Webinar

This is a talk I gave at the Royal Lancaster Infirmary Alcohol Liaison Unit.

You’ll have to forgive the rather dreary monologue, it was better live; talking in front of a live audience is far more engaging than than sitting alone at home late in the evening after a long day at work! You’ll have to forgive the few mistakes as well, I recorded and scrapped it so many times in the end I just had to leave it as it was.

Cravings

This is a slightly amended response of mine to a post in the Facebook Alcohol Explained group about cravings. I thought it was worth sharing a bit more widely:

Don’t forget what a ‘craving’ is. It is you, fantasising about how nice it would be to have a drink. It is a conscious thought process that you are going through. Above all it is FANTASY, it is not REALITY. It is a highly romaticised, utterly distorted, version of reality. A craving it simply thinking about only the good parts of something, and exaggerating those good parts shamelessly. When you find yourself thinking about drinking don’t FANTASISE about it. Just think about the reality. Think about the actual reality of what would happen if you had a drink.

Firstly you’d have a feeling of bitter disappointment that you’d failed once again to stop. Secondly you’d have a slightly dull feeling as the alcohol took hold. Then you’d have a nervous, anxious feeling as it wore off. Then you’d face a simple choice of two. Either have another drink to get rid of that unpleasant, anxious feeling caused by the first, and and end up increasingly intoxicated. The only other option it to suffer this unpleasant feeling for several hours while it gets worse and worse. Either choice would lead you to a sleepless night of anxiety, then a following day of anxiety, exhaustion, and guilt; a day spent agonising about whether to have another drink to take the edge of the anxiety, exhaustion and guilt caused by yesterday’s drinking. And so it would go on, either forever, or until you made the effort to break the cycle all over again.

When you get a craving you don’t need to use a gimmick, or con yourself, or suffer it, or give in to it. Just look at the actual reality of it. Think of a sexual fantasy. For example you may look at someone at work and fantasise about sleeping with them. But if they made a pass at you, you’d run a mile because you would no way betray your partner, hurt them, and risk losing them and your children. You may not have children, or a partner, but I hope you can still appreciate the analogy.

FANTASY and REALITY are different. A craving is simply fantasising. You can short circuit it by forcing yourself to face the reality.

Animation – What Happens to Your Body When You Drink Alcohol

A contact through the Alcohol Explained Facebook Group recently posted an animation of my last blog post. I thought it was incredibly effective so we’ve worked together to create the following which details the physiological effects of drinking.

Please let me know if you find it useful so I can give some thought to making more of them.

 

How Lifestyles Influence Drinking

Let’s look at the ways in which our lifestyle can influence our drinking. This article is primarily about the dynamics that come into play in regular, daily drinking, as opposed to binge drinking. To be clear I am not dealing with traumatic events that have been shown to increase the likelihood of problem drinking (I am working on a separate post dealing with this), this is to do only with our lifestyle. Consider the following situations.

Number one. Male in his 50s. He is a successful businessman running his own company. He works in a high-powered and stressful environment and is unmarried and has no children. He lives alone. He considers that his lifestyle contributes to his drinking because he has no children or family which would cause him to reduce his drinking. He considers his financial situation (he has an excess amount of money) also exacerbates his drinking because he can afford to drink as much as he likes. He also considers that his stressful job contributes to his drinking because when he gets home of an evening he just wants to drink to escape from the stressful day. He has to socialise with clients a few times each week and considers alcohol to be an integral part of this.

Number two. Female early 40s. She has two young children. She considers that her drinking is caused by the stress of having a young family. She finds her two young sons extremely hard work and feels that her life is no longer her own. She considers these elements of her life trigger her drinking.

Number three. Unemployed male early 20s. He considers that he drinks because he has no job, too much time on his hands, and feels worthless. He has very little money which causes additional stress and he feels that the relief provided by alcohol is the only pleasure he can get from life. He has no friends and no social life, and again he feels this is a trigger for his drinking because it relieves his loneliness.

