Why First Responders Are More Prone to Alcohol Abuse

In this episode, we sit down with clinical experts to talk about why alcohol becomes such a common coping tool, especially for first responders. From nervous system overload to environmental triggers and learned patterns, this conversation breaks down what’s really happening beneath the surface.

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Transcript

SPEAKER_02 0:00

In the general population, it's about 10% of the people have a problem. We also know that every single person with a drinking problem directly affects about four other people. You got 150 million Americans who are directly affected by alcoholism. That's over half our population. We start there and then we start talking about first responders.

SPEAKER_00 0:18

In the first responder population, we're looking at one in three. Really, they're cycling fight, flight freeze, fight, flight-freeze, not capable of processing the things that they've been experiencing.

SPEAKER_02 0:29

Everyone, for the most part, wants to say it's a frequency problem and a quantity issue. Yep. And we know that that's not really true. It's a consequence-based disease. It's really about the things that happen when drinking occurs that you can't predict each and every time. Alcohol use isn't black and white. Because you live and work in a world that puts you at risk.

SPEAKER_03 1:26

If you're not familiar with what first responder wellness is, it's a treatment uh center here in Newport Beach dedicated to treating public safety, helping our first responders with post-traumatic stress addiction and all the things that come with being a first responder. Today, my very special guests, Dr. Odom and Dr. Rose, are here to talk to us about alcohol awareness. Right? So uh April is going to be Alcohol Awareness Month, and I thought, what better people to have to sit and talk with us about, you know, alcohol awareness and how it affects our first responder population. So we're just gonna have a little back and forth about what that looks like in hopes to raise some awareness. One, help people maybe with some early identity, uh trying to figure out, you know, um what those early signs might be, and then maybe some tips and tricks on how it is that we can move through this stuff if we see that it's happening. Yeah. So thank you guys very much both for being here. Uh it's always a pleasure to spend time with the two of you. So, first and foremost, why do you think it's so important that we talk about this specific subject when it comes to our first responder population?

SPEAKER_02 2:45

Sure, I'll I'll jump in. Hi, Chris. Great to see you again. Dr. Rose, always great. Um, I think maybe just a little bit of bigger context first. Sure. Um, what we know in the general population is about 10% of the people have a problem. That means about 30 million Americans have that problem. We also know that every single person with a drinking problem uh directly affects about four other people. And so that's another 120 million. So you add those numbers up together, and you got 150 million Americans who are directly affected by alcoholism and addiction every single day of the year. That's over half our population. So we start there and then we start talking about first responders. And there's a lot about first responders that um leads to the potential for alcohol misuse, primarily because it's a cultural phenomenon. Uh in so many ways, you know, they're used to kind of this relentless presence around the clock. They're ready for whatever happens. And in a lot of ways, that just jacks up their sympathetic nervous system. And then when it's time to shut her down at the end of the shift, um, you know, when they're young and and excitable in their career, they work out a lot, they uh go for rides and runs and they hunt and they fish and they have hobbies. But as time goes by, they get tired and it begins to become a little easier to just do something that takes the edge off faster. And because drinking is acceptable, that becomes kind of the go-to, you know, and as we like to say, um, they use alcohol because it's cheap, it's legal, and it works. Um, and so the next thing you know, they're using it as an accidental medication um to take the edge off to not think about the things they don't want to think about. And then when you're dealing with an addictive substance over time, and it's so culturally acceptable, and in many ways it becomes a little necessary, uh, it's the setup for disaster that we start to see in the treatment center every day of the year, too, also.

SPEAKER_05 4:51

Yeah.

SPEAKER_03 4:52

Yeah. And you bring up you bring up something that I also wanted to cover, and maybe we'll talk a little bit about uh alcohol misuse, abuse, and then just straight out dependence, right? Um so when it comes to kind of why these guys are doing it, right? What is it particularly, Rose, that you are seeing as as reasons why? I know Dr. Odom mentioned a little bit about it becomes a medication, but why in specific do we find that first responders turn to alcohol outside of the fact that it's culturally acceptable?

SPEAKER_00 5:25

Yeah, um, as you talked about the sympathetic response, the fight or flight response, especially with um the constant trauma they're exposed to and also the way they've been conditioned probably since they were very young to live in this um hyper arousal state. Um, the job itself, and then as you said, trying to shift off when they get off of work is really hard. And so they use alcohol. Something I tell clients um pretty often as I'm talking about the parasympathetic and the sympathetic nervous system. I I talk about how they are primed and it's functional for them to be in this fight or flight response. And in this fight or flight response, your body is sensing danger. And so you have an excess amount of energy, you have um just like this go, go, go, but you can't function at that state for very long. At some point, you need to come back to rest, which is parasympathetic, or if your body hasn't been patterned to come back to rest, then you move into freeze. In a freeze state, you actually experience your body is sensing life threat. And that makes sense because if I've been in this hyper arousal state, at some point I'm going to run out of energy. If I run out of energy, I'm going to die. And so my body says, I'm going to die. I need to do something about it. And so they freeze. And I will tell clients, I go, What's a really great freezer? Alcohol, right? It's a really great depressant. It's a great way to, um, as we said, it works. It's a great way to fall into that. And so I provide them with a lot of empathy and I'll say, look, like good for you for finding a way to not die. Let me provide you with much more effective and better ways to do that. But I also think it it's very functional because it's common, as you mentioned, in our culture, one in ten people in the general population who meet criteria for substance abuse because uh it's it's it works. Um in the first responder population, we're looking at one in three first responders.

SPEAKER_03 7:24

Wow. So the general population, what we're saying is one out of ten people struggles with some sort of alcohol use, misuse, or abuse. And in the first responder culture, one out of three.

SPEAKER_05 7:36

Correct.

SPEAKER_03 7:37

One out of three. Right. That's a big number. And I think it's interesting when you talk about the sympathetic and this parasympathetic nervous system and what that means, and I think that can get us kind of into this idea of where the misuse begins, right? So tell us just a little bit about for for those people who might be listening and don't know, sympathetic and parasympathetic nervous system, right? Tell us just a little bit about that.

