How to Help Someone with an Alcohol Addiction with Akhil Anand, MD

Podcast Transcript

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John Horton: Welcome and thank you for joining us for this episode of the Health Essentials Podcast. My name is John Horton, and I'm your host today. We're talking to psychiatrist Akhil Anand about what to do if someone close to you has an addiction to alcohol. Maybe it's your spouse who's overdoing it, or your child, or a parent. Dr. Anand is here to help us understand what they're experiencing and to talk about what you can do to help them and, just as importantly, yourself. Dr. Anand, thank you so much for being with us here today.

Akhil Anand: Thanks for having me, John.

John Horton: Hey, let's start by having you tell us a little bit about your work here at Cleveland Clinic. What's your main focus area and who are the patients that you typically see?

Akhil Anand: I work here at the Cleveland Clinic. I'm based at Lutheran Hospital, and I'm an addiction psychiatrist. Although I see all variations of psychiatry, my main focus is addiction.

John Horton: Well, let's begin our conversation today with a basic question, one that I'm sure is much more complicated than it sounds. Basically what is an addiction and does it qualify as a disease?

Akhil Anand: It does qualify as a disease, firstly. Addiction is basically a chronic relapsing brain disorder that has obviously affected millions of people in America. It's a chronic disease, so it's very similar to anything like heart disease or diabetes. It does relapse. People do relapse. There's no such thing as a cure for addiction.

John Horton: Although there are many substance abuse addictions, our conversation today is focused specifically on alcohol abuse. How common is alcohol addiction? I mean, is it an issue that's often ignored by people?

Akhil Anand: Sadly, it is common: 15 million Americans 12 and older struggle with alcohol use disorder. OK and 400,000 adolescents 12 to 17 suffer with alcohol use disorder.

John Horton: That's a staggering number. Wow!

Akhil Anand: Nine million men and about 5 million women — they all struggle with alcohol use disorder.

John Horton: Do you find a lot of people, do they ignore it? Are people getting the help that they need when they have that?

Akhil Anand: There is help available. Sometimes, however, one of the most common symptoms of addiction is denial. Oftentimes, patients don't that they have the problem. Alcohol, as you know, it's everywhere. You celebrate with alcohol at weddings. There's alcohol at funerals. I mean, alcohol's everywhere. It's become normalized in our culture. Oftentimes, it's an insidious addiction. It's not as obvious.

A lot of my patients will come to me once it starts having these really dire negative consequences when it gets really bad, unfortunately.

John Horton: Let's look at it a little bit almost scientifically within your body. What happens in your brain when you have an addiction to alcohol? And then how does that kind of manifest itself into your behavior?

Akhil Anand: Alcohol addiction is a brain disorder. Any addiction is a brain disorder. What essentially happens is these addictive substances, alcohol being one of them, hijacks your reward pathway in your brain. The reward pathway is a natural pathway in our brain. Natural things like food and romance and exercise, they stimulate that same pathway. But addictive substances, they artificially hijack that pathway. Even things that you used to enjoy, you can't and you crave that addictive substance.

And in this case, alcohol. And because of that, you start exhibiting behavioral changes. Someone that suffers from alcohol use disorder... I try to explain this to patients' families as best as I can. That relationship that they've developed with that substance, in this case, alcohol, it becomes everything to them. That relationship they want to keep safe. Whether it means how to obtain it or how to conceal it, they will do all kinds of behavioral personality changes.

We call it personality metamorphosis, that leads them to obtain their drug of choice. You see all kinds of things. I already talked about denial, right? They will deny everything. They will minimize. "I wasn't that drunk." They will justify. They will negotiate with their family members. They will manipulate. They become master manipulators. They put you in guilt trips. They do victim blaming. They'll do emotional hostage taking. They'll do all kinds of terrible things.

They'll deceive. They'll steal. They will lie. I always emphasize that this is the addiction and it's not the person. It's not the person, it's the addiction. If you can separate the two things from the person to the addiction, you can actually communicate with your loved one better. Not only does it change you organically in your brain, but it also changes you as a person.

John Horton: Wow! Really a powerful influence, no doubt. A lot of what we were just talking about obviously involved kind of your mind and your reaction to it. What does alcohol even do like physically to the rest of your body? I'd imagine that there's other symptoms or effects of it.

