Introduction to Alcohol Counseling with Jerome David Levin

WebMD Live Events Transcript

Substance Abuse: Making a diffference through Alcoholism Counseling

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Event_Moderator  Welcome to the WebMD Live Special Events Auditorium. Our guest this evening is the Author of "Introduction to Alcoholism Counseling", Dr. Jerome David Levine. Welcome Dr. Levin thanks for joining us tonight. Can you begin our discussion this evening by telling everyone a little bit about your area of expertise?

Speaker_Levin  My work is on addictions, sexual and alcohol. I direct a program to train addiction counselors at the New School University in New York.  I also do writing. I have published nine books on addiction.  I have a couple more books in the works.

Special_Moderator  What do you mean when you say a Bio-Psycho-Social Approach to Alcoholism Counseling?

Speaker_Levin  Addictions are among the most baffling because they are a slow suicide.  We're trying to figure out why someone would engage in that behavior.  There's a predisposition for addiction, but not a gene.  There is definitely a biological factor.  Psychological factors are also important. For example, we know that childhood trauma predisposes to addiction.  So do certain personality styles.  Then the third factor is environmental, or social.  Both in the family and in a larger culture.  Social factors are very potent.  For example, smoking. 20 years ago, if you were a smoker it said nothing about your personality because that was culturally approved.  Today it's different. There is a lot of social disapproval. To be a heavy smoker today is driven by psychological factors.  It's true for all addictions.  The biological, the psychological, and the social surroundings.

Special_Moderator What are the different personality styles?

Speaker_Levin  The research evidence is that in externalizing, you act everything out, antisocial, angry temperament and behavior; it is highly correlated with chemical addictions.  Another style that accounts for a smaller population is kind of the opposite.  People who are depressed and withdrawn who take drugs for self-medication.

Special_Moderator  How do you know if you or a loved one  is an alcoholic?

Speaker_Levin   The 12 step programs, not how much you drink but what it does to you.  Someone is addicted, for example an alcoholic, if there's a disregard for consequences, the self and others. There is a compulsiveness to it, you'll do it if you want, there's a loss of control... Lastly, the drug use is serving some unconscious purpose.  The drinker thinks they're doing it for fun, but they're self-medicating, or warding off guilt.  There are subconscious elements affecting the person.  When it's driven, it's compulsive and driven by the subconscious factors. 

Addictive drugs do 2 things: they build tolerance so you need more and more to get the same effect and you get withdrawals if you stop.  True for alcohol, and a drugs like heroin.  Withdrawal from alcohol can be dangerous, because of the nervous system, but drugs like heroin and opiates are more addictive.  I would say it's physiological addiction; how long they've been drinking;

Special_Moderator   Is it true that true that all alcoholics have withdrawal systems?

Speaker_Levin  You might not go into withdrawals, but if you do, they come in a form of cravings.  It happens to smokers. They think they want a cigarette and it's actually a conditioned response to falling nicotine levels in the bloodstream.

Special_Moderator With all of the twelve step programs, is it a necessity to abstain completely and why can't people be taught to moderate their drinking?

Speaker_Levin   Two steps: The philosophy of the 12 steps is an abstinence philosophy.  If you participate, the expectation is that you will not use at all.   That comes out the experience of their members that use the AA slogan "One drink is too many and 1,000 is not enough".  Some people with alcohol problems can become moderate drinkers, but the 12 step program would not help.  Some doctors can teach people how to drink well.  You have to look at the consequences of the drinking in making a decision which way to go.  If you've lost three jobs, been divorced and have cirrhosis, there is no questions abstinence is the answer.

  If difficulties are milder, you can modify your drinking. If you succeed, great.  However, if you try this as an experiment and you find your drinking is sneaking up on you, then that approach does not work and you should try the abstinence model.   Judge it in terms of severity and an attempt to moderate. If it works, it works, if it doesn't, you have to try something else.

Special_Moderator   Is alcoholism still defined as a disease?

Speaker_Levin  The American Psychiatric Association publishes a manual called the Statistical Diagnostic Manual which lists all of the mental and emotional illnesses.  There is a section in there on substance abuse disorders.  One disorder is in the use of alcohol and the DNS4 has two categories; alcohol abuse and alcohol dependence.   What they call alcohol dependence is what most people would call alcoholism, so the answer is yes, at least according to the APA.   It is also described by the American Medical Association, National Association of Social Workers, and the American Psychological Association.  The mental health professions certainly believe that alcoholism is a disease.