168 units of alcohol: just an average week on a cruise ship

I read this in The Telegraph and if it is true then it is truly shocking.

An average cruise passenger consumes 42 bottles of beer, 16 cocktails, seven bottles of wine, 16 shots of whisky and two glasses of champagne on a single voyage, new research has claimed

A poll of almost 3,000 Britons, carried out by the website Bonvoyage.co.uk, uncovered the staggering statistics, which suggest that a cruise passenger’s weekly alcohol consumption – during a one-week sailing is eight times the recommended allowance for men (21 units), and 12 times in excess of the recommended consumption levels for women (14 units).

Mediterranean cruises were found to be the booziest, while men and women were evenly matched when it came to the total amount drunk.

“A cruise is one of the most relaxing holidays out there and it is evident from our research that passengers are certainly relaxing with a few alcoholic beverages,” said a spokesman for Bonvage.co.uk.

I am actually speechless and have to question the robustness of the research as it doesn’t sound possible!  Plus I’ve never been on a cruise so don’t have any personal experience.  Have you been on a cruise and does this reflect your experience?

3 days to go

Discussion about alcohol and addiction with Veronica Valli (1)

So last week Veronica Valli and I got together on Skype to discuss alcohol and addiction and we recorded our conversation to share with you :)

In this little nugget we discuss:

If you think you have an alcohol problem what are the things that will be going through your mind?

Is there a line that you cross in terms of alcoholism? (psychological vs physical dependence)

We discuss recovery meetings and barriers we might feel that deter us from accessing them

We plan on doing more of these and would love to involve you in the conversation too! :)

We’d love to hear from you either with comments or feedback on this discussion or questions for the future.  If you have any questions you would like to ask Veronica, as an addictions specialist, or me as a nurse with alcoholic liver disease and public health experience, then put them in the comments below or email Veronica or myself.

4 days to go

8000 strong visible recovery

UK Recovery Walk 2014

Only one word can describe this week-end for me:  mind-blowing

This is the UK Recovery Movement at the Castlefield Bowl in Manchester following the UK Recovery Walk.  There were so many people and it was packed with smiling happy clean and sober people.  So many shared their experience, hope and joy from their recovery.  From a 19 year old who was 5 months sober, to a lady who’d been sober for 28 years, to two mothers in recovery who had both lost son’s in the last two weeks – one to recreational drugs.  So much love and laughter, tears and sadness.  Everyone involved was in recovery whether they were marching or playing music on the stage.  One of the band’s singers shared how he had been in cardiac failure following 3 stints in rehab in one year and how now he had been sober for 2 years and what a gift it was to be playing in this band at this event.

The recovery advocacy movement is relatively new in the UK and I was lucky enough to meet it’s CEO, Anne Marie Ward who has been in long term recovery for 16 years.  I love their message of hope and joy and completely embrace their approach of visible recovery.  If people can see you living happily in recovery then this is a motivator for others.  And this is what we do out here on the sober blogs.  You may not be able to see my face but you hear my voice, stories and experience.  Research into people in long-term recovery show that they have higher levels of well-being than the general populace and recovery can bring new purpose and meaning to lives.  Again this reflects how I feel.

They have just launched their ‘Advocacy Toolkit’ which you can access on their website here: http://www.ukrecoverywalk.org/advocacy-toolkit-england/.   I have become a member of this charity and would encourage you to do the same if you are a UK resident.  They are working hard to change the face of recovery and addiction in this country and they have a way of presenting the recovery message which really resonates with me too, so for me I would say:

‘I’m Lou, and I am in long term recovery, which means that I have not drank alcohol for more than 12 months (next week!).  I am committed to recovery because it has given me and my family new purpose and hope for the future, while helping me gain stability in my life.  I am now speaking out because long-term recovery has helped me change my life for the better, and I want to make it possible for others to do the same’

5 days to go

PS Veronica Valli and I have now sorted out the technical quality issues of talking to each other across the Atlantic and will be starting a Skype interview series in the next two weeks.  One of the first topic of conversations will be The Advocacy in Action conference, Manchester’s dry bar ‘The Umbrella Cafe’ and this walk that I attended this week-end where I can convey in a much more engaging way just how big a deal this week-end was!! ;)

Edited to add:  a video has now been uploaded to Youtube of the UK Recovery Walk which I’ve added in above.

