Alcohol

By Frank Spinelli, M D

Originally published on Advocate.com April 16 2010 4:15 PM ET

 In addition to smoking, there is always a point in a person’s life when he feels compelled to liberate himself from his adolescent self by succumbing to the temptations that we have all been warned against as children. Alcohol, like smoking, has an enticing appeal, yet its consequences are just as devastating for some people.

While some can control their ability to drink socially, others cannot. The debilitating effects alcohol can have on the human body, whether your liver or your judgment, are well known. Thousands die each year at the hands of a drunk driver. Nearly 17.6 million adult Americans currently abuse alcohol, according to the National Institute of Alcohol Abuse and Alcoholism. Several million more engage in risky drinking that could lead to alcohol problems. These patterns include binge drinking and heavy drinking on a regular basis. Not surprisingly, alcohol use and dependence is common among gay men.

Textbook factors that contribute to alcohol dependence include feelings of internalized homophobia, which can lead to psychological stress. Often, gay men experience their first sexual encounter under the influence of alcohol. This can develop into a vicious cycle. In order to overcome their inhibitions about their sexuality, some men drink and then blame their behavior on the alcohol. Acceptance is the key to recovery in gay men. Risk factors for alcohol dependence include men who have a family history of alcohol abuse or those who were exposed to alcohol growing up. Drinking at an early age has been associated with developing problems with alcohol in the future.

Concerning alcohol consumption, you should expect to answer questions regarding exactly how much you drink. Many gay men consider themselves social drinkers, which is an evasive a response when a doctor asks a patient about drinking. Expect to hear from your doctor: “How often do you socialize?” It is also important to understand what you consider a “drink.” Is it a glass of wine a night, a shot of bourbon, or a six- pack of beer? Everyone’s perception is different. Ask yourself, “How often do I drink?” You will be surprised. Gay men underestimate three things in life: how much they drink, how much they smoke, and how much they have sex.

Indications that you, or someone you know, has a drinking problem include:

1. Problems at work or missing work

2. Numerous injuries attributed to falling or being accident- prone

3. Drinking and driving

4. Blacking out or unexplained loss of consciousness

5. Medical problems like peptic ulcer disease Many people consider themselves “social drinkers” because they do not drink every day; however, drinking excessively on the weekends can also qualify as abuse. That is why it is so important to realize that you do not need to drink every day to have a problem. Also, some people can cease all alcohol consumption for days, weeks, or even months before they start drinking again. To consistently maintain control of your alcohol intake, once you have identified it as a problem, takes professional help and social support.

Naltrexone, an opioid receptor antagonist, is used primarily in the management of alcohol dependence. In 2006, the FDA-approved naltrexone extended-release injection under the brand- name Vivitrol, which is administered monthly by a health- care professional for the treatment of alcohol dependence. Vivitrol does not eliminate or diminish alcohol withdrawal symptoms but acts to reduce the craving for alcohol. The product is indicated for use with psychosocial support in patients who are able to abstain from drinking in an outpatient setting and are not actively drinking on initiation of therapy.

Alcoholics Anonymous is a very helpful resource in the treatment of gay alcohol dependence. A.A. meetings offer support as well as counseling, and they are not as religious as some people fear. Most cities even have gay, or gay- friendly, A.A. meetings, which is extremely helpful for gay clients who might not identify with heterosexuals. A.A. even has pamphlets for the gay alcohol dependent.

In addition to A.A., gay men with alcohol and drug issues should be referred for psychotherapy or counseling in order to get evaluated for depression and internalized homophobia. It is imperative that their support system be adequate to ensure their recovery. Recovering from alcohol and drugs often involves facing the same problems as anyone else who has gone through the process of recovery. Patients must learn to give up old friends and stay away from bars and other places that might instigate a relapse. Individuals undergoing recovery must learn to be comfortable without drugs and alcohol and accept a life without them. One of the most important aspects for gay men is learning to cope with the people around you who continue to use drugs and alcohol. Sometimes there is no escaping the temptation. Relapse is extremely common. Those people who do relapse should not be deterred and should get right back up and try again.