Party Time!

In an older blog post titled “What Do I Do At Parties,” written to support persons in early recovery** navigate social settings in which there will be alcohol, I wrote the following paragraph:

“Finally, let’s be honest about the “how can I have fun without alcohol?” The answer to that is as varied and individual as there are people. Laughter to the point of tears is available, connection with others, sex, sports, good food – literally almost anything except alcohol is available and accessible. But if you attend and only see the event through the lens of “everyone else is drinking, and I am not” rather than the whole of the event and human connection and interaction, you need to do some work on broadening your meaning and values.”

I have since spent another year researching just that. Actually, I have spent the last 3 years researching alcohol use disorder and substance use disorder, especially as it relates to high achieving, high functioning persons and their use.

Alcohol especially is paired with rites of passage, with certain foods, with long weekends, and is positioned with “grown up” partying. This is true as we grow up in the U.S., imbuing alcohol with a mystical and magical intrigue, often experimenting with it at mid-teen, using in a binge fashion through early adulthood. This pattern continues for many until a traditionally expected development of a career and family disrupt the use pattern.

I have an older blog post about “What is Normal Drinking” that you might find interesting.

How Does an Alcohol Use Disorder Develop?

For a number of persons, however, misuse or problematic use continues and develops into a substance use disorder (SUD). There are about 6 theories that explain the development of an alcohol use disorder. They include:

1. Trauma –Childhood trauma is strongly correlated with the likelihood of developing a SUD, but trauma at any time is also correlated. When something intense and negative outside the realm of expected and anticipated human experience happens, it can be experienced as trauma. The person’s brain reactions with a chemical pattern and changes the neural pathways of the brain that determine mood, perception, and somatic (body) experience. The trauma changes how the body may experience sensation, psycho-active substances, relationships, pleasure, bio-states such as sleep, pain, fear, and hunger.
2. Interaction with a substance – Surgery, bariatric (weight loss) surgery or other medical trauma can be a precipitant for the development of a SUD. This is how the opiate crisis happened (with the profit motive of pharmacological companies). Opiates are structured in such a way that the substance itself is more likely to create an addictive response in a wider range of brains (even in brains less likely to have an addictive response), which is why we see people who have never been observed to have had a problem develop a substance use issue and why persons formerly in long term recovery relapse after a medical event in which opiates were prescribed.
3. Heritable vulnerability (aka “it runs in our family” or “it’s genetic”) – There is an observed and documented predisposition towards having a hyper-response to substances that “runs in families.” This predisposition is dormant until switched on by interaction with a substance, trauma, or co-occurring mental illness.
4. Reward insufficiency – Research suggests that a percentage of persons who regularly misuse substances do so because their brain’s reward system functions differently. These persons do not experience reward at the same level of pleasure and joy as a typical reward response, and the function of psycho-active substances gets hardwired by neurotransmitters (feeling chemicals) as pleasure. In the case of dopamine, for example, it can carry the brain-message of substance use that “this was better than expected, I want more.” “Salience” is often the term when discussing this theory of substance misuse.
5. Learned behavior (also known as habit or conditioning) – The brain operates on hard-wired behaviors. For example, people usually put their pants on by putting the same leg on first each time. If you have ever tried to start or stop a habit, you have become aware of learned behavior/conditioning. Drinking after work becomes a habit, then tolerance develops and the person drinking needs to drinking more to achieve the desired effect.
6. Co-occurring mental health issues (depression, anxiety, bipolar, etc.) – Persons with co-occurring mental health issues are vulnerable to seek relief from the symptoms of those illnesses. If they continue, tolerance builds and they find they may need more, more often, or more powerful substances but the relief often becomes elusive, and, by then, the substance habit has become established and hard-wired into the neural patterns of the brain (see #5). At that point, the person has both the original mental illness AND a SUD.

So, What Do I Do Now?

So, what should you do if you are new to not drinking or hoping to make some lasting change to your drinking habits?

I have found that many persons with an established alcohol use disorder do better if they adopt an abstinence-based lifestyle when it comes to alcohol. Many persons with an AUD, when they interact with alcohol, find that it is more difficult to limit. That said, the following are ideas that can help if your goals are to stop or reduce.

You need a varied and healthy toolbox to respond to life, and you need excellent self-awareness.

Self-Awareness

What triggers you? That’s a broad and potentially over-used term. Let’s be more specific. What drains you? Too many people? Too many activities? Too few people? Too little structure? Noise? Mess? Are you bio-state sensitive (does lack of sleep, hunger, pain impact you significantly)? Do you need a review of boundaries? There is a lot more you can become aware of in terms of self-awareness. Taking time to reflect, having a professional or well selected person to be vulnerable with or accountable to can be immensely helpful, and/or keeping a log can give you a lot of useful information.

Toolbox

We all have a toolbox of coping skills, and they are on a continuum of healthy/unhealthy. Healthy would be exercise and unhealthy would-be spending money you don’t have. We need to look at our toolbox frequently assessing it for the tools we have and use and in what percentage.

Healing and recovery from AUD needs to increase healthy coping and decrease unhealthy coping. Stress management is key, and the development of an informed stress management plan is essential. This needs to be more than “exercise and eat right.” This needs to include an understanding of who you are, what energizes and depletes you, and an intentional structuring of your days, weeks, and months to build a life in which the use of alcohol is superfluous.

Although many people achieve what is known as “natural recovery” and stop drinking or problematic use without professional help, if you have not been able to, there is no shame, no reason to feel less than. You need professional help, just like someone with another illness.

You Are Not Alone

According to the leading agency tasked with assisting individuals and organizations with the prevention and treatment of substance abuse (Substance Abuse and Mental Health Services Administration – SAMHSA), in 2020:

• 40.3 million people aged 12 or older (or 14.5 percent) had a substance use program
• 28.3 million who had alcohol use disorder
• 18.4 million who had an illicit drug use disorder
• 6.5 million people who had both alcohol use disorder and an illicit drug use disorder.

If you are one of those many persons, call me and we can work together to create a custom treatment plan that helps you with your awareness and toolbox.

**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.