Depression-related drinking: going against the grain

I’ve reblogged this from Libby over at the Depression Lab who has let me re-blogged her work before here.

In Britain, people who experience anxiety or depression are said to be twice as likely to be heavy or problem drinkers.  It surprises me the risk is not much higher.  I mean, why wouldn’t anyone with depression want to get ‘off their head’ with alcohol and into a different head, one with colour, laughter, song, relief and sleep? Perhaps it doesn’t feel like that for everyone; perhaps the light-headedness and loss of control that comes with intoxication is not pleasant to some drinkers. Or the hangover is worse than the anguish of depression.

Sadly, even for people like me who love(d) drinking – from the initial, fleeting pulse of joy at the start of a session, to the numbing slide into sleep – too much of a good thing is a Bad Thing.  Too much alcohol brings headache, fatigue and nausea the morning after. Too much too often and the mental and physical effects become hard to ignore: weight gain (in that peculiar waist-thickening pattern female drinkers have), puffy complexion, jowls appearing from nowhere, sleep deprivation, and loss of self esteem as the drinking starts to take priority over things and people that used to be important.  These are profoundly unhelpful for depression sufferers.

If you persist with the getting off your head trick, as I did for many years, (long after passing the point of too much too often), you may well find yourself with an alcohol dependency problem to add to the depression.  Trying to moderate your drinking becomes extremely difficult, and the inevitable failure to do so further reduces self esteem, with a new twist of despair on top. Very bad news for depression sufferers.

How to tackle a depression-related drinking problem

The NHS has struggled to cope well with ‘dual diagnosis’ – where patients have co-existing mental ill-health and alcohol dependency.  Indeed this was my own experience when I was referred to a CBT course for depression via my GP, only to be told I was drinking too much, and thus unsuitable. (In the end I reduced my consumption levels as much as I could, lied a bit, and was accepted. The CBT course was useful for managing depression, but did not address my drinking. At all.)

I wrote here about how I stopped drinking, and how it only became possible when my depression had improved to a certain level. It had got to that level – and no further – after a few months of trying to do all the right things, eg getting plenty of sleep, healthy eating, exercise, absorbing activity, social contact.  I realised I had to stop drinking if I wanted to feel any better.

Stopping drinking was not easy, but the improvement in my depression and overall health is undeniable, and the benefits came mercifully quickly. If you find yourself in the situation I was in – depressed and drinking out of compulsion (not desire) every day, unable to stop – take heart, there is hope. Here’s what I recommend:

1. Cut back the drinking to a level you can comfortably stand whilst you concentrate on tackling your depression (I am not suggesting you drink  ‘moderately’ – just try to keep the level stable, and not increasing)

2. Use your most lucid/sober spells to do some work on your depression eg CBT, mindfulness, diet, sleep, exercise, social activity. In theory, unless you are drinking 24+ units of alcohol a day, there will be times when the alcohol has cleared your system and you are not ‘under the influence’ – this is the time to tackle the depression.

3. When you start to feel a bit better, plan how and when you will stop drinking – there’s lots of useful guidance and support online eg here, here, here and here as well as AA etc.

4. If you are physically dependant on alcohol (eg experiencing shakes, sweats, hallucinations or fits), take the risks associated with alcohol withdrawal very seriously, as they can be fatal – read this.

5. Stop drinking as per your plan, and give it top priority for as long as it takes. Here’s what I found successful:

  • pick a symbolic date to stop
  • tell nearest and dearest what you are doing
  • find some like-minded new friends in the sobersphere (see links above), or AA
  • use the Soberistas chatroom or other forums to talk through cravings
  • eat lots of chocolate to cope with cravings
  • read lots of sober books
  • buy lots of alcohol free beer and wine here (but note not everyone finds this helpful)
  • start running
  • buy regular treats as a reward

6. Go back to working on the depression when you feel ready. It took me about 6 months to feel stable enough in my not-drinking to go back to prioritising depression.

Note this approach is the exact opposite of official guidance, which is to stop drinking before tackling the depression.  That just was not possible for me; I tried many, many times. Drinking was a habitual coping mechanism, and the depression seemed unbearable without it.  One could easily use this as an excuse to carry on drinking: don’t.

Sources/Further reading

Drinkaware: Mental health and alcohol

NICE Guidance CG115

Alcohol Policy UK

Thanks once again Libby for an excellent guide on depression-related drinking and going against the grain.  Don’t forget to go check out her blog here :)

Alcoholic Drinks and Drugs: Misuse

This was something that was picked up on They work for you the website that ‘keeps tabs on the UK Parliament’s and Assemblies’ for us pertaining to alcoholic drinks and drugs misuse and children.

The question was: To ask the Secretary of State for Education, what estimate she has made of the number of children in (a) care and (b) need who have parents who misuse alcohol or drugs

And the reply:

Edward Timpson (The Parliamentary Under-Secretary of State for Education; Crewe and Nantwich, Conservative)

The Department collects information on the number of children looked after by local authorities in England via the SSDA903 return. However data on the number of children looked after who have parents who misuse alcohol or drugs is not collected.

