November 2020 - Monument

My Family Gets Drunk During The Holidays. Now What?

Posted on November 20, 2020 | by Mark Zauss | Leave a Comment

Drinking excessively is all too common during the holidays and for many of us, it can be our family’s drinking we struggle with the most. Whether we are working to maintain sobriety ourselves, or are otherwise affected by our loved ones’ drinking, navigating familial alcohol consumption can add a great deal of stress to the holidays. There are two questions I encourage you to ask yourself:

What can I do for my family members if they drink too much?
What can I do for myself?

With empowering strategies and firm boundaries, you will be able to celebrate the holidays on your own terms.

You have options

If you’re hosting, limit the amount of alcohol you serve. If you’re a guest, bring the sparkling apple cider.

Let me be clear: putting a cap on the alcohol in your house does not make you a bad host. Limiting access to alcohol sets a boundary for everyone. This reduces the risk of one-on-one confrontation and having to single out anyone who might be struggling to manage their drinking. Instead, offer inspired non-alcoholic drinks and delicious food. Not to mention that water, protein, and carbohydrates can help dilute the effects of alcohol if people are drinking around you.

Have a time limit.

Building a nighttime routine is a highly effective way to boost your mental wellness. And if you’ve been on a roll, your nightly rituals don’t have to waver because it’s a holiday. If your family is sharing a holiday meal, be transparent about the time commitment. Plan on wrapping up soon after dinner, or commit to leaving at a certain time. Again, you’re not being a poor host or a rude guest. In fact, you’re establishing loving boundaries for not just yourself, but your home and your family. If you’re sober or moderating, maintaining that commitment is far more important than staying a couple hours longer after dessert. You are your top priority.

Extra important: Be aware of how everyone’s getting home.

According to The National Highway Traffic Safety Administration, the holiday season accounted for roughly one-third of the yearly driving fatalities in 2018. If you or someone you love is unable to drive themselves home, arrange alternative transportation.

Oftentimes, we cannot control how much our loved ones’ drink. What we can control is how much we drink, and how we support those around us.

Holiday Group: Getting Through Today Without Drinking

The holidays can be filled with joy, loneliness, pressure to drink, and more. Your feelings are valid. Join us for an encouraging conversation about how to get through today without alcohol.

Check out the Schedule

You don’t have to be “on.”

You don’t owe any explanation if you need space from others. I hear frequently from my patients that folks feel obligated to be “on” during the holiday season beyond their bandwidth. There is nothing wrong with opting out of a dinner or a Zoom call. It can be particularly difficult to be surrounded by heavy holiday drinking when we are working to change our relationship with alcohol. Instead, join a Monument alcohol support group (2 are taking place on Thanksgiving!), write into your Community, watch a holiday-flick, or order take-out for one. Your mental health and, if applicable, sobriety or moderation is paramount to any familial obligation. And if you need some support to get started, check out our tips for psychologically distancing yourself from people … and alcohol. Both might apply here!

And it might not just be about the holidays.

Understand where we are.

Understanding where you are mentally and emotionally can be challenging. It takes check-ins, self-reflection, and most importantly: compassion. If you’re struggling to maintain self-compassion as you navigate challenging relationships and alcohol use over the holidays, I recommend thinking of where you are as one stop in a series of stages. Enter: The Transtheoretical model of change. When we become aware of where we fall on our path toward actualizing the changes we’d like to make, we can better understand what we need, what we’re not getting, and review what we have. This model can also help your family members understand their own journey, especially in changing their relationship with alcohol.

What stage do you see yourself in? Allow yourself to be where you are in your process, reflect on what you need in this moment, and continue on your path toward change. You can also use this model to reflect on where your family members may be. This will help you to establish your boundaries (and expectations) this holiday season.

Give and receive support

While you cannot force anyone into getting treatment, you can be ready with resources if they are interested or willing. Monument believes in making this support accessible, with physician-prescribed medication to stop drinking or cut back, specialized alcohol therapy, and free therapist-moderated online alcohol support groups. Bring ideas and resources to the table, and let your loved one know that you are always there to help them in getting care.

You don’t have to do this alone.

This has been an extraordinarily challenging year. According to research from The Journal of the American Medical Association, there has been a significant increase in alcohol consumption since the pandemic started. These are unprecedented circumstances, and undeniably trying. If you’re concerned about your own drinking habits or a loved one’s drinking, know that you are not alone. I encourage you to attend a support group about managing your own drinking, or “Caring for yourself while caring for someone in recovery.” Join with your camera on or off, to listen, share, and discover community. And, know that we are here for you every step of the way.

And finally, I encourage you to claim your health as a priority. The holidays can generate high levels of stress, and family drinking can be difficult to navigate, especially while sober. Remember what you can control and offer your help to those you love. Sometimes a boundary or personal space can be the best gift you can give yourself (and others). Remember that your needs are also at the table.

If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911.

Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

Why You Feel Anxious When You Stop Drinking

Posted on November 20, 2020 | by Randy Smith | Leave a Comment

If you feel anxious after cutting out alcohol, that’s incredibly common, and even to be expected. Before we dive into the scientific reasons behind why anxiety is common in early sobriety, know that your anxiety can be addressed and managed without alcohol, and that you’re not alone.

In summary, there are two key reasons you may be feeling especially anxious when you stop drinking:

You might have already had baseline anxiety. You may have been using alcohol to manage existing anxiety because you didn’t have the tools in your toolkit to address it in healthier ways.
Your brain is in recovery mode. Long-term alcohol use affects your brain’s ability to regulate emotions without it, and when you stop drinking, it takes time for your brain to re-learn how to function without alcohol.

