alcohol abuse

I’m going fucking crazy. I know I shouldn’t be dictating what you do, but seeing you drunk and high so frequently has put me in a tough spot. It hurts me to see you go down such a destructive path trying to ease your pain and calm your thoughts. I want to help. I really, really want to, but I know I shouldn’t step in. You’ll only push me away.
—  J.H.
but when she’s drunk she’ll spill her heart out to you and tell you how you shouldn’t of kissed him, how your lips still belonged on hers even though you broke up months ago and never had the chance to hold her, she’ll cry and she’ll tell you she loves you just like she did the night you told her she meant everything to you, she likes to mix rum and Coca-Cola and along with her throw up comes everything she didn’t tell you when you loved her and all you can do is watch her throw up her heart and it hurts it really does, you hurt for her because she’s so stuck in the past and you hurt because deep down you know you don’t love her anymore.
—  baby, you have an alcohol problem (basedxbri)

Originally posted by stanxstan

request with Sebastian Stan as Sirius

continued: Imagine during the first war Sirius is so distraught over your death that he starts drinking, thinking that it will take away the pain and the other Marauders don’t know how to help.

She loved the way my lips tasted of
sweet honey that had been
entwined with fire.
I remember the way she held me,
how warm her body felt against mine.
Jack. You’re the only one for me Jack.
Her broken voice would whisper.
Among the many men I watched come
in and out of her life,
I knew she loved me most—I never disappointed her.
She was mine.
I loved our nights together,
in her dim apartment,
wrapped in her hands,
sitting on the living room floor.
I listened to her whole hearted monologues,
for each tear that fell, our lips touched.
She needed me.
I remember the mornings
after our encounters.
The way she would awaken,
curled up in a ball— broken,
realizing that I had been in her
secure grip the whole night.
She hated me.
Mornings brought bittersweet nostalgia.
The sight of me made her remember,
but dreaded to leave my side—
a final kiss always prepared her for the day to come.
She can’t live without me.

‘Your Friends Were Right! Dating Has Changed You’

A new study published in Developmental Psychology put to test the hypothesis that adolescents become less similar to their friends and more similar to romantic partners after they start a new romantic relationship. Results of the study showed that adolescents who dated were more similar to dating partners than to friends on measures of alcohol abuse. Non-daters who started dating changed from being more similar to friends to being more similar to romantic partners. This is the first study to use longitudinal data to demonstrate changes in friend similarity that follow from the initiation of a romantic relationship.

“The results confirm what most friends complain about – romantic partners are a distraction from friendships,” said Brett Laursen, Ph.D., one of the authors and a professor and graduate studies coordinator in the Department of Psychology at Florida Atlantic University. “It also is a stark reminder how the peer social world changes during adolescence. Same-sex friends become less important and romantic affiliations become more important.”

Similarity is the hallmark of adolescent friendships and not coincidently, most single adolescents report friends to be among their most important relationships. However, the start of a new romantic relationship alters the balance of close relationships. As romantic relationships surpass friendships in terms of importance, adolescents are inclined to change to become more similar to their romantic partners, even if it means that differences arise with friends.

“Much attention is given to the role that friends play in the acquisition and reinforcement of health-risk behaviors,” said Laursen. “Adolescents rarely drink alone, so concerns over peer pressure to experiment with and abuse alcohol are well placed. Often overlooked, however, is the fact that initial involvement in romantic relationships tend to coincide with initial exposure to alcohol.”

In the first part of the study, participants (662 girls, 574 boys) ranging in age from 12 to 19 years, nominated friends and romantic partners, and completed a measure of alcohol abuse. Friends with romantic partners were less similar on rates of alcohol abuse than friends without romantic partners, especially if they were older and less well-liked by classmates.

The second part of the study focused on a subsample (266 boys, 374 girls) of adolescents who reported friendships that were stable across two consecutive years. At the outset, neither friend was involved in a romantic relationship. Using this longitudinal subsample made it possible to measure changes in friend similarity for those who did and did not begin a romantic relationship. Similarity between friend reports of alcohol abuse declined after one or both of the adolescents became involved in a romantic relationship, to the point where they became more similar to their romantic partners than to their friends.

Levels of alcohol consumption did not differ for adolescents with romantic partners and adolescents without.