SPEAKER_00 8:05

Parasympathetic is your rest and digest, your feed and breathe. This is where every every part of your body is functioning as it should. We have that homeostasis. This is where only true recovery comes from. And this happens when your body senses safety. It's an automatic response. You can't just tell yourself, hey, I'm safe. And so you go into that response. Instead, your body has to really sense it. And so again, when I'm talking to people about it, I'll ask them, you know, you can be sitting in your with your family, your loved ones, and when was last time you actually felt safe? And they really have a hard time with that because they they don't sense that safety. And so that's parasympathetic, and then you have the two branches of sympathetic, which are the fight or flight, as I mentioned, with sensing danger with an excess amount of energy, and then freeze, which is the depletion of energy in your body sensing uh life threat. It's no longer dangerous. Now I'm I think I'm gonna die.

SPEAKER_03 8:59

Which is where they spend a lot of their time, right? So one of the ways that I differentiate the difference between the two, and please correct me if I'm wrong, sympathetic is like the gas pedal, right? Parasympathetic, like a parachute, right, which is there to slow you down. So they spend a lot of time in that sympathetic nervous system, right? Because it's go, go, go, right? Those tones go off, these things happen, they're out on these calls, whether they're BS calls or they're real calls, they kind of kick into that, into that sympathetic nervous system, right? And so they're they spend a lot of time.

SPEAKER_00 9:33

Really, they're cycling fight, flight, freeze, fight, flight freeze, and not really getting to experience that parasympathetic. And in the parasympathetic is where you have the ability to actually have like processing happen, like brain processing. And so um in the constant fight, flight-freeze, they actually are also not capable of processing the things that they've been experiencing. And so, uh, yeah, and I tell I tell all the clients who come here, I go, I'm willing to bet that you haven't spent much time in parasympathetic because otherwise you probably wouldn't have had to come here.

SPEAKER_02 10:06

Right. Sure. And I think what adds to that, um, you know, what we're talking about is just the job itself. But a lot of people uh walk into their careers preloaded in a lot of ways. And what that what I mean by that is in two different ways. A, they've already been experiencing um heightened um response, you know, sympathetic kinds of responses to things because of how they grew up, because they were always ready for things to happen. And so in many ways, it becomes very normalized. They don't even understand that they live kind of bathed in these stress chemicals all the time. But the second factor is that you know what we truly know about addiction at this point is that it has a huge biological component and a genetic component. And so a lot of folks are running around with kind of the disease in their in their genetic code, right, and they're just kind of waiting for activation. And so not only are they going to get it from the job itself and the fact that it makes you want to self-medicate, relieve yourself, feel better, but they come from families that have it multi-generational. Um, and so in many ways, they're kind of sitting ducks for what's gonna happen. And so I think you add all those factors together, and even the strongest, toughest, bravest souls can't escape addiction when it's dealing with neurotransmitter systems. And so, because of that, um, and then back to the whole cultural acceptance thing, um, they have a real hard time. You know, you mentioned a minute ago misuse, abuse, um, and dependence. It's kind of interesting in the world of treatment uh with first responders, we're fairly careful about how we talk about it. We do not automatically say you are alcohol dependent. Nope. Um, we need to do we need to come to that conclusion together because most people think uh that's a really bad thing for me to be an alcoholic. Those are the people I run calls on. Um, I know what that looks like. They're never coming back from that. Um, or I've seen it in my family. I got a brother, I got a cousin, I got an uncle. I'm not that guy. I'm not that guy. And look at me, I have this job, I I I clean up really well. And so we have to be real careful and kind of walk them down a path that lets them use their intelligence as much as possible to make a rational decision about what the difference between misuse, abuse, and dependence is. And in many ways, that's where a lot of the controversy comes in because everyone, for the most part, wants to say it's a frequency problem and a quantity issue. Yep. And we know that that's not really true. It's a consequence-based disease. And so it's really about the things that happen when drinking occurs that you can't predict each and every time. And if you can't predict each and every time, and the next thing you know, bad things happen. You drink more than you said you were going to, you passed out, you didn't make it to your kid's soccer game, all those kinds of things, those begin to add up over time to spell a drinking problem, as we call it. Um, and so that's a big part of our fight around here is a little bit of the semantics around which one's which. Yeah, we're gonna do that. And the truth of the matter is if drinking causes problems, it is one because it causes problems.

SPEAKER_03 13:16

Exactly right. And that's exactly how I explain it to them, right? I don't sit down and talk with them, I don't get into the to the argument of whether you're alcoholic or not, right? And my my professional and personal opinion, that's a self-diagnosed thing. And how do we get you to diagnose it? Because we can, you can, you guys, right, as clinicians, can look at the symptomology and look at all the consequences and look at all the things and go alcohol use, diagnosis, alcohol abuse, alcohol dependence, like you know, right? But to get the the patient andor the client to buy into that to understand what that means, we've got to start looking at what are the consequences in and around it, right? One of the first questions I'll ask them is would you agree that that which causes a problem is a problem? And most of them can say, Well, yeah, that makes sense. Okay, great. You ever have problems around your drinking? Well, what do you mean? You know, and to your point, I'll start asking questions. Ever had any arguments with families, your wife get mad at you, have you ever passed out? You ever drank more than you intended to? Well, yeah, so you've had a few problems in and around your drinking, right? Yep. Then it's safe to say you have a drinking problem. Now, whether that means you're alcoholic or not, I don't know. We're gonna figure that out. Whether it means you have a dependence, I don't know. We'll figure that out. Is it misuse? Is it abuse? I don't know, we'll figure that out. But can we agree at this point you've got a drinking problem? And most of them are willing to go, okay, yeah, I can see that, right? A lot of them want to throw out right away. It's just misuse. I just misuse it here and there, and here's why. Right. And a lot of what you were talking about has to do with that sympathetic nervous system, right? Which we know when they stay stuck in that, they're not sleeping well. These guys don't get adequate sleep. And so what's one of the first things that they reach for? The alcohol. And to that point, what you guys said is it works really well. And it does until it doesn't. That's right. And so they start in on this idea that it's a great tool. I gotta get to sleep, I got stuff I need to do, I'll have a few. And then back to your point, Dr. Odom, is now we've got to look at are you do you have a genetic predisposition? Right? Ha are you somebody who could potentially be set up for alcohol abuse, misuse, or dependence later down the line, and now you've started just using it to sleep. What are some of the the the disruptions and the misnomers in and around alcohol being such a great sleep medication?

