Shedding some light on blackouts

Addiction and Recovery

By Bob Gaydos

There are two enduring views about alcohol-induced blackouts:

1. They don’t exist. They’re just an excuse for inappropriate behavior.
2. They exist, but they’re just a harmless, often humorous, occasional price to pay for a night of fun.

Both views are wrong — dangerously so — for the same reason: Denying the existence of blackouts or minimizing their significance could lead to serious consequences (health, legal, personal, professional) for the persons experiencing them and others. If you’ve experienced blackouts or know someone who has and are not concerned about them, you should be.

To start with, blackouts are not the same as passing out. That’s a comomon misconception. People who drink too much and pass out stay put. They wake up in the same place they passed out and remember, maybe with a hangover, how they got there. People in blackouts can wind up in different states, strange beds, wrong apartments or behind bars when they come to and not know how they got there. “How did I get home last night?” is a common question for blackout veterans. “Where’d I leave my car?” is another.

Many recovering alcoholics who recall their drinking history in Alcoholics Anonymous meetings point to blackouts as one of the “healthy fears’’ that help them stay sober. After all, it can be frightening to find out about some reckless behavior that happened apparently in a blackout and to wonder what else may have happened without your being aware of it.

Some local examples:

— Jordan, a 50ish man from Orange County, who has been sober more than five years, says he once spent a four-day business trip in Texas in a blackout. Airport-to-airport. He did come out of it briefly, he says, to call his boss on Day 2 to tell him he wasn’t feeling well.

— Whitey (all names used are fictitious), who drives for a living, says he regularly drove between New York and Virginia in blackouts.

— John, retired in Sullivan County and sober more than two decades, says he’s positive he was fired from an excellent job because of remarks he made to his boss’s wife while in a blackout.

— Marie, a chef sober less than a year, says she has no recollection of a phone call in which she was extremely rude and insulting to her husband’s sister, other than what her husband and sister-in-law told her. She’s embarrassed by the incident.

— Sunshine, a nurse sober half her life, recalls with a mix of horror and shame coming out of a blackout “as a guy was trying to have sex with me.” She says she fought him off. But she didn’t immediately stop drinking.

That’s often the case — not stopping drinking despite risky or embarrassing consequences. As an isolated incident, a blackout may not signify anything except drinking too much, too fast. Something you might want to avoid because of potential embarrassment or worse. As a pattern, it could be a sign of a more serious problem.

While it’s not just alcoholics who experience blackouts, the connection between blackouts and alcoholism or alcoholic use disorder is real and knowing some facts about the symptom could help dispel some of the myths and avoid more serious problems.

For a long time — most likely from whenever humans first discovered the mood-altering effects of wine until modern science started doing research on the brain and behavior — blackouts were regarded as just one of the possible side effects of drinking alcohol. A little fuzzy memory. No big deal. Just drink less.

When researchers began studying blackouts, however, they soon discovered that persons experiencing them didn’t have just a little amnesia. Rather, they had no recollection of certain events and, try as they might, even when told the details many times over, they had no memory of them. Their research subjects didn’t forget, researchers concluded; they never formed a memory in the first place.

The prevailing accepted science, as cited by the National Institute on Alcoholism and Alcohol Abuse and other similar agencies, is that persons experiencing a blackout can function and appear to be “normal” to others because their brain is operating on stored, long-term, procedural memory, but the short-term memory of what they are experiencing never gets to the hippocampus, the part of the brain that processes long-term memory. Alcohol — especially a lot of it in a short period of time — short-circuits the process.

According to the NIAAA, “As the amount of alcohol consumed increases, so does the magnitude of the memory impairments. Large amounts of alcohol, particularly if consumed rapidly, can produce partial or complete blackouts.”

More about blackouts:

— It’s not what you drink, it’s how much alcohol gets into your bloodstream and how fast it gets there. This means it’s possible for anyone to black out if he or she drinks enough alcohol quickly enough.

— People who have a low tolerance for alcohol are not necessarily more likely to black out. On the other hand, those with a high tolerance for alcohol are often able to drink heavily and carry on conversations, drive, etc. while in blackouts.