Akhil Anand: Alcohol causes over 200 different medical diseases. OK? I tell my patients all the time this, "What do we use alcohol for? We use alcohol to clean our toilets," right? Because alcohol's good at breaking down protein and our whole body's made of protein. From head to toe, it can cause early onset dementia, causes blindness, ages your skin, causes esophageal cancers, oral cancers, stomach cancers, liver cirrhosis, liver cancer, kidney failure.

It decreases the production of your sperm quality. It impacts your estrogen levels. It can cause infertility for both men and women. It causes osteoporosis, osteopenia. It causes fractures, bone fractures because you fall. It causes all kind of diseases. It affects every single organ system. It causes depression, anxiety, panic attacks, even psychosis.

John Horton: Wow!

Akhil Anand: Yeah. Sometimes I wonder why is it legal.

John Horton: Well, and that kind of leads us into the next question, because, I mean, as you mentioned earlier, alcohol is very ingrained in our culture and in many cultures. It's not uncommon to have a celebratory beer or a cocktail or a glass of wine. Where is the line when drinking becomes a concern? And what are maybe some of the red flags you should look for when someone close to you?

Akhil Anand: I always talk about the four C's when it comes to addiction. Four C's. Say for example you're having cravings, right? Cravings for the substance, this being alcohol, where you're compulsively seeking this alcohol. You're looking for it. OK? Where you can't control your use. It's a Friday night, you only want to have one beer, but you end up drinking four, right? And then last but not least, you have negative consequences.

These consequences can be anything from hangovers the day at work or impacting your relationship with your loved ones, driving under the influence, for example. Typically, I see the loss of control as the first, where they just can't control their use whenever they try to use, which is the big first one. But all three follow inevitably. When you're seeing those things, it's very concerning.

John Horton: Let's kind of turn it around a little bit here and look at addiction from a different angle and basically how it starts. A lot of people wonder whether alcohol is a hereditary disease. Could your genetics make you more prone to abuse alcohol?

Akhil Anand: Like I said before, it's insidious. It slowly starts. You don't just after one drink develop an addiction. You have to compulsively use it over and over again. If you continue using it regularly, daily over again, you will become addicted to it. Now, there are certain populations that are more prone. There's many factors, and one of them you just mentioned is genetics. Genetics play about 40% to 60% of an impact on addiction. For alcohol, it's about 60%.

Now, that doesn't mean if you have the genes, if you have family members that have struggled with addiction, that you're going to develop an addiction. It doesn't work like that, but you are more prone to it. Genetics definitely plays a huge role in it. Yes.

John Horton: Now, is that something... Is that just all kind of in your DNA, or are there environmental factors that kind of go into it, just that you see this abuse going on and you might be prone to kind of mirror it later?

Akhil Anand: Yeah. I mean, there are environmental factors, just like you mentioned, easy access, peer pressure, poor parental support, parental neglect has shown that, low socioeconomic status. These are environmental factors. If you have a psychiatric condition, if you have any mental health condition, 40% of folks with an alcohol use disorder have a psychiatric condition.

And if you have another substance use disorder, right? I see nicotine, but aside from nicotine, if you have another use disorder, there's a 20% likelihood that you also have an alcohol use disorder.

John Horton: Wow! Oh man! Well, let me ask you this now. If you see signs of addiction in someone close to you, in general, what should you do? How should you start a conversation with them about seeking treatment and getting some help?

Akhil Anand: This is hard. Communication is one of the most challenging things. It's something that patients' families always ask me about, because you're not talking to someone that's healthy. There's a lot of emotions involved. If it's someone that you love, you ruminate about every conversation you've had with them. How did that go? It leads to sleepless nights. You're always worried and concerned about them. Communication is definitely hard.

What I do tell folks is this, you're not talking to someone that's healthy and you have to be able to break the relationship between the individual and the addiction and the symptoms that come with the addiction. You have to appreciate that you can't stop them from using. It's not up to you whether they stop. And if they could stop, a lot of them would stop. In fact, 99% of them would stop if they could stop. What I tell them is what they shouldn't do.

