Reducing Use of Mood-Altering Substances

Drugs and alcohol are called mood-altering substances for a reason: They alter a person’s mood, and the person has no control over how his mood is altered. People commonly report that they use alcohol to help them relax, but the disinhibiting effects of alcohol often turn into physical aggression, yelling and screaming, tears, and so on. If a person already has difficulties managing his emotions, is it wise to add the unpredictable effects of drugs or alcohol?

Some people use alcohol to help them sleep. It’s important to understand that alcohol actually has a negative effect on sleep due to a rebound effect. Four to five hours after consuming alcohol, the rebound effect kicks in and people usually find themselves awake. In addition, researchers have found that consuming alcohol within an hour of bedtime seems to disrupt the second half of the sleep period, so people don’t get the same deep sleep they otherwise would.

Then there are people who use drugs or alcohol to help numb their emotions so they don’t have to deal with them. This makes sense, and we therefore need to validate it, indicating that we understand it, and at the same time encourage them to see this as a goal to work on, as it’s unhealthy and possibly even self-destructive.

Your first challenge may be to just get a person to see that drugs and alcohol are a problem. But even when people can see that a behavior is problematic, they still might not want to change it. In this case, the next challenge is getting them to set small goals around reducing their use—keeping in mind that if a person isn’t willing to set something as a goal yet, you need to accept this and gently continue to push for change over time.

Sources: DBT Made Simple

Will Tonight Be The Night

July 22nd, 2009

It had been one of those weeks. I was on a bender. I was always on a bender averaging around eight drinks a day, but this one was significant, was impressive even by my standards. I was drinking more than usual during the day and then when I got off work I headed direct to the Bar. I wasn’t eating, hardly sleeping, just drinking heavily. It was a mere two and a half blocks to the Bar, I could stumble to and from there in my sleep.

I slapped my copy of Anna Karenina on the bar. I read it once every year and it was that time of year again. The days of me actually ordering a drink here had long since passed. A moment later I had my well vodka tonic and a rocks glass of Jameson. The perks of being a regular. Work had been slow and I was eager to put it behind me. Tomorrow would be better, it could hardly be worse. I glanced around the oval shaped bar, most of the usual regulars were there. The professor was talking with his latest girl. He wasn’t a full fledged professor, but a lecturer at Montana State University. He read genre fiction in his spare time. He would bring in about five books a month to trade in at my used bookstore. I almost always sold his books online within a day or two. We’d talk a bit of philosophy and the current events at the university.

P was sitting across from me drinking her coke. N her boyfriend and father of their unborn child was bartending. She had her laptop in front of her going through possible baby names. She was a photography student with a penchant for going to the strip club outside of town. N would stop by her every few minutes and they’d exchange a glance or a joke. She was talking to the girl next to her I didn’t know. We would probably talk later as we usually did. She stopped in the store from time to time, but just to say hello and see if I’d be at the Bar later.

The Jameson and vodka was going to my head quickly tonight. It could be the alcohol I’d already consumed today or the blood I’d been passing lately. This was going to be an early night even if it was my thirty-seventh birthday. J walked in, a girl who had taken interest in me a couple of months ago as the guy who was always quiet and reading. She wishes me a happy birthday ordering us each a shot of scotch, Johnnie Walker Blue. We had polished off most of a bottle back on her birthday. It had cost a fortune. She sits down and we begin to chat. She runs a construction crew and has been by my store a few times.

I’ll miss my drinking buddies I casually think to myself when I’m gone. I wonder if it will be tonight or maybe tomorrow. This is what I’ve lovingly begun to refer to as my passive suicide attempt. I’m not leaving a note, just goodbye. The world will be better off without me. I’m sure it will hurt my family, but one large hurt is better than the endless small hurts I’ve been causing them these past few years. I wonder if I’ll have many people attend my funeral. I’d like a decent size crowd. I push my empty glass forward for a refill and return to my book. “If you look for perfection, you’ll never be content,” I mumble.

“What’s that,” J asks.

