Brief Background:

In 1946, a sober recovering alcoholic of Irish decent went back to Ireland to try to carry the message of his recovery using the 12 steps of Alcoholics Anonymous to the many in that country who were still suffering from alcoholism and dying away. He approached hospitals, clergymen, and politicians for contacts of people he could help. The response he received was fascinating. The gentleman was informed by everyone he approached that there are absolutely no alcoholics in Ireland! Even the hospitals specializing in alcoholic patients told him there is no problem of alcoholism in Ireland. Amazing!

While this may seem amusing to most, especially considering that Ireland is internationally notorious for their over indulgence in alcoholic drinking, to me this story shares a frightening resemblance to a more modern trend we are seeing much closer to home. There seems to be a common belief in our Orthodox Jewish community that alcoholism and other addictions are neither that common nor that important an issue to make a big deal about. 

The Theory:

The prevalence of minimizing that we have a problem becomes even more common when referenced in context of comparing addiction in the Jewish community to that of other societies and cultures. While it is true that there exist a number of empirical studies highlighting the low occurrence of alcoholism among Orthodox Jews, still addiction is not a condition that people readily admit to and statistics are far from accurate. The theory is, that cultures such Orthodox Jews, who associate alcohol with religious practice and not with social interaction, convey an attitude of healthy restraint in their approach to alcohol and thereby avoid the pitfalls of unrestrained alcohol usage that are more common in other cultures (such as the Irish!). The young child who is given a sip of wine for religious ritual absorbs a message that alcohol is not a beverage to be imbibed and enjoyed for its own sake but part of a higher purpose.

The Truth:

While there is truth to this theory, still alcoholism and other addictions are not unknown to our community, nor is it as uncommon as the general public would like to think. There used to be a Yiddish expression:  A Shikkur is a Goy (only non-Jews are drunkards) but unfortunately this expression is not accurate. Not only do addictions of all sorts exist in the very heart of our community, it is not a new problem either. Many orthodox addicts report behaviors witnessed at home that clearly indicate that they are second and third generation addicts. For clarification of what addiction is, and what it is not, let us explore the basics.

Some Education:

No matter what addiction one refers to, alcohol still remains the prototype to understanding the nature of addiction and its manifestations. "Alcoholism" is actually not a clinical term, even the word "addiction" was once not used in clinical circles, but it is now with the recent publication of the DSM-5 (DSM is a diagnostic handbook that now includes "addictive disorders" in their 5th edition). The current proper diagnosis for alcoholism is actually referred to as  Alcohol Use Disorder. 

Someone who abuses alcohol over time will likely increase the amount of drinks to the point that when he or she stops they will experience withdrawal. These increases of amount together with withdrawal are the two most identifying criterions for a diagnosis of Alcohol Use Disorder. Of course there also needs to be a persistence in the drinking behavior in spite of negative consequences. However, a person does not have to be in a constant stupor to suffer from addiction. Ironically, he or she may appear to be a high-functioning individual despite the fact that alcohol has become a significant enough part of their life that they are now fully addicted.

A Deeper Look Underneath the Surface:

Addictions rarely occur in isolation. There are typically "underlying issues" driving addictive behaviors. Some are acutely aware of what their underlying issues are. They have been plagued by them all their lives. Others are unaware of any underlying issues at all. It is only when that person gives up their addiction and gets sober that those underlying issues rise to the surface. The addiction kept those issues hidden from sight all those years. It is crucial for an addict to address whatever issues show up once they get sober if they are going to want any success at remaining sober without relapse. The following are some of the underlying issues that are frequently found in the lives of addicts.  

In a majority of cases addiction is strongly connected to trauma. Trauma is personal, it does not need to be catastrophic according to other people's definition, nor does there need to be one specific traumatic episode. Most addicts report traumatic distress in their life that may often seem trivial to someone else. For example: living within, or growing up in, a negative or toxic environment can be one example of trauma. It is the significance in the life of the individual that really matters. This is especially true for children who are not emotionally mature enough to understand what they are experiencing. A child may react to something that seems benign to adults, such as a parent's criticism at the dinner table, the way an adult might react to public humiliation at an important work meeting.    