Number four. Male, mid 30s. He is employed but finds his job boring. He considers that he drinks to relieve boredom at work and finds when he is at work with nothing to do the thing that gets in through the day is fantasising about, and planning, his evening drinking.

All of these are based on real people but I’m sure you can probably empathise with each of them and in all probability have experienced parts of each of their lifestyles and found yourself that it is increased, or discouraged your stopping, drinking. If one of these people sat down in front of you and told you about their lives and how it made them drink, I’m sure you would be nodding in sympathy.

But lets consider this in a bit more detail. We have people drinking because they have a job and people drinking because they don’t have a job. Of those with a job, we have people drinking because the job is stressful and people drinking because the job is boring. We have people drinking because they have money and people drinking because they have none. We have people drinking because they have a family and people drinking because they don’t. We have people drinking because they have too much time on their hands and people drinking because they don’t have enough. There are people drinking because they socialise and people drinking because they don’t.

Isn’t it funny how alcohol always seems to win, whichever way you slice and dice it? How it always holds the upper hand, pulls the strings, has the power? It’s easy to see how people start to think of it as sentient and evil being, how they see it as ‘the demon drink’. Of course it’s not that at all. It’s just an inanimate chemical substance. It has exactly the amount of power that you decide to give it. Like a physically weak, but psychologically abusive, partner. The second you decide you’ve had enough and walk away, its insidious hold is gone. The only way it can retake its hold on you is if you start wanting it back again.

So it is really their lifestyles that are causing these people to drink? Or is it the fact that for years they have regularly been imbibing an addictive drug? Withdrawal from alcohol causes us to feel nervous and out of sorts, weak and scared. The drink then partially relieves that feeling and so we become fooled into thinking it is an essential part of our lives. Whatever we are doing we need that drink to give us that little extra boost, to relieve that decidedly unpleasant feeling that can best be described as the loss of our mental resilience. It is essentially a feeling of not being able to cope with life, and of being too easily overwhelmed by the stresses and strains which, without the withdrawal, we are able to take in our stride.

Your lifestyle is not the reason you drink, or the reason you can’t stop, it is just an excuse. Whatever you change your lifestyle to, even if a change is possible, drinking will remain an integral and essential part of it. You’ll still be miserable if you don’t drink, and ‘happy’ if you do (of course that ‘happiness’ is simply the feeling of mental well being you get by relieving with withdrawal, and is a feeling you would have all the time if you simply stopped drinking for good). What lifestyle change could possibly alter that dynamic? If you are looking at your lifestyle for the reason you drink and find it hard to stop, you are looking in the wrong place. There’s only one thing to analyse to understand why you drink, and that’s the nature of the drug itself.

The Bad Days

Most people can understand how drinking upsets the delicate chemical balance in their brain, leaving them feeling anxious, out of sorts, and even out and out depressed. They therefore have a reasonable expectation when they stop drinking that they will be happier. This is indeed the case the majority of the time. The good times are better and more frequent, and the bad times are fewer and aren’t so bad. Things that caused the drinker significant concern when they were drinking suddenly no longer seem so overwhelming.

However everyone has bad days, either caused by something specific or just by the mood changes that all human beings are susceptible to on occasion. You need to accept that you will have bad times even when you’ve stopped drinking. However there is another mental trap you also need to be aware of.

Take a standard situation. You have a bad day at work, or you have an argument with your partner, or you have a bill you can’t pay. Whatever the reason, you are miserable. You start thinking about drinking. You start to thing that a drink will relieve your misery. Of course it won’t, it will just add to it considerably firstly by the sense of failure because you once again failed to stop drinking, and secondly because the physiological relief is so short lived and is replaced by a corresponding feeling of anxiety. However assuming you don’t take that drink you are miserable, only now you aren’t miserable and thinking about the argument / bill / work whatever, now you’re miserable and thinking about how you can’t drink. You start to blame the misery not on the argument / bill / work, but on the fact that you’ve stopped drinking.

