No alcohol for me tonight, thank you- at least not this year! I don't know what future years will bring, but I am content with this for the here and now.
Tuesday, December 31, 2013
Monday, December 30, 2013
Sober Day #62: A new approach to New Year's Eve!
I was just at the grocery store, watching at least every other person load up on alcohol. Surprisingly, I didn't feel sad, deprived or tempted. I more felt bemused- that it is a well-entrenched cultural meme that the end of one year and beginning of the next is celebrated with alcohol, usually excess alcohol. New Year's Eve sort of carries permission to go wild with booze. So much so that hotels offer party/overnight packages in anticipation of people being incapable of driving home safely after said party.
I never questioned this before- it was just what 'everyone' does. And now I am thinking about it, examining it for 'fit'. And it doesn't fit very well.
In the grocery store, it almost seemed to me that people were functioning in a trance, carrying out cultural/social dictates of how to celebrate. Equating (as I have done for so many years) alcohol with fun. As in 'Alcohol is required in order to have fun'.
And I am thinking: 'hmmm, that doesn't really seem to be true, after all'. And 'the start of a new year sounds like a great time for sober reflection'- on the successes and challenges of the year past, and the possibilities and surprises of the upcoming year.
So, this New Year's Eve, I will be trying out a new way of having fun. And I will awaken on the first morning of the new year feeling fabulous.
I never questioned this before- it was just what 'everyone' does. And now I am thinking about it, examining it for 'fit'. And it doesn't fit very well.
In the grocery store, it almost seemed to me that people were functioning in a trance, carrying out cultural/social dictates of how to celebrate. Equating (as I have done for so many years) alcohol with fun. As in 'Alcohol is required in order to have fun'.
And I am thinking: 'hmmm, that doesn't really seem to be true, after all'. And 'the start of a new year sounds like a great time for sober reflection'- on the successes and challenges of the year past, and the possibilities and surprises of the upcoming year.
So, this New Year's Eve, I will be trying out a new way of having fun. And I will awaken on the first morning of the new year feeling fabulous.
Sunday, December 29, 2013
Sober Day #61: Powerless over alcohol? NO!!!
The well-known First Step of Alcoholics Anonymous (AA) is "admitting we are powerless over alcohol". And the oft-quoted introduction of a new member to a group is "Hi, I'm xxxx, and I am an alcoholic".
I acknowledge that AA has been helpful for many people in coming to grips with/quitting drinking alcohol. But for me, at least, AA delayed my facing that I was not doing well with alcohol.
First off, I am a Do-It person. I'm powerless over the weather, or international politics, or what color is fashionable this spring- but I am NOT powerless over alcohol. I take full responsibility for my actions. Nobody ever propped my mouth open and poured wine into it- except myself. I drank because I thought I needed the respite of wine to deal with the rest of my life. Yes, there is a genetic predisposition for many, and childhood/family-of-origin issues that make drinking more alluring- but it is ME! I made the decision TO drink, and I can make the decision NOT TO drink. I had absolutely no inclination toward joining any organization that told me I was NOT responsible for my own actions.
Secondly: Ask several hundred people to define 'alcoholic'- and you will receive several hundred different answers. The most prevalent image seems to be the homeless bum or bag-lady, drinking El Cheapo wine or whiskey, then passing out face down in the gutter in his/her vomit. This is NOT me. I am an accomplished professional with a great family and home. So I reject using the label 'alcoholic'. I have had problems with alcohol, have been a problem drinker, maybe even alcohol-dependent at one point. But I WILL NOT call myself an alcoholic.
Third, there's all that 'turning oneself over to a higher power' stuff. I am a deeply spiritual person, but not particularly religious, and also found that language to be a turn-off.
Like many other people, I thought my two options were to continue drinking or to join AA. Neither appealed to me much, but AA was worse than continuing to drink. Imagine my surprise- and delight- over the past two months to have discovered a vibrant on-line sober community.
I crossed my two personal 'red lines' for alcohol in a single day, and said, that's it, I'm done for a while. How long that would have lasted I don't know- maybe a week or two? But I came across Belle's 100 Day Challenge, and found that finite goal of 100 days (not stopping drinking forever, just committing to a little more than three months) to be a do-able goal. Through Belle's blog, I have 'met' so many others on similar journeys of exploration. I take pleasure in giving encouragement to those in their first few days or weeks, and find great meaning and help in the posts of those who are many months or years into their sober journey.
