It’s estimated that about 12 percent of Americans suffer from alcoholism at some point in their lives. In a recent Wall Street Journal article writer Paul Carr described his very personal struggle with alcohol and the steps he took to overcome his addiction. He didn’t join Alcoholics Anonymous, but over the last few decades many have with impressive results: A look at the disease of alcoholism, what makes some people especially vulnerable, and the latest research on what works and what doesn’t in the effort to stay sober.

Guests

  • Dr. Markus Heilig clinical director, National Institute on Alcohol Abuse and Alcoholism
  • Samantha ' ' a member of Alcoholics Anonymous
  • Paul Carr writer and columnist

Transcript

  • 11:06:56

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. In the U.S., there are at least 14 million people who fit the clinical definition of an alcoholic. Millions more experience some negative consequences as a result of drinking habits. Joining me in the studio to talk about alcoholism and ways to overcome it, Dr. Markus Heilig. He's clinical director of the National Institute on Alcohol Abuse and Alcoholism. Samantha, a member of Alcoholics Anonymous, and from a studio at KNPR Las Vegas, Nevada, writer and columnist, Paul Carr.

  • 11:07:43

    MS. DIANE REHMI hope you'll join us throughout the hour, 800-433-8850. Send us your email to drshow@wamu.org, join us on Facebook or Twitter. Good morning to all of you.

  • 11:08:00

    MS. SAMANTHAGood morning.

  • 11:08:00

    DR. MARKUS HEILIGGood morning, Diane.

  • 11:08:02

    MR. PAUL CARRGood morning.

  • 11:08:03

    REHMGood to have you with us. Paul Carr, let me start with you. You wrote an article published in the Wall Street Journal, I gather you've also written a book, how you stopped drowning by drink, and you start by saying for years you had told yourself you were not an alcoholic. What finally brought you to a somewhat different conclusion?

  • 11:08:40

    CARRWell, I mean, a lot of people I know who are alcoholics have this sort of one big moment where it's like something dramatic happens and they know they need to get help. For me, it was more of a drip, drip, drip effect, no pun intended, where I just -- I had tried to quit. I had sort of inverted (word?) quit so many times before that I think just one day I woke up and realized after another, you know, huge night -- the previous night that I couldn't remember when sort of covered in all kinds of bruises, and I had phoned a friend of mine who was away on a business trip and sort of hurled abuse at her for no real reason.

  • 11:09:17

    CARRAnd I sort of started by telling myself, well, this time I'm gonna quit, and it was clear, though, I knew really that all the things I tried before just weren't working for me, and it was time to try something else.

  • 11:09:28

    REHMSo what did you try?

  • 11:09:31

    CARRSo my first thought, like hopefully a lot of people, was, well, I need to go into AA. I need to start attending meetings, and I had a surprisingly large number of friends who had gone to AA, some successful, some less successful, but I'm sort of one of those people who before committing to something does as much background reading and research as it's possible to do, sometime a bit too much.

  • 11:09:55

    CARRAnd I sort of read all the literature around AA and again spoke to people I knew, and just decided for a number of reasons that I outlined in the book, and then were extracted in the Journal, reasons why it just wasn't the right solution for me, and I just knew it wasn't.

  • 11:10:15

    REHMBut you managed to somehow create some situation for yourself whereby you could stop.

  • 11:10:29

    CARRYes. So I decided to make a list of the things that I knew were prompting me to drink, and also the behaviors that were associated with drinking. Maybe no directly caused by drink, but the problems with my personality that I wanted to fix and one of the things I realized was that in my sort of circle of friends, but also in my professional work as a writer and a journalist, I had written a lot about my exciting, fun, drunken adventures.

  • 11:10:56

    CARRAnd I knew that part of quitting would involve me being equally public about my problem with alcohol, and about my decision to quit, because I knew that the problem was every time was in a public situation, either personally or professionally, somebody would offer me a drink. It became just a thing you did. PR people would send me bottles of rum trying to carry favor with me. So I knew that the only way I was ever gonna have even a fighting chance of kicking this thing would be to be very loud and very public about my problem, and basically say I'm quitting drinking, and if you see me with a drink in my hand, I will have failed.

  • 11:11:32

    CARRAnd I wanted to create a situation where no matter where I was in the world, there was always a tiny chance that there was somebody who would have read, so I put it on Twitter. I put it on Facebook. I wrote a thing on my blog. All of the sort of social media things that are popular, in the hope that again there was this tiny chance that if I was even in the remotest part of, I don't know, Iceland, if I had a drink in my hand, there was a chance that somebody would see me and say, ah, there you are. I thought you'd quit.

