The Dark Side of the Holidays
Every year, I notice a consistent trend in my practice. Between Thanksgiving and New Year's Day, a significant number of my clients either quit, no-show sessions, or chronically cancel appointments. New client inquiries plummet.
Most therapists experience a "Summer Slow-Down" when their clients go on vacation. As a substance abuse counselor, the trends I experience are a little bit different. My practice experiences a dramatic "Holiday Slow-Down." As my schedule clears up in December and my phone stops ringing, I prepare myself for the inevitable - the crushing demand that will come the first week of January.
The disappearance of my clients officially starts on Black Wednesday - the day before Thanksgiving.
Most of my clients are high-functioning professionals who are NOT alcohol-dependent. This means that they don't experience signs of withdrawal or tolerance such as tremors, feeling a *need* to drink in the morning, or symptoms of psychosis when they stop drinking.
Offices tend to close early on Black Wednesday, allowing my clients to grab a few drinks before heading home. This often escalates into either staying out later and going to other bars, or returning home with a bottle of liquor and drinking alone. The opportunity to continue drinking extends through Thanksgiving Day. Anticipating the day off on Friday, people can drink heavily without fear of negative consequences to their career.
Then comes December, replete with non-stop opportunities to drink indiscriminately without necessarily being judged by peers. Holiday parties, office get-togethers, and family events provide people with an excuse to drink almost every week, often several times per week.
Why it Happens
When I do receive phone calls in December, they tend to come from significant others or family members of people who aren't my clients. They want to know "why."
"Why is this happening again?"
"Why can't he stop after just a few drinks?"
"Why would someone sneak drinks?"
"Why does he lie to my face?"
And of course, in their tortured state, these family members have been wracking their brains with theories to try to understand what is happening.
"It's probably because he hates his parents."
"People get depressed this time of year."
"He isn't dealing with his anger."
"He doesn't love me anymore."
Significant others tell me about their beautiful children, their good jobs, and their white-picket-fence-lives. They are heartbroken and confused. Things seemed to be going well, but then their loved one fell off the rails.
The Holiday Suicide Myth
Although it is a common belief that the holidays are correlated with a high rate of suicide, the suicide rate is actually lowest in December. Regardless of the colder weather, decreased sunlight, and increased holiday stress, there is no evidence to support the Holiday Suicide Myth.
How can this be? We have abundant evidence correlating suicide with substance abuse and depression. The explanation behind this de-bunked myth is complex. In my clinical experience, it starts with Thanksgiving.
A Slow Suicide
When we look at the hard facts and the reality of what people face in the holidays, we naturally come to the conclusion that alcohol and drug abuse in December represents a set of coping skills gone horribly wrong.
It does, indeed, start with Thanksgiving. When you're surrounded by consumer messages of gratitude and happiness, Facebook status updates celebrating a curated "reality," and the cold reality of your own unmet expectations, the numbing escape of alcohol and drugs becomes extremely appealing. When you add that to the fact that we find it culturally acceptable for people to get drunk on Thanksgiving, the dominoes start to fall.
After posting that picture-perfect Thanksgiving dinner on Instagram, couples come home and engage in ugly brawls behind closed doors, often spurred by alcohol. Perhaps someone got too drunk and created a scene, said something inappropriate, or acted in a way that was embarrassing. Drunken fights are wasted energy, most often because people discount responsibility for their actions if they are drunk or in a blacked-out state.
Fast forward to the morning after, and anger, shame, and resentment flourish. Alcohol withdrawal leads to anxiety and depression, and the person who was drunk spends the day thinking, "What is wrong with me?" "I'm a terrible person." "I'll never redeem myself to my in-laws."
By 5pm the day after Thanksgiving, the body is ready for relief and craves alcohol: "I'll just have one glass of wine to take the edge off."
Friday may be subdued, but Saturday provides another opportunity to get after it. Friends may be in town, or people may be returning home and relieved to be in their own homes. Monday feels far away, and there is always Sunday to recover.
It makes perfect sense to me why clients disappear in December. The vicious cycle has started. And one of the reasons why suicide rates really are so low in December is because people are either too depressed to make the attempt, or they are using drugs and alcohol to numb themselves to their unhappiness. In this way, holiday drinking often represents a slow suicide.
