I'm Kimberly Goodrich, LCSW, LCADC - a psychotherapist who specializes in supporting women who are trying to "do it all" and may also be struggling with alcohol use. Ask Me Anything about therapy, women's issues, women's wellness/mental health and...

How do you differentiate between regular alcohol consumption and alcohol abuse? What are the steps we can do to take a step back?

Great questions! Differentiating between alcohol use, abuse and dependency can be tricky!

For me, when I'm working with clients, I define the differences as this:

Alcohol use (what you would deem "normal", "moderated" or non-problematic use) would be having an occasional drink and not drinking to excess. In this case, you're not drinking to mask emotions but rather to enjoy a drink here and there. This doesn't pose much of an issue with most people.

Alcohol abuse more refers to a somewhat regular pattern of drinking which could be things like weekend binge drinking, drinking more than 1-2 drinks per night and/or on more of a regular basis. This type of drinking is often seen as overuse to the point that one experiences negative side effects (hangovers, black outs, heightened anxiety/mood issues, sleep disturbance, etc). At this point, one might also start experiencing other issues such as concerns of friends/family, issues with work (lateness or calling out if hungover), etc.

Alcohol dependence is more of what we consider the serious stage which is when your body builds increasing tolerance to alcohol and you find yourself needing to drink more and more to feel "ok". At this stage it often is not about getting drunk, but more about not going into withdrawals. Serious physical issues are often an issue at this stage as well.

As far as steps to take to cut back - as long as you are not in the alcohol dependence category above - you can try cutting down your drinks by spacing them out and having water in between, you can eat a heavier meal before drinking so you are full and less likely to want to drink more and you can build in a support system of friends/ family who encourages you cutting back or stopping without sabotaging your efforts. Also avoid places or situations where you think you might want to drink more.

My addiction is to my phone-social media, news sites, etc.- rather than alcohol, but likely as a manifestation of the same issues. Can you point me to any resources or suggest a course of action? My kids are similar but I can’t chance it for them when I can’t be away from my screen without feeling pulled back to it.

Thank you for your question. This is a big problem for many people these days! Behavioral addictions are very similar to drug or alcohol addictions in so many ways. Could you consider taking a "phone vacation" - even if it's only for a short time, like an hour or two - and then just ask yourself how it felt. If you can do that, maybe then increase the time each day you're off of your phone a little but more. It would basically work like a behavioral extinction. And in the process, monitor how you feel. Possibly even consider doing this with your kids together so it's not just you and it might make it a little easier. Our brain gets wired from the stimulation of our phones and it takes some time to break. Maybe replace the time you're off of the phone with some exercise or other hobby or fun activity to keep you stimulated, but in a healthier way.

Do you support harm-reduction methods that use medications like naltrexone and The Sinclair Method? TEDx https://youtu.be/6EghiY_s2ts

Thanks for this question! I absolutely support harm reduction methods such as naltrexone and the Sinclair Method. A big issue in this field, I believe, is that we expect that with a snap of a finger, people should just be able to stop and addiction doesn't work that way. I feel like it's very important - especially for that first year - to get any and all support to get solidified in recovery. Medication-assisted approaches and options make it much more likely that people can obtain abstinence and get the physiological support they need to maintain it longterm.

Why did you think that Sinclair Method that had been proven to be effective in Europe, isn't widely used in US?

Thanks for the question! I think the US is still a bit more behind in terms of how they look at addiction, honestly. I think there are people who aren't buying into the medication assisted recovery realm despite what we know about how addiction works. Hopefully we are getting there.

Thanks for taking the time to do this.

Any advice for someone who is stuck in a depressive, self imposed isolation following trauma from more than a year ago? I'm a mom, wife, and artist working from home and I love my family dearly but I have had an aversion to being around nearly anyone, and the feelings seem to be getting stronger instead of lessening.

Thanks for your openness and for reaching out. I would ask yourself what are the things that are really weighing on you. Is it more than the trauma you experienced? Not that trauma can't cause you to feel this way; but I'd wonder if there were any symptoms you were experiencing even before that.