SPEAKER_00 15:47

Uh as you said, like alcohol works until it doesn't. Um, the thing about alcohol is like the way you're processing it and the way the brain processes it, it actually uh makes for really, really poor sleep. And so I'll hear this from clients all the time. Uh I use it to fall asleep, but then I can't stay asleep.

SPEAKER_02 16:06

Stay asleep.

SPEAKER_00 16:07

So I wake up and I drink because that's the only way I get some sleep.

SPEAKER_02 16:12

Yeah, it's it's one of the worst sleep medications you could ever imagine because technically speaking, the half-life of alcohol is very short. And so it takes you down into that relaxed state where you can get to sleep, but then as it begins to wear off within an hour or two, it kind of brings you back up into a withdrawal state, which wakes you up, it excites the neurons, and it's basically saying, feed me Seymour, feed me. Right. And so there's a lot of people who get into the habit of I drink through the night because it helps me get back to sleep again.

SPEAKER_05 16:42

Yeah.

SPEAKER_02 16:42

You know, I wanted to mention one other thing, and maybe we can talk about it a little bit more along the way, is a lot of folks will acknowledge kind of the problem part, yeah. Um, and they'll say, misuse, like you said. And the reason that I think so many people hold on to that is because alcohol use isn't black and white. You know, it's not all bad.

SPEAKER_01 17:02

Right.

SPEAKER_02 17:03

And so when people begin to think about I have to change the way I drink, I have to think about whether it really belongs in my life this way or not. Most people are thinking, I don't want to give up the the fun. I don't want to give up the good part, I don't want to give up the socialization that it allows me to do or the party that I get to go to. Yeah. And I don't want to stick out like a sore thumb. Yeah. Um, a lot of people, especially as their drinking progresses, they get this really interesting um kind of myopic view that whatever it is I'm doing with my drinking, people are watching. People know what I'm doing. And so if I stop drinking, everyone will know. Right. Everyone will care. Um, and so I can't let that happen. It's like that's the last thing anybody really does. And and quite frankly, if if people do notice because they're part of your little inner circle of drinkers, that might be a telltale sign of who you're drinking with. Yeah. Because if they have to say, Come on, man, why aren't you drinking? It's like, there's a thousand reasons why you don't drink. Yep. If nothing else, it's just for my health. Yep. Um, that's the kind of the world we live in now. And so it's it's just interesting. Another thing that's interesting to notice and watch nowadays is that you know, we're we have a lot to say about Generation Z as they come into the workforce. They don't like to drink. Public safety has a lot to say about the fact that sometimes they seem to want a trophy for coming to work on a regular basis and they want to raise every three months, and they like to tell you all about their feelings. But their alcohol use is actually going down. It sure is. It's really interesting. I mean, if you read some of the articles from other angles, there's big issues in the bourbon industry right now. Like they can't sell all their bourbon anymore. Um these kids don't want it. Yeah, like they've shut down distilleries and things like that, um, which is a really interesting way of looking at things. Um, that doesn't mean that other things haven't maybe increased a little bit, right? Uh, because we tend to always seek altered states. Um, but I think specifically in public safety, I have a feeling we're going in a little bit different and maybe healthier direction in a lot of ways as time goes by. Um so I'm I stay mostly concerned about the folks who've been in for five and ten and fifteen and twenty years, right? Because they've kind of created that habit of this is how I do my life and this is what works for me, and this is part of being a firefighter or being a law enforcement officer. And I can't see changing it because then I won't fit, I won't belong, um, I won't feel the same. And so when I already have all these adrenaline dumps all the time, I don't trust people, I don't like all the kind of things I used to in a lot of ways, which is really more around potential PTSD and things like that. And my go-to is my alcohol, I've kind of tied my own hands. It's like I don't really have any good solutions. The only solution I have is actually making things worse. Yeah. So then I'm I've got a real conundrum to try to solve this on my own, which is oftentimes why people end up crashing, quote unquote, um, and end up in in first responder wellness because they couldn't figure out how to get out of their own box because inside the box was them and their drinking. Yeah.

SPEAKER_00 20:07

You bring up an interesting point about the younger generation coming through too. They do have better awareness of their mental health, they do have, you know, better communication about their emotions. And so we're also finding that younger and younger people coming into treatment seeking help sooner because they have that better awareness. But what is also a challenge is um having the like being young, being 24 years old and saying I have an alcohol problem and I'm supposed to stop drinking. I'm only 24. Right for the rest of my life.

SPEAKER_03 20:41

Rest of my life, yeah. Yeah, that's a big thing. Um, you know, you bring up an interesting, a couple of interesting points, right? And I want to talk a little bit more about them, but one is being this idea that everybody is watching what you're doing and cares if you're drinking, right? And it goes back to the fact that those that those that matter don't care, right? And those that care don't matter. If it comes down to your drinking and your choosing not to drink, anybody in your life who cares about you would support that 100%, right? 100%. And whether you had a problem or you didn't have a problem, right? If you said to somebody, you know what, I'm just not drinking anymore, and they're gonna challenge that in a way to encourage you to drink, those aren't the people that you want to be around anyway, because they really don't care about your overall well-being. There is nothing that proves that alcohol is good for you, that it does anything, right? I talk to these men and women all the time, and I say, you know, I've been doing this for a long time. You know what I've never heard? My life has never been better. My finances never been better, my relationships have never been better. I've never been a better employee. Overall, health and wellness and my emotional balance has never been better. You know what I started doing? Drinking. Started drinking and my life just got tremendously better. I've never heard that story. It's the exact opposite, right? Everything falls apart. And we know that because by the time they make it to us, the consequences are there, right? The inability to manage their drinking is out the window. So we look at it in this lens, and you brought up something else that I want to talk a little bit about, and that's this withdrawal, right? I think there's a misnomer in and around what withdrawal actually is and when it occurs, right? So when does that when does withdrawal actually occur? The moment that you consume alcohol, right? When we see when we think about withdrawal, I think most people think severe tremors and I can't drink and all the DT. All of that, right? But let's talk a little bit about what withdrawal actually is. And it's certainly when it comes to when I'm using it as a sleep medication. So when talk to us a little bit about when that the body actually starts to withdraw from alcohol and what that looks like.

