The Difference in Drinkers
Excerpts from 7 Weeks to Sobriety, by Joan Mathews Larson
Your body holds the key to understanding the effect alcohol has on you. If you have the ability to drink large amounts of alcohol, you have good reason to suspect that you might be predisposed to alcoholism. But, capacity is only part of the story. Alcohol affects brain and body processes in different ways in different people. In this chapter, you'll learn whether or not you are alcoholic and, if so, what kind of alcoholic you are. The following case histories drawn from the files or the Health Recovery Center illustrate three different body chemistries that underlie vulnerability to alcoholism (and one type that may lead to a mistaken diagnosis of alcoholism).
Alan was a party animal in high school and college. Even then he had the capacity to drink heavily without noticeable consequences. In fact, alcohol seemed to stimulate and energize him. Later, in the business world, a few drinks at lunch and dinner served to fuel his professional performance.
Alan was the kind of hard driving, compulsive person psychologists describe as a Type A personality: he was ambitious, needed little sleep, and had a strong sex drive. He was proud of his ability to handle alcohol.
For years he wasn't bothered by hangovers and never suspected his supernormal response to alcohol was a red flag signaling trouble down the road. But slowly his body became dependent on alcohol for peak performance. Without it, every cell seemed to feel the let-down. His performance suffered, and he began to crave alcohol.
By the time he was forty-five, he was much less able to withstand the effects of his heavy drinking. He began to experience withdrawal symptoms. Drinking no longer made him feel euphoric or energetic. It simply made him feel normal.
His withdrawal symptoms worsened. He was hyperactive, shaky. His moods and emotions swung wildly from one extreme to another. He blamed his problems on the stress of his job, the inability of his family to understand his needs, and almost every other negative external event he could seize on. His family and colleagues correctly attributed Alan's irritability, mood swings, and the difficulty he had concentrating to his drinking, but they-and he-thought he could and should control it. He began to have blackouts and terrible hangovers, but it was not until he was arrested four times for driving while intoxicated that he admitted that alcohol was destroying him.
Alan's huge capacity for alcohol and the fact that for years it energized him and caused no hangovers indicates that he was born with an alcohol dehydrogenase liver enzyme II ADH) that enabled his body to metabolize large amounts of alcohol without negative effects. His brain made endorphin-like tetrahydroisoquinolines THIQs) from alcohol; the THIQs were responsible for both the euphoria he loved and his eventual addiction.
Alan is a II ADH/THIQ alcoholic.
Leonard first drank in high school and remembers how sick alcohol made him until he learned" to handle it. Unfortunately, that ability was unpredictable. While still in his teens, he totaled the family car and began accumulating arrests for driving while intoxicated. He could never predict whether or not a night out would end in another wild driving spree. The only thing he could be sure of was that when he drank heavily, he paid for it the next day with a terrible hangover. Leonard's father and brothers were affected by alcohol in the same way, so it didn't occur to him that his drinking pattern was unusual.
When I met Leonard, he had been in Alcoholics Anonymous for several years and had completed two alcoholic treatment programs. He had been arrested six times for driving while intoxicated. He was not yet thirty years old.
Leonard's mother had died a short time earlier. Her death triggered yet another binge that ended in a bar fight and Leonard's latest arrest for driving while intoxicated. Leonard sincerely wanted to quit drinking. After his release from jail, he went to his mother's grave and wept, promising to stay sober, but days later he was drunk again. Now he was severely depressed, convinced he was a hopeless failure who would never stay away from alcohol.
His story illustrates the pattern of alcohol allergy/addiction. It takes about four days for the body to completely rid itself of alcohol. During this period, withdrawal symptoms in the form of alcohol cravings and hyper-emotional feelings begin to build. Eventually, the victim drinks to satisfy the craving and calm his mood. All of these symptoms cease as soon as he or she reintroduces the addictive substance. When this type of alcoholic tries to stop drinking, his or her body will seem to scream for alcohol to banish the withdrawal symptoms. No amount of counseling, no effort of will can effectively counter the physical and emotional effects that beset alcoholics like Leonard.
