When does alcohol become a problem?

Katarzyna Kowalska: The onset of addiction is the time when you can still avoid its serious consequences. Only how to notice that the use of alcohol or other substance becomes dangerous for us and that it would be worth asking for help?

Anna Bus: It can be difficult to capture this moment. There are people who contact the therapist because they can see something disturbing happening in their lives, but very often they can see it because they experience adverse consequences or somehow receive such information from the people around them. It is very often someone from the family, colleagues, friends or the employer who notice the problem with substance abuse. In my office I encounter situations when people who abuse substances come to a specialist to some extent triggered by such signals from others since, for example, they want to know more or verify whether the way they use substances is already a problem or not. In the case of addictions, people are not usually aware of the role a given substance begins to play in their lives; the fact that the substance performs some important functions. People who abuse substances often rationalize their behaviour.

KK: Let’s specify which signals can make us think.

AB: It is worth considering not only the amount of alcohol we drink a week, but also how we drink, in what situations and why we reach for alcohol. In terms of quantity, we can refer to the standards provided by the World Health Organization. However, we need to remember that all standards define rather low level of risk than the absence of risk since there is no such thing as a completely safe alcohol amount.

KK: When we turn into addiction, not only the amount of alcohol we drink and the frequency of drinking increases, but also how we drink?

AB: Yes, it is important to capture the changes. If previously we consumed alcohol rarely and rather occasionally, in a small amount, and now we reach for the substance several times a week, then this is a big change, and it is worth looking into it. Certainly, people who abuse alcohol often rationalize their drinking. They can provide different excuses; express interest in less popular brands, sometimes argue that, for example, this is good quality beer, good for the kidneys, good during hot weather, etc. A person who turns into addiction may start drinking not only during meetings but also alone. Sometimes there is a need to catch up, when you meet people and for some reason you cannot reach for alcohol, then after the return home, there is a need to make up for it. A person may start hiding the substance and abuse it in secret. Hiding drinking alone should make us think. The fact that we need to hide the fact that we buy and drink alcohol may become a warning sign. Another important symptom involves alcohol as a hangover cure, namely having another drink to manage the effects of alcohol abuse the day before. Moreover, alcohol becomes no longer an element of meetings, but their goal, namely we meet in order to drink.

KK: But this is a common situation that people meet „to have some wine”.

AB: Yes, people meet to drink wine, but the question is, to what extent they meet solely in order to drink. In a drinking crowd, people do not really meet, if there is no alcohol. If there is no relationship between people, they have nothing to talk about when there is no substance.

KK: This is an important difference. Indeed, in many cases the saying „let’s have some wine” is more of an excuse, and in fact people want to meet to spend time together.

AB: Regrettably, the line here is rather blurry, but it is worth asking a question whether we would still feel like taking part in the meeting, if there is no wine. Sometimes it is difficult to say whether we still meet to spend a nice time together and have a glass of wine or two, and when we begin to meet and drink wine to reset ourselves, forget about difficulties and cut off from the reality. Then, alcohol begins to play an additional role – it is not just some addition to our meeting but becomes a substitute for something – for example our rest.

KK: And a means to deal with emotions.

AB: Indeed. The addiction mechanism also involves the fact that alcohol or other substance becomes a means to deal with emotions. Both, difficult and positive ones – means to deal with the success we achieved, something that we handled well or a task we completed. Alcohol may also be used to control sleeping, to manage difficulties in a relationship, and sometimes to manage depression.

KK: There is no denying that to some extent it works, and you can actually feel better after drinking alcohol.

AB: For a moment, you can perhaps feel better in some way, or at least you do not see the problems around, including the one that is just being created when we replace rest with alcohol, control emotions or sleep after using alcohol or other substances.

KK: So besides how much and how we use a given substance, it is important to notice new functions the substances begin to perform in our lives.

AB: Indeed, if I come home from work and I pour myself a drink to relax, then this should be a signal that something is going on. I may actually need relaxation but the moment I begin to include alcohol in my daily routine, it is good to pause and consider other ways to relax.

KK: Reaching for a drink is often rationalized, followed by assurances that a person can stop at any moment or even attempts to prove it.

AB: Yes, and we should also pay attention to it. The need to experiment like that, to prove something to oneself or to others, should make us worried. In the case of addictions, it happens that addicts make secret attempts to come off substances, without telling anyone. They check whether they can stop, and they succeed for a while – or not. If they fail, they try to rationalize their behaviour by saying „I had a rough day”. The fact that we make attempts to stop, particularly if we fail and reach for substances, should be an impulse to take some specific actions.

KK: Another symptom involves things that begin to go wrong in our lives due to the increasing role of alcohol.

AB: Yes, it happens when we follow the path of risky or harmful abuse. Then we observe the behaviour such as drink-driving, absence at work, being late, neglecting duties and previously important tasks, giving up hobbies. These are strong signals indicating that something disturbing is happening.

KK: What is the reaction of our family and friends to such signals?