At a guess, I'd say that thinking AA was the only alternative to continuing to drink probably delayed by 5+ years my deciding to make a change in my relationship with alcohol. I think the existence of this sober online community and countless other options for help in stopping for cutting down on drinking need to be much more widely known. That is, assuming we have a common goal of helping ourselves and anyone else we come into contact with to be the best, most fulfilled person they are capable of being!
I'm still not sure exactly what I will do after these 100 days. I know I will never go back to a bottle or wine or more every evening! I am becoming far too fond of excellent restful sleep, a clear head and an energetic step to go back to that drowsy, foggy, semi-grumpy place. But neither do I think I can live with: Never Ever Ever will a Drop of Alcohol Cross these Lips.
So I will see what I find out, what I develop- and continue to record my experiences here, where I have sworn to myself to include nothing but my absolute truth!
I acknowledge that AA has been helpful for many people in coming to grips with/quitting drinking alcohol. But for me, at least, AA delayed my facing that I was not doing well with alcohol.
First off, I am a Do-It person. I'm powerless over the weather, or international politics, or what color is fashionable this spring- but I am NOT powerless over alcohol. I take full responsibility for my actions. Nobody ever propped my mouth open and poured wine into it- except myself. I drank because I thought I needed the respite of wine to deal with the rest of my life. Yes, there is a genetic predisposition for many, and childhood/family-of-origin issues that make drinking more alluring- but it is ME! I made the decision TO drink, and I can make the decision NOT TO drink. I had absolutely no inclination toward joining any organization that told me I was NOT responsible for my own actions.
Secondly: Ask several hundred people to define 'alcoholic'- and you will receive several hundred different answers. The most prevalent image seems to be the homeless bum or bag-lady, drinking El Cheapo wine or whiskey, then passing out face down in the gutter in his/her vomit. This is NOT me. I am an accomplished professional with a great family and home. So I reject using the label 'alcoholic'. I have had problems with alcohol, have been a problem drinker, maybe even alcohol-dependent at one point. But I WILL NOT call myself an alcoholic.
Third, there's all that 'turning oneself over to a higher power' stuff. I am a deeply spiritual person, but not particularly religious, and also found that language to be a turn-off.
Like many other people, I thought my two options were to continue drinking or to join AA. Neither appealed to me much, but AA was worse than continuing to drink. Imagine my surprise- and delight- over the past two months to have discovered a vibrant on-line sober community.
I crossed my two personal 'red lines' for alcohol in a single day, and said, that's it, I'm done for a while. How long that would have lasted I don't know- maybe a week or two? But I came across Belle's 100 Day Challenge, and found that finite goal of 100 days (not stopping drinking forever, just committing to a little more than three months) to be a do-able goal. Through Belle's blog, I have 'met' so many others on similar journeys of exploration. I take pleasure in giving encouragement to those in their first few days or weeks, and find great meaning and help in the posts of those who are many months or years into their sober journey.
At a guess, I'd say that thinking AA was the only alternative to continuing to drink probably delayed by 5+ years my deciding to make a change in my relationship with alcohol. I think the existence of this sober online community and countless other options for help in stopping for cutting down on drinking need to be much more widely known. That is, assuming we have a common goal of helping ourselves and anyone else we come into contact with to be the best, most fulfilled person they are capable of being!
I'm still not sure exactly what I will do after these 100 days. I know I will never go back to a bottle or wine or more every evening! I am becoming far too fond of excellent restful sleep, a clear head and an energetic step to go back to that drowsy, foggy, semi-grumpy place. But neither do I think I can live with: Never Ever Ever will a Drop of Alcohol Cross these Lips.
So I will see what I find out, what I develop- and continue to record my experiences here, where I have sworn to myself to include nothing but my absolute truth!
Saturday, December 28, 2013
Sober Day #60! Revisiting the Power of Sleep
Yesterday I had an interesting reminder of the power of sleep!!
In my former drinking life, I was a 4-5 hour a night sleeper. At the time, I felt like this was sufficient to 'get by' on.
In the first weeks of sobriety, I was up to 8-10 hours of sleep each night- mainly because of going to bed very early to avoid evening temptation to drink.
Over the last weeks, however, my sleep time has been shrinking again as I get more enthusiastic and drawn-in by some of my sober evening activities: Just one more square for this quilt, just one more set of glass beads, maybe another chapter of this book... and bedtime creeps later and later.
Everyone 'knows' that sleep deprivation leads to multiple dysfunctions, including slowed reaction time (physical and mental), less creativity and flexibility, and often less optimism. On the other hand, however, most of us, while acknowledging that this is true for others, somehow think of ourselves as 'immune' to this effect.