Alcohol-allergic drinkers often become socially disruptive, engaging in fights and arguments, or become a threat to themselves and others with dangerous driving, decision-making errors, and even criminal acts. Alcohol disrupts their normal brain chemistry, causing erratic, even bizarre behavior. In Leonard's case, this alteration in brain chemistry led to his bar fights and drunken- driving arrests.
The fact that his first drinking experience made him sick was a clear message that his body couldn't tolerate alcohol. His continued drinking forged a pattern of allergy/addiction: at first, alcohol made him high as his body reacted to it by producing its own addictive endorphins; later, as the alcohol began to leave his system, his body began to crave more to stave off withdrawal symptoms. Both the craving and his emotionality (weeping at his mother's grave, his depression) stemmed from the effect of alcohol withdrawal on his brain.
Leonard is a classic allergic/addicted alcoholic.
Stanley's mother was an alcoholic who also suffered from depression. He was an anxious and depressed child.
Stanley began to drink in his late teens. His first drink was a revelation. For the first time in his life he felt normal and happy. However, his depression returned with more intensity after each drinking episode. He began to drink continually to banish his depression. Finally, he admitted to himself that his drinking was out of control and was ruining his future. His wife finally convinced him to join Alcoholics Anonymous. With sobriety, depression returned. Eventually, Stanley decided that he had a choice between suicide and the bottle. He chose alcohol. Again, his depression miraculously lifted, but soon he found that he had to drink every morning to push depression away.
Once again, he became too ill to function. His career and marriage were floundering when his wife and family arranged for him to be hospitalized for treatment.
I met him after he completed a series of four inpatient treatment programs. Each time he was released, he immediately began drinking again. He had lost hope of finding effective help. He had spent $50,000 for treatment. His therapists had unearthed an incestuous relationship he had as a teenager to which they attributed both his depression and his drinking. Now Stanley had this painful memory to add to his guilt and shame.
At this time, he was almost fifty years old. His story suggested to me that he was an omega-6 essential fatty acid (EFA) deficient alcoholic. I was right. Within three weeks he was free of depression for the first time without alcohol. He was ecstatic, although he secretly believed it would all collapse shortly. It hasn't.
Sometimes even two or three glasses of wine made Maryanne sick. She became light-headed and uncoordinated and, occasionally she vomited. Yet her anticipation of that first drink could be overpowering. Her desire for and reaction to alcohol was worse before her menstrual period, a time when she also craved chocolate.
When I met Maryanne, she was afraid she was becoming an alcoholic like her father, a longtime AA member who occasionally falls off the wagon. I didn't think so, Maryanne had a relatively low tolerance for alcohol, a pretty good indication the problem lays elsewhere.
Maryanne had an inherited predisposition to hypoglycemia (low blood sugar). As a result, her brain does not get a steady supply of its only fuel, glucose (blood sugar) Hypoglycemia is common among alcoholics and can be passed on to their nonalcoholic children (it also occurs in families with no history of alcoholism). Maryanne's craving for chocolates and alcohol was caused by low glucose levels in her brain. Her cravings often occurred when she was premenstrual because hormonal shifts at that time of the month lower blood-sugar levels. Indeed, premenstrual syndrome can stem from an acute hypoglycemic state that develops just before menstruation.
Soon after Maryanne drank the alcohol she craved, she felt a lift, but it didn't last long. Because alcohol is a potent sugar that enters the bloodstream through the stomach wall (it doesn't have to be digested like a candy bar), hypoglycemics feel a fast emotional lift as much-needed glucose surges to their brains.
To maintain this up feeling, hypoglycemics must keep drinking. Otherwise, the insulin produced in response to the glucose infusion will push down blood-sugar levels, resulting in mild insulin shock.
In Maryanne's case, the combined impact of alcohol's toxic effect on her glucose metabolism and sensitive body chemistry can and does make her ill. If this is your problem, you may seem drunk after only one or two drinks.
A glucose tolerance test confirmed what I suspected about Maryanne. She was not alcoholic, but she was severely hypoglycemic. Luckily, this type of alcohol problem is not true alcoholism and lends itself very successfully to treatment.