Very soon our mindset changes from the correct position, which is ‘I am miserable because of work / finances / relationship issues’ to ‘I am miserable because I can’t drink’.

Just as drinking gets the credit for benefits that it doesn’t cause (such as the dopamine rush we get when we are socialising) so does not drinking often get the blame for any misery which is in fact caused by issues completely unrelated to the fact that we have stopped drinking.

When you stop drinking you need to accept that it’s not a ticket to paradise. It will result in a startlingly better quality of life, but there will still be bad times, albeit it they will be far fewer and far less overwhelming than when you were drinking. There can be many reasons for these bad time, many possible causes, but your stopping drinking will not be one of them. Don’t fall into the trap of blaming your unhappiness on the fact that you have stopped drinking.

Rock Bottom

There a general accepted platitude about alcoholism that the addict has to hit rock bottom before they can start recovery. Like most of the platitudes and accepted ‘knowledge’ about drinking and alcoholism, it is not only incorrect it is also dangerous and contributes to the problem.

Firstly why should an addict have to hit rock bottom before looking to remedy the situation? If you had a bad cough that you weren’t shaking off and you went to the doctor, what would you think if he or she said;

“Yes, this is getting quite serious. But as yet it’s still just a cough. I suggest we wait for it to develop into pneumonia, then pleurisy, then respiratory failure, then I’ll give you some antibiotics.”

Or to put it another way, imagine if you were addicted a drug that you were taking one dose of everyday at a cost of £5 that left you feeling tired and irritable all day. You have a choice of curing this addiction today or in ten years’ time. If you cure yourself in ten years’ time you’ll be up to ten doses a day, and you will have lost your family, your friends, your job, your friends and your house, you’ll have long term serious health issues and, perhaps worse than all of these things, you’ll have been very very miserable for all of those ten years.

When would you choose to cure yourself?

In fact the reason why the idea of having to hit rock bottom has become so prevalent is that addicts who have hit rock bottom have the best chance of stopping. All recreational drugs starts off being apparently enjoyable with very little downside. Over time the enjoyment decreases and the downside increases. You end up needing the drug just to feel normal, and you feel anxious and miserable without it. The less apparently enjoyable the drug, and the more detrimental the ill-effects, the more likely the addict is to be able to stop long term. The more miserable their life with the drug, the more likely they are to be able to stick with a life without it.

With alcohol this aspect is exacerbated because drinking is so widespread and such a big part of so many people’s lives. People search desperately for any excuse not to stop, to convince themselves that they don’t have a problem, and generally speaking those who have suffered the most damage from their drinking are the ones who are least likely to be able to convince themselves that they don’t have a problem so pretend to themselves that they can safely drink again.

The other problem of course that this ‘rock bottom’ belief causes is that it makes quitting drinking shameful, because it leads to the assumption that the quitter has a serious problem with alcohol and is one of the tainted few, instead of just being someone who has taken a sensible and logical decision to cut something unpleasant out of their lives.

In fact rock bottom should have absolutely no impact on your decision to quit. I have said before and continue to say, the decision to stop drinking should not be;

‘Am I alcoholic? If so stop drinking, if not continue’.

It should be;

‘From a simple costs / benefit analysis, is drinking alcohol worth doing?’

To put is another way is the slightly dulled feeling you get from each drink worth the corresponding feeling of anxiety as the drink wears off, the insomnia, the lethargy, the weight gain, the arguments, the hangovers, the blackouts and the financial cost?

If the answer is no, it’s not worth it, then the only logical thing to do is quit. The more years down the line you are the more likely you are to come to the conclusion that it’s not worth carrying on, but if you fully understand the nature of alcohol even those just starting out will find it hard to justify continuing.