AB: It depends, but for example, we may face arguments at home, our relatives may begin to react. It happens that the family who previously paid little attention to someone making a drink, now becomes irritated. At the same time, this message is often not directly expressed; we may observe the conflicting signals. For example, on the one hand the family becomes irritated that someone reaches for alcohol, fails to participate in daily duties and cannot cope with the reality. But when addicts try to stop abusing substances, they are sometimes rewarded with alcohol. The family tries to control the amount and ways of abuse. Sometimes people do not know how to talk about the problem.

KK: Saying „you have a problem” seems like a straight way to an argument.

AB: Depending on who says it. Sometimes it happens that when people hear „you have a problem” from friends, they actually begin to analyze whether they drink too much. It should be noted that there is a greater chance of such a reaction at the very beginning and not when we experience serious addiction, when an addict denies all the symptoms. Certainly, such information may first provoke anger, which is a normal reaction. When someone tells us something that is difficult or uncomfortable for us, we sometimes defend ourselves and turn to anger. However, sometimes the message is accepted, especially when it comes not from the close family but is confirmed by distant family or friends. With addictions, it often happens that even if family members can see the problem and the resulting conflicts, they make sure the problem does not come out. People around: friends, colleagues sometimes learn much later, and sometimes they do not want to touch the subject hidden by the family, so they pretend they do not see it. People are afraid to deliver unpleasant information. Saying, and on the other hand, hearing “I think you have a problem” can be the first signal and step towards change. Although, indeed the word „problem” may sound a bit scary. Perhaps a better way would be to simply name what is happening. Referring to facts, to what we can see.

KK: In that case, what can we say to a loved one who comes back from work and more and more frequently reaches for a drink, and when we try to comment on it, the partner says that it is justified because of a lot of stress, and that nothing is really happening?

AB: First of all, it would be good not to follow this narrative – figuratively and literally. Figuratively, since it happens that co-addicts support the addiction by justifying such behaviour and running errands instead of the addict. And literally, since co-addicts, by trying to control the other person’s drinking habit, reach for alcohol too, so that the drinking can happen in a more „controlled environment” and that the addict can drink less.

KK: So first we need to pay attention to our co-addiction symptoms?

AB: Co-addiction is a specific relation between the addict and the co-addict. The first is addicted to alcohol and the other – to the behaviour of the addicted partner. You focus your attention on the other person, control their behaviour, wonder if your partner is drinking or not, whether they will come home sober or under the influence of alcohol, are you going to face an argument at home or not; this is also a way of functioning and regulate your own emotions. It may result from growing up in a family with alcohol problem; then, it all seems familiar. It can even be difficult to live without it, so when an addict tries to stop drinking, the tension may increase. The other person experiences tensions, waits for the moment when the partner goes back to drinking, comes home under the influence of alcohol and the situation repeats itself. If it happens several times, the co-addict becomes used to the situation that it is always going to be like that. And paradoxically, when the situation actually repeats itself, the person feels relief and can breathe easily again.

KK: So, it is important to observe how we experience someone's addiction.

AB: And what we focus on, on ourselves and our needs, emotions, duties, or on our partners, their problems and behaviour.

KK: Talking about the facts may be difficult in such a relationship.

AB: It is sometimes complicated, especially when addiction is related to other dependencies. In a marriage where one spouse works and this one abuses substances, at the very beginning there are explanations that one has the right to relax, have a drink or beer after work, etc. Later, even when the problem is getting worse, the co-addict may fear what happens, if the partner loses the job. This spouse may intend to set some boundaries and take care of oneself, but there is also some fear about stepping outside and the potential break-up, managing on one’s own, if the partner loses the job or the relationship is going to fall apart. This may deter a spouse from saying that something is not right, and from seeking help. Sometimes one person threatens to leave, without being ready to actually do it. And we observe a certain roller coaster; a person moves out, then comes back and everything starts again.

KK: Perhaps one needs to go through such roller coaster to be ready to stop it.

AB: Sometimes, yes. It is related to dealing with one’s own emotions, developing self-esteem, focusing on one’s life and own needs. Sometimes addicts are afraid that their partners will undergo therapy and the therapist will suggest breaking up. It does not work this way. It is not about breaking up but trying to focus less on addiction. People may break up or not – this is not the therapist’s decision. It is about standing on their own feet so that both partners can feel that they are two individuals and that they can decide whether they want to stay in a relationship, that in a relationship they can give and receive support. Significant dependence, namely a situation where adults behave as if they did not even know they could function on their own, is frequently a problem.

KK: The point is that the support should not be unconditional, so that we could expect something from the other side.

AB: Yes, so that the world stops revolving around the addict. And the family, instead of tiptoeing around the situation at home, could respond to what is happening, to what is right and what is wrong. It forces an addict to behave differently.

KK: It seems correct to talk about the facts at work. That someone was late for the fifth time, that we could smell alcohol on someone and that the person had difficulty in talking during a teleconference.

