Alcohol Addiction

Featuring Anne Fernandez, Ph.D.

Transcript

Introduction (00:08):
Welcome to Michigan Medicine Presents, a wide ranging podcast series that will explore the progress in scientific research and innovation, historic roots, and the current state of conditions that affect us all. Join us for our first series, a three part look into The Science of Addiction.

Narrator (00:27):
A lot of people think they have an idea of what addiction is, but if you peel away the stigma that surrounds addiction, if you dig deeper, you'll get to the heart of what clinicians actually define as a substance use disorder. Because addiction isn't necessarily what it seems. And that's what this podcast is about. We're going to talk to the experts at University of Michigan Health and the U-M Addiction Center. People whose careers are focused on better understanding addiction and how to better treat and live with addiction. There's a lot here that might surprise you. So, get comfortable. This is Michigan Medicine Presents, and we're going to talk about The Science of Addiction. Episode two, alcohol addiction.

Dr. Anne Fernandez (01:14):
Alcohol use is still the most common addictive behavior, addiction disorder that there is in America right now, despite the opioid epidemic. So, we still see a high proportion of alcohol cases in our clinic. And in particular, because I have a focus on liver disease, I see a particularly high proportion.

Narrator (01:33):
That's Dr. Anne Fernandez, a licensed clinical psychologist at University of Michigan Health Addiction Treatment Services, or UMATS. Dr. Fernandez also works with the U-M Addiction Center. So, addiction is her life's work, and she knows how hard living with addiction can be. Alcohol addiction has some unique challenges though. For many people, alcohol use is associated with socializing, with celebration. It's normalized. But what is normal? How much alcohol use is too much?

Dr. Anne Fernandez (02:07):
So, the warning signs for an addiction to alcohol, but actually the warning signs for an addiction to any substance, are pretty much the same. We use pretty much the same criteria for all addiction. We typically call it either an alcohol use disorder or a drug use disorder of some type. There's 11 symptoms, according to the Diagnostic Manual for Psychological Disorders. And these include things like loss of control, overuse. So people who find that they're no longer able to control, or they intend to use a certain amount, but continuously go over that amount or use more often than intended. So, that kind of thing is a big warning sign.

Dr. Anne Fernandez (02:49):
Also developing tolerance. When a person starts to spend a lot of time using the substance, especially in place of other things that they maybe previously enjoyed. And then there's also a large segment that has to do with consequences. If a person starts to notice that there's harm in their life, they're not doing activities and obligations that they normally do going to work, going to school, that can be a warning sign. In addition to physical health indicators, such as tolerance and withdrawal. So, if someone notices when they don't use the substance, they start to feel really bad in various ways. And then they need the substance to make that feeling go away, that can be a pretty big warning sign as well.

Narrator (03:29):
Knowing you may have a substance use disorder or that someone you care about does is a first step, a huge one actually. But what then? Can you just stop if you have a substance use disorder?

Dr. Anne Fernandez (03:42):
Alcohol use, and also benzodiazepines are probably the most dangerous substances to stop on your own. Alcohol use, if you stop at cold turkey and you're dependent, can actually kill you. And that has to do with neurotransmitters and the way that the alcohol interacts with the brain. And when you remove that, the overexcitement that happens in the brain when you've normally put a depressant in it can cause seizures and actually death. So, for individuals who drink even probably more than a few drinks a day, if they're drinking regularly, should really seek medical advice before stopping use to figure out if they need medications to make their detox not only safe, but more likely to be effective in the sense that they would have something to make them feel more comfortable and not go back to using, to get rid of those uncomfortable symptoms.

Narrator (04:35):
That's a key point that Dr. Fernandez wants people to know. While safety is important when you're talking about going through withdrawal, it's not the only consideration. There's another reason someone might need help withdrawing from alcohol dependence.

Dr. Anne Fernandez (04:48):
I'd say in terms of danger, alcohol and benzos, and to some extent, opioids can be a little bit risky. But the main thing with withdrawal from many substances is the discomfort that it causes, psychological discomfort and physical discomfort, that it can be so extreme that a person has trouble managing and tolerating that on their own. So, detox medications, withdrawal management can really help a person succeed. So, it's not just about danger. I think it's about comfort and likelihood of success. I think the first step would be to go and talk with someone before you embark on stopping. If you do not do that, and you find, particularly with the alcohol use, shakiness, sweating, and that's kind of a mild detox symptom, but if you start to feel extreme like seizures or extreme anxiety and restlessness, that would be a time to call someone, call for help.

