thinkthe thing that I'd like to bring up
(02:37):
just about alcohol use disorder is thereare different different ways to label that as
well, meaning that it can gofrom mild to severe, and those can
be very different. You know,someone that's in the in the severe place,
and you know, Julie can eventalk more about this, but it
is really it is affecting all partsof their life and physically they're dependent on
(03:00):
alcohol. They can't function or getthrough the day without it. But then
you have your people that maybe wewould call binge drink, and binge drinking
is generally defined as five or moredrinks in a setting, but maybe they
don't do that that often, butthat's still if it causes them, consequences
(03:21):
still can be you know, analcohol use disorder, but more on the
mild side, So there there arevarying degrees of that. I also think
we point out that if you're inthat severe category. It's very dangerous.
It can be very dangerous for you, and you know, Julie may want
to talk about the physiological and thephysical parts of that, but it's it's
(03:43):
a very dangerous thing and needs tobe treated appropriately well. Alcohol is accepted
generally in society. That that makesyour that makes you solving that that disorder
even harder, very difficult, becauseit is accepted, so people don't see
it the same way they would seean illicit substance. And you can get
(04:08):
alcohol anywhere, so it's easy accessible, and it is accepted and a lot
of it's even advertised by the state. Even though you know, in Pennsylvania
it's controlled by the Pennsylvania Liquor ControlBoard, they still advertise the stores.
Yeah, I mean it's expected.You go to a sporting event or a
(04:29):
party and people look at you funnyif you're not drinking. Right. So,
I think, like espentially, Ithink the binge drinking thing is really
an important topic to talk about becauseit is actually the problem that affects more
Americans. You know, they askedme about twenty four percent of the US
population has you know, reports havingparticipated in binge drinking in the last month.
(04:50):
That's a lot of people, rightwho are you know, on a
Friday night or Saturday night are drinkingyou know, like ten twelve beers or
it's great, it's it's defined asgreater than five drinks in a male and
greater than four drinks and a femalein a short period of time, a
couple of hours or you know,in a period of time. If somebody
(05:12):
is listening to this podcast, they'reobviously either facing their own addiction to alcohol
or they have a family member.So if you're if you're addressing alcohol use
disorder, what's the first step?So, I mean a first step I
think with anything when you are whenyou love someone who you think has a
problem, is telling them what yousee, what you observe. I can
(05:36):
tell you a lot of things thatdon't work generally, like nagging, you
know, labeling them, throwing awaythe alcohol, driving them to meetings or
dropping them off at rehab, yeah, picking them up, picking up after
them, you know, driving themto work and things like that. So
(05:56):
those those things actually don't work.Well. People are listening to this problem
have tried a number of those things. Oh yeah, I mean that's I
mean, any person would try thosethings, but they're just not generally effective.
This isn't something that would be differentthan any of the things that we
talked about with our listed substances.It's being concrete. It is saying what
you're seeing and how it's affecting themin those specific areas of their life or
(06:21):
or your life. Is the familyAgain, I say this over and over.
Addiction is a family disease. Sowe need to point those things out
and then we need to have healthyboundaries. It's very difficult. It's very
difficult again because alcohol is very muchaccepted in our culture, so it is
difficult, but the same pieces apply, you know, setting those boundaries and
(06:43):
unlabeling the consequence if things don't change, but pointing out the behaviors because sometimes
when you're in the midst of it, you can't see the behaviors. So
if you're pointing that out, isthe next step rehab or what is an
effective way of addressing that problem?Because probably deep down, who's somebody who
is suffering from alcohol use disorder,they probably deep down know something is going
(07:09):
on, or they maybe they they'renot they're denying it, but they know
something is not right in their life. Yeah, I know, things are
spending a little bit about of controland there may be a problem. So
what is the effective way of addressingthat to somebody. I think everybody has
a different path on that. Mypersonal opinion, and I think it goes
along with harm reduction, which we'vetalked about as well, is if we
(07:30):
can get them to do something,it's better than nothing, So meaning if
it has to start at a lowerlevel where you know, we're asking them
maybe to participate in a support group, which which folks, that's not generally
a first step. But maybe they'renot willing to go to rehab, but
they're willing to talk with an individualtherapist. Okay, let's do that and
(07:50):
then maybe with that other person.The other people that are involved in that
situation participate in their own therapy orthey do it as a group. I
think that's great. I mean thatcould be the first step. Could the
first step be rehab? Absolutely?Now I'd like to point out, and
Julie may want to comment more aboutthis from a physician's point of view,
(08:11):
but you know, you have tobe very careful when you're in a severe
state of alcohol use disorder because itcan be lethal to come off of alcohol
and not drink it if you arein that state. We have to be
very careful with those folks, andthat's not something that we encourage people to.