AB: It is definitely worth talking about the facts. It prevents a situation where someone is made redundant and feels that they have not received any signal in advance that something is happening, although the co-workers and employers noticed the problem much earlier. An addict willingly assumes that no one can see the problem and rationalizes the behaviour; therefore, a confrontation may become a chance to change.

KK: These rationalizations often sound convincing and we want to believe in them.

AB: Sometimes we want to believe, and sometimes we do not want to interfere. We tell ourselves that it is not our business, since the person does not want to see what we can see, to make an effort to change. And indeed, it is this person who has to make a decision, but on the other hand, if one does not listen to any message from their close friends and colleagues, fails to experience the consequences of their behaviour, then they do not get a chance to face it, either. So if we can see that something is happening to our co-worker or employee, we should say something.

KK: And draw consequences from our employees?

AB: Definitely, communicate them clearly. I also believe that drawing consequences may be constructive. You can be a supportive employer in a sense that you can give your employee time to start therapy and take care of their health. Whereas pretending that there is no problem, accepting explanations that this was the last time, reacting emotionally and inconsistently provides no support. An addict promises, sometimes lies, provides sick leaves, whereas the most important thing is to start the therapy. We can also offer support: make it possible for an addict to undergo the therapy or to take a convalescent leave.

KK: EAP Programs were developed since the employers were facing a dilemma of whether to only draw consequences or additionally offer support to their employees. And many times, it referred to good employees.

AB: Every so often, people who are prone to addictions, are at the same time very committed as employees, and they value their work. There are people who do their best at work and abuse substances after work. Sometimes these are people who try to meet very high requirements, without taking care of themselves – substances may constitute some relaxation for them, but also a source of additional energy. Certainly, we cannot generalize because among addicts we can also find those who attach no value to work. In addition, a lot depends on the level of addiction, because at some point it may turn out that even if work has been important so far, having a drink becomes more important. It is my experience that often economically active addicts, who value their work, can go from one extreme to the other. On the one hand, they are task-oriented, dutiful, willing to get everything ready right down to a tee, they are even perfectionists. On the other, they tend to be careless about their appearance, show risky behaviour and act very irresponsibly. Such people work by giving a two hundred percent, but when they stop and relax, they also want to give a two hundred percent.

KK: First, there is a lot of pressure imposed on oneself and later when it goes away, there are no restraints.

AB: And alcohol is used to work it off. If people do not know how to rest and relax, they reach for alcohol to make it happen, to do it without any remorse.

KK: If a person begins to notice that something disturbing is going on and begins to wonder what to do, how can we help?

AB: The first step may involve an appointment at a specialist’s, making use of EAP program, register at an addiction treatment centre. This is a place where you can come without a referral, and even without the current insurance since such a possibility is provided by law. It is probably the most important thing to go to a specialist first and talk about the situation, check the level of addiction, its impact on our daily behaviour, to what extent the situation poses a problem.

KK: Such a person can call us because already the first conversation makes it possible to discuss the situation with an objective person. And how about a situation when people think they can handle it themselves?

AB: It is my experience that this is not a good idea. People who think they can handle it themselves often come back after a while and it turns out the situation is not better at all. The question is what it means to handle it themselves. As we said earlier, in the case of addiction, the problem is not only the amount of alcohol consumed, but also the role it plays. It happens that a person tries to handle it on one’s own and falls from one addiction into another. Someone drank alcohol and now begins to take drugs or gamble. It seems that alcohol abuse has been handled but there are still various difficult issues around.

KK: Therefore, it is good to talk to someone who knows these mechanisms and can give us a chance to protect ourselves against such a trap as handling it by ourselves.

AB: Undoubtedly, this protection refers to the behaviour of an addict. The moment when you ask for help – call or come to a meeting – is actually a chance to analyze one’s behaviour. It provides an opportunity to answer the question what we want in life, what we like about life and what we do not, but it is always up to the person who comes in to decide whether and what they ultimately want to do with it.

KK: Not everyone wants to do something right away. It is one thing to come to talk to someone because you heard something about yourself, and another to be willing to change.

AB: Yes, some people want to check whether their behaviour is really risky, whether their drinking is already an addiction, or still a normal element of social life and there is nothing to worry about, and the people around simply exaggerate. There are also people who experienced a lot, sometimes underwent therapies, and they come because they are ready to change. Some are afraid that going to a therapist must involve full abstinence, and they are not ready for it, they do not feel that they can fully commit. It does not have to be like that, because we can focus on limiting the amount of alcohol or other substance consumed, analyze how the decisions and behaviour affect a person’s life. Certainly, provided that the person who calls or comes in is not under the influence of any substances. The therapist may suggest some solutions, such as treatment in the inpatient centre. However, apart from a life-threatening situation, no one can be locked up or sent anywhere against their will, it is always a decision of a particular person.

KK: We encourage you to observe your behaviour and not to delay in taking action.

AB: Yes, it will certainly not hurt, and may provide benefits. The meeting we are talking about aims, first of all, to analyse your situation; the therapist will neither impose anything nor develop anything if it does not exist.

KK: Thank you very much for this conversation.

AB: Thank you and see you at ICAS.