Forgive me if I touch a topic that has been discussed many times before, it's just that I find there are so many different good opinions on this one and I need a little bit of input. Where do you draw the line between having a beer and having an alcohol problem? The reason I ask is not because of myself as I have sort of started to trust my own honest judgement of myself, but because of another persons problem (which they acknowledge). I feel I have to provide some background first because my question is slightly more specifically aimed than the general way I put it. This person used to drink way too much, way too long from way too early age. End result? Minor cortical deficiency before turning 30 according to MRI. It is maybe the worst part of the brain to have damage in, in my opinion. So I'm trying to be supportive by abstaining myself, which seems to be have a huge impact at least. It's good for both of us actually in many ways.
I'm a little surprised how this wasn't as difficult for me as I expected, being at 11 months now and having only had one drink out of curiosity mostly, which felt like confirmation that I have never indeed even liked alcohol despite self-medicating with it for period of time in my life, so I can somewhat sympathize. I still get the occasional thought that it somehow 'helps' in an undefined way when I'm stressed, but I try to remind myself how it was actually unpleasant to have that one drink. Too bad the memory is fading again. Anyway, the other party is unfortunately not as successful even though I'm really proud of their success so far. I don't judge if they end up having a few every now and then and try to be supportive, help them see negative aspects of drinking and positive sides of not drinking to the best of my ability, as subtly as I can.
The damaged prefrontal cortex is the nastiest part here, as it leads to decreased impulse control, addictive behavior in itself, decreased motivation, depression, poor concentration, cognitive decline and sort of a rigidity of thought. They have very negative thought patterns stuck in their head, terrible self-image (as in even if they get praise from others, they feel like an utter failure) this sort of general belief that they are doomed and life can't improve because healing is impossible for them. We have had many long talks where I try to convince them otherwise, but the persistent negativity kind of caught me by surprise at first, it's not rational and there is no logic to it, it is almost as if they have just decided that this is how things are, despite me pointing contradiction after contradiction in what they do or what they say, which they acknowledge too (sometimes). They are trapped, broken and a prisoner of their own mind, unable to do anything about it but watch the shadow of their former self and hope to be put out of misery according to them. Eventually after being perplexed by the problem long enough I realized I need to approach it from a different angle, the physical brain.
So I tried to explain to them what the diagnosis meant after having read it on paper, white matter and grey matter, how they could look at themselves as not broken but sort of hibernating, that their thinking capability isn't dead but is in fact intact in that grey matter but the white matter that connects to it is dead, and luckily for them, they can still form new connections. Like repairing a broken muscle, the nerves are still there but you have to reinforce the pathways and build back the muscle, and while possible it will take effort and won't happen by itself. Sort of tried to turn their hopelessness into hope by pointing out that it is the passiveness that the brain damage brought that is keeping the brain from healing and that the reason they haven't healed yet isn't that it's impossible but simply because of the insidiousness of the damage that makes it very difficult to instinctively and spontaneously perform activities that are necessary for this healing to happen in the first place.
Obviously, the best results are obtained if they completely abstain from alcohol, but it is understandably difficult when the part of your brain that sort of controls behavior is malfunctioning. I imagine every drink is a small setback under these conditions, but I don't know where the line goes where healing comes to a halt. I would really appreciate studies, personal experience and advice. Complete abstinence is touted a lot and again I would put emphasis on the fact that this would indeed be ideal, but is it an absolute requirement? It's hard to believe in absolutes when it comes to life, because the more you expose yourself to it the less black and white it becomes. Primary goal right now is to achieve undeniable progress to bring about the experience of healing which I'm hoping would be the catalyst for their hope and optimism regarding the future, I have both already when it comes to them but it's very hard to pass that forward under these conditions which is an obstacle right now.
I know that at least part of them believes me, because when I asked them to write me a list of all things they find difficult - and retrospectively I think I was a bit vague because I have to improvise here for the lack of experience - since I intended that we would do things that aren't difficult for them but incorporate aspects from that list to the doable things as a form of therapy, well I got a bigger, better and more in-depth list than I knew how to ask for!
The healthcare professionals haven't exactly been too helpful either, they put the blame on the patient for lacking motivation and sort of use it as an excuse that their hands are tied... Finding a competent doctor that actually cares for something other than themselves is like winning a lottery unless you spend a lot of money, the public sector is overworked to the point that the nurses (who you can get to see much more often than a doctor) are having difficulty remembering the names of their clients because there's so many of them. Doctors purpose is mainly to give prescriptions, and sadly they seem to be struggling even at that because there can be multiple doctors treating a single patient (i.e.a psychiatrist, specialized pain doc and a general doctor). Nobody seems to see the bigger picture even if there are extremely obvious errors, to the point I have to ask them to pass a message to their doctor which medications need to be changed and suggest safe alternatives because the current combination can be deadly. I definitely wouldn't want to be taking orphenadrine, bupropion and tramadol at the same time, least of all if there was a known danger of relapsing to alcohol. It even says in the bloody package instruction that "do NOT take these medications together" but the doctors are very insistent on always being correct, just for the sake of vanity in most cases. It's not medical expertise they apply when they check their computer program for an obviously incomplete list of medical interactions.
Turned out a bit longer than I intended, apologies for that but I really needed to speak about it somewhere I suppose.
TLDR: Where do you draw the line between having a drink and having an alcohol problem, especially if there is long-term damage from alcohol already present?