Depression will absolutely cause you to feel like you want to isolate and not deal with anyone. If you feel that it is increasing (which is what it sounds like), then I would recommend finding a good therapist who you feel comfortable with to get some support. A good connection with a therapist is really key. I'm sure you don't want to be feeling this way and so I would really recommend reaching out to someone as soon as you can. And if even that is a struggle, ask someone who you trust to help you.

If someone believes a friend, boss, or coworker has mental health issues while also struggling with alcohol issues, how would you recommend that they share their concerns with her so they can get the help they need?

Great question - My suggestion would be to find a time to speak privately with the person and share your concerns. It's SO important to come from a place of care and concern in these situations because what you can sometimes encounter is someone getting angry and defensive. I think the key is in your approach. Coming from a caring place, stating what you've observed and why you're concerned - but without being too accusatory or blaming. People really need to accept their problem before they are willing to get help for it. It is also super important to remember that whether the person accepts what you say or not, that you are doing the right thing by voicing concern and it is not a "failure" on your part - or that the person doesn't care enough about you - if they don't seek the help they need.

As somebody has been in the alcohol dependent category and knows many others that still are, I would say if the person does have a problem it's more likely than not that they will get angry and defensive if you raise a concern about their drinking. Unfortunately, addiction is a gnarly beast and will overpower the kindest, gentlest souls and twist and gnarl them into whatever it needs to be in order to protect the bad habit.

I don't want to discourage anybody from talking to people they care for about their alcohol problems, because they absolutely need all the support and help they can get, but I just wanted to really highlight that someone you've known your entire life can become a whole other person when their addiction gets threatened.

You are absolutely right.

But the thing to consider is this - when/if this person does get help and gets sober one day, he/she will remember who cared and tried to get them help, and who didn't. Even if in the moment they get super angry - they will often remember who tried to help and who cared enough to say something.

Definitely :) It is VERY difficult to truly know the dregs of despair full blown alcohol addiction can bring on. It can be so painful helping people you care for out of the pit they've found themselves in, and doubly so when they lash out at you for just trying to help. But they will absolutely remember everything you did for them if they make it through the other side!

Thanks for the work you do, it isn't easy!!

Thank you for being a part of this important discussion!

Do you think the disproportionate burden of emotional labour weighs on busy women, and is a contributor to dependence on alcohol?

Absolutely! I not only think emotional caretaking responsibilities often fall on women, but also the cultural expectations of having to "do it all", be perfect at all of their roles, look a certain way, etc. All of these roles, responsibilities and expectations don't often allow women space to maintain their autonomy and independence - therefore, creating huge amounts of stress and self-neglect that can lead to wanting to "escape" with a drink (or 10).

What advice/tips do you have for moms with a history of Alcohol Use Disorder that are going from 1 child to 2 children? How to help cope with the added stress.

Thanks for this question! Having a second child can often be a stressful adjustment and, if there is a history of drinking, this is certainly a risky time. I would recommend two major things:

1 - "Build your Village" and let them help you! I always use this term with my clients. Get people around you who can help support you in this transition. Maybe even get someone to spend some time with your older child so that you get a little quiet bonding time with your new baby at times. Allow people to cook for you, clean for you...whatever you need to make the transition less stressful. You will eventually become used to balancing two children but it does take some time for most.

2 - Give yourself permission to ask for help when you need it! People can't read our minds. And we can't always do "it all". (Trying to do it all will only cause you more stress and want to escape with a drink!) Give yourself permission to ask for help when you need it - it's completely ok and you'll also be a good model for your children as well!

Can you comment about prioritizing when everything feels important? I want a full/rich life with friends, partner, work, home, hobbies, mental enrichment, physical health, etc. I never have enough time or steam to make as much progress as I actually want though even if it's all priorities I set and care deeply about. What's a more realistic perspective that I can adopt while still feeling like I'm not giving up.

I would say this - we can always use more time...but that's not an option (unfortunately). The only option we have is to look at the things that pull us in those difference directions and prioritize. And we need to try to prioritize ourselves first. That doesn't mean that those other things can't still be important and valued. But - The problem becomes putting these other things before ourselves. Are there things that you can give up? Or delegate to someone else? Or that might not need to be done right now?

