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Alcoholism (Transcript)
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[Narrator] Behind every heartbeat is a story we can learn from. As we have for over 80 years, Blue Cross and Blue Shield Companies are working to use the knowledge we gain from our members to better the health of not just those we insure, but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.


[Announcer] "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.


[ Applause ]


[Dr. Peter Salgo] Welcome to "Second Opinion," where, each week, a panel of medical experts discuss a real-life case. I'm your host, Dr. Peter Salgo. I want to thank all of you for being here today. Our experts today are Dr. Louis Baxter from the Professional Assistance Program of New Jersey. Our primary-care physician is Dr. Lou Papa from the University of Rochester Medical Center. And now I would like you to meet Annie Loyd, who is here to tell her personal story, a story that's all too familiar to many people.


[Annie] My name's Annie Loyd. I was fortunate to grow up in the Black Hills of South Dakota, in the community of Rapid City. I'm 53 years old. I returned home about five years ago, after being gone for 30 years. During that time I was gone, I was fortunate to live in Los Angeles, California, for a number of years, and then moved over to Phoenix, Arizona, where I spent more than 20 years. I returned home about five years ago to take care of my mom, who has a form of dementia. When I was very young, about 10 years old, I recall going to -- The bishop was over at our house. We were a Catholic family. And he asked me, "What do you want to be?" And I said, "I want to be a priest." I was so excited about it. And I thought, "This is my calling." It was a calling. And he looked very scornful and angry, and it was very clea that was not an option for me, for girls. Girls don't do that. And shortly right after there is when I began drinking. I remember that separation of my spirit. That crushed me. And taking that first drink – I don't remember my last, but I remember the first. And it burned going down. It allowed me to have -- like, exhale. It allowed me to have a deep breath. And things seemed to come back together for a short period of time during then.


[Dr. Peter Salgo] And thank you so much for joining us. I got to tell you -- I watched your story. And 10 years old, you started drinking. Tell me what happened after that. How did this all progress?


[Annie] It was drinks now and then.


[Dr. Peter Salgo] Okay.


[Annie] In all honesty, I would sneak a shot of Scotch out of the medicine cabinet and fill it up with water. And by the time I entered into high school, I had a NyQuil bottle that I would fill with vodka. Took slugs of it out during school.


[Dr. Peter Salgo] What about college?


[Annie] Oh, well, I successfully drank myself out of college by -- I think it was probably the sophomore year, end of the freshman year. The nuns asked me to leave. [ Laughs ] They thought that I could find something that I was more interested in, which usually began with a bar and ended with a bar. Not drinking wasn't a thought.


[Dr. Peter Salgo] Lou, in your practice, do you hear these stories? And, if you've heard this story in your practice, what would you think?


[Dr. Lou Papa] Sure, I do. And what you may not know about, I mean, I've never taken a drink in my life 'cause there's alcoholism in my family.


[Dr. Peter Salgo] Is that right?


[Dr. Lou Papa] Yes. So, I hear this story all the time, and not only in practice, but in my own life. Unfortunately, I think our society really underplays alcohol. They kind of celebrate it. Commercials celebrate it. You know, and probably a good 1/3 of the patients at my practice have an issue with alcohol, either an issue where I'm worried about the effect it's gonna have on their health, to the extreme where it has an effect on everything around them, in a negative extent.


[Dr. Peter Salgo] Louis, what questions do you have for Annie?


[Dr. Baxter] Well, I really hear that story very often. And, usually, there are explanations that it's a rite of passage. Other explanations are that, "I would rather have my child drink in my presence so that I can somehow teach them how to drink or use alcohol responsibly." And the third thing is that everybody else is doing it. And, so, what we find is that we hear that often. And in early stages of addiction or substance-use disorder that becomes problematic, people can, in fact, manage it. But if they really, really have the disease of alcohol dependence and alcoholism or alcohol-use disorder, it will become progressive.


[Dr. Peter Salgo] But are you concerned that Annie is an alcoholic?


[Dr. Baxter] Well, I need to know – did her use of alcohol impact her social and professional development? I want to find out whether she gave up interests in other activities because of her use of alcohol or her recovery from alcohol and to see if there has been any changes in the amount of substance that she'd need to get the same effect.


[Annie] So, where to begin, right?


[Dr. Baxter] Yeah.