A person suffering from depression, anxiety, fear, or any other feeling of emotional disturbance will often turn to alcohol or other substances to self-medicate these underlying issues. Some people eventually increasing this "medication" as the body adjusts to become immune to its effects. This is called tolerance and it occurs with all addictions - even behavioral ones.  This self medication process can continue so successfully for years that the patient no longer has a clear idea what the underlying issues are. Thus we find that the alcoholic has long forgotten that he initially took that extra shot of scotch at a kiddush or a wedding to overcome his shyness in company. The woman who suddenly realizes that she is a compulsive eater believes her problem is food, without having an inkling that her real problem is a lack of harmony in her home or relationships. As was stated before, it is often not until the addict seeks therapy for the addiction that its real cause is revealed.

Other Variables:

It is very important to mention that there are many variables besides the mentioned underlying issues that are also involved in the development of addiction. Many are social, many are psychological, and many are biological. It is well known in the medical world that people are not created with the same physical and emotional strengths as one another. This is true of psychological experiences as well. People were created by nature with different coping skills and some people are more capable of dealing with trauma than others. While two individuals may both suffer the same serious circumstances, one might be able to shake it off, and the other will resort to artificial relief like alcohol to alleviate distress.

This is true biologically as well. Some people have a greater propensity for addiction than others. There may be two people who both start to drink in seemingly the same circumstances. While one may be able to cease drinking when appropriate the second may not. Science does not yet know why some people become physically dependent on a drug or a behavior while others do not. But there is neurological proof that those who are addicted can do absolutely nothing to reverse that fact. Unfortunately, many people label addicts as weak-willed or simply bad. Such an indictment is rarely the case and is likely to pose a serious obstacle and deterrent for a person trying to recover from his or her addiction.

In this connection it can be noted that there is a widely held view that at-risk teens are more likely to become addicts than others in our community. This is not necessarily so. Although a proportion of these young people may resort to addictive habits, a large number are able to shake them off once they reach the maturity to realize their folly. It will be only a small percentage of those wayward youth who actually evolve into full blown addicts.

Treatment:

The nature and severity of an addiction will determine what measures must be taken to overcome it. Apart from damaging various organs of the body, alcohol causes a drastic upheaval in the workings of the central nervous system, which literally prevents a person from stopping to drink. If placed in a position in which there is no access to alcohol, the nervous system is thrown into such disarray that the addict may suffer seizures, heart failure and even death as a result of withdrawal. Treatment for alcoholism therefore requires an intense initial period of detoxification in order to bring a person back to sobriety, followed by rehabilitation. While not all addictions have the same severe physical withdrawal that alcohol does, it is a mistake that there are some drugs or behaviors that do not come along with withdrawal symptoms like irritability, insomnia, and anxiety.

Once the person is sober, counseling is an imperative tool that is used to uproot the negative thought patterns that originally caused the addiction and create new ones to steer toward good health. In certain cases medication is used in conjunction with counseling to wean the victim from the addiction. Sad to say, however, there is no such thing as a cured addict. Addictions wreak irreparable havoc on the chemical make-up of the body. Even though a rehabilitated addict can remake his or her life successfully in many ways, the individual and the family live with the reality that if recovery is neglected there will likely be a relapse, that is a return to active addiction.

The stigma in our communities that is still associated with addictions often prevents people from getting help. This can and has been the result of unknown pain for many families. The everyday consequences of addiction gone untreated in our community is divorce, jail, and yes, death. Unfortunately both the addict and the family are often in denial that an addiction exists, so they don't even know that help is needed. Here are some red flags:

• If a person drinks regularly to "take the edge off" their stress, he or she is resorting to a substance to change their mood and may already be addicted. They are surely not coping with life's challenges in a healthy way and may want to seriously consider individual or relationship counseling.
• If one drinks too much or resorts to other addictive substances and behaviors only on certain occasions, he or she may be a binge drinker. Binge drinking, when a person becomes drunk a few times a year, is a real illness and can be worse than steady alcoholism.
• If alcohol consumption at any time - at weddings, at the Passover Seder, even on Purim -appears to have no connection to a spiritual purpose and is only for the sake of fun, the "fun" may likely be the signs of full-blown addiction.

If you suspect that a family member has an addiction or is at risk for developing into an addict, now is the time to seek help, even if you are not sure. Trust your intuition! If you are not able to convince the person that he needs help, seek help for yourself. There are several support groups to strengthen the spouses and families of the addict - even the addict who denies his condition. Remember, you should and can learn to be a happy and contributing member of your family.

For more information regarding addictions and how to find help for yourself or others, or if you have any comments or questions about this article, please feel free to send me an e-mail at [email protected]

Shim Frankel is a Licensed Clinical Social Worker. He works as a treatment team member in a private practice counseling agency in Toms River, NJ. He specializes in addiction recovery and relationship healing using his expertise in trauma treatment