Line #59 UsefulNotes/AlcoholismAndAlcoholAbuse


1	->''"There is no degeneration or loose morals or character defects in an alcoholic. It's a physical disease."''
2	-->-- '''Creator/DickVanDyke''', ''Series/TheDickCavettShow'' [[https://youtu.be/XawJPRjKQvQ Interview]]
3
4	Alcohol abuse and alcoholism have existed probably as long as alcohol itself has. In fiction, TheAlcoholic is an often-used angst trope, as are other depictions of alcohol abuse and alcoholism. But what is alcohol abuse and alcoholism? What is the difference between the two? How do you know if you are at risk for or are an alcoholic?
5
6	This article exists to give a short overview of alcohol abuse and alcoholism, and include ways you can find help for yourself and/or someone else if you or someone you know is an alcohol abuser or alcoholic.
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8	''Alcohol abuse'' is simply the regular use of alcohol to a dangerous or unhealthy degree, the regular overuse of alcohol and/or the use of alcohol to a degree that it creates dangerous or problematic behavior on a regular basis. Almost all alcoholics are alcohol abusers, but not everyone who abuses alcohol is or will become a true alcoholic.
9	* Nobody can really agree on safe, moderate, healthy or whatever guidelines for drinking. The only consistency between sources, even the same ones over time, seems to be that the new guidelines keep contradicting earlier guidelines. The only ironclad advice is that safe drinking and drinking habits become known by self-observation. In the same vein, nobody agrees which percentage of the population has an alcohol problem. (Especially, as cynics may say, they don't have the problem, their neighborhood has the problem.) [[http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf?ua=1 WHO Report 2014]]
10	* Safe drinking advice:
11	** Figure out what your limits are.
12	** If you are an inexperienced drinker, do not try to keep up with "veterans".
13	** Try to avoid drinking on an empty stomach. Drink with food.
14	** If you feel that dizzy drunk feeling, refrain from imbibing more until it subsides.
15	** Track your drinking and how much you drink.
16	** If drinking rapidly, only do this initially and settle to a sustainable pace later.
17	** 1hr/drink is the fastest truly sustainable rate.
18	** Do not drink to improve your mood -- it may work initially, but you'll soon feel miserable.
19	** Never try to regain a buzz -- those neurotransmitters are spent and you'll feel like crap.
20	** Avoid "one last drink", especially if you are already drunk, especially if it's a lot of alcohol.
21	** Beer is the weakest alcohol. Wine is twice as strong. Cocktails are stronger. Spirits are mightiest.
22	** An 8floz (330ml) [[note]]5% ABV (10 proof)[[/note]] glass of beer has as much alcohol as a 5floz (180ml) [[note]]12.5% ABV (25 proof)[[/note]] glass of wine, which has as much alcohol as a 1.5floz (45ml) [[note]]40% ABV (80 proof)[[/note]] shot of spirit.
23	** Limit yourself to an average of 100ml of spirits a day.
24	** If you find yourself thinking you'll have to buy more sooner than you wanted, planned, or expected, please slow down your drinking.
25	** Try to have at least one low/no booze day every week.
26	** Don't drink the day after a heavy session. It won't lessen a hangover.
27	** If you aren't enjoying yourself, stop.
28	** If drinking to destress, have one shot of spirits like vodka or whisky (Or other equivalent) and wait twenty minutes before the next one.
29	** If you know you'll likely have to do something or be somewhere or talk to someone important, save any drinking for later.
30	** If you know that you will not like the effects of having this next drink, you've taken enough. Don't ignore this. Abstain from taking more.
31	** Don't get drunk more than twice a week. Get wasted as little as possible.
32	* Signs of potential alcohol problems.
33	** You regularly find yourself drinking more than you think.
34	** You spend more on booze than you would like.
35	** You drink just out of habit.
36	** You pervasively find yourself wanting a drink for no other reason than because you can or you haven't in a while.
37	** Going without alcohol makes you crave it or dependably put you in a much worse mood.
38	** You conceal the true extent of your drinking.
39	** You think of a day or occasion without a drink as a waste.
40	** You specifically choose places or activities because of access to alcohol.
41	** You drink without caring about quality or taste.
42	** You habitually drink, even when you know you shouldn't.
43	** You consider alcohol not as a luxury to augment your life but as something to enable it.
44	** The thought of extended sobriety frightens or angers you.
45	** You are regularly not only drunk but also get far drunker than you would like.
46	** You regularly set limits for yourself, only to proceed to break them.
47	** Your tolerance has grown so high that you still find yourself reasonably lucid after drinking amounts that would have put people with normal tolerances out a long time ago.
48	** You have repeatedly blacked out, ''especially'' if your blacking out usually results in you [[WhatDidIDoLastNight having to answer for something that you did while drunk when you come to]].
49	** People express concern to you about your drinking and they are not TheFundamentalist, militant straight-edge, triggered by witnessing alcohol consumption, or otherwise extremely opposed to any sort of alcohol usage.
50	** You would take drastic measures to get at liquor.
51	** If you saw your pattern in someone else, you would be concerned.
52	** You doubt your self-control.
53	** People only know the "drunk you" or don't really know what your sober personality is.
54	** ''You'' aren't sure what your sober personality is.
55	** You regularly deal with hangovers by [[HairOfTheDog drinking even more]].
56	** You know the opening and closing hours of all the nearby bars, liquor stores, and regular stores that sell alcohol by heart.
57	** You have found yourself waiting outside for one to open at least once.
58	** You have been refused a sale from a store or cut off at a bar because you were too drunk.
59	** You have selected a store based on how lax their staff is with selling to visibly intoxicated customers.
60	** You have consumed household items that contain alcohol but are not intended for consumption (e.g. mouthwash and hand sanitizer) because you needed alcohol that bad.