As I put in a response to a facebook post in the Alcohol Explained facebook group today, it helps to keep things in perspective. Some people see alcohol as a way of life, as a defining feature of their personality, a way of coping with life. It’s none of those things, it’s just a drug that makes you feel slightly dulled, that people just happen to put into their bloodstream by drinking it, instead of injecting it, or smoking it, or snorting it.

Why should you wait for it to utterly destroy you before cutting it out of your life entirely?

Redemption

So how do you redeem yourself for all the terrible things you did while you were drinking? Do you need to seek people out to apologise? Or do good deeds to make up for the bad? Or spend your life dragging around your guilt like Jacob Marley’s ghost?

Well here’s some things to think about. Imagine there’s a drug that drove people insane and caused them to kill people. Imagine if, unbeknownst to them, you put a dose of this drug in someone’s food, and they went berserk and killed someone. Would they be responsible for that death? My opinion is that they would be innocent. They would have no responsibility for that death, it was caused by something outside of their control.

But what if someone took the drug on purpose and then killed someone? What if they took it knowing full well they would end up killing someone? Well that is a very different situation and I would have no hesitation of holding them fully responsible for that death.

These two situations are fairly straightforward, but let’s consider a third situation. What if the person took the drug of their own free will, but had been fooled into thinking it wasn’t what it actually was. What if they were told this drug made them happy and jolly and friendly? What if they took it and then killed someone? Would you hold them responsible for that death, or not? In this situation, as in the first, I would say the person is not responsible for the death.

This third scenario is really the most analogous to doing something dreadful when you are drinking. Society doesn’t see alcohol as something that causes bad temper, anger, emotional instability, spite, thoughtlessness, and violence. It sees it as something that makes people happy and sociable and friendly. Sure we know there’s a link between drinking and violence, but that only applies to drunken thugs, it doesn’t apply to us.

Of course things aren’t quite this simple because when we drink we do get bad tempered and thoughtless and obnoxious and offensive. We know from experience that we do. So to go back to our analogy of the drug that makes us kill people, we may not hold the person responsible who has been conned into thinking the drug makes them friendly, as opposed to murderous. However if they took the drug 600 times and killed 600 people, we might begin to find their excuse that ‘I didn’t know it would make me kill someone, I thought it would just make me happy and friendly’ a bit hard to swallow.

So why do we keep drinking, knowing that it makes us do terrible things? One of the main reasons is that we don’t do horrible things after one or two drinks, only after we are fully intoxicated. Again we come back to society’s view of drinking. Society doesn’t believe there is any withdrawal when you drink. There is a widely held view that alcohol makes you feel relaxed and happy, and that pleasant feeling slowly dissipates with no negative effects. This being the case moderation should be easy. So we keep returning to the drink because logic dictates that we should be able to just have one or two, avoid compete intoxication, and therefore avoid all the obnoxious things we do when we drink.

The real reason people do awful things when they drink is not because they are awful people, nor because they drink in the full knowledge that it will make them do awful things, but because they don’t properly understand that nature of it. They keep returning to the drink, and they keep doing obnoxious things, because logic dictates that they should be able to drink and not do obnoxious things. This is because their logic is based on incorrect information.

Of course if you do fully understand the nature of alcohol and still drink then you have to hold your hand up to every transgression. Those sins are yours to own. But if you understand the nature of alcohol, and you have stopped drinking, then I would say two things.

Firstly you don’t need to beat yourself up about what you did when you were drinking. You didn’t do it through spite, or even do it deliberately. You did it because you believed societies image of drinking. This is the only thing you did ‘wrong’, and frankly it’s not much of a crime is it?

Secondly, in stopping drinking you have done everything you can to make sure the problem never occurs again. You have acted, learnt, and remedied your behaviour. That’s all anyone can expect of you.

You want redemption for all the terrible things you’ve done whilst drinking? Well as far as I’m concerned in stopping drinking you’ve done all you need to do to earn that redemption.

