Gray Area Drinking: You Don't Have to Hit Rock Bottom to Have a Drinking Problem

Alcohol use disorder vs. gray area drinking — what's the difference, and how do you know when your drinking has become a problem?

In this episode, licensed clinical social worker and national mental health expert Kelley Kitley breaks down the real signs of alcohol use disorder (AUD), explains what "gray area drinking" actually means, and answers the question so many people are afraid to ask: am I an alcoholic?

Kelley draws on both her clinical expertise and her own personal recovery journey to help you understand:

✔ The DSM criteria for alcohol use disorder
✔ What gray area drinking looks like — and why it's so easy to miss
✔ Why drinking every night is NOT normal, and what it does to your body
✔ How to talk to a loved one about their drinking without pushing them away
✔ The difference between supporting someone and enabling them
✔ Treatment options: therapy, intensive outpatient programs (IOP), 30-day inpatient, and medical detox
✔ What medications like Naltrexone do for alcohol cravings
✔ Why relapse doesn't mean failure — and when recovery finally "clicks"

Whether you're questioning your own drinking, worried about someone you love, or just trying to understand alcohol addiction recovery, this conversation is for you.

0:00 — Introduction
1:26 — What Is Alcohol Use Disorder (AUD)?
3:05 — Gray Area Drinking: Are You in the Gray Zone?
4:11 — Is It Normal to Drink Every Night?
5:55 — How Alcohol Destroys Your Sleep
7:30 — "I Don't Have an Off Switch" — Kelley's Personal Story
9:44 — Why Trying to Moderate Drinking Rarely Works
11:24 — What Happens When You Quit Drinking
13:23 — How Alcohol Affects Your Kids & Genetic Risk
15:56 — The Moment Kelley Decided to Get Sober
18:29 — How to Talk to a Loved One About Their Drinking
21:56 — Setting Boundaries vs. Enabling
25:15 — How to Encourage Someone to Seek Treatment
30:03 — Treatment Options: Therapy, IOP & Inpatient Rehab
34:14 — What Medical Detox Actually Involves
37:49 — Why Relapse Is Not a Failure
41:15 — Naltrexone & Medications for Alcohol Use Disorder
43:32 — Where to Find Help & Resources

Kelley Kitley is a licensed clinical social worker, national mental health expert, and person in long-term recovery. She specializes in breaking cycles of trauma and addiction using a holistic approach.

#AlcoholUseDisorder #GrayAreaDrinking #AddictionRecovery

Find the right treatment for you at Recovery.com
https://www.recovery.com

Transcript

SPEAKER_02 0:00

It's important to have some self-reflection around what are motivators for picking up that drink.

SPEAKER_01 0:06

National mental health expert Kelly Kitley, a licensed clinical social worker with more than 20 years of experience, shares her holistic approach to breaking cycles of trauma and addiction.

SPEAKER_02 0:16

If you are recognizing that you're setting an intention before you drink and you're not able to stay on that path of stopping after one or two, you may want to seek some more exploration with that.

SPEAKER_01 0:36

So navigating the spectrum of alcohol use can feel like trying to read a map in the fog. On the one end, you've got the clinical diagnosis of alcohol use disorder. On the other, you've got casual social drinking. And in between is gray area drinking. And we're going to be talking about that space where a lot of people live, work, and silently wonder if they've crossed a line. We are joined again by Kelly Kitley. Thank you for joining us. So good to be here. And I'm so grateful to have your perspective as both a clinician and as someone with lived experience with an alcohol use disorder, because it just is such a whole perspective that it really helps to bring that to this discussion. I mentioned two terms in the open alcohol use disorder and gray area drinking. And I'd love to start with you just defining both, please.

SPEAKER_02 1:26

Sure. So alcohol use disorder is a diagnosis in the diagnostic and statistical manual of mental health disorders that we use. And really, it is a list of qualifiers, so to speak, that goes into the area of drinking more or longer than intended, trying to cut down, but being unable to, having cravings or urges, being unable to stop on your own, increased dependence, and having kind of a checklist of saying, can I identify with any two of these over the last 12 months? And then in the gray area drinking, that is more not a specific diagnosis, but it's more culturally looked at as maybe I'm higher functioning, I'm not having a whole lot of negative consequences in terms of losing my job or it impacting my family, but I'm recognizing I'm drinking and it's not making me feel good or I'm regretting things that I did or said. And so it's really important to look at alcohol use as a whole health perspective along the spectrum.