61	* If you show the above symptoms, don't panic. Step back and hold off on drinking for a little while. Reassess as objectively as you can how much you're drinking and why. The rule is that you should be in charge of your drinking, not the other way around. Provided you aren't drinking stupid amounts like dozens of standard drinks every single week, if you are in control of yourself and not negatively impacting your life, you're not alcoholic, but you should reduce your intake. If your drinking is out of control and harmfully so, cut back heavily on drinking and find someone to talk to. If you feel like you may be developing a problem, make yourself abstain for a few days until the urge fades. It is far better to solve issues early and firmly.
62	* Alcohol ''can'' be consumed in ways other than by mouth, but doing so is a ''very'' bad idea in that almost all of the ways to do so are ''far'' more dangerous than ordinary drinking (inhalation, rectal, and IV) and the only way that's less dangerous (skin absorption) is also far less effective, requiring more alcohol and having less of an effect. All of these are much less fun than drinking because you don't even get to taste it, and good luck getting away with butt-chugging at dinner! Inhalation carries the general risks of inhalant abuse and lung damage, whereas rectal and IV pose risks of damage to the anus and rectum or veins, respectively, and ''also bypass the liver,'' meaning that alcohol poisoning can ensue, in some cases, with the amount in ''an ordinary drink.'' Using alcohol by inhalation, AssShove, or IV is almost always by definition alcohol abuse (unless it's a one-time experiment done in a manner as safe as possible, or in the case of intravenous alcohol, given in a medical setting as an antidote for some forms of poisoning). Bathing in alcohol such as beer or wine may or may not be a sign of alcohol abuse, but it probably ''is'' a sign that you're throwing away money.
63	* ''Binge drinking'' is the consumption of five or more alcoholic beverages within a span of 24 hours, generally within the same drinking session (e.g. not four drinks over 10 hours, but four drinks in two hours). If you find that you cannot stop drinking once you've started, you consistently lose track of how much alcohol you've consumed after several drinks, or your drinking sessions almost always end with you passing out (and occasionally stop short of this only because ''you've consumed all the alcohol you could find''), you have almost certainly passed into alcoholism. When excessive drinking goes from being a desire to a compulsion, you have passed beyond the threshold.
64	* ''Relational problems'' from the use of alcohol are a sign of alcohol abuse. Getting criticized for drinking can be a warning sign to monitor alcohol usage, provided that a person expressing such misgivings, once again, does ''not'' view the world through [[TheFundamentalist some kind of a fundamentalist lens]] (religious or otherwise) or for any other reason possess oversensitivity to ''any'' sort of ''any'' alcohol usage. It's also a ''huge'' warning sign if you find yourself getting into fights and actively provoking and engaging in violence while using alcohol. (Whether or not you do those when sober is another matter altogether). Relational problems related to alcohol misuse goes double for people, whose personalities undergo unpleasant shifts after imbibing. If people begin to empty out of a room when you start drinking or you are outright told that you are mean, vicious, and abusive when drunk, ''you should not drink''. Period. If you doubt that the person telling you this is being truthful, ask around. If the general consensus is that you're an asshole when you're drunk, it's a safe bet this is very accurate. Failure to moderate your drinking in this case can cost you friendships and relationships, strain family relations, give you a reputation that makes you a pariah, and possibly even cost you a job if you get verbally abusive at an office party. This goes quadruple for people who become aggressive or violent when drunk: if you [[HairTriggerTemper fly off the handle at everything]], you should seriously consider not even being near alcohol, since the stakes are far higher.
65	** On the flip side, beware of someone encouraging you to drink because "you're more fun when you're drunk," especially if they keep trying to push you past your known limits. Refuse drinks if you know you've had enough, and explain to them that you know your limits and when you're done, you're done. If this person doesn't desist, ''get away from them'', especially if you find yourself in situations where you know you shouldn't be there (i.e., driving home when you know you aren't sober enough). If the person really does think "you're more fun when you're drunk," you're probably better off with someone who likes "sober you" just as much, or more, than "drunk you." Worst case, they're trying to get and keep you drunk enough to take advantage of you.
66	* This considering, not only are the above possibilities magnified, but getting arrested is now a very real possibility. So is getting severely injured or even killed if you fuck with the wrong person. Quite a few alcohol-related murder and manslaughter cases have boiled down to "one guy was drunk, attacked the other guy, and got beaten to death/stabbed/shot in return". Don't be one of them.
67	* ''Legal problems'' are another warning sign of alcohol abuse. Not legal problems so much as in "I carried my beer outside the bar and got a ticket" or "someone opened a container in my car". Those aren't necessarily related to your personal usage. If you get a DUI or drunk and disorderly conduct arrest, ''that'' is a major warning sign.
68	* Finding yourself getting 86'd[[note]]restaurant slang for being ejected as a consequence of bad behavior[[/note]] from establishments or receiving a ban from one isn't in itself a legal problem, but can easily turn into one if your behavior gets the police called or results in charges being filed. Of course ejections and bans aren't automatically due to alcohol misuse. Did you have a dispute with staff over tips or bad reviews? If you failed to meet the dress code, then tough, just remember it the next time or maybe find another place more to your liking. Maybe the fault really wasn't yours, because someone else in your group started trouble and got everyone kicked out. You don't want to be that guy yourself (see below). What's this? You're associated with known troublemakers, and the staff doesn't want to risk more problems? Maybe the staff's reasoning is fair, maybe not. Not fun, either way.[[note]]If a bartender - or a bouncer - ''is'' a dick just for the hell of it or is looking for the thinnest of excuses to act like one just because they took a sudden dislike to you and you really didn't do anything anyone reasonable should take any issue with, that's some bad luck and, [[SincerityMode sure, can happen]] hands down. Aren't there better places to frequent, though? Moreso if the staff overall seems to be dick-ish, shady, or questionable in any way. Why would you want to be in a place like that? Be it as it may, don't go around gossiping, complaining, and/or griping about so-and-so-place unless you seriously want to risk it coming back to bite you in the ass in the form of defamation charges. At best, you can end up making a complete ass of yourself. Don't be an idiot.[[/note]] One ejection can be chalked up to a bad night. Repeated ejections related to your own alcohol-related misbehavior are a sign you need to take a hard look at your own behavior and an outright ban due to the same signals you ''definitely'' have a problem. The following reasons for ejection or blacklisting ''cannot'' be whitewashed so easily:
69	** '''Habitually disputing or refusing to pay tabs''' Mistakes do happen. There are also those rare few staffers who are dumb or dishonest enough to try and sneak in extra charges while hoping that you either won't notice or will be too drunk to have your word taken seriously if you do. But not so fast. If (likely) the charges are all totally legitimate and you were just too drunk to remember ordering half the items, this is a problem.
