Update on Horatio – March – Hope

There was an incident at home that prompts attention before hope appears. Horatio has been staying at my father’s house more days than not. This is good for two reasons; he isn’t allowed to drink there and it provides a way to watch his binges. When he disappears to his house for two days and comes back bleary eyed, we know what he was doing. Horatio isn’t as devious as he thinks. Or is it that he has determined we’re oblivious?

A couple of weeks ago he came strolling back to my father’s house after one of his two day vacations. Still drunk from the binge, he attempted to make breakfast for my father. Clearly he was intoxicated, but my father did not reprimand this behavior. Instead, he quietly ate the half burnt/half runny “scrambled eggs.”

I couldn’t understand his rationale for disregarding Horatio’s state of inebriation. After discussing it with him, the only explanation is that he was at a loss for words at that moment and didn’t know how to react. In hindsight, he knew he shouldn’t have tolerated what happened.

The next day, when Horatio sobered up, my father didn’t hold back in giving him a verbal lashing. I arrived home a few days later, at which time Horatio and I discussed the event. He didn’t deny any of his behavior because he had already been confronted about it. This allowed for an open and honest talk about alcohol.

At the end of the conversation, I made sure that the ground rules were reiterated. There would be absolutely no alcohol in my father’s house. This includes any alcohol in his blood. He will not be tolerated and will not be allowed to stay if his BAC is greater than 0.00. If this means he must sleep in his car outside of the house, then so be it.

At the end of the conversation, my siblings began showing up. The evening would be filled with fun loving childish games as our 7 year old nephew tugged on our arm to get us to play soccer and launch rockets high in to the sky.

The weekend continued this way with museums, kite flying and such. As we were all interacting I was noticing something that I hadn’t seen in a while. As I watched Horatio, I could see a little spark of fire in him. The light had been smothered by alcohol for the past decade, but it was flickering and gaining strength in front of my eyes. The more that Horatio let himself go and enjoyed being with people, the less he thought about his addiction.

It brought me hope that Horatio would one day overcome his lustful relationship with alcohol. It’s obvious that he enjoys being sober more than laying on his couch unconscious. There are many more relapses in his future. He is fighting something that is greater than him at this current time. It will be a remarkable day when he is able to harness and kindle that motivating factor that I have seen in so many of you that I follow. The entity that is defeating him will be overcome by his strength, igniting a lifelong abstinence from alcohol.

My First AA Meeting

Through the motivation of helpful and caring people like Jen, Heidi, and Eden I attended my first AA meeting on Sunday. It surpassed many of my expectations; however it ruined others and left me slightly dumbfounded.

My imagination, with the help of television and movies, painted a picture in my mind of what an AA meeting would be like. It portrayed a room filled with people that obviously looked like addicts; unkempt appearances, borderline offensive hygiene, and at least one person emitting a radiance of booze while swaying back and forth in his chair, balancing on the line between falling forward to the ground and staying in the seat.

You should ignore the video if you only know Bob Saget as Danny Tanner from Full House.

My imagination laughed at me as I entered the room. One look around made me realize that I was deceived. The majority of the members were clean, well kempt, and looked healthier than my medical school classmates. Skeptical, I scanned the room again for the person that showed up with a pint of liquor in his/her system. My imagination rationalized that they must have not shown up today, for certainly you can’t have an AA meeting with 100% sobriety. To say the least, I’m still discouraged by its elaborate depiction of this clean and encouraging environment.

After walking through the threshold and soaking it all in, I found a seat near the back where I assumed the newbies were relegated to. Upon finding my spot, I was immediately welcomed by an older gentleman, John, whom was eager to invite me in and listen to my story. I explained everything that you already know about me i.e. intrinsic interest in addiction, Horatio, and an interest in learning from the people that have the greatest depth of knowledge and widest breath of experience in alcoholism, you.

John and I hit it off and he had a great story that ended in him picking up alcohol counseling after retiring from the school system and being happy and sober for the past 27 years. He introduced me to his friends in the meeting who were equally as welcoming as John. As the meeting got underway, I reprimanded my imagination again for feeding me lies.

It was an open discussion that began with the storytelling of one member’s lifelong battle. This was followed by comments from the audience about how they could relate and included a glimpse of their own story which allowed me to capture a little bit of each person in the room. I would be lying if I told you that I did not relate to the thoughts and expressions in the words that I heard.

