Please welcome Lisa Frederiksen! In our interview, Lisa shares her insights on alcohol use disorder and the effect it has on family members.
1. Please introduce yourself to readers who don’t know you?
First of all, thank you for this opportunity!
Like you, I got interested in this work based on personal experiences. In my case, it was several decades of coping with various loved one’s drinking and ending up hurt, frustrated, angry, disappointed, and scared when they couldn’t stop or cut back or didn’t seem to care enough to do whatever they needed to do to stop!
Finally, in 2003, one of them entered a residential treatment program for alcoholism, and my life started ever so slowly changing for the better. It was all of these experiences that drove me to try to figure out what happened to my loved ones and myself, which has been the focus of my work these past sixteen years.
I wanted to help others in my situation – and in some cases simply start – the conversations around all things addiction and the family member’s experience.
On the fun side 🙂 I love anything outdoors – hiking, swimming, kayaking, rock climbing…and am fortunate to have wonderful friends and two amazing daughters with whom I spend a great deal of time.
2. Can you explain the terminology and/or common language that is now being used by psychiatrists and clinicians for alcohol use disorder?
There is a book used by psychiatrists and other clinicians to give them a common language for understanding, diagnosing, and talking about a range of mental health conditions — including conditions afflicting our loved ones who drink too much. It is called the Diagnostic and Statistical Manual of Mental Disorders (DSM), and it is developed, updated, and published by the American Psychiatric Association (APA).
The terms “alcohol abuse” and “alcoholism” were two of the mental health conditions included in the fourth edition of the DSM, referred to as the DSM-IV, which wasn’t updated until 2013. This is why those two terms are still the most commonly used today. But in May 2013, the APA released a new edition of this manual, called DSM-5.
This revised edition put both alcohol abuse and alcoholism into one classification and called it “alcohol use disorder (AUD).” Then, the psychiatric professionals further divided the alcohol use disorder classification into three sub-classifications: mild, moderate, and severe. You might think of it as the way health conditions like asthma or arthritis are classified as mild, moderate, or severe.
As far as the clinical and psychiatric community is concerned, what we commonly call “alcoholism” is technically classified as a “severe alcohol use disorder.” And what we commonly call “alcohol abuse” is technically classified as a “mild or moderate alcohol use disorder.”
Besides clarifying terms for health professionals, the publication of the DSM-5 also helped fuel a movement within the treatment and recovery field to change the “label” given to people with a drinking problem. This movement is to no longer label people with alcohol use disorders as alcohol abusers or alcoholics.
Instead, there’s now a concerted effort to refer to them as people with a mild | moderate | or severe alcohol use disorder. These distinctions help make the point that individuals are not defined by their drinking pattern — so they are not alcoholics or alcohol abusers, for example.
If you think about it for a moment, you’ll see it’s similar to the way we describe people who have cancer. They are people with cancer; they are not “cancerics.” [Note: For many people in 12-step programs, self-identification as an alcoholic is important to their recovery, which of course is their choice.]
3. What is second-hand drinking and what are some of the repercussions for families with loved ones who drink too much?
Secondhand drinking refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors include:
- verbal, physical, emotional abuse
- neglect of loved ones
- driving while under the influence; getting a DUI (DWI); riding in a car driven by someone who has been drinking
- experiencing blackouts — fragmentary or complete; vomiting; passing out — not remembering what was said or while under their influence
- doing poorly at work or school because of the drinking or recovering from the effects of drinking
having unplanned unwanted or unprotected sex; committing date rape - being admitted to the emergency room with a high Blood Alcohol Content (BAC), in addition to the “real” reason (e.g., broken arm, feel down the stairs, auto accident)
- alcohol-involved domestic violence or death by suicide.
Drinking behaviors are the result of excessive alcohol (which contains ethyl alcohol chemicals) changing brain function. These brain changes are caused by a variety of drinking patterns ranging from binge drinking to heavy social drinking to alcohol abuse to alcoholism.