“Just something from the book,” I pat it tenderly, “if you look for perfection, you’ll never be content.”

“Do you believe that?”

“Yes.”

“I think we need another shot.” Moments later I have my well vodka tonic, a rocks glass of Jameson, and a shot of Johnnie Walker Blue all in front of me. The shot goes down a little rough. I can feel the heat of it in my belly and my stomach churns in response. I take a large swallow of my vodka tonic to calm it down. “You alright tonight?”

“Just tired,” I reply.

“Well you’ve got a long night ahead of you the two of us,” she giggles.

“I’m in,” I lie.

“Be right back,” she gets up heading in the direction of the bathroom. I take it as a sign for me to escape. I quickly stand the alcohol hitting me. Grabbing the barstool I steady myself. This could be an interesting trip home. I can feel the heat of the shots in my belly as my nausea is returning. I have to get out of here quick before I’m ill. I’ve thrown up already twice today, all liquid. I haven’t eaten anything in a few days and the cheap vodka diet is playing havoc on my system.

“Will tonight be the night the sweet comfort of death closes my eyes forever and ends the unrelenting pain,” I mumble leaving the bar for home before J returns.

Please, Just Let Me Fade Away

July 23rd, 2009

Ugh,” it was a long night even though I came home early and now this knocking on my door. Just ignore it and they’ll go away. Persistent buggers they are. Squinting I open my eyes the room has a faint light through the fog or is it smoke. It’s much too early to get up. I glare at the nearly empty bottle of Jameson, my hands are shaking more than usual I need a shot. This endless cycle of drinking needs to end, but not today. I’ll close my shop for half an hour and drive to East Main Liquor. What happened last night after I got home it’s all still so hazy?

I puked. I remember that. How could I forget one hand braced on the bathtub and the other on the sink as I heaved until my throat was sore. Blood. I threw up blood and lots of it everywhere, the toilet overflowing as I couldn’t stop. Blood and vodka. That’s why I’m so weak this morning, I can hardly lift my arms. I’ve cheated death again I wasn’t supposed to wake. I puked at the bottom of the stairs too. I remember mopping it up, smearing the blood everywhere. Bookshelf, I knocked over a bookshelf. I must have been really drunk or is it the blood loss. Maybe I’ll just close the store for today. I need a break a day off just to sleep.

“Mark open up,” a familiar voice calls from outside my apartment door.

“Dad,” I groan, “must be dad.” I grab the Jameson bottle setting it on the floor in a vain attempt to hide it. My apartment hasn’t been cleaned in weeks. There are empty liquor bottles strewn everywhere, an overflowing ashtray, clothes piled anywhere and everywhere I felt like tossing them, piles of books, and trash everywhere. It was in a word revolting, only an insane alcoholic could live this way. I used to be such a germaphobe how did I let it get to this?

I struggle to sit up and get to the door. The knocking is much louder this time, hurried and concerned. Can knocking be concerned? This one is. Yesterday was my birthday and I hardly even spoke to my parents. It’s way too early for a lecture. I unlatch the door and collapse back on to the bed my legs unable to support my weight. I can feel the wave of unconsciousness coming over me. Must stay awake. I see the disapproval in my father’s eyes, no it’s concern, downright worry. I must look worse then I thought. That’s when I remember the blood. Blood everywhere downstairs. He had to walk through the dried caked on blood covering the floor and splattered up the walls.

“Put on your socks,” he pleads. I’m fading everything is going dark. The fog is creeping in burning my eyes. Unable to see. “Mark we’ve got to get you to the doctor, to the hospital. Put on your socks.” I’m fading further into the darkness. Maybe this is it, what I’ve been waiting for. Not like this, not with an audience. Would he cry? My father never cries, not when someone dies, not when he’s frustrated, never. I grab my socks tugging them on, tightly on my hands and up my arms. Later this will be humorous, but for now his youngest child’s life is in danger. Delay could mean my death.