There is a notoriously poor connection between one's subjective assessment of fatigue or sleepiness, and objective measurements of these. (How do you objectively measure sleepiness?- one way is the Multiple Sleep Latency Test). This means we often think we feel 'fine', are doing just 'great' after our sleep-deprived nights- whereas in reality, we are not functioning so well.
How did my life remind me of this yesterday? By way of a game!
A few months ago, surfing around about 'successful aging' topics, I came across an online site called Luminosity. It has a set of game-like activities purported to keep brain agility challenged. One signs up for a nominal feel, plays different games as assigned, and sees scores comparing oneself with ones own former performance, as well as compared to age-based peers. The website emails a daily reminder to visit and play the 5 games it has assigned to you for that day. I find it a lot of fun. And as a highly competitive person, I love seeing my scores in various categories improve day-by-day. I almost always have a new Personal Best or at least a Top Five score on most of the games each day.
Yesterday, my performance was sub-par. I didn't even hit the Top Five score for any of the games. Hey, What's up?
Later in the day, it occurred to me. The night before was a very short sleep night- only about 4 hours, because of getting to bed a little late, and having to get up unusually early for a must-keep commitment.
I think these games are an unusually good discriminator of reaction time and brain connection time, since they depend on quick responses requiring both mental and physical agility. I hadn't noticed any other performance deficits for yesterday. I wasn't depressed, unusually drawn to alcohol, having trouble driving or any other actions I usually think of as resulting from sleep deprivation. But here was concrete evidence that apparently short sleep, even for just one night, DID impact my ability to function 'on all cylinders'.
So: I am re-committing to getting at least 7 (and preferably 8 or more) hours of sleep each night. I think Enough Sleep is also important in helping me meet this 100 day challenge, and figure out what I want to do after that.
Ciao!
In my former drinking life, I was a 4-5 hour a night sleeper. At the time, I felt like this was sufficient to 'get by' on.
In the first weeks of sobriety, I was up to 8-10 hours of sleep each night- mainly because of going to bed very early to avoid evening temptation to drink.
Over the last weeks, however, my sleep time has been shrinking again as I get more enthusiastic and drawn-in by some of my sober evening activities: Just one more square for this quilt, just one more set of glass beads, maybe another chapter of this book... and bedtime creeps later and later.
Everyone 'knows' that sleep deprivation leads to multiple dysfunctions, including slowed reaction time (physical and mental), less creativity and flexibility, and often less optimism. On the other hand, however, most of us, while acknowledging that this is true for others, somehow think of ourselves as 'immune' to this effect.
There is a notoriously poor connection between one's subjective assessment of fatigue or sleepiness, and objective measurements of these. (How do you objectively measure sleepiness?- one way is the Multiple Sleep Latency Test). This means we often think we feel 'fine', are doing just 'great' after our sleep-deprived nights- whereas in reality, we are not functioning so well.
How did my life remind me of this yesterday? By way of a game!
A few months ago, surfing around about 'successful aging' topics, I came across an online site called Luminosity. It has a set of game-like activities purported to keep brain agility challenged. One signs up for a nominal feel, plays different games as assigned, and sees scores comparing oneself with ones own former performance, as well as compared to age-based peers. The website emails a daily reminder to visit and play the 5 games it has assigned to you for that day. I find it a lot of fun. And as a highly competitive person, I love seeing my scores in various categories improve day-by-day. I almost always have a new Personal Best or at least a Top Five score on most of the games each day.
Yesterday, my performance was sub-par. I didn't even hit the Top Five score for any of the games. Hey, What's up?
Later in the day, it occurred to me. The night before was a very short sleep night- only about 4 hours, because of getting to bed a little late, and having to get up unusually early for a must-keep commitment.
I think these games are an unusually good discriminator of reaction time and brain connection time, since they depend on quick responses requiring both mental and physical agility. I hadn't noticed any other performance deficits for yesterday. I wasn't depressed, unusually drawn to alcohol, having trouble driving or any other actions I usually think of as resulting from sleep deprivation. But here was concrete evidence that apparently short sleep, even for just one night, DID impact my ability to function 'on all cylinders'.
So: I am re-committing to getting at least 7 (and preferably 8 or more) hours of sleep each night. I think Enough Sleep is also important in helping me meet this 100 day challenge, and figure out what I want to do after that.
Ciao!
Friday, December 27, 2013
Sober Day #59
Chilling at home- a welcome experience. I've been enjoying working on quilts and making glass beads. This feeds my soul where it is hungry, where in the past I would have tried to feed that hunger with the distraction of wine. This is much better.
I do see better without wine. This is a totally new way of doing Christmas. Now for tackling the alcohol-fest otherwise known as New Year's Eve!