Using Alcohol To Cope with Anxiety

Alcohol is an anxiolytic, or an anxiety (anxio-) stopper (-lytic). And it’s effective. While it’s not a healthy coping mechanism, alcohol does soothe anxiety in the short term. However, your mind and body ultimately pay the price. As Monument’s medical advisor James Besante, MD, shares, “Many times people are self-medicating to treat baseline anxiety with alcohol. For some people that’s the best tool they have in their toolbelt. I never fault my patients for using alcohol to treat anxiety because anxiety can be debilitating.”

However, to live your healthiest and fullest life, Dr. Besante recommends finding alternate coping mechanisms. When getting sober, you might have to confront the reasons you started drinking. Anxiety in early recovery is often baseline anxiety that existed before developing unhealthy drinking habits and getting sober. When removing alcohol as our coping mechanism, it’s important to get a new anxiety-management tool in the toolbelt to replace it.

While it will be uncomfortable, sitting with those anxious feelings is a big part of growth in your journey. And with time and support, they can be managed.

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Why Does Quitting Alcohol Make You Anxious?

In addition to the presence of baseline anxiety, there’s a physiological reason why quitting drinking can make you anxious at first. Here’s a helpful analogy: imagine the central nervous system as a highway. It’s constantly racing with electric signals that pass through our brain and throughout our body to do every function we need to survive. We also have a special neurotransmitter system that functions as ‘brakes’ to help slow down racing signals. Our body naturally balances our need to send these signals with the need to regulate them.

When we drink alcohol, we add more brakes to our highway. We feel more sedated, and have a harder time accomplishing tasks. With long-term alcohol use, our brain realizes that we’re turning the brakes up with alcohol, and starts turning down its natural brakes to stay in balance. Over time, we lose our natural brakes and ability to moderate racing signals without drinking. This is a sign of physiological dependence on alcohol.

When we stop drinking, we are left without any breaks — natural or alcohol-induced. So it is very common to feel those racing thoughts at full speed: restlessness, anxiety, panic, and more. That’s where the more intensified anxiety comes from.

How Long Does Anxiety Last After You Quit Drinking?

The good news is, our brain can restore its natural brakes. For many, anxiety levels can improve within three weeks without drinking. For those experiencing post-acute withdrawal syndrome (or ‘PAWS’), it may take more time. This is because PAWS symptoms often include longer-lasting anxiety and irritability as the brain recovers from the negative effects of alcohol. You can check out the alcohol recovery timeline to learn more about acute and post-acute withdrawal symptoms. Regardless of your timeline, relief is within reach. Alcohol’s depressive qualities intensify anxiety and depression, and removing it from your life is shown to improve your mental wellbeing.

If anxiety symptoms persist after several months sober, you may have an underlying anxiety condition. Working with a therapist is a great way to address co-occurring anxiety and develop healthier coping mechanisms. With time and support, anxiety can be mitigated.

How to Manage Anxiety When You Stop Drinking

There are many tools you can use to help manage anxiety in early sobriety and beyond. These same tools can also be beneficial in managing alcohol cravings and persevering through setbacks.

Practice mindfulness and meditation

Mindfulness describes the process of grounding yourself in the present moment and staying focused on what’s really true. Mindfulness can help you clarify your goals, reroute negative thoughts, and feel more at peace. Incorporating mindfulness into your day can also help reduce acute anxiety and prevent anxiety spikes in the future. Meditation is a popular mindfulness practice that helps you become aware of your thoughts and surroundings by sitting still and observing what occurs. Trying guided meditation is a great way to get started with mindfulness.

Here are a few other ways you can practice mindfulness:

Reach out to a therapist

Working with a therapist is one of the best things you can do to manage anxiety. Therapy can help you identify your triggers, restructure negative thought patterns, and learn new coping skills through methods like motivational interviewing and cognitive behavior therapy (CBT). In therapy with Monument, you get matched with a therapist specialized in using these tools to help people change their relationship with alcohol and minimize anxiety simultaneously.

Explore stress-relieving activities

Finding hobbies and fun alcohol-free activities can be a great way to release anxious energy. These activities may involve other people, or can be self-care practices you do alone, such as taking a bath, practicing yoga, or reading. Even taking a light walk when you notice anxious thoughts can make a huge difference. The key is to find a calming activity that can help break the cycle of anxiety.

Seek peer support

Trying to tackle anxiety alone can be … anxiety-inducing! Sharing our experience with trusted friends and family can help lessen the weight of anxious thoughts and strip them of their power. Talking with others who have similar experiences after quitting alcohol can also be a powerful resource. At Monument, you can join free therapist-moderated alcohol support groups and get encouragement and tips from others. Many of these groups are focused specifically on managing anxiety while in recovery.

Can Quitting Drinking Help My Anxiety?

While quitting alcohol can lead to increased anxiety in the short-term, it’s one of the best things you can do to help minimize anxiety in the long-term. When you stop drinking, you can say goodbye to hangxiety and shame about what you may have said or done when under the influence. Plus, without the influence of alcohol, you’re able to take actions as your truest self, which leads to an increased sense of confidence and self-worth. If you struggle with underlying anxiety, removing alcohol can help you focus on developing healthier and more effective strategies for coping. Overall, quitting or cutting back on drinking can have a tremendous positive impact on your mental health.

The early days of sobriety can be very challenging, but you can get through them. With time and support, it will get easier. Your body will heal, and you will build healthier coping habits that diminish the importance of alcohol in your life. Join Monument today to get connected with an expert Care Team and encouraging community who will support you along your journey.

If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911.

Sources:

University of Pennsylvania. “Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, https://pubmed.ncbi.nlm.nih.gov/19634954/.” Accessed Nov 18, 2020.
Brown University. “Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials, https://pubmed.ncbi.nlm.nih.gov/19515291/.” Accessed Nov 18, 2020.

