I am the child of a parent with an alcohol use disorder. My mom didn’t stop drinking until age 79. She died at 84. There was no warning, no lingering illness. She died two days after an unsuccessful emergency surgery. But we had five years during which she did not drink, after forty-five years during which she did.
You see, my mom knew she had a drinking problem. So did we, the rest of her family. There were times when she fought mightily to stop or control it. There were times when the rest of us fought mightily to help her. She even succeeded in cutting back or not drinking for periods of time, which convinced her and us that she really wasn’t an alcoholic(1) . None of us knew alcoholism(1) was a developmental brain disease; a chronic, often relapsing brain disease. None of us knew one of the key risk factors for developing the disease is childhood trauma. None of her primary care doctors who saw her over the four+ decades her disease marched on ever diagnosed it.
Ironically, my mom was also a 17-year cancer survivor when she died. She knew to do (and did) self-breast exams. She found a lump and immediately contacted her doctor; her doctor immediately ordered a biopsy; and she was diagnosed with breast cancer in 2000. She had a mastectomy, went through chemotherapy, lost her hair, and showed such courage and grace in her battle to recover. (If you’ve ever witnessed someone recovering from cancer, you know what I mean by “battle.”)
But cancer was a disease people and their doctors understood. Symptoms and having the disease were openly talked about and medical protocols were routine. There was no denial, secrecy, lying or self-judgment.
This was not the case with my mom’s other disease – alcoholism.
It wasn’t until my mom’s third alcohol-related collapse and ambulance ride to the ER within a one-week period in the summer of 2012 that she was finally diagnosed with acute alcoholism. The ER doctor said she was too sick to go home and referred her to a skilled nursing facility.
In her first weeks at the facility, she couldn’t walk but a few shuffling steps with someone on both sides holding her up. She had difficultly recognizing her family, didn’t know how to sequence washing her hands or going to the bathroom without help, and ate like a toddler – mostly shoveling food into her mouth with her hands – the idea of using a napkin and utensils didn’t register.
Her treatment included intensive occupational therapy, physical therapy, speech therapy, and eating nutrient rich foods and vitamins. By the end of her stay, as her clarity returned, she felt great shame, guilt, and remorse. She wanted desperately to go home and promised never to drink again. She never did.
As you can imagine, there are many directions this story could take at this point, but I’m going to focus on…
The Legacy of Untreated Secondhand Drinking-Related ACEs
During the last years of her life, my mom and I talked a great deal about the work I’d been doing since 2003. She’d known the gist of it. I had offered my expertise and help over the years and couched it in terms of the other alcohol misusers(2) in my life’s experiences and my own secondhand drinking experiences and eating disorders. She’d get uncomfortable and gloss over my giving a presentation or completing a book on an addiction-related topic with a vague, “That’s nice dear. I’m happy for you.” There were times after a particularly bad bout or a disastrous consequence of drinking that she’d express a willingness to get help, but she never wanted to go to rehab, nor back to AA, something she’d tried early on.
But after she stopped drinking and had some months of clarity, she didn’t cut me off as I shared a new talk or blog post topic.
She eventually started asking questions and was especially taken with the ACE Study and adverse childhood experiences. As we talked over time, she came to understand and appreciate that adverse childhood experiences cause toxic stress and that toxic stress can actually change a child’s brain architecture, negatively affecting their lifetime physical and emotional health. She loved my concept of secondhand drinking:
Secondhand Drinking (SHD) refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors include verbal, physical, emotional abuse; neglect; blackouts; unplanned/unwanted sex, sexual assault; breaking promises to stop or cut down; shaming, blaming, denying; unpredictable behaviors; and driving while impaired, to name a few. Drinking behaviors are caused by a number of drinking patterns, including: binge drinking, heavy social drinking, alcohol abuse, and alcoholism. People engaging in these drinking patterns are referred to as alcohol misusers. The negative impacts a person coping with SHD experiences are related to toxic stress.
But it was the connection between ACEs and SHD and how they set up the key risk factors for developing addiction (of which alcoholism is one) - see image below - that rocked her world the way it had rocked mine. It was this connection and finally understanding that alcoholism (addiction) is a brain disease that set her free. She didn’t “choose” to become an alcoholic just as she didn’t “choose” to have breast cancer; nor was she weak-willed, immoral, uncaring or any of the other adjectives used to label persons with this particular disease.
Often a parent’s alcohol misuse and the resulting drinking behaviors cause secondhand drinking for children in the family. Secondhand drinking creates many of the adverse childhood experiences measured in the ACE Study. Both SHD and ACEs are two of the key risk factors for developing addiction (of which alcoholism is one). The two key risk factors are childhood trauma and social environment. Given SHD’s genetic connection, a person experiencing SHD-related ACEs then has three of the five key risk factors for developing the brain disease of addiction (alcoholism).