Is there ever an awkward incongruity or possibly triggering between balancing a 'gender equality for all' with a requirement for 'unique needs of women' when specialising in a gender divide in your field? The wording for either side would be an HR difficulty here.

Edit: spelling then wording / the wording

Specializing in working with women doesn't at all mean that I don't support gender quality for all - and no, I have not found this to be an issue. This is a population that I have found to be quite underserved and feel like it needs attention. It is also a population that I love working with tremendously.

Issues regarding self-worth, impostor syndrome, home and relationship and their connections to identity, etc can weigh very broadly and heavily on women due to socialization and upbringing. Are there particular responses or tools you use or recommend to combat something that's so widespread and culturally reinforced? Is this a different approach in any way than what you'd use for a more individual issue?

Thanks so much for the great questions! I completely agree with you about those issues weighing very heavily on women due to culture, socialization and upbringing. Women are essentially (and historically have been) indoctrinated into caretaking roles and bearing many burdens of responsibility while also being held to unrealistic standards. I think women are slowly now beginning to realize the weight of these issues on themselves more than ever. All we hear about now is self-care and it's importance - but what the heck does that even mean? I've had women ask me that.

First - I think it's important for women to really understand how they've been indoctrinated into this culture where there are an excess of roles we are "supposed" to take on and that this is how we got here. Once they see it from a more objective view, I think it really changes their perspective a bit. They then go from being a victim of this - to an agent of change. Once some changes are made that help them feel less burdened, it really is a big motivator.

My approaches when I work with women individually on this are education (on what I said above) and then some major boundary work. Setting boundaries on smaller things such as "I need your help with this..." or "this times doesn't work for me, but this time does..." helps them create space for their own needs. Once this starts to happen, it's amazing to see the shift it makes. They learn that it not only feels good to set boundaries - and even more so, that people don't dislike them and the world doesn't fall apart if they can't get to everything (which is often a big worry).

Thanks for all of your insightful questions! I love these discussions. I'll keep this open for a while longer and come back to answer any more questions that come in.

What are some ways you have seen people manage their stress effectively after they start to have alcohol dependence?

Thanks for the question! Typically, if someone is becoming more dependent on alcohol, they are not managing stress effectively in the least. Alcohol dependence in terms of it's nature doesn't allow for healthy functioning really at all. The work in learning to effectively managing stress comes after the person is medically stabilized and enters into recovery.

Can you discuss the roll of anger in relation to post partum mental health?

Mental health postpartum is something that really needs to be monitored closely. Fluctuations in hormones (which can happen as long as up to 18 months postpartum) can cause some rapid and unexplainable changes in mood, including irritability and anger outbursts. In addition, new mothers are often experiencing a lot of stress in the transition to motherhood which can lead to mood issues as well. If you notice a change in mood with someone postpartum, it is important to discuss it with them and encourage them to discuss it with their doctor.

This might be off topic but what would you say is the key difference between a LMHC and a LCSW? I've heard that the work is similar and the pay is the same but for the life of me I can't wrap my head around the difference.

Sure - happy to answer this the best I can for you. There most likely isn't much of a difference, honestly. It's a matter of education specialization behind the license. For example, LCSW's have a Master of Social Work degree. Here in NJ, we don't have a LMHC but I'm guessing in whatever state you are in, they do. Most likely the education needed behind the LMHC is similar to social work but might consist of different types of coursework. At the end of the day, the licenses are probably quite similar and pay rates may be similar too, based on your area.

That's interesting, thank you for answering! Sorry if it was a strange question but I'm currently looking at grad school for clinical psych but I'm stuck between those two as program options. Your response does help a lot in clarifying things though!

Happy to help! And not a strange question at all! Good luck to you!

**EDIT - I'm going to close out the conversation now but may pop back on later to answer another question or two. Thank you everyone for the amazing questions and I hope you found the discussion helpful!

Could you recommend a good resource for linking up with a niche/specialized therapist kind of like yourself for teletherapy? I'm fortunate to actually have really good insurance, but my area doesn't have a whole lot to offer in terms of diverse specialized adult therapy.

I feel like I'm really aware of the general categories that my issues fall into— addiction, gender dysphoria, high achiever burnout type stuff, and I would really like to delve into those with someone who has a lot of knowledge about them.