How To Stop Drinking Alcohol Without Rehab

Posted on November 17, 2020 | by Randy Smith | Leave a Comment

Quitting alcohol doesn’t have to wait until your drinking becomes very severe. You have the ability to make a change at any time. Whether you meet the clinical definition of alcohol use disorder (AUD) or think your drinking is beginning to get in the way of living your fullest life, you might be wondering how to stop drinking alcohol without going to rehab. With personalized online alcohol treatment and the right support system, it can be done.

The team at Monument wants you to know you’re not alone. We’re here to help you change your drinking habits with our research-based alcohol treatment plans, including our approach to specialized alcohol therapy, and physician-prescribed medication. Find detailed guidance on how to quit drinking below.

9 Tips To Help You Quit Drinking Alcohol

Discover 9 ways to help you meaningfully change your relationship with alcohol.

1. Find Tools to Help You Quit Drinking

Is it possible to stop drinking without doing an extended stay at an expensive rehabilitation facility? We’re here to tell you that it’s not only possible but within reach. Monument is committed to empowering our members to change their relationship with alcohol from the comfort of their own home.

Recovery is rarely a linear journey. And while there’s no one-size-fits-all approach, there are tools and techniques that can be tailored to your needs, and get you from where you are to where you want to be. This guide will walk through a holistic, research-based approach to how to quit drinking for good.

2. Examine Your Relationship with Alcohol

Examining your relationship with alcohol is an important preliminary step to quitting drinking. It’s an act of self-care. Not sure where to start? The personalized treatment plans from Monument begin with a pre-screener survey to evaluate your drinking habits. Your answers will be protected and used only by your Care Team to determine how Monument plans can best help you reach your goals for sobriety or moderation.

It can also be helpful to review trusted resources about alcohol use, drinking culture, and how to recognize an unhealthy relationship with alcohol, like the guides and deep-dives from our Reading & Resources. Here are a few expert resources to guide your reflection:

3. Learn About Alcohol Use Disorder

There is no single definition of what it means to have an “alcohol problem.” In reality, unhealthy drinking habits exist on a spectrum, and everyone’s relationship with alcohol is unique. You don’t need to check any boxes to build healthier habits. However, if you’re wondering where to start in assessing your drinking habits, there are common symptoms to look out for that may indicate you fall on the spectrum for alcohol use disorder (AUD).

What is alcohol use disorder or ‘AUD’? Alcohol use disorder (AUD) is characterized by drinking more than you want and for longer than you want, despite wanting to cut down. AUD is also commonly known as ‘alcohol dependence’ or ‘alcohol dependency.’ . AUD is diagnosed per the The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5). AUD is broken down into 11 criteria, including continuing to drink even though it’s causing trouble with your family or friends, experiencing alcohol cravings, and experiencing withdrawal symptoms when the effects of alcohol wear off. While some may not fall on the clinical spectrum for AUD, a person’s drinking habits may still be affecting their health and wellness. Excessive alcohol consumption looks different for different people, whether that’s infrequent binge drinking, daily alcohol use, or somewhere in between. That’s why Monument’s treatment plans are tailored to individuals’ unique goals, needs, and medical history.

4. Identify Your Support System

When it comes to quitting drinking, having a sober support team can play a vital role. Instead of trying to tackle it alone, we recommend leaning on a combination of friends and family, physicians, therapists, and a community of sober peers.

If you’re not ready to talk to your friends and family about your drinking habit, that’s okay! It’s why we created the Monument Community, including our forum and therapist-moderated alcohol support groups. Because so many people are navigating this too, you should be able to connect with them anonymously, entirely online. You can join support groups on or off camera, and will never be called on to share.

Monument Support Groups

You can participate in free online video sessions, which are moderated by experienced therapists and cover a variety of topics relating to changing your relationship with alcohol. In our hour-long sessions, you’ll be able to share your thoughts, voice your emotions, self-reflect, hear from your peers, and practice accountability as you navigate the alcohol recovery timeline.

You can browse groups and select topics related to your unique situation, interests, obstacles, and goals, whether that be reducing your alcohol intake or quitting alcohol altogether. Then, select upcoming sessions that work for your schedule and register for free.

We know how intimidating it can be to talk with others about your drinking, and we want you to be as comfortable as possible. We’ll never call on you to participate or share. But if and when you’re ready, we’ll respond with encouragement, guidance, and compassion.

Monument also has a community forum, a valuable resource where you can:

Post about your challenges with alcohol consumption
Share updates about your progress
Participate in discussions
Read through past threads, member stories, and testimonials

5. Connect with Expert Clinicians

When setting out to quit drinking, it’s a great idea to consult with a physician and therapist. Alcohol use disorder is a biopsychosocial condition, which means biological, psychological, and social conditions interact to influence your drinking behaviors. A physician and therapist can work with you to review your drinking habits, medical history, lifestyle, and preferences and provide holistic guidance for quitting drinking.

Monument can connect you with physicians and therapists entirely online. All providers in our network are licensed, background-checked, and highly qualified to help individuals struggling with unhealthy drinking behaviors. Your Care Team will personalize a treatment plan, including options for therapy and medication, based on your needs and preferences.

6. Use Evidence-Based Therapy

Evidence-based modalities can be very effective in treating alcohol use disorder. When you enroll in one of our Total Care plans, you’ll be matched with a knowledgeable therapist who’ll work with you on changing your relationship with alcohol. They’ll help you define success, and create a personalized therapy program that’s specifically tailored to you and your needs. Therapy can help you build problem solving skills, manage cravings and uncomfortable feelings, address co-occuring mental health conditions like depression and anxiety, and break the cycle of alcohol dependence.

