I saw Loreen, age 32, in follow-up yesterday. She has now gone 20 days with no alcohol.
Making Choices Based on Freedom
For almost a year she was coming to our office regularly to get a Vivitrol shot to help her deal with her drinking. She had been very resistant to the idea of stopping drinking altogether, so she used naltrexone in the form of monthly injectable Vivitrol to help her cut down. I don’t know if she ever told me the true amount of alcohol she had daily. People are embarrassed to admit how much they are consuming. Over the years I have often heard medical professionals say you need to double the amount that a patient tells you.
I do know that every month when Loreen came in faithfully for her Vivitrol, she seemed to be holding on with a thread. She had learned last year that her liver enzymes were elevated. It scared her enough to cut down, but not to stop. She was making a lot of her choices based on fear, not freedom.
Ready to Hear the Answers
When any person comes to the Coleman Institute for Addiction Medicine for help getting off any substance, our staff readily meets them where they are. The truth is, many patients are not committed to giving up drinking altogether, and I am afraid that keeps some people from learning more about treatment. I think the fear of being judged, labeled, or trying to quit and failing, or the questions about if they need to quit drinking, can keep a person from asking for help or even getting more information.
If you’re afraid to hear the answers, it may keep you from asking the questions.
Our job as I see it is to first understand what our patient wants. This may be as important as knowing exactly how much of, or what type of substances one is using, taking or drinking. Abstinence is not everyone’s goal. The idea of never drinking again or never using again can be pretty terrifying and can keep people feeling quite ambivalent and stuck.
Reducing Use
Loreen never missed an appointment for her monthly Vivitrol injection. She defiantly held on to her 3-4 drinks a day and stated she was content with the fact that she had decreased her alcohol consumption from sometimes 18 beers/hard seltzers a day down to this ‘minimal’ amount. (Even at this greatly reduced amount, Loreen meets the criteria for At-Risk Drinking. The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use for healthy women as more than three drinks per occasion or more than seven drinks per week and any amount of drinking for women who are pregnant or at risk of pregnancy. Binge drinking is defined as more than three drinks per occasion.)
As with many patients we have seen over the last year, Covid had significantly contributed to escalating Loreen’s drinking. She works for a company doing customer service and spends her workdays answering emails. It was far too easy to drink at home and she didn’t think her work was suffering. At least, she never had any complaints from her manager.
Filling the Void
As I got to know Loreen and she opened up a bit more at each visit, I came to realize that her deepest desire was to stop drinking. And it was her deepest fear. First, she was fearful of the physical aspect of quitting. She had considered stopping on her many times but was aware of the possibility of an alcohol withdrawal seizure. And then she was afraid of the looming question: how will I do anything without alcohol in my life? What will fill that void?
We talked about outpatient alcohol detox. At first, she was resistant for all the reasons mentioned. However, once the seed was planted and she took time to think about it, the safety aspect felt good to her. Then she was concerned about missing work. She only had four more days left in her PTO package.
Our outpatient alcohol detox at the Coleman Institute for Addiction Medicine requires three days of coming to the office, followed by 48 hours of supervision by the support person of the patient’s choice. By doing her detox on Wednesday, Loreen was able to fit this into her schedule far more easily than she thought. She is also one of the fortunate people whose insurance covers almost 100% of the detox.
So yesterday was twenty days without alcohol. Covid be damned, we hugged when we saw each other. She had tears in her eyes. She is so tentatively proud of herself because she doesn’t remember the last time she has gone this long without a drink.
Finding the Right Treatment
She is feeling better. One of the things she is most delighted about is her skin and face. She told me her bloat has disappeared. Since I’ve only seen her with a mask, I can’t say for sure, but I believe her. We invited her to join a weekly Zoom group, and she has now attended twice without using her camera. She plans to continue seeing a doctor for mood disorders. She may not need pills since she stopped taking drugs after all.
Tips for Staying on Track
Although I’ve never been a big Halloween-er, a 2011 article in Time magazine lists Halloween as one of the Top 10 drinking holidays in the country! So, since her appointment happened on the brink of this holiday, I asked Loreen if she historically celebrated. Indeed, she did.
Very cleverly she had already made plans to protect her budding sobriety over the holiday weekend. She opted out of a big party where people will be downing caramel apple pie shots and be obliterated by pumpkin spice brew. She had a couple of friends over to watch the original Halloween with Jamie Lee Curtis, and maybe The Shining. Dressed in costumes, they planned to walk through town to pick up their favorite take-out and make huge bowls of popcorn. And eat plenty of candy. She couldn’t wait! She has been humbled at the amount of support her friends and family are showing her. Her close friends voluntarily are choosing not to drink when they are together--at least for now.
I encourage you, especially if early in your sobriety to be ready, like Loreen, with a plan to protect your newfound freedom from alcohol or drugs. Even though Halloween doesn’t come with the same emotional baggage other winter holidays bring, here are a couple of ideas to increase your odds of success:
- Mix up some Halloween Mocktails-In a 2-second search I found recipes for Autumn Harvest Punch, Apple Moscow Mules, and Sparkling Cranberry Cinnamon Mocktails.
- Find a local haunted adventure. There are always events happening around Halloween, like haunted houses and hayrides, mazes, and whatever local haunted attractions are near you—classic horror movies, graveyard tours, concerts, etc. Check your local listings to see what's happening nearby and bring a family or friend who supports your sobriety.
- Decide to just enjoy hanging out and watching the kids make their way down the streets tripping over costumes, adjusting masks, and going for the record amount of candy.
- Most importantly, honor how you're feeling today, so if you'd rather stay in and watch scary movies instead of going out, do it. Simply not drinking can take up a lot of energy, especially early on, and especially during the holidays. It won't always be that way, but if that's where you are today, you aren't alone.
We love and respect our patients. This fall, our founder and leader, Dr. Coleman is celebrating thirty-seven years of sobriety. His gratitude for and devotion to his own and other people’s recovery permeates the spirit of our clinic. If you want some compassionate, non-judgmental, competent medical care, give us a call. In the meantime, stay safe.
Joan R. Shepherd, FNP
