Two thousand words from the future

The following essay was created using guidelines learned while attending a technical Meetup at a Philadelphia-based SEO agency called From The Future. Among the most fascinating items learned was the optimal length for a blog post: 2000 words.

Combining this guideline with self-taught SEO techniques, I co-wrote and edited this post about alcoholism for an anonymous friend.

Click here to visit From The Future

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Content note: The topic of this essay has nothing to do with the company mentioned above. The essay is an example of the writer’s ability to create an extended blog post.

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IS MY HUSBAND OR WIFE AN ALCOHOLIC?

What does problem drinking look like?

Problem drinking looks different for different people and is easy to deny. In the same setting, two people of similar stature, drinking the same type of alcohol, in the same amount, can have dramatically different experiences. One might doze off while the other goes off in an abusive rampage, despite virtually identical blood alcohol levels. Ironically, in the above example, both can be problem drinkers -- the former just as likely as the latter -- with perhaps neither being alcoholics because, among other criterion, alcoholism is about patterns of choices and behaviors.

If the former dozes off three times a week and can’t function at their job, a problem might exist. The latter might have anger issues that will arise whether they drink or not. Appearances can be deceiving. Perhaps just as importantly, no pathologies exist as a precise measuring stick for alcoholism.

So, what does alcoholism look like? It looks like a pile of jigsaw puzzle pieces that, when put together carefully, paint a picture of a problem that nobody wants to look at -- spouses, family, friends, colleagues.

IS THERE A CHECKLIST FOR ALCOHOLISM?

Obvious signs of intoxication might be different for an alcoholic

There are unmistakable symptoms of intoxication: slurred speech, confusion, disorientation.  But the chronic problem drinker who, over a course of several months or years, sustains behavior that results in negative effects on their lives when they are not drinking, is presented with one very large piece of the puzzle.

Common signs of a drinking problem

Other common indicators exist. Alcoholics can develop a resistance that requires greater quantities to achieve the same results. Many hide their drinking and their bottles.  Some only drink at home, alone. Others keep their activities as far from home as possible. The homebodies stash their alcohol on high shelves in the garage, in the toilet, buried in planters and in heating ducts. Others hide it in their office desk drawers. More than the behavior while drinking, the choice to hide the alcohol is a huge red flag and, despite likely vehement defiance when confronted with the choice to hide, the choice is a significant indicator.  And, while the defiance may not be an outright lie, be assured that lying is taking place. Lies of omission. Lies of commission. Lies told to oneself. Lies to loved ones.

Ten potential indicators of alcoholism

Unfortunately, there is no checklist that will allow a user to unilaterally -- and unequivocally -- conclude a diagnosis of alcoholism. Perhaps more to the point is the fact that alcoholism cannot be diagnosed like other diseases. Symptoms can seem obvious but there is no blood test and there is little in the way of long term medical intervention except discontinuing the use of alcohol.

An abridged list of things to look for follows:

- High tolerance

- Hiding alcohol

- Drinking to prepare for more drinking -- at parties, events and socially

- Injuries that can’t be explained

- Physical problems: weight gain/loss, sleep disturbances, trouble eating without drinking alcohol and substituting alcohol for meals

- Lying about whereabouts, volume, driving, relationships

- Psychological struggles - depression, paranoia and others

- Gaslighting discussions with spouses to manipulate circumstances and avoid accountability

- Strained/abusive relationships with spouse, parents, children, friends, co-workers, bosses

- Legal problems related to poor decision-making while intoxicated

Dealing with the issues of a high functioning alcoholic

A chronic drinker may be able to hide the symptoms from even those closest to them and, when discovered, have the uncanny ability to convince those with the concerns that the problem is theirs. Some active alcoholics can, at times, be able to get drunk twice a day, for extended periods of time, and not have friends and colleagues know. My loved one was an expert in avoiding detection. Most alcoholics are.

What’s the difference between a problem drinker and an alcoholic?

Semantics, mostly, if the results of the drinking are compromising the life and health of the person. The question, however, can be hotly debated in online reference resources and by those involved. The answer will always be qualified by defining the motivation behind the person who is asking and the person who is answering. A case in point is binge drinking. Binge drinkers can go days -- or weeks -- without physically needing alcohol but, when they drink, they often blackout. Few people who blackout from drinking more than once or twice aren’t problem drinkers.