I found myself intrigued by a discussion on dealing with life events by using alcohol. Many of the members agreed that at one time or another they used alcohol to squelch negative feelings, even if it was as minor as a bill in the mail. This brought my thoughts back to college years. I couldn’t ever comprehend the thought process of the one or two friends that after breaking up with a boyfriend/girlfriend would announce to the world, “I need to get drunk!” Why is it that people want to get drunk when that is the least effective remedy for such an ailment? In fact, alcohol tends to make it worse because the person inevitably makes a bad decision that night. Taking an already emotionally laden person and adding alcohol is like throwing gasoline on a flame. My hope would always be that the night would end in crying over the person rather than the late night vandalism of his/her house.

As the discussion continued, I was struck by another gentleman’s comment on hitting bottom. A rough rendition of his words was, “I thought I hit rock bottom 20 years ago, but I was wrong. Many years later I found out that at the level I thought was rock bottom there was still an elevator that went even deeper to the sub-basement.” This is a subject that I’ve been thinking about tremendously when it comes to Horatio. What will his rock bottom be (or sub-basement)? I know that I can’t force him in to sobriety. The hardest part may be that the only thing I can do is watch and wait for that day. Will it be when he loses his house? Maybe his addiction will take him as far as living on the streets before he’s finally ready to change for good. I have been mentally preparing myself that one day I may have a homeless brother.

As the hour came to an end, I expressed my appreciation to John for taking me under his wing in a place I would have otherwise been lost. Knowing my interest in learning, he informed me about an AA meeting oriented to young addicts (under 25). I look forward to the discussion I will hear there, as well as at my first Al-Anon meeting.

DUI

Reblogged from earlyrecoveryblog:

I remember shoveling mud out of a drainage ditch in an elementary school in Pacifica. It was part of the Sheriff’s Work Program that followed DUI school. I remember not trying very hard. I remember parking near the sheriff station with my temporary license, or my suspended license, remember not being sure which it was, and panicking as I pulled away at the end of the day, waiting for sirens.

Read more… 373 more words

My hardheaded brother (not Horatio) recently appeared in front of the judge to discuss a DUI. This is his third DUI, of which the last two were within a 5 year period. My family and I were expecting the book to be thrown at him which would ensue in a hefty sentence on top of the lengthy restricted license and weighty fines. This is not what happened. His lawyer provided my brother with a ‘Get Out of Jail Free’ card (the card wasn’t actually ‘free’ considering the lawyer fees) which allowed him to skate by the penal system and subsequently not learn from the serious infraction. This post by earlyrecoveryblog does an excellent job of depicting the depth of denial that addiction burrows into the addict’s subconscious mind. Much like the incidents in the author’s life, the slap on the wrist that my brother received was not enough for him to change his ways. I just hope that he doesn't seriously hurt somebody before realizing the ramifications of his actions.

Alcohol Use Disorder

The Diagnostic and Statistical Manual (DSM) is published in order to have a standardized language in the mental health community. Any change to a classification or criterion of a diagnosis is fretted over and fought over for months and years. There is a diagnosis that will be changing which must be discussed.

In May of 2013 the fifth edition of the Diagnostic and Statistical Manual (DSM V) will be dispersed. This publication will essentially eliminate two diagnoses from its predecessor. The classifications of alcohol abuse and alcohol dependence will be replaced by the term, Alcohol Use Disorder.

Alcohol Use Disorder is derived from many of the same basic premises of the two terms it eliminates. The most important of these include: increasing tolerance to alcohol, withdrawal symptoms if alcohol is stopped, larger amount of time spent procuring alcohol, and daily activities are impaired by it. Below is the full diagnostic criteria.

Alcohol Use Disorder
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:
  1) Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
  2) Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
  3) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
  4) Tolerance, as defined by either of the following:
     a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect
     b) Markedly diminished effect with continued use of the same amount of the substance
  5) Withdrawal, as manifested by either of the following:
     a) The characteristic withdrawal syndrome for the substance
     b) The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
  6) The substance is often taken in larger amounts or over a longer period than was intended
  7) There is a persistent desire or unsuccessful efforts to cut down or control substance use
  8) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
  9) Important social, occupational, or recreational activities are given up or reduced because of substance use
  10) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  11) Craving or a strong desire or urge to use a specific substance.

