Raise the Bottom--Book Review

Recognizing alcoholism in the workplace.

In addition to all the other damage they do, alcoholics can literally cost businesses a fortune, says marketing consultant Arthur M. Jackson in his new book, Raise the Bottom. As a means of helping employers identify the problem, Jackson offers a checklist of early, middle and late-stage alcoholic behaviors, from drinking everyone under the table, to blame games, to personal financial problems.

The litany is at times simplistic, and the book is written in the Kenneth Blanchard “One-Minute-Manager” style of easily digestible business books, with a fictional senior consultant doling out data to his fictional protégé. Nonetheless, the author manages to impart some useful information, and draws attention to a problem most people choose to avoid or ignore—the toll active alcoholism takes on workplace efficiency and trust.

Physical early warning signs to watch for, Jackson writes, include a family history of alcoholism, “pre-drinking” before social functions, frequent lying, and cigarette smoking (a majority of alcoholics smoke cigarettes). These are all valid potential red flags, but often difficult to discern in a workplace setting.

Alcoholism is more likely to show itself in the middle stage, when “quotas go unmet, goals unachieved, and promises not kept.” At this stage, bosses and managers are likely to help the alcoholic with his excuses, agreeing that he or she is having an “off year,” or “problems at home.” Indeed, multiple divorces and increasing financial difficulties often accompany the progression of addictive disease.

The author leaves no doubt about where he stands on the disease debate: “We don’t punish someone for having a disease. We separate the alcoholic behavior from the alcoholic... The maladaptive and negative behaviors, and the poor business results following from them, must face direct consequences or they will continue.”

Two other maladaptive behaviors characteristic of the middle stage are “sexual exploitation” and “road rage,” writes Jackson. As odd as this may sound, I think the author is right here. Both behaviors—compulsive promiscuity and episodes of instinctual rage--can be seen as impulse control problems, which alcoholics often exhibit.

As the middle stage increasingly leads to poor job performance and declining results, “the downward slide of the progression begins to be noticeable to others, although the cause—alcoholism—is still well hidden most of the time.” The presence of the “pink elephant in the office” goes unaddressed—and things get worse.

Sensibly, the author notes that a single DUI or DWI does not prove the case for alcoholism. However, landing a second DUI, or continuing to regularly drink while driving, may be another matter entirely.

Jackson is a firm believer in early intervention on the part of friends, family, and coworkers. Moreover, “The job lever—the risk of losing his job because of alcoholism—can have a crucial effect.” Jackson’s two-word prescription: “Stop enabling.” By recognizing potential alcoholism and moving toward treatment rather than turning away, workers can break through the conspiracy of silence and help “raise the bottom” for alcoholics--saving their jobs, their relationships, and often their lives.

Photo Credit: http://www.freshknowledge.co.uk/

addiction alcoholics anonymous

Take the Alcohol Test

CAGE questionnaire still a useful tool

Despite the time, labor, and expense that have gone into the search for a better way to diagnose alcoholism, researchers have yet to outdo what may be the simplest, most accurate test for alcoholism yet devised. A set of four simple, relatively non-controversial questions, first devised in 1970 by Dr. John A. Ewing, still serve as a useful predictive tool for alcoholism.

Neurobiology has taught us that addictive drugs cause long-lasting neural changes in the brain. The problems start when sustained, heavy drinking forces the brain to accept the altered levels of neurotransmission as the normal state of affairs. As the brain struggles to adapt to the artificial surges, it becomes more sensitized to these substances. It may grow more receptors at one site, less at another. It may cut back on the natural production of these neurotransmitters altogether, in an effort to make the best of an abnormal situation. In effect, the brain is forced to treat alcoholic drinking as normal, because that is what the drinking has become.

The likelihood that many alcoholics and other drug addicts have inherited a defect in the production and distribution of serotonin and other neurotransmitters is a far-reaching finding. While it is difficult to measure neurotransmitter levels directly in brains, there are indirect ways of doing so. One such method is to measure serotonin’s principle metabolic breakdown product, a substance called 5-HIAA, in cerebrospinal fluid. From these measurements, scientists can make extrapolations about serotonin levels in the central nervous system as a whole.

However, testing for serotonin levels is imprecise and impractical in the real world of the doctor's office and the health clinic. Despite all the promising research on neurotransmission, what can physicians and health professionals do today to identify alcoholics and attempt to help them? For starters, physicians could look beyond liver damage to the many observable “tells” that are characteristic patterns of chronic alcoholism—such manifestations as constant abdominal pain, frequent nausea and vomiting, numbness or tingling in the legs, cigarette burns between the index and middle finger, jerky eye movements, and a chronically flushed or puffy face. Such signs of acute alcoholism are not always present, of course. Many practicing alcoholics are successful in their work, physically healthy, don’t smoke, and came from happy homes.

The CAGE test takes less than a minute, requires only paper and pencil, and can be graded by test takers themselves. It goes like this:

1. Have you ever felt the need to (C)ut down on your drinking?

2. Have you ever felt (A)nnoyed by someone criticizing your drinking?

3. Have you ever felt (G)uilty about your drinking?

4. Have you ever felt the need for a drink at the beginning of the day—an “(E)ye opener?

People who answer “yes” to two or more of these questions should seriously consider whether they are drinking in an alcoholic or abusive manner.

--Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.