The former title, for most people, often seems more palatable. In our culture, the ugliness and fear associated with the “A” word is sometimes enough to keep people from getting help so, if the patient or their circle needs to use a kinder term, do so. That said, if the results are the same, the name is just a name. Alcoholism does not require a physical reliance on the substance.

How long does it take to become an alcoholic?

Problem drinking may go on for years or decades.  An alcoholic may drink excessively -- and compulsively -- for 30 years without interruption.  Despite this fact, different people have different risk profiles. Binge drinking, for example, is a rising problem among many young people who have only begun drinking.

Conversely, over that course of decades of non-binge drinking, problem drinkers can develop a tolerance that results in the need to drink as much as 10 times more than normal drinkers, without showing as many signs of being drunk. A strong case can be made that the correlation between alcoholism and the length of one’s drinking career can vary dramatically.

What if my spouse has a problem with both alcohol and drugs?

Many people mix alcohol and drugs.  The drugs may include both prescription drugs (like opiates) and illegal drugs. It should be noted, too, that other comorbid compulsive behaviors are common, like gambling, sex, food and more.

Drugs and alcohol present a particularly dangerous combination, for several reasons.  Mixing alcohol and most mind-altering drugs can very easily result in deadly overdoses. Alcohol is a sedative, as are opiates and, when combined, can suppress breathing to point of death. In addition, if we choose to drive after taking a combination of alcohol and drugs, the risk to those sharing the road (and ourselves) is greatly increased.

Protecting the spouses of all active alcoholics

Concerned spouses are encouraged to seek the help of a licensed therapist if there is a concern about dealing with a potential alcoholic for four reasons: 1) To identify healthy and safe ways to discuss concerns, 2) To identify appropriate ways to ensure the alcoholic’s accountability with resolutions, 3) To maintain one’s own ability to navigate the difficult circumstances that result from a spouse’s alcoholism, 4) To receive guidance to other professionals whose services may be required if the situation continues to deteriorate -- like attorneys, detectives, family counselors, women’s shelters, etc.

TREATMENT FOR ALCOHOLISM

What is an intervention?

Alcoholism eventually affects everyone with whom the alcoholic comes into regular contact. And, while observations and experiences can differ based on the relationship with the alcoholic, the problem will eventually become undeniable. When those within the alcoholic’s sphere of influence have a chance to compare notes, the ugly truth is usually identified and an intervention becomes the next appropriate step.

Is professional support important for an intervention?

Intervention is a process undertaken to address the shape of the group’s life when an alcoholic’s problem is unambiguous. It is usually a formal process that includes a professional in addiction treatment and a number of persons affected by the behavior of the alcoholic. The inclusion of an independent certified professional is strongly advised.

How do I prepare for my spouse’s intervention?

The process begins when a family member -- often a spouse or significant other -- requests help from a rehabilitation center or the family physician.  An intervention professional meets with the family member, and possibly also with other members of the family and friends, to coach them on the intervention process.  Family and friends are taught not to accuse the alcoholic. Instead, they are coached to share how the alcoholic’s alcoholism has affected them. For example, a wife may offer that “when you showed up drunk at our daughter’s Father/Daughter dance, it embarrassed our daughter and me”.  The technique is designed to prevent the alcoholic from denying whether or not something happened and, just as importantly, the alcoholic cannot deny the feelings being expressed.

What happens during an intervention?

All of the family members and friends who wish to participate are gathered in a private room with the interventionist. Then, the alcoholic is brought to that room, often without warning, and confronted.  The interventionist explains that the alcoholic’s family and friends have gathered to explain the impact of the alcoholism on each of the participants. Then, one by one, each of the family and friends take a few minutes to share how they have been affected by the behavior of the alcoholic. The alcoholic is asked to listen to the feedback, without commenting, until the end of the intervention.  

Is an intervention a structured event?

Yes and no. Experienced interventionists always have a firm yet adaptable game plan that allows for adjustment based on the number of participants, their temperaments, the personality of the alcoholic and other factors unique to a given situation.

The interventionist often coaches the participants to describe consequences, if the alcoholic chooses to continue drinking. For example, in one situation, the alcoholic’s boss was part of the process. The boss explained to the alcoholic that the alcoholic could participate in a formal, inpatient rehabilitation process and, at the completion of the process, the alcoholic’s job would be waiting for them. If the alcoholic chose not to participate, he was told that the boss would terminate the alcoholic’s employment immediately. The alcoholic accepted treatment.