[Annie] I remember, early on, that there was a tolerance that I had that exceeded everybody else's tolerance almost immediately. And they saw that my behavior was erratic. I was angry at one time, but I'm a happy individual, always have kind of been hopeful and happy. But there was a temper that I had that was uncontrollable, and anger. And the alcohol helped subside that. Later on, as I moved into college, there were so many incidents of, "I have no idea how much I had to drink" and would wake up the next morning and have passed out and blacked out.


[Dr. Baxter] Yeah.


[Annie] Later on, when I moved to Los Angeles, I spent five years -- I didn't drink anything. However, during that time, I grew a propensity for different types of narcotics or Benzodiazepine, you know, downers, smoked a lot of weed. Loved smoking weed.


[Dr. Peter Salgo] Anything else you need to ask her?


[Dr. Baxter] No. She pretty much ticks off. She's got 6 out of 7.


[Dr. Peter Salgo] Uh-huh.


[Dr. Baxter] And I'm sure that if I pried, we could get 7-out-of-7 criteria.


[Annie] You know what was interesting? I worked all the time. I didn't miss any work. So, for me, you know, I didn't think of being an alcoholic or a drug addict.


[Dr. Lou Papa] That's a big misconception. You know, "the working drinker." There are a lot of -- You know, it's on that spectrum of unhealthy use to abuse. And there are a lot of people that have very unhealthy alcohol use and work 60 hours a week.


[Dr. Peter Salgo] How many people in this country, right now, are considered to be alcoholics?

[Dr. Baxter] Well, that varies, depending upon whom you read. But I would tell you, conservatively, it's about 10% to 12% of the population has at least alcohol-use disorder.


[Dr. Peter Salgo] Okay. Now, if we -- I can do this in my head. 300 million people in this country. 10% -- that's 30 million people.


[Dr. Baxter] Yes.


[Dr. Peter Salgo] That's a lot of folks.


[Dr. Lou Papa] But there's probably about 1/4 or more that have at-risk or unhealthy alcohol use. So that's a lot of patients.


[Dr. Peter Salgo] Is alcohol different, medically, chemically -- alcoholism different than other addictive drugs?


[Dr. Baxter] Not at all. And that's part of the problem. We were talking earlier, and what we like to talk about is dis-ease, not feeling comfortable with one's self. And when you study the neurobiology of addiction, it all works through all of the same neurochemical systems. Once that reward system gets involved, you can substitute any sort of a psychoactive substance and cause the addiction or the substance-use disorder to progress.


[Dr. Peter Salgo] And you did. You told us that you used other drugs in addition to or instead of alcohol. Did you consider yourself an alcoholic along the way?


[Annie] When I left college, I went to work at the state hospital. Probably should have been admitted. I remember taking that – They did an inventory, and you had to check off. And I lied through the whole thing about the amount I used. Nonetheless, I became a professional in the mental-health industry, around drug addiction and alcoholism, interestingly. And I was working in that professional when I sobered up, and it did not occur to me until I sat down with somebody one afternoon. I couldn't maintain anymore, and it wasn't about the amount that I drank. It was that, at one moment, I could drink an entire fifth of Scotch and not get drunk, and another time, I could take a shot of Scotch and be blacked out.


[Dr. Baxter]  Mm-hmm.


[Annie] And so it became unpredictable. And my management of my staff was unpredictable. And so I went to somebody and said, "Hey --" I felt crazy. I felt absolutely insane, thought that I needed to go seek some type of in-patient. And my friend suggested to me -- She said, "Have you thought about not drinking?" And my response was, "I quit drinking for five years." And she said, "No, Annie. Not drinking, not taking any prescriptions, not smoking any weed." And my response to her was, "You mean all at the same time?" [ Laughter ] It didn't occur to me.


[Dr. Peter Salgo] And, Lou, something else she said brought this to mind. To patients lie to you about the amount of alcohol they drink? She said she lied on her in-take --


[Dr. Lou Papa] Oh, absolutely. I mean, that's one of the problems with -- The screening tools are great, if the patient is being honest. And there's an old -- And you probably know the same thing, Peter. You grew up in the same kind of training situations. What they used to tell us, "When you ask your patient how much they drank, double or triple it, because they're not telling you the truth."


