Is alcoholism a mental illness or symptom of one?
Alcoholics often suffer from low serotonin levels, which they try to combat by “self-medicating” with alcohol. So can addiction to alcohol be a symptom of underlying chemical imbalances in the central nervous system? And how is alcoholism be treated chemically? Andrew Seaward explores here, and we invite your questions or comments about alcoholism and happy recovery alcohol at the end.
Alcoholism as Demonic Possession
Back in the old days (and I’m talking pre-industrial revolution here) alcoholism was widely regarded as a product of demonic possession. Alcoholics lucky enough to have ties to the Catholic Church would often receive a house call from their local priest or pastor who, with a sign of the cross and a couple dashes of holy water, would attempt to exorcise the demons from his or her body. But, if after the Bible was packed away and the rosary was untangled, the alcoholic still went for the wine locked away in the tabernacle, then he or she was regarded as simply having weak moral fiber. As a result, alcoholics were, and in large part remain, the objects of scorn and derision.
The Disease Model of Addiction
It wasn’t until 1935 when Robert Smith and Bill Wilson co-founded Alcoholics Anonymous (AA) that the paradigm shifted and alcoholism went from being viewed as a moral deficiency to a medical illness. The way Bill and Bob saw it…alcoholism was an illness or an allergy to the body, and just as people weren’t responsible for contracting Polio, neither were they morally responsible for their alcoholism.
This was great news for the alcoholic. For one, they no longer had to worry about Father O’Malley coming over and trying to give ‘em an exorcism, because they actually had a place to go and get real medical treatment, like a Betty Ford clinic. It sure beat being strapped down to a bed by your wrists and ankles while some rotund, rosy-cheeked priest doused you with holy water.
The only problem was, and still is, that even though AA helped to eliminate the “sinner” label associated with the alcoholic, it replaced it, in my opinion, with an even more debasing label of…well, the ”alcoholic.”
Go to any AA meeting or “twelve-step” rehabilitation center and you’ll get a dose of the central tenet of Alcoholics Anonymous, which says that alcoholism and addiction are incurable, chronic, and primary diseases. Well, that’s not very promising, is it? Not only do I have a disease, but it’s also incurable? Hell,at least with cancer, I’d actually have a shot at eliminating it with some radiation therapy. But, according to my AA sponsor, even if I stop drinking I’m always gonna be an alcoholic. This strikes me as a real problem. If you tell people they have an incurable disease over which they’re powerless, you’re not giving them much hope for recovery, are you?
Now, I do understand the rationale behind it. (I’m not a complete idiot.) If you view alcoholism as an allergy then there’s really only one solution, which is abstinence (although alcohol harm reduction strategies are gaining interest in medical communities). This is helpful for people early in their recoveries, who are still holding on to that obsession that they can drink like a “normie”. If you tell them that a sip of alcohol will kill them, then there less likely to take that first drink, right?
But, what about the people who have already surrendered their obsession, and are now actually trying to get to the root of the problem? Are you just gonna label them as an “alcoholic”, tell ‘em to go read the Big Book, and pray to their Higher Power for just one more day of sobriety? What good will that do? Sure, they won’t be drinking. But are they gonna be living a happy, worry-free existence? Probably not.
A Paradigm Shift to the Underlying Issues
Fortunately, the paradigm is once again shifting. Experts in the medical community are now realizing that people who abuse drugs and alcohol are doing so in order to compensate for an underlying chemical imbalance, which can be the result of anything ranging from a mental disorder to a traumatic event from childhood. They’re realizing that people don’t just lock themselves in a closet and drink themselves silly for no reason. They do so, because they’re compensating for some unresolved issue.
As a result, addiction or more accurately, chemical dependence, is no longer being viewed as the problem itself, but a symptom of a much deeper issue. This is evident by the increased number of “dual-diagnosis facilities” popping up all around the country, which are staffed with certified psychologists and psychiatrists who can identify mental disorders and administer the proper therapy and medication.
Dual-Diagnosis and the Cingulate System
I was fortunate enough to be a patient at one of these facilities after my parents, fed up with my failed attempts to stay sober in a traditional twelve-step environment, dug deep into their checkbooks and sent me to a place called, Foundations in Memphis. Foundations, unlike the previous rehab I had attended, actually had real life psychiatrists who didn’t just label me as an “alcoholic” and tell me to go pray and read the Big Book, but actually took the time to find out who I was and what I was feeling. Alcohol abuse in families affects everyone in the family unit, but to get to the root of the matter, I had to look within.
Together, my doctor and I dug pretty deep into my human psyche. We looked at things like my unhealthy obsession with self-achievement and my tendency to isolate from friends and family in pursuit of that obsession. What we realized is that I suffered from an overactive cingulate system, which as Dr. Daniel Amen describes in his wonderful book, Change Your Brain, Change Your Life, is the part of the brain that allows us to shift attention from one thing to another. When the cingulate is working properly, we are more flexible and able to adapt to different circumstances. But, when impaired or overactive, we have difficulty shifting attention and tend to get stuck in ineffective behavior patterns. It’s no wonder people with obsessive-compulsive behavior are characterized as having overactive cingulate systems. They get stuck doing things that seem silly to an onlooker, like excessive hand washing or flipping of the light switch.
An Unhealthy Obsession with Personal Achievement
Now, I didn’t quite fit the criteria for obsessive-compulsive behavior, but I did show hallmark signs of someone with an overactive cingulate system. For example, when I was a kid, I had an unhealthy obsession with the game of basketball. And when I say unhealthy, I don’t mean the occasional pick up game with friends at the neighborhood park. I mean, two hours of dribbling drills up and down the street I grew up on, followed by two hours of shooting on the hoop in my driveway. And that was after practice. I probably spent seven hours a day trying to become the next Michael Jordan. The only problem was I was a 5’-7”, 110 pound slow kid from the suburbs. I couldn’t compete with most of the other athletes, especially the kids who could do front flips over me. But that didn’t stop me. I still put everything I had trying to perfect my skill set.
