I am always intrigued by the process by which patients can be admitted to a hospital with one or another sequella of either binge drinking or chronic alcoholism and the can get a mega-workup for the evaluation and management of their symptoms without anyone ever having asked them “Why do you drink?”
Sometimes the response to that question is to essentially say “I drink because I come from a family of alcoholics,” and sometimes people say “Well, I started drinking in high school or college and I just never stopped,” but it is the very rare person who can either volunteer a statement about his or her need to drink or can even actually answer the follow-up question of “Why do you need to drink?” when it is asked of them. All of us know people who drink too much, and many of us drink too much ourselves, but in order to be able to help a friend who is drinking too much or to be able to control our own drinking it’s that last question that needs to be addressed.
There are at least five different kinds of drinkers. Betty Ford was a woman of great courage who was able to address her drinking and then actually create the Betty Ford Center to address chemical dependencies at a time when no one spoke of such things publicly (or at least only spoke of them as the patterns of wayward children in their 20’s). She herself has written about her life, and others who knew her well have done so too, but the gist of the issue was that some people turn to alcohol to self-medicate emotions that they do not know how to handle any other way.
One patient of mine drank because he was basically bored with his job and just wanted to “turn off the thinking machine” so he could get an end to the day. Another patient went into the basement after dinner to finish off a six-pack because he was living with a second wife and a 16 year-old stepson who belittled him; the wife was enabling that behavior and my patient didn’t know how to stop it short of going after his step-son. People often drink as a way of “fitting-in” with peers; the alcohol calms the anxiety, and this is often how people start drinking in college. Others drink after a break-up, also to “turn off the thinking machine.” Too many of us have known a “mean drunk” who is filled with his own inner rage and needs the cover of drunkedness to let it out. Another pattern of drinking has come up recently after a hiatus of almost 50 years: men who had PTSD after Korea often self-medicated it with alcohol Men who had PTSD after Vietnam tended to self-medicate it with pot. Now both men and women who are having PTSD after Iraq and Afghanistan are going back to self-medicating with alcohol to calm their nerves.
Thus, there’s usually a story behind the drinking in ourselves or in those we know. If we want to help ourselves or help someone else who is having problem drinking, the story needs to come out. Every doctor and every therapist and every member of the clergy has heard someone say “I’ve never told this to anyone.” Yet you don’t have to be a doctor or a therapist or a member of the clergy to ask a friend “what has you’re life been like?” “What was it like for you growing up?” “What is it like at work?” “What’s going on at home?” A person who may be drinking out of control may not be ready to answer any of those questions at first, but even if they’re not, the reply may help them move forward: “Haven’t you suffered enough already to get some help with that?” Friends don’t let friends drive drunk; they don’t have to let a friend wallow in his or her drinking, either. Make a move. Care enough to ask the question.