When a person doesn’t understand: 1) how heavy drinking chemically and structurally changes the brain, 2) how the brain wires and maps heavy alcohol use as “an answer,” and 3) the brain changes caused by different drinking patterns, they believe there is something they can do to help that person or to make them stop. And it is this that can result in toxic stress-related brain changes to those coping with someone’s drinking.
Toxic stress is what happens when a person’s fight-or-flight stress response is repeatedly triggered — like that which occurs when repeatedly coping with drinking behaviors. This fight-or-flight stress response is one of the survival instincts built into humans to keeps us safe when threatened with danger.
When it is triggered, a cascade of stress hormones causes a series of changes in the body to prepare it to fight or run — changes like the tensing of the muscles, increasing the heart rate, and shutting down of the digestive system.
These changes enable us to jump out of the path of an oncoming car or experience superhuman strength to lift a fallen beam pinning our child to the ground. The physical act of jumping out of the way or lifting the beam — averting the danger — allows the body to return to normal functioning. This triggering and resolution are known as positive stress.
But when our fight-or-flight stress response is repeatedly triggered, and we never physically fight or run, the cascade of stress hormones and physical changes “marinate.” They “sit” in body organs and tissues — like the brain, heart, muscles, and stomach. This is when stress becomes toxic.
The physical and emotional health consequences of toxic stress include migraines, stomach problems, muscle aches, sleep difficulties, tension headaches, anxiety, depression, difficulty concentrating, racing heartbeat, and skin problems, to name a few.
When children experience toxic stress, it “weakens the architecture of the developing brain, with long-term consequences for learning, behavior, and both physical and mental health,” according to the Center on the Developing Child Harvard University.
4. What effects does adverse childhood experiences or ACE’s and the CDC-Kaiser ACE Study have to do with alcohol use disorder and the impact on families?
ACEs refer to traumatic or stressful events that happen to a child before age 18. Hence the connection with childhood trauma, one of the key risk factors for developing alcoholism (or other drug addictions).
The concept of ACEs and their physical and emotional health consequences came out of a study conducted in the late 1990s by Kaiser Permanente, San Diego and the Centers for Disease Control (CDC). It was a huge study involving 17,000 Kaiser patients. The study participants were mostly white, mostly middle to upper-middle class, all had health insurance, and all had jobs.
Participants were asked to fill out a 10-question questionnaire. Then, their answers were compared to their medical histories. The results showed that experiencing adverse childhood experiences were linked to a variety of physical and emotional health problems across a lifetime.
These health problems included: depression, substance abuse or addiction to alcohol or other drugs, obesity, diabetes, suicide attempts, heart disease, cancer, STDs, broken bones, smoking, and having a stroke. The more ACEs a person had, the more likely they were to have or develop one or more of these health problems.
10 types of ACEs were measured in the questionnaire. Five were personal, meaning it was something done to the child. These five included physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect.
Five were related to other family members’ behaviors that affected the child. These five included a parent who abused alcohol or other drugs or was addicted to alcohol or other drugs; a mother (or step-mother) who was a victim of domestic violence; a family member in jail; a family member diagnosed with a mental illness; and the disappearance of a parent through divorce, death, or abandonment.
The study found that almost two-thirds of the 17,000 participants had experienced at least one ACE. Of those with one ACE, 87% had two or more. The more ACEs the person experienced, the more likely they were to have developed an alcohol (or other drugs) use disorder, marry someone with alcohol (or other drugs) use disorder, have depression or any of the other health problems listed above.
A person with five ACEs, for example, has an eight times greater chance of being an alcoholic, and a person with four or more ACEs has twice the risk of cancer.
Since that original CDC-Kaiser ACE Study, many other kinds of adverse childhood experiences have been identified. These other ACEs include poverty, racism, bullying, watching a sibling being abused, losing a caregiver (grandmother, step-mother, grandfather, etc.), homelessness, surviving and recovering from a severe accident, living in a war zone, witnessing a grandmother abusing a parent, involvement with the foster care system, and involvement with the juvenile justice system, as examples.