  • 11:12:01

    CARRAnd my ego is such, and I'm not suggesting ego is a good thing, but me, for me, I knew my ego was such that I just would not allow that to happen. So -- and then, but that was the big thing I did. But then beyond that, once I stopped drinking, I then looked at all the other things that were wrong with my personality, and that's what the book and the article were about, were about saying, this was my list of steps which I somewhat cheekily, you know, I somewhat cheekily had 12 of them, and my suggestion was don't take my advice.

  • 11:12:32

    CARRMy advice worked for me. The whole thing with these sort of self-help programs is they tend to work very well for the person who created them, not necessarily for you. My advice is make your own steps, which by the way may be go to Alcoholics Anonymous. It definitely, definitely wasn't for me for a number of reasons.

  • 11:12:48

    REHMWriter and columnist, Paul Carr. Turning to you, Dr. Markus Heilig, how similar, how familiar does Paul Carr's story sound to you?

  • 11:13:03

    HEILIGWell, you know, so every human history is unique, right? And at the same time, there are so many common elements that Paul really captures very elegantly and very importantly. So, you know, I notice that he basically identifies many of the things that both are recognized as clinical diagnostic criteria for being an alcoholic, but also, he -- well, so, you know, he describes for instance how getting a small dose of alcohol, that we in the scientific pursuit of these questions call a priming dose, is one of the things that makes him relapse, makes him go into a drinking binge that...

  • 11:13:44

    REHMSo he's got to avoid that at all...

  • 11:13:47

    HEILIGAnd so he identifies as one of his behavioral strategies, he can't do that.

  • 11:13:52

    REHMRight.

  • 11:13:52

    HEILIGRight? So basically, this and many other examples, I hope we can come back to them, really show what an astute observer he is, and, you know, then he also is astute in observing that works for one person may not work for the other.

  • 11:14:09

    REHMExactly.

  • 11:14:09

    HEILIGSo it's a really a very complex -- it's a disorder. It’s as complex as the people who have it. At the same time, there are some common elements and we are beginning to understand a lot of those, and what happens in the brain as they play out.

  • 11:14:24

    REHMSamantha, we are obviously not using your last name. You are a member of Alcoholics Anonymous. How did you know first that you had a problem?

  • 11:14:51

    SAMANTHAWhen I realized that I could not stop drinking on my own. I just could not stop, and I found myself in a situation that as a sober woman I would never have put myself in.

  • 11:14:56

    REHMHow old were you when you first recognized your own symptoms?

  • 11:15:03

    SAMANTHAI was in my early 30s. The battle started in the 20s though. I would count the drinks, I would try not drinking. I struggled against drinking by myself and it didn't work for me. Eventually I got to the point where I was desperate and I was introduced to AA. It was not something that I could comprehend at the time. I was too damaged by the alcohol, but eventually I got to the point where there was nothing left for me to do except for to pick up the phone and call AA.

  • 11:15:38

    REHMWere you employed at the time?

  • 11:15:42

    SAMANTHAYes. I'm one of the alcoholics that doesn't have a DWI. I haven't been to treatment. I wasn't locked up. I wasn't fired. I wasn't kicked out. I crumbled on the inside emotionally.

  • 11:15:54

    REHMWhen you say you crumbled on the inside, what do you mean?

  • 11:15:58

    SAMANTHAMine was a moral bottom. I found myself living with someone who I would not choose as a sober person to have a relationship with. I had gotten to the point where I had no relationships with my family members, and everyone that I associated with was drinking alcohol to excess.

  • 11:16:18

    REHMTo excess. Was there one point at which you finally said to yourself, I must make this telephone call?

  • 11:16:31

    SAMANTHAFor me, what happened was, I got on my knees and begged God for help, and the next thing I know, I was on the phone with AA, and the next thing I know I was in an AA meeting. And there was a period of time where I didn't go to AA. There was about a year period. I didn't understand that my body was detoxing at all that time. All I could do was go to work, come home, eat dinner, and go to bed.

  • 11:16:58

    REHMNo drinking.

  • 11:16:59

    SAMANTHANo drinking.

  • 11:17:01

    REHMBut you had gone to one AA meeting?

  • 11:17:05

    SAMANTHAAt the beginning of this journey. Prior to that, I had bumped into AA a few times, but it made no mental connection in my mind.

  • 11:17:14

    REHMAnd then, somehow you turned around.

  • 11:17:19

    SAMANTHAWhat happened was, a family member at one point prior to this journey of being sober said to me, I think you might have a drinking problem, you may want to go to AA. And very glibly I said, oh, if I drink again, I'll go to AA. It was during one of my dry periods. And so I went to AA and I was introduced to a woman who drilled into my head what AA was and how it worked, but I hadn't made the connection emotionally and mentally and spiritually that this was a problem for me and there was a solution.