— Women may be more susceptible since they tend to be smaller than men, meaning each drink has a greater effect on the body’s blood alcohol content.

— Drinking on an empty stomach can make blackouts more likely, again because of a more acute impact on the blood alcohol concentration.

— People sometimes have glimpses of memory of an event, but not total recall. These partial lapses are called “brownouts.”

— Blackouts are the product of consumption of an amount of alcohol that affects motor coordination, balance, impulse control and decision-making. This is bad enough when someone is not in a blackout, never mind being unable to recall any risky, self-sabotaging behavior that may have caused serious harm to others.

— Some researchers suggest that people in blackouts, operating on procedural memory and little more, have little impulse control and are more likely to do things they would not otherwise do. (See examples above.) This presents embarrassing, sometimes dangerous situations for the person in a blackout, family, friends and even strangers.

— Blackouts are often the unrecognized explanation for someone’s uncharacteristic actions. “Why did you (say/do) that last night?”

— Because of a shortage of evidence-based science on the subject, there is considerable difference of opinion on the use of blackouts as a defense in criminal trials.

So, what to do if you have blackouts? Take them seriously. Maybe talk to a professional health provider who knows about them. While blackouts are not solely the result of years of heavy, alcoholic drinking, they can be a sign of an existing or potential alcohol problem. Even one or two — perhaps the product of binge drinking in college — should be enough to cause concern since not being aware of what one has done is not considered acceptable to most people.

Being the unaware “life of the party” may be tolerable as a one-time experience, but repeated bizarre behavior of which you have no memory is nothing to laugh at.

 BobGaydos.blogspot.com.

Know the warning signs of problem drinking

Addiction and Recovery

By Bob Gaydos

More than three drinks a day or seven per week
 is considered risky drinking for women.

There are “heavy-hitters,” “weekend warriors,” and petite women with ”wooden legs” who can drink burly construction workers under the table. There are also “social drinkers,” who simply enjoy a bottle of good wine with dinner and others who appreciate a few beers after a softball game.

Problem drinkers? Maybe, maybe not. More to the point, maybe a few at risk of becoming problem drinkers. April being Alcohol Awareness Month, it’s a good time to review personal drinking habits, if just to see if there are any warning flags of a potential future problem that can be avoided. It’s worth the time.

According to the National Institute of Alcohol Abuse and Alcoholism, about 88,000 people die from alcohol-related causes each year, making it the third leading preventable cause of death in the United States. Alcohol use disorder (AUD) affects 15-18 million adults. It’s a major health issue, but drinking is so ingrained in our society that many people are reluctant to look at their own drinking patterns. This common resistance to self-reflection, along with a lack of information on the risks of abusing alcohol, can be harmful to your health.

For example, having a high tolerance for alcohol, often worn as a badge of pride, is a reason to be wary. People with a high tolerance are likely to drink more and hang out with people who drink more and more often. They are at higher risk for AUD (alcoholism) and serious health problems affecting the liver, heart or brain caused by alcohol abuse. This is not to mention the obvious risks of drinking and driving and other physical harm as the result of impaired judgment.

Just one more example, for those who feel they drink “in moderation.” The NIAAA, which does research on these things, says, for men, more than four drinks on any day or more than 14 per week and for women, more than three drinks on any day or seven per week is “heavy” or “at risk” drinking. A standard drink is defined as one containing .6 fluid ounces of “pure” alcohol, regardless of the liquid -- a 12-ounce can of beer or a 1/1/2 ounce shot of some 80-proof liquor are the same.

The agency offers a list of questions to help determine if you have an alcohol abuse problem or are at risk of one:

In the past year, have you:

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn't?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Spent a lot of time drinking? Or being sick or getting over other after-effects?
• Continued to drink even though it was causing trouble with your family or friends?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

Says the NIAAA: “Depending on the symptoms and their severity, just one or two can be a red flag. The more symptoms you have, the more urgent the need for change. The symptoms toward the top of the list tend to be early signs of potential trouble, whereas the ones further down the list indicate that you have moved further down a risky path.”

If you take the test on the NIAAA website (https://www.rethinkingdrinking.niaaa.nih.gov), it will provide individual feedback. The site is anonymous.