SPEAKER_01 2:39

Does the lack of those really high losses, those high consequences, you know, I've never lost my job, I've never gotten a DUI, I'm still married, I'm still functioning in a relationship, so I can't be. Does the lack of those negative consequences allow some people to stay in an addiction without understanding that's where they are? Absolutely.

SPEAKER_02 3:07

I think it gives us a benchmark of saying, well, I'm not that bad or I'm not as bad as. And so sometimes we do need some consequences to make behavior changes. And that can be an internal motivator sometimes if we're having some shame around some of those consequences. But oftentimes people we have our blinders on, and sometimes it's helpful for a family member or a friend to shine light on maybe things that they're noticing with our drinking habits.

SPEAKER_01 3:43

And it's significant to note that the list you just read doesn't have lost your job, trashed your car. You know, it's it's very different criteria for diagnosis.

SPEAKER_02 3:53

It is, and and it has changed over the years, um, especially we're in the the fifth manual now. Removing labels sometimes for people can be very helpful, but it's also important to be realistic and honest about how you're drinking.

SPEAKER_01 4:11

So to that end, here's one of the top questions asked on the internet from people who are looking this up, this topic, and it is is it normal to drink every night?

SPEAKER_02 4:21

No, it is not normal to drink every night. Um, and it depends on how much you're drinking as well. Um, the medical guidelines say that one drink a night for women and two drinks a night for men is considered moderate drinking. One. One.

SPEAKER_01 4:37

That's interesting. So when when somebody asks that question, they're looking for the line. Where's the line? How do I know if it's just like I just have a nightcap? This is how I unwind. It was a really stressful day. The kids finally went to bed, whatever it might be. I've got to have a drink or I need to, you know, whatever, whatever the inner dialogue is.

SPEAKER_02 4:57

It's important to have some self-reflection around what are motivators for picking up that drink. And some people aren't particularly honest with themselves in terms of why they want to drink and can they substitute it with something else? Oftentimes alcohol just becomes so habitual and kind of a knee-jerk reaction. And oftentimes we need to pause and maybe make a different decision.

SPEAKER_01 5:23

So you were emphatic with your know there that daily consumption is not, in fact, normal or healthy. What does daily alcoholic consumption do to our bodies and mine?

SPEAKER_02 5:35

It can cause many cancers. It can cause liver damage. It can, it has been noted to be uh linked to breast cancer, colorectal cancer, hypertension, increased blood pressure, cognitive decline, memory loss. And that's not an exhaustive list.

SPEAKER_01 5:55

What about sleep? If you think I'm just gonna have a drink at the end of the night, at the end of the day, to help it helps me sleep. I remember thinking that it helps me sleep.

SPEAKER_02 6:05

So typically that is something that people associate alcohol with too. It makes them relax, it might make them sleep better. And that may be true initially, but once the sugar wears off and you know, alcohol is a depressant as well, it is not, it becomes interrupted sleep. And so we are not, we're interrupting our sleep pattern when we incorporate alcohol into our nightly ritual or any ritual, not just nightly.

SPEAKER_01 6:33

Yeah, right. In part one, we asked, why can't I stop at one when other people seem to be able to? Another of the most searched questions is how? How do I stop after I've had one or two when that's my intention?

SPEAKER_02 6:49

If you are recognizing that you're setting an intention before you drink and you're not able to stay on that path of stopping after one or two, that's diagnostic information that there may be something more problematic going on. And you may want to consult with a trained professional and seek some more exploration with that.

SPEAKER_01 7:11

It's like the off switch just sort of disappears once you start.

SPEAKER_02 7:16

That is oftentimes what many people with a diagnosis of alcohol use disorder describe. And is that something you hear often in your clinical work? I hear it often in my clinical work and I relate to that as well. Tell me about that.

SPEAKER_01 7:31

What was your experience?

SPEAKER_02 7:33

Alcohol use was something that I could engage in or not. It but it was a very specific choice. So whether I I never wanted to give it up completely, to be totally honest. I was trying to find different ways to manage and control it. If I took off for 30 days, that would be a great cleanse for me. And then I would be able to pick up and have one or two drinks and I would be a regular drinker again. But that was never the case. And it took me many times to experience that, to recognize that I couldn't manage it or I couldn't have one or two drinks, that once I decided to start drinking, I continued to drink and didn't have an off switch.

