Alcoholism Is Contagious Lisa Eliassen

Alcoholism Is Contagious

Lisa Eliassen

Tara Jill Ciccarone

Alcoholism is Contagious

"The development and practice of alcoholism is an integral and presently unavoidable aspect of American culture (Wilcox, 1998)." This statement, made by an expert on Alcoholics Anonymous (AA), is a perfect description of the current state of alcoholism in the United States. It is not an incurable disease; rather, alcoholism is a maladaptive addiction that "develops" and is "practiced" (Wilcox, 1998). This development and practice of alcoholism is likely so prevalent as a result of the wide availability of alcohol and its acceptance by society. In fact, alcohol use is encouraged by advertising in America; young, impressionable people are especially susceptible to this kind of advertising. "Approximately two thirds of the entire population (in the U.S.) over the age of 18 consumes some form of alcoholic beverage (Wilcox, 1998)." And because there are so many people who can control their drinking, it is a drug available at most social events. This can make life more difficult for alcoholics who want to socialize yet need to abstain, particularly during the beginning stages of their recovery. (Wilcox, 1998) However, despite the fact that an outrageous number of alcoholics die prematurely from the destructive effects of their condition every year, in today's society there is no excuse for this fatal deterioration. Society provides expert counseling and support services in the form of individual therapy, family interventions, or groups such as AA (Wilcox, 1998). In addition, medications and other interventions can prevent, heal, and correct problems from alcohol abuse. Finally, family and school educational programs, as well as government laws, can make a big difference in preventing the patterns of behavior that lead to alcoholism. Alcoholism may have a genetic component; however, it is the social and environmental factors at play that truly determine an individual's susceptibility to the disease. Therefore, alcoholism is a contagious, curable disease, not the fatal life sentence that so many people fall victim to each year.

Alcoholism has many classic symptoms and many more destructive effects on mind and body. Common symptoms include an inability to drink moderately, denial, progression of the disease over time, withdrawal if drinking is controlled, black-outs, inability to hold a job or maintain stable relationships, and a kind of "dual personality." (Rosenthal, 2003) While some of these symptoms are also effects, further short-term and long-term effects of alcohol abuse include indulgence in crimes and violence, depression, irritability, gastrointestinal irritation, fatigue, loss of appetite, chronic or frequent headaches, insomnia in the absence of alcohol, dizziness, anxiety, and a generalized passive attitude. Further effects on the brain and body might encompass liver damage, malnutrition, heart disease, increased risk of certain cancers, brain injury or inflammation, memory loss, dependence on other drugs, suicide, or fetal alcohol syndrome as a result of alcoholism during pregnancy. (Berkow & al, 1997) (Oscar-Berman & Marinkovic, 2003)

Not only does alcoholism have a myriad of symptoms and consequences, it also has many faces. The first thing anyone seeking help should determine is the exact nature of their individual disorder. The two main categorizations are alcohol abuse vs. alcohol dependence; these two forms exist on a continuum of alcohol use extending all the way from social drinking to severe addiction (Vaillant, Hiller-Sturmhofel, & Susanne, 1996). One of the least common forms of alcohol abuse is called "periodic"; this attests to the addictive and habitual nature of alcohol use (Chafetz & Demone, 1962).

Many people use their genetics and family history of alcholism as an excuse for "giving in" to the disease, but this is a huge mistake. There are just too many options these days for alcholics and their families in terms of assistance with prevention and recovery. Still, there are those who argue that alcoholism has such a powerful genetic component that the outlook for successful treatment is bleak. In a classic study (Cotton, 1979), researchers concluded that alcoholics are six times more likely than nonalcoholics to report a positive family history of alcoholism (PDX, 2010). Another typical study (Russell, 1990) resulted in the claim that children of alcoholics are "approximately four times more likely to develop alcoholism than people without such a history" (Gilbertson, Prather, & Nixon, 2008). However, this correlation is likely the result of many complicated behavioral and environmental factors within the family, and shouldn't be blamed on genetics. This is a just a convenient excuse for destructive behavior, as hundreds of thousands of AA members can attest to the success of the AA program as just one treatment option (Begleiter, Reich, Hesselbrock, & Porjesz, 1995).

Group therapy through AA meetings is probably the overall best treatment option for alcoholics; but proponents of the AA 12-step program argue that it is still misunderstood. They cite a prevalent skepticism toward the program, despite its success not only with alcoholics but also with compulsive eaters, sex addicts, smokers, and compulsive gamblers (Wilcox, 1998).