Your therapy plan might involve:

Motivational interviewing to help you overcome indecision and uncertainty while motivating you to make positive changes
Cognitive-behavioral therapy (CBT), which addresses behaviors and patterns that lead to negative thoughts while helping you develop healthy coping strategies
Contingency management (CM), which uses motivational incentives to enforce positive behaviors, helping you reach and maintain your goals

7. Take Medication If Appropriate

Like many physical and psychological health conditions, alcohol use disorder can also be treated with a physician-prescribed medication to stop drinking. Though medication isn’t for everyone, Monument can connect you with a licensed physician who’ll provide information and recommendations about how medication might fit into your personalized treatment program.

Your physician can prescribe FDA-approved, science-backed medications, such as disulfiram or naltrexone, to help you cut down on alcohol consumption or quit altogether. Your pre-screener survey will be followed by a video appointment with a physician who’ll incorporate medication into your plan if they deem it appropriate and safe.

That being said, medication is always optional, and we encourage you to share your input and preferences with your physician.

8. Set Clear, Realistic Goals

Another helpful component of changing your drinking habits is goal setting. If you decide to quit drinking, you don’t have to completely transform your lifestyle overnight. Additionally, quitting alcohol cold turkey may not be recommended by your physician. Setting realistic goals and milestones, after connecting with a physician and therapist, can help you make meaningful progress and feel in control of each step in your journey. Your Monument Care Team can help you identify your intentions and set feasible objectives. You don’t have to see the entire staircase to take the first step, and sometimes goal setting looks like identifying those first few stairs.

9. Build Healthier Habits and Find Alternative Activities

To set yourself up for success with quitting drinking, it’s a great idea to fill the time you once spent drinking with healthy habits and rewarding activities. It’s especially helpful when experiencing alcohol cravings. Though the path to sobriety is not always an easy journey, a sober lifestyle can be incredibly rewarding. It’s all about discovering new ways to relish life and establishing healthy habits.

Here are a few alternative activities you can take up instead of drinking:

Cooking
Redecorating your home
Training for a half-marathon
Writing a book
Doing yoga
Learning a new language
Practicing self-care
Hosting friends for an alcohol-free night in
Exploring non-alcoholic beverages

It’s great to stay busy and have backup activities on hand for when you’re experiencing alcohol cravings or boredom. Additionally, if you drink alcohol to cope with anxiety or another mental health condition, developing healthier ways to manage distress and discomfort is an important part of the recovery journey and replacing your drinking habit. You can check out our Reading and Resources to see expert insights about managing anxiety, practicing mindfulness, and more.

10. Pursue Flexible Treatment

If you aren’t sure how to stop drinking, you’ve come to the right place. Showing up and seeking support is the first step in your journey to stop drinking alcohol, and we’re here for you. Our online alcohol treatment program offers a specialized therapy approach to changing your relationship with alcohol, in addition to physician care and medication options. We do this by providing 100% online research-based treatment plans tailored to your unique needs and situation.

Treatment should be responsive to what your needs are. For some, applying each of these modalities and strategies is the most effective way to quit alcohol, and for others, the process may look very different. Take the tools that best serve you. If something isn’t working, you can always reassess your approach and work with your Care Team on adjusting your plan. From moderated support groups and community forums to therapists and physician-prescribed medication, you have options, and you’re never alone.

Ready to change your relationship with alcohol? Join Monument today to reach your sobriety goals.

Important Safety Information:

Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with active liver disease must be carefully considered in light of its hepatotoxic effects. In the treatment of alcohol dependence, common adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list.

The most common side effects of Disulfiram may include drowsiness, tiredness, headache, acne, and metallic-like taste in the mouth. Call your doctor if you have signs of serious side effects such as decreased sexual ability, vision changes, numbness of arms or legs, muscle weakness, mood changes, seizures, or confusion. Do not take Disulfiram if you are allergic to any of the ingredients. If you begin to have signs of an allergic reaction, then seek immediate medical attention. Avoid consumption of alcohol while taking this medication, as it may lead to adverse side effects. Talk to your doctor about the history of your medical conditions including if you have or have had diabetes, underactive thyroid, brain disorders, liver or kidney disease, personal or family history of regular use/abuse of drugs. Certain drug interactions may lead to serious adverse side effects. Let your doctor know about any other medications you are taking. This is not a complete list of potential adverse events associated with Disulfiram. Please see Full Prescribing Information for a complete list.*Monument Inc. provides administrative and business support services to independent medical and clinical practices and providers. Monument Inc. does not provide medical or clinical services and does not own medical or other clinical practices. All medical services are provided by Live Life Now Health Group, PA d/b/a Live Life Now Medical Group. All counseling and therapy services are provided by independent licensed practitioners including licensed clinical social workers (LCSW) and licensed mental health counselors (LMHC). Individuals should contact their physician or therapist with any questions about their treatment.

Sources:

NIAAA. “Introduction to Alcohol Withdrawal, https://pubs.niaaa.nih.gov/publications/arh22-1/05-12.pdf.” Accessed Nov, 17. 2020.
WikiHow. “How to Quit Drinking without Alcoholics Anonymous, https://www.wikihow.com/Quit-Drinking-without-Alcoholics-Anonymous.” Accessed Nov, 17. 2020.
NIAAA. “Support strategies for quitting, https://www.rethinkingdrinking.niaaa.nih.gov/Thinking-about-a-change/support-for-quitting/Self-Help-Strategies-For-Quitting.aspx.” Accessed Nov, 17. 2020.

Is Quitting Alcohol Cold Turkey Dangerous?

Posted on November 17, 2020 | by Randy Smith | Leave a Comment

Disclaimer: This article does not constitute health care services. If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911.

