Drinking guilt and its big brother shame

When I used to drink the drinking threw in a free gift of a helping of guilt and shame on the side – how kind!  Guilt is the emotion that we feel when we have behaved in a way that we perceive to be hurtful to others or as a moral lapse.  Guilt serves a purpose when we recognise, acknowledge and rectify the behaviour, such as apologising if necessary.  The thing is, when I was drinking, sometimes I didn’t remember the behaviour so what I got left with was guilt’s big brother, shame.

Shame is the emotion that we feel when ‘we’ as a person are at fault, not our behaviour.  It is the way we feel if we have fallen short of our own internalised ideals or if there is a public disclosure of a perceived weakness or defect. For me shame was the fast track path to self-loathing, failing self-esteem and crushed self-confidence and it was hard not to feel shame as I felt like I couldn’t control my drinking and therefore my behaviour.  Erik Erikson argued that “shame is blame turned against the self” and Pete Walker writes that “shame is the death of self-acceptance and self-worth.”  If I couldn’t manage this there was something wrong with ‘me’ right?

But if you drink alcohol, which is addictive and designed to make you thirsty (so you drink more) and acts as a disinhibitor (encouraging behaviour that you would not normally engage in) then how is that a weakness or defect in yourself?  Now I’m not handing total responsibility for my actions over to the booze monster as the choice to pick up the first drink was always mine.  What I didn’t fully choose was the addiction created by the substance to go on drinking to the point of total black out, guilt making antics and no memories to attach the guilt to therefore leaving me with an overwhelming sense of shame.  And then I would drink to forget the shame compounding the problem. Shame, drink, shame, lather, rinse, repeat.

The leading expert and queen of shame research is Brene Brown who I love.  Her PhD was studying vulnerability.  You can watch her TED talk on vulnerability here and her follow up TED talk on ‘Listening to Shame’ here.

What her research found was that shame is highly highly correlated with addiction.  Shame is the voice in my head telling me that I’m ‘never good enough’ and I can’t do life sober.  Shame is that same internal critic saying ‘who do you think you are’ to blog about my sober journey thinking people would be interested in what I have to say.

This is the most toxic of emotions and now I don’t drink I don’t really experience it like I used to anymore.  I know that I can do life sober and have done it for over five months. I know that people are interested in what I have to say because they take the time to read my blog and comment.  My internal voice of shame has gone quiet and this gift is perhaps bigger than the gift of no hangover.  The no hangover is the physical gift of not drinking but the diminished feeling of shame is the psychological gift of sobriety.  And the two go hand in hand for me as part of the hangover distress was the angst caused by the shame.  In the words of Brene, for shame to survive it needs secrecy, silence and judgement (of self or of others).  Choosing not to drink and this blog is the answer to resolving my shame and I would chose this option hands down every day over drinking now 🙂

PS My other most popular blog post is my Goodbye Letter to Alcohol which you can read here

Edited to add: I found this brilliant card that summed up how this drinking shame and guilt felt for me so if this is how you feel too then can I recommend this self-compassion break  🙂

Overindulgence Disposal Unit

Thursday Sober Inspiration: 4 years clean and sober! (Straight Sun)

As I celebrate 4 years clean and sober it has prompted renewed reflection. So much has happened between this time last year and now.  Much of it has not been as positive as we would have hoped but then sh*t happens whether you are sober or drinking.  Some of it has been stressful, emotionally overwhelming, and felt downright difficult and unfair but again such is life.  One thing is true through all of this though – at no point has the thought of drinking crossed my mind as a good idea.

So when I wrote last years 3 year soberversary post I hoped that we would now be living in Australia and that isn’t so.  Our plans took a turn for the worse at the end of June when the Australian govt announced that they were reducing the age cap on the permanent residency skilled migrant visa from 50 to 45 effective 1st July.  As I’m 48 that was pretty much the end of the road to our emigration plans.  We may get the opportunity to go over on a temporary work visa for 4 years but it’s highly likely we’d have to return after that. The odds aren’t looking good so we’ve accepted as a family this is most likely the end of the living there dream but we  can still go back on holidays to visit our family whenever we wish.

I hoped that I would have been able to successfully publish my Cambridge research and that isn’t so either.  It is however my writing and so I can publish it here if I so wish, and I do.  So here is my research paper written last year for the University of Cambridge Postgraduate Diploma in Education Studies (Counselling).  This isn’t a true academic piece of writing because it is written in the first person rather than the third.  It uses much of my lived experience (phenomenological approach) so is a mix of qualitative and quantitative research.  That is partly why it isn’t suitable for academic publishing without a great deal of rewriting.  What I would ask is that you are respectful to the personal content contained within it.