And enjoying the company of my family, human and fur-faced:
Thursday, December 26, 2013
Sober Day #58- Medication help for Quitting Alcohol (long post!)
All of us who have struggled with addiction are wary of adding another medication to our intake- wary of another dependence, wary of in-authenticity, wary of adding to our woes. But a recently-published study offers a potentially axis-altering option for making quitting a bit easier. (The full reference is below)
This was a 12 week randomized double-blinded placebo-controlled trial (DBPCRT). This is the gold standard for clinical studies:
Randomized: Participants are randomly assigned to treatment (in this case, active medication) or control (placebo, inactive medication) arms. This avoids the potential bias of patients ending up in a group because of their own or the researchers expectations of which arm they'll do better in.
Double Blinded: Neither the participants nor the researchers interacting with the patients are aware of which ones are getting active vs. placebo medication. This is important because many many studies have shown that expectations (on the part of the patient or the research) can subtly influence interactions, and actually affect outcome.
Like one study of grade school kids and their teachers. The teachers were told that tests showed certain students were expected to excel during this school year. Analysis at the end of the year showed that these students had indeed done very well, achieving excellent grades and great evaluations from the teachers. EXCEPT: There was no testing. The students were randomly chosen for the 'expected to excel group'. Which means this group included the extra-smart and the not-so-smart, the previous-thrivers and the previously-indifferent students. Expectations of excellence on the part of the teacher apparently helped each student to achieve his/her best.
The medication used in this study was gabapentin (trade name Neurontin), basically an anti-seizure medication. It has, however, proved useful for lots of other problems. Chronic cough and laryngeal sensory disorder are areas I have experience with using it, and it can work very well for these. One really important thing about this medication in the alcohol-context is that is has no abuse potential. Unlike the benzodiazepenes (valium, klonopin, xanax, etc) frequently used for alcohol withdrawal, and sometimes for help with anxiety in early sobriety, which have major abuse potential. People have inadvertently replaced an alcohol addiction with a pill addiction! Other medications like Antabuse cause physical sickness (nausea, vomiting) when alcohol is consumed while taking them. So these options make Neurontin look like a less disagreeable or dangerous option!
This current study included 150 men and women who were alcohol-dependent, and lasted for 12 weeks. The participants were divided into 3 groups. One received placebo tablets, the second received a total of 900 mg of gabapentin daily, and the third received 1800 mg daily. (The pharmacy prepared special versions of the medication so that the pills received by each of the three groups appeared identical, even though the active medication was different).
The outcomes measures tabulated by the researchers were whether complete abstinence occurred. And if not complete abstinence, did the patient at least have no episodes of heavy drinking. They also looked at some secondary outcomes like changes in mood, sleep, cravings.
Here's where the results get fascinating:
Abstinence rates were 4.1% for the placebo group, 11.1% for the 900 mg a day group, and 17% for the 1800 mg a day group. This shows a dose-dependent improvement in abstinence, that is, more of the medication was associated with higher abstinence rates. Further statistical analysis showed that there was a very small chance of such a result occurring by chance alone, allowing presumption of a cause and effect relationship between more medication and better abstinence rates.
Occurrence of No Heavy Drinking showed a similar spread: 22.5% in the placebo group, 29.6% in the 900 mg a day group, and 44.7% in the 1800 mg per day group.
My editorializing: that means that over 12 weeks, over 60%, nearly two thirds, of the alcohol-dependent subjects in the 1800 mg per day group made a major change in their alcohol consumption: 17% did not drink at all, and another 44.7% did no heavy drinking. Wow!
My Epocrates iPhone app says that the maximum dose per day of neurontin is 3600 mg, which obviously leaves more room for research about the optimal dose.
There is no Magic Bullet for quitting alcohol. And Neurontin (Gabapentin) is not one either. But perhaps, especially for those who have cycled through Day #1 of Abstinence again and again, getting more and more frustrated- maybe, just maybe, this could be the little shove over the top that is needed to get to longer abstinence.
CAVEAT: Although I am a medical doctor, I do not know you individually. I have not sat with you, listened to your medical history, and examined you. So this post is tantalizing information to consider, not a prescription for you to start taking Neurontin on your own. Although impressive, this study mainly opens the door to further questions that need to be answered before this medication is recommended on a routine basis. What is the best dose? How long should the medication be continued? What ancillary services best reinforce this anti-alcohol effect? Are there particular types of people/drinking patterns for whom this works better/doesn't work?
In the US, at least, this remains a prescription-required medication. Even if you could get some on your own, it would be A VERY BAD IDEA to experiment with this without the approval of your personal physician!!