 

Guest post: Mr HOF on 1 year sober

I thought I’d ask my other half if he would kindly share some thoughts on his view of the journey from his perspective on this day – his one year sober birthday!

Mrs Hangover-Free has asked me to write a few words on the first anniversary of giving up drinking. It may irk her somewhat that I am about a week ahead of her on our abstinence journey but if it does, she doesn’t show it and generally she wears her heart on her sleeve. I like to think of myself as the swarthy native hacking down the undergrowth of the jungle at the forefront of her expedition into hitherto uncharted territory. But more of my bizarre delusions later.

One aspect of my own experience of dry sobriety has been a gradually dawning realisation that I have been playing this game of life all wrong. Well, not completely wrong but let’s say I have been missing some major tricks. I can’t help thinking of the best episode of the sci-fi comedy series Red Dwarf. In Back to Reality the crew of the spaceship were attacked by a giant ‘suicide squid’, seemingly resulting in a crash and a massive ‘game over’, whereupon they ‘realised’ that they had been playing a total immersion game called Red Dwarf. As the characters were unplugged from the apparatus they were told by the game engineers that not only had they scored very poorly but they had missed out on all the best parts of the game. All this turned out to be a massive hallucination but it looks like I am finally here in my own reality (whatever that means) and here to stay.

So what are the things that I have missed out on? This is a difficult question to answer as it involves a considerable amount of speculation. I can’t help imagining what my life might have been like if I hadn’t spent so much of it imbibing alcohol. For most of my life it has been a constant ‘companion’ of sorts. I acknowledge that there have been many experiences which I may not have had if I had not been under the influence and not all of them cause me acute embarrassment when (and if) I recall them, but sometimes the embarrassment and regret I feel about not doing things is much worse. For example, I could have spent more time playing music. This is something that I have focused on recently as an alternative to drinking, which also provides some kind of escapism, I might add. I finally immersed myself in a focussed, concerted effort to learn more about playing guitar. This has meant learning stuff that I previously found really boring like scales and theory. Previously I might have given up and had a drink instead but my rapid improvement has not only been a revelation but also one of the best presents I could ever have given myself. In fact, I can’t help thinking how much better it would have been if I had done it years ago. Who knows where it could have led. Of course this is a dangerous game to play. Nowadays I have a different set of values to when I was younger. But I do still love playing guitar. Maybe even more so.

As a musician, I’ve written quite a few songs and many of them whilst under the influence, well the lyrics at least. I struggled to come up with ideas to write about so I would often sit up late with pen in one hand and glass of rouge in the other, telling myself I couldn’t go to bed until I had finished the song (or the bottle). When I first gave up drinking I struggled with the words but now I seem to have more ideas than I could possibly write about. It is as if some kind of veil has been lifted and I have become more exposed to and in touch with life.

The first song I had written in ages was inspired by Mrs HOF mentioning that I had reached a significant milestone in my abstinence. When I told her that I had written 300 Days in the Desert she said that it sounded very negative. Yes it is, but within the lyrics I have included some very positive metaphors; 300 days in the desert under a cloudless sky / The Sun’s burning brighter as my blindness has gone. Both are references to my depression lifting and my outlook improving. While my immediate view might be one of a journey of endurance the overall impression I have is that though my destination might be unknown, the feelings I have inside are more within my control, like a personal inner journey that I am making on my own terms, though I really must give credit to Mrs HOF for her part in this journey. Were it not for her I may well have given in at some point. I can think of at least one occasion when it would have been easy to surrender to temptation and/or peer pressure. She has been an inspiration in so many ways, providing encouragement, support and irresistible incentivisation.

Whilst drinking it was easier to delude myself that I had all the things that I wanted and needed and that I was within a gasp of becoming the person that I thought I always should be. Around midnight, I’d feel like I could take on the world, maybe even be a great musician or songwriter, but come the morning though the feeling still lingered like a dream there was a usually a humdinger of a hangover to take the edge off of the reality which was that nothing had changed. And so it went on like a pernicious circle.

