Alcoholism

Define

Drinking should be defined as the amount of alcohol consumed of alcohol. According to the National Institute on Alcohol Abuse and Alcoholism there are two separate levels of alcohol consumption. All of which can be dangerous, but obviously the more alcohol consumed the more you put yourself and others at risk of injury and even death.

Moderate levels of alcohol consumption is the lowest level. In its definition It includes 1 drink per day for women and 2 drinks per day for men.

The final level of alcohol use is “Heavy Alcohol use”. It has been defined as binge drinking for 5 or more days days in the past month. Binge drinking is consuming enough alcohol to reach or surpass a blood alcohol content of .08 or higher.

It should be noted that the criterion of “one drink” changes dependent on the % of alcohol in that drink. For beer, a 12 fl oz at 5 % alcohol is consider 1 drink; Wine, 5 fl oz at 12%, is 1 drink; Liquor, 1.5 fl oz at 40% alcohol (80 proof). It is estimated that 1 fl oz can take an hour to metabolize.

What is the problem?

According to the National Council on Alcoholism and Drug Dependence, Inc alcohol is the most used addictive substance in the United States. With one in twelve Americans suffering from alcohol abuse or dependency, it is a dangerous but popular drug. Alcohol abuse does not only affect the person who uses alcohol, it also adversely affects the spouse, children, and coworkers.

Identification of risk of developing Alcohol Use Disorder (AUD) for women is having three or less drinks a day and not drinking every day of the week. For men it increased to four drinks a day and 14 drinks per week. The good news is that even if you meet this criteria only 1 out of 50 actually develop/have AUD.  In other words, many “casual drinkers” already show risks of developing AUD, but only 2% actually are diagnosed.

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of time drinking? Or being sick or getting over other aftereffects?
• Wanted a drink so badly you couldn’t think of anything else?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

 

 

Basic Facts (Population, demographics, facts.)

It is estimated that there are 88,000 deaths a year due to alcohol, and it is the third leading cause of death in the nation. Alcohol affects men and women differently: it takes women longer to metabolize it; however, alcohol abuse is more common in men than in women. In the world, over 2 billion people drink alcohol, and around 75 million people are affected by alcohol-related disorders.

Although not all alcohol use leads to addiction or dependency, alcohol has been the only drug banned as an amendment via the 18th amendment only to be repealed in the 21st.

Effects

According to drugabuse.com short term effects of alcohol may include some positive symptoms such as mild euphoria, mood enhancement, lowered anxiety, marked sedation. It should also be noted the negative short-term consequences such as impaired vision, delayed reaction time, confusion, vomiting, blackouts, loss of bladder control.

Long-term consequences may include cancer, hepatitis, scarring of the liver, and increased blood pressure which could lead to heart problems. Financially it takes a toll too.

According to a 2000 report on alcohol, the cost estimate for alcohol abuse was over 184 trillion dollars in 1998, which was up from a 1992 estimate of 148 trillion. These include the cost of loss of an individual, services such as counseling, criminal justice, and medical consequences.

How Alcohol Affects your Brain and Body

Habit Analysis and Common Triggers

To best analyze a habit we first must devise it up into three parts. The trigger, or what is evoking or eliciting the habit, the habit itself, and the rewards granted by that habit.

Triggers for alcohol consumption vary and can be very subtle. Here are some to consider:

• Friends invitation to a bar
• A sign on at a bar
• Being in a setting that sells liquor
• Lack of alternatives in the evening
• Holidays such as St. Patrick’s Day, the day before Thanksgiving, and birthdays
• Free samples offered at stores
• Deals and specials
• An abundance of time waiting (airports, casinos, hotels)
• Social events
• Sporting events (Football game, Bowling, Darts)

Like triggers the form of habits may vary from case to case. It is important to note which behaviors are “acceptable” and which should be avoided. For example many consider drinking at a bar is acceptable; however, drinking on the job may be less than satisfactory. Of course many of these depends on the individual circumstance. Each may mold both a different trigger and reward.

• With friends at a bar
• Alone at a bar
• Drinking at home
• Concealed drinking on the job
• Drinking and driving
• Binge drinking
• Taking shots
• Drinking Wine
• Drinking Beer
• Drinking games such a beer pong, flip cup, and others which speed of consumption matter.

Although rewards and reinforcers differ conceptually, the following should be considered more like reinforcers as they are likely to be maintaining habit. They may not be considered as rewards to general society.

• Social praise (Chug! Chug! Chug!)
• Social bonding as a chance to meet new people
• The “buzz” feeling of alcohol
• Passing out
• The escape of a less desirable situation
• “Liquid confidence”
• The taste
• A marker of celebration such as holidays, end of a work week, and a completion of a task
• Inclusion in a participation in a cultural event
• Access to other things such as pool, darts, food

After analyzing a habit cycle we then know the best place to manipulate one of the three variables. By doing this we may encounter more than one trigger, habit pattern, or reward type that controls the drinking behavior. We should choose one habit to change first and work our way towards others.

It may be easiest to manipulate the trigger variable in many of these cases as we can change many things before the trigger occurs to break the habit. More on this later.