I’m fading ever closer, closer to the brink. It’s welcoming me to the other side. Screaming, blood curdling anguished screaming. Someone shut that person up! “It’s cold,” the voice cries inside my own head, inside my body. I’m the one screaming my eyes flash open. I’m in the ER now, how did I get here, doctors and nurses huddled around me. A large IV piercing my vein as they dump the blood into my body. I’m near death and they’re saving me. Jerk out the IV and let me fade, fade away from this world. This isn’t how I wanted to go. I thought I’d go silently into the night, not with a struggle, not a fight.

Somewhere in the darkness of my mind Anne Sexton speaks to me, “Death, I need my little addiction to you. I need that tiny voice who, even as I rise from the sea… all there, says kill me, kill me.” I’ve been reading too much of the confessional poets lately: Sexton, Sylvia Plath, Robert Lowell. They speak to me, to my depression, to my hallucinations, to the people implanting thoughts in my head I can’t control. Would a therapist have made things different for me, a different outcome. Am I simply too proud to seek help, too stubborn, too foolish, too drunk.

Time passes fast and slow depending upon your mental state. For the next day I’m certain it crawled by for my parents as they awaited an update. For me it flew by as I faded in and out of consciousness a multitude of medical procedures performed. Before I was able to answer the doctor’s questions they performed an endoscopy banding my varices in an attempt to stop the bleeding. I was given seven units of blood, your body holds ten.

Vignette of The Past

Vignette of The Past

I sit at the end of the bar,
A tattered copy of Percy Bysshe Shelley before me,
An ashtray overflowing with Camel Straight cigarette butts,
The fifth double Vodka-Tonic of the night resting upon a stained coaster,
Three shots of Jamison Irish Whiskey in a rocks glass,
I down a swallow of the whiskey, followed by a gulp of Vodka-Tonic,
And finally a slow drag from my cigarette,
Silent pleasures of a life already lived.

Crisis: Diagnosis Alcoholic Cirrhosis

Mayo Clinic (Jacksonville, Florida)

Bozeman Deaconess Hospital
July 25th, 2009

The limp body father and son carried a couple days earlier, an arm over each of their shoulders, was jaundiced, and helpless. They were headed for Doctor Patterson’s office hastily not certain what was wrong with their load. It would only take him a moment to recognize the signs and call the emergency room. A few hours earlier the father had broken into his youngest son’s apartment to find him confused and disoriented soaked in sweat and droplets of blood.

I had been diagnosed with end-stage liver disease. I was forced to close my little bookstore I lived above. I was lying in the intensive care unit as I had almost bled out from ruptured esophageal varices, abnormal, enlarged veins in the lower part of the esophagus. My parents were moving my possessions from my apartment into storage, I was moving back in with them unable to care for myself. I was an alcoholic who had brought this on myself. I was at ground zero, I had bottomed out, my life was in shambles and I was clinging to the unknown, the long road ahead of me through liver transplant and back to life. I had screwed up, screwed up big this time. I don’t make small mistakes, I make grandiose ones. I don’t screw up my life in subtle ways, I go over the top. I hadn’t really been living for sometime, merely existing, languishing too afraid to live, too afraid to die. My parent’s worried faces were burnt into my brain as they looked down on my body love in their eyes, tubes pouring out of me to the ticking, clicking, beeping monitors that kept me alive. The doctors had poured seven units of blood into my body in an effort to save my life, with three more to come in the next few days. It’d worked. Beyond all reason, I was ready to fight!

I had known for sometime I was slowly killing myself with each drink, I was unhappy, severely clinically depressed, ready to die. I had begun passing blood two days before my thirty-seventh birthday. My stool was black, grainy, appearing like coffee grounds. I googled the symptoms. Word for word there it was on the computer screen, I was passing blood. Get yourself to the emergency room immediately. There was no grey area in the instructions. I poured myself another pint sized vodka tonic, heavy on the cheap vodka, Kamchatka. The tonic water just enough to give the hint of effervescence. I was sitting in the dark at my desk in the bookstore a half empty bottle of Jameson Irish whiskey on the desk, my vodka tonic in hand, and the computer screen screaming liver failure, alcoholic cirrhosis. I didn’t care, perhaps this would be it. I’d lie my head on the pillow and never wake, an end I was anticipating, even welcoming.