What is the link between insecure attachment, alexithymia & addiction

If I had to write a time-frame of what this journey has been like to date I would say this:

  • Year 1 was about escaping the physical & psychological pull of drinking & getting through all the social triggers or big sober milestones (week-ends, weddings, parties, Bank Holidays, birthdays, Xmas & New Year, holidays, seasons).
  • Year 2 was about living sober – having made it through the milestones this year can be harder than the first because it is now ‘normal’ to be a non-drinker rather than a drinker in these social situations.  As Mary Karr writes in Lit: “If you live in the dark a long time and then the sun comes out, you do not cross into it whistling.  There’s an initial uprush of relief at first, then – for me, anyway – a profound dislocation.  My old assumptions about how the world works are buried, yet my new one’s aren’t yet operational.”  Sums it up beautifully 🙂
  • Year 3 was where I started to process the emotional sobriety elements of living in recovery.  It was too soon to start deep diving in to the issues but I started to tentatively explore the work that needed to be done later and build my emotional resilience in preparation.
  • Year 4 has been the mother-load of emotional recovery work for me.  Now I’ve felt emotionally robust enough to deep dive on some of the underlying reasons why I drank and to be resilient enough to sit with those feelings and it not trigger an emotional relapse that is then a risk for a full relapse.  And again in the words of Mary Karr from Lit: “A lot of therapy is looking through a child’s eyes, she says.  This is looking through an adult’s”  Again, absolutely bang on!

This is only my experience of sobriety though and we are all very different in how we experience both drinking and recovery.  Melody Beattie in her book: Beyond Codependency describes the stages of recovery as expressed by Timmen Cermak as: survival/denial -> reidentification -> core issues -> reintegration -> genesis (which beautifully mirrors my years 1-4 so far!).  She goes on to say: “This is the recovery process.  It’s a fluid process, with carryovers and crossovers at different stages.  There isn’t a fixed time frame for moving through these stages ….. Recovery is a healing and a spiritual process.  We travel from self-neglect into self-responsibility, self care and self love.  I’ve learned that self-care isn’t narcissistic or indulgent.  Self care is the one thing I can do that most helps me and others too.

And of the genesis stage which is where I now consider myself:

This isn’t the end.  It’s a new beginning.  We’re no longer carrying around our “imprisoned” selves.  Nor are we indulging in all our whims and desires.  Discipline has found its place in our lives too.  Like butterflies broken loose from a cocoon, our selves are “flying free” …  We’ve found a new way of life – one that works.

I would not have changed any of it and remain certain that my decision to stop was one of the best of my lifetime so far.  My life would have been poorer were it not for the friendships and connections I have made out here on the inter-webs because of that single decision to put down my last drink on the 20th September 2013.

Although drink holds no appeal right now I am under no illusion that like Smaug in Lord of the Rings my addiction is like a sleeping dragon that one drink could awaken.  Because as Tolkien wrote Smaug is “a most specially greedy, strong and wicked wyrm”.  I remain alert and resolute heartened by the knowledge that as I head on towards 5 years sober this time next year, the risk of relapse drops to around 15%.

And to end this post?  The only way I know how to celebrate – with a tune!  Orbital ‘Straight Sun’ and some fantastic timeframe video of the UK 🙂

Tighten alcohol availability to reduce alcohol-related harms

Following last weeks blog post about alcohol availability this feels like the perfect follow on.  As reported by Alcohol Policy UK in June IAS in the UK & FARE in Australia released this report looking at tightening alcohol availability to reduce alcohol-related harms.

A new report has called for tighter restrictions on alcohol availability to help address alcohol-related harms, including pressures on emergency departments, hospitals and the police.

The report Anytime, Anyplace, Anywhere? [pdf] reviews fourteen alcohol licensing policies in Australia and the UK rating them for their effectiveness in reducing harm. It follows recent research identifying the extent of alcohol availability in England, and a recent call from the Lords Licensing Review Committee for a fundamental overhaul of the Act.

Produced jointly by the the UK Institute of Alcohol Studies (IAS) and the Foundation for Alcohol Research and Education (FARE) in Australia, the report makes ten recommendations for reducing alcohol-related harms through existing licensing policy frameworks including:

  • Restricting trade hours of on-licence venues to limit the availability of alcohol in the early hours of the morning
  • Enhancing community involvement, better facilitating the engagement of local residents with licensing systems
  • Adding / prioritising public health and / or harm minimisation objectives in alcohol legislation
  • Restricting the sales of high risk products in areas of concern; and
  • Deprioritising government support for industry voluntary schemes in place of policies supported by evidence.

In the document’s foreword, Professor Robin Room states:

“The availability of alcohol is a crucial element in what happens with consumption trends and with rates of alcohol-related harm. Public policy needs to prioritise evidence-based controls on the availability of alcohol to reduce rates of harm.”

Ahead of the launch of the report, Kypros Kypri, Professor of Public Health at University of Newcastle, Australia said:

“There is strong evidence to show that earlier closing times can make a significant difference to the strain alcohol places on emergency services. In Sydney, bringing forward closing times to 3am was associated with a 25% reduction in alcohol-related presentations to the local hospital.”

UK policy calls – falling on deaf ears?

In 2016 the IAS released an extensive report on the 2003 Licensing Act, which said the interests of the licensed trade have benefited over those of local communities. Despite mounting calls to review licensing legislation in England, including from the subsequent Lord’s licensing committee, there appears no intention to fundamentally change national policy – perhaps not surprising within the immediate political climate.

Currently national policy may be best inferred from the 2016 modern crime prevention strategy which sets out three main alcohol-related crime and disorder objectives, including a pledge on ‘equipping the police and local authorities with the right powers’. Critics of the current Act though have also argued that enforcement powers are not fully utilised, possibly reflected by the falling number of premises being called for review. In addition the crime strategy emphasises building local partnerships through industry led schemes – an approach the latest IAS & FARE report calls to be replaced by those supported by firmer evidence. Indeed questions have been raised over the lack of evidence to support the impact of voluntary partnerships schemes, notably ‘Community Alcohol Partnerships’ (CAPs). In contrast, Cumulative Impact Policies do find overall favour in the latest report, albeit with some limitations.