Now it seems like I can’t hide from myself. Gradually, I’m coming to terms with who I am. I’m learning more about the person I’ve become, maybe always have been, truth be told, and getting a grip on how best to deal with him. Who knows? I might even get to like him! Perhaps it’s possible to mould him into someone who might be able to live with himself more comfortably and actually take on the role of playing himself?

Now that my year is up and I look back, one of my thoughts is how quickly it has gone. Some people say if you give up drinking and smoking you won’t live any longer – it just feels like it. I have to disagree. In my song I sing “the further I go, the further I know I have to go”, which is kind of illogical, but it makes perfect sense to me – I know that the longer I continue to abstain from putting poisons into my body, the better my chances are of living longer and what’s so bad about life going slowly anyway? It goes too quickly, with not enough time to cram in all that I want to do – I want to learn to play the piano next and who knows what after that?

A few people have asked if I would go back to drinking upon reaching the magical mark of a year. Would I launch myself into a celebratory binge-drinking session? Somehow I don’t think so. If I am honest with myself, I probably told them I was having a year off because it was easier that way. If I had said I was giving up for the rest of my life that would have sounded like madness to them as well as being a daunting task for me. Right now, it feels like it would be madness to go back to drinking. And the rest of Mr Hangover-Free’s life doesn’t seem so daunting after all.

1 year for MrHOF!!

6 days for me to go ;)

Abstinence violation effect

This is something I’ve been thinking about for a while and thought it was about time I wrote a blog about it.  With just a week to go until I hit one year sober I’ve been thinking about what would be the impact of having a drink.  Now don’t get me wrong I am not thinking about having a drink I’m just interested in the whole counting days thing and how it differs to when I gave up smoking.

When I gave up smoking if I lapsed I would think of it as a slip and get back to not smoking.  I didn’t consider it going back to day 1 – I saw my quit attempt and stop date intact with a small blip.  But in the world of giving up booze it is very different and I don’t know where that comes from.  If anyone can share what the source is of this much more ‘all or nothing’ view I’d love to know.  This difference in view between a lapse and relapse has consequences for how we see ourselves and our actions about further drinking moving forward.  If I lapsed and had a drink now it would feel like the whole year had been wasted as I would have to go back to day 1 and that would probably lead to me thinking “well  I’ll keep drinking then”.

It is recognised and called the ‘abstinence violation effect’ (AVE) which is defined as “what happens when a person attempting to abstain from alcohol use ingests alcohol and then endures conflict and guilt by making an internal attribution to explain why he or she drank, thereby making him or her more likely to continue drinking in order to cope with the self-blame and guilt”

The problem with this way of thinking is that a lapse has the potential to become a relapse and then a collapse.  That moment of yielding fully to addiction is what Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington, describes as “a form of black-and-white thinking,” says Marlatt. “You blame [your failure] on internal factors that you consider beyond your control.”

Those factors, such as a belief that addiction is a disease that robs you of free will are what derail thousands of quitters and abstainers. You could also call it the “f___ it” effect, the idea that once you cheat, you’ve blown it, so you might as well binge. In traditional 12-step programs for addiction, that line of thinking is encapsulated in the slogan “A drink equals a drunk.” But understanding and overcoming AVE, says Marlatt, is crucial to conquering a problem behavior or dependency in the long term. You have to know what to do when you fall off the wagon to learn how to stay on it.

And this is where my ponderings and Marlatt’s article in Time magazine come together:

While studying cigarette smokers who were trying to quit in the 1970s, Marlatt discovered that people who considered the act of smoking a single cigarette after their quit date to be a complete defeat and evidence of an innate and permanent lack of willpower were much more likely to let a momentary lapse become a full-blown relapse.

Most people who try to change problem behaviors will slip at least once. Whether that slip provokes a return to full-blown addiction depends in large part on how the person regards the misstep. “People with a strong abstinence-violation effect relapse much more quickly,” says Marlatt. A single slip solidifies their sense that they are a failure and cannot quit, creating a self-fulfilling prophecy.

