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

MDMA used in world’s first trials to treat alcohol addiction

This was a news piece in The Independent in July looking at MDMA being used in trials to treat alcohol addiction.

In a world first, scientists in Bristol are using the psychoactive drug MDMA as part of a treatment programme for addicts and alcoholics.

The study was created by a research team at Imperial College London, and involves giving doses of MDMA – known by the street names Molly or ecstasy – to help patients battling addiction. They claim this could be more effective than conventional methods. Those on the trial will also be put on a course of psychotherapy.

“We know that MDMA works really well in helping people who have suffered trauma and it helps to build empathy,” said Ben Sessa, a clinical psychiatrist on the trial and senior research fellow at Imperial College London.

On his website, Sessa stated: “3,4-methylenedioxymethamphetamine is a remarkable substance. Forget what you know about the popular use of this compound in the context of the recreational drug ecstasy.

“MDMA is a medical drug that started its life in the clinical setting. It has a unique receptor profile that makes this drug, when combined in a supervised clinical setting with experienced psychotherapists, the perfect tool to enhance trauma-focused psychotherapy.”

Participants on the trial are all heavy consumers of alcohol, typically drinking about five bottles of wine per day. They were chosen through the alcohol services in Bristol and have undergone repeated treatments for alcoholism.

After going through a detox period, those on the trial receive two therapy sessions, followed by a day where they receive a capsule of high-dose MDMA.

The drug has shown promise in treating those with post-traumatic stress disorder (PTSD). At the Psychedelic Science 2017 conference in Oakland, researchers showed that after more than one year after two or three sessions of MDMA-assisted therapy, about 67 per cent of participants no longer had the condition.

However, experts warn that recreational use of the drug can cause harm. “I’ve seen people in my practice who took MDMA at a party and weren’t prepared for the memories that came up, and it was really harmful for them,” Michael Mithoefer, a psychiatrist and a principle investigator in the MDMA trials said in a Nature report.

Alcohol-related deaths have increased by 13 per cent over ten years, according to the report Statistics on Alcohol: England, 2016.

I will be greatly interested in reading the research papers following this trial to see what the outcomes were from this experimental process.

Alcoholism continues long after you stop drinking: my 15 years sober

This exceptional piece of writing comes courtesy of Tanya Gold featured in The Guardian earlier this year.  Beautiful writing about alcoholism and how for many of us it is but the symptom of much deeper issues.

It is easy to get morphine in University College hospital, London, if you are a good liar. It hurts, you tell the midwife, although you can’t feel anything, being so high on morphine already that someone could hit you with a sledgehammer and you would only laugh: what else you got? It was close to midnight on 13 August 2013, and I was on medical-grade opiates; nothing else can make you forget you are about to give birth. Eleven years without alcohol or drugs, and I fell, complete, into the waiting groove. I loved it. I was having a party in the high-risk maternity ward and they didn’t even know it. I lay back on my pillow and gurned with joy: oh, Morpheus, god of dreams.

When the morphine ran out, I had a baby. He was very small and handsome, and he was an imposition. I could say I was frightened, but that would be self-serving. It is possible, even likely, that I was afraid. I was definitely high.

I stared at him and thought: I am more vulnerable than you, even if you are a baby. Then I told the midwife: my husband is trying to kill me. My evidence was that he had brought me a tin of biscuits. This, then, was the comedown, and I was at the bottom of the curve. I must have said that the baby was not important to me, because my husband became angry and I became angry, and I told him I hated him and had never loved him. I considered walking out into the traffic, or throwing myself under a train, and that was our baby’s first night on Earth. We went home and I locked myself in my bedroom, without the baby, and looked at photographs of him on Facebook, and ate a ham.

Strange things can bring you to a crisis, like realising that you cannot read Dickens out of jealousy. Or more obvious ones, like thinking: the baby should live with my sister, she will do this better than me. Or, when he was two months old: when is he going to university? In my history of alcoholism, I have been at my most healthy when I knew that I was ill. If you remind yourself that you are ill, you can do better. Now, in my son’s room, wishing his childhood away because I did not know how to care for him, I knew I was ill. I was not drinking or using drugs, but I was as lonely and frightened as I had ever been. I was back where I had started.

