A common misconception about alcoholism is that if the individual goes to work, they’re not alcoholics. But Dr. Martin Buxton, the chief of psychiatry at Chippenham & Johnston-Willis Hospitals, an affiliate of HCA, begs to differ. “You can still be an alcoholic and get to work,” he says, “but ultimately, it’s going to catch up to you.”

And it will. It always does.

Alcoholism is a progressive illness that affects nearly 18 million Americans and sees more than 3 million new cases each year. And those numbers are rising. Why?

“Theoretically, I think drinking has become more normalized – everything you watch on television and movies, they’re drinking, using, doing something,” Dr. Buxton said. “People are being exposed at a younger age, some substances are more addictive unto themselves – take the opioid epidemic, for example – and for some, it’s simply genetic.”

Besides being an addiction problem, alcoholism is also a cognitive illness. It affects the way people think and interact with the world.

“The bottom line is that people who are struggling with addiction are not very self-observant. If they’re slipping into the difficulty range, oftentimes, they don’t notice it,” said Dr. Buxton, who also serves as the medical director of behavioral health at Tucker Pavilion at HCA’s Chippenham Hospital.

In medicine, nothing is 100 percent, says Dr. Buxton, but there are a lot of tale-tell signs for an individual who is on the slippery slope towards alcoholism. Here, we talk about how much is too much, the warning signs on the road to addiction, and advice that we hope will lead to recovery.

Let’s take it from the top, what is alcoholism?

That’s probably the hardest question of all. There are many definitions to what we call alcoholism, addiction or the “‘isms”. It’s kind of like a diagnosis of mosaic.

In the Diagnostic Symptom Manual, or DSM 5, you have to have a certain number of the symptoms listed in order to fit the diagnosis of an alcoholic. But clinically, alcoholism is when you have somebody who is continuing to drink or, whatever their addictive behavior is, even though it’s causing them hardships and difficulties. Other people define it as a mal-attempt to cope.

Every individual has a definition for what alcoholism is, and generally their definition is exclusionary, e.g. “I’m not an alcoholic because I work”… “I’m not an alcoholic because I don’t drink on Friday’s”… People find ways to see that alcoholism does not apply to themselves.

What’s happening in the brain when someone has an addiction?

There are pathways in our brain called the reward pathways. It’s a Darwinian (Charles Darwin) way of thinking – to keep our species alive. So, things like eating, sex, and sleeping are pleasurable, and you can see why it would be important for survival to enjoy those things. But what happens is, people learn the behavior or substance – alcohol, in this case – that light up those reward pathways to get more pleasure. Eventually, it becomes distorted and then it has a life of its own. Inflation happens and you have to have increasing amounts of the pleasure pathway to get that same feeling. And that’s why it progresses.

How much is too much?

If there’s a family history of addiction, any amount could be high-risk because alcoholism is a highly genetic familial illness. There’s a point of no return and you don’t know when that’s going to be.

It would be erroneous to say that because you have a drink every night, you’re an alcoholic. Families have their own cultures. One time I was interviewing someone and I asked, “Does anyone in your family have a drinking problem?” They said, “No, everybody is normal drinkers.” And I kept going and something drew me back to that, and I said, “What do you mean by ‘normal drinkers’? They said, “We all wake up in the morning and have an eye-opener and go to work.”

So the question is: Did the dwarfs know they were dwarfs before they met Snow White? It’s the same thing. If the family model is: everybody gets drunk on Friday night, then you’re not going to think you have a drinking problem.

Is alcoholism an illness?

Alcoholism is an illness that often travels with other mental health illnesses. Genetically, people who have mood disorders, depression, and are bipolar, particularly, are more apt to suffer from alcoholism.  It has as much as 50-60 percent comorbidity, meaning, if you have one, you’re going to have the other.

According to a Washington Post article, women are drinking far more than they used to; alcohol advertising and pop culture may play a role from wine brands targeting moms, to popular Facebook pages like “Moms Who Need Wine,” to, dare we say, the real Housewives franchise. Why do you think moms may become susceptible to abusing alcohol?

So, “Witching Hour” is 5 o’clock, and for some stay-at-home moms, they are home alone all day, it’s stressful, it’s routine, they’re more isolated – the drink takes the edge off. In recovery we talk about four things that predispose people to relapse and there’s an acronym called H.A.L.T. – Hunger, Anger, Lonely, Tired – and stay-at-home moms, particularly, may find themselves in that position. It’s isolative. It’s all day, all night. There may be resentments that their spouse is not doing their share. But I think a major variable on whether or not it moves on to become a problem are the genetics.

People are more likely to drink if…

…their social set drinks, if their family drinks, if they don’t have other coping mechanisms…

Signs that one might have a drinking problem?

It’s a progressive illness. If you start to notice signs like:

  • One drink doesn’t help as much, so they have to go to two drinks and then they start to develop a tolerance;
  • They’re taking medicine they were told not to take with alcohol;
  • They’re not themselves before they drink, after they drink, and/or coming off;
  • They start to get agitated if they don’t get their drink;
  • They have a change in personality;
  • They’re drinking so much they don’t remember;
  • They’re passing out;

Again, it’s a diagnosis by mosaic. There are a lot of tell-tale signs, but if people in their family have struggled with or died of alcoholism, that will be a strong indicator.

What advice would you give to someone who is living with an alcoholic?

So, now you bring up the other half of the illness, which is what we call co-alcoholism or co-dependency. There’s a personality valve that’s pretty universal for people growing up in alcoholic homes. They become caretakers and fixers; they try to manage and take on things that are not their responsibility; they try to control life. They’re the kind of people that pick the runt of the litter and tries to nurse it back to health. There’s an unconscious notion that their love and care can stop this problem. But the best way to do it is to get out of the way so the cause and effects become clearer to the alcoholic. Don’t call in to work for him/her because they are so hungover they can’t get up. Don’t make up a story at Thanksgiving that he/she was nauseous before you came and that’s why he/she vomited, etc. Often there’s a lot of covering for the alcoholic – the family secret kind of thing – but, it’s best to get out of the way.

What resources are out there for alcoholics who want help?

There are many. One of the greatest systems in the world is free – it’s the 12-step program. They’ll accept anyone who wants to go to meetings. Or, they can talk to their physician about getting help, and be referred to various treatment programs. There are medications that can help, too. What you don’t want to do is have a serious consequence like a divorce, job loss, DUI, advanced pancreatitis, diabetes, etc., before you seek help.

April is Alcohol Awareness Month. Dr. Martin Buxton has served on the medical staff at HCA Virginia’s Chippenham & Johnston-Willis Hospitals since 2004. He has been voted Top Doc by Richmond Magazines Peer Survey every election since 2000.