This tightrope, this cliff, this edge was the precipice where I seemed to live. The only people who truly know this precipice are those that have gone to excess. I had fallen. This was it, this is where I’d been headed for a few years. I wasn’t the heaviest drinker I knew, far from it in fact. There was Taylor who infamously in my circle of friends routinely completed the Jäger challenge. I’d watch with some perverse fascination as he’d slam down an entire pint glass of Jagermeister in one swallow. It was impressive on some level. There was Frank who was twenty years my senior and would drink pint glasses of whiskey sours with maybe a shot of sour mix. I would sit with him while he drank four, five, six or more of these in an evening, every evening. I was always the quiet one at the end of the bar, a classic novel perhaps Hemingway or Tolstoy in front of me, sipping my vodka tonic and a rocks glass of Jameson Irish Whiskey. I used to be a beer drinker, but that had changed somewhere along the way. I had built up a tolerance and needed something stronger, faster, cheaper.

I knew I had lost control about a year and a half earlier. Up until then I never drank at home, I never drank alone. Now my alarm went off in the morning and I’d pour myself a shot of Jameson and drink it down before I sat up in bed. How had I gotten to this point? The negative self talk had gotten worse, much worse. I’d wake each morning tremors wracking my hands as I needed my fix. A shot of whiskey and my hands calmed down, not steady but functional. I’d head downstairs to open my store. I’d pour myself a vodka tonic I kept in the dorm fridge behind my desk. My store that had once been doing pretty well, now the recession, a new public library, recently opened Barnes & Noble and Borders Books all cutting into the bottom line. I had poured myself into my little store and somehow I’d turn it around I endlessly told myself. I couldn’t fail at this, it’s all I had. I wasn’t ready to admit failure, not if I could help it, I’d rather die first.

Something had transpired between those last days of drinking and waking up in intensive care gazing into my parent’s eyes. It was utterly simple, for the first time I could recall in several years I wanted to live. I’m not sure at first if I wanted to live for them or myself, but unmistakably my thirst for life had returned. I had long known I needed a therapist, a psychiatrist. I desperately needed help. It had come on slow and suddenly at the same time. I guess that’s how mental illness works. It was hard to recall when I hadn’t been depressed. I was barely a teenager when I first noticed the hole growing inside me, something empty. It was small at the time, faint and lacking the substance it would develop in later years as I fed it with each cocktail. I’d learn to nurture and focus on the emptiness I felt so acutely. Did I really have it all that bad though, so many had it worse. After all I had a loving family, my own business, friends, and vodka. I’d just feed the growing hole another drink, ignore it, block it out. It was a sign of weakness to seek professional help for your problems, I could handle it myself, I’d simply pull up my bootstraps and carry on.

They say what doesn’t kill us makes us stronger. You are only given what you can handle. The cliches are endless and infuriating, but sometimes on target. I had the most difficult fight of my life directly ahead of me. I was being held together by tubes and wires, the intensive care nurse checking on me every few minutes to take my vitals. I had no idea what I had been through the last few days as I lie there fading in and out of consciousness. No recollection of what I’d put my parents through as they prayed that I’d survive. I could read the worry in their faces as the doctor asked me questions. “Do you know the date? Do you know where you are? Do you know who these people are?” I could only imagine he’d asked me these questions before and I hadn’t known the answer. Guilt was already swelling inside me, but there was a more acute emotion dominating shame. Admitting to my Alcoholism was only the final confirmation of how weak I truly felt. My natural reaction was to pour myself another shot of Jameson and bury these feelings, but that wasn’t available to me here. Instead when the doctor asked how much pain I was in, I responded with a ten. In minutes a shot of morphine was administered and I faded into sweet numbness these negative thoughts would be there when I woke. The running was over, I’d make my stand.