Read the full report here

Friday Sober Inspiration: Out of Time (Midlife, if you still think you’re young)

Prim recently lent me this book to read ‘Out of Time‘ – a book about midlife, or as Carl Jung called it the ‘midlife transition‘ between youth and old age.  As I approach both my 4th soberversary and my 49th birthday it feels hugely prescient.  Thank you Prim! 🙂

And as you would hope there was a passage about stopping drinking as part of that experience.  Over to Miranda:

An old friend of mine gave up drinking when he was 45 (I was 6 weeks before my 45th birthday).  He says: ‘I decided I was going to divide my adult life into two halves.  Twenty five years’ boozing.  And twenty five years without booze.’

He gave up after a many-week bender that took him to New York, then Manchester – partying ‘with a bunch of doctors and judges, everyone off their tits’ – then out to the countryside and a New Year’s Eve on the Jim Beam and the JD and the charlie: ‘I was totally out of it for a month.’  He woke up on New Year’s Day and couldn’t get out of bed until 6pm.  His kids were worried about him, he was three stone overweight and he was in agony.  I thought: ‘This is going to finish me off, if I carry on like this.  Don’t get me wrong, as a swan song, that month was brilliant.  But I had to stop.’

So he did.  No drink, no drugs.  His social life had to change, obviously, but he gave himself some rules.  Now, if he’s going out with friends, there has to be a purpose to the evening – ‘a third-party stimulus’ – like a meal, or a comedy night, or a film.  If he’s going to a party, he will stay only two hours: ‘9.30 till 11.30.  And then I leave.  It’s fine. Nobody cares.’

He says: ‘There’s nothing so good as a night out on the piss.  And I’ll always have the Pub Years.  But I’d like to live the life I’m living until I’m 70, to be active and thoughtful, to work and engage with things.  You get less sharp as you get older and I don’t want to do anything to make that worse.’

We talk about the difference between drinking in your twenties and early thirties and drinking when you’re older.  His forty-something boozing resulted in him getting into some proper scrapes.  The drinking kept him behaving as though he were younger, as though he was the same age as when he’d first started properly drinking.  It helped him ignore the fact that his life had changed, that it involved other people: wife, kids, workmates.  It made him continue to take risks, to believe himself hilarious and invicible.  To suppress his psychological baggage by never confronting it.  To drag his angst around, through being drunk or hungover all the time.

‘And then’, he says, ‘I stopped drinking and discovered I was far less complex than I thought.  My main problem was I was a pisshead.

‘Also, why pretend you’re young?  You’re less interesting when you’re young.  At uni, what are you going to talk about after you’ve banged on about your parents and your course?  You have to drink to hide your inadequacies.  But at our age, if you can’t find something interesting to talk about with someone for two hours, with all the shit you’ve done and all the stuff you know, then that is pathetic, really.  Middle-aged people have a lot to say, and it can be really fascinating.  You don’t need to drink to get you through that.’

So so true for me all of that, like the biggest loudest ‘amen brother’.  And Miranda writes a brilliant description of what we have chosen to leave behind too:

Madness is doing the same thing over and over, expecting different results.  Your reaction to drink and drugs changes as you age.  Especially the aftermath.  The hangovers arrive like a hostile alien invasion.  They swarm you, you cannot fight.  You are pinned down, poisoned, from head to heart to soul.

And why would I miss that exactly? 😉

And now the only tune I can follow this with …..

Ever present alcohol

This was an excellent guest post for Alcohol Policy UK in May which I am sharing again here about alcohol availability in England – or as I see it ‘ever present’.

In this guest post, Colin Angus, a Research Fellow at the University of Sheffield, explores recent research on alcohol availability in England and considerations for policy.

A recent study from the Sheffield Alcohol Research Group highlights how widely available alcohol is in England, and how this has changed in the last decade. The study explores the availability of alcohol through measuring travel distances to the nearest outlet selling alcohol and counting the number of places where alcohol could be bought within walking distance (1km). Researchers looked at how availability had changed between 2003 and 2013, particularly changes in the type of outlets where alcohol was sold, and how availability was related to socioeconomic deprivation.

The key findings include:

  • The average distance from the centre of each postcode to somewhere selling alcohol was 323m, with 85% of postcodes being within 500m of an alcohol outlet.
  • The average English postcode has 31 outlets selling alcohol within walking distance (1km) of its centre
  • Alcohol is more available in the on-trade (places like pubs and restaurants where alcohol is sold for consumption on the premises) than the off-trade (shops where alcohol is sold for consumption elsewhere) based on numbers of licensed premises
  • The most deprived 20% of postcodes have around 3 times as many outlets selling alcohol within walking distance of their centre as the least deprived 20%
  • A rapid proliferation of convenience stores and metro supermarkets since 2003 has meant that access to pubs and bars has decreased by 8%, while access to off-trade alcohol has increased by over a third.
  • Pub closures have been far more common in deprived areas while pub access has increased slightly in other areas.

There are many possible explanations for these findings. Significant changes to licensing were introduced in the 2003 Licensing Act, which came into force in 2005 and made it substantially easier to apply for new off-trade licenses. It is also likely that the economic pressures of the recession have had a major part to play in the economic viability of many pubs, as well as the effects of the 2007 smoking ban. This may explain the more acute declines in deprived areas where the recession has hit harder and smoking rates are higher.

