Day two of my journey in rehabilitation and (hopefully at least) recovery began much like Day One….but worse. A knock on the door, waking me from a fitful sleep, telling me that we would depart for “the meeting” in 20 minutes.

Disoriented, sweaty, and still uncertain of exactly where the hell I was, I stumbled out of bed and threw on the same clothes I had worn the day before. It just did not seem to matter to me what I wore at the time, I had worn the same booze-soaked clothes for days on end before, so why change now?

I was still on a medication regime of Librium and whatever other pills they gave me to take. My body was starting to really break down by day two – the tremors, the dizziness, the beginning of my central nervous system realizing it was no longer getting what it was addicted to – in short, the actual delirium tremens were trying to break through despite the pharmaceutical assistance I was getting.

I’d been through physical withdrawal and detox before, but normally I was medicated to a greater degree. Every time I was in the hospital, they would dope me up with Librium but also had healthy doses of narcotics and sedatives. Maybe not the best choice for an addict to be given, but hospitals are focused on preventing physical or mental breakdowns due to withdrawal. And they successfully got me through that – more than once.

But here, in this rehab facility, they were focused on first preventing my body  and/or mind from shattering but they were just as focused on getting me on a path of recovery. So, no dialudin, morphine, oxycodone or the like this time. Damn the luck.

In the morning A.A. meeting, I still was not feeling up to sharing, but I was starting to feel a connection to some of the people there and what they were sharing. Plus there was lots of coffee at the meeting, which was quickly becoming my substitute addiction in lieu of vodka.

After the morning meeting we returned to Detox Mansion, where I promptly collapsed back into bed. Around lunchtime came another knock on the door, but this knock was from the person in charge of the facility. He asked if he could come in and talk with me for a bit. I obligingly said yes, and he came in and sat in one of the chairs provided in my room.

He talked with me about his background, his life, and his experiences. He told me he had never personally suffered from any addictions but that he had worked with addicts for over 25 years. As it turned out, it was his wife who had conducted my intake interview the night I arrived and who had (correctly) surmised that, as she delicately put it, “we might have a detox situation on our hands.”

She could not have been more correct. And so ends my memory of that miserable day two, feeling as though I were plunging into the depths of detox and delirium once more, but this time remembering…remembering and feeling every single minute of it.

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It is an interesting fact about alcoholics that we do not particularly care for being told what to do. Someone tells us we “have to do” something and we are automatically, viscerally turned against the proposed thing.

Someone says that the “best way” to do something is x, and we immediately access y in our memory banks while another part of our brain concurrently begins a search for z, the “optimal” solution. And people say we are killing thousands of brain cells with our drinking. Ha!

I have not seen any official studies supporting these theories, but we alcoholics tend to be sceptical of such studies anyway.

From the research, reading, and studying I have done, I have to recognise the fact that in some cases forceful, hard-hitting interventions are necessary. Such an event would be the prime time to tell an addict exactly what they need to do – but that direction must be preceded by explaining to them the effects on others and themselves of what they are currently doing.

Prior to reaching the point of an intervention, one of the worst paths of action you can possibly undertake with an alcoholic is to tell them what they “must” do.

We are clever (but stupid enough to wreck our lives with drink). We are stubborn and generally control freaks (but so weak that we become prisoners of booze). We have become accustomed to a life of subterfuge, resourcefulness, and independence (we have become masters of our destinies by becoming slaves to alcohol; we can acquire it by hook or by crook on our own, we don’t need anyone or anything….other than that liquid medication we find in each bottle).

We live in a state of denial, but I do not mean to say that “denial” means we are “liars” about that state. I heard a wonderful explanation of the concept of denial once. A therapist explained that she did not believe that “denial” equated to “lying”; rather, she espoused that someone who is severely addicted has reached a point where their brain is so constantly “fogged” that they actually no longer can comprehend much less acknowledge the state they are in. So all you Oprah fans can keep saying “Denial ain’t just a river in Egypt” and snapping your fingers. But know that the alcoholic who you consider to be lying is likely at least somewhat unaware of their true state of physical, emotional, and spiritual well-being.

