Lisa Frederiksen Interview

LISA FREDERIKSEN INTERVIEW

Lisa Frederiksen, researcher and author, has recently published her eighth book dealing with addiction, treatment and recovery -- Loved One In Treatment? Now What?

"Lisa's newest book is a useful guide for family and friends dealing with a loved one's addiction, treatment and recovery," reports leading family business expert

Don Schwerzler "In her new book, Lisa presents interesting insights into the problems associated with SHDD (Second hand drinking/drugging)."

Schwerzler has been studying and advising family business entrepreneurs for more than 40 years and he is the founder of the

Family Business Institute , headquartered in Atlanta GA

Family Business Experts (FBE) discussed her new book in this Lisa Frederiksen interview .

1. FBE How can this book help our family business clients and visitors to our website?

LF To begin to answer this question, I would like your family business clients and visitors to your website to look at the following statements and see if any sound familiar:

If your family business clients and visitors to your website find these kinds of statements familiar or they are the family member or co-worker of a person whose drinking or drug use is a source of concern, they will find this book helpful. It covers far more than what’s involved with effective addiction treatment and recovery to answer additional questions, such as:

- What causes addiction? Why do some people become alcoholics or drugs addicts and others do not?

- Who among family members and friends can help a loved one get treatment? Or can they?

- What if you can’t get them to stop or seek help?

- How is it possible that addiction is a disease when they are choosing to drink or use drugs?

- Is someone who drinks a lot but still goes to work really an alcoholic?

Best of all, this book answers all of these questions and more in just over 100 pages.

2. FBE One of the confusing aspects for most people who are worried about someone’s drinking is trying to figure out how much is too much. Is there some sort of definition of “normal” drinking?

LF Yes there is. For women, it is no more than 7 standard drinks in a week, with no more than 3 of the 7 in a day. For men, it is no more than 14 standard drinks in a week, with no more than 4 of the 14 in a day.

A standard drink is defined as 5 oz. of wine, 12 oz. of beer, or 1.5 oz. of hard liquor.

Often drinks or drink containers have more than one standard drink. A margarita, for example, can contain two–three. A bottle of table wine contains five, and a 24-ounce can of regular beer contains two.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a very user-friendly site Rethinking Drinking where people can anonymously assess their own or someone else’s drinking patterns and learn ways to cut down or get help.

3. FBE You talk in your book about addiction being a disease. What makes it a disease?

LF One of the most difficult aspects of all this is to understand that addiction (whether it is to alcohol or illegal or prescription drugs) is a chronic, often relapsing brain disease, and here is why this is true.

Everything about our body – what we can see and what we cannot see – is made up of cells. Diseases change cells in our body — that’s what makes a disease a disease. A disease might change cells in body organs (like the heart or liver or eyes) or in body organ systems (meaning several organs working together), like metabolism or cardiovascular. For example, the disease of breast cancer attacks cells in the breast, and the disease of diabetes attacks cells in the metabolic system.

The diseases of addiction (drug addiction or alcoholism) change cells in the brain, thereby changing how the brain works. Because neural networks in the brain control everything we think, feel, say and do, these brain changes get in the way of a person’s ability to act normally and make good decisions. It can cause that person to do things like: starting fights with friends, yelling at or hitting family members, missing work, carrying on rambling arguments, accusing family members or friends of doing things they haven’t done, driving while under the influence, being super nice, not getting to work on time, not being able to fully concentrate when at work or school, or continuing to use/drink after promising not to. We call these “things” drinking/drugging behaviors.

Additionally, alcoholism and/or drug addiction often change cells in several other body organs, as well, such as the liver, heart, and kidney. As true with other diseases, if untreated or during a lapse in management of the disease, a person can die from alcoholism or drug addiction, just as people die from other diseases.

4. FBE So are you saying that substance abuse is different than addiction?

LF Yes I am. Substance abuse is different than addiction even though BOTH cause chemical and structural changes in the brain and therefore changed behaviors as described in #2.

So, when explaining alcohol abuse, for example, it is defined as one or more of the following occurring within a 12-month period:

• Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).

• Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).

• Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct, DUI).

• Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).

• Recurrent binge drinking, which is defined as 5 or more standard drinks on an occasion for men and 4 or more for women.