SPEAKER_02 22:58

Well, like I mentioned a little while ago, I think it's about the half-life of ethanol and the fact that most folks metabolize about an ounce an hour and so of ethanol, right? Not of the water content. And so as I begin drinking, it begins withdrawing almost immediately. Immediately. And so over the course of four or five hours of me drinking seven or eight drinks, um, it's gonna take me another four to twelve hours for all that to come out of my system. But from peak levels, it comes down pretty fast. And if I'm trying to medicate, even though that's not what I'm calling it, I'm just trying to stay asleep, um, my neurotransmitter systems will start to agitate because they're not filling the gaps with the the right kind of neurotransmitters because I was putting it in artificially through my drinking. Yep. And so it will wake me up, it will make me want to have another drink, and I just think, I just want to take the edge off again. Um, and so it's kind of a subjective feeling of I want another drink, but biologically and chemically speaking, it's because I don't have enough neurotransmitter flowing the right way, because I've been using that artificial kind, and the next thing you know, I'm I'm I'm drinking through the night, or I just continuously drink to keep the edge off.

SPEAKER_03 24:17

And I think that's a really important thing for people to understand, right? That message to your brain that says, Hey, I want another drink, is a state of withdrawal, right? The brain is such an efficient, efficient machine, and you can speak more to this, right? That the minute that the alcohol enters the body, the brain goes, Hey, you know what? That's really effective for bringing me down. The brain doesn't want to work to produce the chemicals needed, or it's gotten the message that regardless of how many times I produce this cortisol and all of these stay-down chemicals, right? You keep doing what you're doing and raising me back up. So you you take this exogenous stuff in, right? The alcohol, and the brain goes, Wow, this works and it works really well. Remember that. And now what happens is you drink it, you calm down, you go to sleep, and the brain says, Hey, I don't want to reproduce all these chemicals. It's in the refrigerator, dummy. Get up and go get another one. So you get up, you go get another one, and so on and so forth. And then now we've entered a pattern of misuse, right? Through some withdrawal that most people don't even recognize as actual withdrawal. Because everybody thinks you gotta be shaken and bacon to be in a state of withdrawal, and that's just not true. The brain is in withdrawal the minute, right? The other thing I think is really important is the toxicity of alcohol that a lot of people don't understand, right? So if you were to ingest right cocaine, if you were to smoke some marijuana and you were to drink some alcohol, out of those three, right, and you guys know the answer to this, but I'll ask you anyway, which one does the which one does the body start to to get rid of first? The alcohol, right? Because it's so toxic. It prioritizes. It takes a look at that and it goes, hey, out of all of this stuff, right? And this is the other, I think, misnomer or or piece of information that people have out there is that it's you know it's not that bad. And especially in the way that they're advertising this stuff these days, it's a healthier version, it's lighter, it's ultralight, it's whatever this garbage is that they're telling us that it is. But people don't realize it's it's poison to the brain and the body. And the body and the brain have to work tremendously hard to get it out, and then it becomes addictive early, early on before people even know it.

SPEAKER_00 26:43

There, um, you know, we're talking a lot about people as they're coming in and they're struggling with their substance. I also think it's worth noting as people are leaving treatment and how the brain is really patterned to still want it. It's very it's really common when clients come here, they go, Look, I'm good. I only need, you know, two weeks, I need 30 days, I just need a little bit of time. And I feel really good. I haven't had any craving since I got here. I'm solid. And then I talk to them about how their brain remembers, um, talking about this patterned behavior. And so um I I will give them the example of you know that chair, that chair that you sit in, the place that you usually spend time in. We'll use the example of a basement, right? Every time you walk down the stairs, you go to the basement, you sit there, you drink, and you do that again and again and again. Eventually, your brain starts to know, oh, we're going to the basement. I know what's gonna happen here. And so it adjusts it adjusts its chemical levels to prepare for that intake. And so when you drink, then it goes, I didn't get that same feeling that I normally do when I drink this amount. It's because your brain has adjusted and prepared for it. And so you have to drink a little bit more to get a little bit more of that buzz. And that continues on and on and on and on. This is why we often hear about people who overdose or or overuse in other places, in hotel rooms or outside of here, because their brain didn't recognize the place, couldn't adjust for the levels, they intake the same amount that they were used to at home, and then their body just wasn't prepared for it. But I tell them, look, when you go home, your brain's going to try and kill you. Your brain's going to say, Hey, I remember this place. I know how we feel here, I know what we do here. And so as much as they go, this I've never had any cravings here. Of course, you've never drank here. But when you go home, uh, your brain's gonna go, Oh, I know what this feels like. And it starts to adjust the chemical levels preparing for the intake, and you're supposed to try and ignore that feeling. It is so much harder going home than they think.

SPEAKER_02 28:43

Yeah, I I I think and just to add on to that just a little bit, when we when we think about um addiction and how powerful it can be, um, oftentimes we tend to be relating that to prescription medications and street drugs. And um when we talk about those, we talk about everyone has a using ritual. Yeah and the fact that you kind of do things the same way over and over again, and there's a bit of a high in doing it the same way, and many people forget that the using ritual for drinking is just as powerful, or even more so. Um, and so to your point, uh Dr. Rose, I think you know, you don't realize it when you're in treatment because all your rituals are interrupted. You're not at that chair, you're not walking home, you're not going by the liquor store, you're not picking up the same thing, you're not walking into the into the kitchen, taking the same glass out of the same cabinet, putting the same tinkling ice into the glass, or popping the can. Yep. Every one of those things is part of ritual. And when the ritual begins, you go on auto autopilot. Yeah. And we have so many people who say, I didn't even realize I was drinking until I drank. Yeah. Because I I walked down that line of ritual behaviors that I didn't interrupt.

SPEAKER_05 30:03

Yeah.

SPEAKER_02 30:04

Um, which is one of the reasons why in our treatment program we try to be very mindful of that. Yes. It's part of why we do the transitional living the way that we do, because we actually want these guys to experience those feelings. That's why they go shopping in the grocery store and they walk down the liquor aisle and they probably get activated or triggered so that we can keep working on them with that so they're prepared for it when they get home. Um, and those are even the guys who just say I misuse, and the guys who say I might abuse it a little or from time to time. Because the whole point is addiction isn't just a physiologic dependence. That's kind of what we've been talking about. It's also a psychological dependence.