The degree of severity is determined by the number of criteria that the patient meets:
Moderate if he/she meets 2 to 3 of the criteria.
Severe if he/she meets 4 or more of the criteria.

The diagnosis is further broken down in to whether or not the patient is physiologically dependent on the drug. Physiological dependence is determined to be evidence of tolerance or withdrawal (i.e., either Item 4 or 5 is present).

Thus, a diagnosis may look like:
Alcohol Use Disorder, Severe, With physiological dependence
or
Alcohol Use Disorder, Moderate, Without physiological dependence

The most interesting part for most that read my blog is that the DSM V will define the stages of recovery. I will have to elaborate on them in a different post, but I can list the categories here:

Early Full Remission
Early Partial Remission
Sustained Full Remission
Sustained Partial Remission
On Agonist Therapy
In a Controlled Environment

Update on Horatio – Late December 2011

Horatio’s work called my father when he did not show up to work a couple of weeks ago. This was then followed a week later by another call from his manager regarding the same subject, except this time he had missed both Monday and Tuesday (I’m reminded of the scene in Office Space in which the consultants inquire about him missing days of work, and he responds, “well I wouldn’t say I’ve been missing it, Bob”).

After receiving the call, my father went over to Horatio’s house and found him completely drunk with an empty 1.75 liter of Smirnoff Vodka in his kitchen. My father asked Horatio to come with him back to his house where it is an alcohol free home. This would allow him to sober up and resume working (I disagree with my father forcing Horatio to come back to his house because this is a form of enabling as well as the fact that it must be my brother’s own motivation to stay in an alcohol free home). From what I heard, there was a lot of resistance to get him to leave his house, but he finally came with my father.

These two occurrences are very disappointing and demonstrate a new pattern of Horatio’s drinking cycle. It appears that he is able to maintain his sobriety during the weekdays in which he must show up at work (sober or not), however, when it comes to the weekend, he is unable to control the temptation to get obliviated with a large bottle of vodka.

A simple solution for him to avoid these severe alcohol binges would be to temporarily move to my Father’s house over the weekend when he is most vulnerable to his weaknesses. Unfortunately, this is not something that he will be too agreeable with, but I hope that he will at least listen and contemplate the idea.

For some reason, I am looking forward to getting home and having a discussion with Horatio. I shall update you after I sit down with him and discuss the current situation. Your ideas and suggestions are much appreciated, feel free to leave a comment or send an email.

Update on Horatio – Early December 2011

It is coming up on 2 months since I last wrote about my alcoholic brother, Horatio. He has had some great success at abstinence along with some unfortunate bouts of relapse. Every relapse is just as hard, if not harder than the last on him.

When Horatio and I sat down and talked 2 months ago, together we decided on two large areas. The first being that he will give me 30 consecutive days of abstinence. We discussed that this is a mountain of a task and that I would not expect him to be able to accomplish this without relapsing at least a handful of times. I emphasized that I did not care if he relapsed, only that he was honest with me when he did so that we could start over from day 1 again. He has still not given me 30 consecutive days, but I look forward to when I can congratulate him on a job well done.

The second order that we agreed on was that he would put all areas of his life aside until he was sober for at least 30 days. This meant that he could not look for a job, he could not look for a girlfriend, and he could not work on other areas of his life that were not directly related to remaining sober. If he wanted to exercise or go to AA meetings or relax with family and friends, then that was perfectly acceptable, so long as it was sober activities. Unfortunately, he has not succeeded in this area either. He had been actively looking for a job and was hired 10 days ago.

This concerns me for many reasons. The primary reason is that Horatio does not have good coping skills. This is what leads him to pick up the bottle in the first place. An individual with poor coping skills will have a much greater likelihood of succumbing to relapse. He has already disclosed to me that over the very first weekend after his first 3 days of work that he had a relapse. Fortunately he was able to sober up before Monday morning and still has the job as far as I know. I assume that it is only a matter of time before they find out his dirty habit.

In our most recent discussion I reiterated that I was uncomfortable with him having a job when he still has not given me 30 days of abstinence. Rather than hassling him about this, we discussed ways to help him cope with stress and made sure that he knew I would always pick up the phone if he was thinking about having a drink. I hope that he has the strength to do so.

30 Days of Abstinence

Thirty days ago, I sat down with Horatio and discussed with him my thoughts on working together to overcome the disease that he may very well die from, alcoholism.  This was not the first time that we had sat down like this, although this may be the first day that he remembers us doing this.  In fact, I was over at his house two days before this particular discussion. 