What does this mean for public health?

The physical availability of alcohol is clearly not a barrier to obtaining alcohol in this country. Whilst there is a strong body of evidence showing that reducing the availability of alcohol reduces alcohol-related harm, this evidence is overwhelmingly from countries such as Australia and the USA where there are substantially fewer places to buy alcohol from in the first place. Although a steady reduction in the number of UK alcohol outlets may yield benefits in the long-term, it seems less likely that the closure of a small number of outlets will result in significant reductions in harm as long as alcohol is still widely available.

Declining availability in the most deprived areas, which suffer the most alcohol-related harm, may be seen as a good thing. However, shop-bought alcohol is generally substantially cheaper than that bought in pubs and bars, and access to shops selling alcohol has increased. Some have also expressed concern that a shift from drinking in pubs to drinking at home may bring increased risks to health; pubs may potentially offer a more controlled drinking environment where bar staff and patrons act as a moderating influence on levels of consumption.   

Two recent studies have found an association between higher levels of licensing activity in local authorities (in terms of challenging license applications and introducing cumulative impact policies) and greater reductions in alcohol-related hospital admissions and crime. Our findings suggest that unless a radical change in levels of availability can be achieved, local licensing boards may be more likely to have a greater impact on harm if they focus on particular problem outlets. Seeking to address other aspects of availability may also be more fruitful, such as opening hours or the selling of high strength low price products, rather than seeking to reduce the overall number of outlets in an area.

The findings also suggest that licensing actions and government legislation over the past decade or so has done little to directly address the shift in availability from on- to off-trade. Indeed, recent cuts to alcohol duty rates, whilst portrayed by some groups as a boost for the pub industry, have increased the relative gap in prices between the on- and off-trades, potentially accelerating this trend. Whatever the underlying causes of this shift may be, cheap alcohol is easier to access now than at any point in recent history.  

This research was part-funded by Alcohol Research UK (R 2014/03).

I find some of those statistics staggering particularly these two: 85% of postcodes being within 500m of an alcohol outlet & the average English postcode has 31 outlets selling alcohol within walking distance (1km) of its centre.

Both shocking and unsurprising to me, how about you?

 

Friday Sober Jukebox: Do The Hustle

So it’s been a while since I’ve had a moment of clarity in my sobriety so it feels like one was way overdue and then it arrived.  Not with a bang but as Laura McKowen said recently to Nicole Antoinette in a podcast, it was a ‘soft click’.  I’ve been doing the hustle again – the hustle for worthiness.

The soft click moment came lying in the bath having listened to 3 podcasts in quick succession; Meadow DeVor with Nicole Antoinette, the Laura McKowen one and then Dan Siegel talking about The Wheel of Awareness which I’ve talked about here.  It’s like they all coalesced in my brain and then I have a realisation.

So Dan talked about our Adverse Childhood Experience (ACE) score which I also talk about in my attachment, alexithymia & addiction research paper I wrote and I will share soon here, plus Veronica Valli linked to an excellent article about it recently here too.  Mine is 8/10 which meant I was environmentally and genetically primed for addiction.  And Meadow talked about the hustle for worthiness as it relates to professional remuneration, overworking, underearning and overspending – an addiction of another kind in all but substance.

And when I looked back and reflected on different memories it all became clear.  Some clues?  Memories of hearing my parents arguing when I was teenager at being unable to afford the cost of my school fees (I was educated at private boarding school of my mother’s choosing not mine) and how it was wasted on me because he thought I wasn’t intelligent enough – and me thinking ‘I’ll prove you wrong’; having to tenaciously pursuit contacts I’d established to secure an assistant research psychologist post; badgering a manager for a reference to apply to the University of Cambridge and the joy at finding out I’d been accepted; writing the blog and then the tears at people signing up for the London workshops; and most recently approaching agencies as I try to secure a job (and accompanying visa) in Australia.  The soft click of awareness that I was feeling way too comfortable with all of this and how it all felt very familiar – the clenched jaw, breathe holding and giddy rush of the chase.  Good things come to those who hustle right?

And now I have the awareness I have to decide what to do with it and that I haven’t quite figured out yet.  So a musical interlude in the meantime  with Pan’s People no less! 😉

PS Tomorrow is the UK’s 9th Recovery Walk if you would like to join them here are all the details:

Faces And Voices of Recovery UK Blackpool 2017

 

I know how alcohol can ruin your mental health. So why is it so rarely discussed?

This article on alcohol and mental health was in The Guardian in May.

It’s amazing to see the British finally begin to talk about our feelings. But even as we mark this year’s Mental Health Awareness week, there’s still an elephant in the therapist’s waiting room: alcohol.

The physical health risks of drinking are well known. Less discussed are the mental health consequences. These are real and significant, and seem to be getting worse. For instance, the number of people admitted to hospital with alcohol-related behavioural disorders has risen in the last 10 years by 94% for people aged between 15 and 59, and by 150% for people over 60.

Alcohol played a key part in my own problems but it took me years to come out of denial about it.

I never drank in the morning or in parks, just in a British way, bingeing along with, well, everybody else. I didn’t question it because no one else seemed concerned.

Presenting to therapists over the years with anxiety, patterns of self-destructive compulsive behaviour, swinging between thinking I was the most important and the most worthless person on the planet, they barely asked how much I was tipping down my neck. And it was a lot.