SPEAKER_01 30:40

Hugely.

SPEAKER_02 30:41

Where you know what, it's part of my life, it's part of my psyche, it's how I do things, um, it's part of my habituated rituals. And I really have to interrupt all those kinds of things to get me to the next place. We also find a lot of people who get to the other side who say, I can't believe I ever thought I needed that stuff or that I even wanted that stuff because I really don't like the way it made me feel in the end. And now here I am, and I I've reinserted healthier rituals, things I do that are good for me, and I don't have to feel like that anymore. And I don't have to explain myself to myself or to anyone in my life. So there is another side to it, but you have to kind of be very conscious of what you're doing to get there.

SPEAKER_03 31:19

It's and it's so powerful, right? And I can tell you that early one of my first attempts at getting sober, I ended up in a relapse because I went to the same liquor store that I'd gone to a hundred times, right? And then there's that golden wall behind the the register, right? Oh all the alcohols. But there's this one little thing in a lot of liquor stores, right? It's this little fishbowl that sits right next to the register and it has all these little airplane shooters in it. And I would go to this liquor store and I would buy a pack of cigarettes, and I'd always get one or two of these little dollar ninety-nine cent shooters, whatever the shooter of the week was, right? And I remember, to your point, I dri I went in to get a pack of cigarettes, and that was my only intent, and I didn't think anything else about it. And on my way out, I had already drank two of those airplane shots before I even realized what happened. I had experienced one of the worst cravings that I had ever had, and it didn't even dawn on me what happened. It was just habitual. Got the cigarettes, I got the shooters, I walked out, I cropped the tops, and I threw them in the garbage can and I'm walking to the silver living, and I just let oh my god, what did I do? And it started, you know, it started that. So it's hugely psychological, right? There's that piece. It's a stress-related disorder. And we know that when stress goes up, the cravings go up. And one of the things that we do here, right, is we really minimize that stress. And so for them to go back home, stress. There's so much stress. You know, we get we get a lot of relapse in and around family programs, right? We get we get the the potential for relapse and we they experience relapse sometimes the first time that they go back home. So we do try to introduce them to as much of this, but they don't see how low the stress levels are in a in a such a supportive environment. I think that's where they forget how psychological and physiological this whole thing is, right? So I think we got a pretty good idea, right, of what misuse is. Anything else that you would like to add in and around misuse? Because I I want to help people understand where they might be when it comes to misuse and how they slip into abuse.

SPEAKER_02 33:35

Sure. I I think you know, back to what we talked about a little while ago with the whole genetic component. Um, I get a lot of questions from a lot of people who say, I've got kids, um, we've got it running in our family. Um does that mean I have to tell my kids they can never drink? Um, does that mean that you know if they ever touch a drop, we're gonna be in trouble? Right. And I don't think that's necessarily true. I think you know it's a percentages game, but what it what it really means is that if we know we have it running in our family, we have to exercise a lot of control. And so when we start drinking and we hear that everybody just drinks till they pass out, that's not a game we can play. So when I think about things like misuse, misuse for me is any time I can't predict exactly what I said I was gonna do. And if I've got it running in my family, I'm a person who should never think about having more than two. Right. It just has to be the way it is. And if I feel like I really want or need more than two, that's a cautionary tale for me to start paying attention to. That's where the misuse starts, you know. And we will all say, Oh yeah, but I was young and I remember that time I did that thing. It's like, that's true. And then how many of those that things did you do? And over the course of time it gradually builds up. Yeah, so when I say misuse, that just means to me, that's just using a word that sounds innocent to describe alcohol abuse behavior, you know. And again, in some ways we play along with that because we want to be partners with people, we don't want to put people off to say we think this about you, but you have to make your own decisions about wow, does it keep getting in the way of decisions? Does it keep getting in the way of behavior that I don't really like about myself? And if that's true, then it's really not misused, and it probably wasn't in the first place. You know, there's a lot of simple ways to talk about this, you know. We there's simple little um evaluations you can do, like the cage questionnaire. Yeah, you know, have you ever decided to cut it down? Um, has anybody ever been angry or aggro about your drinking?

SPEAKER_03 35:42

About your drinking.

SPEAKER_02 35:43

Have you ever felt guilty about anything you've ever done? And have you ever had to have one first thing in the morning or first thing when you get up to kind of make yourself feel better? And it's not that you have to have all four, it's one is a big sign, two is absolutely three and four are just like icing on the cake. And so it can be that simple in a lot of ways. And I also think that anybody who really wonders if they have a drinking problem.

SPEAKER_03 36:08

You got a drinking problem. Normal people don't ever consider the fact that they they have a drinking problem.

SPEAKER_02 36:15

I've never wondered if I had a tomato juice problem.

SPEAKER_03 36:18

Right. Yeah. No, and and there's a lot that goes to it. And I want to just go back really quickly because I think that's a really good tool, and certainly for people who might be listening. So can you go over that cage assessment again? And can you explain? Well, I'll explain to people what it is. It's kind of a self-assessment, right? And he's gonna give you a series of questions that you can ask yourself that might determine whether or not you have some sort of a drinking problem.

SPEAKER_02 36:42

That's kind of a down and dirty thing that was developed in hospitals, you know, for folks on medical floors. And the idea is have you ever tried to cut down or control your drinking? Well, I'm not gonna drink that much. So the acronym is CAGE. CAGE, C-A-G-E. The second is anger. Has anybody ever been angry with you about your drinking? Why do you drink like that? You told me you weren't gonna drink so much last night. And you did it again. Yep. You know, why did you say that stupid thing that you said? Why did you keep talking to her? You told me you weren't gonna talk to her anymore. Why did you bring up politics again? Yeah, you name it. Um guilty is did you ever have that moment of clarity when you thought, oh God, what did I do? I didn't really like myself for that, what I said or what I didn't say, all that kind of stuff. And then the whole concept of an eye opener, which is just first thing in the morning that I do something, you might just call it the hair of the dog. Yep. Um, but the fact of the matter is it's really not normal to wake up and drink. Yep. But there's a lot of people who do it. Yep. And so any of those, again, one is one is a really strong sign, two is like, yeah, we got a problem here. And again, three and four, like that's just kind of proving that it's absolutely true.