On the previous day, it was about 8:00pm when I knocked on the wooden door of his town house.  There wasn’t a response, no sound of him trying to clean up empty liquor bottles, no sound of him stumbling to hide.  Before I headed over there, my father handed me the key to his house.  This had become the usual situation due to the lack of response from within the house after knocking on the door, which was happening at that very moment.  Although Horatio would be inside, he would either be passed out, or unwilling to open the door. It’s understandable why he wouldn’t want to open the door for me, the sight of him in a state of drunkeness would make him feel shameful.  Even though I do not portray a look of disappointment, I can not change how he feels about himself when somebody looks upon him after he has been drinking. 

So I slid the key into the lock and entered his home.  I called out for him, hoping that at least if he hears a familiar voice that he wouldn’t think somebody had broken in to his house.  I could not find him anywhere.  There wasn’t a sign of him on the main floor where the living room and kitchen are, nor was he to be found in the basement.  I was also not finding any empty bottles, which made me curious.  When I went upstairs, I found him sprawled out diagnolly across his bed, as if he barely made it there before passing out.  Understanding that he was still drunk, I went back downstairs, for I knew that starting any conversation with a person with a BAC above 0.00% was hopeless.  In his kitchen, I was amazed at how empty his cupboards were.  A lonely package of pasta and a can of chicken soup.  The refrigerator was just as bare, some ketchup in the door and a 1 liter bottle of Smirnoff vodka chilling in the freezer.  I had a fleeting thought of immaturity to empty the bottle and refill it with water so that when he drinks it he would sober up.  Realizing that I am not twelve years old any more, I instead emptied the bottle and left him a note saying that I was hoping we’d be able to talk.

It’s two days later and I am knocking on his door again.  This time it’s 10 in the morning, but I still hear nothing from within.  As was becoming the custom, I pulled out the key and opened the front door for myself.  Once in, without realizing it, I headed to his refrigerator to check for liquor.  To my surprise, it was empty.  I then began to meander toward his living room, where a movie was playing quite loudly.  As I entered the room, I could see him laying on the couch in front of the television.  He was asleep.  There weren’t any bottles in his immediate vicinity.  I could see a couple of new scabs that appeared to be more than a few days old.  One above his left eyebrow that was 3cm by 1cm in size and the other just below his right cheek bone was 2cm by 1cm.  Scabs and scars had become a normal sight to see on his face since he had been drinking heavily over the past year or more.

I woke him up and he came to a groggy aroused state.  He was surprised to see his brother, despite me leaving a note asking him to get in touch with me.  It was apparent that he had not tried too hard on that.  The conversation started out with normal bullshit, I suppose he was hoping that I wouldn’t notice that he had been on an alcohol binge.  When I asked him about the scars on his face, he described being in bicycle accident on a trail in the nearby park.  I’m not able to determine when he’s lying to me, so I take everything he says with a grain of salt.  Besides, If I call him out on something minuscule so early in our conversation, he’d just become defensive throughout the rest of our encounter.

I’m not particularly fond of beating it around the bush, especially when there’s a looming black cloud of a topic that needs to be discussed.  I open things up by explaining that my father, siblings, and I are not stupid.  We know that he is in a perpetual cycle of drinking to the point of passing out, then waking and starting the cycle again.  I also try to emphasize that we don’t like being lied to (holding back my thoughts on how he acquired the new scars on his face).  After a rough start to the conversation I tried to explain to him that we all love him.  Everybody wants to help, but nobody knows what they can do for him.  We are an Irish family of independent people that refuse to accept a hand from others.  Along with that, we don’t know when to give help either, and in this particular situation, we are lost in knowing what type of support Horatio needs to get better.

The conversation then led to determining what had been successful in the past for him in remaining abstinent, even for the briefest of periods.  Horatio describes AA meetings that have become his support group along with his friends at church who have gone through similar troubles.  Digging deeper in to the effectiveness of these groups for him, it seems that he has not been utilizing them anyway.  When I asked Horatio if he had any tokens from recent AA meetings, he made an excuse about how he didn’t pick them up the last few times he went.  Again, it’s a constant balance of what to believe from his mouth and knowing when to call him out on lies.