The more I drank to medicate my low self-esteem, the worse my anxiety got and the more I drank to dull it. Years passed and I couldn’t see I was stuck right in the classic “cycle of addiction”.

Eventually a friend of mine who had gone into Overeaters Anonymous sheepishly suggested I might have a problem. I resented it hugely. I was successful with a good job. There was no problem.

Eventually, it was a work incident that woke me up. As editor of Attitude magazine, I believed it would be culturally significant to have Harry Potter on the cover of a gay magazine. When Daniel Radcliffe, who played Harry in the film franchise, agreed, the only gap in his schedule for a shoot was early on a Sunday morning, which was annoying. Saturday night was my favourite time to go out. But fine. I could do this.

I decided not to drink the day before. No wine at lunch, nor during the play I went to see, and then straight home. All went well. Just as I was about to go to bed, ready for the shoot the next day, curiosity got the better of me and I logged on to a dating site, just to check my messages.

The next thing I remember was waking up, empty cans everywhere, with a bunch of messages on my phone asking where I was. Daniel and his publicist couldn’t have been nicer when I arrived with my lame excuse, insisting I go home to bed and that the shoot would be OK, and he found time later in the week to do our interview. Disaster was averted but it was the wake-up call I needed.

Since finally giving up alcohol, I’ve learned many things. First, that addiction is everywhere. That it is not about the drinking (or whatever the substance is), but the feelings underneath. Usually there is some kind of childhood trauma that needs to be addressed. I’ve learned that it isn’t about when or where you drink but about whether you can easily stop once you’ve started. I’ve also learned that there is an astonishing lack of understanding about addiction in general, not just from the public but sometimes by professionals who, being human too, often have their own issues to deal with.

The positive news is that despite alcohol being a socially acceptable carnage-causing drug that is pushed on us from an early age, it too is beginning to be talked about less furtively. Brad Pitt spoke in an interview last week about his struggles, Colin Farrell recently spoke on Ellen about being 10 years sober. Daniel Radcliffe himself has spoken about his problem drinking.

Last year I did another interview, with Robbie Williams and singer John Grant talking about their life-saving experiences of recovery from alcohol, drugs and sex addiction – and this time, I wasn’t late for it. Studies continually show a link between alcohol abuse and violence, domestic abuse and suicide, so talking about it is not a luxury, it is a necessity.

The British drink too much. Alcohol must be next on the mental health agenda.

Completely agree Matthew!

Sober inspiration: Out of the Shadows, Out of the Shame

So another month another book – the final one downloaded onto my kindle relating to recovery before I pause and allow all of this reading to be internalised and processed.  Out of the shadows, out of the shame indeed.

Claudia Black’s book Changing Course is about recovery and as the book is described:

“Claudia Black extends a helping hand to individuals working their way through the painful experience of being raised with addiction. “How do you go from living according to the rules – Don’t Talk, Don’t Trust, Don’t Feel – to a life where you are free to talk and trust and feel?” Black asks. “You do this through a process that teaches you to go to the source of those rules, to question them, and to create new rules of your own,” she explains. Using charts, exercises, checklists, and real-life stories of adult children of alcoholics, Black carefully and expertly guides readers in healing from the fear, shame, and chaos of addiction.”

This particular section really struck me and so I’m sharing it here:

Recovery is living a life free from shame.  It is recognising that you are not your secret; you are not your family secrets.  You are a person with a myriad of experiences, some of them very painful.  But, the pain of exposing the secret very, very rarely compares to the pain of keeping the secret.  And once the knowledge is shared, the relief feels like the warmth of the summer sun after a very long, cold winter.

The following are some of the reasons people reveal secrets:

  1. It relieves a burden.  You no longer have to continue to lie to others.  The secret has made life more difficult.  It is no longer necessary to spend any more energy keeping it.
  2. It allows you to be true to yourself.  It allows you to be honest with yourself.
  3. It prevents a possible surprise discovery.  Some secrets are shared to lesson the shock or surprise that would be created if a significant other found out.
  4. It enables you to have a more honest relationship with another.  When you share a secret with someone, you are conveying the added message that you trust them with something very important to you.  You are sharing at a more vulnerable level and that often creates in the other person a reciprocal willingness to be open and vulnerable.  The result is that a greater trust develops between the two of you.
  5. It stimulates family change.  When you decide to speak up, other family members are encouraged to make changes in their own lives.
  6. It could be a plea for help.  When the secret you confide still needs to be attended too (for example, if you are drinking too much and not yet in recovery), telling another person is a way for you to begin to move yourself towards getting help.

Recovery does not include secrecy.  It means speaking your truth.  You must end the Don’t Talk rule for yourself.

This is all so true for me and I carried such shame around my drinking.  At approaching 4 years in recovery my shame is almost non-existent.  A friend recently asked me if I was still not drinking.  I said that I wasn’t and that it held absolutely no appeal to me now.  I now know deep in my soul that drinking would not improve or make any situation better.  To be free from the shame is a gift that one drink can never compete with, and that is all it would take to undo it all.  If you’re reading this and think you’re drinking too much, reach out to someone and share your secret.  It could be the most powerful thing you could do for yourself.

Drinking in pregnancy: where next for preventing FASD in the UK?