When your body gets used to a substance, suddenly going without it can be alarming biologically, psychologically, and socially. If you or a loved one have an unhealthy relationship with alcohol, you might be wondering what happens if you stop drinking “cold turkey.”

To address both the biological and psychological effects, working with physicians and therapists who provide specialized alcohol therapy can be valuable in helping you reduce your alcohol consumption safely. To arm you with information to share with your healthcare providers, we’ve outlined potential effects of quitting alcohol cold turkey.

What to Consider About Quitting Drinking Cold Turkey

Those with alcohol use disorder might feel like they need to drink to feel “normal.” If you’re feeling this way, you are not alone. This is often an indication of alcohol dependence. This chemical dependence is both mental and physical, so when a person attempts to quit drinking cold turkey, they might start to experience mental and physical alcohol withdrawal symptoms. Because your body has a physical dependence on alcohol, the symptoms can sometimes be dangerous. Before considering quitting cold turkey, it’s important to be informed of the potential effects and to also consult with a licensed physician.

The withdrawal process looks different for everyone, and the symptoms of quitting cold turkey can range from uncomfortable to potentially dangerous and life threatening. We’ve outlined what the acute and post-acute withdrawal symptoms from quitting alcohol look like below.

Alcohol Withdrawal Timelines & Symptoms

Acute Alcohol Withdrawal

Since alcohol is a depressant, it slows down the central nervous system. With an extended period of heavy drinking, the body eventually adapts to the presence of alcohol and grows accustomed to a slow-functioning nervous system. This is a sign of physical dependence, and it’s a risk factor for acute alcohol withdrawal. Acute alcohol withdrawal often takes place within the first week of quitting alcohol.

Other risk factors for acute withdrawal include:

Long-term heavy drinking
A history of seizures
A history of delirium tremens
Previous medical detox

If you’ve tried to stop drinking in the past and experienced physical symptoms like alcohol shakes, elevated heart rate, or hallucinations, you are at higher risk of experiencing acute withdrawal after going cold turkey. However, we recommend anyone considering quitting alcohol cold turkey connect with a physician about how to safely change your drinking habits.

If you believe you are experiencing alcohol withdrawal syndrome, please contact your provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911.

Mild Alcohol Withdrawal Symptoms

Withdrawal severity, like alcohol use disorder severity, falls on a spectrum and some may experience more severe forms of withdrawal while others may experience mild symptoms. Here’s what you need to know about mild withdrawal.

Mild alcohol withdrawal symptoms may include:

Headaches
Nausea or vomiting
Fever or chills
Sweating
Difficulty sleeping
Irritability or feelings of anxiousness
Alcohol cravings

Anyone who’s had a hangover following a night of heavy drinking has likely experienced at least some of these symptoms. And while they’re unpleasant, they aren’t necessarily dangerous.

Mild withdrawal symptoms can last anywhere from a couple of days up to about a week as the body adapts to not having alcohol. This process involves resetting the complex neurocircuitry that is disrupted from chronic alcohol use.

Severe Alcohol Withdrawal Symptoms

Many people can successfully quit or cut down on their drinking without needing in-person medical assistance or a clinical alcohol detox program. For those not in need of in-person supervision, their physician may refer them to online alcohol treatment to help them reach their goals for sobriety or moderation.

However, some forms of complex alcohol withdrawal can be dangerous and even life-threatening without medical supervision, which is why connecting with a physician is an important first step in safely changing your habits. Here are some of the more severe forms of withdrawal that can stem from quitting cold turkey.

Delirium Tremens

Delirium tremens (DT) usually begins between two to five days following the last drink of alcohol. This severe withdrawal symptom can involve a combination of high blood pressure, convulsions, disorientation, confusion, hyperactivity, and hallucinations. The risk factors for DT include previous episodes of DTs, history of complex alcohol withdrawal requiring medications for detox, prior hospitalizations related to alcohol withdrawal, and medical comorbidities, like advanced liver disease or other chronic health conditions. Acute illnesses like trauma, pancreatitis, hepatitis, or infection also increase the risk of DTs.

Hallucinations or Seizures

Hallucinations can put a person at risk for harming themselves or those around them. An alcohol withdrawal seizure can also be unsafe. Not only that, but these severe withdrawal symptoms can be unpredictable. They can take place at any time during the alcohol withdrawal process, presenting a hazardous, and even life-threatening, situation that’s difficult to deal with alone.

Psychological Symptoms

Lastly, the psychological symptoms of acute alcohol withdrawal can be dangerous. Due to a drop in dopamine, feelings of anxiety and depression might be accompanied by suicidal thoughts in extreme cases. Those struggling with a serious underlying mental health conditions or past trauma may be particularly susceptible, especially considering the relationship between alcohol and depression, anxiety, and PTSD. In these instances, undergoing detox in a monitored detox program may be the safest option.

Post-Acute Alcohol Withdrawal

In addition to acute alcohol withdrawal, there’s also a lesser known withdrawal experience called post-acute withdrawal syndrome (PAWS), which occurs on a longer alcohol withdrawal timeline.

Some of the most common signs and symptoms of post-acute withdrawal include:

Anxiousness or panic
Feelings of depression or apathy
Irritability or mood swings
Heightened sensitivity to stress
Trouble concentrating or remembering things
Disrupted sleep

PAWS can continue for weeks or months after quitting alcohol. These symptoms can range from mild to severe and may occur at any time, even without an obvious trigger. While experiencing PAWS can be discouraging, it’s often a normal part of the recovery timeline, and it does get better. Knowing that PAWS is a possibility can help you manage your expectations for quitting alcohol. If you do experience post-acute withdrawal, it’s important to remember that what you’re going through is normal, and over time, the symptoms will subside.