Narrator (05:53):
Call for help. Take the first step towards taking control of a substance that feels like it might be controlling you. Making the decision to get help is arguably the biggest part of the battle, but where does someone begin on the road to recovery?

Dr. Anne Fernandez (06:08):
So, yes, it's definitely okay to drink around people within recovery. Some people who've been in recovery for 30 years and they're very comfortable being around alcohol and are around alcohol frequently in their lives. However, if someone is very early in recovery or they're struggling in certain ways, it may be difficult for them. So, I would say the individual also has to decide in what situations they want to put themselves.

Dr. Anne Fernandez (06:34):
So, for example, if someone is in a bar, then they're probably going to expect that alcohol use is going to be going on. So, I think for if you're a friend or a loved one, and you're wanting to know what's appropriate for someone that you care for, the most important thing, if you can, is to just ask them and try to support them in their goals. If you're not sure, but I'd say if you're in a place where alcohol use is common and the person would expect it, then it would probably be something that they would anticipate was happening. So, I don't know if that makes it okay, you could still ask, but it's something you could consider is the setting.

Dr. Anne Fernandez (07:12):
One of the things that people really struggle with when they stop using alcohol or other drugs is finding social outlets that don't involve substances. So, if your friend or loved one is in recovery and wants to stop using, if you can create social engagements or social situations where they can enjoy themselves and alcohol and drugs aren't going to be a part of it, that's something that people really want. So, as a mental health professional, as an advocate for people in recovery, I would say, try to support your friends and offer those opportunities as well.

Dr. Anne Fernandez (07:49):
Stigma is definitely a real problem in the United States around addiction and is something in research that people cite as a barrier to them seeking care. It's something that's somewhat... It's hard to move the needle for any one individual at any one time. But I think as a field and as someone who works in healthcare, I think one way that I think about this is that alcohol use or other addictive behaviors are not unlike other health-related conditions or other diseases or illnesses. There's debate about whether addiction is a disease or not, or how people like to articulate that.

Dr. Anne Fernandez (08:36):
But I would say, in general, I think thinking about alcohol and drug use in the context of health can be de-stigmatizing for people. So, considering the health impacts when someone comes into a clinic or a primary care and talking about alcohol addiction and health with them, can I think be de-stigmatizing. I think for individuals, when they think about their health and what they want in their life and their goals and whether this substance or behavior gets in the way of it is a helpful way to consider alcohol and drug use as opposed to, is this a moral failing? Is this a disease I have forever? To kind of keep it in the here and now like, is this serving me right now? What are my long-term goals? Do I want to continue doing this behavior? And to try to think of it in those contexts and then reach out. It might be uncomfortable. It might be difficult. But hopefully in a clinic setting, there's going to be less stigma and more understanding once you start talking with people who are experiencing something similar as you.

Narrator (09:47):
Dr. Fernandez's work at the University of Michigan Addiction Treatment Services is packaged in the form of a program called an IOP, an intensive outpatient program.

Dr. Anne Fernandez (09:58):
So, generally speaking, if a person is trying and failed multiple times to stop on their own, it's probably a good time to try something different. That thing that could be different could be AA, NA, or going into treatment. So, it's kind of up to the individual, but generally a healthcare professional, if you take your loved one to be evaluated, can give you recommendations based on a lot of different factors. At our clinic, we offer it three days a week for a month. So, it's a four-week program, Monday, Wednesday, and Friday. The person comes in for a group therapy from I believe it's 9:00 AM to noon. So, it's more intensive therapy than you would get if you were just seeing a one-on-one provider. So, you've got a group and you're there three days a week working and learning about addiction and in therapy for that whole time.

Dr. Anne Fernandez (10:53):
So, you get a more rich treatment experience, but you don't have to go and stay in a residential program. And typically, and ideally the person also has an individual therapist that they're also having contact with. Some programs in other places might be a little longer, or maybe it's four days a week instead of three. But essentially that's the model of an IOP. An intensive outpatient program and an AA program, or NA, which is Narcotics Anonymous, are similar in that they have the same goal, which is to help people stop using substances long term and to support them in doing so. But the programs themselves are quite different.