  • 11:17:57

    SAMANTHAOnce I knew there was a solution, and the problem became abundantly clear to me, in other words, I was emotionally tortured by my own behavior, that's the point that I begged God for help, wound up in AA, knew that eventually AA would just be a way of life for me. It was an internal knowing.

  • 11:18:18

    REHMSamantha, who is a member of Alcoholics Anonymous. Paul Carr is on the line with us from KNPR in Las Vegas, Nevada, and also here in the studio, Dr. Markus Heilig. He's clinical director of the National Institute on Alcohol Abuse and Alcoholism.

  • 11:20:04

    REHMAnd welcome back. We're talking in this hour about a problem that affects many millions of people in this country, alcoholism. And as you can imagine, there are a wide range of questions beginning with one from Marion in Dayton, Ohio. "Please talk about the difference in, if any, between people who abuse alcohol and alcoholics." Dr. Heilig.

  • 11:20:40

    HEILIGSo today the American Psychiatric Association has two diagnoses, alcohol abuse and alcohol dependence. I think that's a very bad idea. All research shows that abuse concept is very vague. Basically you can get drunk and engage in behavior that shows poor judgment and has high risk, get into a car crash and you've basically qualified for alcohol abuse. That's not really a medical diagnosis. That can be a function of many things. Not having adults around who tell you what's sensible behavior, you know.

  • 11:21:13

    HEILIGSo I really, I think together with most researchers in this area, don't think that abuse concept is very useful. When we come to the more serious diagnosis, or at least the way we view it, the more serious diagnosis of alcohol dependence, that's a very different issue. That is really an entity in its own right, as was famously written by a British scientist many years ago.

  • 11:21:39

    HEILIGAnd so there are criteria that are right now under revision by the American Psychiatric Association but there are some core elements. And it's important to say there is not any single lab value that will tell you you're an alcoholic. There's not a single brain image that'll tell you you're an alcoholic. This is a behavioral syndrome and it's complex. And so many things go into it but at the core is your loss of control of your own behavior. I think both Samantha and Paul have described this.

  • 11:22:11

    HEILIGYou intend to do one thing but you end up doing something else because your normal mechanism for controlling your behavior, for working toward the goals that you would normally be working to get swayed by alcohol intoxication, by your loss of control over how much you drink. And so over time you will also see this reflected in losing out in other areas of life. So again I think we've had both our other guests describe this and how you end up losing on hobbies, on inter-social relations.

  • 11:22:44

    HEILIGIn the end, because of these changes in your behavioral control in your brain ultimately that controls your behavioral choices, you will end up in a place where you really don't want to be.

  • 11:22:56

    REHMPaul, have you asked yourself, or is this even an important question, why am I an alcoholic?

  • 11:23:11

    CARRIt's quite a question. I've not asked myself that because I think I couldn't think of a reason why answering that question would help me. I mean, the fact is I was. And I don't think there's some cosmic reason why I was an alcoholic. I also don't necessarily think there was any genetic reason why I was an alcoholic. I hear a lot of people talk about the disease of alcoholism, and as Dr. Heilig said there, there's no clinical measurement that says you're an alcoholic. So I don't buy into the use of the word disease.

  • 11:23:40

    CARRSo no, I just happen to think it was something within me, whether, you know, whether it is genetic, whether it's psychological, whatever it is, that caused me to behave in this way. And that's why I knew in myself that it was me who had to beat it, that there was no drug I could take. There was no other thing that would stop -- like electric shock therapy, nothing. It was in me to fix it.

  • 11:24:05

    REHMSamantha, if I put that same question to you, do you have any idea why you became an alcoholic?

  • 11:24:19

    SAMANTHAI would imagine for me -- I know the home that I grew up in was very scary and alcohol relieved the emotional pain. But physiologically, from what I've read, I'm predisposed. And when you put alcohol in an alcoholic body you wind up -- if you drink too much of an abusive substance you're going to wind up drunk. That's my understanding.

  • 11:24:43

    REHMWhy are you predisposed?

  • 11:24:47

    SAMANTHAMy understanding is it is a genetic disease. I never have really cared why I'm an alcoholic. I am an alcoholic. I have to deal with what I've got.

  • 11:25:01

    REHMDr. Heilig.

  • 11:25:03

    HEILIGSo we need to put a few facts on the table. They don't negate any of the things that Paul and Samantha say but first of all, there's no such thing as a disease being genetic or not. It's all varying degrees, right. And we know by now that there's very good psychiatric geneticists at the Down Institute. David Goldman and many others have studied this extensively. And if you sum up all the studies about half the risk for becoming alcoholic is indeed determined by your genes.