Talk with your physician before attempting to quit drinking. They’ll help you assess your risk for withdrawal and can recommend the safest course of action.

Supervised Detox to Be Safe

Withdrawing under clinical supervision is the safest choice for more severe forms of withdrawal. This is because in-person medical staff can make sure you receive medications to prevent a seizure. It is also much safer because they can monitor heart rate, oxygen level, and other vital signs. Additionally, some detox programs ensure individuals are hydrated and fed to avoid dehydration and nutrition issues that can arise during a withdrawal.

How Monument Can Help You Quit Drinking

There’s no one-size-fits-all approach to treating AUD or an unhealthy relationship with alcohol. If you want to learn how to stop binge drinking, forgo your nightly drink, or change other unhealthy drinking behaviors, Monument is here for you. Whether you want to stop drinking on day one or gradually reduce your drinking, our network of clinicians can help advise you on what’s best for you.

Monument’s online alcohol treatment program was built so that you can change your drinking on your own terms. We provide evidence-based treatment plans that are tailored to our members’ individual needs. And our platform is entirely online, allowing you to work toward sobriety or moderation on your own time. Read more about how to stop drinking without rehab, including resources for alcohol support groups, specialized therapy, and more.

If you think you may be at risk of experiencing any of the acute or post-acute withdrawal symptoms shared above and don’t know how to stop drinking alcohol, we encourage you to connect with a physician about your options.

Sources:

Science Direct. “Alcohol Withdrawal Syndrome, https://www.sciencedirect.com/topics/medicine-and-dentistry/alcohol-withdrawal-syndrome.” Accessed Nov. 10, 2020.
National Institute on Alcohol Abuse and Alcoholism. “Introduction to Alcohol
Withdrawal, https://pubs.niaaa.nih.gov/publications/arh22-1/05-12.pdf. Accessed Nov. 10, 2020.
National Library of Medicine. “Alcohol withdrawal syndrome: how to predict, prevent, diagnose and treat it, https://pubmed.ncbi.nlm.nih.gov/17323538/.” Accessed Nov. 10, 2020.
Semel Institution for Neuroscience and Human Behavior. “Post-Acute Withdrawal Syndrome (PAWS), https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS.” Accessed Nov. 10, 2020.
Medline Plus. “Delirium tremens, https://medlineplus.gov/ency/article/000766.htm.” Accessed Nov. 10, 2020.

Authentically Changing Your Role In Your Loved One’s Recovery

Posted on November 6, 2020 | by Sabrina Spotorno | Leave a Comment

If you’ve been concerned with your loved one’s substance use for some time, I can imagine you’ve been on your own emotional journey. It’s common (and normal!) for fear, anger, and shame to arise. Everyone dances around these emotions differently when inadequacy or uncertainty of where we fit into our loved one’s recovery becomes overwhelming. But by digging deeper into the role you are currently playing, you will be able to shift into a new path of authenticity and empowerment.

Roles we may play, but didn’t audition for

First, keep in mind that there’s nothing wrong with an individual who falls into any of these roles. They are commonly observed archetypes and a natural result of how we try to resolve difficult emotions.

“The Addict”
What’s more traditionally known as ‘The Addict’ is the family member who is struggling with alcohol use disorder. Their unhealthy drinking behavior often affects their loved ones, leading to familial grief and shame, despite their having a medical condition. We don’t use this label at Monument, as we believe drinking is something you do, not who you are.

“The Enabler”
They feel it’s their responsibility to repair “The Addict” and do everything they can to quickly clean up the aftermath of any setbacks. The Enabler has a hard time allowing for negative consequences, even when these experiences are natural parts of the healing process.

“The Scapegoat”
This role is exactly as it sounds. The Scapegoat is regularly singled out and blamed. Utilizing a “scapegoat” is a common way the family diverts attention away from how they are each internally managing their emotions surrounding alcohol use disorder.

“The Loner”
The Loner tends to delay decision-making, downplay their strengths, and not see the value of taking many risks, such as sharing their emotional world with others. The Loner is most comfortable staying distant or hidden from view, especially when it comes to engaging with family recovery.

“The Achiever”
The Achiever can point to their success — maybe it’s their childhood trophies or a high-powered job. However spectacular, their accomplishments are often being fueled by a need to cover up underlying shame. The Achiever may end up feeling they don’t have permission to fail or experience emotions they fear could get in the way of “success” throughout their loved one’s recovery.

“The Mascot”
This role is the class clown of the bunch. While their knack for entertaining can often help their family through pain, it can be harmful when The Mascot doesn’t feel like they are allowed to express their feelings around the challenges of unhealthy drinking and recovery.

Making progress together: For family, friends, and those in recovery

One of the most effective strategies for achieving sobriety or moderation is engaging with friends and family. This group is for those looking to cut back on drinking and those supporting them. Join the discussion about how to better understand one another and support each other throughout this journey.

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Pause and take a breath

If you’ve identified with one or more of these roles, you are not alone. The beauty of recognizing these labels is that they are just that — labels. The first step toward change is awareness. Let’s break it down.

Recognize what is under the surface of “helping”

Take a closer look at your behaviors. Your “helping” may actually be rooted in control, and wanting to fix the people around you. I encourage you to first, own that experience. Second, maybe even let your loved one know about this role you’ve been playing. And third, remember that no one is broken here, so it’s not your responsibility to “fix” anyone. To show up as our most authentic selves, we approach relationships with patience, empathy, and ownership of the shame that comes with not always knowing how to support or seek support from those around you.

Once you explore what is under the surface, dive in deeper

Ask yourself, what would it look like to allow myself to feel this fully? What are the core feelings under the surface of this emotion? Your self-healing means trusting your ability to notice where it resides in your body and recognize it as a cue that one of your needs has not been met yet. Emphasis on yet! The goal is to learn to communicate these needs effectively and open the door for your loved ones to do the same.

