Alcoholism Episode V: Dinosaurs, Debts, & Diagnosis

I’ve written before about what I termed the “self-medicating alcoholic.”  When I wrote that piece I claimed to have coined the phrase, but I’ve since found it used elsewhere, such as in drugrehab.com’s section on co-occurring disorders.  HuffPo got in on the act with this painfully accurate description of the self-medicating road to alcoholism back in 2013.  Even the Daily Mail have published an article on it, but I’m not giving you a link to that repulsive, spiteful little rag.  If you want to hurt yourself like that, I refuse to be your enabler.  Get help.

Given the evidence though, I’ll have to bravely face the stark reality that I’m not the first to recognise this phenomenon, and it may have already crossed the minds of a few amongst the hordes of professionals that deal with mental health and addiction every day.

I use “self-medicating alcoholic” to describe folks like me, who first became alcoholics by dint of self-medicating against an undiagnosed mental health issue – in my case Generalised Anxiety Disorder (GAD).  My friendly psychiatrist is confident the GAD was screwing with me from no later than about nine years old, and I know I wasn’t necking schnapps in front of Thundercats – so the chicken and egg question seems fairly clear cut.

By the by, birds evolved from egg-laying dinosaurs – Paraves – so the answer is egg.  Someone please hurry up and find a better analogy.

A Paraves 150 million years ago, yesterday

Image: Jim, the Photographer – CC BY 2.0

Nonetheless, it’s undeniable that alcohol and other substance abuse has a tendency to cause anxiety and depression in individuals previously unaffected by it, on a short to medium term at the least.  This creates an all too easy reflex reaction in your average primary care practitioner.  There are simply far too many GPs that, because of this cause and effect relationship, will dismiss any talk of mental health by an addict as just an unfortunate side-effect – and label it as ‘depression’ no matter what.  Here, have yet another SSRI/SNRI.  The last six we tried didn’t work, but seventh time’s the charm!  In my case the underlying issue is GAD, and for my brother it’s PTSD (which I’ve now learned also falls under the Anxiety umbrella).  Anti-depressants don’t tend to be a hell of a lot of use when the major clinical problem isn’t depression.  So Gee, thanks doc!  I’ve dislocated my shoulder as well, do you have some Thrush ointment handy?  It’ll be about as appropriate a treatment as what you’ve just prescribed.  Perhaps some worming tablets for my syphilis too.

As the anxiety worsens, and especially for those living alone and without a day-to-day support network, a vicious circle of anxiety and alcoholism can kick in frighteningly quickly.

Tasks of daily living can assume monumentally overwhelming status.  Often, those around them will be entirely unaware of it.  For a long time, I was what some would describe as a ‘high functioning alcoholic’.  I got up, showered, put on a suit and tie, navigated difficult, challenging, contentious issues and decisions at work, came home, started drinking, made dinner, carried on drinking, and passed out – usually in bed.  I didn’t get hangovers – never have – so the next day would just be a carbon copy of the last.  Rinse and repeat.  The outside observer never saw the drinking.  All they saw was a well presented, assured young man confidently presenting to the board and getting on well with his colleagues.

As far as I was concerned, what I felt inside, I was a massive fraud getting by purely due to my seemingly infinite capacity to blag it – but they didn’t know that.

What they also never saw, was the ever-increasing pile of unopened post beside my front door.

Unopened post, yesterday

Image: Keith Williamson – CC BY 2.0

I was able to weave my way through the day with a facade of utmost capability and charm – but it depleted the totality of my daily reserves.  Any additional challenge was thus amplified out of all proportion to reality, into an impossible task.  Opening the post – confronting the fear that it might contain an unexpected bill for instance – became an impossible undertaking.

And what does a drinking alcoholic do when the world all seems too much?  They take a few minutes out to do some deep-breathing exercises, phone a trusted friend to take their mind off things, and almost certainly they’ll go for a brisk jog to get the blood pumping and clear their head.