So I guess the question becomes is counting days helpful?  If I was to consider a one off return to drinking as a slip rather than a relapse would it help me get back in the saddle quicker after the event?  This will remain a hypothetical question of course but do we need to change our perspective on counting days and moments of lapse?

7 days to go

PS If you’d like to say thank you for the blog by making a donation to Alcohol Concern you still can!  Go here :)

 

Flooding the booze away

Thanks to Prim for the idea for this post :)

Since I’ve stopped drinking I’ve been addressing many issues in CBT that have felt at times intractable as they have been my way of thinking for so long that they felt as hardwired as drinking did back in the day.

What I’ve been experiencing is systematic desensitization, a milder less traumatic version of a type of behaviour therapy called flooding.

The process of systematic desensitization occurs in three steps. The first step of systematic desensitization is the identification of an anxiety inducing stimulus hierarchy. The second step is the learning of relaxation or coping techniques. Once the individual has been taught these skills, he or she must use them in the third step to react towards and overcome situations in the established hierarchy of fears. The goal of this process is for the individual to learn how to cope with, and overcome the fear in each step of the hierarchy.

It is a form of counter conditioning, a type of Pavlovian therapy developed by South African psychiatrist, Joseph Wolpe. In the 1950s, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure (thanks Wiki!)

So in the post I wrote about ‘the 15 minute rule‘ I talked about my almost Pavlovian drinking: certain time on the clock = wine o’clock.  So Pavlov’s dogs have been treated by Wolpe’s cats! ;)

When we give up booze many of us withdraw from social situations that involve drinking as this becomes an anxiety inducing stimulus (step one above).  Then we learn self-care strategies to replace the drinking with, similar to the second step described above as ‘learning of relaxation or coping techniques’.  This enables us to then return to the previously anxiety inducing stimulus with the fear of the situation removed because we have completed step three and can then use these skills to react towards and overcome our fear of those scenarios.

But once we’ve conquered drinking many other scenario’s that were fear inducing present themselves and our former way of coping with them has now been resolved/removed.  So then we have to apply the same processes to all the new anxiety inducing stimuli whether it’s job interviews for me or paperwork and desk sorting for Prim!

This feels like one of those really big aha moments for me in the continual journey to a life lived straight-edged.  If I can remember this in times of fear and stress it should offer some respite from the Itty Bitty Shitty Committee who pipe up at these times and that I’m edging ever closer to firing from the inside of my head! :)

8 days to go

 

This is why I stopped drinking

This is why I stopped drinking and why I need to stay stopped.  It may not have been how I was when I stopped but there was no way of knowing how it was going to play out in the future.  That was a gamble I was not willing to take and I did not want this for my children.

Shared from Upworthy and thanks to the kind person on the Booze Free Brigade Facebook group who shared it there :)

He’s Counting Down From 21, And By the Time He Reaches 15, My Stomach Is In Knots

A video like this needs no introduction, but I’ll go ahead and give it just this one word:

Goosebumps.

9 days to go

PS I’m off for an early sober birthday treat today – having drinks at the new ‘Umbrella Bar’ in Manchester that is the brainchild of the lovely fellow sober blogger SoberMalarky.  She and I will be supping mocktails galore! Overnight stay in a hotel and then attending the UK Recovery Walk the next morning with 8,000+ other clean and sober folks.  Will post about it all next week and won’t’ be about to respond to comments until late tomorrow night! :)

A bottle of wine a day is not bad for you

and abstaining is worse than drinking, scientist claims.  Now there’s a headline that will warm the heart of all heavy drinkers and make us that have taken the abstention route a moment of questioning.

These articles appeared in the Daily Mail and The Independent back in April 2014 but have been doing the rounds again in the last few days.  At the time a Guardian piece questioned the validity of the claims.

From The Independent:

Former World Health Organisation alcohol expert Dr Kari Poikolainen has analysed decades of research into the effects of alcohol on the human body, The Daily Mail reports.

His conclusion – drinking is only harmful when you consume more than 13 units a day – that’s four to five pints of beer or more than a bottle of wine – which typically contains around 10 units.