I remember specifically not allowing myself to go in for the night until I made at least 20 out of 25 free-throws. Sometimes I could do it right away and there’d be no problem. Other times, I’d be out there all night, cursing, crying, throwing fits of frustration.
My parents knew that something was wrong with me, but simply dismissed it as drive and determination. Meanwhile, I spent most of my childhood teetering on the brink of insanity. I let my entire self-worth be defined by how well or how badly I played on game night. If I played good, I was on top of the world. If I played bad, I was so depressed I could barely drag myself to school in the mornings. Sometimes it got so bad, I even contemplated suicide. I figured anything had to be better than the personal hell I was in. I was a complete mess; an obsessive-compulsive, suicidal monster. I could barely even eat, my stomach was so knotted with stress and worry.
I eventually grew out of it when I went off to college. Of course, there I found a whole new thing to become obsessed about; academics. Once again, I let my self-worth be defined by my personal achievements. The only difference was, instead of a basketball, I used a calculator. And it was no walk in the park, let me tell you; chemical engineering isn’t just a major, it’s a frigging vocation. I spent many sleepless nights perfecting my knowledge of thermodynamics, while all the business majors were out partying and hooking up with one another.
Now, I’m not saying that studying and getting good grades isn’t important. It is. It’s just not worth isolating yourself from your friends and your family, which is what I did. I wasted a lot of good years hunkered down in my bedroom, reading page after page of engineering textbooks. I didn’t have many friends. I rarely went out to parties. The only “fun” I had was drinking by myself in a dark, lonely apartment.
Alcoholism as a Symptom of Serotonin Deficiency
Of course, the drinking eventually took on its own maddening obsession, which brings me back to my stay at Foundations. As I told my assigned psychiatrist all of this history, I saw a light bulb suddenly go off in his eyeballs. He told me my problem was mostly likely a deficiency of serotonin, a neurotransmitter in the brain responsible for modulating mood, emotion, sleep, and appetite. As he explained, people with low serotonin levels often display emotional rigidity, meaning they get “stuck” on a single idea and are unable to shift attention. This would explain my unhealthy obsession with self-achievement and my predilection towards harmful, repetitive behavior like say…alcoholism.
Alcoholics often suffer from low serotonin levels, which they try to combat by “self-medicating” with alcohol. Unfortunately, the increase in serotonin levels is only temporary, and overtime, the natural production of this neurotransmitter is depleted. This is why alcoholics who suddenly stop drinking, experience heightened irritability, not to mention uncontrollable shaking and seizing. Since their natural levels have been completely depleted, the only way to get back to a normal level or “homeostasis” is by taking another drink of alcohol. Of course, this only propagates the deficiency, which explains why alcohol is so harmful. You end up having to drink more and more just to feel “normal”, when, in reality, the alcohol is slowly deteriorating your brain and liver.
A Medically-Based Solution
So, step one for me was obviously to stop drinking, and step two, was to get my serotonin levels back up to normal. To do this, my doctor put me on a drug called Sertraline (a.k.a Zoloft), which belongs to a family of anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRI’s). The way these drugs work is by inhibiting serotonin’s reuptake into the presynaptic cell, resulting in a natural increase in the level of serotonin.
I felt the results almost immediately. In fact, my rehab roommates said that I was a completely different person. Almost overnight, I went from keeping my nose buried in a book, not talking to any of the other patients, to making friends, telling jokes, even speaking up in group therapy! I wasn’t as stressed out and sick with worry. I felt almost relaxed, even comfortable with my surroundings.
I continued taking the Zoloft after my discharge and even went on a “serotonin-rich” diet, which included foods rich in tryptophan. According to Dr. Amen, tryptophan is the amino acid building block of serotonin, and by eating foods rich in it, like chicken, turkey, and salmon, you can actually increase your levels of serotonin. This makes perfect sense. I don’t know about you, but I always feel sleepy after eating my Thanksgiving turkey dinner. That’s because the tryptophan in the turkey is being converted into serotonin. The result is a calm, sort of sedated feeling.
Exercise is also a good way to promote serotonin levels. According to Dr. Amen, “tryptophan, a relatively small amino acid, has trouble competing against the larger amino acids to enter the brain. But, during exercise, more of the larger amino acids are utilized to replenish muscle strength, which causes a decrease in the availability of these larger amino acids in the bloodstream. As such, tryptophan can compete more efficiently to enter the brain and raise serotonin levels.”
No wonder I always feel so relaxed after running. The serotonin in my brain must be skyrocketing! With all of this, who really needs alcohol? I can feel just as relaxed and worry-free with the right combination of diet, exercise, and medication. I don’t find myself obsessing about personal achievement like I used to, and I certainly don’t let mistakes hurl me into a deep, dark depression. Today, I’m much more relaxed and flexible, and I enjoy a healthy balance of work and recreation.
I’ve even started going back to AA meetings. Yeah I know, from what I said earlier, it sounds a little hypocritical. But the way I feel about AA, is the same way I feel about the Catholicism. I may not agree with all of its tenets—especially the one about being powerless over the “disease” of addiction—but I do appreciate the support and community. And now that I’ve tackled the underlying chemical imbalance, I actually want to be part of the community, instead of just isolating.
At that, I’d like to hear some of your opinions about dual-diagnosis facilities and the advantages or disadvantages you see with a more “symptom-based” view of addiction.
Photo credit: Alex E. Proimos