SPEAKER_01 8:14

So if someone has been in recovery and sober for X amount of time, having one can lead to that again. Absolutely.

SPEAKER_02 8:27

There is a saying that we go back to exactly where we started once we stop drinking. And so we are, we don't become normal drinkers, so to speak, once we've abstained for a certain amount of time, which is why I use the language as well of we are not recovered. We are in recovery.

SPEAKER_01 8:48

And for people who aren't, that can be uh a little confusing because when you hear someone say, I've been in recovery for 40 years, and you think, why are you still, why are you still talking about it? Why do you still consider yourself an alcoholic? Clearly, you're not anymore. Yeah. That's not the case.

SPEAKER_02 9:03

Oh my gosh, I love this. I was just having a conversation with somebody about this, that one person, uh, my mother actually describes herself as being recovered, that alcohol no longer controls her life. She doesn't think about it, um, but she wouldn't pick up again. Where the language my brother and I use is that we are in recovery, that it's an active practice of making sure that we are spiritually aligned and that we're taking care of our mental health. We may not have a desire to drink, but the goal is to not get to a place where everything feels so out of control and overwhelming that that would drive me to want to drink. How can someone test if they are capable of moderate drinking? Anybody who has a desire to change their relationship with alcohol can put a goal in place and look at how they can try to reduce the amount that they're drinking and also do some personal inventory about what they're noticing, about how they feel before they drink or after they drink, or if they're having increased cravings. So that physical component as well as the um intellectual component to that.

SPEAKER_01 10:16

I know for myself, I tried that a whole bunch of times. The just was the number of drinks, the just was the number of days a week, all of the machinations to see. And eventually I'd get back to where I was in the beginning, which is why I realized, like, oh, I just have to stop. Is that a common experience?

SPEAKER_02 10:37

It is so common because there's a progression. And so we may be able to postpone, but alcohol is a substance that is highly addictive. And it is important that if we try that and we are not able to do it, that we engage in a higher level of care where we have more support services so that we don't have to try to manage and control our drinking anymore.

SPEAKER_01 11:07

We will get to some of the uh support organizations and also some of the treatment options for alcohol use disorder. But before that, what are the benefits? What benefits did you experience and do you see others experience from quitting drinking?

SPEAKER_02 11:24

Oh my gosh, there are so many benefits to quitting drinking: increased clarity, better sleep, more consistent mood, overall health, being able to have closer relationships that I am accountable to and for, and being able to stay true to my word, um, remembering things. My whole health has changed in terms of being consistent. I have never been more consistent in my life than I have in the last 13 years of not drinking alcohol.

SPEAKER_01 11:57

You brought up being true to your word. Let's talk about what's involved in keeping your dirty little secret and how much lying goes on.

SPEAKER_02 12:07

That is uh, I would say, character defect that a lot of people engage in when they're trying to hide their drinking. And it can feel so freeing to not have to play the game of charades to try to hide. And I want to make sure that people recognize that the link of shame and continuing to do a behavior is very linked. And even though shame can sometimes be a motivator, if somebody is feeling so badly about themselves, the alcohol is a quick escape. So when somebody is practicing a life of recovery, being able to show up and say you're gonna do something and follow through, where sometimes alcohol clouds those promises. And for me, having good intentions and making a promise either when I was drinking or before I started drinking, but then canceling plans or not being consistent with my kids the day after because I felt so horrible.

SPEAKER_01 13:10

You brought up your kids. Let's talk about this if you're willing to. What have they seen from mom when she drank to mom in recovery? And how has that impacted your relationship and your authenticity really with them?

SPEAKER_02 13:23

Well, my kids were six, four, two, and nine months old when I stopped drinking. And I like to say they they paused my progression because I was pregnant for nine months each time and didn't drink. But that's really where my drinking escalated. I had postpartum anxiety and depression, and I used alcohol to self-medicate and cope. So I was drinking wine every day at home. And the progression from binge drinking to regular drinking happened pretty quickly for me. And I come from a family line of addiction, which I mentioned. So I knew that I was at high risk. Um, but I was just trying to manage and control a chaotic household being primary income earner and having small children. And we had just moved to a new city. Gratefully, they have very few memories. There are our oldest two have one or two memories of things that, you know, I felt horrible about bringing a baby monitor with me to the neighbors after I had put them to bed so I could drink on the porch with the neighbors, um, which was a regular occurrence in our community. Um, so they will say to me sometimes, even in their teen years, well, at least you don't leave us at home anymore. I mean, they're old enough now, but it's kind of, you know, they celebrate my sober anniversary with me. They're all teenagers now, so they're in this experimental phase of being curious about alcohol and educated them at a very young age, the risks involved in drinking alcohol. And look, I am not anti-alcohol across the board for people who can drink regularly without problematic behavior. Um, the good news is they know where to come if they recognize that they may have a problem at some point. And it's not my job to police them in that arena, but I will keep a watchful eye because I do have concerns about their high risk.