[Dr. Peter Salgo] Now, the other thing is that -- Lou mentioned he doesn't drink alcohol 'cause there's alcoholism in his family. Is there alcoholism in your family?


[Annie] Oh, I come from a long line of proficient drinkers. It's not something that was talked about, though, at the time.


[Dr. Peter Salgo] Okay.


[Annie] It was -- When my grandfather went into the nursing home, you made sure that there was a bottle of booze over there all the time for him. It was just part of living in that. And it still is part of the American story. You know, the sponsors between rodeo or NASCAR or whatever it is, it's considered an acceptable escape tool, along with --


[Dr. Lou Papa] It's considered a sign of success. It's considered a sign of living a good life.


[Dr. Peter Salgo] But when did that change? When did this sign of success, when did this pervasive alcohol culture finally, in your case, reach the point where you said, "I've got to stop. Something has to change."


[Annie] Truly, it wasn't because of anything that specific had happened. I just woke up one morning and thought, "Oh, my gosh. I've got stuff to do." And I went to talk to this friend of mine. And with those of us that have been in recovery, it was a moment of clarity.


[Dr. Peter Salgo] So, what did you do then?


[Annie] I talked to her. She suggested that I not drink for 30 days or use any drugs or smoke any weed, all at the same time, and that if I was interested, that I should seek out some support groups to do so.

And I did.


[Dr. Peter Salgo] Before we go there, there is a risk, Lou, for somebody who's been drinking heavily and using other drugs heavily, to go cold turkey. There are medical hazards to that.


[Dr. Lou Papa] Because of the withdrawal that can occur. And it can be pretty nasty. It can put people in the hospital. It can kill people. But lots of times, we use that technique very often because we know the patient's not gonna do it. Part of it is just to let them know, "Okay. You say you've got this under control. You say this is not a problem. This is social. Then it shouldn't be a problem." And, very often, they'll come back and say, "Oh, my gosh. I couldn't do it."


[Dr. Peter Salgo] You know, one of the phrases that we hear, Annie, is that you've got to hit rock bottom before you pull yourself together and go to get help. Is there, medically, something to this, Louis, about rock bottom?


[Dr. Baxter] Oh, yes. Well, absolutely, but I think that that is something that we need to work harder on dispelling, because just like any other chronic medical illness, there can be prevention efforts that will help people come to recognize that there is a problem earlier, rather than later. And so individuals do not necessarily have to hit rock bottom, which means losing everything, unemployed, locked up in jail, relationships destroyed.


[Dr. Lou Papa] And you don't want to be that way with any other disease, 'cause if we're gonna treat it like any other disease, you don't want to say, "Well, you'll quit smoking when you get lung cancer. You know, you'll treat your Crohn's disease when you bleed out. You want to address the disease early on.


[Annie] I would even say that we wait too long.


[Dr. Lou Papa] Mm-hmm.


[Annie] Particularly with drug addiction and alcoholism, we wait too long. When we wait to the point that somebody is homeless on the streets, that they have cirrhosis of the liver, that we have all these other opportunistic dis-eases that have occurred, we've almost waited too long, sometimes.


[Dr. Lou Papa] Because it takes more than one person to hold up a facade.


[Annie] Yeah. Exactly.


[Dr. Peter Salgo] Now, you went to get some help, right? So, tell me -- what was that help like? How did you integrate yourself into some program or system to get off alcohol?


[Annie] I did not go to a treatment facility. In fact, I went to a psychiatrist. And I said, "You know, maybe I need to go to treatment." She said, "You've worked in it all these years. It's not gonna work for you. You need just to go around people --" So, I went to a particular support group that I continue to be involved with today. And there were old-timers there that had sobriety of 30, 40 years, and they just sat there and they petted my arm and said, "Just hang in there, Annie. It's okay. Keep coming back." And I attended these support groups 2, 3 times a day 4 or 5 years.


[Dr. Peter Salgo] Do you need a program? Can you do this without one?


[Dr. Baxter] I think that you cannot just stop, if you actually have the

disease. What I hear Anne tell us is that she actually did the three necessary parts. She stopped using, and that's -- We talk about detoxification. So, you can do that in a number of ways, including cold turkey. The next thing that has to happen is that you have to have education about the disease and why people do what they do. And she worked in the field for a long time. And then the third part is the continuing care or the continuing support or counseling. So, in fact, although she didn't go to rehab, in-patient or out-patient, she had enough experience that she got that information.