The First Week of January
My phone won't stop ringing. My answering service is handling multiple inquiries per day. And I spend as much time scheduling clients as I do referring them elsewhere, since my private practice has limited capacity.
By January, bridges have been burnt. Perhaps those bridges were burnt before, but now things are even worse. January is the ultimate hangover, where isolated people are forced to face everything they avoided in December. Their social support has worn thin, and they are filled with shame.
The Way Out
My work is focused on behavior change, and my clients spend the year identifying new coping skills and effective tools to prevent the shame-cycle. We prepare for the reality of the holidays, and develop contingency plans if they relapse. I tell them about this trend, and they understand that they can pick up the phone and call me in January even if they blew me off in December.
However, even if our work together is perfect, it does not change the fact that there are millions of people in this country who suffer during the holidays. If we look at substance abuse during the holidays as a symptom of a larger cultural problem, we can see that we all need to embrace significant changes.
- Rethink social media. With robust research indicating the correlation between social media and depression, we all should embrace a more honest presence during the holidays. It is wonderful to see pictures of children, pets, and happy families, but look at your Facebook wall or Instagram feed and ask yourself if you are presenting a curated reality. The solution isn't necessarily to disclose all of your personal problems on social media, but rather to consider the collective impact of your presence online, and whether or not you see an accurate representation. Your own likelihood of depression and substance abuse increases when you create a mismatch between your perceived self and your actual life. Friends who might otherwise reach out to you and confide in you may feel hindered because "your life seems perfect." We owe it to the people we love, and to ourselves, to be honest in our presentation to the world.
- Avoid the drunken brawl. You may have a significant other who overdoes it one night during the holidays. You probably feel a sense of anger, betrayal, and embarrassment. But bear in mind that the right time to confront your loved one is not WHILE they are intoxicated, but the morning after. And in that confrontation, be descriptive of what you saw and of your feelings: "You were slurring your speech while talking to my niece, and I was so embarrassed. I'm really worried about you." Do NOT label your significant other, "You're an alcoholic!" "You're a jerk!" "You're a horrible father!" Even if you FEEL these things are true, you will inevitably push your loved one away, who will become defensive, argumentative, and less likely to change.
- Reach out to supportive friends. Each time you interact with someone with whom you feel OBLIGATED to interact (eg a parent you do not like), make a point of scheduling time to interact with someone who is fun, helpful, supportive, and non-judgmental. Even if this involves actually picking up the phone and calling someone, you will help to counteract the negativity of seeing someone you did not want to see.
- Cut out the texting tirades. This may seem unrelated to drinking, but the connection is stunning. Take a moment to scroll through your text message inbox and look for the people who have gone on text tirades with you over the past few months. Text tirades are ones where someone is emotional or angry and texts you long, multi-message paragraphs of text (Hint: this tends to be family members, significant others, or exes). Texting tirades are 100% unhealthy for you. Make a commitment to only e-mail with this person, even if they bait you with multiple, provocative text messages.
- Do something nice. Even if you end up shame-cycling throughout the month of December, you can mitigate the awfulness of it by following through on a commitment to helping others. Find a charity or non-profit that means something to you and get involved. Hand out gloves, hats, and scarves to panhandlers. Make a charitable donation to a cause you care about. When you can remind yourself that you are indeed a good person, you dramatically reduce the likelihood that you will engage in a slow suicide.
- Identify when you're thinking in "shoulds." Nothing hurts us more during the holidays than thinking in "shoulds." Should-statements reveal our expectations, for ourselves and others, and many of them are unrealistic. "I should have a father who loves me." "I should be able to buy nicer gifts for my children." "I should be happy right now." When you notice a "should" showing up in your thoughts, just remember that your thoughts are just thoughts - a form of information that is sometimes useful, sometimes not.
These commitments to ourselves are not selfish; rather, they enable us to be the best person possible and truly engage in behaviors that represent our personal values. The holidays can be hard, but they do not need to be awful. And if you read this article the morning after a rough Thanksgiving Day, just remember that it is never too late to take personal responsibility and get on the right track. SS
This article was republished on The Good Men Project.