SPEAKER_01 15:24

Well, the risk, right? You you have ancestors who who had unhealthy relationships with alcohol, and now your children have that plus yours. They have another generation of it. So what is the increase in risk if family members also had sub alcohol use disorder? It's hard not to say alcoholism because that's what I was raised saying.

SPEAKER_02 15:44

Sure. Yeah, absolutely, me as well. I mean, one of four of them will likely develop some kind of addictive behavior. What made you quit? My kids. I grew up in an alcoholic household, and I promised myself that I would never repeat the same patterns. And I vividly remember this picture in my home um making dinner, and I was pouring a glass of wine, and I thought this has got to stop at some point. I didn't stop then, I stopped a couple months later. A best friend of mine had gotten sober um a couple months before me and took me to my first women's alcoholics anonymous meeting. And that was a game changer for me.

SPEAKER_01 16:32

And what clicked what clicked inside of you that allowed you, after decades of drinking, to say, I'm done.

SPEAKER_02 16:42

Well, I still didn't say I was done. I just said I'll go to the meeting with you.

SPEAKER_00 16:47

Okay.

SPEAKER_02 16:48

But like we were talking in the beginning of the first part of this conversation, and you shared some thoughts you had had over the years. It sounded familiar. So when I was in a room of other women who were some similar in age with me, some other moms who were saying the same thoughts I was having, that was the game changer because I thought that I was so I felt so alone and thought I was alone in those thoughts. And when I went to that meeting that night, I felt like I was at home.

SPEAKER_01 17:20

So that's the community, because it's we whether it's depression or an addiction, it isolates us. And the behavior, it seems social, but it can isolate us as well. How did it matter? How how did it matter to you to hear other people say, yeah, I can't stop either?

SPEAKER_02 17:37

Well, as a newcomer, it's so nice to see somebody else who has gone to the weddings, who is in a relationship with a partner who still drinks, just not problematically, um, who have had some of the self-hatred and self-loathing around their own drinking. So it was hopeful to see these women on the other side. And so whether it's Alcoholics Anonymous or a sober, curious support group or any other kind of community, that's really where the change comes from, is connecting with other people who have been to a similar place or are going through a similar situation.

SPEAKER_01 18:21

And that might be the missing piece from when we were earlier discussing when you order a book that says, like, how do I moderate my drinking? You're still trying to do it alone.

SPEAKER_02 18:30

Absolutely. We can read and read all the books and listen to all the podcasts. And those are so helpful and those are absolutely tools. But the human connection, whether it's virtual or in person, I have seen over and over again that being the switch, so to speak, that helps people to abstain.

SPEAKER_01 18:56

So we've been talking about ourselves and our process of, you know, to at least be curious and then to take some steps. How do we support a friend or family member? And this is a question from the internet. How can we support a friend or family member who we believe has a problem with alcohol?

SPEAKER_02 19:15

It's really important to take a non-judgmental approach and to also have the conversation with the person we're concerned about when they are not under the influence. So sometimes tensions can rise when the behavior is happening and people say things that they regret or feel like they the other person isn't receiving their concern with clarity. So take a gentle approach. And sometimes words that can be helpful to say is, hey, I've noticed that you have been drinking more lately, and I'm wondering how you're doing. And so you keep an open dialogue and an open-ended question rather than anything that is accusatory. And it may take several conversations, but certainly there are other resources available, perhaps if somebody is combative and doesn't recognize after multiple attempts that somebody may bring an interventionist in at that point.

SPEAKER_01 20:15

So that the way you asked that question would make the person on the other side hopefully feel less defensive and less judged. Yes. I still probably would have said, I'm fine, it's fine. Everybody does, or you just don't, or you're not fun, or whatever. You're right. You're so so where do you go from there?