These case histories describe the four most common categories of drinkers who have sought help at the Health Recovery Center during the past ten years. A new biotype might be identified in the future, but, in all likelihood, if you have a problem with alcohol, you fall into one of the four groups. If there are alcoholics on both sides of your family, you may find that you fit into two categories. If so, the one that predominates, even slightly, is the one to work with as you embark on this program.
The first step will be to test yourself to determine whether or not you are an alcoholic and, if so, what kind you are. Once you know your chemical traits, you can choose the right course to restore your health. Establishing your underlying physical vulnerability has another major advantage. It takes all the shame out of being alcoholic. There is no reason to be embarrassed about the hand your genes have dealt you.
Establishing Your Biotype
The biotype survey below will help you identify your alcohol biotype. You may find that more than one statement applies. Print out this questionnaire and circle any that are true for you today.
Biotype Survey
A. Physiologic Response
1. Alcohol quickly makes me light-headed, spacey, and uncoordinated. It has always affected me this way.
2. Even a little alcohol makes me sick. This has always been true.
3. When drinking, I have lots of energy and perform better.
4. At first, alcohol exhilarates me; then I may lose control and drink until drunk.
5. In the past, alcohol always gave me a lift, now it just takes away my shakiness and makes me feel normal.
6. After only a few drinks, I usually feel sedated by alcohol.
7. I can overcome my depression by drinking alcohol, but afterward the depression seems worse.
8. (Women only) I need and use more alcohol premenstrually.
9. Usually, I can't feel the effect of my first one or two drinks.
10. Now alcohol lifts my depression temporarily. In my earlier drinking years, I did not suffer from depression.
B. First Experience
1. I remember the first time I drank alcohol; I liked the feeling it gave me.
2. My first drinking experience was not good; I reacted badly to alcohol.
3. I can't remember my first drinking experience.
4. From my first taste, alcohol has had no appeal for me.
C. Hangovers
1. All my drinking years I have usually felt miserable the morning after heavy alcohol use.
2. I rarely have hangovers.
3. I frequently suffer from depression after a night of heavy drinking.
4. 1 never got hangovers in my early years of heavy drinking, but now I do.
5. I don't get hangovers from my habitual light drinking.
6. I do get uncomfortable even with very little alcohol. This has always been true.
D. Patterns
1. I drink six or more eight-ounce glasses of beer a day or the equivalent in wine (six four-ounce glasses) or hard liquor (six drinks, each containing one and one-half ounces of alcohol) and do not get hangovers.
2. I usually can't predict or control how much alcohol I will drink at one time.
3. I may go for days, weeks, or months without alcohol, but when I drink I tend to binge for several days. This has been my usual pattern since I began drinking.
4. I rarely want more than two or three drinks at one time.
5. I do not drink because I dislike the way even a little alcohol affects me.
6. I often experience an urge to drink at the end of the workday following job-related exposure to fumes from gasoline, printer's ink, house paint, hydrocarbons, or formaldehyde.
7. 1 recognize that I can regularly drink a lot, need little sleep, have a strong sex drive, and tend to be a compulsive type-A personality.
8. (Women only) I drink quite moderately except before my period when my need for alcohol seems to increase.
9. I have never been a heavy drinker, but I notice if I haven't eaten, I can get drunk on one or two drinks.
10. I drink daily (or frequently) to avoid depression.
E. Heredity
1. No one on either side of my family has regularly consumed large amounts of alcohol.
2. I have a close maternal and/or paternal relative who drinks (or formerly drank) alcohol in large amounts.
3. I am of Scandinavian, Celtic, Welsh, or Scottish ancestry and have drinking relatives who suffer from depression.
4. I am adopted and do not know my biological parentage.
5. My family may or may not be teetotalers, but my biological origins are predominantly northern European or Native American.
6. My family is from a southern Mediterranean country.
7. A close relative is a heavy drinker, but even one or two drinks makes me spacey.
8. I am of Oriental descent. My relatives and I become flushed, dizzy and nauseated from very little alcohol.
F. Personality Effects
1. My personality and behavior often change markedly when I drink. This effect has been my response to alcohol since I began drinking.