  • 11:25:36

    HEILIGNow so we have to get this out of the discussion. You know, saying that there is a genetic risk, say that this is destiny, of course it's not. But you're at higher risk just like someone who has the genes for becoming obese is at higher risk for getting cardiovascular disease. It shouldn't be this black or white, you know. We don't want to acknowledge that it's genetic because then it's all genetic.

  • 11:26:02

    HEILIGSo there is a substantial genetic risk and that of course -- then, of course, that risk interacts with what you live through, your experience, your environment. And in the end, if the genetic risk combines with various life events, or most importantly because alcohol is actually the most important environmental factor in determining what the environment does to your brain, if you drink enough you will become an alcoholic. So both these things play together.

  • 11:26:34

    HEILIGJust one more thought along that line is even the component that's genetic in the risk is very different from person to person. And so Paul says, why would I care whether this is genetic or not. Actually, you might benefit from knowing that so because -- so in one person the genetic risk may be because you're very impulsive. And when you drink you experience a lot of pleasure and you start doing risky things. Well, that's one kind of risk. And you can imagine certain behavioral things you could do in order to avoid that risk.

  • 11:27:09

    HEILIGAnother person is very prone to anxiety, perhaps social anxiety and so can't go out into a group of people and interact freely without taking a couple of drinks. Well, that will lead you to very different behavioral strategies in order to mitigate the risk that you were born with. So the important point here is to say that understanding the role of genetics, both in terms of how much it plays a role and in what way it plays a role is not to tell people this is not something you can do something about yourself. It is to help people understand how to manage the body we were born with.

  • 11:27:49

    REHMSamantha, how effective has AA been for you and why?

  • 11:27:56

    SAMANTHAIt's been 100 percent effective. And the reason it's been 100 percent effective is because the person that told me what AA is and what AA does and showed me how to be a member of AA was very clear. And that was she said study the Big Book, don't just read it. Take the steps as quickly as you can. Get a sponsor. Be a sponsor. Stay in the middle. People on the edges fall off. And do whatever you can for AA.

  • 11:28:25

    SAMANTHAAnd so that's what I've done for many years and it's been successful. My home group is a Big Book study group. We focus on the new person. Anyone that's suffering from alcoholism or has a desire to not drink is welcome. We pay special attention to them. We offer them what we have. I go to a step meeting on Monday nights. Again, we study the literature, we study the traditions.

  • 11:28:53

    REHMYou've mentioned the Big Book. What is the Big Book?

  • 11:28:58

    SAMANTHAThat is a fond nickname for the book "Alcoholics Anonymous." That's referred to as our basic text. A lot of the language may be viewed as antiquated and perhaps even the chapters. But if time is actually taken and you read the literature from front to back, as an alcoholic. I relate to many, many portions of each chapter within that book.

  • 11:29:28

    REHMAnd how important is God in the overall concept?

  • 11:29:34

    SAMANTHAGod is the concept. All of the stories in the back of the Big Book are written so that people can identify in, if they're an alcoholic and this AA is what's going to work for them, how that person developed the relationship with a concept of a higher power and how their life has changed as a result of that relationship with AA and their concept of a God.

  • 11:30:04

    REHMAnd, Paul, that's where you have a problem.

  • 11:30:08

    CARRWell, I mean, I should start by saying I have absolutely no problem with religion. I have no problem with people believing in any god. I just find it awkward that the concept of recovery from alcohol, which we've talked about in medical terms up until now, is so closely allied in the Big Book in AA with the concept of God and with the concept of -- there's a lot of talk about handing over your, you know, admit to God that you're addicted to alcohol. Put yourself, you know, in God's hands to fix -- I mean, I'm paraphrasing clearly, but put yourself in God's hands to fix this problem that you have no control over.

  • 11:30:50

    CARRAnd, you know, and Samantha talked very movingly earlier about how she, you know, she prayed to God to give her an answer and end up in AA. And that to me just doesn't seem -- I'm just not comfortable with that. I'm not comfortable with the idea that if you want to get help with alcohol abuse or with alcohol addiction or dependency, you have to go to this sort of pseudo-religious group and you have to talk about God. And even the way that AA meetings are described feels very religious.

  • 11:31:22

    CARRThe whole thing feels like a very religious organization. And there is nothing wrong with a religious organization, but I just don't understand why -- I mean, and not to be flippant, but when I went to church, they were quite happy to hand out alcohol. It doesn't seem like alcohol and the church are mutually exclusive so I don't understand why it's God's job to cure us of alcoholism.

  • 11:31:43

    REHMSo for you, in addition to going very, very public with your own problems, what else did you do on a daily basis to help you not to drink?

