Wanna deal with your “self-medication” based addiction? Try this: recognize the fact that your substance use isn’t medicating anything, that is, that you are taking the wrong medicine. Once you know this, you can stop it.
Let’s tackle the issue of stress, a ubiquitous experience that is widely believed to be relieved by alcohol. This is one of those myths that goes virtually unquestioned, but direct observation can blow it up in a second. Try this – go to your nearest bar, and observe people drinking. Notice that some seem to loosen up and become relaxed, while some get agitated and on edge. Why should alcohol do both of these things so readily? Notice also that you probably know drinkers who become relaxed on one occasion, and become more stressed or agitated on the next. How can alcohol have opposite effects within the same person? It just doesn’t make sense. This has been observed by alcohol researchers for a long time, but for some reason, this insight never makes into the system of help for people with substance use problems.
Sometimes alcohol may be a relaxant (the martini after the hard day at the office) and sometimes it may act as a stimulant (the first drink at the party).
-Norman Zinberg – Drug, Set, & Setting
To fully understand this takes more than a blog post, so I’ve prepared an entire chapter on this issue for Saint Jude Retreats’ upcoming book The Freedom Model. Look for that later this year. For now, just consider it – maybe alcohol doesn’t relieve stress at all. Here’s a lengthy quote reviewing some of the research from a book written in 1970 that I ran across yesterday:
The common assumption that alcohol reduces anxiety and depression in the alcoholic was first challenged by the clinical observations of Mendelson (1964). Ten alcoholic subjects studied in a programmed drinking paradigm became progressively more tense and anxious while drinking. One subject showed severe depression early in the drinking period and as the 24-day drinking period continued, many subjects evidenced depression, hyperaggressiveness and a decrease in general activity. All subjects verbalized considerable ambivalence about their drinking.
We confirmed these basic findings in a second group of 14 subjects allowed to work for their alcohol at an operant vigilance task over a 7-day period (McNamee et aI., 1968). Observations made during the predrinking baseline period were compared with those made during the drinking and withdrawal periods. Psychiatric interviews were carried out with each subject once or twice daily. The interview was nondirective and focused upon affect and general behavior, interpersonal relationships, thought content, and expectations. Interview data were supplemented with information obtained from the nursing staff.
Nine of the 12 subjects showed a marked increase in anxiety and depression during the second or third day of drinking and this dysphoria grew more intense the longer the drinking period continued. In addition, subjects expressed other emotions not previously displayed, e.g., hostility, guilt, resentment. There appeared to be a relationship between the amount of alcohol consumed and the severity of anxiety and depression. However, in no instance was drinking stopped voluntarily as a result of these unpleasant mood changes. During the withdrawal period, subjects were almost completely preoccupied with their symptoms and frequency ·of their medication. They were hostile, demanding of attention, irritable, and anxious. Depression was not a prominent symptom during alcohol withdrawal.
Although it is possible that the changes in affect observed during experimentally induced intoxication may be different from those which occur in real life, it seems more probable that the alcoholic reports alcohol-induced changes which fulfill his own expectancies when sober or which are concordant with the expectancies of the interviewer. These subjects verbalized expectancies concerning their drinking behavior and the effects of alcohol did not predict their,actual behavior observed during the drinking period (McNamee et ai., 1968).
Mello, N. K. (1972). Behavioral Studies of Alcoholism. In B. Kissin & H. Begleiter (Eds.), The Biology of Alcoholism (pp. 219–291). Springer US. Retrieved from http://link.springer.com/chapter/10.1007/978-1-4684-0895-9_9
The NIAAA published a review paper in 1999 looking at the evidence on whether alcohol relieves stress or not, and it’s generally inconclusive – showing there’s definitely no smoking guns proving it does, but holding out the possibility that it may be proven some day. Where stress relief was found, it seemed dependent on environmental factors. I’ve given this paper to several students who found it eye opening. They took alcohol’s stress relieving powers for granted, yet reading this allowed them to question it, and for many this resulted in a decrease of the feeling that they need a drink for stress. Here’s an excerpt showing the inconclusiveness in the topic:
By the 1980s researchers had conducted numerous studies to determine whether drinking reduced stress. To the surprise of many investigators, the relationship between alcohol and stress was inconsistent. Alcohol consumption reduced stress in some studies, did not affect stress responses in other analyses, and exacerbated stress in still other investigations (Sayette 1993a). (Steele and Josephs [1988] described the latter outcome as the “crying-in-your-beer effect.”) These contradictory findings led some researchers to conclude that the tension-reduction hypothesis had not been confirmed. Other scientists argued, however, that despite some discrepancies, the study results generally supported the tension-reduction model. Perhaps the most common conclusion was that alcohol’s effects on stress were complex and that further research was needed to specify the conditions under which drinking would most likely reduce stress (see Sayette 1993a).