2. My personality and behavior now change markedly when I drink. This was not true in my earlier years of drinking.
3. I mellow out and grow sleepy on a few drinks.
4. I feel revved up and can often party all night when I'm drinking with few or no signs of intoxication.
5. I sometimes get into fights when drinking a lot. This has been true almost from the time I began drinking.
6. I use alcohol to control anxiety whenever possible.
7. I can count on alcohol to lift my lifelong depression temporarily.
8. My behavior sometimes gets bizarre when I drink.
9. I dislike drinking alcohol because it physically upsets me; it does not alter my personality.
10. I feel a quick sense of well-being from my first drink or two but can't handle more than that without feeling spacey and light-headed.
G. Tolerance
1. I have always had a high tolerance for alcohol and can drink large amounts without problems.
2. I have been able to increase my tolerance for alcohol markedly over time, handling it super-normally with minimal hangovers.
3. I have no ability to handle a lot of alcohol.
4. My tolerance for alcohol has gone down recently. It was much higher for many years.
5. I am inconsistent in how much alcohol I can handle. Often I cannot predict or control how much I will drink.
Your responses in four or five of the seven categories should be consistent within a particular alcohol biotype. If you are over forty and have been drinking heavily for several decades, you may have circled many allergic/addicted responses as well as II ADH/THIQ answers. This would indicate that your drinking has damaged your immune system, your body's defense against disease. However, you are predominantly a II ADH/THIQ alcoholic. In rare cases, a person will be a combination of biotypes if there are different kinds of alcoholics on each side of his or her family.
Scoring
A. Physiologic response
Nonalcoholic chemistry
Nonalcoholic (alcohol-intolerant) chemistry
Nonalcoholic hypoglycemic chemistry
II ADH/THIQ alcoholic chemistry
Allergic/addicted alcoholic chemistry
Omega-6 EFA deficient alcoholic chemistry
A6
A2
A1, A8
A3, A5, A9, A10
A4
A7
B. First experience
Nonalcoholic chemistry
Nonalcoholic (alcohol-intolerant) chemistry
Nonalcoholic hypoglycemic chemistry
II ADH/THIQ alcoholic chemistry
Allergic/addicted alcoholic chemistry
Omega-6 EFA deficient alcoholic chemistry
B3
B2, B4
B3
B1
B2
B1
C. Hangovers
Nonalcoholic chemistry
Nonalcoholic (alcohol-intolerant) chemistry
Nonalcoholic hypoglycemic chemistry
II ADH/THIQ alcoholic chemistry
Allergic/addicted alcoholic chemistry
Omega-6 EFA deficient alcoholic chemistry
C5
C6
C6
C2, C4
C1,C3
C3
D. Patterns
Nonalcoholic chemistry
Nonalcoholic (alcohol-intolerant) chemistry
Nonalcoholic hypoglycemic chemistry
II ADH/THIQ alcoholic chemistry
Allergic/addicted alcoholic chemistry
Omega-6 EFA deficient alcoholic chemistry
D4
D5
D8, D9
Dl, D7
D2, D3, D6
D10
E. Heredity
Nonalcoholic chemistry
Nonalcoholic (alcohol-intolerant) chemistry
Nonalcoholic hypoglycemic chemistry
Alcoholic chemistry (possible to probable)
Omega-6 EFA deficient (possible, probable)
Unidentifiable chemistry
El, E6, E8
E8
El, E7
E2, E5
E2, E3
E4, E5
F. Personality effects
Nonalcoholic chemistry
Nonalcoholic hypoglycemic chemistry
II ADH/THIQ alcoholic chemistry
Allergic/addicted alcoholic chemistry
omega-6 EFA deficient alcoholic chemistry
F3
F3, F10
F2, F4, F6
Fl F5, F6, F8
F7
G. Tolerance
Nonalcoholic chemistry
Nonalcoholic (alcohol-intolerant) chemistry
Nonalcoholic hypoglycemic chemistry
II ADH/THIQ or Omega-6 EFA deficient
Allergic/addicted alcoholic chemistry
G3
G3
G3
G1, G2, G4
G5
The Characteristics of Your Biotype
1. Nonalcoholic Chemistry (Normal Drinker)
A6 With a few (one to four) drinks, alcohol has a sedating effect on you.