70	** '''Habitually being rude, belligerent, or verbally abusive''' If drinking turns you into an abusive, belligerent asshole.....
71	** '''Sexually harassing patrons or staff''' ....or a disgusting lecherous creep, stop drinking. '' '''Please''' ''
72	** '''Antagonizing bouncers''' Ditto. Why would you even do this? It's one thing if a bouncer acts like an unreasonable, power-tripping dick when you genuinely have done nothing wrong, which is obviously not a pleasant instance but at least doesn't rule out seeking out another, better place to go to. Even if a bouncer was one of those stereotypical dick-ish ones, what would it even prove to go out of your way yourself to act boorish? So doing does yourself no favors.
73	** '''Starting or participating in fights''' As anyone in nightlife can tell you, fights happen. There are times when they may genuinely not be your fault. People do sometimes have to defend themselves against unprovoked attacks from others, including when they have been trying to clear out. Unfortunately, there are people out there who either look for anything to start a fight over or habitually see things in the worst possible light and react aggressively. Please don't be one of them. If ''you'' become aggressive when drunk and respond to things that sober people would see as minor annoyances by getting in the faces of others, taking swings at them, inviting them to meet you out front, or informing them that you'll be waiting outside, the bar staff has every right to call the cops and/or ban you for life. Unless a reasonable person would agree that you were absolutely blameless, a fight-related ban or arrest with alcohol involved should be a ''major'' wake-up call.
74	** '''Sitting around all day being irritating and disruptive''' Sitting on the same stool for most of the day and drunkenly attempting to make conversation pisses off staff (who likely can't continue to serve you if you've hit the cutoff point) and other patrons alike (who don't want to listen to you aimlessly and indecipherably ramble about stupid shit) and signals that you seriously need to "get a life". Anyone who has worked in a bar can tell you that being this kind of regular ''will'' wear out your welcome. This isn't even the only way of...
75	** '''Being obnoxious''' Sure, "obnoxious" is kind of a subjective definition, ''but'' if your drunk behavior would irritate a reasonable person enough to get them to ask the bouncers to step in and the bouncers agreed that you were being annoying enough to warrant an ejection, you should at least '' '''think''' '' about drinking less. If it takes a certain amount to get you to go from "fun" to pissing off half the bar, it's a sign you need to reduce the amount of drinking. Especially if this leads to...
76	** '''Getting your party thrown out repeatedly''' If the bar staff opts to kick the entire group out after you have a few too many and getting obnoxious yet '''''again''''', your friends ''will'' be pissed off, even if you don't have a drinking problem per se. You can count on this. There are only so many instances (sometimes even once is enough) before the staff eventually decides you're not worth the trouble. They will tell your group you're not allowed in with them - if your friends don't opt to do it themselves. This is if your friends aren't banned, too, because of their association with you. Guess how much ''that'' makes them appreciate your company. If any of this happens, you need to take a long, hard look at yourself, alcohol problems or not.
77	* ''Regret over one's actions while under the influence'' is another major warning sign of alcohol abuse. If your drinking causes you to lose control of your actions or emotions, it's a bad sign. If you regularly find yourself apologizing to people when sober for the things you said and did while you were drunk, you need to take a look at your drinking. This leads back to the whole mean drunk thing; if drinking turns you into an abusive asshole, abstaining and trying to address the underlying issues behind your undesirable personality shifts is a good idea.
78	** Alternatively, ''loss of memory'' or blackouts are ''always'' a major warning sign of alcohol abuse and a warning sign that alcohol abuse may be becoming alcoholism.
79	* ''Drinking regularly for DrowningMySorrows'' is another warning sign of alcohol abuse. It should even be taken with far more seriousness than the others. There is a very important saying in the recovery community regarding this: "sorrow knows how to swim."
80	** Additionally, if you have anxiety problems and regularly find yourself using alcohol to loosen up, you should use that as a wake-up call to address the underlying issues that make you feel like you need to drink to function socially. While this itself isn't outright destructive, it ''is'' unhealthy (if you are not doing so in full awareness that you are using alcohol as medication, if you do have an anxiety disorder, and treating it with the same respect that you would a prescription anxiety medication) and can lead to worse patterns. On the other hand, if your habit of using alcohol as a social lubricant is less "being buzzed and/or drunk makes it easier to function socially" and more "my drunk self is the only side of me that people see because I can't function socially if I'm not wasted", you definitely have a serious problem that requires professional help.
81	** If you have Bipolar 1 (especially rapid cycling or with severe mood swings such as psychotic mania and suicidal depression), drinking is a ''horrible'' idea no matter whether you're medicated or not. If you are medicated, alcohol interacts horrifically with most meds for Bipolar 1. The meds and alcohol often amplify each others' effects, so one glass of wine can equal five or your med dose can feel quadrupled - and sometimes alcohol makes the meds ''less'' effective. Unmedicated, heavy drinking can make cycling happen faster, or potentiate a cycle into something far worse (e.g. your mania that was equivalent to a constant cocaine buzz becomes a psychotic breakdown, your depression that was "just" paralyzing and miserable becomes a cause for a suicide attempt) If you have Bipolar 2, you should not drink during depressive episodes or if you are on medication. Cyclothymia is probably the ''only'' mood swing disorder where moderate drinking is okay regardless of where you're at - and even there you have to be very careful.