Sayette, M. A. (1999). Does drinking reduce stress? Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 23(4), 250–255.
The paper concluded that “the evidence for a direct stress-reducing effect of alcohol remains controversial.” I asked the author if he knew of any newer research that would update this paper, and he had nothing to offer. It seems the scientific case hasn’t been nailed down in favor of a true stress relieving power inherent in alcohol.
At best, it seems that in some specific times and places for some people, alcohol relieves the physical side of stress – the blood pressure, heart rate, tense muscles, changed breathing, etc. However, what I contend is that the emotional side of stress can never be touched by alcohol, because it, like all other emotions is the product of an interpretation of the conditions of one’s life. That is, as was described in the NIAAA’s review, stress is “the interpretation of an
event as signaling harm, loss, or threat.” A drink isn’t going to change that. At best, a drink can be a distraction from the harm, loss, or threat you see in your life, but if its stress relieving power is based in mere distraction, then it is no more inherently a stress reliever than is fishing, bowling, crafting, watching a movie, or reading a book.
To make the point that alcohol doesn’t pharmacologically relieve stress, I present my students with this thought experiment: Imagine you’ve been highly stressed; you go to the bar, have 5 drinks, and feel your stress go away; now you get in your car to drive home, suddenly you hear sirens, and look to see that a cop is pulling you over. Are you stressed in that moment? Most everyone says yes they would be stressed. Many have been in this or a similar situation and been stressed. The question is this: if alcohol pharmacologically took away your stress, then how could you feel stress in that situation while you have 5 doses of stress meds coursing through your veins?
The focus in treatment tends to be on avoiding all stress (which is impossible) and being prepared with a bunch of stress relief/coping techniques so that you won’t have to turn to alcohol again. It’s great to find effective techniques for dealing with stress and I encourage it. However, before any of that, you should simply recognize that alcohol won’t relieve your stress to begin with. Sadly, I think the alternative coping skills model just validates the view that alcohol is an effective stress reliever by framing it as “use this coping skill or else you’ll drink.” That would be like saying “use a coping skill or else you’ll eat dirt.” That is to say, since alcohol doesn’t really relieve stress, the statement is a sort of non-sequitur.
Knowing the truth about alcohol will actually take you further than any alternative coping skills. Alcohol’s stress relieving properties are mythical.
UPDATE: just 2.5 hours after posting this, I got an email from a recovery website with an article title “Top 5 Emotional States That Can Trigger a Relapse.” Number 1 is stress, and the article states:
Whether it’s about work, financial concerns or relationship worries, we all have times when we experience stress and need to work harder to maintain our recovery. Stress is one of the biggest reasons people reach for their substance of choice—wanting to take a break from reality for a short space of time.
Learning to manage our stress in more productive ways will guard it from causing a relapse. You can do this by exercising regularly, sleeping well and eating a healthy diet. Some meditation, time out for yourself and willingness to ask for support during a stressful situation can do wonders in reducing your stress levels and preventing it from becoming a trigger.
This stuff seems helpful, but it actually plants the seeds for struggle. It builds up stress as something that directly “causes” heavy substance use, and it legitimizes substance use as a stress reliever. It does the “or else” thing I mentioned above, saying that we need to deal with stress better to “guard it from causing a relapse.” Nonsense. You just need to know that substance use won’t help – and know this first, no matter what you do to deal with stress. If you don’t hold onto the truth that substance use doesn’t relieve stress then you keep substance use alive in your mind as a worthy response to stress. You hold stress as a potential reason for heavy substance use. You don’t need to do this if you know it doesn’t help.