[Dr. Peter Salgo] So she put it all together on her own.


[Dr. Baxter] Yes.


[Dr. Peter Salgo] Did you have to change your friends, change your location, change your lifestyle drastically and suddenly all at once?


[Annie] Ironically, I moved from Los Angeles to Phoenix right at the time that I cleaned up. It wasn't a plan. But I knew a lot of people in Phoenix. The support group that I attended allowed me to be around people that, through their role-modeling, through their stories, through their experience, strength, and hope, I learned how to go through deaths and different experiences without picking up a drink, without going and taking drugs.


[Dr. Lou Papa] You touched on something very important, which is the people, places, and things, because it makes it very difficult, very often, if there's someone in the house who has a drinking problem, there's other people in the house who have drinking problems. There's a lot people around you that would like to reconstruct that facade. And I think a big part of that is getting people around you who are gonna be very supportive of the fact that you're trying to get away from it.


[Annie] My experience was that not drinking anymore had to be more than not drinking. It had to be a desire to have a different life.


[Dr. Lou Papa] Bingo. You've got to be reborn.


[Annie] So act differently, be different, have actual revived dreams once again. It couldn't be about not drinking.


[Dr. Lou Papa] Absolutely.


[Annie] Just the same with smoking. It couldn't be -- I had to want a different life and be different. And, so, that brought up different friends and different ways of living.


[Dr. Peter Salgo] Couple of quick questions. If you are an alcoholic and you have quit, can you ever go back and have just one drink? Will you automatically fall off the wagon?

[Dr. Baxter] People think that you can, but if you have a chronic medical illness, once you put the substance back, it will take over, 'cause it has nothing to do with willpower. It's physiologic.


[Dr. Peter Salgo] What is the alcohol doing to your body?


[Dr. Lou Papa] It's one of the leading causes of trauma and traumatic deaths and head injuries. It's one of the leading causes of congestive heart failure. People don't realize that. It's one of the leading contributors to head and neck cancer, lung cancer, stomach cancer, pancreatic cancer, pancreatitis, stomach ulcers. And it's one of the – Studies have come out now that it plays a huge role in accelerating and contributing to dementia. And people don't realize that it's a carcinogen. And there's about -- Independent, 4% of cancers are due directly to alcohol.


[Dr. Peter Salgo] That's just astounding. Annie, how long have you been sober?


[Annie] 25 years.


[Dr. Peter Salgo] 25 years. [ Applause ]  How common is it for people to get sober and stay sober after the first try? You want to start, you can pick it up?


[Dr. Lou Papa] Well, because that I'm primary care, it's not too often. And I think part of it is what Annie hit on, is they don't get reborn. They very often say, "I just want to go back to the ways I was doing things." And the alcohol and the social setting of it and those people -- I agree with you. You can't do that. And a lot of it is that sense where you have to get to the point where you've got to be reborn.


[Dr. Peter Salgo] Is he right, Louis?


[Dr. Baxter] Well, he's right in that if you don't have a full treatment experience, you will relapse. There's no doubt about it. It's just like any other chronic medical illness. If you do what you're supposed to do, it will stay in abeyance. If you stop, then the symptoms will come back.


[Dr. Lou Papa] And I agree with you. When I think about my patients that failed, they're the ones who say, "I stopped drinking. I don't really need a program. I got this."


[Dr. Baxter] That's right.


[Dr. Peter Salgo] You know, I wanted to point one thing about, though. If you fail the first time, you can't just give up.


[Dr. Lou Papa] No.


[Dr. Peter Salgo] You go back and do it again.


[Dr. Lou Papa] Right.


[Dr. Peter Salgo] Absolutely.


[Dr. Lou Papa] It's like smoking. It doesn't make sense that if you can't quit smoking, you just keep smoking. That's not an option. You really have to look at it. You've gotten to the point where you know it's not an option. You have to say, "This is not an option." If you didn't stop, you've got to figure out a way to stop. It's no longer an option for you to go on.


[Dr. Peter Salgo] We're gonna pause just for a moment. We'll be back. You know, every day, we hear about medical innovations that make an impact and hold promise for improving our healthcare. Take a look at this.