My son was conceived on a Bank Holiday August week-end.  Ironically I also attended a Hen Do that week-end where as you can guess much alcohol was consumed despite my trying to conceive at the same time.  So this post today seems fitting.  It is courtesy of a guest blog for Alcohol Policy UK that I read in May called Drinking in pregnancy: where next for preventing Fetal Alcohol Spectrum Disorders (FASD) in the UK?

In this guest blog, Kate Fleming, Senior Lecturer, Public Health Institute, Liverpool John Moores University, and Raja Mukherjee, Consultant Psychiatrist, Lead Clinician UK National FASD clinic, Surrey and Borders Partnership NHS Foundation Trust consider the context and future for Fetal Alcohol Spectrum Disorders in the UK.

A recent opinion piece in The Guardian entitled Nothing prepared me for pregnancy- apart from the never ending hangover of my 20s took a, presumably, humorous take on the tiredness, vomiting, dehydration, and secrecy that so many women live through in early pregnancy, likening this to days spent hungover after excessive drinking in the author’s early 20s.

In an article that was entirely about alcohol and pregnancy there was reassuringly no mention of the author consuming alcohol during pregnancy, indeed quite the reverse “I don’t actually want booze in my body”.  But neither was there explicit reference to the harms that alcohol can cause in pregnancy. 

The harms caused by consuming alcohol in pregnancy

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term that encompasses the broad range of conditions that are related to maternal alcohol consumption.  The most severe end of the spectrum is Fetal Alcohol Syndrome (FAS) associated with distinct facial characteristics, growth restriction and permanent brain damage.  However, the spectrum includes conditions displaying mental, behavioural and physical effects on a child which can be difficult to diagnose.  Confusingly, these conditions also go under several other names including Neuro-developmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE) the preferred term by the American Psychiatric Association’s fifth version of its Diagnostic and Statistical Manual (APA DSM-V), alcohol-related birth defects, alcohol-related neuro-developmental disorder, and partial fetal alcohol syndrome.

How common is FASD?

A recent study which brought together information from over 300 studies estimates the prevalence of drinking in pregnancy to be close to 10%, and around 1 in 4 women in Europe drinking during pregnancy. Their estimates of FAS (the most severe end of the spectrum) were 14.6 per 10000 people worldwide or 37.4 per 10000 people in Europe, corresponding to 1 child in every 67 women who drank being born with FAS. 

Given the figure for alcohol consumption in pregnancy is even higher in the UK, with some studies suggesting up to 75% of women drink at some point in their pregnancy, conservatively in the UK we might expect a prevalence of FASD of at least 1%.  We also know that it is highly unlikely that anything close to this number of individuals have formally had a diagnosis.  This lack of knowledge of the prevalence in the UK is hampering efforts to ensure the required multi-sector support for those affected by FASD and their families.  

Current policy

For some time a significant focus of alcohol in pregnancy research was to try and identify a safe threshold of consumption, without demonstrable success.  No evidence of harm at low levels does not however equate to evidence of no harm and as such in 2016 the Chief Medical Officer revised guidance on alcohol consumption in pregnancy to recommend that women should avoid alcohol when trying to conceive or when pregnant.  Though this clarity of guidelines has been well received by the overwhelming majority of health professionals there are barriers to its implementation with few professionals “very prepared to deal with the subject”.  In addition, knowledge of the guideline amongst the general public has yet to be evaluated.    

As part of the 2011 public health responsibility deal a commitment to 80% of products having labels which include warnings about drinking when pregnant forms part of the alcohol pledges. A study in 2014 showed that 90% of all labels did indeed include this information. However, it has also been shown that this form of education is amongst the least effective in terms of alcohol interventions, and the pledge is no longer in effect.

Pregnancy is recognised as a good time for the initiation of behaviour change yet in the context of alcohol consumption it is arguably too late. An estimated half of all pregnancies are unplanned and there remains therefore a window of early pregnancy before a woman is likely to have had contact with a health professional and before the guidelines can be explained during which unintentional damage to her unborn baby could occur.  The same argument can be used when considering the suggestion of banning the sale of alcohol to pregnant women – visible identification of pregnancy tends only to be possible at the very latest stages.

How then to address consumption of alcohol during pregnancy? 

Consumption of alcohol is doubtless shaped by the culture and context of the society in which one is living.  Highest levels of alcohol consumption in pregnancy are, unsurprisingly, seen in countries where the population consumption of alcohol is also highest.  Current UK policy that is directed to reducing population consumption of alcohol will likely have a knock-on effect of reducing alcohol consumption in pregnancy.

Many women will however be familiar with the barrage of questions that they encounter when not drinking on a night out.  From the not-so-subtle “Not drinking, eh… Wonder why that is? <nudge, nudge, wink, wink>” to the more overt “Are you pregnant?”.  The road to conception and pregnancy is littered with enough stumbling blocks and pressures that the additional unintentional announcement of either fact of conception or intention to conceive is an unnecessary cause of potential further anxiety. Until society accepts that not drinking is an acceptable choice, without any need for clarification or explanation, then pregnant women or those hoping to conceive who are adhering to guidelines will continue to identify themselves, perhaps before they want to. 

What next?

