STEP TWO. SELF ASSESSMENT.  DO I NEED HELP?

It’s A Disease: That’s Why There’s A Cure.

In its policy statement on Alcoholism as a Disease, the American Medical Association (AMA) states that it ‘urges change in federal laws and regulations to require that the Veterans Administration determine benefits eligibility to require on the basis that alcoholism is a disease’.  The issue of whether of not ‘alcoholism is a disease’ is most relevant in terms of funding.  If patients have ‘a disease’, then it is is easier to obtain paid access to treatment through private and public health insurance programs.  The American Medical Association considers alcoholism to be an ‘illness characterised by significant impairment that is directly associated with persistent and excessive use of alcohol.  Impairment may involve physiological, psychological or social dysfunction’.  The amount you drink is not the crucial issue – it is a question of what happens when you do and that is why it is said, ‘If you have problems when you drink, you have a drinking problem’.  One of the problems is simply the impairment produced by intoxication.  Other problems are caused by the fact that alcohol tends to accentuate whatever we are feeling at the time we drink it.  If we are feeling happy and talkative, we may feel more intensely elated and talkative.  But it can also accentuate feelings of depression and despair.  And if we are angry or aggressive, alcohol can exaggerate those feelings while interfering with the good judgment need to keep out of a fight.  On the other hand, much of what distinguishes alcoholics is what happens when they do not drink.  How severe does craving become?  Some of the Mediterranean-style alcoholics do not know they are alcoholics until they try stopping and find it impossible.  This is probably the most important sign of alcoholism: the inability to remain abstinent.

Alcoholism is a ‘progressive disease’ that has been described in stages.  Do any of these stages apply to you?  Are you in the early or middle stages?  Do you have a loved one or friend to whom any of these apply?  Begin thinking about your drinking in terms of these stages:

Early Stage:

1. You are beginning to experience problems with your drinking.  You become preoccupied with drinking, start sneaking drinks, and feel some guilt about your drinking behaviour.
2. You sometimes become intoxicated, and may have had blackouts – not remembering what you said or did while drunk.
3. You look forward to drinking sessions, associate with other heavy drinkers, and are less interested in activities that do not involve drinking.
4. Friends and family are concerned about your drinking, and drinking interferes with your work – for instance, you being calling in sick because of a hangover.
5. You experience withdrawal symptoms such as tremors, depression, and anxiety when you stop drinking.

Middle Stage:

1. You may or may not openly acknowledge it, but drinking has become a problem for you.
2. You are unable to manage your drinking.  Even though you wish that you could drink less, you find yourself drinking compulsively.
3. You begin to use alcohol as an antidepressant but find that drinking results in hangovers, which make you even more depressed.
4. You begin to have health problems, and your doctor may recommend you drink less or stop altogether.
5. You may miss workdays and lose your job, get convicted of drunk driving, or get into alcohol-related conflicts with loved ones and friends.  You start having alcohol-related medical problems such as liver inflammation, heart disease, or diabetes.
6. Withdrawal symptoms – tremors, depression, and anxiety – as the alcohol wears off are now a regular part of your life.

Late Stage:

1. Your life is now totally unmanageable.
2. You may have hepatitis, cirrhosis, pancreatitis, high blood pressure, and internal bleeding.
3. Deep depression, sleep disorders, and memory problems are prominent.  If you have been drinking many years, your memory may become impaired by Wernicke-korsakoff Syndrome, a condition that results in permanent brain damage.  In The man Who mistook His Wife for a Hat, Oliver Sacks describes how one of his patients thought he was living decades earlier because years of drinking had erased entire portions of his memory.
4. You may experience hallucinations, convulsions, and have brain seizures know as delirium tremens (DTs) when you stop drinking.  This can be fatal and you need medical attention urgently.

Is the Cure Right for Me?

Do you identify with any of the stages described here?  Do you agree with the statement: ‘If you have problems when you drink, you have a drinking problem’?  Does alcohol control you?  Would you like to regain control over your drinking?  Do you want to stop altogether?  Has drinking interfered in your family, social, or work life?  Has your health suffered?  Have you had any bruises, falls, or accidents while drunk?  Have you experienced ‘blackouts’ as a result of heavy drinking?  Have you encountered legal problems as a result of your drinking?

If you answer affirmatively to any of these questions, then you should definitely consider the Sinclair Method because it is grounded in mainstream science and offers the most hopeful, effective, and clinically proven plan to break the cycle of compulsive drinking – without the demands of going cold turkey or abstinence.  It is especially work considering if you have tried and failed with other therapies.