He also believes that drinking more than the current recommended daily intake may in fact be healthier than being a teetotaler.

The weight of the evidence shows moderate drinking is better than abstaining and heavy drinking is worse than abstaining – however the moderate amounts can be higher than the guidelines say,” Dr Poikolainen reportedly told The Mail.

Unfortunately none of the news coverage shared any of the ‘decades of research evidence’ cited so it is difficult to validate or dispute.

So according to Dr Poikolainen drinking between 3  and up to 13 units is not harmful.  He doesn’t say whether this applies equally to men or women or whether this is acceptable on a daily basis.

I could list all the documentaries and radio programmes I have shared on this blog where UK medical experts dealing with liver disease have cited the levels of drinking which they consider harmful.  It is between 60 and 150 units and over, and my own experience working on an alcoholic liver disease ward backs up their numbers.  Dr Poikolainen’s assertions run counter to all of that by saying that 91 units a week is safe.

I’m sorry Dr but until I see the ‘decades of research evidence’ that support these claims then that is all these are – claims.  Putting this ‘supposed’ evidence out in the media with no way for us to verify the research’s credibility, validity and the sources of research funding is both irresponsible and dangerous.  If I was still drinking I would have grabbed this news and held on to it tight as a way of justifying my own dysfunctional drinking.  How many other people out there reading that news story have done the same?

10 days to go

Why was I never honest with my GP about how much alcohol I drank?

I had been planning to write this post months ago and have only just got round to it, plus I was prompted and reminded when reading this article in the Telegraph and in particular this paragraph:

I am amused to note that I claim to consume an average of 14 units of alcohol a week, a figure I had offered up because I knew damn well it was in line with the recommended upper limit for booze-inclined ladies who don’t want to think of themselves as having a Bit Of A Problem. I can remember the chic French GP asking me the same question at roughly the same time, and saying, “It’s curious how many women drink precisely 14 units of alcohol a week. It’s almost as if we’re trying to convince ourselves,” before laughing.

This both struck a nerve and jolted my memory as I too had done this with my GP.  This was my tack in the later years of my drinking when I knew I was consuming well over the Govt recommended guidelines.  Earlier on in my drinking career, and when my drinking was not so problematic, I had used the tactic, well-known within the medical profession of doctors and nurses, of halving my consumption and sharing that number.  But the problem was because I sat on both sides of the consultation desk I both knew that this happened and knew that the professional would just double the number in their head and that would be their ‘unofficial’ assessment.  And I did this for both my drinking and smoking and for patients drinking and smoking.

Why is it we find it so hard to be truthful with the medical profession when their help is predicated on us being honest?  With drinking there is the concern that as parents we will be judged and our ability to parent called in to question.  As a healthcare professional, who currently works within the multi-agency setting,  I can assure you that all agencies primary focus is to work with you to resolve the issue that you have with alcohol and to support you and your family during this process.  The days of the perception of social workers as ‘kiddie snatchers’ is outdated and long gone.  For a start the only people who can remove a child and place them under an emergency protection order (EPO) within the UK is the Police or the NSPCC.  Yes any healthcare professional can make a referral to Social Care, but they have a duty to tell you they are doing so unless to do so would place the child/children concerned at greater risk.  All social care referrals have to be logged, followed up, and potentially investigated, but it is a process and parents are consulted as part of it.  If you go to your GP, request help and engage in the process of getting and using the help offered then there is no reason for them to refer to Social Care.

Other reasons for not being honest, in my case, was that I knew I would potentially get what I would perceive as a ‘lecture’ about my drinking and would know that it would be followed up and I would have to do something about it.  This tells more about the issues we have with the substance than it does about us as a person.  The World Health Organisation have since 1979, discouraged the use of “alcoholism” in medicine, preferring the category of “alcohol dependence syndrome”.  It is medically considered a disease, specifically an addictive illness.  But we also know that part of the disease is our denial of having a problem with it and our concerns about needing to stop if confronted.  But we know that in the UK the management plan is to offer an alcohol brief intervention (ABI) and that stopping completely is not expected – unless you are referred to specialist alcohol services who would be the one’s to recommend this.