  • 11:32:01

    CARRWell, so the public thing was very important and continuing to update and continuing to talk about sobriety. And I created a silly website called ispauldrinkingagain.com because I would be often asked by people who couldn't believe I was sober. Oh, so are you drinking again? And I ended up creating this silly website to track the number of days that I was sober.

  • 11:32:20

    CARRMore importantly, though, it was about the other behaviors. It was about realizing that, for example, when I was drinking I would often tell these, to my mind, harmless lies to people. You know, where were you last night? Oh, I was, you know, in bed asleep when in fact I was out painting the town red. Or why was I late for a meeting. I'd say it was traffic rather than a hangover. And so one of the things I tried to do every day was address that and make sure that just in every aspect of my life I was as honest as possible.

  • 11:32:43

    CARRAnd obviously, if somebody tells you if a dress looks nice on them, you don't want to hurt their feelings. So I'm not saying I'm 100 percent, you know, truthful in everything. But the big lies and the ones that were damaging I tried to deal with. And I tried to deal with my health. That was another thing that drinking had definitely impacted negatively on my health. So I -- as I stopped drinking sure enough I started losing weight and becoming just generally more healthy and feeling but also clearly physically more healthy.

  • 11:33:09

    CARRAnd so I tried to pursue that a bit more. And I would walk more rather than taking cabs and just everything that I felt that alcohol had either contributed to or that I'd used alcohol as an excuse to not fix about myself I set out to fix.

  • 11:33:23

    REHMPaul Carr, writer and columnist and you're listening to "The Diane Rehm Show." During those times, Paul, when you were trying to be truthful, honest, you were taking care of your health, was it on a minute-by-minute basis that you were dealing with, do I want a drink or not?

  • 11:33:56

    CARRNo, it wasn't on a minute-by-minute basis. I mean, the initial few days it was certainly on a minute-by-minute basis. I was just surprised that, you know, the first time somebody offered me a drink and I said, no I'm not drinking, you know, I was shocked by my own decision. And so at the beginning, it was minute-by-minute, but very soon it became, you know, more of a daily decision. And I would have these occasional moments where somebody would offer me a drink and I'd have the moment of, you know, decision.

  • 11:34:23

    CARRAnd sometimes I was caught totally by surprise. I'd just suddenly find myself thinking, oh, I need a beer. And it was like, where did that thought come from? But generally, no. And this is another reason that perhaps for me AA didn't feel like the way forward, was I didn't want to make my entire life about sobriety and about constantly thinking about not drinking. I didn't want to replace one addiction to alcohol with another which is sobriety. I didn't want to be spending every waking hour thinking, I'm not drinking.

  • 11:34:50

    CARRAnd so one of the other things I did was try to replace my drunken adventures, many of which were fun. Some were horrible and damaging, others were fun, with sober ones. And I tried to find new and interesting, not just hobbies but places I could go that I'd never been to. I found myself saying yes to opportunities to go to places I'd never been or to meet people I'd never met just to see what would happen.

  • 11:35:15

    CARRAnd that was always my thing when I drank was I never had a sense of consequence. I never thought, oh well I won't do that 'cause something bad might happen. So I thought, well I'm going to translate some of that into sobriety. And if somebody says, hey we're all going to, you know, Spain to live up a mountain for a few weeks. Do you want to come? If there was any way of me doing that without sort of giving up work I would say yes. And then I'd think later about, you know, the logistics. So it was more thinking about stuff like that than thinking constantly, do I want to drink. Am I drinking?

  • 11:35:45

    REHMSamantha, how about you? How did you manage during those early days, months, years of sobriety? How did you test yourself? How did you manage to refrain?

  • 11:36:06

    SAMANTHAI was desperate. I don't ever want to go back to the lifestyle that I had prior to drinking. The early days, I was very damaged. I was afraid in that I didn't know how to live life without alcohol because I had drank virtually every day. I remember when I was first starting to have my emotions come back it came back as a sensation in my cheeks. And I'm thinking why -- what is going on? I mean, I was so removed from my emotional state.

  • 11:36:41

    SAMANTHAI'm a true miracle. The amount of alcohol I drank for the length of time I drank and the damage that I did to myself as a result of drinking, there's no reason why I should have the ability to sit here and have an intelligent conversation with you. The early days I just followed the directions. I didn't pick up the first drink. I listened to what people said. I didn't understand anything. I would say, I don't understand, I don't understand. I don't get it, I don't get it. And that's the nice thing about AA. No one said, well, you're stupid or you don't -- what do you mean, you don't understand?

  • 11:37:21

    SAMANTHAI just would show up and I would listen. And eventually what happened was I started to understand.