5. What helped you the most in overcoming your personal challenges with having a loved one whose drinking affected your life?
Three things were especially helpful to me.
The first was doing cognitive-behavioral therapy (CBT) with a therapist who specialized in addiction and helping the family side of this disease.
The second was attending as many family group programs at the treatment center my loved one was enrolled in. I participated in Al-Anon – a 12-step program for people affected by someone’s drinking. It’s helpful to know there are AlAnon meetings for parents only.
The important thing is for people to understand not all meetings are the same. You are not “wrong” or “just not getting it” if you find it takes trying several different meetings before you find the one that’s right for you.
And the third was the research I’ve talked about. Additionally, the research that explains how “plastic” the brain is — we really can rewire our brains for better lives. How one does this is a big part of my latest book.
6. What advice do you have for families, especially parents struggling with a son or daughter who has a problem with alcohol?
Know that you are not alone. Nearly 80 million Americans are affected by someone’s drinking. Know that you did not cause it. Know that your child (or other loved one) has a brain disease that makes it impossible for them to function and behave “normally,” but know it’s entirely possible to treat addiction and return the brain to health.
The key is knowing there are many, many ways to treat it and that treating adolescent addiction is very different than treating adult addiction because of where the adolescent brain is developmentally. Learn as much as you can about this disease and about what it takes to treat it effectively.
And, lastly – know that one of the most important things you can do to help your child or other loved one is to treat, heal and rewire your brain of the toxic-stress consequences of coping with their drinking problem.
Lisa Frederiksen’s 40+ years of experience coping with loved ones who drank too much and her 16 years of work studying the scientific research on brain development, alcohol use disorders, and the family members’ experience culminate in her “10th Anniversary Edition If You Loved Me, You’d Stop!” She is a nationally recognized keynote speaker, consultant, and author of 12 books. She founded BreakingTheCycles.com in 2008 to change – and in some cases, simply start – the conversations around the myriad of topics related to a loved one’s drinking and the family member’s experience.
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Thank you for being there for your child when they need you the most! XO, Cathy
I find the descriptions informative! I have had no idea as to what alcohol use disorder meant. Having distinctions is helpful to understand how severe the problem is. It’s great to know that there are different treatment solutions to rewire the brain and to help children and teens who are affected.
Alcohol Use Disorder is a term that many people have not heard of, so you are not alone, Evelyn. I agree that having the distinctions around the severity of the problem is helpful. It can give people a context to understand the problem better.
Thank you for sharing this information, Lisa and Cathy. I find the scientific explanations behind the behaviors especially helpful, and also the list of things which helped Lisa the most. CBT was also extremely healing for my emotional issues. I think it can help no matter what the cause.
Lisa does a great job with the research and explanation of the science behind alcohol use disorder. I also like how she describes the different levels of drinking. It is helpful to know where to turn. Glad to hear that CBT is helping you. It seems to be quite popular now and people are seeing benefits from using it.
This information on the toxic stress that can result from being around someone with alcohol use disorder is so illuminating. Thank you for this. Both of my parents drank every evening and drinking at holidays would lead to fights. I’ve always wondered if they were alcoholics, but this gives me some context. It’s more likely they were on the mild to moderate range of alcohol use disorder. It still had impacts.
I do like the way Lisa describes the different levels of the problem. Many people do assume that you need to be an alcoholic to have issues because of alcohol use. Most people can drink socially without a problem, but it is helpful to understand the side effects of drinking. I appreciate you stopping by.
I find it very informative! I have had no idea as to what alcohol use disorder meant. It’s great to know that there are different treatment solutions to rewire the brain and to help to both children and teens who are affected.
Hi Hazel,
The science has changed and improved around helping those with alcohol use disorder. One size doesn’t fit all, as every situation is different. I appreciate you stopping by.
Once you start taking drugs, it’s impossible to stop. These tips will help you a lot if you’re looking for inspiration.
Such a informative post! Learnt something new From this post.
Great that you found the post, helpful, Lizza. Thank you for stopping by.