I’m not drunk!” roars Ira. His family sits silently around the holiday table. They stare at their plates, afraid to look up. “Honey, please don’t shout. You’re scaring the children. ” His wife Mary speaks carefully--her voice tiptoeing through dangerous territory. She is afraid to make him angrier. The tension around the table is intense. Later that evening Ira passes out on the sofa. His family sighs in relief. At least there will be no horrible fighting tonight…

Alcoholism afflicts millions of adults throughout the world. It causes automobile fatalities, family violence, absenteeism and catastrophic industrial accidents. Its social cost is immeasurable.

Not only is the alcoholic impacted by his drinking. But so is his family, relatives and members of the community. My own brother was killed by a drunk driver when he was 32 years old. My life and his were forever changed by alcoholism although no one in my family has ever been an alcoholic.

With all of the technological breakthroughs in medicine in the last 20 years, the physiological and psychological mechanisms underlying this condition are still not well understood; there is definitely a genetic and biochemical component. Today, we think of alcoholism as a disease rather than a moral or ethical failing. But we still wonder: What are the effective treatments? Why is the relapse rate so high? These questions haunt both researchers and clinicians alike.

Ira and Mary, a few weeks later, sit in my office. Many individuals with alcohol problems end up in a psychologist’s office, rather than at a chemical dependency clinic.  I ask Ira, “How much do you drink?” “Not much,” he says. “How much is not much,” I ask. This line of questioning circles around, like an airplane waiting to land.  Finally, he admits the truth. And it isn’t pretty.

Ira, feeling cornered, goes on the offensive. He turns towards his wife. “She makes me drink with all of her nagging!” he shouts. Both Ira’s and Mary’s fathers were alcoholics. Ira and Mary are familiar with this painful scene. But, they also feel trapped in this intergenerational drama, unable to extricate themselves from its grip.

Helping Ira see that his drinking is a major problem is my challenge. I ask him how his alcohol use affects him and his family. He looks right in my eyes and announces, “You don’t know anything. I don’t have a drinking problem. I can stop anytime I want!” Denial is a dominant symptom of alcoholics. They refuse to admit the hold that alcohol has on their lives.

Many adults have a mistaken belief about alcoholics. They imagine a disheveled bum, wine bottle in hand, who wakes up in the morning and has first drink of the day. They think that only adults who have to drink every day are alcoholics. But this is false. The disease of alcoholism comes in many shades and hues.

Another mistaken belief is that an adult is only an alcoholic if it affects their work. But this is not true. While one’s work may be impacted (absenteeism, tardiness, or lower productivity), it is the alcoholic’s relationships that generally feel the effects of alcohol first. Many alcoholics never drink at work. But watch out when they get home.

The common threads among all alcoholics are 1) the use of alcohol itself causes the drinker problems in his or her life, 2) when the alcoholic drinks, he doesn’t stop. Alcoholics drink until they’re drunk, pass out, or until they can’t drink any more, and 3) they drink an increasing amount of alcohol as the years progress as they develop tolerance to alcohol.

The first step for alcoholics is admitting that they have a problem that they cannot control; then recognizing that they need help. In Washington State, a certified dependency counselor can help the alcoholic take the first step towards recovery.

More about treatment in a future blog.