What causes Addiction? 27/1/2017 – Occasional blog series.

This is the six million dollar question! If there was a clear, concise answer those of us in the treatment arena could save individuals, families and communities a load of grief and unhappiness.

Various specialists have their own strongly held theories and beliefs. 

Here is my attempt to throw some little light on the subject;

Addiction is mostly connected with, drugs, legal and prescribed, including nicotine and alcohol of course, gambling, gaming, food and pornography/sex. 

The substance or behaviour itself is one strong causative factor. I know this is obvious but it still needs to be said. There would be very high rates of addiction amongst people who smoke or use heroin for example. Some clients know instinctively that they are not at risk for many addictions but have a specific ‘weakness’ around one or more substance or behaviour. In Ireland it has often been said that ‘our drug of choice’ is alcohol and it is hard to argue with that. As a nation we have a complicated relationship with alcohol and a predilection to drunkenness and binge drinking.

Hereditary factors are almost certainly important factors as are neurological hereditary factors. In simple terms this means that some people may be ‘hot wired’ to be dependent on a particular substance or behaviour due to genetic factors.

Life Circumstances play a part too. There are high rates of addiction in socially deprived areas. That said addiction is in every sector of society and does not respect gender, class or creed. People who worked in bars at a young age are more at risk to alcohol problems. Social isolation is also a probable cause while it is also a consequence of addiction.

We know, for sure, that depression and anxiety are important factors in the development of any addiction. Such a dual diagnosis, may result from addiction as well. Addiction can result from a lack of social confidence or a difficulty fitting in.

Trauma of any kind I believe is highly relevant too. An individual who endured sexual abuse as a child, for example, learns ‘denial’ at a young age and later on addictive substances/behaviours can serve to help to block out traumatic memories and feelings even if only in the relative short term. There are all sorts of other forms of trauma too and many of them are specific to the individual and highly contextual.

In my view and experience all or many of the above factors are at play before someone presents for help. There are many other causes too that I have not mentioned. To be very Irish, addiction is caused by a bit of this and a bit of that. The job of the therapist is to help the individual or family member to assess the level of the problem, and help the parties to come to terms with the reality of addiction in their lives and then to make appropriate changes over time. Sadly only a relatively small number of people who are suffering from addiction, including family members, get proper help and distressingly some are not even aware of to whom or where to reach out. Many are afraid of the process and do not know where to begin. Others are worried about labels, stigma and social humiliation. 

The good news is that if you can identify that there is a problem, all sorts of help is available. Many people go on to make a full recovery. 

 

 

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The 12 ‘Daze’ Of Christmas

I wrote this blog around the same time last year and have decided to update it to try to help those who wish to drink less at this time of the festive seson or who want to abstain. I love Christmas and I reckon most people do but for many people it is a living nightmare. Existing in the same small place as someone with an active alcohol problem means stress, anger, fear and heartbreak. Every day I hear deeply distressing stories from family members of Christmases ruined by booze. Many of which can never be told as they are too specific and identifying. A lot of them are ‘x-rated’ incidents involving serious assault and deep, long term resentment and hurt. Shouting and screaming, vicious remarks, and/or poisonous angry silences. A wife of a problem drinker; “after three days of heavy drinking he surfaced from the bedroom on Xmas day just in time for dinner and proceeded to kick the turkey around the floor because in his drunken craziness it was too dry”, — ironic or what! Santa does not visit in some homes. No food in the larder and all in all innocent victims, mostly children, utterly miserable.

For people in recovery it is a very difficult time too. Bad enough the proliferation of all the profit driven alcohol advertisements and promotions but also so many insensitive people, especially with too much drink taken, trying to force alcohol onto folk who have extremely good reasons for choosing not to drink. Some people dread Christmas functions as a result. It is such a major problem I help patients with scripts to avoid slipping back.

Advice for the general public;

Treat the whole Xmas period and New Year as any other time of the year. Avoid drinking too much.

Stick to a game plan. Decide on exactly how much to drink on any one occasion. Set personal rules. Make sure (even at home) that you know what a standard drink is. Some people for example think there are only four drinks in a bottle of wine. You can double that! Designate alcohol free days during each week and drink water and/or soft drinks in between alcoholic drinks.

Drink slowly.

Stay with your family and friends and make sure they get home safely on nights out. Getting into a taxi intoxicated on your own is never a good idea.

Do not participate in drinking games that involve drinking more in a few hours than is considered to be ‘hazardous/harmful’ drinking for the whole week. The 12 pubs of Christmas comes to mind, hence the title of this blog.

Be firm with people who are drink pushers.

Put the money you save into a jar and treat yourself in the new year.

Never ever drink and drive. Your rights are one important consideration but so are the rights of everyone else.

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Cutting down on Alcohol and Cutting out

In my last blog (July 16th, see under ‘links’ on my website – www.rolandeanderson.ie) I promised to write some suggestions to help people who want to cut back on the amounts they drink or who want to stop drinking altogether or even for a period of time.