82	** If you have epilepsy, drinking is one of the worst things you can do. While alcohol does have some anticonvulsant action (it works on GABA), this is ''heavily'' outweighed by its pro-convulsant properties and its tendency to play very badly with most anti-convulsant meds. Drinking even moderately (much less heavily) if you are epileptic is risking seizure events and further brain damage.
83	** If you are on certain medications that you are advised not to mix alcohol with, ''stay clear of alcohol''. This is because the interactions between those medications and alcohol can kill you, make the medications not work, or cause other issues. When your doctor or pharmacist tells you that you cannot drink while taking a medication, they are ''not'' only saying it to legally cover their ass in most instances. They are saying it because that med has a dangerous interaction with alcohol. If you are uncertain as to whether a medication can interact with even moderate drinking safely or you think the doctor or pharmacist is just making a big deal out of nothing, ''look it up'' before you take a drink.
84	*** On that note, there are some medications where very limited or moderate drinking ''is'' okay, but heavy, frequent drinking or becoming drunk causes the problem. In those cases, you ''must'' know your limit. If you can only have one drink, you can only have one drink. If you can only drink once a week, you can only drink once a week. Adhere to it. If you cannot, don't even begin drinking.
85	* Physical health problems as a direct result of your alcohol use are a major warning sign that you may have a serious problem with alcohol. If you are clinically malnourished or anemic as a direct result of your drinking or the money you spend on it, if you have abnormal liver function tests or outright develop cirrhosis or alcoholic hepatitis or hepatocellular carcinoma, if you have even ''one'' episode of vomiting blood or passing blood rectally, if you have a seizure, or you or others around you are noticing a sharp decline in mental performance, it's time to get treatment.
86	** More seriously, if you or someone that you know begins to show serious memory issues (''especially'' when coupled with the manifestation of false memories), issues with eye movement, a decline in mental functioning (including hallucinations), an abnormal gait, and any number of deficits with language, motor planning, sensory processing, or executive functioning that occur when not intoxicated or experiencing withdrawal, medical attention should be sought ''immediately'', as these are the hallmarks of Wernicke-Korsakoff syndrome, a life-threatening thiamine deficiency that is frequently present in long-term alcoholics who have largely stopped eating and sustain themselves through drinking.
87	* ''Dangerous behavior while under the influence'' is another warning sign to be taken with the utmost seriousness. It means that your(or another person's) irresponsible use of alcohol is ''immediately life-threatening'', as opposed to liver damage, cancer, or other long-term effects. If you find yourself, '' '''even once''' '', driving drunk, getting into a car accident drunk, walking on a freeway, fighting people twice your size and stronger than you, randomly going up to people to act provocative and start shit (you never know when someone might be a trained martial artist or have weapons on them), engaging in unwanted or unsafe sex, jumping from windows or other heights, using firearms, attempting or even contemplating suicide, breaking bones or sustaining other injuries requiring hospital treatment or anything similar while drunk, you need to either immediately stop drinking or seek treatment for alcoholism. This is also a major warning sign that you may be self-medicating or triggering another underlying mental illness with alcohol.
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89	''Alcoholism'' is even far more serious than alcohol abuse. Alcohol abuse can become alcoholism and is always a part of it. The difference between alcoholism and alcohol abuse is that alcoholism is a literal physical and emotional ''addiction'' to alcohol itself. Someone who is abusing alcohol but isn't addicted (yet) can, even if they drink problematically, manage their drinking. TheAlcoholic cannot, at least not without outside help and therapy in almost all cases.
90	* The alcohol abuser may binge drink at every party and may even get busted for DUI leaving one - but he/she can go days without drinking with no ill effect, ''can'' drink moderately, and/or can just go "you know, I don't want to get plastered at ''this'' party." It is a ''want'' for alcohol, even at the expense of one's health or other consequences.
91	* {{The alcoholic}}, on the other hand, ''needs'' to use alcohol or will go into a possibly fatal withdrawal syndrome called delirium tremens. A person past this threshold cannot stop drinking once he or she begins to drink, even if the circumstances would demand moderation or sobriety. Alcoholic drinking is a need or compulsive behavior - an alcoholic may drink even when they do ''not'' want to do so.
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93	!Rehabilitation
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95	Whether someone can ever drink responsibly again after having been an alcoholic is an issue of [[FlameWar fierce debate]].
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97	One side (that of most therapeutic opinion and of Alcoholics Anonymous) says that complete abstinence is required for anyone who ever reached the point of physical addiction. In some cases, being even short of that threshold is enough according to this side. It insists that any consumption of alcohol after beginning rehabilitation is a relapse.
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99	The other side (championed by Moderation Management, Rational Recovery, and some other therapists) postulates that it is ''possible'' for someone who was once an alcoholic to drink responsibly/on a limited basis. Considered are the variables of personal willpower to do so and structured settings to reduce the temptation to overconsume or revert to addictive use. That said, with the development of medication treatments that can, if properly adhered to, restore the ability to stop drinking/"have enough," moderation/harm reduction ''can'' possibly be a more viable alternative to abstinence than it was in the past when it relied solely on self-control that an alcoholic almost always by definition doesn't have.
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101	It's also possible that BothSidesHaveAPoint, what with how the legal system and people seeking help for relatives/friends can conflate true alcoholism (where the latter side may or may not be correct, depending on what side of the FlameWar you're on) with non-addictive alcohol abuse/misuse (where the latter side ''is'' the correct first approach)
102
103	* [[http://depression.about.com/od/screeningtools/l/blmast.htm The Michigan Alcohol Screening Test]] can also help you determine whether you are an alcohol abuser or an alcoholic. This is the primary screening test for alcoholism.
