Watch: This Interview With a Clinical Manager Is a Mini Master Class on Alcohol Use Disorder

For Alcohol Awareness Month (April), we asked Dr. Harry Beaman, clinical manager at our East Valley Healthcare Center, to reflect on the role that alcohol plays in our lives and in society as a whole. What followed was a mini master class on the relationship between alcohol and mental health; how current events have impacted alcohol use among teenagers; the normalization of alcohol in our society; managing stress in recovery; and the resources JFCS provides.

Watch the 16-minute video or read the transcript of our discussion with Dr. Beaman below. If you would like to learn more about our substance use counseling and recovery services, go here.

Transcript

Dr. Harry Beaman: So this is Alcohol Awareness Month and it's a time to reflect on a little bit about the history, a little bit about our current problems related to alcohol use. Alcohol has been around for a very, very long time, prior to any of the profits even being on the scene and we've had problems with alcohol since then. We've made progress. But progress has been two steps forward, three steps back.

It really does depend on the cycle of current events in our culture. For example, alcohol use amongst teenagers went down from about 2008 to 2013. The rate of alcohol use among teenagers in high school dropped precipitously. But it's back.

One of the reasons that it's back is because we experienced COVID. COVID caused a great deal of social isolation, spending a lot of time away from school, away from work, away from the normal social developmental processes that teenagers go through.

In addition to that, there was an explosion of social networking and social kind of Internet experiences that have also aided to the reduction of self esteem. A lot of the developmental processes that teenagers go through, appropriate developmental processes they go through, involve socialization and there's a lot of question of self. Who am I? What am I about? How do I fit in? Where do I belong? Anytime you take a bit of that away, you take away the opportunity to make progress through that life cycle stage change.

In other words, it causes people to have increased anxiety. It causes an increase in depression and those kind of issues can cause, especially in our social culture, people experimenting with alcohol, and other drugs. But alcohol is what we're primarily dealing with. So alcohol is the focus. They experiment with alcohol and alcohol makes you feel better.

On the Normalization of Alcohol

Dr. Harry Beaman: Substances like alcohol have been socially normalized for a very, very long time and the problems that it causes have been normalized and recorded for a very, very long time.

As I indicated, we've kind of made some advances and it's like two steps forward, one step back. Part of that is related to a lack of understanding, a lot of education and a lot of misinformation in our social network, even misinformation and application within the professional mental health field.

There's still a lot of stigma about not only mental health, but about substance use. It is a little bit surprising that here in 2023 we still have staff working in the mental health field that don't really fully appreciate that substance use is a real issue or is actually a mental health issue or belongs to be treated in a mental health setting.

About 50% of the people that walk through our door have tried substances and alcohol is the easiest one to get. They use substances as a way to try to self medicate. The human brain would much rather feel good than bad and so it's very easy for someone to fall into the trap. The physiological dependency kind of issues on a substance over the years when they're trying to self medicate an anxiety disorder, depression disorder, even a bipolar or schizophrenic disorder, we see in an awful lot of people.

As I've said about half the people that walk through the door have tried to use a substance as a way of self medicating. Some of them progress into full blown substance use disorders and others don't. We've got a long way to go in fully understanding not only mental illness, but what causes some of these disorders like alcohol use syndromes.

But besides half the people walking through the door that have tried to mitigate or treat their own symptoms with alcohol, we also find that people that have an alcohol use disorder will also have brain changes that will mimic other psychiatric conditions.

For example, alcohol has a tendency to put different areas of the right and left frontal temporal lobe to sleep, if you will. It used to be we thought alcohol killed brain cells, but it doesn't. It disconnects them and people can rebound because the brain is wonderfully plastic. But somebody under the influence or someone that's been using alcohol for a really long time might look like a personality disordered person because over the right eye is my impulse control. It's my understanding of right and wrong. It's my decision making. It's the part of the brain that tells me that there's something wrong with me. And if that part of the brain is asleep, I'm going to do things on impulse and I'm probably going to be the last person to know there's something wrong. Everybody else in the environment can point and go, wow, there's a problem, but I'm going to be the last person.

Over the left eye is what Alfred Adler used to call social interest. Under the influence, I might look like a personality disordered person that's a self absorbed BS artist, if you will, who is doing things and saying things that are very hurtful to other people. If I'm under the influence or been under the influence off and on for many years, that part of my brain is not dead, but damaged. The ability to control impulses, the ability to care what other people think, the ability to empathize with other people is going to be reduced and that's going to look like a personality disorder sometimes.

The general rule of thumb is always evaluate for substance use. Always evaluate for alcohol. Always evaluate for any other substance that people might be using, including marijuana and THC. Because even that has profound issues relative to early onset of schizophrenia in teenagers. So always evaluate for that. Once the alcohol clears up, once that's treated, once that's under control, then you're going to see what's left over and then you're going to better understand what it is the person is really dealing with.