***

Alcoholism is a strange condition. If you survive the drinking stage, and many don’t, it has relatively little to do with alcohol, which is merely the drug with which the alcoholic treats herself. It is, rather, a way of thinking, and continues long after you have stopped drinking. It is a voice in the head: a malevolent voice that wants you to die. I certainly see it that way: it makes it easier to pick my way through the days if I know what, exactly, I am dealing with. Is this the voice speaking, or not? Which one made a decision, and which one doubted it? To discover the true root of any plan can require forensic vigour, and much time. It is perpetual inner warfare.

The party in the maternity ward aside, I have not taken drugs or alcohol for 15 years. You might think I would be better by now, but for the alcoholic there is nothing as prosaic as “better”. There is only a daily remission, based on how you deal with the voice in your head. (“Hello, monster. Where have you been?”)

One morning in early 2002, at perhaps 5am, which is, as all addicts know, when the night breaks, leaving you with mashed lips and mad eyes, I stood in front of the mirror in my mother’s house. I had been drinking alcoholically – that is, without stopping – for almost nine years, and I was very near the end. I pointed at myself – I remember myself as a very attractive drunk, red-lipped and irresistible, but this is the voice again, for I was nothing of the sort – and I said, very clearly, “I hate you and I wish you would die.” I knew then what the voice in my head wanted, and how powerful it was. It made a mistake by being honest and, because it made a mistake, I lived.

I could no longer blame circumstances or others; I would have to do something about it myself. It is frightening, seeing yourself wish death on yourself in a mirror, and – because you are full of cocaine, as well as alcohol – being able to remember it. Alcohol shrouds itself in blackout, and you wake to a queasy blank; but cocaine is very bright, and pointed – it is almost telescopic. I was frightened enough to attempt one year without alcohol.

I was prepared to be conscious (I loved the WH Auden line “But who can live for long/In an euphoric dream?”) but I was under the delusion I was a literary genius, even though the only job I could get at the time was as a freelance reporter for a now defunct Daily Mail showbusiness column called Wicked Whispers. Wicked Whispers was so awful that, occasionally, the subs forgot to put it in the paper and no one would notice. If the celebrities I stalked stared at me, and asked, kindly, about my pitiful excuse for a career, I was stunned. Looking askance at Gillian Anderson when she, clearly and without malice, pities you, is, for me, a definitive act of insanity.

I was too scared to drink alcohol, but I couldn’t do anything else about a condition I barely understood. I went to self-help groups in gloomy church annexes, which seemed as despairing – though less vivid – as what I had left behind, and heard people talk about “spiritual growth”. I missed my near-death, for it had not been boring. I did not know what they were talking about. I could not hear them. I said I was an alcoholic, because I supposed I must be, but I didn’t really know what it meant.

I did know I needed a new soul, the old one having broken, and I chose to build it with ink. I thought that I should be a famous journalist, so I stood outside the Daily Mail building and offered up a prayer, like Salieri: Lord, make me a great short-form showbusiness columnist, and then, if you think it right, Lord, may I progress to features. I got a job on the features desk, a job I called “Idiot Girl”. I was required to report in fancy dress – Saxon peasant, old woman – and I loved it. It was evidence of my survival: she mugs, she pratfalls, she lives! The voice was impressed, and temporarily silenced. (I believe everyone is a secret Daily Mail reader, even the voice.)

I built a career in journalism but I felt, always, that the person in print had nothing to do with me. She looked like me, but she was my ghost, and she was not reliable. I could never stop working, but I could never stay in any job; as soon as I arrived, I yearned to leave. I became marvellous at being fired and learned to soothe, and even thank, the person who was firing me, the better to start again at the beginning. It was a game I played with myself. I would procrastinate over my work to stoke the fear, but I was not lazy. I met a sensitive, clever man and married him, but I worked on my wedding day. I worked on my honeymoon. I worked in the labour ward, until I was offered the morphine. I was terrified of losing things and I would try to lose them so I could be, momentarily, at peace. My husband, at least, knew that, which is probably why I chose him. I am not a complete idiot.