Dr. Anne Fernandez (11:39):
I mean, to just touch on a few of the dimensions, AA or NA is not a professional mental health, professional delivered treatment. It's a community-based 12-step program and it's free and it's also very ubiquitous. They're in so many communities nationwide. And they're run by peers. So, other people who have had alcohol or drugs in their life that are trying to stop. And you can go daily, some people have them in their community, they'll do 90 and 90. That means you go 90 meetings one a day, every day for 90 days, and then people will continue to go frequently. So, they also offer a constant and frequent source of support, but they're different because it is a peer run 12-step organization with a particular treatment philosophy.

Dr. Anne Fernandez  (12:35):
While an IOP may include other types of treatment philosophies. It might have some 12-step within it. It might have cognitive behavioral therapy and it's run by a therapist. So it'd bill insurance often and would have psychiatry potentially available and also a one-on-one therapist who generally has a degree in mental health or addiction treatment training.

Dr. Anne Fernandez (13:00):
So, it's definitely going to vary by individual, by gender and by age. So, even some of those guidelines around no more than a drink a day for women, and no more than two drinks a day for men are loose guidelines. That's the cutoff for "healthy versus unhealthy" alcohol use. And for older adults, for example, those numbers are even lower, so that's someone 65 or older. So there's a lot of variability, even something like a guideline is just a guideline.

Dr. Anne Fernandez (13:31):
And for any family member or individual to determine what's harmful, it's a bit complicated. I think that you can see that sometimes it's very obvious for the family. Other times it might be more ambiguous. There is something called the ASAM criteria. It's essentially a set of criteria that evaluate the severity of substance use, risk for withdrawal and a lot of different factors, including other medical issues that the person may be experiencing to essentially assess the severity of the disorder and match the person to what treatment that they may need. So, that's something that healthcare professional is really going to be in the best position to do, as opposed to someone in the lay community, looking things up on Google.

Narrator (14:20):
Whether treatment comes in the form of a 12-step program, an IOP or a residential program, getting help from an established program is essential for someone who needs help quitting. So, what keeps some people from getting the help they need?

Dr. Anne Fernandez (14:35):
I usually think of barriers as falling into two buckets. One is more about the individual's motivation, interest and the stigma. So sort of more things going on within the person. And the others are the things outside the person, the external factors, which can be where the treatment's located, whether they have insurance, whether they have childcare, whether they can get out of work. So, all of those things need different tools or skills or changes to impact, but they are surmountable and people do come into treatment, but sometimes it takes some planning and time.

Dr. Anne Fernandez (15:18):
The first step might be different for different people, depending on where they're at in their motivation and their readiness for what they want to do. There's definitely a great website, it's called findtreatment.gov. It's the Substance Abuse and Mental Health Organization of the United States that essentially puts this together. It's called SAMHSA, and they have a treatment locator. Essentially you can put in your ZIP code and find people who offer treatment for addiction and other mental health problems.

Dr. Anne Fernandez (15:54):
You can also search online for AA or NA meetings, other 12-step meetings that you could go to. They're often offered multiple times a day in a lot of communities. So, that's something someone could just do right away. They could call up a local provider's office and make an appointment. Or if they're not quite ready to jump into treatment, they could just talk to a friend or loved one about their concerns. I think voicing your problem, talking about it, considering it is also really important, even before you maybe enter treatment, or if you're not ready to enter treatment. But you don't have to kind of hide it. You can also just talk to someone, especially if it's someone you trust and can be supportive.

Narrator (16:39):
That was Dr. Anne Fernandez in our three part series, The Science of Addiction. For more information about the University of Michigan Addiction Treatment Services, call 734-764-0231, or visit uofmhealth.org/addiction. And don't miss the other two episodes in the series. You can find these and other Michigan Medicine podcasts at uofmhealth.org/podcasts, or by looking up the Michigan Medicine Podcast Network, wherever you stream your podcasts. 

Connect with us

• Learn more about U-M Addiction Treatment Services (UMATS) and the U-M Addiction Center. 
• Learn more about the University of Michigan Department of Psychiatry.