SPEAKER_03 37:47

Beautiful. Right? And that's something that anybody out there can do. Doesn't necessarily mean that you're going to assess those that you love, right? So don't do that. It's called a self-assessment, right? I do other assessments, right? And it goes by the acronym of CADE. Have you ever tried to cut back? Has anybody ever been angry because of your drinking? Has there ever been guilt guilt in and around your drinking? And you ever had an eye opener? Have you ever had to you know drink to get over a hangover? Right, doesn't necessarily mean that you drink first thing in the morning, but hair of the dog. Have you ever had to drink to feel better? Right? One, kind of alarming, two, even more alarming, but you don't have to have all of them, right?

SPEAKER_02 38:28

To to my blood various mimosas and screwdrivers were invented.

SPEAKER_03 38:34

There you go. Right. So that really kind of gives us this idea of misuse and a nice way of really kind of looking into you know that abuse factor, right? Because I think a lot of people, and to your point, Dr. Odom, it's an easier, softer way to use misuse than abuse, because a lot of people just won't buy into the fact that they're abusing alcohol. Um, but I think more times than not, and especially if we know the statistics say that one out of three of our first responders is struggling with alcohol in some way, there's a lot of people that are abusing it or misusing it, right? Um, and for good reason, right? We understand that. Maybe there's a genetic predisposition, and you and you couple that with some of the stress-related stuff that you're dealing with at work. Maybe you've just, you know, you you tried to use it to sleep or self-medicate, and now or you're treating your own PTSD.

SPEAKER_02 39:29

Yep. Because it works until it doesn't. We've been saying that all along.

SPEAKER_03 39:32

And so let's take a look at that. And I think dependence is pretty easily recognized for most people, right? Dependence says you have to have it, you know, you've built a tolerance, you're now drinking more than you, you know, started off drinking.

SPEAKER_02 39:47

Well, I will say um what we've noticed here over many, many years now is that it doesn't exactly look the same, depending on what kind of public safety professional you are. Typically, law enforcement officers show a typical pattern of intoxication and withdrawal. You know, they often drink some at night or in the morning when they get off. Um, and then when they wind up coming into treatment, they go into withdrawal generally within you know six to twelve hours. Pretty normal. Firefighters are tricky. Firefighters are tricky because of the way they work their shifts, because they work 24s or 48s or they get mando to 72 or longer, and they get into a binge drinking pattern so that they can go several days of not drinking at all, and then on their off days, they drink for three or four days in a row. And so oftentimes when they come into treatment, they show zero withdrawal symptoms for 48 hours, maybe up to 72, and then suddenly, boom, it hits them hard, and that's when their withdrawal shows. So a lot of firefighters can kind of trick themselves into thinking, see, I don't have withdrawal symptoms because my body is so used to the way alcohol is in it and out of it that it never really looks like I have a problem with it because I don't feel the withdrawal because my body, you know, is is ready for it.

SPEAKER_03 41:04

And this goes back to some of the denial in and around what you talked about early on, which was frequency and duration, right? And and amount, like, oh, I don't I don't, you know, I don't drink that often. And these guys will tell you, I'm not an alcoholic, man. I have to work, I have to go through shifts, and I work three, four, sometimes five days in a row. I don't touch a drop when I'm at work. So I can't be alcoholic, I can't have a problem because I don't have the I don't drink every day. Right, and that's what you hear. I don't drink every day, right? And it's like, to your point, you don't have to drink every day.

SPEAKER_00 41:36

But when you drink, how much are you drinking?

SPEAKER_03 41:39

Because you're trying to make up for all those days that you missed, right? So you're drinking a ton, and to your point, uh, which is really interesting, is that your body and your brain have now locked into this period of, oh, it's okay, it's normal for us not to have alcohol for three, four, maybe even five days. Right. So we don't have to go into withdrawal. He's gonna give us what we need, or she's gonna give us what we need. Here in four or five days, we're gonna be good. We always wait for the fifth day. We're gonna go the fifth on the fifth, right? Uh, but it's really interesting and it really shows how powerful what we're dealing with is, right? Right, is that it's so you know, Alcoholics Anonymous describes it perfectly cunning, baffling, and powerful. How cunning it lays in the cut, it waits because that you have set it up for this pattern of three to four, sometimes five days without drinking, and then on that fifth or sixth day, you're gonna give it everything that it needs for the next three days or four days, however long you're off, and then you're gonna stop, and then it doesn't go and prove that you're okay, right? But your body goes, Okay, good, we got what we needed. Your brain says, All right, we're good for another three or four days, and then they'll go back to work, they'll shift, they they process it pretty good, and they don't.

SPEAKER_02 42:57

Watch what happens when they're mandatory on day six. Now you're angry.

SPEAKER_03 43:01

Day seven.

SPEAKER_02 43:02

Now you're irritable, now you're discontent.

SPEAKER_03 43:05

Just because of now you're withdrawing. And listen, it's all a combination. Sure, it's all of it. And it's probably a very bad combination at that point because to their point, they haven't slept well.

SPEAKER_01 43:15

Right.

SPEAKER_03 43:16

They are working a long time now, but now they're also going into your body has an expectation. They're also that body's going into this expectation that hey, you're supposed to give me my alcohol. We had a deal.

unknown 43:27

Right.

SPEAKER_03 43:27

My expectant trans neurotransmitters are really pissed at me. And listen, I don't know that many people understand that. Right? And now you can see why you might couple that with some, you know, a healthy dose of PTSD and you know, uh, the wrong call, the wrong person says the wrong thing, and you're flying off the handle. You're flying off your handle at the at the coworkers, you're angry, you're irritable, you're discontent. Your your disease has disease.

SPEAKER_05 43:59

You don't

SPEAKER_03 44:00

Feel well, and it's withdrawal, and we don't re and and we don't even realize it.

SPEAKER_05 44:04

Right.

SPEAKER_02 44:05

So I think I want to say one more thing, and that's you know, given that this is Alcohol Awareness Month, um, and we've been talking a lot about kind of the warning signs and the trouble and all those kinds of things. There are still a lot of people out there who can drink, yeah, socially, sure, whatever that means, you know. And in the world of alcoholism, we say a social drinker is the one who says if you'll have a drink, so shall I. Yeah. That's a social drinker.