Prior to most interventions, arrangements are made for inpatient rehabilitation, if the alcoholic chooses to receive help.  In some cases, the alcoholic is taken directly to a rehabilitation facility. Unfortunately, many alcoholics refuse treatment. Some refuse to participate in the intervention, choosing to leave the intervention and continue their alcoholism.

The goal of an intervention, in almost all cases, is to get the alcoholic to accept the fact that a life-endangering problem exists, to offer a concrete solution (rehab) and to immediately move toward resolution of the problem (attending rehab).

What is the difference between rehab and detox?

Family members seeking help for the alcoholic are often confronted with new language and jargon. Among the most commonly misunderstood are “detox” and “rehab”. Often, people use the two interchangeably despite each being very different.

Detoxification (or “detox” for short):

A medical process of weaning the alcoholic off of alcohol.  This process usually involves a short hospital stay (2-3 days), where the alcoholic is observed closely, receives around-the-clock medical support, and medication (if needed), to alleviate the symptoms of withdrawal.

Alcoholics usually experience significant withdrawal symptoms when we stop drinking.  The consequences of those withdrawal symptoms can be severe, including seizures, psychiatric symptoms, and in rare cases, a syndrome called Delirium Tremens, which may be fatal. Also, withdrawal symptoms produce an intense craving for alcohol in order to stop the withdrawal, which makes the alcoholic/addict much more susceptible to relapse.

Rehabilitation (or “rehab” for short):

Rehab takes place over a longer period of time. Usually 28 days. Medical support is often included (although not as intensive as in detox).  Additionally, psychological/psychiatric support, counseling, and group therapy take place. Beyond the described supports a reorientation to a healthier, more organized everyday life is stressed. The patient makes their bed, arrives on time for scheduled events, maintains hygiene, is encouraged to build relationships and performs chores common to most healthy people.

In short, detox focuses on the medical management of the patient. Rehab, on the other hand, focuses on why the patient became an alcoholic, in an attempt to prevent relapse.

Does every alcoholic need to go to rehab?

Every alcoholic should have a medical evaluation by a physician who understands alcoholism. Admittedly, this suggestion often isn’t possible until the alcoholic is literally inside the rehabilitation facility and, sometimes, the physician may find that alternative medical tactics should be undertaken and/or replace rehab altogether. It should be noted, too, that most physicians, with an emphasis on family practitioners, receive almost no training on alcoholism in medical school.

What is the difference between inpatient and outpatient rehab?

Inpatient rehabilitation is a process that occurs when the alcoholic remains at a specialized facility 24 hours/day. Stays as short as three days take place. Some last as long as three months.   

Intensive support is necessary for many alcoholics. Very poor health is common, as is homeless, malnourishment, broken families and evaporated personal infrastructure.  Full time treatment gives an alcoholic the time and the place to work on their recovery, and to receive all of the required support under one roof. Another advantage to inpatient rehabilitation is the safety and security provided, keeping unnecessary life stressors and the temptation of friends who are drinking and taking drugs at arm’s length.

However, some people choose not to receive inpatient care due to lack of insurance, time or money and, instead, participate in outpatient rehabilitation. Outpatient rehab generally involves meeting with a counselor, and possibly a small group of other alcoholics, several evenings a week for several weeks. Some outpatient rehabilitation is called “intensive outpatient”, and may meet as many as seven times per week.

The advantages of outpatient rehab include lesser cost and also the possibility that the alcoholic can continue living at home and working, if they still have a job.

How do I find a good rehab?

Your family physician can help identify a good rehab. As described above, many physicians don’t have substantial training in addiction, but almost all family physicians have a long list of patients experiencing alcoholism and have had to help each take the first step toward a healthier life -- beginning with rehab.  

In addition, if the alcoholic has health insurance, their insurance company will have data on rehabs with good (and bad) results. The insurance companies have a vested interest in ensuring the best treatment possible. It is good for them if the patient receives treatment that works.

Is rehab expensive?

Most facilities cost $500-$1,000 per day, with some charging significantly more.  Sometimes treatment may be required for one month or more.  That means treatment can cost $20,000-$30,000, or more.

Some insurance companies cover the cost of a rehab stay for the treatment of alcoholism.  If you or a loved one is considering rehab, call your insurance company to discuss costs. Even with health insurance, however, there may be significant out-of-pocket costs.

Can AA help a problem drinker?  Can I just go to AA and do this myself?