I was, for a while, a columnist, but that was no good, either. To write a good column, I had to work myself into such a state of rage that the week was empty of anything else. I had a schedule of rage, which I followed dutifully; if I wrote on Wednesday, I would be numb on Thursday and would then stoke the rage over the weekend. On Monday, the rage would ebb, to be replaced by terror, which would reach a pitch on Tuesday night, after which I would write what seemed to me not sentences, but tiny, insistent stabs. That is not a job; it is a condition.

I was still at the mercy of the voice, but she had regressed to sludge. She manifested as a cloud of anxiety that travelled with me and occasionally mutated, helpfully, into dread, and then back to anxiety. I was a cartoon character with a personal cloud, Charlie Brown with a mood disorder.

Late summer in 2013, I was sitting in a self-help group. This one was surrounded by a very fine, old graveyard, like a metaphor, with many famous intellectuals in fabulous tombs; we sat calmly with the dead, as if we belonged there. The baby was at home in the cradle. I always said the same thing at this self-help group, and they were very patient with me. If I had published a good article in the previous 24 hours, I was happy because I existed in a form with which I was comfortable, and which other people could recognise and approve of. If not, I moped, and complained that I was not happy. I avoided self-help groups where they talked about their gratitude. I did not believe them.

I listened and thought about how much, then, I hated being an alcoholic. I mourned the lives I could have lived if I had not been cursed with this condition. I could have been an MEP! I could have been a chef! I wondered, in a broad way, what had happened, and what I could do. I became aware, quite suddenly in the quiet by the graveyard, of the constancy of the voice. I had waited, every day for 15 years, to wake up and find she had gone, and that was my error.

I knew then that she has always been there. When I was five, she told me my parents didn’t love me. I remember repeating, very insistently, to my parents that I knew they did not love me, because she had told me so. Evidence doesn’t matter to the voice; she kicks it away. She cherishes a passing piece of thoughtlessness, nurtures a harm. She lives in the small places beneath my conscious mind.

When I was 10, she said I was friendless at a noisy suburban school. When I was 12, and mooching about the dull streets of Kingston upon Thames, she said I was alone, and probably always would be. For the nine years of my active alcoholism, she told me to drink, first because it wouldn’t harm me – and what else was there? – and then because I couldn’t be saved.

She says only what she can get away with. She could never, for instance, convince me that my sister doesn’t love me; instead, she tormented me, when I was drinking, with the possibility that my sister might die. She wants so much to be believed, this voice, and is almost as pitiful as the other me, which is the one that is writing this story: the one that wants to live. I am quite aware how mad this sounds, but it is the truest narrative of my alcoholism that I can offer. Perhaps in 15 years I will have another one.

We coexist uneasily, today, the voice and I; she tells me to procrastinate over my work, to start fights, to give up. If I am unwary, she can plunge me into the deepest despair, and I have learned to construct an obstacle course to thwart her. It is made only of ordinary human love. Nothing else works.

My son helps me. His is three now, and knows what is important. “I must teach you to play, Mummy,” he says, and invites me, without irony, to pretend to be a monster. Then, of course, the voice whispers, “You have made him a parental child”: a creature who will care for me and not himself. I try to ignore her, because I cannot send her away. But I wonder now if it is she who is afraid, and not I.

As so many of the comments said too – thank you Tanya.

Moderate drinking: risk Vs reward?

A brilliant post by my friend Libby Ranzetta for Alcohol Policy UK written back in June about moderate drinking: risk vs reward.

Over to Lib:

A study recently published in the BMJ found that alcohol consumption, even at moderate levels, is associated with adverse brain outcomes. The research also found no support for a protective effect of light consumption on brain structure. The authors, from Oxford University and University College London, concluded:

These results support the recent reduction in alcohol guidance in the UK and question the current limits recommended in the US.

