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mental health mondays :: tippling too much?

many of you may be viewing this through the fog of a hangover [or possibly while still inebriated], which made me think that it might be a good idea for us to dedicate this week's mhm to the phenomenon of alcoholism. sure, you might be thinking you'll never drink again, but chances are that'll wear off faster than a temporary "kiss me i'm irish" tattoo. [at least, we all hope it's temporary.]

for those of you in doubt, alcoholism is classified as a mental disorder. actually, it's a broad term that can refer to a range of mental disorders related to the compulsive consumption of alcohol, to the detriment of physical, social and psychological health. and if you think that sounds vague, it's only just beginning. because even by the standards of a mental disorder, alcoholism is fiendishly difficult to identify and treat.

for starters, the question of how much alcohol consumption constitutes too much is problematic. different cultures have different views on healthy versus unhealthy alcohol consumption. and while consuming alcohol in even moderate amounts can cause some damage, there's also evidence that it is generally benign or even helpful in many other ways. complicating things further is that there is often a moral and social stigma attached to alcohol in general, which affects the way that its consumption is viewed and shapes [most often implicitly] the guidelines that determine how much consumption is acceptable and under what conditions. [and let's not even talk about the fact that these same social stigma often stop people from seeking help when they do have a problem.]

in the last few iterations of the diagnostic and statistical manual of mental disorders, there has been a distinction made between alcohol abuse- repeatedly and frequently drinking to excess despite adverse consequences- and alcohol dependence. of course, both conditions can co-exist and, since binge drinkers are far more likely to have a problem with dependency than those who drink in moderation, it can be assumed that they often do co-exist. but it does underline the complexity of even talking about alcoholism that mental health experts believe it to be at least two separate problems. [personally, i've always loved the old-fashioned term "dipsomaniac", although i have to admit that it's more just because i think it sounds like a good word to describe someone's behaviour when they're crazy loaded. i can understand that the condition requires a little more gravitas...]

existing cultural biases can confuse efforts to distinguish problem drinking from non-problem drinking, but in fact, the process is confusing enough without that help. after all, alcohol can cause or worsen problems with the liver and kidneys, but so can tylenol. increased tolerance to alcohol is seen as a warning sign for dependence, but alcohol tolerance varies significantly depending on genetic background: children of alcoholics, for instance, often have a higher tolerance for alcohol regardless of whether or not they drink heavily or even regularly. but there even seem to be differences based on where you live. differences that make absolutely no sense whatsoever.

for instance, here's a listing of global alcohol consumption by country [separated into wine, beer and spirits]. and here is a very helpful interactive map produced by the world health organisation of deaths caused by alcoholism. while it might be difficult to determine when exactly drinking becomes a problem, i think that we can all agree that when it leads to death, it's clearly crossed that threshold. so you would expect that countries that have similar drinking patterns to have similar results. and you would be wrong.

for instance, the death rates in honduras, nicaraugua, guatemala and especially el salvador are by far the highest in the world. but not one of those countries cracks the top twenty in terms of alcohol consumption. and northern neighbour mexico has a lower rate of alcoholism deaths than either the united states or canada.

france, with a death rate of 4.2 people per one hundred thousand citizens, has one of the highest rates in western europe. but italy and spain, who have similar drinking patterns, have among the lowest, with 0.2 and 0.6 deaths per hundred thousand respectively.

even stranger, moldova, the heaviest consumer of the hardest liquors, has a lower death rate than many countries with healthier habits, which would imply that the level of harm from alcohol doesn't necessarily correlate to the amount of alcohol consumed, at least averaged out over an entire country.


the bottom line is that what's most important is not necessarily the amount of alcohol consumed or the regularity with which it's consumed. what matters most are the effects and those may be up to the individual to evaluate. after all, the physical effects of alcoholism may take years to become noticeable enough to be of concern. and basing a decision to seek help on how much or how often you drink, as you can see from the above statistics, is not necessarily a reliable barometer. better to ask:

  • is it interfering with your relationships with other people? are you getting in arguments? ignoring people? avoiding the people whose carpet you vomited on last wednesday?
  • are there things that are important to you that you miss out on doing because of drinking or being hung over? 
  • do you actually enjoy what you're drinking? does it taste good? do you like the way it complements your food? or are you drinking just for the "side effects"?  
  • is drinking stopping you from meeting commitments? are you missing work, skipping time with family or friends, passing on doing the stuff that really needs to get done because you're inebriated or hung over?

in other words, look seriously at what the current consequences are. of course, even if you answered "no" to all of the above [or other questions that you might pose yourself in the same vein], if you have the habit of drinking more than a couple of alcoholic beverages a day on a regular basis, you might want to check up on your liver and other potential problem areas... just to make sure.

hopefully, you're leaving this blog confident that you have everything under control, no matter what you got up to over the past few days. but if not, remember that there is help available and that, however confusing it may be, what you have is a disorder that needs treatment, not something you need to feel ashamed of.

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