The Legacy: Blindly Passing SHD-related ACEs to the Next Generation
During our conversations, mom identified herself as having five ACEs and that her own mom (my grandmother) had a drinking problem. She talked about some of her mom’s drinking behaviors.
My mom and I discussed how I had four ACEs, and my daughters both had four. We identified similar ACE history patterns in some of my other alcohol misusing loved ones(2). One had five, another three, and a third six, for example.
And all of us had long-term exposure to secondhand drinking. To be clear – not all ACEs are related to SHD, of course. My mom had two and I had one of those, as well.
Mom and I talked about my realization that I’d blindly participated in passing along the consequences of my own untreated SHD-related ACEs to my daughters the same way my mom had blindly passed hers to me. And these consequences were not limited to developing alcoholism or an alcohol use disorder. They were the consequences of insecurity, anxiety, fear, anger, self-judgement, unclear boundaries, accommodating the unacceptable, constant worry, and the other physical, emotional and quality-of-life consequences of toxic stress. It was this shocking insight that moved me to treat my untreated SHD-related ACEs and help my daughters treat theirs.
Bottom line is these discoveries helped my mom finally forgive herself the way I had forgiven her years ago. Not the kind of forgiveness that excuses trauma-causing behaviors, rather the kind of forgiveness that lets go of wishing for a different outcome. It is the kind of forgiveness that recognizes we were all doing the best we could with what we knew at the time.
Breaking the Cycles – Changing the Conversations
To close this post I want to share one of my mom’s greatest gifts to breaking the cycles of untreated SHD-related ACEs and untreated ACEs in general. It happened during one of our phone calls.
She said to me, with deep emotion, “Lisa – please – please use my story – our story – to help others.”
And so I am.
There wasn’t enough time for my mom to heal from her ACEs, nor for she and I to develop the mother/daughter relationship I now have with my two daughters. Our experience is so different because of the healing work the three of us were able to do to change the legacy.
But my mom started her process by breaking the denial, secrecy, lies, and self-judgment about her alcoholism and its root causes. And it is the four of us together – my mom, myself, and my two daughters – who have now changed the legacy in our family. As such, we pass forward not lies but the truth, not self-judgment but self-compassion, not secrecy but openness, not denial but seeking awareness. Something I didn’t even understand let alone could have imagined possible just fourteen years ago.
My 30s would roll into my 40s before I realized my anorexia and bulimia were the symptoms of, the soothers for my deeper, unresolved issues. In fact, it wasn't until 2003 when one of my loved ones entered a residential treatment program for alcoholism that my "true" recovery began. I say “true” recovery because back in the day (early 1980s) there was no ACE Study, nor an understanding that ACEs are often rooted in secondhand drinking.
So while I’d learn to re-eat, I’d never dealt with my secondhand drinking-related trauma; SHD-related trauma that had multiplied in the ensuing decades as my close relationships with other alcohol misusers multiplied.
Thus the “voice” that had previously ruled my life with bulimia settled on attacking me for not being important enough, good enough, loveable enough – just plain, enough. Enough to make my various loved ones want to stop drinking and thus stop the crazy, convoluted drinking behaviors it spawned.
…I would have given anything if my doctor had asked me about alcohol misuse in my family when I went in to talk with her about feeling depressed. Not my drinking, but that of my family members.
Instead, I was diagnosed with situational depression and put on Prozac for several months. When that didn't seem to work, I was put on Zoloft. That didn't work, either. I wasn't "depressed," but I wasn't "living" either.
Requiring a person with heart disease to wait for treatment is impossible to imagine. It just wouldn’t happen. And, yet, people with a different chronic disease – the brain disease of addiction (aka substance use disorder) – experience this situation ALL THE TIME.
(1) Current terminology defines any drinking pattern that exceeds “low-risk” limits as an alcohol use disorder (AUD). In other words, the more commonly used terms most people are familiar with — binge drinking, heavy social drinking, alcohol abuse and alcoholism — are all considered alcohol use disorders (AUDs). Alcoholism is the most severe of the AUDs.
Additionally, a person with the most severe AUD is no longer referred to as an alcoholic. Rather s/he is referred to as a person with an alcohol use disorder. I like this distinction. It allows us to see the person with an AUD as a person, first, and then second, as a person with an AUD.
When referring to alcoholism, it is also currently correct to use the term Substance Use Disorder (SUD). A substance use disorder is either alcohol or other drug misuse.
(2) Another outcome of growing up with untreated SHD-related ACEs is the propensity to marry or have close relationships with persons who misuse alcohol. Their behaviors are felt to be “normal” because one’s coping skills for dealing with those behaviors are wired in, mapped, during the brain’s key developmental processes from birth through early-to-mid 20s (the subject of another post, I’m afraid). In my case, marrying a person with an alcohol use disorder felt normal because “normal” was trying to do whatever I could to accommodate, change, or “fix” the drinking behaviors and anything that threatened to trigger or exacerbate them.