In its original form, the Method involved close supervision over either sessions with a physician and psychologist.  However, the research now proves that it is possible to proceed on your own with minimal therapy, as long as you are medically fit to receive a prescription for naltrexone or nalmefene.

Your Mental Health

You can benefit from the Sinclair Method even if you have a psychological or psychiatric condition in addition to alcoholism.  For instance, if you suffer from clinical depression distinct from your drinking problem, the treatment can help you with compulsive drinking.  However, if you have been diagnosed with a psychiatric condition, you should always consult with a trusted physician before beginning the Sinclair Method.

One of Sinclair’s findings from an analysis of the Finnish alcoholics was that the treatment produces a very large decrease in depression.  The patients took a test for depression (the Beck Depression Inventory) before treatment and again after about three months of being treated with naltrexone.  Naltrexone, or nalmefene, themselves do not have any antidepressant effects, but the depression was dissipated because the drinking had decreased.  This helps to answer an old puzzle in the alcoholism field: does depression cause people to drink excessively or does excessive drinking cause people to feel depressed?  The fact that it was possible to reduce depression to normal levels in the vast majority of patients with naltrexone shows that usually it is the drinking causing the depression.  There were, however, exceptions: patients with a primary problem of depression remained depressed even after their drinking was well under control.

The Cure Does Not Judge You

The Sinclair Method advocates a non-judgmental position with respect to addiction.  From a philosophical and practical point of view, it is imperative that you try to avoid the stigma, taboo, and shame so often associated with the label addict, alcoholic, or drunk.  You should not consider yourself morally degenerate, weak, or inferior because you have a drink problem.

From a Sinclairian perspective, you would most certainly not be labelled in a negative way.  In any event, labelling does not help with treatment.  Nevertheless, it is useful to ask yourself important questions about your drinking patters.  The questionnaires and tools in the next parts of this chapter can help with that.

In the past, a great deal of effort has been expended trying to draw a demarcation line between alcoholics and people who are not alcoholics.  In fact, alcoholism exists on a continuum – some are more badly affected than others – and there is no split between the two.  It is like trying to define between red and yellow: it is impossible to say at which shade of orange that red stops and yellow begins.

The effort would be worthwhile if the treatment given to alcoholics were different from what should be done with heavy drinkers, or if the treatment were so dangerous, painful, or expensive that it should only be given to alcoholics.  None of these condition are true, however, for the Sinclair Method.  It will cure the alcoholic, but it also is useful for the heavy drinker as a preventative against developing alcoholism.  It is safe, painless, and cost-effective.

On the positive side, diagnosing someone as being an alcoholic can be useful in helping the person get into treatment.  The self-diagnostic tools here may be useful for getting yourself into treatment.  If you have found that you do fit the following criteria, then  by all mean get help.  The Sinclair Method, however, is also for people who simply want more control over their drinking or want to prevent future problems with alcohol.  You do not need to have the scarlet letter ‘A for Alcoholism’ branded on your forehead.

Questionnaires and Tools to Help with Self-Assessment.

Please consider the following questions for yourself right now:

1. Do you have a blood relative who has had a drinking problem?  Yes/No
2. Has anyone ever told you that you drink too much?  Yes/No
3. Do other people have different opinions about your drinking style than you do?  Yes/No
4. Do you sometimes think that drinking causes problems in your life?  Yes/No

If you answered yes to question 1, you should consider the possibility that you may be at risk of alcoholism if you ever start drinking.  If you answer yes to questions 2 through 4, consider the relevance of your answer.  Others might be wrong, but sometimes they can tell if you are harming yourself, even before you recognise it yourself.

CAGE

The CAGE questionnaire, which was developed in 1970 by Dr. John Ewing, founding director of the Bowles Centre for Alcohol Studies for family practitioners and alcohol treatment profressionals, consists of four powerful questions:

1. Ever felt you ought to Cut down on your drinking?
2. Have people Annoyed you by criticising your drinking?
3. Ever felt bad of Guilty about your drinking?
4. Ever had an Eye-opener to steady your nerves first thing in the morning?

Interpretation of CAGE Questions

These questions are significant if your affirmative answers apply within the past twelve months.  Answering yes to two questions is considered a strong indication of an addictive drinking problem; answering yes to three questions is said to confirm an addictive drinking problem.  These questionnaires are not intended as a formal diagnosis; they are included to help you begin thinking about your drinking style.