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized controlled trial. JAMA Int Med 2013. doi: 10.1001/jamaintmed.2013.11950
This was a 12 week randomized double-blinded placebo-controlled trial (DBPCRT). This is the gold standard for clinical studies:
Randomized: Participants are randomly assigned to treatment (in this case, active medication) or control (placebo, inactive medication) arms. This avoids the potential bias of patients ending up in a group because of their own or the researchers expectations of which arm they'll do better in.
Double Blinded: Neither the participants nor the researchers interacting with the patients are aware of which ones are getting active vs. placebo medication. This is important because many many studies have shown that expectations (on the part of the patient or the research) can subtly influence interactions, and actually affect outcome.
Like one study of grade school kids and their teachers. The teachers were told that tests showed certain students were expected to excel during this school year. Analysis at the end of the year showed that these students had indeed done very well, achieving excellent grades and great evaluations from the teachers. EXCEPT: There was no testing. The students were randomly chosen for the 'expected to excel group'. Which means this group included the extra-smart and the not-so-smart, the previous-thrivers and the previously-indifferent students. Expectations of excellence on the part of the teacher apparently helped each student to achieve his/her best.
The medication used in this study was gabapentin (trade name Neurontin), basically an anti-seizure medication. It has, however, proved useful for lots of other problems. Chronic cough and laryngeal sensory disorder are areas I have experience with using it, and it can work very well for these. One really important thing about this medication in the alcohol-context is that is has no abuse potential. Unlike the benzodiazepenes (valium, klonopin, xanax, etc) frequently used for alcohol withdrawal, and sometimes for help with anxiety in early sobriety, which have major abuse potential. People have inadvertently replaced an alcohol addiction with a pill addiction! Other medications like Antabuse cause physical sickness (nausea, vomiting) when alcohol is consumed while taking them. So these options make Neurontin look like a less disagreeable or dangerous option!
This current study included 150 men and women who were alcohol-dependent, and lasted for 12 weeks. The participants were divided into 3 groups. One received placebo tablets, the second received a total of 900 mg of gabapentin daily, and the third received 1800 mg daily. (The pharmacy prepared special versions of the medication so that the pills received by each of the three groups appeared identical, even though the active medication was different).
The outcomes measures tabulated by the researchers were whether complete abstinence occurred. And if not complete abstinence, did the patient at least have no episodes of heavy drinking. They also looked at some secondary outcomes like changes in mood, sleep, cravings.
Here's where the results get fascinating:
Abstinence rates were 4.1% for the placebo group, 11.1% for the 900 mg a day group, and 17% for the 1800 mg a day group. This shows a dose-dependent improvement in abstinence, that is, more of the medication was associated with higher abstinence rates. Further statistical analysis showed that there was a very small chance of such a result occurring by chance alone, allowing presumption of a cause and effect relationship between more medication and better abstinence rates.
Occurrence of No Heavy Drinking showed a similar spread: 22.5% in the placebo group, 29.6% in the 900 mg a day group, and 44.7% in the 1800 mg per day group.
My editorializing: that means that over 12 weeks, over 60%, nearly two thirds, of the alcohol-dependent subjects in the 1800 mg per day group made a major change in their alcohol consumption: 17% did not drink at all, and another 44.7% did no heavy drinking. Wow!
My Epocrates iPhone app says that the maximum dose per day of neurontin is 3600 mg, which obviously leaves more room for research about the optimal dose.
There is no Magic Bullet for quitting alcohol. And Neurontin (Gabapentin) is not one either. But perhaps, especially for those who have cycled through Day #1 of Abstinence again and again, getting more and more frustrated- maybe, just maybe, this could be the little shove over the top that is needed to get to longer abstinence.
CAVEAT: Although I am a medical doctor, I do not know you individually. I have not sat with you, listened to your medical history, and examined you. So this post is tantalizing information to consider, not a prescription for you to start taking Neurontin on your own. Although impressive, this study mainly opens the door to further questions that need to be answered before this medication is recommended on a routine basis. What is the best dose? How long should the medication be continued? What ancillary services best reinforce this anti-alcohol effect? Are there particular types of people/drinking patterns for whom this works better/doesn't work?
In the US, at least, this remains a prescription-required medication. Even if you could get some on your own, it would be A VERY BAD IDEA to experiment with this without the approval of your personal physician!!
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized controlled trial. JAMA Int Med 2013. doi: 10.1001/jamaintmed.2013.11950
Wednesday, December 25, 2013
Sober Day #57!! Enough.
Fifty-Seven days without alcohol- a quiet little Christmas miracle all my own! Just for today, that is enough!
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