Introduction to Alcohol Research

The above is the title to the book by Daniel Yalisove (Allyn & Bacon: N.Y., 2004). We have so many myths about alcohol floating around it is helpful to examine what the research says so that we can sort out the inaccurate myths from the realities. All the following quotes are from this book.

Everyone knows two basics: One, a lot of people drink and have done so for thousands of years. Two, some of those who drink cause a tremendous amount of damage to themselves and others. So, the key question before us is why do some abuse alcohol? This is a complex problem and no simple answer exists. Therefore, anyone who claims to have a simple answer is being simplistic and is not being helpful.

Why do people drink?

People drink because it has a variety of positive results. We should never forget this basic reality. When we are treating an alcoholic and are expecting them to stop drinking, we first must acknowledge that we are expecting them to give up something that they value, enjoy, and/or are addicted to and we need to think in terms of what we can find to help compensate for this loss.

However, we also need to acknowledge that alcohol consumption, in moderation, is a positive. People who drink in moderation live longer than those who abstain from the use of alcohol! So, we should encourage the moderate consumption of alcohol. The BIG problem is that a significant number of people don’t drink in moderation! But for those who do so, it reduces plaque deposits in arteries protecting us from arteriosclerosis, protects against blood clot formation, which protects against heart attack and atherosclerotic ischemic stroke, and it promotes blood clot dissolution, which protects against heart attack and atherosclerotic ischemic stroke (p. 51). “Alcohol has a pharmacologic effect of reducing negative emotion…alcohol consumption enhanced mood for normal drinkers…alcohol reduced anxiety both by self-report and by physiologic measures…the experimental evidence suggests that at low does for normal drinkers, alcohol serves to facilitate positive mood and relieve negative affect and that these effects are due primarily to pharmacologic effects rather than expectancy” (p. 160).

However, heavy drinking increases the risk for heart muscle disease, for disturbed heart rhythm, for high blood pressure, and for hemorrhagic stroke. “Exposure to alcohol disrupts the normal development and maturation of the immune system” (p. 52). “Heavy drinking is associated with anemia, a condition caused by a lower than normal number of functional red blood cells. Red blood cells carry oxygen to and remove carbon dioxide from cells thorough out the body. Disruption of this process, anemia, causes fatigue, shortness of breath, lightheadedness, reduced mental capacity, and abnormal heartbeats…Certain types of white blood cells are also reduced by heavy alcohol consumption and compromise the body’s ability to fight infection…With excessive alcohol consumption, the brain shows physical changes. There is brain shrinkage…it is clear that prolonged use of alcohol leads to neurocognitive deficits in the areas of problem solving, forming visual association, spatial memory, tactual learning, and abstraction ability” (pp. 52-53).

This is just the tip of the damage iceberg! To this you have to add the following:

1. Aggression: “Alcoholics, unlike normal drinkers, seem to have a negative emotional reaction to drinking even through they expect a positive one” (p. 161). “Alcohol facilitates aggression through its pharmacologic properties or a combination of its pharmacologic and expectancy effects” (p. 163). “Even those with nonaggressive dispositions showed higher aggressive responses when intoxicated…those with aggressive tendencies increased their aggression when intoxicated” (p. 163-4). “Alcohol intoxication was judged to facilitate aggression by crating a focus on the here and now, reducing anxiety about sanctions or danger, and creating heightened emotionality. Factors in the environment judged to facilitate aggression were permissive environments and expectations that aggression would be tolerated” (p. 165).
2. Criminal behavior: “A large body of data consistently links consumption of alcohol with violent crime…minor conflicts between intoxicated participants can often lead to severe crimes, including murder…Alcohol intoxication is implicated in violent crime much more often than illicit drug use” (p. 176). “Violent crime decreases when alcohol is less available” (p. 166). “Males who had engaged in date rape: 75 percent stated that they purposely got the date intoxicated to have sex with her. Research shows that alcohol consumption is associated with unsafe sex practices” (p. 166). “Intoxication…decreases the normal discrimination between socially approved sexual behavior and disapproved behavior…intoxicated men showed less empathy for a female sexual victim…Intoxicated males…ignore cues from the women that indicated a lack of interest” (p. 167). “Withdrawal effects as well as intoxication have been associated with increased violence. Heavy drinking patterns in husbands are associated with high rates of marital violence” (p. 179).
3. Job loss
4. Mental Illness: “Research consistently shows that those with alcohol use disorders have high rates of psychiatric disorders. Patients who have both alcohol and psychiatric disorders do not respond well to conventional alcohol treatment. Developing successful treatment for these patients represents one of the greatest challenges in the substance abuse and mental health systems” (p. 197). “Psychiatric disorders predispose adolescents and adults to alcohol disorders. On the other hand, symptoms of anxiety and mood disorders may be caused by excessive alcohol use” (p. 206). “Exposure to a wide variety of trauma frequently leads to the development of alcohol abuse” (p. 206).
5. Car accidents that kill and injure others
6. Death: “The more heavily the alcoholics drank and the earlier problem drinking began, the more years of life were lost…alcoholics were 9.5 times more likely to die than a matched community sample” (p. 126).

Keep in mind that most people are aware of some of the above and still they go out and drink excessively. So, why is someone so self-destructive?

1. Genetics: “Genetic contribution is a significant factor in determining susceptibility to alcohol use disorders” (p. 77). Fortunately for some, due to genetics they are less likely to be alcoholics, while genetics increases the likelihood of becoming and alcoholic for others. “People of Asian descent consistently experience lower levels of alcoholism and higher rates of abstinence than other ethnic groups. About half have the alcohol-flush reaction” which discourages alcohol use (p. 79).
2. Childhood factors: “Normal drinkers…(are) more likely to have closer relationship with their fathers and more childhood environmental strengths compared to future alcoholics. Future alcoholics were more likely to have school behavior problems, truancy, and sociopathic traits” (p. 124). “Certain childhood factors appear implicated in higher risk for developing an alcohol problem. Problem behavior, poor adjustment and coping, and aggressive behavior in childhood and adolescence are linked to later alcohol problems. Children raised in families with conflict and poor parenting have an increased risk for developing alcohol problems later on. Children with a history of sexual abuse have an increased risk for developing alcohol disorders” (p. 133).
3. Economics: If you come from the lower class or the working class, you are more likely to be an alcoholic (p. 125 and p. 137). In general, all the problems of life are tied to economics and alcoholism is no exception.

In conclusion, the brain of the alcoholic does not function normally and therefore when you try to help them you have to take this into consideration. For the therapist to assume the attitude that I stop drinking, therefore, so can my client, is a vicious and non-empathic approach to the client. For the therapist to utilize logic in helping the client see the mistakes in their behavior is equally ridiculous. Mind you, both of these approaches can be helpful, but only within a context that recognizes the complexity of the problem and is responding to that complexity with a program of treatment that takes into full consideration all the causes of the clients drinking and develops a program tailored to the complex needs of that individual client.