Alcoholism is a somewhat unique addiction when compared to addiction to illicit drugs (and before anyone takes offence at that statement, I recognise that alcohol is a drug, but it is legal, and that’s the key point I’m trying to make here). An alcoholic can go to a convenience store, a bar, a liquor store, a shoppe, or any number of other places and get their stash on. A user of illicit drugs must make connections and contacts with other people to find and acquire their chemicals.

My point here is dead simple. Alcoholism is a very isolating disease – and I believe a key reason for that is we don’t need anyone or anything to easily acquire what we crave. “Druggies” have to network to score street drugs. “Drunks” can just wander down to the nearest Kwikee Mart and buy a bottle.

And so we become more alone and isolated. More convinced that we don’t need anyone to tell us “You have to do…”

It is a lonely road we walk, where we are convinced we are the “worst person in the world, the most miserable drunk ever, who else could possibly be so fucked up that they have a nice, stiff drink first thing after waking to make my hands stop shaking?”

So, for those of you who suffer from the disease I have, I say simply this: You are not alone. I guarantee that you will hear stories much like your own in AA meetings and in talking with others afflicted with the disease. We are each unique, but we also each have much in common

And for those of you with loved ones in your lives who are slowly but surely killing themselves with drink, I say simply this: Resist the temptation to tell them what to do, or to believe that you can “make them stop.” You can’t. Just be there for them, ready to help them find help when they are ready or able, and know that you are doing everything you can….and sometimes there is nothing you can do at the time.

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Hi my name is Jack and I am a stage 4 alcoholic.

I don’t want to focus too much in this article on the different stages of alcoholism – not because I think information about the other stages is unimportant, but because the fourth stage is so unique among drug usage that there are some critical factors I want to discuss for anyone in need of help or knowing of someone who might need help.

Stage four alcoholism’s primary indicator is a physical addiction to alcohol. Put another way, a person at stage four actually has to do one of two things – drink or detoxify under medical supervision – or they run a serious risk of death.

When I say they must drink, I do not mean the psychological craving many indicate by saying or thinking “I could really use a drink” or “I NEED a drink.” I mean that their body’s central nervous system will begin to break down during withdrawal, causing high risks of:

• seizures
• hallucinations
• profuse sweating and dehydration
• severe shaking or tremors
• alcoholic psychosis
• decrease in tolerance to alcohol
• further and severe loss of motor control skills

If you believe you may be physically addicted to alcohol, do not attempt to “quit cold turkey” or to otherwise do it on your own. You would be needlessly risking your life.

If you know someone who may be physically addicted, do not attempt to be the sole or primary facilitator of a physical withdrawal. It will be tempting to try to help your friend or loved one - especially for people who like to help “fix things for other people.”  But in reality, there is little you can directly do for a stage four alcoholic until they have completed a medically-supervised physical detoxification.

Alcohol is the only drug where withdrawal from it can kill you. Someone I know who has worked in substance abuse recovery for decades once said:

Alcohol is the worst when it comes to hardcore addictions. I’ve worked with heroin junkies while they went cold turkey, and they wished they were fuckin’ dead but they didn’t die. I’ve seen stage four drunks in withdrawal have seizures and not make it out.”

I know first-hand what stage four alcoholism feels like. I reached a point while I was drinking where I literally was drinking to avoid a withdrawal that I knew was very likely to be permanently physically and mentally damaging if not directly fatal.

Some key indicators that someone may be physically include:

• very shaky hands after waking up in the morning
• needing at least one drink first thing in the morning to calm those shakes
• waking up two or three times during the night to get a drink
• profuse sweating and/or disorientation after a few hours without a drink
• extremely blurry vision, very bloodshot and/or watery eyes

When attempting to diagnose physical addiction, it is important to also remember a few myths or misconceptions.

A stage four alcoholic may still be somewhat functional. Their acquired tolerance to alcohol will, for a time, remain quite high. The stage four will not always appear drunk at first glance. Many stage four alcoholics begin to lose their tolerance in the latter part of stage four, and at this point their ability to conceal their drinking will diminish correspondingly.

The good news is that there are effective protocols and treatments to physically detox a stage four alcoholic. Librium and Ativan are two of the primary medications used to keep the body from seizing up during the process.

Stage four is the terminal point of the progressive disease of alcoholism. Once a person has reached stage four, they must choose between a certain and premature death or a comprehensive treatment program that begins with physical detox.

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