B3 You probably have no outstanding memory of your first alcoholic drink or your reaction to it.
C5 Your alcohol use is usually light; hangovers are rare.
D4 Typically, two to four drinks are enough for you.
El Usually, no one on either side of your family drinks or has frequently drunk large amounts of alcohol.
E6 Some of your biological relatives come from southern Mediterranean areas of Europe.
F3 Getting sedated by alcohol is the typical response of a nonalcoholic.
G3 Your ability to "keep up with the boys" when drinking at parties is poor. You would consider it punishment to have to drink twelve beers or a pint of vodka daily and simply couldn't do it, no matter what your personality or character. You are blessed with the chemistry of a nonalcoholic drinker
2. Nonalcoholic (Alcohol-Intolerant) Chemistry
A2 Drinking even a little alcohol tends to make you dizzy or nauseated or causes flushing or other negative reactions.
B2 Your first drinking experience made you sick.
B4 Because of alcohol's negative effects on you, it has never had any appeal.
C6 Even a little alcohol may give you lingering effects the next day.
D5 Because you dislike the way even a little alcohol affects you, you don't drink.
E8 Your family may be of Oriental extraction and you may possess only one alcohol dehydrogenase enzyme in your liver.
F3 Getting sedated by alcohol is the typical response of a nonalcoholic.
F9 Alcohol offers you no rewarding highs; it only upsets you physically.
G3 You learned quickly that you are alcohol intolerant and you avoid drinking.
3. Nonalcoholic Hypoglycemic Chemistry (May Mistakenly Be Labeled Alcoholic
Al A little alcohol tends to make you light-headed, spacey, and uncoordinated.
A8 If you are a female hypoglycemic you often want and use more alcohol premenstrually; your altered hormonal levels depress glucose metabolism, resulting in severe sugar cravings. Alcohol can temporarily correct this by supplying your brain with glucose, its vital fuel.
B3 Your first drinking experience probably does not stand out in your memory.
C6 You usually get a hangover from moderate drinking because alcohol triggers an outpouring of insulin, which creates mild to severe insulin shock and symptoms of fatigue, confusion, depression and irritability.
D8 If you are a woman, you may drink more alcohol premenstrually.
D9 The effects of one or two drinks on your empty stomach are dramatic. You almost certainly feel a quick lift followed shortly thereafter by light-headedness, confusion grogginess, clumsiness, and weakness.
El Quite possibly, no one in your family is a heavy drinker. Or...
E7 A close relative may be alcoholic, but even a few drinks make you spacey. In certain alcoholic families, one or two children may inherit the tendency to abnormal glucose metabolism (hypoglycemia) but be spared the high tolerance for alcohol that can lead to alcoholism.
F3 You may be the type of hypoglycemic who tends to become light-headed and sleepy rather quickly as a result of drinking alcohol.
F10 You usually feel a quick sense of well-being from a drink or two.
G3 You never could handle much alcohol. You don't need much to raise blood-sugar levels; a drink or two gives you the temporary lift you seek.
4. II ADH/THIQ Alcoholic Chemistry
A3 Alcohol gives you energy and improves your performance. or...
A5 It used to do this, but now it just stops the shakes and restores you to normal.
A9 You need several drinks to get the feeling you seek.
A10 Alcohol is stimulating the production of endorphins; gradually, this will inhibit natural production of these opiates. Depression can develop as natural endorphins become less available; drinking temporarily relieves your depression.
El Your first drinking experiences were pleasant; alcohol didn't make you sick.
C2, C4 Alcohol causes few adverse effects; your hangovers were rare in the heyday of your drinking, but years or even decades later liver damage changed the picture.
Dl You can handle a lot of alcohol. For many years you did not ordinarily have hangovers or experience other alcohol-related consequences.
D7 Besides your ability to handle a lot of alcohol well, you tend to be a Type A personality compulsive with a strong sex drive; you require very little sleep to function efficiently.
E2 A close relative has shown a pattern of high alcohol tolerance.