[Jean] When dopamine levels spike, does the brain adapt to these new levels of dopamine? Yes. That is what leads to the very strong reinforcing properties that says, "I will do anything to get this drug." Ultimately, we'd like to be able to take this research to humans. This may decrease the desire for opiates and other drugs of abuse. When you become addicted to a compound, such as morphine, heroin, alcohol, cocaine, you get a huge increase in dopamine levels in the nucleus accumbens region of the brain. Then the brain adapts fairly quickly to needing and wanting that higher dopamine, whereas any of the pleasures that we normally have -- a good meal, chocolate candy bar -- it's just getting some dopamine release, yes, but not this huge spiking that your drugs of abuse can elicit. FGF21 -- it's a hormone, and, recently, it's been found to be involved in a number of brain functions. Previous studies showed that FGF21 administered to mice will decrease preference for both alcohol and sweet. And what it's doing is suppressing levels of dopamine. FGF21 -- we're looking at it to say, "Will it suppress opiate desire?" We've got mice that express a high level of FGF21, and we're comparing them to litter-mates that don't express a high level of this hormone. Is there a difference between them in their preference for morphine? What we're doing is -- You've got three chambers, essentially -- a middle one and then two side ones. And, initially, which of the two big chambers does it prefer? And then you give it morphin and put it in the chamber that it prefers the least. Then you take the mouse six hours later, give it saline, and put it in its preferred chamber. Do this for a couple of days, it learns that if it goes into what initially wasn't its favorite chamber, it gets morphine. If it goes into the other chamber, it gets saline. Then you stop administering the drug and just give the mouse its choice. "Where do you want to go?" Our preliminary results are suggesting that the FGF21 mice expressing high levels of this hormone don't go as often to the morphine side. Well, this research is early on right now, but the potential is -- it's very exciting, because you're looking at it for more than one drug. You can be looking at both alcoholism and opiates, say. And most people aren't addicted to only one drug. They're addicted to multiple drugs.


[Dr. Peter Salgo] Lou, Louis, why don't you give us some final words, some final thoughts. And we'll start with Lou.


[Dr. Lou Papa] Any patient that I've had that's given up any substance very rarely says, "That was not a good idea." They all come out a stronger, better person. They discover parts of themselves and things that they want to do that they were held back from doing. They're always a much larger, better version of themself -- every time.


[Dr. Peter Salgo] Louis?


[Dr. Baxter] It's really not the substance. It's the way that people who have this disease have to deal with dis-ease, and that's fear, aspirations, hurt, anger. And, so, once that we can understand that addiction is a brain disease and that will manifest itself by the use of psychoactive substances, I think we'll have a better understanding and approach to managing this disorder.


[Dr. Peter Salgo] Annie, what advice do you have for people who think that someone in their family or their friends might have this issue? What do you want to tell them?


[Annie] So, the interesting thing, to bring it all together, alcoholism, drug addiction is a family disease.


[Dr. Peter Salgo] Yep.


[Annie] It's a societal disease. We all are affected by it, either intimately or – And let's talk about it.


[Dr. Peter Salgo] Based on the numbers we heard, there's somebody out there in our audience – more than somebody, lots of folks out there -- who have this problem. What's your message to that person?


[Annie] To the people that are suffering with this, I did not aspire to be an alcoholic. That's not what I dreamt of growing up. You know you have a problem. It's inside of you. Go and have the courage to talk to somebody and say, "I just need some help and I'm scared." And it's not easy. And don't give up. Do not give up and keep talking about it, keep asking for help, and be willing to say, "I don't know how to do this." You'll get there.


[Dr. Peter Salgo] Annie, thank you so, so much for joining us today and sharing your story. It's important that you did that. I just want to tell you how much we all appreciate your being here. Lou, Louis. Great to see you again Louis, and you, Lou. Thank you for joining us here today. Thank you, everybody, here in our studio audience, and, of course, thank you at home for watching, as well. Remember, you can get more "Second Opinions" and patient stories on our website, at You can continue the conversation on Facebook, Twitter, and on Instagram, where we're live every day with health information. I'm Dr. Peter Salgo, and I'll see you next week for another "Second Opinion."


[ Applause ]




[Narrator] Behind every heartbeat is a story we can learn from. As we have for over 80 years, Blue Cross and Blue Shield Companies are working to use the knowledge we gain from our members to better the health of not just those we insure, but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.


[Announcer] "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.