The "12-steps" of AA are summarized as follows: 1) admission of powerlessness over the disease; 2) recognition that a higher "power" can make this control possible; 3) decision to turn your will and life over to this higher power; 4) make a searching and fearless moral inventory of yourself; 5) admit to God, yourself, and another "the exact nature of your wrongs"; 6) be ready to have God remove these defects of character; 7) humbly ask God to remove these shortcomings; 8) make a list of all people you have harmed, and be willing to "make amends to them all"; 9) make these amends in all cases except when doing so would cause harm; 10) continue an ongoing personal moral inventory with willingness to admit when wrong; 11) use "prayer and meditation to improve your conscious contact with God,…praying only for knowledge of His will for us and the power to carry that out"; 12) have a spiritual awakening as a result of these steps, and carry the 12-step message to other alcoholics and into all aspects of your daily life." (serenity found, 2004) Although these steps have an obvious focus on God or a "higher power," AA members argue that it attempts to treat alcoholism without any religious or other bias; it should apply to anyone suffering from the disease (Wilcox, 1998). In addition, new members are encouraged to attend meetings daily, and "sponsors" are an important part of getting and staying well. A "sponsor" is another recovering alcoholic upon whom you can rely for emotional support during difficult times. This person will always be there to guide you through the "dark times" of recovery (Wilcox, 1998). AA is very much about ritual, ceremony, and tradition; they believe this repetitiveness has an anxiety-reducing affect on members, and helps to combat the ritualism involved in alcoholism itself. Some rituals involved in every meeting include: reciting the Serenity Prayer, reading from the AA "Big Book," open sharing from all members, "basket" passing for announcements, presentation of "chips" representing different levels of sobriety, and recitation of the "Lord's Prayer" (Wilcox, 1998). Again, this may seem like a biased Christian gesture, but AA members argue that anyone is free to alter the rituals to fit their own beliefs; their main focus is on being a "community of healers (Wilcox, 1998).

The development and instillation of values to assist with recovery is also stressed at every AA meeting. These critical values and "sayings" include: surrender, faith, acceptance, tolerance, patience, honesty, openness, willingness, humility, recognition of character defects, "one day at a time," "keep it simple," fellowship, belief in miracles, and gratitude. (Wilcox, 1998)

Opinions about the effectiveness of AA in treating alcoholism vary widely; it's just as easy to find skeptics as supporters. After all, it is much easier to believe that alcoholics are genetically "doomed" to a life of suffering and causing suffering in the lives of others. Taking responsibility for the illness and acknowledging that conquering alcoholism requires difficult, daily effort and commitment is a scary, daunting thought. Even more difficult is constantly battling a pro-alcohol society. Overall, skepticism toward AA is likely rooted in pervasive misunderstandings about the roots of alcoholism, and pervasive cultural behaviors that support the progression of the disease.

There are many examples of these pro-alcohol beliefs and behaviors. Alcohol use is such an important part of adolescence for many Americans that it has become a "rite of passage" from childhood to adulthood. Moreover, studies have found a correlation between early alcohol use (particularly before age 14) and the progression of full-blown alcoholism; in some cases this initial exposure takes place with parents or other family members (Warner, White, & Johnson, 2007). Other studies have demonstrated the complex ways in which genetic and environmental factors can interact to decide the personal experience between an alcoholic and his or her "poison." In other words, the way a person metabolizes alcohol, combined with the impact of initiation experiences, can have a powerful effect on adult outcome of the disease. Anthropological, cross-cultural studies have revealed less of a genetic link and more of a cultural basis: "it became very apparent that not only was proper drinking behavior learned, but that abnormal behavior was also learned (Wilcox, 1998)." In addition, many anthropologists have agreed that "cultural expectations define the ways in which drinking, both normal and abnormal, is done in a society" (Mandelbaum 1965: 288) (Wilcox, 1998). Comparisons of drinking behavior patterns across cultures suggest that, "like all other behaviors in any given cultural system, were based on cultural expectations. Who drank and when and how much they drank was determined by custom" (Wilcox, 1998). For example, in Ireland, where alcoholism is a major problem, alcohol use is frowned upon yet considered "a good man's failing." As in America, use is prohibited until age 21; most drinking occurs in bars rather than the home. In contrast, there is very little alcoholism in Italy. In that country, drinking with meals is ubiquitous and common even among children; however, intoxication is viewed negatively. (Vaillant, Hiller-Sturmhofel, & Susanne, 1996) One might argue that Italian children view alcohol no differently than any other kind of food or beverage -- it's healthy as long as it's consumed in moderation. This early introduction might result in a "comfort" with alcohol that minimizes temptations to overindulge.