The gauge for determining alcohol abuse is actually simple: Alcohol is a problem when it causes problems in your life -- at home, at work, with your health.

Regardless of the results of the test, there are several factors that suggest quitting drinking might be advised:

• You’ve tried to cut down, but can’t.
• You have had some symptoms previously.
• Alcohol affects a physical or mental condition or it interacts with medication.
• You are pregnant.
• You have a family history of alcohol problems or a personal history of alcohol-related injuries.

The NIAAA website offers suggestions for cutting down on drinking if you think it could become a problem. If it already is, seek professional help. It won’t get any better by avoiding it.

bobgaydos.blogspot.com

Alcoholism: There’s no cure, but there is a test

Addiction and Recovery

By Bob Gaydos

Living in a world in which seemingly anything one might want is just a click away, it’s easy, maybe even natural, to assume there are quick fixes for everything. A robot for every chore. A cloud for every data storage problem. A pill for every illness.

Not yet. Sorry, alcoholics, there is still no pill that cures alcoholism.

It’s not for a lack of trying, to be sure. While research continues to find the magic pill, thus far the U.S. Food and Drug Administration has approved three medications to treat what is referred to clinically as alcohol use disorder or alcohol dependence. The FDA says the medications are non-addictive. According to the National Institute on Alcohol Abuse and Alcoholism, they are:

• Naltrexone, which is used to treat opioid addiction, but some researchers say can also help people reduce heavy drinking. It is available in pill and long-acting injectable form. Researchers say it acts in the brain to reduce the craving for alcohol in those who have already stopped drinking. However, treatment with naltrexone is not enough on its own. NIAAA says the medication was reported to be effective when combined with counseling, psychotherapy, and alcoholism support groups.
• Acamprosate, which the Substance Abuse and Mental Health Services Administration (SAMSHA) says makes it easier for some who have already stopped drinking to stay stopped by reducing withdrawal symptoms such as anxiety, insomnia and restlessness, that may follow lengthy abstinence. Of course, counseling, psychotherapy, and alcoholism support groups might help in these cases also.
• Disulfiram (Antabuse), which blocks the metabolism of alcohol by the body, causing unpleasant symptoms such as nausea, headache, sweating and flushing of the skin. The idea is you will get so sick if you drink alcohol while taking Antabuse you won’t want to drink alcohol. Or, as some alcoholics decide, you won’t want to take Antabuse. It’s the nature of the disease.

There are complications, starting with the fact that each individual is different, meaning some medications might work for some and not others. For example, according to SAMSHA: “Patients with liver damage usually cannot use either naltrexone or disulfiram. However, because acamprosate is not metabolized in the liver, patients with liver damage can safely take the medication.” All the medications have a variety of possible side effects.

Also -- and here’s the major stumbling block for many with a serious alcohol problem -- for each of the treatments the optimal recommended situation is that the person is abstinent at the beginning and is committed to recovery. That may mean detox and, for many, in-patient or out-patient treatment. It also means being honest with your doctor and rehab counselors about your goals, actually being willing to stop drinking and not looking for a quick fix for your problems.

Having a primary care doctor who has more than a cursory understanding of alcohol and drug abuse is an excellent starting point, especially if medication-assisted treatment is to be involved. This doctor must screen patients to determine the level of alcohol use, assess the need for or appropriateness of medication-assisted treatment, develop a treatment plan, choose an appropriate medication and monitor patient progress. If your doctor is unable or unwilling to do all this and you want to try medication-assisted treatment, he or she should refer you to one who is.

But remember, none of these drugs cures alcoholism. They are designed to help manage a chronic disease by discouraging or reducing alcohol intake. That’s obviously crucial, but on its own is not necessarily recovery, which is generally defined as avoiding the trouble associated with drinking as well as avoiding the alcohol itself.

This being a disease of the brain, it is recommended that some kind of counseling or support group accompany the use of these medicines.

It’s also important to know that, while there may not be a magic pill to cure alcoholism, there is a way to help determine a diagnosis of alcohol use disorder. The NIAAA offers a test that you can take:

***

In the past year, have you:

• Had times when you ended up drinking more, or longer than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of time drinking? Or being sick or getting over the aftereffects?
• Experienced craving — a strong need, or urge, to drink?
• Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Your score: Mild: The presence of two to three symptoms. Moderate: The presence of four to five symptoms. Severe: The presence of six or more symptoms.

