Yesterday was all about fun and games and a bit of thrill seeking. We spoke of clowns. There is a darker side to clowns and many people have a morbid fear of them. Think of Pennywise in the film “It”. Today I want to consider the other side of the coin – the negative aspects of drinking. After looking at the reward side of learning theory yesterday, what you might call the carrot side, today I want to look at the punishment side, or the stick side. I like a bit of learning theory, me.
We noted that people will continue to use alcohol even if the pleasures associated with it are starting to be outweighed by the negative consequences – health concerns, relationship troubles, financial problems or involvement in the legal system. There comes a point when the balance tips in favour of reducing or stoppimg alcohol use completely. But the person has to recognise that this is the case – thanks to the processes of denial and self-deception, it can take a while to reach this point (the contemplation stage in the Stages of Change model we touched on in an earlier post). It is often the case that other people will notice that drinking has become a problem before the person themself does. It is a key characteristic of addiction that the person persists with the behaviour even when they know the harm it may be causing them.
People can develop physical and psychological dependence on alcohol. In the case of the former, stopping or reducing drinking can produce distressing symptoms of alcohol withdrawal, some of which can be life-threatening. Thus drinking is continued not for the direct pleasure but for the avoidance of unpleasant symptoms (in learning theory, this is negative reinforcement – not punishment). In cases of psychological dependence, for example if they are drinking to cope with troubling mood states such as depression or anxiety, alcohol can make the symptoms worse in the long run. Remember, alcohol is a depressant, so long term use can excacerbate depression (possibly fuelled by regrets, guilt or feelings of hopelessness), and the effects of withdrawal can include a worsening of anxiety symptoms. In effect, the person is trapped in a vicious cycle.
Oh dear, this is all a bit negative I’m afraid. But all is not lost. Alcohol withdrawal can be safely managed under medical guidance either in hospital or in the community. Medication can take the edge off the symptoms with a reducing dose over a few days. Talking therapies such as Motivational Interviewing can help people recognise the links between their drinking and the problems it causes them, thus helping them move towards a decision to make changes and giving them hope and confidence they can take this step. After withdrawal, a range of individual or group therapies can be helpful, as of course can AA. In some cases, people might be offered forms of psychotherapy such as Cognitive Behaviour Therapy or EMDR (eye movement desensitisation and reprogramming), especially where there is a history of trauma. Addiction problems do not arise and survive in a vacuum – they come from personal histories and can be kept going by environmental factors. The reasons for starting to drink are not necessarily the same as those that maintain the drinking – especially once the pleasure has gone.
When problems with alcohol are more severe or chronic, there is the possibility of being prescribed disulfiram (” Antabuse”). This is a serious decision to take, because if the person comes into contact with alcohol (sometimes including when it is an ingredient in cosmetics) they experience severe and very unpleasant symptoms – flushing, headaches and vomiting – which can sometimes be life threatening. The roots of how this drug was developed lie in the rubber industry where it was used in the process of vulcanisation – it was found that workers experienced unpleasant symptoms if they were exposed to alcohol after working with the product. In terms of learning theory, this is a punishment model – drink and you will regret it. In the early days of use back in the 1940s and 1950s patients were deliberately exposed to the consequences while in hospital to reinforce this message, but thankfully that does not happen now – people are sufficiently motivated by the fear of the effects in most cases. In general, carrots are better than sticks in promoting lasting changes, the history of aversive conditioning tends to show that immediate effective results are short-lived.
Well, this has been a bit heavy for a Sunday evening. You have done well to get this far. I thought it was important to look at both sides of drinking – the pleasure and the pain. If you are struggling yourself, then I hope it gives you some hope and understanding. If you know someone who is struggling, then I hope it gives you some understanding and confidence to be there for them. Compassion is the keyword – for self and others. Keep safe and well, and who knows what tomorrow’s post will be about? I don’t yet. What. you thought this was all carefully crafted?!
Alcohol Trivia Quiz
Yesterday’s answers:
1. It is the pulp left after the apple juice has been extracted in cider making.
2. John Steinbeck
3. Bacchus
Today’s questions:
1. The body of which naval leader was transported back to land in a cask of brandy?
2. Who had hit with “I heard it through the grapevine”?
2, Who had a hit with “Magic Moments”?
Understand Yourself Better 