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105	!! Immediate help (protecting someone who is very drunk)
106	* ''DO NOT'' overserve, if you are hosting a party or bartending yourself. Realize there is a point at which people ''should not'' consume more alcohol. Don't be afraid to cut them off and supply them with nonalcoholic beverages at least until they've had time to process some of what they've had. If you are a bartender and decide that a customer is too drunk to continue serving but is also too profitable to cut off and lose out on tips, you can at least severely water down their drinks and substitute alcoholic components for non-alcoholic substitutes, as the body loses the ability to perceive alcohol after a certain point anyways. While morally dubious, it IS a win-win situation for you nonetheless. If they don't notice or protest, they'll keep throwing money at you. If they do, they'll look like any other drunken asshole bitching about how weak the drinks are and will get hauled out by the bouncers.
107	** As a secondary tip for bartenders/servers: alcohol and caffeine are an okay combination but only to a point. After that point, it leads to everything from people being "awake drunk," (e.g. drunk but not aware of how drunk they are) to actual heart attacks and poisonings (because both intensify the other's cardiotoxicity). Over two drinks with an energy drink or strong coffee as a mixer is generally a very bad idea. If someone is repeatedly ordering such, try to steer them toward something with a non-caffeinated mixer even ''before'' you cut off the alcohol. Also, try to avoid doing Jaegertrains for large groups who order lots of Jagerbombs. While they look impressive and can net handsome tips, it's impossible to keep track of that many people. If one of them decides to drink multiple Jagerbombs and has a bad reaction, your ass ''will'' be on the line.
108	* If you're a bouncer, the following seems like a no-brainer: "Do your goddamn job and don't act like a dick." Not so fast, please. Anyone who has worked in nightlife can tell you there ''definitely'' are bouncers, who fit the societal stereotypical perception of bouncers "barely-verbal, troglodytic meathead who only took the job to get a chance to get away with being a violent, power-tripping asshole" to a T. Though this isn't true of the whole, it's imperative you scrupulously avoid doing anything that could be seen as this. Basically: Don't start or join in on fights. Don't be a dick to patrons. Don't argue with or antagonize drunks. Don't blow up at rude patrons (no matter how provocative or idiotic their misbehavior is). Listen to what patrons and coworkers are trying to tell you. Failing to keep these in mind could get you fired, ruin your reputation and restrict your job options to sketchy, poorly-managed shitholes. It could possibly even cause you to get your ass kicked or cost you your life if you piss off the wrong person. This is without mentioning what should be another no-brainer: Don't drink or do drugs on the job. Unfortunately, this, too, is all too common in the nightlife industry.
109	* ''DO NOT'' let someone drunk get behind the wheel of a vehicle. ''Ever.'' If someone is visibly drunk (or even if they don't seem so but you suspect they have had more than one drink in the last two hours) drive yourself if you're sober, find a sober driver in the group, call a cab or ride service, get on public transit (and keep an eye on the worst-off drunks), let the drunk people stay over at your place until sober. Drunk driving kills and injures many people every year around the world. Even when no one is injured or killed and no property is damaged, people (especially poorer people who can't fight the charges with a lawyer/don't know how to act when arrested) will face life-altering criminal charges and legal trouble. It's entirely stupid and entirely preventable.
110	** Furthermore, negligence on your part that leads to someone else drunk driving can also have major legal consequences for you. Taking keys at gatherings where people are likely to get piss drunk is customary. This is not just because it's a very easy way to keep people from being able to drive drunk. If you fail to take someone's keys and they subsequently go off and drive drunk (or worse, get into an accident), they implicate you when an arresting officer asks where they got the alcohol. In such a case you can get in ''serious'' trouble for negligence in the form of arrests or lawsuits. If you could have prevented it and failed to, your ass will be on the line.
111	* ''DO NOT'' allow someone drunk to use a firearm, fireworks, or pyrotechnics or to be in too-close proximity to them. Yes, people do drink alcohol on occasions like holiday parties with fireworks, hunting trips, and target shoots, and as performers and audience at shows involving pyro. But if someone is visibly drunk or acting recklessly, that person should be kept away from guns, fireworks, and stage pyro. Many fatal and injurious accidents have occurred as the result of combining drunk people with things that are dangerous even with the utmost care and skill applied.
112	* If a drunk person or people (or one using any substance for that matter) is in a place where they could fall/jump from a height that could be fatal (e.g. high-rise apartment party, roof...) either keep them in sight at all times and make the hazard harder to access (close the balcony door or the window) or, better yet, walk with them somewhere safer.
113	* This also applies to other things that are dangerous or even to things that might not ''seem'' dangerous at first glance. Drunk people (especially those who are also high on a stimulant at the same time, anything from too many Jagerbombs to cocaine or meth) ''can'' be highly inventive in regard to ways to get accidentally injured or killed. If someone could fall on it or fall off of or out of it, get stabbed or cut on it, choke themselves on it or with it, consume it when it shouldn't be consumed, shove it into a bodily orifice, etc, etc - make sure that it's not easily accessible to someone drunk.
114	** Something a lot of people don't even realize could be dangerous here is ''food''. Specifically hard candies, nuts in shells, sections of soft pretzels, grapes, or food that contains inedible garnishes or bones can prove to be hazardous. If you're putting out food for a party where you're expecting lots of people to be drunk, ask yourself if someone could choke on it. If the answer is "yes," either don't serve it, remove the choking hazard or serve it early on before people have the chance to be very drunk. Furthermore, think long and hard before you put out anything that contains common allergy triggers. Sober people are usually very good about remembering what their triggers are and are generally quite capable of administering an epinephrine shot if they carry an [=EpiPen=] on their person. Drunk people are forgetful and easily confused when things go awry. They won't react to sudden changes in the way that they would if they were sober. In short, alcohol-induced forgetfulness and serious food allergies are a ''lethal'' combination. If a drunk person goes into anaphylaxis, their diminished ability to know just what the hell is going on means that death is a ''very'' real possibility.