Alcoholics Anonymous (AA) can help a problem drinker. AA is the only place that alcoholics can go where they can speak directly with other people who have had the same experiences -- the good, the bad and the ugly. The people in AA do not lecture, they do not charge any money for their time, they do not set or enforce rules. They offer their time and their experience in the hope that doing so will help themselves stay sober. In this context, even alcoholics who choose to go their own way are not alone in their struggle. Almost every rehab program will encourage the alcoholic to embrace AA.

There are some limitations to the do-it-yourself approach though.

No one in AA acts as a healthcare professional. Nobody directs another member’s recovery. Nobody tracks a participant’s progress. Everyone is free to come and go as they please and, for those alcoholics whose early sobriety requires structure, organization and accountability, the flexibility can offer another place to hide behavior. The problem with the DIY approach is that the person in charge of the patient’s recovery is the patient -- and most come into recovery with serious medical and mental issues.

Despite the success stories associated with AA, the grim reality is that the recovery rates for someone who walks into their first AA meeting are shockingly low. Most people don’t recover from alcoholism. (For more detail, read later on “Alcoholic Data and Progress”).

What happens after rehab?

The importance of aftercare -- including AA meetings, group therapy, participation in support groups, family counseling, and medical checkups -- cannot be overstated. A lifetime commitment is often required.

Alcoholic data and progress

Sadly, solid statistics on recovery do not exist because the necessary data is hard to compile for several reasons:

There is no central repository for this information.  Rehabs don’t have to report outcomes to a central authority.

Twelve step programs (e.g. AA, NA) do collect estimates on the number of members that they have, but they do not track or record the progress that individual members make in their recovery.

There is a lot of shame associated with alcoholism. As a result, individuals (and their physicians) are reluctant to record honest diagnoses on hospital admission and discharge notes.

When people die of alcoholism, the cause of death is often described as something else. Accidental injury, exposure, pneumonia, infection and suicide are commonly reported causes.

Briefly, the Center for Disease Control (CDC) published a report estimating that 632,000 Americans die every year from tobacco, alcohol and drug addictions. The World Health Organization published a report that estimates that 3 million people die worldwide from alcohol abuse.

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Newsletter: Sugary candy for the soul

I don’t teach, preach or sell hard. I do send out silly ten second stories about people, places and things.