“The findings suggest that participation in a romantic relationship does not elevate the risk of alcohol abuse beyond that involved in participation in friendships,” said Laursen. “Instead, it is the source of the risk that changes. Friends no longer shape drinking habits the way they used to. Romantic partners now dictate terms. Your friends were right: You aren’t the same person you were when you were single.”

The Case of the Shaky Songwriter

If I know anything about musicians, it’s that they all love to drink, frequently do drugs, often have mental health issues, and almost never take care of themselves as they should.

When Tim (age 57, not his real name, not a real case, put together from several cases for your learning and enjoyment) came in complaining about his new, essential tremor, I asked him about how it was affecting his life. As a songwriter, the biggest problem was in writing things out long hand and having a hard time keeping things legible. I then asked about his drinking. Tim has always hidden his drinking from me, but it’s a small town, so I’ve heard about his enjoyment of EtOH.

He said he’s been trying to cut back, and has more than halved his consumption over the past month because he had noticed his tremor getting worse.

A ha! I said, we have the culprit! If it doesn’t get any better, come on back to the office in 4 weeks.

4 weeks pass and Jim is back. His tremor is getting worse.

I worry about alcohol induced Parkinsonism. Tim gets booked for a head CT which shows diffuse grey matter atrophy. It’s not likely enough to cause the signs and symptoms I’m seeing though. I send him to a neurologist who tries him on levo-dopa. 

In the meantime we do Tim’s regular blood work for his mental health meds (seroquel, lithium). Lithium comes back elevated, not by much, just a point or two. 

We decide to try lowering the lithium to watch the results carefully. 

Tim’s tremor eventually decreases and we begin to lower his levo-dopa as well, successfully. 

Lessons I Learned from Tim

  1. Prejudice is not helpful. Knowing the gossip on the street is sometimes helpful but should not be the basis of your diagnosis. It is easy to do, to just jump to the first conclusion and go from there, but keeping an open mind is so important. Make sure your patient is comfortable coming back so you can both work on a possible cause. 
  2. Always be suspicious of medications as the cause of an illness, especially when a patient is on more than 3. Docs are terrible at stopping medications. We aren’t taught it in school, and specialists are often ardent in their desire to keep patients on meds. Learning to stop meds is as important as anything else we learn. Build faith between you and your patients and make plans for close follow up and weaning off or down medications. 
  3. Lots of meds need follow up. Some closer than others. Lithium in particular can be fickle. It is renally cleared which means that if your patient has acute renal failure, they may suffer from lithium toxicity. Whenever you see strange behaviour in a patient who is on lithium, do a level. It takes 3 days for us to get it back in our hospital, so don’t expect quick response back from the lab. In the meantime, if you are suspicious, it’s worth treating this patient as though they are lithium toxic.  
    1. ABCs - these patients often have decreased level of consciousness. 
    2. Fluid resuscitation.  Be as liberal as you can be without causing CHF or more damage to the kidneys. 
    3. Vomiting and diarrhea is common. Make sure electrolytes are in a safe range. 
    4. Consider stopping ACEis, definitely stay away from NSAIDs, keep those kidneys as healthy as possible. 
    5. Kayexelate may be helpful. If not, you might need to consider dialysis. Charcoal is useless. Don’t do that to your poor patient. 
    6. Old folks have a lower eGFR, be more suspicious of toxicity with them. 
  4. How a patient spends their day will determine what is they want from you. Tim was focused on his tremor because it was interfering with his writing. He didn’t notice that he was urinating all the time. We didn’t pick up on that until we were rehydrating him later. Once again, a lack of a good systems review kicked me in the ass. If I had done this at the first visit instead of gleaning onto the first diagnosis I thought of, I would have suspected lithium faster. Taking my time to do everything correctly would have saved Tim months of symptoms. 

but see

you can’t judge me for how i choose to cope

so fucking what i like to drink?

you don’t fucking earn the right to judge me

until you were young when you saw your parents cope with alcohol at a young age

and you thought it’d be a good idea to try it

you don’t fucking have the right to judge

until you’ve drank so much that by age 10,

the taste of vodka doesn’t even make you cringe anymore

you can’t fucking judge me

until you run to the bottle instead of a friend

time and time again

please don’t fucking judge me

and i won’t fucking judge you.