To identify at-risk drinking, start with a single question. How many times in the past year have you [male] had more than 5 drinks per day? (NIDA Quick Screen, 2011) [Insert 4 drinks, if female. Drink defined as 5 oz. of wine, 12 oz. of beer, 1.5 oz. of hard liquor.] If the answer is once or twice, that person is engaging in “at-risk” drinking – the type of drinking that can lead to alcohol abuse and/or alcohol dependence (alcoholism).

5. FBE If #4 describes substance (alcohol) abuse, then what makes substance abuse different than addiction?

LF The disease of addiction (whether it’s to alcohol or illegal or prescription drugs) has four characteristics that make it different than substance abuse. These include: cravings, loss of control, tolerance, and physical dependence. An addiction craving, for example, can be five times stronger than our instinctual, hardwired drive to eat food when hungry because of the neural networks that are compromised. These powerful cravings override all other “thought” and are what cause an alcoholic or drug addict to lie and steal and do whatever it takes to drink or use. Addiction cravings and these other characteristics (loss of control, tolerance, and physical dependence) are more fully explained in my book.

6. FBE What makes one person become an alcoholic or drug addict, while another person does not, even though that person drinks or uses too much?

LF While both substance abuse and addiction (aka substance dependence) cause chemical and structural changes in the brain and thus changed behaviors, there are five key risk factors that contribute to a person developing the brain disease of addiction. These risk factors include: genetics (if it runs in the family, genetic predisposition); social environment (where heavy drinking or drug use is viewed as “normal,” causing a person to drink or use heavily, which given their brain/genetic make-up, may lead to substance abuse and/or addiction); childhood trauma (verbal, physical, emotional abuse, which “wires” unhealthy coping skills and brain changes); early use (critical brain development ages 12-early 20s makes the brain especially vulnerable to brain changes caused by alcohol misuse), and mental illness (e.g., depression, anxiety, ADHD, PTSD, bipolar – which also cause brain changes and often a tendency to “self medicate” with alcohol or drugs). The more risk factors, the more susceptible a person is to the possibility of “crossing the line” from abuse to addiction.

7. FBE Is treatment for substance abuse different than it is for addiction?

LF Yes. With substance abuse, abuse patterns may be modified to fall within “normal” limits (see # 2), although for some people, “modification” is to stop all together. With addiction, the substance must be stopped all together. There is no amount that a person who is addicted can “safely” use or drink, ever. Why this is so and how to do it [and there are many options besides AA and NA, for example] are covered in my book.

8. FBE You talk about secondhand drinking/drugging (SHDD) in your book. What is it?

LF When a friend, family member, or co-worker is on the receiving end of someone’s drinking/drugging behaviors and/or on the receiving end of someone’s reactions to those drinking/drugging behaviors (i.e., a non-drinking spouse trying to control a husband/wife’s drinking behaviors), that person experiences SHDD (like the idea of secondhand smoke). Examples of secondhand drinking impacts include the consequences for others as a result of a person’s DUI, drunk arguments, blackouts, problems at work related to drinking or recovering from heavy drinking bouts, or having unprotected or unwanted sex. It also includes the fall-out to others who have to deal or work with a person exposed to repeated SHDD. For example, the non-drinking spouse who calls in sick or is distracted at work after a night of fighting or worrying about the drinking family member’s whereabouts.

9. FBE What have you discovered to be most helpful for those struggling in a relationship with an alcoholic or drug addict (i.e., suffering SHDD)?

LF First is to really understand the answers to the above questions. Second is to learn what they can do to better cope with SHDD and the person who is abusing or addicted to drugs or alcohol. Third is to know they are not alone. Over one-half of American adults have a loved one with a drinking problem, and one in four children will live with alcohol abuse or alcoholism or both before the age of 18.

10. FBE Can a family member actually get someone to stop abusing drugs or alcohol or get them into a treatment program for drug addiction or alcoholism?

LF Yes, but not in ways they may think. Arguing, blaming, shaming, deal-making, minimizing, denying – none of those methods work. In fact, they backfire. They give the substance abuser/addict/alcoholic a target to attack, to blame, to whom to offer plausible excuses as the cause of their drinking or drug use. Then, the alcoholic/drug addict/substance abuser goes on the offensive – turning the tables, if you will, so that the family member or friend becomes defensive.