Yeah.  That doesn’t happen.  Having a drink or twelve to make it all go away happens.  It’s a common phrase around recovery – “we drink on our emotions.”  If an alcoholic experiences unmanageable anxiety, and they’ve not yet found an alternative way through recovery, there’s only one way that story ends.

So those letters go unopened.  In my case I had arranged everything possible to go out on direct debit, the day after payday – so by and large my bills still got paid.  Some can’t or don’t do the direct debit thing though, and man – they’re just screwed.  Even for me there were still things that needed attending to, changing, sorting out in some way.  But instead they would just sit there, lying patiently in wait for me, growing into a bigger problem with each passing day.

Eventually I’d have a particularly good day, where I felt I could face them.  I’d sit myself down on the floor with that big pile of envelopes in front of me.  I’d have a full glass and cigarettes by my elbow, and I’d start opening them, sorting them.  The vast majority would be junk, or just bank statements telling me that yes, my bank balance was still in minus four figures because yes, I was still drinking all of my considerable salary bar rent, tax, and utilities.  No one was taking me to court over it though, so that’s fine.  But now and then there would be an anomaly.  An extra expense I hadn’t considered maybe, or even a mistake, charging me for something that was nothing to do with me.  Utilities companies are particularly good at the latter example.  Whatever the case, occasionally there would be something that would require a phone call at the least.

Then you open the next envelope, and it’s a reminder.  And the next one is a final demand, and so it goes on getting ever more threatening and scary with each opened letter – debt collection companies and so on.

It doesn’t matter if you know it’s all just a mistake.  At this point you’re sweating, your heart is racing, and your chest feels tight.  You can’t cope.  You can’t deal with it.

Drink.  Make it go away.

And so you do.

And the worse the drinking gets, the less you can face dealing with those things – and the bigger those issues become, the more you drink.  Welcome to the spiralling vortex of alcoholism, incessantly sucking you down into its churning void.

A vortex, yesterday

Image: Chris Searle – CC BY-NC-ND 2.0

I described myself up top as having been a ‘functioning alcoholic’.  That’s what I was at the time, and I damn well knew it.  If I’m totally honest I probably felt a degree of twisted pride in it – I was waltzing with addiction, and still leading the dance.  I remained like that for many years, but as you may have gathered, it didn’t last forever.  I lot of alcoholics in recovery refuse to recognise the label of ‘functioning alcoholic’, but I think it serves a purpose.

The thing that needs to be absolutely clear though, is that it’s only a transitionary phase.  The length of time may vary – for me it was over a decade before it all came crashing down – but believe me, it will inevitably end in tears.  That perverted sense of pride I felt back then looks a bit silly now.

With that primer on anxiety and alcohol in mind, consider this snippet from drugrehab.com:

Individuals with co-occurring disorders frequently struggle with everyday tasks, leading to a number of hardships. They often develop multiple dependencies and try to self-medicate the side effects of drug use and mental illness.

There are recognizable signs that an individual may be suffering from a co-occurring disorder. Typical symptoms include:

Employment and housing instability

Difficulty budgeting funds

Legal problems

Social isolation and repeated social difficulties

The list continues, but those are chosen to take the top four spots.  The next one down involves sexual deviancy.  I never graduated to that, but perhaps only because it sounds like it would involve far too much hard work and exercise.

That top four shouldn’t come as any surprise.  Anxiety leads to drink leads to anxiety leads to drink leads to anxiety and in the meantime those mundane everyday issues are growing into seriously life-affecting problems.  Those mounting problems in turn just feed the anxiety, and the drinking.  Round and round we go, ever deeper with each spin of the wheel.  In my case, ultimately resulting in the loss of job, relationship, home, friends, self-respect, and any glimmer of hope.  And lots and lots of rides in the big yellow taxi with the flashy blue lights on top.  Usually with a few tubes coming out of my arm and a fetching silicone mask over my face.  Very à la mode for alcoholics in the death-throes of their disease.

