On a different site, I often get comments and letters from folks with questions about alcohol and their recovery. The one I’m reproducing below, along with my answers, was especially interesting. Since the writer gave me permission to use it, in the hope that it might help others, I answered with publication here in mind. As they say around the Interwebs, “I hope it helps!”
Bill: Dear Joy,
Thanks so much for writing, and for your thoughtfulness in specifically making your letter available to others. It is so long, and so chock-full of commentable (word?) material, that I’m departing from my usual format of simple Q&A and will address each paragraph or so as they come.
Joy: I’m a 38 year old female with a long history of being a drunk. I started drinking in college and it was often binge drinking. After college, I continued to drink, sometimes binging, but usually mostly on weekends. I was in a bad relationship for 2 years and drank more often than that. Then my relationship after that was better, but I still drank. This was still weekend binges and sometimes during the week as well. My next relationship was with a non drinker, so my drinking was cut way down, but that was only for a year. Then for the next 2 years (about age 26-28), I was more of the weekend binge drinker with sometimes some drinking during the week.
Then from 28-38 (now), I’ve basically drank every night. My boyfriend of a decade is also a drinker. The first 5 years it was mostly beer (5-6 a night), with some hard liquor on the weekends. Some weekends I would drink more than 5-6 a night. Then I developed a wheat allergy (so bloated and horrible stomach and digestion problems, as well as infections), and switched to vodka about 5 years ago. I also have a history of bladder and yeast infections. I would have 6 or 7 shots a night, pretty much nightly (often mixed with club soda because it’s without calories). Sometimes I would take 1 or 2 days off and felt even worse, so started drinking again. I continued to have bad digestion and stomach problems, but not as bad and the bloating went away quite a bit. But I continued to have infections, and almost 4 years ago was sick with one for 2 months. They think it was my colon. No antibiotics worked and I got a yeast infection in my mouth. I should also mention I had infections even as a kid (ear and acne) and was frequently on antibiotics. So that history mixed with the booze equals disaster.
Bill: Your progression down the road to alcoholism closely parallels my own, except that it took me about another five years to catch on to the fact that I had a problem. That’s not unusual, BTW. Alcohol damage progresses more rapidly in women, because you don’t produce as much of the enzyme that breaks down alcohol. Your BAC rises faster, and the drug stays in your system longer.
- Alcohol is alcohol. The body can’t tell the difference between beer, wine, spirits and pure ethyl alcohol (ETOH).
- One 12 oz. beer = 1 shot of 80-proof = 1 four-oz. glass of wine when it comes to alcohol content (we refer to each as one “unit” of ETOH).
- Five to six units of ETOH a night is about 5 times the recommended daily intake for females, and about three times that recommended for males.
- Alcoholism compromises the immune system. Your frequent infections could easily be connected. The oral yeast infection (Thrush) is a pretty sure sign of that.
Joy: After that infection almost 4 years ago, I mostly lost my sex drive. Then last October (2011), I detoxed after getting some questionable blood work back. My vitamin D was very low and my white and red blood cells were a bit low (not too crazy yet though), and there is booze in my bone marrow. MY GP WAS NOT CONCERNED. Really?! I think I am a bit anemic!
Bill: Loss of sex drive isn’t unusual with advanced alcoholism, and the discomfort of the infection most likely didn’t encourage activity either. That will probably improve.
The bone marrow is connected to the circulatory system, and any time there is alcohol in our blood (within several hours of the last drink — longer, with heavy drinking), the blood marrow will test positive as well. Your physician may have meant that the presence of alcohol in the marrow could have been the cause of the anemia, but more likely it’s your diet. I hope she put you on Vitamin D supplements immediately, as low D can affect bone strength, especially in women, and is related to immune deficiency as well. Oh, I see below that she did. Did she also tell you to stop drinking or it wouldn’t help?
Joy: All of this is reversible, right? So I detoxed and it was SO AWFUL. I was a complete mess for about 2 weeks and I thought I was going to die. My GP even sent me for tests because I had a bounding aortic pulse. That test turned out okay and they found no issues there. But when I withdraw, or even as a part of hangovers, I have some cardiovascular symptoms. My chest is tight and I can’t breathe really deeply. I feel anxious. I hope this is also reversible.
Bill: With all respect, I believe your GP may not be well-acquainted with treating alcoholics (or did you not ‘fess up?). Everyone has cardiovascular symptoms when they detox from alcohol. That’s why we recommend that you never, EVER attempt it without close medical supervision. Strokes and seizures are common, along with psychosis and hallucinations. The rest of your symptoms are consistent, as well. For more information on acute withdrawal, go here. As to reversibility, that all depends on you. First you must get and remain sober.
Joy: Within 2 months of my quitting of the booze last October-December 2011, my physical symptoms went away for the most part! My heart felt fine, I could breathe, and I was even able to lift groceries and walk without pain! I was feeling a bit manic without the booze though. I should mention I have a long history of what was called fibromyalgia, but I often wonder how much is the effects of alcoholism. I’ve been in full body pain for years, and weak and tired. I also have had tendonitis, plantar fasciitis, and stress fractures in my feet. And of course I am an emotional mess.
Bill: All characteristic of early abstinence. Regarding the body pain, weakness, musculo-skeletal and other problems: again nutrition may be the key. All alcoholics suffer from malnutrition, because the presence of alcohol in the body inhibits the absorption of vitamins and minerals, and can even cause leaching of some. Even supplements do not help, as they are not absorbed. I suggest a complete nutritional workup after you have been abstinent for at least four months. I’d consider consulting a specialist for that, if possible. I’m a bit uncomfortable with your GP’s performance so far.