The research may be seen in the context of the much debated J-shaped curve suggesting potential health benefits of alcohol consumption at lower risk levels. Indeed another recent BMJ study found evidence to support the potential protective effects of moderate consumption on cardiovascular disease (CVD), addressing some of the previous question marks over the CVD protective effects research. However expert reactions highlighted several reasons why drinking should not be taken up by abstainers for any potential CVD benefits.

In producing the new UK ‘Low risk drinking guidelines‘ last year, the Chief Medical Officer’s (CMO) group considered the evidence that moderate drinking may reduce risks of death alongside ‘a large body of evidence’ demonstrating that these potential benefits are likely to be overestimated due to the limitations found in most studies of the long-term health consequences of alcohol consumption.

The group also factored in modelling by the University of Sheffield which included protective effects for some health conditions weighed against the alcohol-related risks of mortality from others. The conclusions were:

  1. Any benefit to cardiovascular health for moderate drinkers in the UK is largely cancelled out by their increased risk to health from other diseases, and
  2. Any remaining benefits to health from moderate drinking are small and uncertain. (See here for more details)

The Oxford/UCL study, which scanned for structural brain changes such as hippocampal atrophy, grey matter density, and white matter microstructure in the Whitehall II study cohort, has its limitations too of course, summarised in an NHS Choices explainer as:

  • The participants are all people who were civil servants in the 1980s and were mostly male and more middle class and higher IQ than the general population, meaning results might not be applicable to the UK as a whole.
  • The effect of hippocampal atrophy was found in men and not women which may be down to the lower sample size of women and that few of them drank heavily.
  • The information on alcohol intake was self-reported and therefore might be inaccurately reported by participants.
  • It is difficult to link brain structure with alcohol intake when it might have been down to other confounding factors such as intelligence, cognitive stimulation and other lifestyle factors.
  • The MRI scan only took place once, at the end of the study, so it is difficult to tell if and when any changes in brain structure took place and rule out other influencing factors.

No safe level?

Of course such studies do not intend to suggest that alcohol does not have potential social benefits, rather than the seek to answer the question of the possible health implications of moderate consumption – an issue that seems to generate substantial public and media interest. Back in January 2016 when the revised guidelines were announced, an article in the Telegraph covered a range of responses to the ‘Low risk drinking guidelines’, from health professionals discussing risks to critics of the guidelines calling nanny statism. We also published our own expert reactions on the revised guidelines and media reaction, also followed by an analysis of Twitter reactions.

This latest studies nudge the argument further along the current direction of travel regarding potential health risks and benefits: light drinking probably won’t make you healthier; potential CVD benefits need to be considered against other risks. A somewhat tricky message, but as Matt Field, Professor of Addiction at the University of Liverpool, put it in the Telegraph: 

Any amount of alcohol consumption carries some risk. However, it is important to bear in mind that most activities that people undertake on a daily basis – e.g. driving to work – carry some risk, and people need to make informed choices about the level of risk that they are prepared to accept.

In his APE: Alcohol and Epidemiology blog, John Holmes discusses the difficulties of turning research findings – which posit different levels of risk for different diseases – into simple health promotion messages that are ‘scientifically robust, sufficiently compelling and easily understood’.

He highlights a recent meta-analysis of cancer and alcohol research supports the judgement that ‘alcohol causes cancer of the oropharynx, larynx, oesophagus, liver, colon, rectum and breast’, although the risks are pretty small at low levels of drinking. However, as mentioned above, the CMO’s evidence review considers many other conditions, including ischaemic stroke, ischaemic heart disease and type II diabetes, which show U- and J-shaped relationships, indicating a beneficial effect of alcohol at some levels of consumption and a detrimental effect at others.

While addiction professors and epidemiologists may feel confident in making informed choices from the complex information available, the degree to which the wider public choose whether or not to take notice of the CMO’s headline messages on lower risk drinking will remain a hot topic.

Completely agree Lib!

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.