SPEAKER_02 20:39

You have to detach with love because oftentimes people who are involved, I'm gonna say addicts life or somebody who's actively using can get so enmeshed in that relationship and almost take it on as their own. So it's important to say, this is what I'm gonna say. I don't know how it's gonna be received in your own mind. Right. And then be able to walk away and say, I did what I could do to help that person. And now I'm going to get support for myself in being in this relationship. And that can come from other 12-step meetings for family members. Al Anon is a really um great resource as well as Alatine for T family members who have a parent or f family member who is either actively using or in recovery.

SPEAKER_01 21:30

What do you see as the number one mistake that people make when trying to have a discussion with someone they care about about their drinking?

SPEAKER_02 21:39

Pointing the finger and saying you and blame because that automatically puts somebody on the defensive.

SPEAKER_01 21:48

How do we set healthy boundaries for ourselves when we're in a relationship with someone who is drinking and we believe it's problematic? And we know it is.

SPEAKER_02 21:57

And maybe you live with them. That's r it's really hard. Set boundaries when you live with somebody who is actively using, but there can be small boundaries that you put in place, such as I don't want alcohol in the bedroom at night, if that is something that the person is engaging in, or I will not drive with you when we leave a restaurant if you have been drinking and that person can take an Uber then. So there are other ways to focus on taking care of yourself rather than trying to change the behavior of the other person. So putting limits in place that you feel comfortable with for yourself is so important.

SPEAKER_01 22:36

Which leads right into the next internet question. Where's the line between supporting somebody who is drinking in your life and enabling them?

SPEAKER_02 22:47

Support is wonderful. And the way that that can look is driving somebody to treatment or talking with them if they're struggling or having a difficult time. It becomes blurred lines when somebody tries to rescue the addict or alcoholic and tries to make excuses for them or minimizes the behavior for other family members or doesn't require them to pay rent if they're living at home and spending that amount of money on alcohol instead. That can sometimes be a boundary that's crossed, especially in a parent-child relationship. So it's really important to focus on what do I feel okay with? And that is a boundary I can set with taking care of myself. And what is that person that I'm trying to support need without taking over and trying to manage and control their life for them?

SPEAKER_01 23:46

And what would some of those, what are some examples of what enabling would look like? It's calling in and saying he's sick.

SPEAKER_02 23:53

So let's say this especially comes up with husband and wife and parents and children that the husband would make excuses for his wife as to why she couldn't come to the family party that weekend or why she missed her their child's graduation. You know, they were sick, they weren't feeling up for it, they were throwing up this morning. A lot of that is excuse making that is allowing the person to continue their behaviors without any consequences. So a lot of times it's a cover-up for the person that they love for the behaviors that they are engaging in. That could also be job loss and not holding the partner accountable to look for another job because maybe they're engaged so much in their drinking instead of job searching.

SPEAKER_01 24:48

And is that trying to spare yourself as the enabler? You don't want to say, don't want to say, right? My partner was drunk and couldn't come to graduate. Your dad couldn't come, your mom couldn't come to graduation because they've been drinking. Like who it seems like it can be trying to protect them and your family's reputation. You are absolutely right.

SPEAKER_02 25:09

Protect them and protect me so I'm not embarrassed by you. That makes it even more likely it will happen. Yes, absolutely. Which is why it's important to get support around that, because oftentimes people interpret boundaries as being mean. And it is really the opposite of that. It is, I'm taking care of myself so I don't resent you later.

SPEAKER_01 25:32

And how keeping those boundaries and not enabling, do you encourage treatment of some kind?

SPEAKER_02 25:42

You can offer to help somebody look for treatment, whether that's finding a therapist or attending a doctor's appointment with them and waiting in the waiting room. Sometimes it's just the first step that is the hardest. So offering to provide support there. You can also, if somebody's in treatment, you can ask them open-ended questions about how it's going for them. Um, you can also celebrate small wins that they might report or celebrate sober anniversaries. Those are great ways to be supportive to a partner or a friend.

SPEAKER_01 26:15

Let's talk about what resources are available for people struggling with alcohol addiction.