So they would have been my fears had I been honest.  We owe it to ourselves to be honest with our GP about how much alcohol we drank or still drink otherwise they can not properly help us as they do not have all the accurate facts.  If you are reading this and wondering about seeing your doctor about your drinking please go and please be honest.  Your health might depend on it.  I have been honest since I stopped but then maybe that’s because it is easier to say something after the event.  And if you still are concerned about being  honest what concerns stopped you or are stopping you?

11 days to go

 

 

GP’s and alcohol brief interventions (IBA’s)

This is reblogged from the Alcohol IBA blog and I have cherry picked what I’ve included, so do go over there and read it in full.

Primary Care is the key setting for alcohol brief intervention or ‘IBA’. Most the evidence base revolves around delivery in Primary Care settings and in England ‘DES’ payments are made for new registrations screened (and then in theory offered brief intervention when appropriate). IBA is also is part of the NHS health checks being offered to all 40-74 year olds.

In one local area, working with commissioners we attempted to get local practices to complete a short survey on their IBA delivery – about 8% responded. A subsequent proposal for a collaborative ‘mystery shopping’ approach, based on a successful pilot in sexual health settings, was rejected by the local medical committee – most members (yes some were GPs) didn’t support it. No alternative suggestions were offered though.

Not surprisingly, there can be a sense of despondency amongst those trying to raise the standard of Primary Care IBA. Is there any point in organising good IBA training, resources and pathways if there’s no interest in taking them up?

One crucial point though, its not really GPs we are talking about here as the key Primary Care IBA role, rather than Practice Nurses or Health Care Assistants. These are the people doing most new registrations and health checks. So when we talk about the issue of IBA in Primary Care, it isn’t really about GPs finding an extra 5 minutes in an already tight window, its about something that is supposed to be planned into other contacts.

Of course if someone is talking to their GP about a commonly alcohol linked issue – high blood pressure, depression, tiredness to name but a few – then IBA should be certainly be offered by the GP. But the real issue is the thousands of Practice Nurse or HCA contacts every day where the IBA box might be ticked on the system, but the actual intervention could be anything – and we’ve no way to tell. Or do we?

The DES (Direct Enhance Service) alcohol contract has been criticised for not being robust enough by offering payment for screening only, following which brief advice ‘should’ be offered to at-risk drinkers. Perhaps saying ‘at-risk’ drinkers ‘should’ be offered brief intervention isn’t legally binding, but what about a basic duty of care? Furthermore, the current DES contract is clear that local ‘area team’ commissioners can and should hold practices to account:

Area teams are responsible for post payment verification. This may include auditing claims of practices to ensure that not only the initial screening was conducted but that the full protocol described in the enhanced service was followed i.e. that those individuals who screened positive on the initial screening tool were then administered the remaining questions of AUDIT and that a full AUDIT score was determined and that appropriate action followed, such as the delivery of brief advice, lifestyle counselling or where needed, referral to specialist services or assessment/screening for anxiety and/or depression

Where required, practices must make available to area teams any information they require and that the practice can reasonably be expected to obtain, in order to establish whether or not the practice has fulfilled its obligation under the ES arrangements.

So the current DES is clear. Doing AUDIT-C only and giving a leaflet to all risky drinkers isn’t in line with the contract. And commissioners have the right to ask practices to prove they are doing it properly. I’m well aware that good care and interventions mean less form filling and more time with the patient. But until the picture coming through is one of a better overall standard for IBA, practices should be required to demonstrate IBA is a person-centred intervention, not an opportunity to trigger a quick payment.

I appreciate that maybe their content is too detailed for this blog but my reasons for including so much of their original blog post is two fold.  Firstly are GP’s discussing alcohol if you go to them with ‘high blood pressure, depression, tiredness’?  That is not my experience, is it yours?  Secondly, if this intervention isn’t being implemented properly then we have no effective primary care intervention tool.  And that’s before we get on to the issue of whether people are honest with their GP about how much they drink when asked which is the subject of tomorrow’s post.

12 days to go