Binge Drinking Basics, Part I

Professional Q&A with E.T. "Moe" Briggs, Regional Clinical Director, Kolmac Clinic

Binge Drinking Basics, Part I

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E.T. “Moe” Briggs began working with young adults, some of whom were developmentally challenged in 1981 and specifically in the Chemical Dependency field in 1992.

Moe received a Master of Science degree in Clinical Community Counseling, specializing in addictions, from the Johns Hopkins University in Maryland.

Prior to admission to the Johns Hopkins University program he served on the Maryland Board of Professional Counselors and Therapists as first advisor appointed by Governor Paris Glendenning.

Moe holds credentials as a National Certified Counselor; Licensed Clinical Professional Counselor; Licensed Substance Abuse Treatment Practitioner; Master Addiction Counselor and Substance Abuse Professional.

He has served in a variety of clinical settings providing direct services as well as management.

Moe served as an Adjunct Professor in the Graduate Counseling Department at Marymount University in Arlington, Virginia. In that role he instructed students in the Psychology of Culture.  As an adjunct professor, he realized that senior members of the addiction treatment community were, like himself, ageing out of the profession. With that in mind he set out to mentor young interns and practitioners entering the field of addictions healthcare.

In 2007, Moe found a way to support his mentorships and he began a formal internship program at the Kolmac Clinic in Washington, DC.  The Kolmac Clinic partnerships include local area universities and continue to this day as an effective means of educating new practitioners.

Additionally, Moe facilitates a variety of trainings, locally and out of state, related to addictions and mental health counseling for a variety of public and private audiences.

His professional goal is to maintain clinical and managerial skill sets at a level which enables him to continue delivering quality services, believing that “every decision we make, everything we do, must be in the best interest of patients, students and organizations we serve”.

His personal goal is to be a mentor to the younger generation and an example of the mental, physical, emotional and spiritual benefits “right living” can bring.

Moe was kind enough to take some time and discuss issues about binge drinking and the impact it has on our culture.

 

Why did you start working in the substance abuse field?

It fit my new found passion for helping people.  In my own struggle I found gifted professionals who had an extraordinary ability to work with my denial and resistance.  At some point, I felt I had the ability, and clearly the desire, to become a competent helper for those on the journey of recovery.  I was encouraged to stay on a path of learning and never reach the point of “I know it all”.

 

When you started working in the chemical dependency field in 1992, did you know that binge drinking would become such a ubiquitous problem?

No I didn’t.  [At that time] the focus centered on the harm related to “hard drugs” and “drunk driving”. This was especially true as it related to “crack cocaine”.  The focus began to change when it became evident that binge drinking was not only prevalent in the younger population, but deadly as well.

 

Is binge drinking a problem, an epidemic or simply a trend?

I don’t see binge drinking as an epidemic, in that every college student does not binge drink and I believe it to be more a “practice” rather than a trend.

However, it is clearly a problem in that a binge drinker cannot predict the consequence of an episode of binge drinking and therefore, they are at high risk for harm to self or others.

Since the potential for risk extends across the population of binge drinkers without “rhyme or reason” it is a clearly a problem.

 

Does treating a binge drinker differ from treating an alcoholic?  If so, in what ways?

Yes, in that every binge drinker does not meet the criteria for Alcohol Dependence that an identified alcoholic would.

Nonetheless, both categories [of drinkers] might need to receive medical services and possible treatment services.

  • For the binge drinker, periodic consumption of a large quantity of alcohol in a short period of time could lead to acute alcohol poisoning.
  • For the chronic drinker, the beginning of recovery could require a medically supervised detoxification to prevent death from acute withdrawal.

Both end results are due to the toxic effects of alcohol. Every binge drinker has the potential to move into addiction to alcohol, but many do not meet the full criteria for dependence and therefore would not receive levels of care designed for persons with alcohol dependence.

 

Is there a difference between binge drinking (abuse) and alcoholism (dependence)?

Yes.

According to the Diagnostic and Statistical Manual of Mental Health Disorders IV-TR published by the American Psychiatric Association (found here http://www.ncbi.nlm.nih.gov/books/NBK44358/)]

Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:

  1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
  2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
  3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
  4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

However, substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

  1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
  2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
  3. The substance is often taken in larger amounts or over a longer period than intended.
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Note that the symptoms for abuse have never met the criteria for dependence for this class of substance. In other words, according to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time.  I include the different diagnostic categories so that it’s clear that as a practitioner I have guidance on how to help determine [this].

Other guides are available as well. Diagnosis aside, Alcohol affects the brain in ways that lead to bad judgment, behavior and consequences. The fact that one category of use is different from another does not mean much if one is injured on the job or kills someone as the result of a drunk driving episode.

 

Physically speaking, is binge drinking behavior just like abusing other substances, such as oxycodone or cocaine?

Clearly there are different behaviors associated with various drugs of abuse/dependence including alcohol, however, from the perspective of impairment, the difference can be subtle.

Behaviors resulting from impairment, from any psychoactive substance negatively impact the safety of the user and others.  I see no distinction based on the type of substance.

 

Moe, thank you so much for your time.  If people would like to reach you or seek treatment from the Kolmac Clinic, what methods should they use?

They can contact me at memberservices@bingebehavior.com or (240) 821-1222. They can also go to the Kolmac website at www.kolmac.com.

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