By Mike McMahan, LPC
Kudos to ABC News anchor Elizabeth Vargas for speaking openly about alcoholism. It is a very difficult disease to cope with affects millions of people. A special will air tomorrow night, Friday September 8, 2016, but excerpts are already making the rounds. In addition, Vargas will publish a memoir, Between Breaths: A Memoir of Panic and Addiction, next week.
In the clip available in the E! Online story above, Vargas discusses the challenges that anxiety posed in her life and how she initially drank socially to deal with it. This is not an uncommon reason for people to start drinking. In fact, drug and alcohol use are a complicating factor when it comes to diagnosing things like anxiety; as a clinician, you have to ask yourself “are these symptoms due to substance use?” This is especially complicated in trying to figure out what, if anything, underlies the substance use. It can very easily become the classic “chicken or egg?” dilemma. Did the client start using to cope with something (anxiety, depression) or is the substance use creating the symptoms? For example, as alcoholism progresses, people can begin having withdrawal effects when they aren’t drinking. So if they come to you for help, how can you, as the therapist, be sure that the anxiety they are feeling at that moment isn’t due to not having a drink? This is why many times, clinicians recommend that a person get sober before looking at other issues. However, this in and of itself poses obvious challenges, as becoming sober is no easy task for people with long-standing drug or alcohol addictions.
The most striking element of the clip above was, to me, the moments when Vargas talked about her anxiety during the opening of the ABC Nightly News during her anchor spot. As she points out, she is gripping the table with fear, something that would not have been noticeable had she not called attention to it, but is painfully obvious once she points it out.
Vargas seemed to be in a place where total sobriety was the only solution. However, for substance users who have not reached the level of problems she described, there may be an alternative approach. I have had success with people who likely don’t meet the clinical criteria for full-blown alcoholism, and whose goal is to reduce drinking before it becomes a problem. This approach, part of Solution Focused Brief Therapy, involves a gradual reduction in alcohol usage. The client may say that they are drinking “3 or 4 beers a night” and want to “have a couple of beers on the weekend with friends.” This is an achievable goal, though is quite likely unrealistic for someone who is drinking 18 beers a night and blacking out. The treatment involves writing down the number of beers consumed each night, and gradually reducing the consumption. For example, a goal for one week might be to drink one less beer a night. Another week it might be to only drink on three nights. This client will hopefully learn coping skills on the nights with reduced or no drinking, and apply these skills to achieving their goal. These new skills can be highlighted and reinforced by the therapist during weekly sessions. I do want to say that I don’t recommend this approach without the assistance of a mental health professional or a doctor. While this is a rough outline of the approach, it is not intended as an instruction manual and any sort of alcohol or substance use (or the cessation of) can potentially be dangerous.
It's great that Elizabeth Vargas has made such a great turnaround. I hope she continues her success, as the fight against alcoholism and efforts to stay sober can be a daily challenge.
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.
Therapy Goes POP
Perspectives on therapy and mental health as viewed through the lens of popular culture