A large part of my visits with him are to gauge his motivation to take serious action against his disease.  Horatio is an optimistic individual and I know that his motivation on a 1 to 10 scale (1 being not motivated at all and 10 being extraordinarily motivated) is always skewed.  At this time he states it is a 9, which is relatively promising.  Another factor that I use to gauge his motivation to change is his reaction to the topic of going to rehab.  I never try to force it on him; I merely try to see if he is willing to give it a try.  On this occasion he describes that he was looking in to it.  The hang up is that his insurance would not pay for it (that’s no surprise) and that he hasn’t been working in the past 6 months, which means he does not have the money to pay out of pocket.  I do not push the subject any more than that, because I know that when he is ready and is tired of the repetitive cycle of relapsing, he will finally be motivated to do what it takes to try rehab.

Since he is not ready for rehab yet, I change the conversation to what he should focus on in order to have the best hope of remaining clean.  I placed a huge emphasis on forgetting his concerns in his life (finding a job, getting a girlfriend, etc.) and using all of his energy to overcome the primary problem that is causing the other dominos in his life to topple.  He tells me that multiple people are trying to get a hold of him for a job, but he has not responded.  Horatio thinks that if he can stop drinking for a few days, then he will be able to get a job and continue to be sober.  Unfortunately, it does not happen that easily.  The reason that he has not been able to hold a job and will continue to be unable to maintain a job is due to his inability to suppress the urge to get black out drunk.

Thus, with some negotiation we were able to reach an agreement.  We decided that he would give me 30 days of not working on anything except for remaining abstinent, one day at a time.  He agreed that he would not concern himself with finding a job, getting insurance, starting new relationships, or anything else that causes him negative stress.  However, during this time he is encouraged to exercise, eat healthy and stay as long as he wants at my father’s house, which is an alcohol free zone.

After discussing this, he looked me in the eyes and gave me the strongest hand shake that I had ever felt from him.  I know that in his heart he did not want to let me down.  It is his strong desire to not disappoint people that eats away at him when he relapses.  Thus, before departing his house, I remind him that nobody will feel that way about him if he stumbles again.  We only care that he is strong enough to pick himself up again and we can start the count over.

With that said, I leave his house hoping that he remains as strong as his handshake.

Alcohol Abuse Vs Alcohol Dependence

These two words are often used interchangeably, however, when it comes to an alcoholic, there is a huge difference between them.  The Diagnostic and Statistical Manual, 4th Ed (DSM IV) defines the criteria that separates alcohol abuse from alcohol dependence.

Alcohol Abuse
A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:
  1) Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
  2) Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).
  3) Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
  4) Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).
These symptoms must never have met the criteria for alcohol dependence.

Alcohol Dependence
A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:
  1) Tolerance, as defined by either of the following:
     a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
     b) Markedly diminished effect with continued use of the same amount of alcohol.
  2) Withdrawal, as defined by either of the following:
     a) The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).
     b) Alcohol is taken to relieve or avoid withdrawal symptoms.
  3) Alcohol is often taken in larger amounts or over a longer period than was intended.
  4) There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.
  5) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
  6) Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  7) Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

What the two terms boil down to is this:

Alcohol abuse is repeated use of alcohol to a point of it causing adverse consequences, yet continuing to use it despite those consequences. The individual does not develop a tolerance or withdrawal because the drinking usually takes the form of a one night binge. He or she also often has a criminal record related to alcohol (i.e. DUI).

Alcohol dependence is seen in a person that has built up tolerance over time due to continual ingestion of alcohol. This person will often develop withdrawal symptoms within 24 hours if restricted from alcohol. This person will often be unable to quit drinking for extended periods of time and will relapse back in to a state of intoxication. The behavior, if not interrupted or stopped, will usually affect their social and work life.

Alcohol abuse differs from alcohol dependence in behavior. The individual that succumbs to alcohol abuse will usually have a one night binge and will sober up the next day suffering through the headache and general feeling of crap. The alcohol dependent will drink until passing out the first day, then continue to drink upon waking up the next day and persist in that cycle until it is somehow interrupted. The interruption may be in the form of simply running out of liquor, or it may be in the form of a family member that forces him or her to become sober for a certain time period.

It should be noted that the DSM V that is to be published in May of 2013 will no longer include these terms. The distinct categorization of abuse and dependence will be eliminated and replaced with a single diagnosis, ‘Alcohol Use Disorder.’ This subject is discussed in further detail here.