On Managing Stress in Recovery

Dr. Harry Beaman: We have stress because it serves a purpose. It tells us, hey, something's not right. It gives us the opportunity to use our frontal lobe to determine a response. A response that, according to the left side of my frontal lobe, is socially appropriate. So stress is always around. When I get into recovery, I need to figure out a way, a more appropriate way, a less damaging way, a less socially destructive way of managing my stress than drinking or using a substance.

It really does depend on the individual. Some people are a little bit more introverted. Some people are a little bit more extroverted. So the extrovert does well by talking, by being gregarious, by talking with people in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), in therapy and maybe with family members. That's one of their avenues, basically talking about it, being able to verbalize, hey, I'm starting to have a trigger. I'm thinking about using. What do you think I should do? What did you do the last time you felt that way? Am I crazy for having these thoughts? So being able to verbalize that and talk it out with someone else who cares that you trust is very helpful.

If I'm more of an introvert, I might find a way to relieve that stress is through exercise and exercise is something that you can do by yourself. Exercise is a beautiful way to get the endorphins flowing, the way to get the cortisol actually exercised from the body and cortisol is very influential in the development of depression.

It really does depend on the individual. It depends on their way of interacting in the world. But exercise is a beautiful thing to do. Talking with someone else is a nice thing to do. Getting outside of your shell and the first part of getting outside of your shell is being able to recognize, whoa, I'm feeling distressed. I'm a little anxious right now. I'm feeling a little bit sad. And then to ask yourself, why is that happening? And if I'm under the influence or if I've been drinking for a really long time, I'm not going to have the capacity for being able to ask myself that or to have that internal dialogue. But if I can, I ask myself, where do I think that's coming from? And I'll be able to process that. And then I'll be able to ask myself, well, what should I do about it? What have I done before? And has that worked? And if not, what do I do now?

Getting outside of oneself and directing towards other people for help, getting involved in things that used to be fun to do is important because one of the things that alcohol does is it robs us of our natural and normal ways of enjoyment, of stress reduction. It robs us of that.

One of the things I do in therapy with people is to ask them, what did you used to do? There was a time before you ever picked up a substance, before you ever had a drink, that you used to do. What was that? And would it be a good thing to try to do that now? So being able to get outside of oneself and into the problem, into the solution, getting in with people, figuring out what used to work and maybe even exploring some new things.

As we grow older, we change. The things that I used to do as a kid worked fairly well. Exercise and being on sports teams and playing football and water polo and swimming and diving and used to work really well. It's not something I can do so well right now. So what do I do? I garden, I fish, I go hiking, I spend time with my grandkids on the damn trampoline. So things change. But the most important thing is to realize that, hey, I'm not feeling or thinking so well right now. What might be causing that and what am I going to do about it? That's helpful.

On How We Help

Dr. Harry Beaman: So the question is, what do we do here at Jewish Family when it comes to substance use disorders, specifically alcohol use disorder in this case.

The first part of that is doing a very good comprehensive assessment and always trying to determine if the person is using a substance and if they are using a substance, do they cross the threshold into a use disorder? There are eleven different criteria and it's important that we identify that because you can be doing a lot of very nice individual therapy, and if the person is continuing to drink at a very harmful rate, they're not going to make the progress that you would expect. In fact, usually what we see, instead of them getting better, they get worse. The comprehensive assessment needs to include an evaluation of substances first and foremost.

Here, if they have that identified as a use disorder, then we do what's called an American Society of Addiction Medicine (ASAM) assessment. What the ASAM assessment does is help us understand what level of care does this person need. Can they stay here at the basic kind of clinical level? Do they need to step it up a bit to go to an intensive outpatient program, which is three to five days a week about 3 hours a day? Do they need to go to a residential program because their recovery environment won't support their ability to either get sober or stay sober? Then there are people that need to detox from substances and need to go to a hospital. The ASAM assessment helps us make that determination.

Every clinic, every provider in the Maricopa County system needs to either be dual diagnosis capable or enhanced. At this clinic we're capable. We can handle people that basically will admit I have a problem, I'm not using right now, I want to learn how to stay sober. That's the person we can typically kind of help here. If the person is very deep into their own, what we used to call denial, and they're still using, they're going to need something that's a little more intensive and the ASAM tool helps us identify that.

When a person goes away to an intensive outpatient program or a residential program or even the hospital, we want them back. Because once they get sober, we want to help them stay sober. Going to detox is no solution other than a physiological response and a real treatment for the immediate. It affects the withdrawal. Going to a detox facility needs to be followed up by continued treatment because the trick is not to get sober, it's to stay sober. That's what we can do at this clinic.