Does A Purple Nose Indicate Alcoholism?
The short answer is, “No.” The long answer is more complicated than that. The condition of “purple nose” is called rhinophyma, which is, in truth, end-stage rosacea of the nose. Rosacea, itself, is a condition that causes redness, swelling, and bumps on the skin, mostly on the face and neck. While it is true that alcohol can exacerbate the symptoms of rosacea and/or rhinophyma, it doesn’t mean that rosacea is caused just by heavy drinking. In fact, a single drink can cause a rosacea flare-up. However, so can spicy foods, hot beverages like coffee or tea, stress, or even just the sun, particularly if you’re exercising.
Rhinophyma, Rosacea, and the Unfair Stigma
The sad truth is that people who suffer from rosacea, rhinophyma, or both become unfairly targeted, mocked, and judged as Gopman et al., showed in a 2015 study. The condition can become so bad that the nose will swell shut, necessitating surgery so that the person can breathe normally and easily again.
When rosacea progresses to rhinophyma, the skin not only becomes red, but small blood vessels in the skin also burst, and pus-filled pimples that are similar to acne form. Rosacea also affects the eyes and eyelids. Rosacea in the eye is painful and irritating. Interestingly, rhinophyma is almost exclusively a disease of people who are assigned male at birth while ocular rosacea is mostly a disease of people who are assigned female at birth.
Rosacea itself, including ocular rosacea, has no cure, but even if surgery isn’t required to restore normal nasal breathing in someone with rhinophyma, surgery is the chief treatment when it comes to reducing the size of and reshaping the nose of someone with the condition. It’s not just spicy foods and alcohol that cause flare-ups of rosacea or instances of rhinophyma. Different people have different trigger foods. As shown in the previously linked information from both the Cleveland Clinic and Mayo Clinic, genetics also play a part in the development of either condition.
The erroneous conclusion that rhinophyma is directly caused by alcoholism means that people who have the condition often don’t seek treatment for fear of being judged. Their quality of life also suffers because they often don’t go out to socialize, preferring to avoid contact with others so that they avoid the stigma.
The stigma also has a detrimental effect on a person’s mental health. Not only is there public stigma, but there is also self-stigma. The self-stigma comes about when people think that they’ve let others down and experience mental harm through a combination of shame and embarrassment. Their self-esteem plummets, and they are at risk for conditions such as depressive disorder. These risks are over and above the risks of alcohol or any other substance which they intend to misuse.
It also becomes a self-fulfilling prophecy when someone experiences stigma, develops shame, and then says, “Well, why should I try?” “The hell with it,” is also common. The latter is tied to the concept of self-efficacy, which is the drive to succeed, seek and keep employment, and even just be independent. In the worst cases, the mental health challenges that arise from a combination of public stigma and self-stigma keep people from seeking help. The colossal tragedy of the whole situation regarding rhinophyma is that, in many cases, it has nothing to do with alcoholism.
Alcohol Use Disorder: A Disease Too
It is also grossly unfair to heap stigma upon someone who misuses alcohol. Alcohol Use Disorder, or AUD, is a brain disorder. According to the National Institute on Alcohol Abuse and Alcoholism, the condition is self-perpetuating because misuse of alcohol causes brain chemistry changes that make it more likely for a person to relapse, even if that person is undergoing treatment for the condition. According to the National Survey on Drug Use and Health, 28.6 million people aged 18 or older experience AUD. That’s one in nine people that age. Further, 894,000 children aged 12-17 experience AUD, which is one in 30.
Several factors contribute to the possibility of someone developing AUD, and these include family history, starting to drink early, and a variety of mental health conditions. Those conditions include attention-deficit hyperactivity disorder, post-traumatic stress disorder, and depressive disorder among others. The symptoms include spending a lot of time drinking, wanting to cut back and not being able to, stopping other activities, blacking out, going through withdrawal when you stop drinking, or putting yourself unwittingly into dangerous situations.
AUD Treatment Options
Treatment of AUD is a multifaceted discipline that encompasses both physical and mental strategies. Generally, if you’re concerned, then you’ll go to your family doctor. If your doctor suspects that you might be misusing alcohol, then your doctor will start with some pertinent questions.