Sure - there are absolutely therapists out there who specialize in this who do teletherapy. It really depends on where you live. Where do you live? I would recommend Psychology Today, Therapy Den and Mental Health Match as places to look. Generally you can filter by state, niche, etc. With teletherapy, you'll have more options as long as you find someone licensed in your state.

Thanks for the response! I'm in Kentucky.

edit: I missed the last part of your comment somehow— long day— so you answered my question. haha

Is it common to get licensed in many states?

Yes it is somewhat common, especially now with Telehealth. I’m licensed in NJ, PA and FL (for Telehealth).

How would you help a person who abuses alcohol doesnt recognize that he/she has a problem? Why do they hang around the same people as them? Do they care more about alcohol than their children?

As far as your first question, I would start with working from where the person is. Meaning, that if he/she doesn't think they have a problem, why are they there? What are they looking for? I would start with that. We often want to jump into the problem before people are ready to even acknowledge that it is a problem. It's just counterproductive to do that.

They often would surround themselves with others who are similar because to not do that, they would realize more so how they are different and might need help. And no - I do not believe that people care more about alcohol than loved ones. I hear that people often feel like that is the case - "if they love me why won't they stop?" - but the addiction has nothing whatsoever to do with how much one cares for their children or other loved ones.

Thank you for what you do. Wine moms tend to be such a normalized part of society, when in reality it's just another addiction and distraction for the underlying issues, which often aren't properly addressed.

I actually have two questions. I also went to school for psychopathology (BAs in Psych and Soc, with a minor in cognitive science), and got my leg broken around when I was taking the GREs then just kinda crapped out, and I've noticed a significant amount of people in the field do so with a purpose. I wanted to work with children, specifically due to my own background. What led you to choose this specific speciality and cause?

The other question I have is as a woman with alcohol dependency who has been to the shrink (she just wanted me to lessen my use, but did not give me the effective tools to overcome the dips and urges. DBT helped, but isn't enough to satiate the ultimate "need" for the recurring behavior, and its yucky consequences...). It started gradually until it became a full blown problem, and while I would like to think I'm "smart and educated enough" to not fall prey to the same tendencies, it happened. Besides the obvious of therapy, meds, support systems, etc, what would be your single best and most effective recommendation for the "functional" drunk woman who does in fact wake up to work at 4 every morning, goes to work, pays the bills, and yet falls back into the hole time and time again?

ETA: I'm also diagnosed CTPSD, Borderline, GAD, MDD, and PMDD. It's fun being me, and still trying to function in an appropriate manner ..

Thanks so much for your openness and questions. What led me into this field was having addiction in my family and wanting to really understand it better. I found that I loved the field the more I learned about it - which also helped me personally. Working with women I slowly realized was where my real passion was ; I LOVE watching women transform, become empowered and find themselves. Plus it is an underserved population where I live and work and felt the pull to do it. It's what really lights me up.

My biggest recommendation to you would be to ask yourself who you REALLY want to be. You sound like you are going through the motions, but are you really "living"? If not, ask yourself why. And what do you want? What lights you up? Once you let yourself lean into those questions, you'll probably have much more motivation to prioritize yourself. I wish you the best!

As somebody who deals with mental health issues and addiction and has a supportive mum, what's the best way to mitigate causing her stress and worry? I really worry that my own struggles have a negative impact on her health, mental and physical.

When I was younger I was worse, and I know for a fact how much it affected her, I have one horrible memory of her in tears because of me. Since then I've tried harder not to let it get that bad. But even so I know she worries about me even if I'm careful in how I talk to her about how I'm doing, or even if I pretend I'm doing ok when I'm not.

Obviously she's my mum I can't stop her caring or worrying about me. But maybe there are certain less-obvious things I could do or say (or not do or not say) that might help?

Thanks.

First of all, thanks for sharing and you are very blessed that your mother is supportive and cares so much for you. I understand that you may feel like you put too much on her and don't want to burden her with more worry. However - the thing to remember is that we can't be responsible for other people's feelings or how they handle them. I'm not saying this to sound callous in any way - I understand you care about her. I'm sure you want to be able to have an open and honest relationship with her - and this might mean her hearing things that effect her. It is then important that she seek her own support in managing those feelings. You have enough on your plate managing your own mental health, right? Encourage her to get her own support system in place and then you will feel much less stressed and you can have a positive relationship where you feel like you can both share your feelings honestly with one another.