One thing they shouldn't do is they shouldn't plead with the patient. You shouldn't blame them. You shouldn't demand. You shouldn't judge them. You shouldn't berate them. You shouldn't exaggerate. You shouldn't debate with them. None of that works, and you should definitely not enable them. I see this often. Enabling is a dysfunctional behavior that shields folks with addiction from the consequences and pain that they develop from their addiction.

All right? By telling, "Oh, he's on his way," when he was actually getting... He missed his appointment because he had a hangover. Or when you do their homework for them, you take on that responsibility. You can't enable these people, and you can't fight with them. You're not debating what these folks. What you can do is create healthy boundaries that are sustainable and that are for you, the loved one.

You have to be honest and open with them and communicate with them in a succinct manner and not be emotional. Be calm and constructive. If a debate happens, or if they're trying to negotiate with you, you end the conversation right there.

John Horton: I think that point leads us into the next question just perfectly. As a lot of people know, I mean, there's some people who when you drink, you become very angry and you can also become violent. What tips do you have for a situation where alcohol is just fueling somebody's temper and they kind of just burst into a rage?

Akhil Anand: I mean, violence is obviously unpredictable, right? You can't predict everything. What I will say to loved ones is that if you're going to have a conversation that might provoke violence, bring someone with you. You can't help the person that's suffering with addiction if you're harming yourself. Bring someone who you love and who you trust with you. If you don't have that, call the police. I mean, that's when the danger and you can't put yourself to danger.

John Horton: Right. Right. Good advice. Let's take an optimistic view here. You've had your discussion. Your loved one decides that, "I do need to take care of this." Once someone makes a decision to embrace sobriety, what can you do to support them as they go through the process?

Akhil Anand: First things first is you have to decipher whether or not this is a negotiation tactic on their end, or if they're doing partial progress of things, it's not a full change. "Yeah, if you give me the car, I promise I'll go to a meeting." That's not... You want more focused, targeted type of intervention. There is no deadline or anything like that. The present, whenever they are ready, you should be supportive. Make sure that it's targeted and it's formalized treatment.

You know what I mean by formalized? It's you have a licensed professional, whether it be a therapist, whether it be going to rehab, available, and you have multiple treatment options for them. That's when you're really doing something productive for them. But if it's not targeted, if it's more of a negotiation or they're doing it for somebody else, that's not good. That's not effective.

John Horton: Yeah, yeah. Once they start down that path too and it seems like they are making the progress and they're doing it for the right reasons and taking the action that they need, what can you do to support that and to kind of encourage them to continue down that path?

Akhil Anand: Unconditional love, right? Positive affirmations. Acknowledging the change. Those things do matter. Oftentimes, I tell my patient's families also to see a therapist too, because they need also that support system while these changes. It's because what a lot of folks don't understand, family members especially, sometimes it takes not once, but 10 times to have to go to treatment. It can be very hard for families to see that, specifically if they don't have any history of recovery themselves.

Being positive, giving them unconditional love, and then making sure that you have your own support system set up so that if there are some derailments or things that don't go as well as you liked, you can have that support and not put it on the patient.

John Horton: Yes, yes. Thank you. We've covered a lot of ground here today, Dr. Anand. Is there anything that we haven't discussed that's important for people to know or understand about dealing with friends or family with an alcohol addiction?

Akhil Anand: A lot of patients' family members will ask me about who can they tell. They worry about privacy. I always talk about privacy and urgency. I tell them this, that if you feel a lack of support and you feel that your intentions are not malicious to shame or embarrassed your loved one that's struggling with addiction, you should tell someone, whether it be in complete confidentiality, a therapist that you're seeing, or whether it be someone that has good intentions, ideally someone that's also in recovery, because you need that support.

Sometimes you can't do it on your own and having that support can really help. Sometimes addiction... It's not a sprint, it's a marathon. It's a chronic condition. There are setbacks. I do encourage if the person needs to talk to somebody about it, as long as it's not on a malicious, embarrassing, or shameful intent at all and it's to someone that you trust, you should do it.

John Horton: Right. Great. Dr. Anand, thank you so much for being here with us today for speaking with us on such an important topic.

Akhil Anand: Thank you for having me.

John Horton: To make an appointment with the Alcohol and Drug Recovery Center here at Cleveland Clinic, please call 216-363-2120. Or for more information, you can visit www.clevelandclinic.org/adrc. Thanks for being with us here today.

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