What is the correct order of the habit cycle?

Habit, Trigger, Reward,
Reward, Habit, Trigger
Trigger, Reward, Habit
Trigger, Habit, Reward

Changing the Habit

As mentioned above to change a habit we must alter the habit cycle. The usual goal of treatment in alcohol is usually abstinence, in other words completely removing alcohol consumption. This can be done in three different ways: by removing the trigger (the trigger), reducing the motivation (the reward), or by reducing the ability to perform the habit.

Stopping the Habit for Good

Possible triggers for alcohol consumption as discussed above include most bars and restaurants which serve alcohol. Many sporting events serve alcohol, and it is popular to consume alcohol while watching a sporting event. Some peers could also serve as a trigger as in many settings drinking is a social event. To accomplish the elimination of alcohol consumption it may be suggested to remove these triggers. One could simply avoid any place which serves alcohol, which may be a difficult challenge. The other solution is to find similar triggers that do not yield the same consequence, such as drinking alcohol free beer and sparkling champagne.

Rewards for alcohol varies from person to person: the buzz feeling, the excitement of events that are paired with alcohol consumption, and the feeling of belonging with your peers who are also drinking all may function. It is suggested to try to reduce these motivation. Possibly by finding alternative sources that fulfill that same level of motivation. Find alternative activities that can be done without alcohol, locate different peer. More specifically one could join a club that meets up at the same time you would normally drink.

An alternative view is that alcohol consumption may not be due to a reward, but rather as a way to gain distance from something aversive. If a bar is the only place to get away from a nagging spouse or daily responsibility, the environment may be perfect to establish a dependency on alcohol. One report may describe it best as an escape from reality.

Reducing the Habit

If your goal is to decrease alcohol consumption, we still need to examine the habit cycle. Instead of blocking the ability to drink, if one would like to just decrease the behavior, we may reduce the ability to drink. This could mean purchasing less alcohol, limiting the nights of the week you goes, and drinking only drinks with less alcohol content. Here it would be helpful to have clear goals: a specific number of days you may consume alcohol, how much money you can spend, or the amount you can assume.

Which one of these is not a specific goal?

A. I want to drink only 1 day a week
B. I want drink less
C. I want to spend $10 or less on alcohol this week
D. Drinking is bad, I only want to drink after work on Friday

B is correct. Drinking less is not specific. We need to know how much.

To replace rewards rather than simply to reduce, we can associate drinking with an aversive stimulus such as pain, fear, or rejection. In this approach we drink, but may pay for it. This can be with money, electrical shock, or with the loss of something pleasurable.

Treatment

To best analyze treatment solution we may use a Cost and Benefit Matrix featured below. The boxes here are not an exhausted. Any intervention, independent of success can fit into these boxes to be analyzed. There are four ways of reducing the drinking behavior:

1. Increase the cost of drinking
2. Decrease the benefits of drinking
3. Decrease the cost of alternatives
4. Increase the benefits of the alternative

Cost and Benefit Matrix of Consuming Alcohol Compared to Alternatives

 

	Cost	Benefits
Drinking	(1.) $, Hangover, Cancer,…	(2.)Buzz, Social, Escape,…
Alternative	(3.)	(4.)

 

Most interventions aim at intervening at only the first two levels by manipulating the effects of drinking. Here are some examples:

• Going to AA – (1.) Drinking results in the loss of tokens and social acceptances
• Antabus drug (1. ) Drinking now makes you nauseous
• Naltrexone and other drugs (2 Orange.) Drinking now loses it’s appeal
• DWI (1&2) A penalty for drinking and now blocked from going places
• Removal of all alcohol from home (1 Yellow.) It is now harder to get alcohol
• Acceptance and Commitment Therapy (ACT) (1.Pink  ) increases the costs of drinking by paying for therapy
• Advertising and state funded programs  (1. Black)  

Alternative solutions include:

• Providing community activities for kids (4.) Gives a community outlet
• Free/movie nights  (3.) Gives a cheap alternative to accomplish
• Marriage Counseling (4.) May save failing marriage.

 

How the Pavlok Can Help

The Pavlok is programmed to track your behavior. With the If This Then That (IFTTT) app a beep, vibration, or shock can be sent directly to the Pavlok when you are close to any programmed location. This means a user of the Pavlok can simply type the address of their local bar and if they approach this site, a stimulus will be administered.

To reserve your Pavlok click here.

If you already own a Pavlok and want to set up the location feature with IFTTT click here https://ifttt.com/login to set up account and follow these steps.

1. Click My Applets
2. Click “+This”
3. Type  “Location”
4. Click location and choose one of the three options
   1. Pick the location by typing in the address
   2. Press “Create Trigger”
   3. Press +that

5. Type “Pavlok” in the search
6.  Choose one of the four options “zap”
7. Set strength (low, medium, high)
8. Click “Create action”
9. Click “Finish”

Sources And Resources

• Dickter, C.L., Forestell, C.A., Hammett, P.J. et al. Psychopharmacology (2014) 231: 2031. doi:10.1007/s00213-013-3348-6
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