  • 11:37:29

    REHMSamantha. She's a member of Alcoholics Anonymous. When we come back, it's time to open the phones. I look forward to hearing your questions and comments.

  • 11:40:03

    REHMAnd welcome back. It's time to open the phones. We'll go first to Indianapolis, Ind. Good morning, Mary, you're on the air.

  • 11:40:15

    MARYHi there. I'm wondering, can your guests discuss some of the new medications that are available for treatment of alcohol and drug addiction like Naltrexone and Vivitrol?

  • 11:40:24

    REHMAll right. Thanks for calling, Markus?

  • 11:40:27

    HEILIGSure. So, actually Naltrexone is not that new. It's been around since the first results that we have convincingly showed that it helps to some extent with reducing heavy alcohol drinking, go back to the early '90s. It's a very particular kind of mechanism. So it basically blocks the rewarding or pleasurable effects from alcohol. And so it's a fascinating scientific story that’s evolved because, you know, it was discovered in those days and we didn't quite understand it. And so we saw that it helped on an average. And studies came out, Chuck O'Brien in Philadelphia and Stephanie O'Malley at Yale were the leaders of this research.

  • 11:41:12

    HEILIGBut once you summed up the studies, after some years, it appeared that maybe the benefit wasn't all that great. And so that combined with some, actually, hesitation to use medications in this field, then we can come back to that and also the lack of commercial interest because there was really no patent anymore for anyone. All that combined with the fact that less 5 percent of people with alcoholism, who go to a specialized treatment provider, receive a prescription for Naltrexone. Now, so it's dramatically underused. If there's one thing I'd really would like to highlight during this program, is there is these medications can help together with behavior strategies that we've now heard both Paul and Samantha describe and that in more formalized ways have been studied for many years and certainly provide benefit.

  • 11:42:04

    HEILIGThe medications can help. It's a fantastic scientific story because over the recent years, we've started to understand that this particular medication probably helps people with a particular genetic makeup. So again, people are different, right. And if we are willing to take an interest in how people are different, we can understand that the person who has a particular genetic makeup will actually benefit big time from Naltrexone.

  • 11:42:32

    HEILIGAnd that's reflected in our clinical experience where we have some people come back and tell us, for decades, I could not sample alcohol without going into heavy relapse. And now I've tried, even though you advised me not to, but it doesn't happen the same way, not that I'm -- and then you have a lot of other people where actually the benefit doesn't seem that clear. And so it's emerging that, in fact, that is related to our genetic differences.

  • 11:42:57

    REHMWhat happens to the brain through alcohol, Markus?

  • 11:43:05

    HEILIGSo alcohol is probably the nastiest drug of all addictive substances.

  • 11:43:12

    REHMReally.

  • 11:43:12

    HEILIGWhen it comes to its ability to reshape the way the brain works. It's just so broad and, you know, it affects pretty much every signal substance in the brain you can imagine. So, you know, this is not to say that cocaine or heroin will not change brain function. But I think heavy alcohol use, over time, does more to the brain then those drugs. And this is a fact that we really need to educate the public about because it's not appreciated.

  • 11:43:43

    REHMAnd yet alcohol is the legal drug of choice. Cocaine, heroin, all those others off the table.

  • 11:43:55

    HEILIGObviously so.

  • 11:43:56

    REHMWell, when you say it changes the brain, what do you mean? What does it do?

  • 11:44:04

    HEILIGWell, in the long term, it creates what we call structural damage. So you will lose your gray matter and basically your brain will shrink in volume. And that reflects very broad impairment of how your brain functions. But that's the extreme case. The important point is that way before you get to that point, you start changing the way two very important systems in your brain function. So we have, you know, the pleasure or go for it systems that evolution developed to make us put effort into achieving things that are good for us. And those systems will really tone down as heavy alcohol use exposes the brain for many years.

  • 11:44:51

    HEILIGAnd we also have other systems which are, sort of, the fear, stress, aversion systems which I tend to lump together under the stay away from it systems because they activate when we need to feel an unpleasant internal state to keep us away from things that are not good for us. So and that's perhaps an inside from more recent research over many years of alcohol use those stress and aversion systems will go into overdrive in a pathological way so that even in the absence of anything that's stressing you out, you will now feel unpleasant inner state.

  • 11:45:31

    REHMAll right.

  • 11:45:31

    HEILIGSo now you have to drink again to eliminate that.

  • 11:45:34

    REHMPaul, how long has it been since you've had alcohol?

  • 11:45:40

    CARRIt's just about over two and a bit years. Nearly two and a half years.

  • 11:45:45

    REHMTwo and a half years. Samantha, how about you?