Most of the people I see in my professional capacity are ‘problem drinkers’ in the sense that drinking has caused them minor to significant problems and harm. Many of the people I see are dependent on alcohol.

I can never impose sobriety on anyone and would not wish to even if it was possible. Change is only effective if the person (himself/herself) buys fully into it and actually wants to make the lifestyle change. No more than any other journey this one needs to be carefully planned and an experienced guide might be necessary too.

I often recommend that people stop for a period of time, for example 3 months. Many are frightened by this prospect but usually find it much easier that they thought. A relatively short period of time off drink will offer complete clarity to allow a well thought out more long term decision and will obviously serve to reduce any alcohol related harm as well.

The advice from the ‘Specialist’ as to abstinence or reduction comes on foot of a detailed assessment. Sometimes questionnaires are used and clinical judgement/experience comes into play too.

Whatever the decision, there is a fairly comprehensive list of tips (under Tips on the website) to help.

One of the more simple ideas therein is to place alcohol on your non-dominant hand and water on the other one as this can help people to avoid loading up inadvertently when chatting for example. Setting a date for change and telling good friends about your drinking/non-drinking plan prior to a social occasion also work. Problem drinkers need to develop more hobbies/interests and if possible to take up more exercise to widen their social repertoire and improve overall health and wellbeing. In the early days of reduction and especially abstinence there may be mild to severe sugar cravings and people should be aware of this too.

Sadly as per my other blogs it is essential to have a ‘story’ ready as to why alcohol is not taken in the Irish culture as ridiculous pressure is put on people to drink or ‘only have one’ in social settings here.

When change is established people should be encouraged to continue and not become complacent.

 

 

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Harm Reduction and Alcohol

Yonks ago those of us working in the field of alcohol problems used, if asked, to try to decide if someone was ‘alcoholic’ or not. Nowadays we are a little bit more sophisticated and instead try to use the categorisations; Low-risk, Hazardous, Harmful and Dependent in relation to alcohol. We have various skills, questionnaires, and clinical experience at our disposal to help decide which category a patient may be in at this current time but it is not easy to fully decide, even for the trained eye, except in the extremes.  As implied risk status vis-a-vis alcohol can also change at any time or over time so it is not a static once for all time assessment. Labelling is not the most important issue in my view. Far more important is the harm a person’s drinking is having on his/her own health and well-being. Often, sadly, people are blisfully or miserably unaware that their drinking is badly affecting themselves and/or their loved ones, often with eventual disastrous consequences. Denial is strong in all forms of addiction due to perceived opinions, fear, anxiety, shame and guilt. The impact on children and spouses/partners is particularly severe when someone is dependent on alcohol but harmful and hazardous drinkers can unwittingly make the lives of those around them unbearable too. Assessment of risk status is also difficult because factors such as age, gender, occupation, mental and physical health, hereditary, previous traumatic events, and many others as well, can also adversely affect one’s relationship with alcohol. Following the asessment or assessments some patients are advised to abstain while others may be able to reduce their intake to avoid harm to themselves and others. Tips can be offered as well as insight into socail or personal triggers that set people off. However each person needs to take control of their own drinking behaviour. Of course all of us are vulnerable with blind spots and it can help greatly to talk with a trained addiction specialist who will engage appropriately in a collaborative manner to help alleviate problems and to find solutions. The main point is that reducing drinking occasions and amounts can make an enormous difference to all concerned. Specific tips to reduce or abstain from alcohol will be offered in my next blog.

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Go on, Go on, Go on, Go on

Every day of the working week I see people in my work who struggle, to varying degrees, to cope with the reality of alcohol dependence and all of its consequences. Men and women, of all shapes and sizes by the way, who are human and vulnerable like the rest of us. Those in recovery have to learn to cope without alcohol in a society and culture that is deeply soaked and invested in booze. Marketting of alcohol is pervasive and powerful. People who almost by defintion are lacking in confidence have to cope with drinkers who push alcohol on to them at functions and parties. A community of Mr. and Mrs. Doyles (Ref; Father Ted) who encourage, bully, manipulate and cajole others to use alcohol. ‘Just have one’, ‘what’s wrong with you?’, ‘you are very quiet’ or ‘not much fun’, ‘let your hair down’, ‘don’t be a stick in the mud’ etc etc. A peculiarly Irish trait. No joke for those who want or need to abstain. On most of the continent if you are offered a drink it is just that – one drink, and if you say no, then it has no moral importance and you are not interrogated further!  In Ireland if you say you do not want to imbibe you are likely to be the subject to all forms of speculation and conjecture. Young women have the added problem that there are nods and winks that she might be pregnant. It is much more extreme when those in the company are the ‘worse for drink’. Such is the extent of this social pressure to conform that I spend quite a lot of time helping people to develop ‘scripts’ to have rock solid reasons for not drinking. Pressurising people to drink is so disrespectful and we should all be mindful that there are many individuals who find it hard to cope, for good reasons, in drinking situations.

