A Minute with Dr. Hancur
Like many of you, I wake up in the morning and turn on the news, more for the weather than anything else. All too often, the top story is a murder or a horrific car accident that took place during the night. The murders are often the result of an argument or fight that begins in a bar and is finished on the street. The anchorman tells us a little about the people involved and describe the circumstances, but almost never mentions that the common denominator is alcohol. Sometimes alcohol is mentioned in the story about the car wreck, but it is generally in a matter-of-fact and understated way.
Domestic violence, child abuse and neglect, a fire started by a smoker falling asleep in bed--all of these are often alcohol linked, but too often, that link goes unnoticed and unreported.
Those of us who have spent our professional lives in the substance abuse area have learned to apply a simple but effective rule to identify substance trouble. It is called the "50% notion" and states that about half the time, substance abuse is the cause or is a contributor to trouble that people experience. This is true of emotional trouble like depression. It is true in family trouble like broken marriages. It is true with medical problems like heart disease and diabetes. It is true with violence, like murder and suicide. The substance most often involved is alcohol. Heroin, oxycodone, cocaine, ecstasy, and even marijuana, get more attention, but alcohol is the real killer. The statistics are known and are overwhelming. Why then do we not do a better job of identifying it?
The answer lies in our American culture, the one that says that driving with a blood alcohol level of 0.08 is wrong but driving with a level of 0.07 is just fine. Alcohol is so glamorized in the media that most people, especially youths, equate its use with success, maturity, sophistication and sexuality. Reality, of course, is another matter. In my work with couples, I've learned to warn them about a glass of wine, not a bottle. Most people recognize that when a drunk person talks, it is alcohol speaking. But it is the much more subtle alteration in consciousness, perception and judgment, including lowered inhibitions, that creates conflict and trouble in relationships.
Similar confounding effects often occur with depressive syndromes, anxiety disorders, and indeed all of the psychiatric problems we treat everyday. If we only look for obvious inebriation, then we will likely miss the more insidious, and perhaps more destructive, influence of alcohol on our patients thoughts, feelings and behavior. The mistaken idea that alcohol is medicine and somehow helps emotionally disturbed people is just that, mistaken.
All of us in the helping professions, whether in medicine or behavioral health, need to be more sensitive to the way in which any alcohol use contributes to the physical, emotional and psychological condition of our patients. Once we accept that alcohol use does not have to be the biggest problem in a person's life in order to be a critical trigger for misbehavior, then we can begin to see it more clearly in everyday life. It is no coincidence that the murder victim was shot or stabbed in the parking lot of a lounge and not a grocery store. Or that the driver who enters the highway using the off ramp just spent the last few hours at a sports bar. Ignorance is not supposed to be an excuse. It isn't for us, either.