This leads into a very interesting phenomenon relating to alcohol abuse; one societal influence that appears to have a profound effect on rates of alcoholism is ambivalence. When ambivalence about alcohol use exists within a culture, it takes on a "naughty" feel that contributes to the "high"; it causes the user to become secretive and obsessed about its use, and leads to a potent "love-hate" relationship with the drug that is more likely to take over the life of the user. Fascinatingly, in cultures where alcohol use has no ambivalence or fear tied to its use, these cases of obsession leading to abuse are few and far between. (Chafetz & Demone, 1962) in other words, the fact that alcohol use in America is both accepted and encouraged, as well as frowned upon and feared, makes it all the more likely to become a problem. For example, in the Arctic Eskimo Aleut culture, alcohol use has been common since its introduction by Russians beginning in the eighteenth century. But alcoholism among the Aleuts was virtually nonexistent, until the 1960s. Before that, while the Aleuts had mild concerns about the effects of drinking to excess (in terms of noise and damage or injury to self or property), their general attitude was devoid of guilt or ambivalence. However, as some American teachers who chastised alcohol use became incorporated into Aleut society, attitudes began to change. (Chafetz & Demone, 1962) as one researcher stated in 1962: "This attitude, if accepted by the Aleuts, may lead to feelings of resentment, fear, and shame, ultimately creating unfavorable group attitudes of ambivalence and guilt, and thus opening one of the doors to alcoholism (Chafetz & Demone, 1962) and in fact, just a decade later, another study found "alcoholism to be the most prevalent mental disorder in all the Native groups and to have a special prominence among Athabascan Indians and Aleuts" (Spiegler, 1993). In summary, the human brain doesn't handle ambivalence well; psychologists call this phenomenon "cognitive dissonance." (Palijan, Kovacevic, Drazen, Kovac, Turcinovic, & Medak, 2007) People feel guilty and conflicted when they drink, particularly to excess; one way to numb these uncomfortable feelings is by drinking even more.

In addition, alcoholics struggle daily with a set of beliefs known as "alcoholic thinking (Wilcox, 1998)." Among AA members, these thought processes are taken very seriously and are often considered the main underlying cause of the problem. Overall, these alcoholics believe "alcoholic thinking" is what led them to view alcohol use as "desirable, then necessary, and eventually an inevitable part of their existence." (Wilcox, 1998) in very generalized terms, some beliefs, behavior patterns, and destructive thinking typical among alcoholics include: a desire to be people pleasers, a sense of hopelessness, powerlessness, fear, anger in response to fear, an inability to let go of resentments, and self-centeredness (Wilcox, 1998). Certainly these are all character traits and emotional issues that can be successfully addressed and treated through some form of therapy (like AA), or a combination of therapy and medication. Whatever genetic component exists in alcoholism, it is no match for the power of human will.

Other psychotherapeutic treatment options for alcohol abuse include family therapy, individual therapy, and professional interventions involving family and friends. Even Behavioral Couples Therapy (BCT) for alcoholism is gaining ground as an effective treatment, since many marital issues and dynamics can exascerbate and "enable" the problem. Some of the marital behaviors associated with homes having at least one alcoholic partner include "poor communication and problem solving, ineffective arguing habits, financial stress, nagging" (Fals-Stewart, O'Farrell, Birchler, Cordova, & Kelley, 2005), verbal abuse, and inappropriate excuse-making for or care-taking of the alcoholic. In addition, studies of emotional transmission between couples indicate that "distressed couples show more reciprocation of negative affect"; in other words, negative interactions between husbands and wives can become a downward spiral, with alcoholism being a major complicating factor (Larson & Almeida, 1999). Of course, there are also far-reaching effects for any children in the home. (Fals-Stewart, O'Farrell, Birchler, Cordova, & Kelley, 2005)

In many cases, alcoholism is complicated further because it coexists, or is comorbid with, other psychological or medical disorders. Examples include anxiety and mood disorders, anti-social personality disorder (ASPD), bipolar disorder, panic disorders, post-traumatic stress disorder (PTSD), and even schizophrenia. (Shivani, Goldsmith, & Anthenelli, 2002) These are often "chicken or egg" cases; doctors find it difficult to tease out which came first -- the alcohol abuse or the mental illness. Certainly, it has been proven that alcoholism can cause any of these disorders as a result of its damaging effects and nutrition depletion; and it's easy to imagine that someone suffering from mental illness will be more likely to drink to excess. The question on a case by case basis is: what needs to be treated as the primary root or underlying cause? Often, successful treatment means a combination of approached designed to address multiple causes. (Rosenthal, 2003)