The UK’s All Party Parliamentary Group for FASD had its inaugural meeting in June 2015.  This group calls for an increased awareness of FASD particularly regarding looked after children and individuals within the criminal justice system, sectors where the prevalence of FASD is particularly high. Concerted efforts need to be made to identify children with FASD to ensure that the appropriate support pathways are in place. Alongside this, efforts to ensure the best mechanisms for education of the dangers of alcohol consumption in pregnancy need to be increased, including training for midwives, and other health professionals who may be able to offer brief intervention and advice to women both before and after conception.

NOFAS run a national FASD helpline on on 020 8458 5951 as do the FASD Trust on 01608 811 599.

Friday Sober Inspiration: Reasons to Stay Alive

So I read the book by Matt Haig Reasons to Stay Alive quite early on in my recovery.  It was published in December 2015 and it was Bryony’s interview with him on the MadWorld podcast series that reminded me of what a great book this is.

You can read an extract from it here.

And here’s an interview with Matt from The Guardian when it was published:

Why did it take you 15 years to get the courage to write about depression?
I was meant to be writing a blog for the Books Trust, as their writer in residence, about novel writing but ran out of things to say and was starting to repeat myself. So I thought: OK, I’ll write about depression, this thing I had always had inside me and wanted to get out. And I got an incredible response, not because the blog was great but because I’ve noticed when anyone talks honestly about depression, it breeds a warm, sincere response from people. Everybody has a story about depression yet, for decades, we have been silent about it.

Is writing a way out of depression?
Writing is not the way but it helps. In February 2000, I was in the depths of depression. I was 24 and back from Ibiza, living at home in Newark [Nottinghamshire], in my childhood bedroom. I started writing bits and pieces – unreadable, angsty stuff. Articulating what is in your head is therapeutic. Words are a shared thing – depression lends itself to melodrama: you believe you’re going through something no one else has been through. At 31, Abraham Lincoln wrote: “I’m the most miserable person now living.” That is the drama of being a young man. That is the drama of depression.

How did you recover?
I still get bouts of depression but I am a lot better than I was. Staying sane and well is a complicated, never-ending process. The critical thing was that I had people I could talk to around me. My solution was never medical. What ultimately helped me was time. Depression told me I wouldn’t make my 25th birthday, then I made my 25th … and then I made my 30th.

One of the surprises is how speedy you make your experience sound, saying that adding anxiety to depression ‘presses fast-forward’?

Most people have depression with anxiety. They overlap in complicated ways. Mine trickled over into OCD and panic disorder. One of the main symptoms of anxiety is racing thoughts.

Why were you living in Ibiza?
I was a party person at university. I went to Hull, then Leeds. I used to drink a lot. (In one fell swoop, I gave up drinking and smoking. I became scared of anything that could alter my brain chemistry). Anyway, I met my partner, Andrea, early on and we went on holiday to Ibiza. After another winter in Hull, we thought it would be nice – probably against our parents’ wishes – to try and get work in Ibiza. I was selling tickets, doing a bit of PR. Andrea got the good job – running the office for the island’s largest party. Ibiza contributed to depression in that I was run down: we weren’t eating well, there had been heavy drinking, no sleeping, a lot of unhealthiness.

How worried were your parents when depression struck?
It happened suddenly so they had to be aware of that. I wasn’t mad or delusional but I was worrying about things too much. I knew who I was. I could hold a conversation, there was nothing obviously wrong with me. My mother had experienced postnatal depression but that made it harder for her because it brought it all back. Unlike with physical illnesses, there is always with depression, I believe wrongly, guilt and blame attached.

Your dad is quoted telling you to pull yourself together …
I feel guilty about that but you can’t write what is vaguely a memoir without betraying someone. I wanted the main person I betrayed to be myself. My mum has only just read the book…

How did she react?
Long, emotional texts that said it was hard for her to read but she thought it was brilliant and that it made her understand depression better.

Is depression different for each person who experiences it?
I don’t know. I’ve only ever been me.

Is it safe to generalise?
It is dangerous not to – despair is universal.

Is technology a contributing factor?
I became ill in 1999 and didn’t even have a mobile phone. Facebook and Twitter provide a Samaritans culture: people are there to chat to 24/7. That said, the addictive aspects of the internet, comparing yourself against other people, is negative for mental health.

Your most unexpected message is that depression can be a force for good?
If you took away all pain, if everyone lived for ever, everything would be bland, flat and boring, there would be no reason for art, music, newspapers, love because we would all be in a mono state of happiness. You cannot belittle depression yet a lot of people would not undo that side of themselves because it changes your thoughts. It makes you appreciate things you would not have appreciated before: like just being alive. Thinking about death makes you analyse what life is. Anxiety makes you curious and curiosity leads to understanding. I wouldn’t be a writer without depression.

Did becoming a published author boost your self-esteem?
It gave me a sense of identity. I had the confidence to write a novel and send it off which I wouldn’t have had before. We were in debt which gave me this ridiculous drive. I wrote a book about talking dogs – a reworking of Henry IV Part 1 – and ended up in more debt! Being published gave me that sense of: that is what I am here for.

What does Andrea make of your writing about depression and her role in helping you?
She is a shy person and we are both a bit antsy because it is your life and people are going to be disbelieving. She and I used to write side by side. Her books were – she hates the word – “chick lit”. When we had kids [now 5 and 7], she stopped but is now writing again, she has some ideas for children’s books.

Do you worry about your children inheriting the depressive gene?
Yeah. It is a confidence thing – if there is a link between how you raise a child and the adult. We try not to be unreasonably critical but I’m of the grim belief that each generation corrects its parents’ mistakes and then makes new mistakes of its own.