E5 Your ancestors are predominantly northern European or Native American.
F2 After years of handling a lot of alcohol super normally, you are finally showing signs of the damage alcohol is doing to your brain and nervous system.
F4 Alcohol serves to rev up rather than sedate you; you can party for long periods with few or no signs of intoxication.
F6 Alcohol helps you handle situations that make you anxious.
G1 You had a high tolerance for alcohol even as a teenager. Or...
G2 Your tolerance increased markedly with continual use of alcohol. Or...
G4 Your high tolerance of yesteryear has declined after a long drinking career.
5. Allergic/Addicted Alcoholic Chemistry
A4 Alcohol will exhilarate you at first, but you often lose control and may drink until drunk.
B2 You probably can remember getting sick after your first drinking experience. At the time, your body was able to tell you how it felt about alcohol. With repeated use, your body was forced to adapt and accommodate alcohol. The result is the altered response of allergy/addiction.
C1 You usually have serious after effects the morning following heavy drinking because of the toxicity of alcohol to your allergic body.
C3 Depression usually follows a night of heavy drinking.
D2 You often can't predict or control how much you will drink at one time because alcohol quickly alters your brain's ability to make choices.
D3 You may go without alcohol for days, weeks, or even months, but when you drink, you tend to binge, sometimes for several days.
D6 Daily exposure to such chemicals as gasoline, formaldehyde, printer's ink, and hydrocarbons can easily intoxicate your sensitive brain and set off cravings for alcohol. If you work around these chemicals you may notice an overwhelming urge to drink immediately after work.
E2 Typically, you have a close relative with a similar drinking pattern. Or...
E5 Your relatives are all teetotalers for good reason. Chances are you are of predominantly northern Europe or Native American background.
Fl Your personality and behavior are often dramatically affected by alcohol because your brain and nervous system are easy disrupted by alcohol's toxicity.
F5 When drinking, you often engage in arguments and bar fights with anyone, even total strangers.
F6 Alcohol tends to mediate your high levels of anxiety and is your preferred way to deal with stress.
F8 The physical changes alcohol triggers in your allergic brain can result in irrational or bizarre behavior; contrary to appearances, you have little control over these actions once you are locked into this altered brain state.
G5 You often can't control how much you drink.
6. Omega-6 EFA (Essential Fatty Acid) Deficient Chemistry
A7 You know you can temporarily relieve depression by drinking alcohol.
B1 Your first drinking experience produced immediate relief from long-standing depression.
C3 Your depression returns after you stop drinking.
D10 You drink daily (or frequently) to prevent depression from returning.
E2 You have relatives who are alcoholics and/or depressed; there may have been some suicides in your family.
E3 Your ancestry is predominantly Scandinavian, Irish, Welsh, or Scottish.
F7 You have come to depend on alcohol for relief from depression present since childhood.
G1 Your tolerance for alcohol probably has increased over the years. Or...
G4 Your tolerance may be much reduced after years of drinking which has caused liver damage.
What's Next?
If you clearly fall into an alcoholic category, you now have the opportunity to rewrite your future. You may decide to keep drinking even though your alcohol biotype indicates that you are headed for disaster. I hope not. You are vulnerable to alcohol and will become addicted in the future if you aren't already. The physical addiction cannot be managed into social drinking.
Since alcoholism is progressive, your drinking habits won't improve; they won't even stay the same. They will get worse. Your physical need for alcohol will gradually speak so loud that no act of will can overcome it. Life will become an unending quest for the normalizing lift alcohol provides, even though it will be destroying your health and sanity. Please remember that most alcoholics today do not recover. They die prematurely from alcohol-induced diseases.
In Seven Weeks to Sobriety you will learn how to break this addiction and end your cravings once and for all. You will learn how to repair the harm alcohol has done to your brain and body. Without repair the damage will continue for months and even years after you stop drinking. All too often, this emotional and physical misery leads alcoholics back to the bottle in the quest for relief. You hold in your hands the tools to help you repair this damage now. These techniques have been used successfully at Health Recovery Center for the past nineteen years. They have helped many others. They may save your life.
