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Heath Talk 

In New Orleans, people know more about absinthe than abstinence. So it was no surprise that after the levee failures, folks used the bottle to cover some of their sadness. It was probably the least of their worries at the time, especially if they were sharing those glasses with others going through the same type of pain. But it's been more than two years since the storm, and some still find themselves drinking too much, with alcohol becoming an alarming force in their lives. Maybe it's time to take a closer look. April is Alcohol Awareness Month, and Dr. Dean Hickman, a psychiatrist and the medical director of the addictive behavior unit at Ochsner Health System, discusses what alcoholism really is and when enough has become too much.

Q: Does the public really understand what alcoholism is?

No, I think the public's perception of an alcoholic is that it's a moral weakness more consistent with someone who is on skid row. Alcoholism is a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestation. It's often progressive and fatal. It's characterized by continuous or periodic: impaired control over drinking, preoccupation with alcohol, use of alcohol despite adverse consequences and distortions in thinking, most notably denial. It's a complicated illness that often starts with a genetic contribution, which people obviously can't change. Some people have a genetic predisposition to heart disease; some people have a genetic predisposition to developing alcoholism.

Q: Does alcoholism have levels? Is there an alcoholism scale?
Psychiatry defines it in two scales. One is where there's a recurrent pattern of drinking that results in complications in someone's work, school or home environment. Drinking is connected to hazardous situations such as driving an automobile. There could be some alcohol-related legal problems — arrest for disorderly conduct — and more commonly, there's continued drinking despite having recurring social, interpersonal problems. (The other scale) is dependence, where you're physically addicted to it. You need more alcohol to achieve your effect, so you're building tolerance and withdrawal complications — drinking more than you would intend to, or over a longer period of time.

Q: Has the level of alcohol abuse in New Orleans risen since the levee failures?
Yes, even the level of alcohol dependence has increased, where people have started having withdrawal complications when they try to abruptly stop drinking. What we dealt with after the storm was at first seen to be a marathon. Everything is devastated and it will take a long time to fix it, and we understood that. What we didn't count on were the innumerable obstacles that were going to be put in front of us almost immediately. If you were lucky enough to find your insurance agent and then get a contractor, would the contractor show up? Would he take your money and leave? People thought they had various levels of insurance and it turns out they didn't. Government policies have continued to evolve about what you could and could not do.

Q: So with these barriers, what were people using alcohol for?
Alcohol regrettably does temporarily take you away from your difficulties where you do get to forget about your [problems]. Unfortunately, your difficulties don't go away and, the alcohol usually compounds them.

Q: What about those who were social drinkers before the storm but consumed more after the storm?
Are they alcoholics? When it starts to impact their lives, that's when it starts to become pathological and they start to see complications.

Q: It sounds as if you're hesitant to call them alcoholics?
We don't have a good definition for alcoholics because it's such a broad word. We have alcohol abusers and we have people that are dependent on alcohol. I don't mind labeling diseases; I have trouble with tagging titles on to people. Different people have different levels of complications in their lives that they're willing to tolerate before they're willing to address their alcohol problems. We call that low-bottoms and high-bottoms. For instance, your spouse comes to you and says, "You're becoming more isolated, spending more time drinking and less time with us. Would you please look at that?" And you respond, "You know you're right. I have to stop this." That's a high-bottom: you're not irrevocably harmed. Low-bottoms are things like loss of job, injuries to others in terms of drunk driving, severe medical complications such as alcohol-related liver disease.

Q: Did most of those that over-drank after the storm eventually level off?
Many did level off. Regrettably, though, some people haven't met their expectations. Some people have returned to their homes, but their friends haven't returned. Not everybody had the same spirit of "we'll all come back and rebuild our neighborhood." So that's left some continued depression in these people. They develop new patterns of coping — their old patterns aren't there; their old friends aren't there — and the new patterns involve alcohol.

Q: What are some questions people might ask themselves to see if they're abusing alcohol?
Are they drinking alone more often? Do they see drinking as a means to escape their problems? Have they had an inability to cut back on the amount of alcohol that they're drinking? Do they have regrets about their actions after they've completed drinking? Have they noticed any physical symptoms related to abruptly stopping alcohol? Tremors, nausea, vomiting or even a seizure.

Q: If they answer 'yes' to any of these questions, what are some of their options?
People experiencing physical withdrawal should go to an emergency room. For people concerned with their measure of drinking, there are many options. They can talk to their primary care physician, who would be knowledgeable about the resources available in the area; they could call 2-1-1 (a United Way/ Via Link crisis line), and there's Alcoholics Anonymous with meetings throughout the Greater New Orleans area. There's a myriad of options available, depending on the level of complications at that time.

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