  • 11:45:48

    SAMANTHANineteen.

  • 11:45:49

    REHMNineteen years. Does...

  • 11:45:51

    HEILIGWow.

  • 11:45:51

    REHM...that damage to the brain begin to reverse itself after these two people and others stop drinking?

  • 11:46:04

    HEILIGSo that's very difficult to study but I think it's safe to say that there are data that are actually quite hopeful. Even some of the damage that we can see on a brain scan in terms of, you know, what appears like loss of brain volume which I think most of us would've assumed that's brain tissue gone...

  • 11:46:24

    REHMGone.

  • 11:46:25

    HEILIG...that never to be regained.

  • 11:46:25

    REHMRight.

  • 11:46:26

    HEILIGThe fact of the matter is, there are studies showing that some of that volume is regained.

  • 11:46:31

    REHMInteresting.

  • 11:46:32

    HEILIGAnd that probably goes to say that, you know, before brain cells die, they start losing their various extensions that connect to other brain cells. And that accounts for the initial loss of volume. And so if you stop drinking, which always will be helpful, you will not only halt the damage but in fact you will give the brain cells an opportunity to recover. And if you combine that with a healthy lifestyle like Paul is describing...

  • 11:47:02

    REHMExactly.

  • 11:47:03

    HEILIG...that, of course, maximizes the...

  • 11:47:04

    REHMAll right.

  • 11:47:04

    HEILIG...opportunity.

  • 11:47:05

    REHMTo Dallas, Texas. Good morning, Gary, you're on the air.

  • 11:47:11

    GARYGood morning, Diane. Big fan of the show.

  • 11:47:13

    REHMI'm glad. Thank you.

  • 11:47:15

    GARYThis one in particular. I stopped drinking on October the 10th, 1991. It's been 20 years, just this past October. And it's kind of interesting that I agree with all of your guests for certain and different reasons. The AA was where I forced myself to say, okay, I'm an alcoholic. Not the denial, not the maybes, you've put it out there and people heard you say it. And that helped me. And then also, I could tell and I'm sure they could tell you, six months in, you get that clarity and you could focus again.

  • 11:47:47

    GARYAnd you can remember things and finish something. And you start to go, this is already -- I can see the benefit. And certainly after 20 years, I mean, you know I can hold somebody's drink and not even be tempted to drink it. You just remember that person, that alcoholic, waking up in the morning feeling miserable. I mean, how do you have a life like that where at the very beginning of your day, you're already in regret, you're feeling misery. You know, all of it goes away.

  • 11:48:15

    GARYI wake up every morning, I feel fine. I'm never hung over and I don't -- you know, and so I just wanted to tell anybody, listen, I assure you the benefits are there when you've stopped drinking alcohol. And it may take six months like it took me, it may take you longer but you start thinking, you know, I woke up, I don't feel horrible today. And, you know, under those circumstances, possibilities, you know can be there for you and the better way, you know.

  • 11:48:41

    REHMYep, Gary, congratulations to you. I'm so glad you called and I'm glad for your success. Here's an email from Julia who says "I have a family history of terrible alcohol abuse and drug abuse. I drilled it into my children's head now how alcohol almost destroyed our family. But I have a son and daughter who I feel drink way too much and feel it's a problem. They tell me, it's under control. Can you tell me if there's such a thing as inheriting alcoholism?"

  • 11:49:32

    HEILIGSo there isn't such a thing as inheriting alcoholism, that's for sure. But it's equally certain that there is very much so such a thing as inheriting a high risk for developing alcoholism. And I get very worried when I hear because this is stories I've seen over and over in my clinical practice. When you have a family with many generations of alcohol problems, you can assume that the genetics that we've studied more statistically are at play in that family. And so exposing yourself to the risk knowing that you have that increased vulnerability is just a bad idea. And this is a case where actually understanding genetics helps because it helps us tailor the prevention.

  • 11:50:19

    REHMPaul, was there anyone in your family who had alcoholism?

  • 11:50:27

    CARRYeah, on both sides of the family, there were certain history of it. And definitely the evidence suggests that there could be a genetic link. Again, though, my view is, I actually try not to focus too much on that because it's my problem to deal with and actually even if I knew there was a genetic risk, I mean, it's easy to sort of talk in theory about how, you know, knowing that there's a genetic risk, you should avoid these risking behaviors. But telling young people and telling me when I was in my 20s, oh, there's a genetic risk that you might be an alcoholic, you should not drink alcohol, I mean, it's an important message not to dismiss Dr. Heilig's point.