If the pain continues after you are abstinent, Neurontin (gabapentin) may prove useful. It will not trigger your addiction, and is especially effective against the kinds of pain your describe. Its anti-seizure qualities can also be of help, but you must remember not to stop taking any seizure medication abruptly, for obvious reasons. Do so only under a doctor’s supervision, and gradually.
Joy: I started drinking again, and at first moderately (2-4 drinks once a week in general, sometimes more) from December-May. My parents visited in May and I fell off the wagon due to stress.
Bill: Stress is the principal cause of (and often excuse for) relapse. However, if you were drinking at all prior to that, you were already off the wagon. There’s no such thing as slightly sober for an alcoholic.
Joy: I never worked my way up to daily drinking or keeping vodka in the house, but it got bad again. I lost 30 pounds in 3 months with the huge reduction in calories. I also wasn’t eating as much because my stomach didn’t feel irritated from drinking all the time. But in April 2012, I stopped getting my period! Could it be the shock of significant weight loss? I wasn’t overweight to begin with and am now 5’8″ and 130 pounds (I have since gained a few pounds back). I have a gyno appointment next week. Should I tell her of my drinking, or will she do the same tests to figure out what is causing the period loss whether or not she knows of my drinking history?
Bill: If you don’t tell every physician in your life about your drinking — which is the biggest cause of avoidable health problems in this country after smoking — you needn’t even bother seeing them. They can’t treat you effectively while you have alcohol in your system. You can’t even be accurately diagnosed for some conditions until three or four abstinent months have passed, and many treatment protocols won’t work, even with accurate diagnosis, until you are alcohol free. Your health has unquestionably been severely compromised, and there is no reason — so far — to ascribe it to anything but the booze.
Joy: Also in October 2011, I did not have hepatitis and my liver function was okay (blood tests were done). I hope I am still hepatitis and liver issue free? The last time I drank was 8 days ago, and I had a mini-detox (nothing like October 2011). I’m actually still having one now, but it’s mostly cardiovascular (pounding heart and anxiety), See previous remarks about detox. but it’s definitely improving. My whole abdomen felt like it was on fire, but that’s improving as well. I felt like my liver hurt, but everything else did as well, including a shooting colon pain that would get riled up with booze.
So obviously I want to quit again, and this time longer than 2 months! Do you think I have any permanent damage? I’ve been walking and eating well and I have always taken a multi-vitamin. Also I have been supplementing with vitamin D since March. (See previous remarks about nutrition.) I’m worried I have a permanent heart issue, but when I didn’t drink for 2 months last year, all of the symptoms went away, so it might just be that I need to get over the PAWS, which I realize can last 1-2 years with the amount I drank for so long.
Bill: I can’t say about the permanent damage. I’m not your doctor — in fact, I’m not a doctor, period. I can tell you that many chronic issues disappear when we stop drinking and using other drugs, but what might linger remains, at this point, a mystery to all. You should be able to get more definitive answers at around six months sober. I guarantee one thing, though: a lot of the problems will be gone by then.
Joy: I have a lot of the PAWS symptoms you describe and when I didn’t drink for 2 months last year, I was definitely more manic and felt bipolar at times, as my boyfriend has noticed as well. I have worked full time through all of this, and as an editor for more than half of it. My job requires a ton of very focused work and great attention to detail. It’s also very busy all the time and very stressful, which made me want to drink more.
I definitely have problems concentrating, emotional overreaction, sleep disturbances, stress, problems making decisions, and rigid, repetitive thinking. I think some of this could describe me even in childhood, as well as low self-esteem. Being able to turn off my brain was a great draw to booze for me.
Bill: Tell me about it!
Joy: Thank you for reading this and your article about PAWS. I read everything, including all the comments and your comments. I’m planning on going to my first AA meeting on Saturday (a women’s group), and I hope to be able to meet someone in a similar situation for support. I probably also need referrals to sort out all my health concerns. My diet has actually been good through all my boozing, but I know the booze took away from what was actually absorbed by my body, so I don’t know how much I saved myself there. I used to do yoga, which I want to start again. I’ve also always been a writer and will continue my journaling.
P.S. I am emailing you as well as posting this as a comment in case my situation may help someone else.
Bill: It sounds like your heart is in the right place. Here’s the key: we have to want to stay clean and sober more than we want anything else in our lives. It is trite, but true, that we will eventually lose anything we put ahead of our sobriety. Your drinking is already affecting your job and your health. It probably hasn’t impacted your relationship so far, because your boyfriend is a drinker too.
More will certainly be revealed about that! After a few days in treatment, 23 years ago, I had to tell my wife of 9 years that I believed I would not be able to remain sober if she kept drinking and drugging, and that we would not be able to stay together. A week later, she came into treatment with me. She is now one of the best addiction therapists I know — and I know quite a few.
The publishing industry is rife with drinkers, and anyone connected with administration has had ample exposure to the various alternatives. I suggest that, in addition to your meetings, reading and journaling, you approach your EAP about possible treatment options. You might be amazed at the possibilities that are open to you. At a minimum, you should insure that you are under the care of a physician who is trained in the management of recovering addicts.
It sounds as though you are getting serious about this. Please stay in touch. Pay attention to the suggestions in the article. It’s the distilled wisdom of a lot of drunks and other experts. (That was not an error in syntax, Ms. Editor; no one understands drunks like another drunk.)
It’s one day at a time, Joy. Anyone can stay sober for one more day. Do it!
And keep on keepin’ on!