You once worked in a cabbage factory warehouse. That could bring on a depression?
Strangely, I don’t get depression in adverse situations. Hard work can be therapeutic. I hated the cabbage factory but it wasn’t capital D depressing.

You suggest we’re losing sight of what matters in over-affluent lives?
Yes, absolutely. I’d feel worse in shopping centres. Adverts, designed to make you feel bad, depressed me – they create a void. It’s easy to lose your priorities and think: I’ve got to have this sort of job or earn this amount of money. It would be lovely to live in a culture where calmness was the aim.

What is the single most important thing to tell someone depressed?
However much in the foreground depression feels, you are separate to it. This is going to sound cheesy but I’d say: You are the sky. A cloud comes and dominates the sky. But the sky is still the sky. Depression tells you everything is going to get worse but that’s a symptom. Don’t give depression power – constantly discredit it.

Giving up alcohol was a major part of Matt’s recovery in the earlier years and you can hear him talk about it with Bryony here:

https://bryonysmadworld.telegraph.co.uk/e/mad-world-matt-haig/

Like Bryony I loved his lists in the book.  Although this is written about depression it could so easily be about alcohol dependence too (excerpt taken from his blog):

7. Ignore stigma. Every illness had stigma once. Stigma is what happens when ignorance meets realities that need an open mind.

My alcoholic daughter, 26, must leave home – or I will

This was a Guardian Dear Mariella letter in June that garnered almost 600 comments so clearly it is a subject that hit a collective nerve that prompted people to offer advice and share their perspective.  An alcoholic daughter cared for by ageing parents who have had enough and write in asking for help.

The dilemma I’m a 69-year-old retired engineer with two children; one who lives abroad and seems to be doing well, and the other, my 26-year-old alcoholic daughter.

She appears incapable of holding down a job, is a strain on our resources and frequently goes on binges during which she might fall and get bruised.

I am her enemy, it seems. Today she told me she wishes I had died when she was 15. Yesterday the police called because she had gone to the local shop, bought cheap spirits, and was outside in a stupor.

I want her out of my house. I am depressed by the constant arguments between her and her boyfriend (a decent sort of guy), her and her mother, her and me. She behaves like a devious psychopath, manipulating others.

Unfortunately my wife keeps enabling her behaviour. I think I am going to have to leave to preserve my sanity. I hate to seem as if I am attacking my wife, but I can’t see any other way.

Mariella replies How sad. Your daughter is an addict plain and simple, but it’s not just her own life she’s destroying. One of the frustrating aspects of addiction is how useless it can make those around feel, even when they are doing their utmost to be helpful.

Your daughter needs professional help, ideally a clinical stay, but as you’ll be all too aware you can’t force her to seek that out. You can, however, make it less easy for her to dodge the fact that she is making a problem for all of you.

All addicts become adept at manipulation, as deluding others is often their only way of maintaining their habit. Lying becomes their lifeline. It’s easy for me to say this, but you must try – no matter how terrible the things she says – not to confuse your daughter with the creature her addiction makes her.

The day she liberates herself from her dependency on alcohol she will be an altogether different human being, so please don’t abandon hope for the return of the girl you once knew. Insisting, if she’s to remain living with you both, she attend AA meetings would be a step forward, but you would have to be prepared to go through with the alternative of her leaving the house.

Have you tried family counselling? It can be a helpful step towards getting the person to realise that they need to look to themselves instead of attacking those trying to firefight for them. At present she’s casting you as a demon, but that would be much harder if you and your wife built up some solidarity. Parenting in partnership is one of the most constructive things you can do with children generally. Speaking in one voice is one of the toughest collaborations to maintain, but it’s indispensable when dealing with an addict. A united front helps to create a sense of security, offers less chance to indulge manipulative tendencies and presents a clear idea of where the boundaries lie. Your daughter is over-stepping every one of those lines and it may be that things have to get worse before they can improve. What would be really destructive would be allowing your daughter’s behaviour to drive a wedge between you and your wife.

Don’t underestimate the immense strain you are both under, which is clearly having an impact on you both in different ways. Your wife’s enabling of your daughter’s behaviour puts her in a majority. There are very few parents who come around easily to abandoning their child in the hope of them hitting rock bottom – it’s an incredibly hard choice to make.

However, your girl needs to see that there are expectations and consequences, and the life you are all enduring is unsustainable and damaging. If you haven’t tried family counselling it’s worth investigating. There’s no downside to having an honest discussion and there can be surprises for all concerned. No amount of therapy, however, will cure her addiction – she is an alcoholic and needs to understand that whatever is at the root of her problems her addiction to alcohol is only exacerbating it.

Maybe her dependable boyfriend can help convince her of the invaluable support available at her local AA meeting. This is an issue for expert advice, not just an email to an agony aunt, so do ensure you’re in touch with the organisations whose expertise has helped many a family, including Al-Anon Family Groups (020 7403 0888) and adfam.org.uk.

Ultimately, the best I can offer is my certainty that you won’t be able to make changes until you and your wife find common ground. Leaving won’t cure the problem and removing yourself will be a temporary respite at best. Refraining from calling the family home “my house” as you do in your letter is one small correction to your own approach that you might make. The way forward will take compromise and a willingness to accept change from all concerned to dig you out of this dark hole.

I liked her advice and thought it was sound – what did you think?