Effectively helping someone stop comes through learning what substance abuse / addiction is and is not, what you can and cannot do, and how to better draw a boundary around the behaviors you will or will not tolerate and what your intentions are for your own behaviors if that boundary is crossed. Loved One In Treatment? Now What! provides helpful information about all of this.

By the way, it’s very important to know that a person does not have to “hit bottom” to get and/or to be encouraged to seek help. In fact, the sooner the drinking or drug abuse / addiction is interrupted, the better for all concerned. As a family member, effectively helping can and should be done – but again, not as you’d typically think of helping.

11. FBE Are there any common reasons why people don't act to intervene?

LF Yes. Stigma, shame, denial, a lack of understanding of the disease vs. substance abuse, fear of labeling a loved one an alcoholic or drug addict.

12. FBE Why don’t more people know about this information?

LF Much of this is new research and information (a great deal in the 21st century) that’s now available as a result of new brain imaging technologies. Scientists and medical professionals can actually study the live, human brain. The following are but a few of the agencies conducting and sharing this kind of research:

NIAAA – National Institute on Alcohol Abuse and Alcoholism

NIDA – National Institute on Drug Abuse

SAMHSA – Substance Abuse and Mental Health Services Administration

WHO – World Healthy Organization

AMA – American Medical Association

ASAM – American Society of Addiction Medicine

13. FBE Many of your other books are on women’s issues and other topics, what motivated you to start writing about substance abuse and addiction?

LF In 2003, one of my loved ones entered treatment for alcoholism, and I found myself plunged into a world with terms like addiction, alcoholism, adult children of alcoholics, codependency, dual-diagnosis, and on it went. [I soon realized that I'd experienced decades of coping/fighting with family members and friends' alcohol abuse and/or alcoholism.] To answer my questions — namely, “How could it possibly be a disease; they choose to drink?” and “Why have I put up with it for so long!?,” I immersed myself in my own recovery work (e.g., therapy and 12-step programs for family members) and research and found there was a whole new body of knowledge (much published in just this century), thanks to the new brain imaging technologies. It was this new research that I wanted to share in the hopes I could help other family members/friends who struggle with a family member’s drinking and to help all of us, as a society, end the stigma and shame that surrounds and perpetuates the disease.

14. FBE Can you talk about the effects of a parents substance abuse, drug addiction or alcoholism on children?

LF The effects (namely SHDD) are profound and unfortunately too involved to try describe here. Briefly, however, SHDD contributes to a child developing/experiencing several of the risk factors (see #6), such as childhood trauma, social environment, mental illness (e.g., depression or anxiety). Add to this, genetics, and a child may develop/have 4 of the key risk factors before having their first drink or drug use experience. Both of my books touch on this and what the non-drinking/using parent can do to help their children.

15. FBE Is there anything else you would like to add?

LF First of all, I really want to thank you for inviting me to do this interview and share this with your family business clients and visitors to your website. And, then I’d just like to make a quick list of the highlights:

• Substance abuse and substance dependence (addiction) cause brain changes, which in turn cause drinking/drugging behaviors. It is not the “person,” it is the brain changes caused by substance misuse.

• Substance abuse is not addiction . Addiction is a chronic, relapsing brain disease.

• A person abusing or addicted to a substance causes SHDD (secondhand drinking/drugging) for others, especially family members, friends, and co-workers.

• SHDD, in turn, can have health, emotional and work-related repercussions for others.

• A person with addiction cannot use any amount of the substance if they want to succeed in treatment and recovery and thereby stop the drinking/drugging behaviors and enjoy a healthy, joy-filled life.

• A person with a substance abuse problem may be able to change their use patterns to fall within moderate use. For some with a substance abuse problem, stopping all together is their solution. Stopping does not necessarily mean that person is drug addict/alcoholic, however.

• A person does not have to “hit bottom” before they seek or get help, and there is much family members, friends, and co-workers can do, provided it’s not blaming, shaming, argumentative, or deal-making in nature.

FBE Thanks for taking time to chat with us and we wish you success with your new book: Loved One In Treatment? Now What?