Recognize authenticity as a process

Don’t get down on yourself if you fall into default patterns. If you return to a retired role, it’s not starting over but a gentle reminder that authenticity requires nourishment. This takes minimizing triggers and reminding yourself that you are bringing all the knowledge of the past cycles before it. We need a more empowering word than “relapse.” Finding new language to destigmatize these patterns can be a great first family project towards developing a recipe for healing.

Savor the process

Remember to give yourself a chance to savor all of this work! Set an intention each morning, set an alarm for a mindful minute, create a visual reminder as obvious as a sticky-note on your mirror that says “savor this.” These moments of grounding can go a long way in your healing process. You are opening all kinds of new doors!

How To Talk to A Loved One About Their Drinking

Posted on November 6, 2020 | by Kimberley Rodriguez | Leave a Comment

Worrying about a loved one’s drinking habits can be confusing. It can be difficult to establish when it’s appropriate to be concerned. And then, of course, the ensuing question of what can I do about it?

How to Navigate a Loved One’s Drinking Habit

Have you suspected that your loved one has an unhealthy relationship with alcohol, and thought about bringing it up? You may feel fearful of your loved one’s reaction, scared of how the conversation will go, or you may be second-guessing yourself (i.e., is it really a ‘drinking problem’?). As a first step, it’s helpful to understand the signs of an unhealthy drinking habit.

Learn more about alcohol use disorder

There is no single definition of unhealthy drinking. There are, however, common symptoms to look out for that indicate someone you love has alcohol use disorder.

So, what is alcohol use disorder (AUD)? Alcohol use disorder, or AUD, is measured based on 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). AUD limits a person’s ability to control their alcohol consumption, despite the negative consequences experienced from excessive drinking and alcohol dependence.

Based on the DSM-5 criteria, below are a few questions to ask yourself:

Have there been 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?
Experienced craving – a strong need, or urge, to drink?
Found that drinking often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
Continued drinking even though it was making you feel depressed or anxious or adding to another health problem?
Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, alcohol shakes, irritability, anxiety, depression, restlessness, nausea, or sweating?

In brief, if your loved one has experienced two or more of these criteria, they are on the clinical spectrum for alcohol use disorder. You may notice any combination of these signs, and naturally, it could be affecting you and your loved one’s relationship. The way you are feeling is valid, and you both deserve your needs to be communicated and met.

It’s also important to note that even if your loved one doesn’t fall on the spectrum for alcohol use disorder, they still might be drinking in unhealthy ways. Additional signs of unhealthy use might look like them being irritable when not drinking, experiencing memory loss and blackouts due to binge drinking, and continuing to drink to avoid withdrawal symptoms. If alcohol is getting in the way of their physical, emotional, and social wellbeing, having a conversation about their drinking can be an incredibly meaningful step in encouraging healthier habits.

Confront Your Loved One

Previously, you might have been asking yourself, ‘what does an alcohol problem look like?’ and ‘when is it appropriate to have an intervention about a loved one’s drinking problem?’ Now, hopefully it’s clear that unhealthy drinking exists on a spectrum, and that your loved one doesn’t have to ‘hit rock bottom’ to warrant a conversation about building healthier habits.

If you’re having trouble starting the conversation about your loved one’s drinking, these tips can help guide you as you cultivate a stronger, healthier relationship.

How to Talk to Someone About Their Drinking: 6 Tips For Having the Conversation

1. Authentically express your feelings about your loved one’s drinking.

Try to use “I” statements. For example, “I feel sad when you go to sleep in the recliner after you drink” or “I am worried because it is the 3rd time you missed work. I love you and want you to keep your job.” Using “I” statements keeps the focus on the drinking itself, and how it affects you.

2. Prepare specific instances where their alcohol use has made you worried or scared for their safety and well-being.

Offer examples of how their alcohol consumption has contributed to an unsafe environment while maintaining that this is not about their character. Recall instances in which the negative consequences of drinking alcohol have affected your relationship.

3. Express your concern in a genuine and loving manner.

Be mindful of belittling language, preaching, lecturing, forcing, bribing, or even begging them to pursue help. Offer to attend therapy, support groups, and doctor appointments with your loved one. Go over options with them and help make a plan of action if they show willingness and/or interest in an alcohol treatment program.

4. Do your best to maintain compassion while your loved one is trying to quit or cut down on drinking alcohol.

This isn’t easy for them, either. Remember that alcohol use disorder is a medical condition, not a moral failing.

5. Be conscious of enabling your loved one, such as supplying them alcohol or pushing any boundaries of having it in the house.

Another example of enabling unhealthy alcohol use is attempting to protect them from the negative consequences of drinking by trying to remedy the situation yourself. Practice setting personal limits while letting them know that you love them and are there for them.

6. Be prepared for your loved one to disagree with you.

Your loved one may be in denial about their drinking or tell you that they will quit or cut down on their own. Give them a suggested timeline and of course, always have options for alcohol treatment on hand. If they are unable to cut down or quit their unhealthy or heavy drinking habits on their own, professional help can provide guidance and relief.

Making progress together: For family, friends, and those in recovery

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Advocate for Treatment

As your loved one navigates this journey, knowing about treatment options is a great way to provide guidance and support. Understanding how an alcohol treatment program can support their goals for sobriety or moderation, while taking into account co-occurring conditions, can help you gain a more holistic understanding of the treatment landscape and provide informed suggestions. Aspects that may impact alcohol misuse can include mental health conditions like anxiety or depression, and it’s important to address these issues in treatment as well.