115	* Make sure drunk people are not vulnerable to rapists. This means, again, watching out for them until they are either sober or with someone ''they'' previously have known and trust. It means not committing rape yourself. It bears repeating: Drunk people past a certain point of drunkenness are ''not capable'' of consent to sexual activity - even if they are outright verbally requesting it. Furthermore, if you're with someone who is drunk while a known predator is also in their vicinity, keep a close eye on both parties and be prepared to step in the minute that that predator tries to make their move. You could very easily prevent a rape that way.
116	** Added to this, BDSM play while drunk at any point beyond "slightly buzzed" is generally considered ''not'' SafeSaneAndConsensual. This is because, as noted above, alcohol lowers inhibitions and boundaries beyond what someone sober might draw a line at doing, while, as noted below, being highly drunk makes people nearly insensible to pain - meaning they may well not realize they need to stop and use their SafeWord (or forget it entirely) and get badly injured for real as a result - and passing out in some bondage positions or while doing anything related to asphyxiation has killed people. There is a ''reason'' why most professional BDSM events will either ban alcohol and drug use entirely, or will demand people actually participating be not visibly drunk or high. Whether you're a partner or a professional "worker," it's a good idea to never play with someone beyond "slightly tipsy," and to keep an eye on them to protect them from less ethical people and/or themselves. If someone insists anyway (e.g. they've hired you as a dominant and don't want to "waste their money,") ''at least'' try to placate them with activities that don't require them to know their body's condition or how much pain/pressure they are actually feeling to be safe. Also, do not "top" while intoxicated. Judgement, coordination, and awareness of yourself, your partner, your space, and anyone within it are crucial to pretty much every form of BDSM play, and alcohol intoxication inhibits ''all'' of these. Anyone can make a mistake throwing a whip, tying with rope, doing fire or wax or knives or needles; mistakes are almost a certainty if the top is inebriated. A drunk top is a dangerous top, to themselves, their partner, and anyone in the vicinity.
117	* If someone drunk is being aggressive or overemotional, do your very best to distract them with something that doesn't involve starting a physical fight or harassing/insulting other people. Treat them like you would an unruly, tantrum-prone child: don't attempt to argue with them or convince them that their behavior is unacceptable, because they a). aren't functioning at a level where they can process it and b). don't really give a fuck anyways and very well may just take it as a reason to escalate things. Make simple, direct statements that don't come off as antagonistic, don't argue with them or take the bait if they try to start one, and if they're being aggressive or acting in a threatening manner, make sure that your distraction doesn't piss them off further and can hold for long enough to make them forget why they were angry. Drunks have short attention spans and tend to be forgetful. Use this to your advantage.
118	** Additionally, if you wind up getting attacked, ''do not'' physically take your frustration out on them. '' '''Don't''' '' use any more force than you need to get away from them. You will probably be understandably furious at getting assaulted like that. Remember that drunks do not process pain on the same level that sober people do. They may [[ImplacableMan continually get up again and again]]. While their injuries from getting beaten are still the same, there's a good possibility that they won't realize that they've broken or dislocated a bone or received a major laceration or even that they're bleeding internally (which is normally immensely painful). Plenty of beating deaths with alcohol as a factor have boiled down to "the victim attacked the offender, got pounded into jelly, and was too drunk to know just how badly injured they were". If someone winds up dying by your hands under similar circumstances, you will almost always - almost certainly - be facing manslaughter charges. Please don't be either party.
119	* If you have a friend who is a mean, abusive, belligerent, or violent drunk, has been informed about their repellent behavior while they were sober and able to process it and insists on drinking anyways even after that, you should probably not let them wander out of your sight if they're drunk. Be ready to defuse bad situations and/or break up fights and talk people out of continuing them. You never know if the person they're threatening or loudly insulting has a bad temper, is a skilled fighter, or carries guns or knives on them. Even if your friend is steadily wearing away at your patience and desperately needs to accept that they have a problem and need treatment, the last thing you want is for them to wind up getting beaten to a pulp, stabbed, or shot. Beating-related deaths or permanently-crippling injuries are particularly common among drunks due to the body's greatly dulled ability to perceive pain while inebriated, which leads to people getting up from injuries or attempting to struggle out of holds that would have a sober person howling in pain.
120	* Generally, it's best to do your best to keep drunk people from encountering law enforcement. Being drunk is temporary, but a criminal record - or being shot or even sometimes "just" beaten up and tased - is permanent. This ties into several of the above - keeping them away from driving, fights, or dangerous activities - but it also means if someone really, really drunk can be kept out of public view or any situation where they are likely to encounter police, it's a good idea to do so.
121	* Most importantly, '' '''NEVER, EVER, EVER, EVER LEAVE A SEVERELY DRUNK PERSON ALONE.''' '' This encompasses all of the above and the points below. Always make sure an adult who is at least ''somewhat'' sober is keeping an eye on anyone who is overwhelmingly drunk until they sober up. In an absolute pinch "buzzed" people are okay for supervising - in that someone who's only had a couple of beers or smoked a little bit of a joint watching someone who is in a far worse state is better than ''nobody'' watching them.
122
123	!! Recognizing alcohol poisoning
124	* Often, the line between "overwhelmingly drunk" and "alcohol poisoning" is hard to tell at first, especially with milder cases of alcohol poisoning (e.g. those that are likely survivable with minimal intervention aside from observation and protecting the person from suffocation due to vomit or positioning), and sometimes even with moderate and severe cases that ''do'' need hospital intervention to keep the person alive. If someone appears overwhelmingly drunk, you should make sure they have ''no more access to alcohol,'' and possibly use a personal breath alcohol testing device if you have one to make sure they are in safe territory, and observe them for any of the [[http://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-poisoning following signs]]- which mean they need to be in a hospital at once.