Alcohol Withdrawal

I’ve been thinking a bit recently about how and why alcohol withdrawal is so powerful. As I cover in Alcohol Explained the physical withdrawal from alcohol occurs because the brain seeks to counter the depressive effects of the alcohol by releasing its own supply of stimulants. The alcohol is then processed leaving only the stimulants. This is the period when we are restless, anxious, and out of sorts due to the excess stimulants. This is the period I refer to as the withdrawal period. If we take a drink during this period, the alcohol depresses the stimulants leaving us feeling far more relaxed; in essence it returns us to the feeling of peace and tranquility we would have experienced had we never drunk in the first place. In this way the primary benefit of alcohol is to relieve problems it has previously caused. More details on this can be found in Chapter 2 of Alcohol Explained which you can find in the ‘First 5 Chapters’ part of the website.

Some people who have never had problems with alcohol appreciate this concept but still struggle to understand the depth of power alcohol holds over people. They struggle to understand how this feeling of restlessness, anxiety and nervousness can cause people to sacrifice their jobs, their family, and even their very lives.

The fact is that the words ‘anxiety’ or ‘nervousness’ don’t really do it justice. What it really amounts to is the erosion of our confidence and resilience. Everyone has problems. The key to a happy life isn’t avoiding problems, that is impossible. The key is not letting them grind you down. Let’s say you have two people with the same problem, let’s say they have an electric bill they can’t pay. Person one can’t see how they can get round the problem. They can’t see how they can pay it, and they can’t see how they can continue if they don’t pay it. How can they exist without electricity? The result is utter despair, misery and panic. Person 2 is in exactly the same position but they have a huge amount of mental resilience. Their state of mind isn’t despair, misery and panic. Their state of mind is that they will find a way to pay it, and if they don’t they’ll learn to live without electricity. Which of these people is the happiest? The problem could be bigger or smaller than not being able to pay an electricity bill. But what alcohol withdrawal does is the same; it leaves us feeling unable to cope.

My wife (who is a one glass of wine a month drinker, if that) highlighted the problem perfectly. We were watching some rubbish on TV (Eastenders I think) and one of the characters was alcoholic. He’d woken up after a huge binge, with his wife threatening to walk out on him, and he was scrabbling around trying to find a drink. My wife said (aghast) ‘His wife’s threatening to leave him and all he cares about is having another drink. How selfish of him.’ My thoughts were different. He cannot even begin to cope with or resolve the situation he’s in until he’s had a drink. He simply doesn’t have the mental stamina, resilience, or capability to even start to address the problem until he’s relieved the withdrawal which is preventing him from functioning at all, let alone being able to deal with a problem of that magnitude.

The other point to bear in mind is that alcohol withdrawal isn’t all or nothing. You don’t go from no withdrawal to the overpowering and debilitating withdrawal of the chronic alcoholic. Everyone suffers with withdrawal but to a correspondingly reduced level.

I’m on holiday at the moment. It would be the easiest thing in the world to go to the bar and order a couple of drinks. After 4 and a half years not drinking the withdrawal from them would be minor. But the fact is it would be there. It would be an unpleasant, anxious feeling and suddenly I wouldn’t be enjoying the holiday, or enjoying playing with my sons, I’d be thinking about when I could have that next drink so I could get rid of that unpleasant feeling so I could then get on with enjoying my holiday. I wouldn’t be enjoying myself because the usual stresses and strains of everyday life, that are still there even when on holiday, would suddenly be worrying me more and more, and my ability to enjoy the holiday would drop away. I’d be having to keep drinking just to maintain the level of mental resilience I have all the time now that I’m not drinking.

That is what the alcohol withdrawal amounts to. It is an inability to cope with problems. That is why it is so powerful. No one believes that alcohol will solve their problems. But what they do end up believing, on either a conscious or subconscious level, is that alcohol will give them the mental resilience to cope with, face, and deal with their problems. One of the keys to understanding alcohol is that alcohol doesn’t do this. What it does do is to erode the  mental resilience you naturally have, and then partially restore it.