  • 11:51:07

    CARRBut it's, to me, would've been meaningless. And to a lot of young people to say, you are genetically predisposed to alcoholism. Yeah, okay. I’m just going to have a drink now because that's what my friends are doing. It's important -- bearing it in mind and knowing about it is very different from actually acting on it.

  • 11:51:22

    HEILIGSo I would like to argue with that a little bit. Since I've seen so many people with clinical alcoholism, I've also met their children. And it's not uncommon for the kids of these alcoholics to come up with that conclusion themselves. "Because this runs in my family, I'd rather stay away from it." So certainly, 20-year-olds may not be sensitive to risks that lay 10, 15 years ahead every time. But every case we can prevent is worthwhile.

  • 11:51:53

    REHMAll right. To Catherine in Indianapolis. You're on the air.

  • 11:51:59

    CATHERINEYes, thank you for taking my call.

  • 11:52:00

    REHMSurely.

  • 11:52:00

    CATHERINEMy husband's family has a strong history of alcoholism. His father had just out of control alcoholism, died at the age of 52. And we lost one of my stepsons to suicide several years ago that was going to alcohol and drug abuse. My other stepson has found a way to manage it and has my -- he doesn't drink at all. And my husband has his, I guess I would say, under control. But the problem is that none of my family members or my husband's family are religious people. And every time there was any attempt to go get help through AA, the very first thing they were told was that "You got to hand it over to a higher power."

  • 11:52:46

    CATHERINEWell, he doesn't believe in a higher power. What are you going to do? I know that there are smaller groups out there that encourage support and provide a lot of the things that AA provides. And I know that even pre-prohibition there was a group called the Washingtonians that the churches hated because they didn't turn to God. But I guess I would just like to say, I wish there could be less of emphasis in AA on God and more of an emphasis on just getting healthy and taking responsibility and not blaming or assigning over to something you don't believe in.

  • 11:53:24

    REHMThanks for calling, Catherine. And just to remind, you're listening to "The Diane Rehm Show." This goes back, Markus, to the discussion that both Paul and Samantha were having about the different approaches to alcoholism. And you wanted to react to that.

  • 11:53:50

    HEILIGWell, I think your caller has a very important point. And also, I'd like to say, that listening to Paul and Samantha may be the approaches are not so different. So what I'm hearing, is again, what I've heard over and over in clinical practice and research, both Paul and Samantha and Samantha through AA, Paul through his own thinking and analyzing, have in fact come up with many -- or started practicing many behavioral strategies to stay sober. And it's amazing how, you know, many of the things Paul describes are in fact things that any AA group would quite possibly be discussing at the meeting and teaching its members too.

  • 11:54:32

    HEILIGSo that's great, so that tells us that there are behavior strategies that help you stay sober. Avoid the things that trigger relapse and find other rewarding things in life. Now, people are different. If for Paul the rewarding things in life that can fill the void are the adventures of a sober life, globetrotting, that's wonderful. If for another person that rewarding thing is spirituality in the AA group, that to me is equally wonderful.

  • 11:55:04

    REHMIn other words, there is no single way to approach this.

  • 11:55:10

    HEILIGSo I think the behavior strategies are very much the same. And we need to be, you know, those fall in the domain of science, right. We need to really be able to pin down what are these behavior strategies? Which ones are the ones that are helpful? Which ones are not? But beyond that, you know, I step back and I tell patients, you know, AA is out there. It's a major player. They have put together a lot of the wisdom. Go try it.

  • 11:55:36

    HEILIGAnd it's very clear that for some people, they step into an AA meeting and they feel at home. And it gives them what they need. And if so, so be it. But it's also very important that we are aware of the fact that if that does not feel like at home, there's other help to get and you can still be practicing the same behavioral strategies to stay sober.

  • 11:55:56

    REHMPaul, have you been able to help other people? Have they come to you for help?

  • 11:56:04

    CARRYeah, I get so many emails. And at the end of the "Sober is My New Drunk," the book, I put my email address and say, tell me your 12 steps. And I got so many emails off the back of that from people, some of whom are in AA, some of whom had never sought help and thought they might have a problem. And I've always said, I don't want -- my method might not work for everybody. The whole point is finding your own path. But at the same time, I think there is some value and if you have successfully moved on from problem drinking or even full blown alcoholism, hearing other peoples success stories, I think, is valuable.

  • 11:56:41

    REHMAnd Samantha, you have helped a great many people.

  • 11:56:48

    SAMANTHAThank you.

  • 11:56:49

    REHMThank you for being here. Samantha is a member of Alcoholics Anonymous. Writer and columnist, Paul Carr. And Dr. Markus Heilig of the National Institute on Alcohol Abuse and Alcoholism. I do hope this program has been of help to lots of people. Thanks for listening. I'm Diane Rehm.

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