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126	** Seizures
127	** Irregular or slow breathing (less than eight breaths a minute)
128	** Blue-tinged or pale skin
129	** Low body temperature (hypothermia)
130	** Stupor – when someone’s conscious but unresponsive
131	** Unconsciousness – passing out (without being immediately rousable - someone who passes out but is awakened by your talking to them or poking or shaking them probably just needs to be watched until sober so they don't pass out doing something dangerous to them. Someone who ''doesn't'' wake up needs a hospital immediately.)
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133	The following signs are debatable - they could mean alcohol poisoning, but if someone is ''only'' showing these and not worsening to any of the above, they could be fine with observation and no further alcohol - that said, if someone is showing these and even slightly any of the above, or they are severe, it's also a good idea to call EmergencyServices.
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135	** Confusion - If someone is confused to the level of being absolutely unresponsive, they likely do need a hospital, but if they are talking - even if what they are saying is silly or stupid or weird - they are likely not immediately in danger of dying, or at least capable of being taken to the hospital without a call to EmergencyServices.
136	** Loss of coordination - This can happen with even slightly drunk people (and it's why driving isn't a good idea) but if someone has lost control of even generally involuntary functions or if they have lost bladder or bowel control - they probably need to be in the hospital immediately.
137	** Vomiting - This can happen with people who are not in immediate danger but also with people who are in severe danger. If someone is vomiting, do ''not'' let them fall asleep or go to bed until the vomiting has been over for at least a few hours, do not allow them to consume more alcohol, and watch for the far more threatening symptoms - and if they are vomiting heavily enough to become dehydrated (e.g. they've vomited more than a couple times) they also need to be hospitalized, and if it contains blood (it can be tricky to spot the difference if they've consumed multiple red-colored drinks, but blood is a pretty distinctive shade of red), you need to call an ambulance or drive them to the nearest emergency room RIGHT AWAY. If they are showing no other more threatening symptoms and dehydration is the only worry, it's probably a good idea to risk a bit of vomit in your car to drive them yourself, or call for a taxi to the hospital, rather than call EmergencyServices if law enforcement response is a possibility.
138	*** As another couple of notes on gastrointestinal bleeding and alcohol, if a long-term heavy drinker or alcoholic has prominent abdominal veins (especially in the upper abdomen) they need to be in a hospital '''IMMEDIATELY,''' as this is a symptom of a ''life-threatening'' condition called portal hypertension. If someone (whether a long-term heavy drinker or alcoholic or just someone who had ''way'' too much to drink or has consumed any amount of alcohol rectally) has rectal bleeding or passes bloody feces - they ''also'' need to be immediately hospitalized.
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140	Whether to call EmergencyServices, a private ambulance, or a taxi or drive someone to the hospital yourself/have a sober driver drive them is a very complicated decision. If you have the money or connections for a private ambulance call, it is likely the very best option - medical assistance ensured to arrive solely with no law enforcement response and the person in a safe environment if they do begin experiencing a life-threatening issue. EmergencyServices is best if someone is experiencing life-threatening problems and you ''don't'' have the means for a private ambulance call - and it is ''sometimes'' possible to avoid law enforcement response if you give the person's age as being of legal age and you emphasize that there is no violence or threat of violence. (In addition, many states and universities in the US will ignore underage drinking or possession of alcohol where it's not allowed if it only comes to their attention because an ambulance was called for someone with suspected alcohol poisoning. This is called a medical amnesty policy. It often also covers the use of illegal drugs.) Your/someone else's vehicle or a taxi, however, is the best idea ''if'', and only '' '''if''' '', the person is '' '''not''' '' experiencing any of the life-threatening symptoms (e.g. their breathing is fine and they are not seizing) and the concern is dehydration/sickness/vomiting or similar alone.
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142	!! Withdrawal
143	Long-term drinkers become habituated to the presence of alcohol in their system. Alcohol is a depressant, meaning that it slows nerve function, as can be seen, for example, when its impact on the motor cortex causes clumsiness and slurred speech. To compensate, the body ramps up nerve function, like driving harder with the parking brake on. This is a bad thing, as the brain tends to manage multiple operations that work in opposite directions, maintaining a balance. This results in symptoms and complications, some of which can be very dangerous. If you recognize the symptoms of withdrawal, urgent medical care may be necessary. For example, hallucinations and seizures are serious problems.
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145	* The brain monitors the levels of calcium ions, as they're necessary for both bone health and muscle function. The neurotransmitter of the final synapse is calcium, and their lack leads to muscle cramps (as the signal stops the muscle, rather than starting it). The bones, meanwhile, have osteocytes to build new bone and osteoblasts to destroy the old bone. When blood calcium levels get too low, the brain signals the osteoblasts to ramp up their efforts and release more calcium into the blood. When they get higher, the osteocytes ramp up their efforts, removing calcium. Over the long term, this compromises bone health and can lead to osteoporosis. In the short term, muscle cramps impair function and are a sign of withdrawal.
146	* The brain also monitors blood pH. Whereas oxygen requires hemoglobin to be effectively transported throughout the body, carbon dioxide is sufficiently soluble that it can dissolve in blood serum to be transported to the lungs and expelled. However, when dissolved in water, carbon dioxide combines with water to produce carbonic acid, lowering blood pH. When the brain detects decreasing pH, it recognizes that physical activity has increased, so triggers increased heart rate and breathing. You'll find yourself suddenly gasping for breath with a pounding heart without the associated physical activity. Alternatively, you might find yourself with an artificially depressed rate of both.
147	* The brain also manages body temperature. You'll find yourself cycling through fevers and chills. This includes paroxysmal sweating (sudden, excessive bursts of sweat), as your body desperately responds to an external heat wave that doesn't exist. Consider this the opposite/inversion of the "beer jacket", where alcohol's inhibition of your ability to detect cold means you're comfortable in cold temperatures where you would ordinarily wear a light jacket.