SPEAKER_01 44:27

Yeah.

SPEAKER_02 44:28

Um, but the fact of the matter is, um, people in public safety are at risk because of sympathetic nervous system, because of adrenaline dumps and cortisol dumps and noradrenaline dumps. And in many ways, when you use alcohol, you're potentially you think you're pouring water on it, but you're really pouring gasoline on your fire. And so I think the real trick is to learn to have coping skills that don't involve ethanol as the coping skill. That doesn't mean you're not going to have a drink every now and then, doesn't mean you don't want to have your whiskey or your bourbon or your beer or whatever that is. But I think we all need to pay attention to am I using this as medicine? Right. Um, am I using it when I could be doing other things that really bring me into parasympathetic nervous system? So we're not being, you know, teetotaler um for sure packages and all those kinds of things. No. We're just saying be really careful about this because you live and work in a world that puts you at risk, like I said before. And I think the last thing I want to say about it is that in many ways, um, it's really difficult for first responders to acknowledge alcohol problems and addiction problems because they see it every single day in their jobs, but they see the nasty side. It looks sad, they see the traffic collisions and they see the overdoses and they see the domestic violence and they see the crime. Yeah, and they see all that and think, well, I'm not like that. And so I kind of give myself a hall pass because I'm doing good good work here and I'm just trying to relax a little bit. But ultimately, it's all the same thing, you know, because uh you are dealing with something that actually is getting control over your brain. And from all the first responders I know, we they like to believe they're in control.

SPEAKER_03 46:11

Constantly.

SPEAKER_02 46:12

And if I have this chemical that's controlling me and I don't even realize it so subtly, then it's almost always too late before I recognize what I needed to do, which was to never really go there in the first place.

SPEAKER_03 46:24

Yeah, and you bring up a great point because the whole idea here is to raise awareness, right? To put information out there that has you questioning your relationship with alcohol if you have one, right? And to your point, if you have a genetic predisposition, you're vulnerable. Now, if you're in the public safety world, you're even more vulnerable, right? And so that's what we really want to look at. We want to give you the tools to say, it's not to say that you maybe you are the person that can have a bourbon or two or whatever it is. Maybe you are the person that goes out to a restaurant and pays $16 for a glass of wine and leaves half of it at the table, which I never understood. Being a you know a recovered alcoholic, I still don't understand that. It's like, what? Who does that? But to your point, it's what is your relationship with alcohol, right? Are you using it to treat some of these symptoms? And to your to your point again, this is just a vulnerable population given what it is that they deal with it and how they deal with stuff on a constant basis. So I think we let's talk a little bit about, you know, again, there's a lot of misnomers in and around what alcohol will do for you, right? What benefits are there? Or, right? Should we look at well, what benefits are there to somebody drinking who has mental health challenges? See that those are the benefits right there.

SPEAKER_02 47:47

That was a loaded question, yeah.

SPEAKER_03 47:49

Speaking of alcohol unloaded, right? Because I think a lot of times you'll hear people say, well, there's benefits to it.

SPEAKER_02 47:56

Well, you know, there there were studies over the years about red wine and your heart. Sure. But all that's kind of come, it's been unraveled. And they're saying that's not really true. It's the grape juice. Yeah.

SPEAKER_03 48:08

Just drink grape juice.

SPEAKER_02 48:09

Yeah, it's the fermentation that kind of gets in the way. Um, and so we I think you can always justify and explain whatever it is that you want to justify and explain. I think in many ways, we should all be at a place in our lives where we're saying, what's healthy for me? You know, and what's healthy for the people I care about. Because, you know, another interesting way of looking at alcohol problems is that not only is it potentially a problem for you, but it could also just be that it's a problem for the people who care about you. Like you may be fine with your drinking, but your spouse and your kids aren't very happy about it. Right. And if you don't want to have an unhappy spouse and kids, it might be something worth looking at. And if you say, well, that's just their problem, well, then you've kind of set things up for problems. Um, so it kind of has to be something that you're willing to look at from every angle and make healthy decisions because in the end, you know, tough career, honorable career, great career. We like folks getting out of the career at a relatively young age and having a chapter two or three, whatever that means. And if you're gonna have something like alcohol in the middle of it, I can guarantee that it will be shortened. It will not last as long, and it will not be exactly the one that you want it.

SPEAKER_00 49:23

Something that I commonly will tell clients when they they are really adamant, I'm not done drinking, I can do this, you know, I I can, I have in history had only just one drink and that's fine. I I really encourage them to look at why. Like when you go to pick up that drink, ask yourself like, what is the motivation for that drink? If it's because you're stressed, it's because you're uncomfortable, if it's because you're feeling a little awkward, like that's not the reason why. You mentioned um, do I tell my kids if there, if I know there's a genetic history, do I tell my kids never to drink? In my family, uh, there is a history of addiction. And my dad, as teenagers, he would say, know your limit and never go past it. He was really big on that. And clients will ask constantly, how do I talk to my children? How do I tell them what I'm doing here? What and I I tell them, be honest with them. And so as we're building awareness, you know, building awareness to your families as well and saying, This is what I'm doing here. And I remember um one time just having like a I don't know, it's early 20s, having a really hard day at work, came home, drank a beer, and went, why? Right. That same hearing in the back of my head, my dad going, like, know your limit, never go past it. But then also this question of like, but why did you feel the need to drink that? And knowing that I have this history of addiction because my parents are very open about that, then going, This is not, this is not the reason. I remember I drank like half of it, and then I was like, I'm just gonna, somebody else can have this or I'm gonna throw it out or whatever, just because, like, what was the purpose of that drink?