Be honest with yourself and -- as the test suggests -- acknowledge your drinking’s effect on others. That’s key, whether you call it alcoholism or alcohol use disorder and whether you use some pill to treat it or not.

bobgaydos.blogspot.com

The 'worst thing' can actually happen -- talk to your kids about alcohol

Addiction and Recovery

By Bob Gaydos

Talk to your kids about alcohol before
they start drinking.

What's the worst thing that could possibly happen?

It's a question all parents should ask themselves when considering any event involving teenagers and alcohol. In fact, it's a question teenagers should ask themselves about any event involving them and drinking.

Unfortunately, even on the rare occasion when the question is asked, the “worst thing” seldom comes to mind. Until it happens. It happened New Year's Day in the Town of Crawford in upstate New York and a young man is dead and several people’s lives have been dramatically impacted.

A fight broke out at a party in a private home in which, police say, about 100 young people, most believed to be underage, were drinking. A 20-year-old male who tried to break up the fight was stabbed to death. Police are still looking for his killer. There were no adults present at the party, according to police.

According to New York state law, the parents whose teenaged children hosted the party could be liable for fines. Lawsuits are possible. It's called the social host law and its intent is to discourage underage drinking at parties in private homes by imposing penalties on persons responsible for overseeing the home when minors other than their children consume alcohol. Some New York counties have their own social host laws, which are tougher than the state’s. Orange County, where the killing occurred, is considering adopting one.

Such punitive laws -- essentially designed to protect us from ourselves -- are necessary in our society because the preventive approach is too often ignored. That approach consists of parents educating their young children -- preteens or young teens -- on the risks of drinking alcohol before they are physically, mentally and emotionally able to handle it and, yes, letting them know they do not approve of them drinking if they are not of legal age.

A common response to this suggestion is that kids don't listen to their parents and teens are going to rebel and drink anyway, because all

their friends do. If we don’t let them drink, the thinking goes, they’ll be ostracized. So let's teach them to drink responsibly when they’re young. That way they won’t have problems with alcohol when they are older.

Well, the National Institutes of Health, Mothers Against Drunk Driving, Partnership for Drug-Free Kids, the Treatment Research Institute, the World Health Organization, the U.S. Department of Justice and pretty much any organization that has studied the impact of alcohol consumption on young people, disagree with that view. The research all says that, despite a widespread assumption to the contrary:

• Parents still have the most influence on their children, especially when they are young;

• Having conversations, not lectures, with children about your feelings on alcohol before they begin drinking (eighth grade is not too soon) will have more influence than if they have already started;
• Even in later teen years, parents can still exert major influence on their children’s behavior.

The reasons for focusing on teenagers and alcohol have been discussed in this column before, but, briefly, teens who drink are more likely:

• to be victims of violent crime,
• to be involved in alcohol-related traffic crashes
• to have serious school-related problems
• to develop alcohol dependence than persons who wait until adulthood to start drinking

The earlier the child starts drinking, the greater the odds of some of those problems developing. This comes from the National Institute on Alcohol Abuse and Alcoholism, which also says, “The bottom line is that most young teens don’t yet drink. And parents’ disapproval of youthful alcohol use is the key reason children choose not to drink.”

The NIAAA has an excellent pamphlet for parents who are unsure about whether to or how to talk to their children about alcohol. It’s not unusual to be uncomfortable with the subject and each situation is different, but dealing honestly with uncomfortable issues and modeling responsible behavior are proven ways to help children make responsible decisions when they’re on their own. The pamphlet is called “Make a Difference. Talk to Your Children About Alcohol.” http://pubs.niaaa.nih.gov/publications/MakeADiff_HTML/makediff.htm

When the worst possible thing happens, it gets people’s attention. Unfortunately, that’s the way it is. At the very least, the New Year’s Day tragedy presents an opportunity to remind ourselves that there are positive ways to deal with difficult issues and help available in doing so. Now that we’ve got your attention, talk to your kids about alcohol.