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Meath Community Drug and Alcohol Response (MCDAR)

MCDAR

Addiction of all sorts, and problems with alcohol and drugs, impact on everyone, sometimes with devastating consequences, especially for family and friends, but also on community living. Addiction affects people from all walks of life and people of all shapes, sizes and creeds. Stereotypes are largely inaccurate except in the most extreme cases. Few families can claim to be unaffected. In these stringent times funding is very hard to attract and so essential services are often cut back or non-existent. In some areas services are hit and miss at best. So locally well run counselling and support services are worth their weight in gold. MCDAR was founded in 2001 and in 2004 yours truly was kindly invited to give the opening address at a joint local school/MCDAR information evening for the community. I have had a very close affinity with the organisation ever since. By complete coincidence I play golf in ‘Co. Meath’, Trim and MCDAR are based there too. They have recently moved to the town centre. I admire their committed voluntary community approach so much and have watched as they added services year on year. I know many people who have been successfully helped thanks to their dedicated work. Cathy Whelan who has run the organisation since its inception wrote the piece below to let folk know what they do. Cathy, her husband Noel and I go back to our early days working together in St. Patrick’s Hospital, D.8. I only met her occasionally in the intervening years until she started this important venture and two years ago MCDAR Management Committee asked me to be ‘Patron’ of the organisation. What an honour! I didn’t know what it meant in practice and having accepted then came the worry – how can I help them out?! So writing this for readers assuages my guilt a little and Barbara and I ran a quiz last year in the golf club, to raise some funds for MCDAR. It was fully supported by the club officials and the members and was a great success. So we are doing it again in the same venue this year, Friday 21st March at 8 p.m. We have wonderful prizes thanks to all our sponsors and all are welcome. It is a unique table quiz in that it is indexed to match the par of each hole, and 73 questions in all. We give prizes too for funny answers and it should be a great fun night.

Please read on to learn about the work of MCDAR —

Meath Community Drug & Alcohol Response is a Voluntary Community based Initiative founded in 2001 to respond positively to identified alcohol and substance misuse issues for individuals, families and the community.

MCDAR is a confidential service providing a range of services to individuals and family members who may be experiencing difficulties with addiction. We create a safe non-judgemental environment where issues underpinning addiction can be explored. We operate our service on mutual respect, dignity and equality and strive to continually improve and develop our services.

Services available

  • Advice and Support
  • Drop In
  • Key Working
  • Harm Reduction
  • Group Work
  • Affordable Counselling Service
  • Aftercare Group
  • Alternative Therapies
  • Skills Based Family Programme
  • Community/School Initiatives

Our service is an over 18’s service and anyone can make a referral to MCDAR.

We are based in Trim, Co Meath in Unit 1, Haggard Mews.

Phone; 087 0933759 or 086 4081511                           Email; mcdar@eircom.net

 

 

 

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Market Alcohol Sensibly! Messy Monday and the like

I have been a long campaigner against some of the more dubious tactics of the drinks  industry in general which are designed as far as I am concerned only to increase consumption and to ensure continuing profits. The ‘vested interests’ in my view are just focussed on selling as much alcohol as possible. They ‘use’ pithy messages to appear to care such as ‘Enjoy alcohol responsibly’. Meanwhile society is suffering badly from our national problem.  Everyone sees the awful effects of excess drinking on our streets. Violent random assaults, and vomit, and other human waste, in public areas, are common. People are afraid to go out in some areas and at some times.  Individuals and family members  suffer horribly from alcohol related harm and all the catastrophic consequences of alcohol dependence.  Anxiety, depression and other mental health problems as well as the tragedy of attempted suicide and suicide are often caused by alcohol. A myriad of physical problems result including everything from skin rashes and hypertension to liver problems and cancer. In short our relationship with alcohol causes terrible, ongoing trauma for many people in Ireland.

So ——-  even I was shocked to hear, in various media reports, that one alcohol outlet recently advertised for people to come to “Messy Monday” for cheap drink and “serious craic and sensible shifting”!!. As Mc’Enroe famously said ‘You cannot be serious’. I thought there were strict regulations against this sort of thing. My understanding is that advertisements are not permitted to link ‘alcohol with sexual success’ according to advertising standards in Ireland.  Are  promotions  exempt from such guidelines? Now I can already hear some people saying before I finish this note ‘but people can make up their own minds’, well yes of course they can and they don’t have to go out to such nights but folk are looking for a cheap night out these days and all drink outlets should behave responsibly (sic) as the most vulnerable are most at risk. Though it has to be said that everyone can be crushed by heaving crowds.

Someone please define ‘sensible shifting’ and then responsible marketing!

I  sincerely hope that this latest incident will be investigated thoroughly by the appropriate authorities, criticised in all quarters and that such irresponsible advertising will not be allowed in future.  Deaths and more serious injuries will happen if action is not taken.

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