• November 2022
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• October 2022
  • Oct 3, 2022 A brother helping me remain in light Oct 3, 2022
• September 2022
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• August 2022
  • Aug 1, 2022 The question of an evolving identity made whole by street artists and vandals Aug 1, 2022
• July 2022
  • Jul 4, 2022 The warmth of knowing my baseball glove is in the sweater drawer Jul 4, 2022
• June 2022
  • Jun 2, 2022 Sonny Rollins standing on the bridge in Giverny Jun 2, 2022
• May 2022
  • May 1, 2022 Sitting in front of forever May 1, 2022
• April 2022
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• March 2022
  • Mar 2, 2022 Foghorn Leghorn inside the flower garden of the mind Mar 2, 2022
• February 2022
  • Feb 6, 2022 My first cup of Tibetan butter tea Feb 6, 2022
• January 2022
  • Jan 4, 2022 Dancing is better with a corn dog in each hand Jan 4, 2022
• December 2021
  • Dec 1, 2021 Even Edgar Degas made mistakes Dec 1, 2021
• November 2021
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• October 2021
  • Oct 2, 2021 Still life painting at 36 Via Fondazza Oct 2, 2021
• September 2021
  • Sep 19, 2021 True creative genius Sep 19, 2021
• August 2021
  • Aug 17, 2021 "Sometimes you need to just lay on the sidewalk and bleed for a little bit" Aug 17, 2021
• July 2021
  • Jul 12, 2021 Dozens of worn-out couches in a true art house Jul 12, 2021
• June 2021
  • Jun 14, 2021 Daft Punk Frida Jun 14, 2021
• May 2021
  • May 17, 2021 Eating cake in a cemetery May 17, 2021
• April 2021
  • Apr 8, 2021 Mindfulness, meditation, a drum circle and the yellow doves of Mount Airy Apr 8, 2021
• March 2021
  • Mar 9, 2021 That diner in Brighton Mar 9, 2021
• February 2021
  • Feb 17, 2021 Tibet via North Philadelphia Feb 17, 2021
• January 2021
  • Jan 11, 2021 Bukowski is family Jan 11, 2021
• December 2020
  • Dec 23, 2020 Mindfulness, meditation, parking meters, poems, love notes and library books Dec 23, 2020
• November 2020
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• October 2020
  • Oct 20, 2020 Tequila, cops and grace Oct 20, 2020
• September 2020
  • Sep 25, 2020 Feeling the machinery Sep 25, 2020
• August 2020
  • Aug 17, 2020 The futile fury of a final letter Aug 17, 2020
• July 2020
  • Jul 4, 2020 It all begins with the word Jul 4, 2020
• June 2020
  • Jun 19, 2020 Hate in the abstract. Love in the specific. Jun 19, 2020
• May 2020
  • May 19, 2020 Dirty hands drawing a circle May 19, 2020
• April 2020
  • Apr 19, 2020 A singularity built from many pieces Apr 19, 2020
  • Apr 14, 2020 Resurgent feelings and the Bowery's Blitzkrieg Bopper Apr 14, 2020
  • Apr 5, 2020 Channeling my inner Iggy for the third time Apr 5, 2020
• March 2020
  • Mar 24, 2020 A golden eagle's echo will carry forever Mar 24, 2020
• February 2020
  • Feb 21, 2020 Seven crappy poems Feb 21, 2020
  • Feb 11, 2020 Words from the white space Feb 11, 2020
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• January 2020
  • Jan 30, 2020 Mindfulness, meditation and the Yah-Yah contraption figure Jan 30, 2020
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  • Jan 16, 2020 Mindfulness, meditation, nevermindishness and nothingness Jan 16, 2020
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• December 2019
  • Dec 31, 2019 Baked beans and ice cream Dec 31, 2019
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  • Dec 13, 2019 Obscure references lend credibility, especially when you make them up Dec 13, 2019
  • Dec 9, 2019 Three fingers tickling the air Dec 9, 2019
  • Dec 5, 2019 Sunday dinner at the DiGiulios Dec 5, 2019
• November 2019
  • Nov 26, 2019 One man's silly secret to writing an online dating profile Nov 26, 2019
  • Nov 20, 2019 Burning man at Burning Man Nov 20, 2019
  • Nov 18, 2019 A didgeridoo full of goo Nov 18, 2019
  • Nov 16, 2019 Two thousand words from the future Nov 16, 2019
  • Nov 14, 2019 Every scar is cool Nov 14, 2019
  • Nov 12, 2019 Daily affirmations and anonymous encouragement taped to the back of a stop sign Nov 12, 2019
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  • Nov 2, 2019 Ferried on the fingertip wings of an angel Nov 2, 2019
• October 2019
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  • Oct 29, 2019 Nietzsche was wrong about almost everything Oct 29, 2019
  • Oct 27, 2019 A singular reason to hate social media Oct 27, 2019
  • Oct 25, 2019 Mindfulness, meditation, chance and The Village Vanguard Oct 25, 2019
  • Oct 23, 2019 Umbilical Oct 23, 2019
  • Oct 21, 2019 The curve of a single elegant line Oct 21, 2019
  • Oct 19, 2019 Five Boro Flamingo Oct 19, 2019
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  • Oct 15, 2019 A python named Tom and a Toyota test drive Oct 15, 2019
  • Oct 13, 2019 Sweetie pie and the sugary fire Oct 13, 2019
  • Oct 9, 2019 A great artist doesn't need to leave a single great artwork in his wake Oct 9, 2019
  • Oct 7, 2019 Eleven effective ways to control the tempo of negotiations with a car salesperson Oct 7, 2019
• September 2019
  • Sep 28, 2019 What to expect from the dealer trade vehicle evaluation Sep 28, 2019
  • Sep 24, 2019 Three stories being told at once Sep 24, 2019
• August 2019
  • Aug 24, 2019 Thirty years away from the Blues Aug 24, 2019
• July 2019
  • Jul 22, 2019 Ten hours in Madrid Jul 22, 2019
  • Jul 11, 2019 When life slows down to let you take a look Jul 11, 2019
  • Jul 6, 2019 The Buddhist Manager Jul 6, 2019
  • Jul 2, 2019 The perfect, hopeful, subversive headbanger Jul 2, 2019
• June 2019
  • Jun 27, 2019 Scribbleheads Jun 27, 2019
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• May 2019
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  • May 28, 2019 Five 70s albums every Millennial should listen to this weekend May 28, 2019
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