SPEAKER_02 50:58

Yeah. Yeah. I think one more thing about kids. Um, you know, there's a couple of real important studies out there that say everything else being equal, including predisposition, family history, all that. People who kids who start um using addictive substances under age 15, so 14 or under, are five times more likely to become alcoholic or addict than kids who wait until they're 16 years old. Interesting. It's just a huge difference. So my little anecdote is we've got a lot of kids, and I've been talking about this our whole lives. It runs in our family for sure. We went on a vacation, and my older daughter was um she had turned 18 and we were out of the country. She asked if they could have drinks, and we said, Absolutely, you can have a drink. Just be careful and do it in front of us. And so she had some sweet, stupid Mai Thai or something like that. And all of a sudden, my three little boys come running up, and one of them's crying. And he says, My sister's drinking, my sister's drinking. And um, I said, Okay, but it's like she's breaking the law. I said, Well, we're in another country, it's not exactly breaking the law. And he said, But you also said that if you start drinking too young, like it doesn't, your your brain's not grouped done until you're 25 years old, and and she doesn't even have the best spring to begin with. So my family has always been very aware of what drinking looks like. Um, and I was actually very pleased with that moment because somebody had been listening. So he says, I'm waiting until I'm at least 25 to drink. Good. I don't think he did. I think he did when he was 21, but it's okay.

SPEAKER_03 52:32

I think that's a huge thing, right? Because we get a lot of that here. They want to know how how do I talk to my kids about and I'm I'm the same stance. Just talk to them. You're learning about it. For sure. Tell them what you're learning, raise an awareness, educate them. The other thing that I like to tell them because they get so stuck in the idea of what their relationship with alcohol has done to the family and how much damage and all that. I said, well, you also get to pass on your recovery, by the way. That goes just as far as the damage that you potentially did with your addiction. So know that, right? So we've talked about alcohol misuse, we talked about alcohol abuse, we've we've brought these ideas to the table to ask people to just look at your relationship with alcohol. Why? Pause for a moment. One of the things that I like to do is you know, a lot of people say, I don't have an alcohol problem. You know, there's a lot of people here that have the alcohol problem. I don't have that. I said, okay, great. I'm here, you know, just for mental health. Okay. And again, I tell them the story of, you know, I've never heard A, B, and C, right? And I've never heard the great benefits of drinking. I said, so take it off the table for a month. Take it off the table for two months. Take it off the table for three months. If at some point you feel that there's a need to invite it back into your life, set some rules around it. And can you follow the rules? One of the things that I learned early on when it comes to misuse and abuse and potentially dependence is how many contracts are you breaking with yourself?

SPEAKER_02 54:00

Right.

SPEAKER_03 54:01

How many times have you said, not today? How many times have you said, and you can't predict, right? You should be able to predict. Um I'll have a beer with my tacos, and it should be it. Not two beers, three beers, and then pick up a six-pack on the way home. And hey, nothing happened. That's not the point. You broke the contract that you had with yourself. So, what's your relationship? If you're gonna invite it back into your life, set some rules around it. And I always go back to that same thing. If you're a person who's asking questions, if you're having to set rules around your drinking, there's a real good chance that you have a drinking problem, right? So I think we've talked a lot about that, right? What would you say to somebody who might be thinking about, like, hey, you know what? Some of the stuff that you guys have talked about really applies to me. What's the next step? What do you think somebody should do if they're they're going, hey, you know what? I think I might have a drinking problem. Maybe they don't need treatment just yet.

SPEAKER_02 54:58

Well, I think you already said it. Um set yourself up with a contract, you know, and see if I can stick with this 30-day plan and say how I feel at the end of 30 days. Yeah. You know, um, there is that program called Alcoholics Anonymous. It's for fun and for free. It's all over the place. They have two kinds of meetings. They have closed meetings, which means you have a drinking problem. They have open meetings, which means I'm just kind of here to check it out, see what's happening. Um, it's not a bad, not a bad thing to do. There are hundreds of them everywhere all the time. You can find one far away from home if you're worried about who's gonna see you there. But you always need to remember that whoever you see there, they're there too. Right. So um, I think that's true. And I think sometimes even I've seen a lot of people go do a couple counseling sessions. You know, a lot of folks in public safety have good employee assistance programs. Um, you've got your counseling covered, and it might be worth going in and just having some conversations about kind of this is where I'm at in my life. I want to make sure I'm making good choices. Um, I heard some things that made me think, and I'd like to talk with someone about it.

SPEAKER_00 55:57

I also will add, you you don't have to wait until you need detox. You don't have to wait until it's so severe to seek even to seek treatment. You know, there we have lower levels of care for a reason. You may not have to be here for you know an extended stay because you waited so long. I think a lot of times people think that I need to be so severe to start seeking treatment. And I really wish people would seek treatment much sooner. Come in at a lower level of care, come in for less time and get that really high intensity care and just like knock it out much quicker.

SPEAKER_02 56:33

Yeah, it's like with other medical diagnoses. The sooner you seek care, the better the outcome.

SPEAKER_00 56:39

And look, if people don't know when that is, our admissions team is really great at being like, hey, this is what I recommend. This is the level of care you're appropriate for.

SPEAKER_03 56:47

Yeah. And I love that idea. You know what? Just seek some counseling, just go talk to somebody who doesn't have a horse in the race, right? And be honest with that person, what your relationship is with alcohol, what the stress levels are like in your life, right? I think that's a huge factor for why people drink. Uh, and learning how to manage stress without, you know, inviting the drink. If you have people in your life who are not drinking beside you, maybe just ask them, hey, what do you think about my relationship with alcohol? Have you ever noticed anything? Right. And just question some things in and around what your relationship is. And I think that's really the big question. You know, what is your relationship with alcohol? Can you can you put it away, right? I mean, there was a was it sober October for a long time. People were doing that just to, you know, to see if they could do it, which I think is great, but just challenge yourself and in those moments, right? Keep a running um journal about how you're feeling, what the difference is between when you don't have those weekend beers or or barbecue beers or whatever you might have, you know, those those few you know bourbons after work or whatever. Just just see. Just see. And it's just about awareness. And if you're having some problems, I think uh again, we're always here, right? So any last words for you guys? Anything that you would like to say?

SPEAKER_00 58:12

Thanks for talking to us. Of course.

SPEAKER_03 58:14

Yeah, it's been a blast. No, and I think we're gonna do it, we'll we'll do it, we'll do it again. I think there's you know, having the two of you here uh with the vast amount of knowledge that you have is incredible, and I think it does a great job in prevent uh you know preventing and and getting people information that that they will need and that they can use later on. So it's always a pleasure to see the two of you. So thank you, ladies and gentlemen. Don't let the stigmas keep you sick and stay resilient.

SPEAKER_01 58:43

Stay resilient.