Doctors will usually ask about your drinking habits. If they’re not satisfied with your answers, or they simply need more information, then they might also ask you for permission to speak with your friends, colleagues, and family members. Remember, though, that you have to give your doctor permission. Doctors aren’t allowed to disclose anything about you without it.
They’ll also perform a complete physical. Even if rhinophyma is not necessarily a symptom of AUD, many other physical conditions and complications are, and doctors will be able to detect those. Also, even though they can’t “test for AUD,” they can test for other things, the combination of which could suggest AUD. To achieve an accurate diagnosis, which also could include a dual diagnosis of AUD and a mental health condition, doctors will refer you for a psychiatric evaluation, which is the mental health equivalent of a physical exam.
Once your doctor has established at least the likelihood that you are experiencing AUD, then the next step is to develop a treatment strategy. These strategies can include:
- Managed detox
- Counseling
- Oral medications
- Intravenous medications
- Treatment of comorbid conditions, either mental or physical
- Therapy
- Support group participation
- Spiritual treatment if you’re religious in any way
- Rehab
Rehab and managed detox are only for serious cases when there is no other option. Whenever someone is experiencing severe AUD, a “cold-turkey” quit can be lethal. Severe alcohol withdrawal is called delirium tremens. Untreated, the condition can be fatal in up to 37% of cases. Even with treatment, the mortality rate is still 5%. Therefore, even with the danger, controlled alcohol detox that is attended by medical professionals is essential for treating severe AUD. Controlled detox can help prevent someone from experiencing the DTs.
Once a person has gone through detox, then the rest of the treatment strategies are lifelong. Although the term “alcoholic” is losing favor in the 21st century, you can paraphrase the old saying, “Once you have AUD, you always have AUD.” Controlling the disorder is the number one goal of treatment.
When it comes to medications, there are three that are FDA-approved. The first is Disulfiram, which is also known as Antabuse. This medication interferes with the metabolism of alcohol, causing discomfort in the form of nausea, palpitations, and flushing, itchy skin. It’s mostly a psychological deterrent, but the nausea is an intense physical discomfort. Outside of a controlled environment, it’s not that effective because folks with severe AUD will just “grin and bear it.”
Naltrexone decreases the psychological effects of alcohol, limiting the “buzz.’ Many people who experience AUD also misuse other drugs. Naltrexone is contraindicated in cases where the client is using opioids because it causes immediate withdrawal. That can cause heapatotoxicity.
The third is Acamprosate. This medication restores the balance between the excitation and inhibition of neurons. It’s safer than the other medications because it’s not reliant upon the liver, so there is no danger of hepatotoxicity. It’s also more effective than the other two medications.
When it comes to psychotherapy, there are two chief approaches to AUD. The first is cognitive behavioral therapy, or CBT. CBT examines the thought processes behind why someone drinks and helps clients come up with coping strategies when the cravings hit. It’s “thinking about thinking” and how to focus on positive thoughts and outcomes instead of negative ones. This is especially true when there’s a family history of AUD and experiencing the disorder has become a self-fulfilling prophecy.
The other kind of therapy that is common is motivational enhancement therapy. With this discipline, therapists strive to get the person to embrace change and to be motivated to accept any changes for the better as good things. The idea is to drive home the point that negative emotions, thoughts, and legacies don’t have to affect the present. It is most effective in younger clients.
Secondary to these two treatment options is eye movement desensitization and reprocessing or EMDR. EMDR is a treatment for trauma-related mental health conditions, so it’s not a direct treatment of AUD. Rather, in cases where a client’s AUD stems from a trauma of some kind, the EMDR treatment of that trauma will possibly lessen the client’s AUD because the underlying cause will be correspondingly lessened. It should be borne in mind, however, that EMDR is not a treatment to be delivered alone in cases of trauma-related AUD. Instead, it should be part of a multipronged treatment approach.
How We Can Help
At Alcohol Awareness, we seek to provide just that kind of multi-pronged approach. We seek to treat “the whole client” rather than the disease. We’re always available to help, so if you find yourself in need of that kind of assistance, please contact us immediately. You don’t need to suffer alone. You can call us at any time, and we can refer you to a healthcare professional or an Alcoholics Anonymous group near you. Check the website to get our phone number.