Beverages are alcoholic. Not me.
“Alcoholic.” I hate that word, unless of course it is followed by the word “beverage.” Over time the word “alcoholic” has come to be an identity term: a noun that defines who a person is rather than the adjective it once was. I even tweeted my disgust with the term once, a tweet I expected to disappear into the Twitterverse but instead continued chirping for quite a while.
It’s not that I don’t have a problem. I do. I cannot drink alcohol because I firmly believe that, for reasons unknown to me but much better known to psychologists, it will kill me. And it won’t be a slow death. Alcohol will, if ever it decides to do me in, kill me in spectacular fashion.
Alcohol will kill me. It has already tried at least once.
Indeed, it almost killed me once already in 2014, on New-Year’s-Eve Eve (December 30th, for those trying to count). After a night of drinking, which followed a day of drinking, which in turn followed several previous nights and days, I got into my car and drive. It was a dramatic and traumatic night before I got into that car, so dramatic it merits its own post. However, the reason I got into the car does not matter. I managed to stay conscious behind the wheel for about 30 seconds before I drove off the side of the road and crashed into a telephone pole. While I walked away with only an airbag rash and seatbelt bruise, the car was totaled. I am grateful that I drove alone that night, because the passenger side front seat took 90% of the impact. It would have been unsurvivable.
[Editor’s note: I could–and will–say more about the events of this night when I describe it in my memoir. As of this posting, the DUI charge I received three years ago remains unresolved. I have a trial date set and plea negotiations coming up. And although I am ‘pseudonymous’ on these pages, the powers of internet anonymity (pseudonymity?) do not trump the power of the subpoena. You will be able to read all about that night at a later date].
Diagnostic criteria for Alcohol Use Disorder.
I used the phrase “I’m an alcoholic” in the title of this post because it is convenient shorthand for saying that I suffer from a condition called Alcohol Use Disorder (AUD). I prefer that phrasing because because you cannot treat a label, but you can treat an illness. As classified in the DSM V, a person must exhibit at least two of the following symptoms over a 12 month period in order to receive a diagnosis of Alcohol Use Disorder:
- Alcohol used in larger amounts or over a longer period of time than intended
- Persistent desire or unsuccessful attempts to cut down or control alcohol use
- Significant time spent obtaining, using, and recovering from the effects of alcohol
- Craving to use alcohol
- Recurrent alcohol use leading to failure to fulfill major role obligations at work, school, or home
- Recurrent use of alcohol, despite having persistent or recurring social or interpersonal problems caused or worsened by alcohol
- Recurrent alcohol use despite having persistent or recurring physical or psychological problems caused or worsened by alcohol
- Giving up or missing important social, occupational, or recreational activities due to alcohol use
- Recurrent alcohol use in hazardous situations
- Tolerance: markedly increased amounts of alcohol are needed to achieve intoxication or the desired effect, or continued use of the same amount of alcohol achieves a markedly diminished effect
- Withdrawal: there is the characteristic alcohol withdrawal syndrome, or alcohol is taken to relieve or avoid withdrawal symptoms.
Severity is determined by the number of symptoms. I have taken the liberty of highlighting those that apply to me. As you can see, my disorder is quite severe.
Treatments for Alcohol Use Disorder.
In addition to therapy, there are three medications that have received FDA approval for the treatment of AUD:
- Naltrexone is thought to work by numbing the “pleasure center” of the brain that is activated when we drink, with the ultimate goal of reducing cravings. Tried it. Didn’t work because I don’t crave alcohol or derive pleasure from it. I crave relief from anxiety, an effect that alcohol easily supplies.
- Acamprosate is used similarly to Naltrexone and is thought to reduce the desire to drink. I have never tried it.
- Antabuse inhibits an important enzyme required to fully metabolize and excrete alcohol from your body. The liver metabolizes alcohol in two main steps. First, it converts the ethanol into a chemical called acetaldehyde. This is the toxin that builds up in your body after drinking and is partly responsible for hangovers. Second, an enzyme called aldehyde dehydrogenase converts the acetaldehyde into acetate, which is pretty darn close to the vinegar you buy at the grocery store. It is harmless in normal quantities, and your body excretes it when you urinate. Antabuse works by inhibiting aldehyde dehydrogenase, preventing your body from metabolizing the acetaldehyde, and making you very sick in the process.
Antabuse worked a miracle for me. Because I do not crave alcohol as a pleasure seeking activity, and because I now have access to medication with which to manage my anxiety, it was the perfect drug. I no longer had to choose not to drink; the choice was made for me. If I were to drink even half a shot, I would end up sick for hours.
Fun fact: Aldehyde Dehydrogenase Deficiency is a genetic condition that causes that characteristic alcohol flush that so many of your Asian friends develop after 1-2 drinks.
Drug allergies are a bitch
I lasted for about three months on Antabuse before developing an allergic reaction, something that typically would have happened within days or weeks. The details are unimportant, but I can no longer take Antabuse.
So, I am left to my own devices. Now I must, every day, make the choice not to drink. To my great surprise, after two months without being able to take Antabuse, I have not drank or felt any strong compulsion to do so. It’s been close to five months in total since my last drink. Maybe I can handle sobriety after all.
I could write more, but I actually have a 9:00am meeting with the prosecutor for my three-year-old DUI charge. My attorney and I are trying to work out a better plea deal with the prosecutor, a negotiation that I suspect will be unsuccessful. What is more likely is that we will bump everything out yet again to give my doctors time to stabilize me on medication for my Bipolar Disorder, and that we will reconvene after the new year to decide how much time I will be spending in jail or under house arrest.
It is 8:30am now, and I would like to brush my teeth before leaving. Please forgive any typos. I will fix them when I return later today.