To many people, alcohol is often regarded as a welcome social lubricant, reducing the anxiety that is common in some social interactions. For Bill Wilson, the co-founder of Alcoholics Anonymous, the effect was more dramatic. He is quoted as having said, “For me, alcohol dissolved the barrier between myself and the rest of the world.”
For many years, I have repeated his words as an illustration of the positive impact that alcohol can have on alcoholics compared to non-alcoholics. I did not think through, however, the contradiction inherent in the quote. After all, interpersonal isolation is one of the characteristic features of alcoholism, as well as of substance use disorders in general.
Some recent interactions with my patients have led me to think about this issue in different terms. One of the psychological characteristics of the “addictive thinking” that accompanies the evolution of a substance use disorder is that the substance is regarded as not just useful, but as essential to the accomplishment of certain tasks. The prospect of being at a party, for example, without preparatory drinking followed by heavy use at the event itself seems impossible – too dangerous to even consider.
As patients in early recovery begin to revisit familiar social events, such as dinner parties, without using alcohol, they begin to make startling discoveries. They begin to notice not only how little alcohol other people drink, but how enjoyably they interact with each other in the absence of large amounts of alcohol. With further progress, patients notice how disconnected from others they had become as a result of their alcohol use.
In other words, the alcohol that had initially served to reduce minor anxieties, facilitating social connections with other people, ultimately came to create separation from others. Often, this primarily takes the form of psychological distance and reduced intimacy. Sometimes, however, the progression is more severe, leading to the stereotype of the physically isolated alcoholic drinking alone.
Like diabetics and hypertensives, the majority of alcoholics have fundamentally healthy psychological foundations beneath the sometimes dramatically pathological surface induced by their addictive use of alcohol. When they are able to resist returning to using alcohol, they begin to rediscover their psychological strengths and social skills. Previously unthinkable behaviors – such as attending parties without alcohol – become not only possible but actually enjoyable. Positive experiences such as these help to rebuild damaged self-esteem; the recovery process builds momentum, ultimately leading to a stable sobriety.
Watching such recovery journeys is a gratifying experience that I have been fortunate to witness many times – an experience that I invite other clinicians to share.