148	* The Delirium Tremens (the [=DTs=]). As a result of multiple systems overclocking, you experience delirium and tremors.
149	** Tremors: Your motor cortex controls your fine motor skills. Because of hyperactivity, you shake and twitch. This can be measured, to a degree, by steepling your fingers. Fingertip to fingertip, the shaking becomes obvious.
150	** Delirium: This is more complex, but you will experience brain fog, or the inability to effectively process and consider things, and more irrational extremes, with periods of lucidity being the common norm. You may experience the inability to follow conversations, tv shows, books, etc. during these periods.
151	* Hallucinations: The brain obviously monitors audio and visual input. In minor cases, amplification of these signals can cause the equivalent of fever dreams in sleeping alcoholics. Your dreams will be unusually intense and strange as your brain turns the most minor of stimuli into extreme signals. In more extreme cases, you can experience vivid audio or visual hallucinations while awake, making it difficult to be certain of what you have genuinely experienced. Alcoholics may become evasive about the past as a result of this uncertainty, being taught by experience that their difficulty with reality leads to them being questioned by friends and family, resulting in difficult situations that highlight their problems.
152	* Outside the brain proper, the nerves of the body as a whole are also effected.
153	** The overclocking of muscular nerves contributes to cramps.
154	** Nociceptors are the nerves responsible for detecting noxious signals, such as pain or nausea.
155	*** As they overfire, you won't experience pain, but an overwhelming sensation of discomfort. You'll find yourself constantly trying to find a comfortable position as your brain struggles to understand exactly why you're miserable.
156	*** You'll also itch. Itching is a minor nociceptor response to a minor irritation. Minor itching all across the body is a common response to withdrawal.
157	*** Random, pointless nausea. Feeling sick to your stomach, barely able to keep down food, or even vomiting can result.
158	* Finally, seizures. As all of us on Website/TVTropes know, [[NinetyPercentOfYourBrain using more of your brain]] is ''a very bad thing''. If your brain overperforms, you can have seizures, possibly life-threatening seizures. If you experience symptoms of a seizure, you should seek help immediately.
159	** Absence seizures, previously known as petit mal seizures are characterized by staring into space or by subtle body movements, such as eye blinking or lip smacking. They usually last for five to 10 seconds but may happen up to hundreds of times per day. These seizures may occur in clusters and cause a brief loss of awareness.
160	** Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms, and legs and may cause you to lose consciousness and fall to the ground.
161	** Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse, fall down or drop your head.
162	** Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face, and arms on both sides of the body.
163	** Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs. There is often no loss of consciousness.
164	** Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. They may last for several minutes.
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166
167	There are countless other neural systems, inside and outside the brain, impacted by alcohol, and whose effects may not be obvious for years to come (such as alcoholic osteoporosis, or alcohol-related Dementia). However, there are other injuries related to alcohol that aren't associated with withdrawal, such as chronic damage to the muscles, which can lead to alcoholic cardiomegaly, as your body tries to sustain cardiac function by growing the heart even as individual heart cells die. Or the alcoholic's ass, as your butt loses definition and sags due to the destruction of the muscle cells that form the glutes, a less serious condition overall, but an indicator of serious health problems elsewhere.
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169	!! Getting help in the long term
170	* [[http://www.aa.org/ Alcoholics Anonymous]] is often considered the best recovery program for those who are alcoholics or severe alcohol abusers. That said, [[http://www.salon.com/2014/03/23/the_pseudo_science_of_alcoholics_anonymous_theres_a_better_way_to_treat_addiction/?utm_content=buffer86760&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer there is major controversy ]] as to whether Alcoholics Anonymous is anywhere near as effective as it claims, or whether it is the best approach. There are also some [[http://orange-papers.org/orange-cult_a0.html#ca_guru_right valid arguments that]] [[https://filtermag.org/deprogramming-from-aa-when-a-fellowship-resembles-a-cult/]] Alcoholics Anonymous could actually be considered a cult, if not a specifically "religious" one. Alcoholics Anonymous is incredibly hard to research because they keep absolutely no records (being anonymous, after all). Researchers believe AA only works for about 5-8% [[https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/]] of patients who try it, which is the same rate as for people who try to quit without assistance. Some research shows that the program actually worsens or causes [[https://www.huffpost.com/entry/problems-with-aa_b_989832]] addiction by convincing people who could learn to drink responsibly again (potentially with the help of medication) that sobriety is the only answer, setting them for failure and leading them to binge or give up if they relapse. The program's origins as a religious program include the use of guilt and shame for those who relapse (The program didn't fail you, you failed the program). There's also the problem of sexual predators using meetings to find victims. Also, the lack of regulations means that certain groups are especially toxic or dangerous. The fact that the meetings are run by people with absolutely no medical or therapeutic training is also worrying. If alcoholism is indeed a disease, it should be treated by doctors - not laypeople.
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172	* [[http://www.smartrecovery.org/ Smart Recovery]] and [[https://rational.org/index.php?id=1 Rational Recovery]] both are alternatives to AA that take a slightly different approach than AA's traditional 12-step recovery with no focus on the idea of a higher power, whatever it may be.
173	* [[http://www.moderation.org/ Moderation Management]] is a harm-reduction approach that allows for continued drinking but strictly controlled. It is at odds with much of the 12-step recovery community (which demands total sobriety - an approach that may actually be more hurtful than helpful in many cases), but that's arguably a positive thing. For many serious drinkers and drug users, harm reduction is the best option
174	* Medications, such as naltrexone [[https://filtermag.org/alcohol-drinking-harm-reduction/]] can also help heavy drinkers reduce their drinking to a safer level. When taken before an event with alcohol (such as a wedding or dinner), naltrexone reduces cravings and makes it easier for former alcoholics to drink responsibly.
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Context UsefulNotes / AlcoholismAndAlcoholAbuse