SPEAKER_02 26:21

There are 12-step programs as we uh have talked about. Alcoholics Anonymous has been around the longest and has a wide uh reputation that a lot of people who are even unfamiliar with uh alcohol use disorder know about Alcoholics Anonymous. It's been portrayed in movies. Um, it's free. It there are meetings every hour of every day in every city that are online or um in person in your own community as well. Um, and that can that is obviously group support. Um, a family physician can be another great treatment if somebody's needing a higher level of care and needing a referral for inpatient treatment or um intensive outpatient treatment. So typically, if somebody is needing a higher level of care for detox and medical assistance with withdrawal symptoms due to their dependence, um, they may go to a 30-day treatment facility. Um, and then stepping down from there, they may go to an intensive outpatient program that typically meets um for three hours a day, several days a week. And that can be without overwhelming people, because it is a really can be a really overwhelming process, um, can also be an alternative to inpatient treatment if somebody's not having um a physical dependence on alcohol, but one hour a day or uh one hour a week of a meeting isn't enough, they're getting a lot more upfront in terms of support.

SPEAKER_01 27:57

I'm gonna dive into treatment more next, but I want to stay with the programs and the resources. So you mentioned a virtual 12-step, virtual AA. Is that an easier entry point for some people? Because you're not risking looking across the room and being like, oh no, you know I'm here, but we have to remember they're here too. I don't know why people forget that part. But is is the virtual a little easier entry point?

SPEAKER_02 28:23

You know, since COVID, it has really opened the doors for people who were more hesitant to go into in-person meetings because you can turn your camera off. You can just listen and be an observer in a meeting if you're not uh feeling comfortable enough to share. And so it is a lot easier for people, I've noticed, just in the last six years since um COVID to get to meetings. Is it still effective?

SPEAKER_01 28:50

Absolutely. So, what about people who are looking for a non-faith-based option? How do you find that in your own community?

SPEAKER_02 29:00

So that is really important. And I don't know if people know this, but Alcoholics Anonymous does have a non-faith-based meeting. They're um alcoholics agnostics, never heard, which was something that I had learned along the way. Um, but other programs that are not faith, faith-based, especially going along the lines of virtual. She Recovers is a program of women. It was started by a mother and daughter in Canada who are both in recovery. And they were able to launch an online support group for women all over the world that log on and connect over similar issues such as eating disorders and trauma and are also women who are in recovery from substances.

SPEAKER_01 29:52

So we've been talking about resources. Now let's shift to treatment, which you mentioned a little before. What are the treatment options available for somebody with an alcohol addiction or alcohol use disorder?

SPEAKER_02 30:03

Well, if you're working with me, no matter what you're coming for treatment for, I always ask about alcohol use because that is important in terms of how somebody's mental health is, first and foremost. But if they are on this journey with a therapist, having a conversation maybe that they have brought up about, yeah, I had this one incident that I don't remember driving home, or I got in a fight with a coworker at a happy hour. For the therapist to get inquisitive about that and ask more questions. And really, I think having somebody do an alcohol use timeline can be really helpful. What age were you when you had your first drink? When did you notice any kind of progression? Did you experiment with any other substances? And sometimes clients will recognize the progression on their own because they're reporting it back. Or people will say, nobody's ever asked me about my alcohol use before. So it can start with just a very casual conversation, similarly as I would ask somebody about their exercise routine or their sleep hygiene. This is no different. And I think depending on how open that person is to look at their patterns will determine maybe what next level they're willing to go to in terms of treatment.

SPEAKER_01 31:29

So the progression. So I come to a therapist if I'm able to have access to one, and we go through the timeline and we both maybe come to the realization like, you might, you might want to take this to the next level. What's the next level?

SPEAKER_02 31:43

So sometimes I will suggest that somebody attend a 12-step meeting for an added support. So now you're having therapy and you're having community support. If that still seems to be, you know, somebody's drinking in between that time and they're unable to abstain on their own, they I would refer them to an intensive outpatient program that can be, again, virtual or in person, where um it's more of a small group setting and it's run by a trained professional. It's not peer support like Alcoholics Anonymous.

SPEAKER_01 32:20

And if I'm in an IOP, which is what they're frequently called, what what's gonna happen? What can I expect? Because this is all scary. This is all scary. Like I don't even want to acknowledge I have a problem. Now you're telling me I need some treatment for this problem. What's that gonna feel like?

SPEAKER_02 32:36

Well, it is really scary. And like you said, people walk in and they're like, what if I see somebody that I know and they're there for the same reason? So, you know, it is this safe space, so to speak, to share share experience, your experience with your alcohol use, as well as psychoeducation. A lot of people don't have the understanding of the risks of alcohol use. And they will also look at different patterns in relationships or different things that they are learning new coping mechanisms or how to go places without alcohol, using alcohol in a very alcohol-saturated community. So it's really using a cognitive behavioral therapy approach is typical for treatment and being able to change the way that you think, which will then help you change your behaviors, which ultimately will then uh help you feel different. And usually that's better.