Uber for drunks

Image: hazelisles – CC BY-NC-ND 2.0

I was in rehab twice.  I learned ridiculous amounts about the psychology of addiction, tools and techniques to deal with it, the importance of self-discipline and routine, meditation, prayer, the works.  Hell, I can even bore you with a mini-lecture about the hedonic circuit and the role of dopamine and glutamate if you like.  I’ll admit a twinge of pleasure at the look on the guy’s face in Holland & Barrett, when I pulled that out as he was explaining how 5HTP works to my mum.  I’m guessing he was a bioscience undergrad earning some extra in the university holidays – in any case, he certainly wasn’t expecting that.  I didn’t, however, follow it up with an explanation that I’d learned it in rehab.  It’s always nice to maintain an air of mystery, after all.

I learned a lot.  What they never taught me, was how to open the damn post.

I don’t know how long I’d been out exactly before I felt so overwhelmed that I drank again, but I doubt the sun had set.  I was dry, I was sober, I was equipped with lots of knowledge – and I was still every bit as messed up as I was when I went in.  My mental and emotional sores were still just as gaping as they ever were, I’d just had a few weeks without the outside world pouring vinegar on them.  Everyday life with a severe anxiety disorder makes every minute of every day feel like staggering through a minefield, with artillery raining down on you.  Waking each morning and screwing your eyes shut, willing yourself to go back to sleep, because when you’re asleep you’re simply not awake.  Because being awake is unbearable.  It’s an inexplicable state of perpetual terror, of horror.

I’ve read that the risk of people with anxiety disorders developing addictions is well established:

Although people with anxiety disorders don’t always develop substance use disorders, or vice versa, research shows strong associations between the two. An estimated 18 percent of all people with substance use disorders have an anxiety disorder.

Yet it took more than twenty adult years for my GAD to be diagnosed.  For the last six or so I’d been totally open about both my mental health and my drinking with doctors, to which they’d responded every time by just chucking more antidepressants at me.  If it had been picked up and treated earlier, it’s quite possible I’d not have burnt my entire life to the ground, nor wrought so much pain and chaos on the lives of those around me.  I have caused irreparable harm to people thoroughly undeserving of it.  Good, kind, loving people.

It can be difficult for health care providers to diagnose anxiety disorders in people with a substance use disorder because it is difficult to tell the difference between symptoms of intoxication and withdrawal and symptoms of anxiety.

I don’t give a fuck; try harder.

---

A Request

Hey y’all.  If you’re reading this then I’m assuming that you don’t think the blog is entirely terrible.  I’m flattered.  Despite the sarcasm usually pervading my writing I genuinely mean that – the positive feedback I’ve received from assumedly unbiased randoms on t’interweb has been very unexpected, and very generous.

I write for three reasons, and one of them kinda depends on you guys.

I write partly because I’m a mental.  I’ve got a certificate from the doc and everything.  Sticking my thoughts down as text helps me make sense of things, and even occasionally rationalise them into what’s generally regarded as a more normal perspective.

I write because I enjoy it.  Some would claim that’s the only thing that matters.  For me, I disagree.

I disagree, because I write to communicate.

I attempt to craft phrases that are aesthetically pleasing.  I hope to make people smile a little, or even offer them a perspective or insight they’d not previously considered.  I’m not on a mission or anything, I just hope that people enjoy reading what I’ve written whether they agree with it or not.  Without this aspect I may as well just scribble stream of consciousness diatribes on the back of a napkin.  I stick my stuff out on the web instead, because that element of communication is important to me.

That being so, it would be great if I couldn’t count the number of people reading it on the fingers of one foot.  There’s no material gain to me, I just want to feel that there’s some point to me pounding away at a keyboard until two in the morning.  That I’m connecting with someone, somewhere.

I’ll carry on doing it anyway – but my smile would be much broader if you could share it around on Bookface, twitter and whatever.  There’s even dinky little buttons to make it easier down the bottom of the page, if you click on the post title itself.

Hey, you could even go mad and leave a comment!

Serenity,

‘rax