Job related burnout is not something most people would associate with higher rates of alcoholism and other drug abuse. Yet studies show when burnout is severe, alcoholism and drug addiction become highly connected. No one who’s severely burned out at work ever wakes up one day and decides, “Gee, I think I’ll make things worse by becoming an alcoholic or drug addict” but it happens nonetheless.
As people burnout without any promise of relief, a significant number will act out in an attempt to make themselves feel better. Many turn to alcohol, others to illicit or prescription drug use, and still others to a wide array of alternate self-destructive behaviors.
In the United States, alcohol is a pervasive and socially acceptable drug. Unlike other mood-altering drugs, no prescription is needed. Supermarket and other retail outlet shelves are lined with all manner of alcohol containing beverages from beer to wine to liquor. All that is necessary to purchase any of them is proof of legal drinking age and a monetary means of exchange.
In 2016, total alcoholic beverage sales in the US totaled 223.2 billion dollars. Annual sales were level for many years but have been rising year-over-year since 2011.
If one is industrious, alcohol doesn’t even need to be purchased. Alcohol containing beverages can easily be made at home with a modicum of inexpensive, off-the-shelf equipment and supplies.
Introduce a large group of individuals to alcohol repeatedly and over time a certain percentage of them will become problem drinkers or alcoholic. Both genetic and environmental factors exert an influence. There are no educational, gender, cultural, or socioeconomic barriers as to whether or not a person becomes alcoholic following repeated exposure to alcohol.
According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4% of people 18 years of age or older reported drinking alcohol at some point in their lifetime. Some 70.1% stated they drank alcohol within the past year, 56.0% within the past month.
Most concerning is the current level of binge drinking nationally, 26.9% of individuals within the past month. For those unfamiliar with the term binge drinking, it is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men when consumed over about two hours.
Binge drinking is defined slightly differently by SAMHS—Substance Abuse and Mental Health Services Administration—which conducts the annual National Survey on Drug Use and Health (NSDUH). They define binge drinking as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month. Binge type of drinking is typically prevalent at bars, parties, weekend barbeques, sporting events, entertainment venues, and on college campuses all across the country.
According to the 2015 NSDUH, 15.1 million adults ages 18 and older (6.2 percent of this age group) had an alcohol use disorder (AUD). This includes 9.8 million men (8.4 percent of men in this age group) and 5.3 million women (4.2 percent of women in this age group).
The number of fatalities as a direct result of alcohol are heartbreaking. An estimated 88,000 people (approximately 62,000 men and 26,000 women) die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. The first being tobacco and the second being poor diet and physical inactivity.
In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities). The chances are high someone you know has had one or more DWI’s. Our society now takes DWI very seriously, and rightly so. The reason, there is roughly a 35% chance that someone receiving their first DWI has an underlying alcohol use disorder (SUD), a 65% chance with a second DWI, and a 99% chance with a third DWI.
I am often asked how to know if someone has a problem with alcohol. While it may be glaringly apparent to everyone around the problem drinker or alcoholic, it is often not readily apparent to them. Remember, denial is one of the principle hallmarks of any addiction. It is huge part of addicted brain thinking.
There are various definitions of addiction which have been put forth, essentially all different ways of saying the same thing. There is one definition I’ve adopted over the years which I believe aptly describes the disease of addiction in simple terms—excessive use of a substance, negative consequences from use of that substance, continued use of the substance in spite of the negative consequences. This is especially true of alcohol.
There are clinical criteria which are used to diagnose and classify addiction to alcohol, or any other substance. They come to us from the Diagnostic and Statistical Manual of Mental Disorders, Version 5 (DSM-5). Here are the eleven symptoms currently in use for diagnosing an alcohol use disorder. One answers yes or no for each.
- Have there been times when you ended up drinking more, or longer, than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over other after effects?
- Wanted a drink so badly you couldn’t think of anything else?
- Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?
Answering to the affirmative for at least 2 of these symptoms indicates an Alcohol Use Disorder (AUD). The severity of an AUD is defined as follows:
- Mild: The presence of 2 to 3 symptoms from the list.
- Moderate: The presence of 4 to 5 symptoms from the list.
- Severe: The presence of 6 or more symptoms from the list.
All individuals with an alcohol use disorder should receive some form of support or treatment. These reasons are clear. Left untreated, all addictions will become progressive, permanent, and terminal.
Different levels of a SUD require different levels of treatment based on severity. This can range from 12-step recovery meetings to intensive outpatient treatment to inpatient treatment, with or without add-on counseling, therapy, medication assisted treatment, or care from an addiction medicine specialist.
Unfortunately for the general population, only about 6.7 percent of adults who had AUD in the past year received any treatment (7.4 percent of males and 5.4 percent of females) and the success rates of abstinence/recovery without treatment and follow-on support are abysmally low.
If you will recall from previous posts, with job related burnout the damage is primarily emotional so rates of depression are high. Add in an alcohol or other chemical use disorder and these central nervous system depressants will cause any depression to worsen. Is it any wonder suicide rates are highest when burnout, alcohol, or other drug use coincides?
If you are reading this and feel you may have developed an alcohol use disorder, or aren’t quite sure, help is available in may forms. Start by having a conversation with your primary care provider, therapist, or psychiatrist.
If you know a co-worker, colleague, friend, or family member who is suffering from alcohol, another chemical use disorder, a mental health issue, job related burnout, or from something else, please urge them to seek help.
You can begin with a confidential conversation. Let them know how much you care about them, how much they are valued. You might just help save a career, a relationship, a family, and most importantly, a life.