SPEAKER_01 33:38

And other than an IOP, what are some of the available treatments?

SPEAKER_02 33:42

So 30-day inpatient treatments, those tend to be where somebody would maybe take a leave of absence from work. Um, and they don't need to report that to their employer as to why. They can take a medical leave and do go somewhere for 30 days where they're focused on treatment eight hours a day and they're living in community and they're um responsible for working together to maintain the household and also unpacking some other things outside of alcohol. So, yes, as we talked about before, it's about the sobriety piece, but this is really when you start stepping into the recovery piece too, looking at triggers as to maybe why somebody was drinking. And um, some of it is just sharing some of the despair that somebody may have felt while they were drinking as well. And a lot of the shame and we say in the program, telling on yourself. Because a lot of times, as you mentioned earlier, people are stuck in in secret keeping and that just keeps us more isolated. You got it.

SPEAKER_01 34:50

Yep. So I want to ask more questions about that because if you if the thought of that, right, it's like, whoa, 30 days. First of all, 30 days of not drinking, but 30 days of having to talk about it, you know, 30 days of like, boom, it is in your face. What about you haven't done it and I haven't done it. So, but you know about it. So, what what can someone expect if they're listening to this and they're like, well, that's what's been recommended for me? Or I'm at the point where I think maybe I need that, or I think maybe my partner or my child needs that. Yeah. What's it gonna be like?

SPEAKER_02 35:24

So, you know, I've worked in 30-day facilities and it is a lot, it's intense, um, but it is a very structured environment, which is a lot of the treatment of what people need when they're eliminating alcohol. And I do wanna make sure that people recognize people have a right to choose what they believe and want for their own treatment. So there are options as we're laying out, but certainly in my experience, people are going to 30-day treatment programs after they've exhausted all of the other um options. So it tends to be either somebody is chronically using alcohol and may need detox and then inpatient programming, or they've tried individual therapy, they're going to meetings, they've done intensive outpatient, and now um they need uh more support.

SPEAKER_01 36:19

Let's talk about medical detox. When would someone need that? And how does that factor in in the levels of care?

SPEAKER_02 36:28

That is a very high level of care for somebody. And um sometimes people will say to a partner who is drinking a lot, can't you just stop drinking? Don't pick up. But there is a physical dependence to that. And there are other drugs to help somebody come off of the alcohol, but it is so important to have medical supervision during that because people can die from alcohol withdrawal, which can cause seizures. So the medical detox has to be under the supervision of a doctor. And somebody would need medical detox if they're drinking during the day and into the night and have built up this dependence to alcohol and they are having tremors and they are not able to function without the alcohol because the alc their body has become so accustomed to functioning with alcohol that it can't function without it.

SPEAKER_01 37:28

How do you explain how someone can go into a treatment program for an alcohol use disorder and return to use? Go into a treatment program, maybe return to use. And this can happen any number of times. And then at some point they don't return to use, that it it works, it clicks, it takes. And you hear it all the time. And it's amazing to me. So what's different? What happens? How do you explain that?

SPEAKER_02 37:55

I do believe that it's all part of the process. Some people will say relapse is part of the process. Going to multiple treatment facilities is part of the process. For some people, we don't know what necessarily needs to internally click for somebody to quote unquote get it, but it could be outside circumstances. Maybe they've lost everything. It could be internal motivation, that they're feeling so emotionally and spiritually bankrupt that they feel motivated to get it right this time. Maybe it's one thing somebody said to them that clicked and made them believe that this was the right option for them. So I wish there were uh a manual as to, you know, why this happens or doesn't happen sometimes. Um, but it again, it's an individual process.

SPEAKER_01 38:47

And the belief that we can have if is say I go to a 30-day program, a 60 to 90-day program, and I return to use. I have failed and or treatment failed. Treatment doesn't work. It doesn't work for me. I tried.

SPEAKER_02 39:02

There is not a one size fits all for treatment. Maybe that treatment didn't work for you. Maybe that model didn't work for you, which is why there are increasingly more options because it isn't a one size fits all. And so what might work for me might not work for you or somebody else. I think there are multiple pathways to get to a place of recovery.