At Monument, we connect members with licensed physicians to go over their treatment goals and discuss medication options to stop drinking, and licensed therapists to address psychological influences. As part of their online alcohol treatment program, members meet with their Care Team to personalize their treatment plan in a way that empowers them to reach their unique goals.

Care for yourself while caring for someone in recovery

If someone you care about has an unhealthy relationship with alcohol, it can be incredibly stressful. When learning more about alcohol use disorder (and why there’s no one definition of a ‘drinking problem’), remember that a fundamental part of being able to support your loved one is related to your own wellbeing. It’s important that you are emotionally ready before having these conversations. Are there any ways you can start putting more care toward yourself and your needs today?

Continue learning about alcohol use disorder, lean on your own support network, consider exploring treatment options for your loved one, such as medication and online alcohol therapy, and lastly, join in our free support group “Caring for yourself while caring for someone in recovery.” Come just as you are, camera on or off, to listen, share, and find community.

You are not alone in this, and it’s not on your shoulders to “solve” unhealthy drinking behaviors. There are many resources to assist you and your loved ones while navigating the alcohol recovery timeline, including tools for identifying signs of codependency, and guidance on how to build healthy boundaries. We are here for you. Join friends and family of people navigating sobriety or moderation to discuss how to support yourself and your loved one’s recovery.

Even if a conversation seems nerve-wracking at first, you have options and support. No matter where you are on the journey, making the decision to find a new path will empower you and your loved one toward a better future, one you both so deserve.

How To Practice Gratitude When You’re Not Feeling Grateful

Posted on November 4, 2020 | by Monalisa Ghose | Leave a Comment

If the thought of practicing gratitude feels perplexing, you are certainly not alone. Many of us grew up with traditions and customs focused on gratitude, especially during holiday celebrations. But what is gratitude? Is it an emotion? A habit? A virtue? Gratitude can be difficult to define, and even harder to commit to practicing regularly.

Cultural expectations may pressure us to be grateful for what we have, which can feel disingenuous at times. As a result, I tend to be cautious of those who preach gratitude. But despite my misgivings, I have found that taking time to actively reflect on what I am thankful for on a regular basis has been beneficial for my mental health and increased my capacity to endure challenges.

My gripes with gratitude

There is no shortage of wellness teachers telling us we could easily change our lives if our thoughts were just more positive! Our culture tends to reward the expression of happy emotions while penalizing the expression of anger, sadness, fear, and beyond. This idea is called toxic positivity and can be found in every facet of our lives, from work culture to social media to our relationship with drinking.

Gratitude can also be weaponized by those seeking to preserve the status quo. For example, if we bring a problem up at work, our boss might shame us for being ungrateful, dismiss us as being too negative, or tell us “it could be worse.” In cases such as these, portraying gratitude as a moral virtue can lead to feelings of inadequacy on our part, while allowing the other party to dismiss our concerns and avoid scrutiny.

Problems arise when we deny our true human experiences by minimizing the pain we are feeling. Forcing an outlook that “all is well” (when it may not be) can contribute to the negativity we were trying to avoid in the first place. This may be especially difficult when working toward changing your relationship with alcohol. Processing new and difficult emotions may not come easily if we limit our permissible emotions to happiness and gratitude. Personally, when I find the time to reflect, I try to honor anger, sadness, jealousy, or any other emotion that arises. Welcoming the entire spectrum of emotions often leaves me in a better place than if I had tried to suppress those feelings to focus only on the positive.

With these thoughts in mind, I believe we can still build a practice of gratitude that is attainable, nurturing, and suited to our individual needs.

My gratitude practice

I began playing around with the idea of practicing gratitude when I realized my habit of ruminating was clouding my memories. The day I spent outdoors in the sun was remembered as the day I got hangry and fought with my partner on the way home. The night spent catching up with friends was remembered by the moment I spilled my drink across the table. The otherwise rewarding day at work was remembered by the one patient who was angry I was running late and left in the middle of the visit.

I was hopeful that a gratitude practice would help me remember my reality more accurately, with less of a focus on the negative. Additionally, I knew that ruminating was a hallmark of depression and anxiety. So, I began writing down a few lines at the end of each day (or at least whenever I had the time and energy to do so), trying to include both negative and positive things that had happened during that day. Over time I started to see changes in my thinking. The day was less likely to be thrown off by one or two inevitably negative moments. I began to feel more appreciative of the things most important to me, and better able to recognize when they were showing up in my life.

Despite my skepticism that gratitude is a panacea for all of life’s problems, I do believe that gratitude has been a useful tool in my collection of self-care practices. It has helped me guard myself against feelings of inadequacy, of not being enough, and of not having enough (even amidst the stream of materialistic messages inundating us constantly).

Managing your drinking through quarantine

Managing your drinking can be especially challenging during times of heightened stress and isolation. Join the discussion about how to moderate your drinking or stay sober through quarantine.

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Benefits of and strategies for a gratitude practice

Studies have shown that practicing gratitude in its different forms can reduce stress, decrease depressive symptoms, and help us do better academically and professionally. Other studies have shown it may boost our immune system and improve pain and sleep scores. Practicing gratitude may even change the activity of the brain long-term. One study where individuals wrote gratitude letters showed that three months later, participants had greater neural modulation in the medial prefrontal cortex.

Many quick and simple ways of practicing gratitude have been studied, the most common being:

Journaling about things for which to be grateful
Thinking about someone for whom you are grateful
Writing or sending a letter to someone for whom you are grateful
Meditating on gratitude
Writing down three things for which you were grateful at the end of the week
Practicing saying “thank you” in a sincere way
Writing thank-you notes

Most of these interventions can be done in a few minutes a day or a couple of times a week. I hope this inspires you to try or revisit a gratitude habit! And, if you’re sick of hearing about gratitude, I think that’s okay too. 🙂