bobgaydos.blogspot.com

For more information

-- Partnership for Drug-Free Kids

(212) 922–1560

http://www.drugfree.org/join-together/

-- National Council on Alcoholism and Drug Dependence (NCADD)

(212) 269–7797; Fax: (212) 269–7510

http://www.ncadd.org

-- National Institute on Alcohol Abuse and Alcoholism

(301) 443–3860

http://www.niaaa.nih.gov

-- Substance Abuse and Mental Health Services Administration

National Drug Information Treatment and Referral Hotline

(800) 662–HELP (4357) (toll free)

http://www.findtreatment.samhsa.gov

-- MADD

24-hour Victim Help Line

(877) MADD--HELP

www.madd.org

-- Partnership for Drug-Free KIds

1-855-DRUGFREE

www.drugfree.org

So, you think you’re just a ‘heavy drinker’? Try this

My latest Addiction and Recovery column

By Bob Gaydos

“I’m not an alcoholic. Alcoholics have to go to those meetings. I’m just a heavy drinker.”
Maybe yes; maybe no. Either way, if you’re having this conversation with someone else, or just with yourself, it’s likely there are issues lurking that are related to your consumption of alcohol. As rules of thumb go, the one that says: “If drinking is causing problems in your life, it’s a problem,” is as reliable as it gets.
For those who describe themselves as “heavy drinkers,” it would probably be useful to know what health experts mean when they use the term, as well as possible risks involved in that pattern of behavior.
The Centers for Disease Control recently issued a report on heavy drinking which defined it as 15 or more drinks per week for men or eight or more drinks per week for women. That raised the limit by one drink per week in each case from standards issued by the National Institute on Alcohol Abuse and Alcoholism. But, as some professionals in the field would say, if you’re counting drinks, there’s already a problem.
Of course, it’s important to know what is meant by a drink. A standard drink, according to the NIAAA is 1.5 ounces of hard liquor or brandy, 12 ounces of beer and five ounces of table wine. All alcohol has the same effect, regardless of the form. If your “standard” drink is larger, the total drink count will be higher. And, possibly, the risks.
It’s true, some people can drink more than others and not have problems as a result. It’s also true that at least 40 percent of Americans drink little or no alcohol at all. But for anyone describing himself or herself as a “heavy drinker,’’ the NIAAA says it matters how much you drink on any one day and how often you have heavy drinking days.
        Among those who have one heavy drinking day per month, the agency says one in five, or 20 percent, already have alcoholism or alcohol abuse. One heavy drinking day per week raises the odds to one in three. Two or more heavy drinking days per week, makes it 50 percent, according to the NIAAA.
        And so what? says the “heavy drinker.” I have a job. My family loves me. I’m young. Alcohol is good for the heart. I get good grades. I don’t drink any more than my friends do. If it becomes a problem, I’ll cut back.
        Again, maybe so. But also again, it’s good to know the risks involved with heavy drinking. There’s nothing new here. Heavy drinking increases the chances of being injured or killed in auto accidents, fires, drownings, or being the victim of an assault or suicide. It poses greater risk of liver disease, heart disease, depression, stroke, sexually transmitted diseases and more. It can pose a risk to the baby if a woman drinks during pregnancy and, just as with alcoholism, alcohol abuse -- or heavy drinking -- can cause legal problems, trouble in relationships and failure to meet responsibilities at work, school, home, etc.
        If you’re serious about wanting to know if you’re just a heavy drinker -- someone who can successfully manage his or her alcohol intake and even curtail it -- rather than someone who “needs to go to those meetings,” the NIAAA offers a test, as it were.
       For one week, with dinner, have one standard drink of wine or beer. Or if you prefer, one standard drink of hard liquor or brandy before dinner. That’s it. Nothing else. No changing drinks from day to day. The NIAAA says people who can take it or leave will have no problem. Alcoholics flunk.
       As always, the idea is not to judge or condemn, but rather to take an honest look at one’s drinking in the hope of avoiding or eliminating problems that can arise from the abuse of alcohol. A heavy dose of honesty can be the best medicine when substance abuse is in question.

rjgaydos@gmail.com