SPEAKER_01 39:29

And when someone goes to a program and returns to use and goes back to that same place, and this time, it it does take. Yeah. And the program seems to be the same, right? So it's not like, oh, that program didn't work, that place didn't work. Are you just at a different place? You know, it's that the same man can't step in the same river twice because he's not the same man and it's not the same river. Are you just in a different place? And now you are able to, for whatever reason, take that in.

SPEAKER_02 39:56

I do believe that because there are so many people who will say, I'm trying and I'm just not getting it and feeling frustrated. And they hear from other people who have been in their shoes that it took eight times and I think, or six times, or whatever it might be. It is an internal shift that happens. And I don't know how to explain it other than the universe or divine intervention or, you know, not getting religious, but more so of a surrendering of the power of I can't do this alone. I need to find something bigger than myself to help me in this journey.

SPEAKER_01 40:32

So let's look at that same situation from the outside, because from people who've never been in treatment or have never had an alcohol use disorder, you just like you're just wasting my money. It's so easy to be critical. It's so easy to be judgmental and to think, what is wrong with you? You went to treatment and you're still drinking.

SPEAKER_02 40:51

That's why it is extremely important to uh get educated about the disease, uh, in my opinion, of alcohol use disorder and how cunning, baffling, and powerful it can be. Some people end up getting divorced because of this, because it's been over and over and they don't see hope or light at the end of the tunnel. It has to be a personal decision. Some people uh unfortunately, I hate to say this because I'm an eternal optimist and hopeful, but some people don't recover or choose recovery.

SPEAKER_01 41:29

What about medications, FDA-approved medications that help with cravings?

SPEAKER_02 41:34

Naltrexone is one that many of my clients have used over the years, and it will be something that they either take pretty regularly, like an antidepressant, um, or something that they choose to take before an event that they think might be triggering for them, or they're having a physical craving and it will cut that craving off. And you find those effective in your I do. And and you know, there is uh a stigma attached to that, certainly in in the community, depending on who you ask. Um, some people even self-report that they feel like they've failed because they took another drug. They're not really sober. Yes. And that's the same that I don't want to open up a whole other canvas. Um, but yes, sometimes they will they have heard other people say it, or they will think this for themselves that it's a crutch, that they weren't able to do it on their own. But that is not true. It is another tool to use to help with alcohol use disorder.

SPEAKER_01 42:30

How does a person determine the level of care or who determines the level of care that someone needs to get on this path?

SPEAKER_02 42:38

It's really important to have a full diagnostic assessment. And certainly any place somebody is going for a higher level of care, whether it be intensive outpatient or inpatient, they will do that upon calling, if somebody's calling and, you know, I think um ease people's nerves. Sometimes they think if they call, that means they have to go and they have to stop drinking. A lot of it's information gathering, and you get to choose at the end of the day if that's a good fit for you. But it's important to get a proper diagnosis. And I usually suggest people seek that through a recommendation of their primary care physician. Some people have a good relationship with their doctor.

SPEAKER_01 43:17

And it's less stigmatizing, I think, to start with your primary care physician. I recommend that to people with mental health conditions too, because you're going to a psychiatrist or somebody, well, then you got a problem. But we go to our doctors when something's off.

SPEAKER_02 43:29

And this is the treatment is no different.

unknown 43:31

Yeah.

SPEAKER_01 43:32

Well, I would be remiss. This is where we'll end here because we could just talk forever because I haven't questions and you have answers, which is a beautiful combination. But while we're talking about treatment options, I would be remiss if I did not say, and this is not an ad, but it is a free resource, that if you are curious about treatment options and different levels of care, you can go to recovery.com and you can look in your own state or a different state where you prefer to be. If anonymity is an issue, you can search under. what kind of insurance you have, whether that's Blue Cross, Blue Shield, or Medicare, Medicaid, and find out what options are there. You can do that anonymously. You don't have to put in your email address or anything. And it just makes it easier if there's a next time that you want to explore that you've already done it. It's the same with 988. You know, I I live with depression and I have called 988 to see what'll happen if I ever call there when I'm in crisis. Unfortunately I haven't had to do that, but I know now there's a pause between you know you getting through to someone and that might freak me out if I was in crisis. So that is a resource that's available to you to check out different treatment options. Kelly Kitley, thank you so very much for being here. Thank you for sharing your personal story and your expertise and experience as a clinician as well. I think it's been really helpful. And you know you can't more than scratch the surface in a way with this even talking for two hours because it's a very complicated topic. But I really appreciate the insights you've given.

SPEAKER_02 44:57

Thank you for having me. It's an honor. Thanks