Can someone do the same thing for men? I had next to zero support with my severe alcoholism (overwork and depression) from the medical and psychology community and pretty much had to beat it thru sheer force of will. Cause you know, men are bitches if they ask for help 🙄🙄🙄

I'm sorry that was your experience. There are therapists out there who do specialize in working with men - but availability, etc also depends (unfortunately) on where you live, accessibility, etc. I hope more men do begin to feel more comfortable asking for help and getting what they need.

I’m a smart successful white collar working mother, on the outside. On the inside I’m resentful, angry, anxious, terrified, bitter, and I suck back a bottle of wine to myself and go to bed sober because I am also a drunk.

Is this Norma? Or am I fucked?

You aren’t alone and this is exactly why I focus on working with these issues! There are a lot of women out there struggling just like you. There is help out there- the key really is finding a therapist you feel a good connection with. I wish you the best.

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Thanks for the question! Not all headaches or stomach issues are related to alcohol use but...if you know someone is drunk, often it's good to let them sleep it off on their side. If you feel they warrant medical attention, then it's safest to call 911.

What do you think about Naltrexone?

I think it’s a big help for many people and really sets people up for success with sustaining recovery. I answered a question on this earlier also.

Do you help men as well?

I do work with men as well, yes!

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Trauma, grief and loss are expressed and processed in many different ways and in different time frames. It's never a linear process. As I therapist, I don't judge how my clients grieve. I just help them try to understand what they're feeling and how the ways they are dealing with it (or not dealing with it) may be impacting them. People will do lots of different things to try to stabilize or neutralize the intense feelings they are carrying - which is what we as human beings will do to just survive during emotionally difficult times.

You state that you specialize in "supporting women who are trying to "do it all" and may also be struggling with alcohol use." Why is there a focus on women if these issues affect men just as much if not more? (as in the rate of alcoholism in the US is higher amongst men, as well as rates of suicide)

Thanks for your question. First, I do treat men as well and don't deny that they are a population that needs attention as well. For me, I have found that women who drink are an underserved population in my area, so I have chosen to gear my practice towards that population. Also - because that is the work that I really lights me up.

I guess my question would be, Why do you specialize by gender? You are limiting your patients big time for what reason? Are you disinterested in males of the same species plights? Help me understand my ignorance.

Thanks for your question. I do treat men in my practice as well but I have found women with substance abuse issues to be an underserved population in my area. Plus - I personally really enjoy working with them. There are plenty of therapists out there for everyone and I certainly do treat male clients as well.

Why specifically only for women? How are their needs unique compared to men?

I don't at all dismiss the fact that men struggle as well and are in need of services. But for me - over the years, I've had a lot of women come in for help who are drinking a lot more behind closed doors and because of the shame associated with it are often an underserved population. Culturally speaking, men drinking is seen as much more "acceptable" than women - and women who are struggling the trying to meet the demands of their jobs, families, loved ones, etc are drinking to manage the burdens, responsibilities and stress they are carrying and feel like failures for not being able to do so. Women in our society are typically expected to be caretakers, emotional supports, "perfect at everything", look good physically, etc. and it's a completely unrealistic bar to meet.

Culturally speaking, men drinking is seen as much more "acceptable" than women

Could you elaborate? Despite the outward presentation of "men drinking = acceptable" compared to women, how different are the root causes of alcoholism for both?

Also, have you noticed any divide along cultural lines (say, mixed race individuals), or is it fairly homogenous across them all?

The root causes for alcoholism can be both the same - and different - for men and women, really.

For both - certainly factors such as genetics, environment, etc can certainly create more of a predisposition to alcoholism regardless of gender. But then you have specific factors that are unique to men and to women. To women, as I mentioned previously. And for men, I often see factors like stress of being a provider, not feeling comfortable sharing emotions, etc as some of their underlying issues.

I personally haven't seen a huge difference in terms of cultural/racial lines in my practice in this regard.