If they're drinking on a daily basisand can't function without drinking, they
(08:33):
need to be getting medical care inorder to stop drinking. So that is
what we call withdrawal management or detox. That's we generally do that in an
inpatient unit where we can monitor theperson and we do give them, usually
benzodiazepines if people are familiar with that, like I mean, I think the
(08:54):
name on the street would be likexanax or klonopin or adavan, but generally
we use adavan or librium and wegive those in lessening amounts over decreasing amounts
over the course of several days,and we use other medications as well to
keep them comfortable and to keep themsafe, and then we monitor them very
(09:16):
very closely for withdrawal symptoms. Andwhat if somebody is reluctant to address their
problem, or you're talking to afamily member who's reluctant to if you brought
up the topic, that that wouldbe the you know, we're not nagging,
we're bringing up Hey, you mightwant to see somebody. If they're
reluctant, what do you do.That's where you have to set your boundaries
(09:37):
and the consequences for those boundaries,and you know, for the health of
the rest of the people in thefamily. Obviously you're always going to be
concerned about that person. But ifthey're unwilling to listen to you, obviously
it's affecting you if you're bringing itup as well. And so the advice
we generally would give is, Okay, set your boundaries. If this,
then that, and but you've gotto stick with them. And the one
(10:00):
thing I caution people on when youset boundaries or healthy boundaries is don't go
to the extreme. If you don'tgo to rehab, we're getting divorced,
if I'm taking the kids away,whatever it may be, because that extreme
is not the start off point.Let's have something that's in between. We
can't tell people what those consequences are. Necessarily, sometimes we can bring up
things that we know other folks havebrought up, but you know it might
(10:24):
be if you continue to do thisand drink and drive and you have my
children, I'm going to call thepolice and let them know it's a very
hard step to take, but it'sa consequence. It's an unfortunate consequence,
but it is and it's a safetyissue. Yeah, I mean, I
think it's important for the individual whoidentifies the problem. You know, if
(10:45):
your loved one has a drinking problem, you think and they're not responding to
you, the most important thing foryou to do is to really get yourself
help because addiction destabilizes everybody and everybodyand everything exactly. So in getting your
self help and basically finding you know, that will help you develop these healthy
(11:11):
boundaries and you will still participate inself care and you will still be able
to function in your everyday life withouthaving this other person completely bring you down
in the process. And you know, still it's the same things that we
talk about. You want to treatthat person with compassion. You want to
kind of separate the disease from theperson. You know, when a person
(11:31):
drinks, they can be pretty awfuland then they can be really great when
they're sober. But you know,there are really some steps that a person
can take that are very healthy forthat individual. If the person that they
love isn't ready, why get help? Why are some people reluctant to get
help if I had, let's saycancer, I was diagnosed with cancer,
(11:52):
Obviously, I'm going to seek outhelp to get rid of the cancer.
And if I recognize that there's there'san alcohol abuse situation there, why are
people reluctant? Is that maybe becausethey're self medicating there and they're they're they're
realizing that this is how they copewith everything, and they're reluctant to give
up that mechanism. Sure, Imean that certainly can be a reason why.
(12:16):
I think with alcohol use disorder aswell, it's such a social part
of our culture that the thought ofparticipating in social activities without that if you're
using alcohol could alter it. Sometimesit's just like it's not my life's not
going to be fun anymore. Andthat's not true, that's not true,
(12:39):
but that's what you see it as. Now. We talked a lot about
the stigma of addiction, but isthere a stigma in going to rehab?
Sure? I mean, like there'sso much shame associated with addiction in general.
I mean the individuals that we thatwe care for, almost all of
them will say that they feel shamedof themselves, and it takes a tremendous
(13:03):
amount of courage to you know,ask for help or go to a meeting
or go into inpatient rehab. Imean, we're asking people to step away
from their families, their jobs,and and and get this. You know,
when you're talking about in patient rehab, it's a it's a pretty you
know, yeah, pretty involved process. So yeah, but I think the
(13:26):
shame of the disease itself definitely isa barrier for people. It's a deterrent.
One interesting topic is is is dailyalcohol use healthy? You know,
you know, there was a periodof time where we heard, oh,
like a glass of red wine aday is really really good for you.
Actually, the current the current recommendationsare no alcohol or you know, alcohol
(13:50):
in moderation because you know, weknow that even low amounts of alcohol can
increase your risk of cancer, youknow, liver disease, all you know,
all kinds of other diseases. Soyou know, the current recommendation now
is for a woman no more thanone drink a day and for a man
no more than two drinks a day. But there seems to be a movement
(14:13):
more towards the less the better somebodyhas is facing addiction alcohol addiction or a
family member or a friend or coworker. What's what's what do you recommend?
Recommend that they look into possible servicesthat the family members, they themselves get
help, possibly participate in their owntwelve step program as a support alan On
(14:35):
or narn On if it's not alcohol, and really ask that person and point
out to that person, these arethe things that are concerning me. What
can we do? Let me helpyou get the help that I think you
need. You're listening the Gateway RehabsRecovery roll Call
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