Figures are provided in the table below for assessments of children in need:

Number of assessments of children referred to social care where alcohol or drug misuse by the parent or carer was identified as a factor, year ending 31 March 2014

Factor identified1 At initial assessments2 At continuous assessments2
Number Percentage Number Percentage
Total assessments completed at which factors were reported 206,000 . 145,700 .
Of which reported:
Alcohol misuse: Concerns about alcohol misuse by the parent/carer 18,800 9.1 16,100 11.1
Drug misuse: Concerns about alcohol misuse by the parent/carer 15,300 7.4 13,800 9.5

Source: Children in Need census

1. This data was reported for the first time in 2013/14 for initial and continuous assessments completed in the year. A child may have more than one assessment in the year and an assessment may have more than one factor recorded.

2. An initial assessment is a brief assessment and a continuous assessment is a more in depth assessment of a child’s needs where the child has been referred to children’s social care services with a request that services be provided.

This was the first year this data item was collected. Data was provided by around two thirds of local authorities so this information should be treated with caution.

Factor information is published within table A6 of the ‘Characteristics of children in need: 2013 to 2014’ statistical first release: https://www.gov.uk/government/statistics/characteristics-of-children-in-need-2013-to-2014

A ‘child in need’ is one that has been referred to and assessed by Social Care as requiring additional support for their well-being.  This is below the level of ‘Child Protection’ where the child is judged to be at risk of significant harm  and if you would like to read more the NSPCC have excellent resources here.

So the data.  It reflects 2/3rds of local authorities so we could extrapolate out and say that the total number could be 300,000 initial assessments and 225,000 continuous assessments.

In 9% of initial assessments and 11% of continuous assessments booze is a factor.  2% try to keep it  hidden – otherwise why is there an increase between the two assessments?

There are 12.9 million children under the age of 16 within the UK so this represents  2.3% of the population – granted a small percentage but for 10% of them alcohol is a factor in social care assessments.  And it is higher than those impacted by drugs by 2%.  That’s still 206,000 children too many whose lives are blighted by alcohol.

Where am I going with this?  I’m not really sure.  This data does support my professional experience and I would like to think that the govt would support reform to policy and legislation if children were going to benefit.  Who wouldn’t want that? ……

 

Veronica Valli and I (9) discuss Step 4

So this was a marathon conversation between Veronica and I with 3 Skype discussions as there was so much to talk about.  Here we discuss Step 4 which reads: Make a searching and fearless moral inventory of ourselves.  I post this with a warning as some of the information (particularly part 2) discussed maybe a trigger for you.  Proceed with caution.

Part 1 of our discussion on what Step 4 means and how by examining our resentments we can become free of alcoholism.

Part 2 is a discussion on resentments and the inventory process helps us become free of them

And then finally part 3 where we have a discussion on what it means to do a fear inventory and sex conduct inventory.

A lot of what this process does is very similar to what I am learning at Cambridge.  Yes truly!  What she describes in part 3 about putting things down on paper and moving from the unconscious to the conscious is us ‘labelling’ them.  Taking the emotional heat out of them by engaging our higher cognitive function as we discussed in the flipping our lid post here.

I appreciate that Veronica covered a great deal of ground and so I’ve written some notes for the key parts of what she said that you can access here: Step 4 with Veronica Valli notes

Just having this discussion with Veronica was hugely cathartic for me and I am now really beginning to understand the power of the 12 steps if done well with a sponsor (and a secret wish that Veronica was my sponsor!)

We’ll be back in a few weeks discussing Step 5.  We do hope that you are enjoying these and finding them useful and please let me know your thoughts in the comments.

Veronica Valli is an Addictions Therapist and the author of Why you drink and How to stop:http://www.amazon.com/Why-You-Drink-H…

2013 How to Stop Cover 960x1280

Week 2 of sugar free for Lent!

Boy I am missing my ‘Friends’ sugar and sweetness in my life right now ;)

matthew perry

So I began to write daily notes of the experience and to compare and contrast it stopping with drinking.  Turns out for me it’s much the same it would seem!

Day1: Was looking for excuses to cave.  Went to Cash & Carry in day and spent ages deliberating over whether to buy a HUGE bar of 70% dark chocolate (told myself it was for cooking!).  Resisted.  On way home thought about taking kids to MaccyD’s – dressed up as a treat for them but just as much for me. Can’t have sugar – how about a shed load of processed food instead? Didn’t.  Started to feel itchy in my skin around 16.45 –  just like with booze.  Wasn’t hungry, it was almost like an emotional itch I felt the need to scratch.  Not sure why.  Ate 3 Davina digestive biscuits.  Same squirrelly  feeling appeared at 20.50 but think it was because kids were up late due to half term and we hadn’t eaten so was hungry.  Ate a sugar free mint before bed too?!

IMG_0479

Day 2: No honey on my toast so had to resist the automatic reach into the cupboard for the jar! Random snacking on Davina’s digestives again today – one at 14.00, 17.00 and 22.30.  Don’t know if it’s because I was having sugar lows as finished up home-made white raisin bread post run and had late lunch of poached egg and white muffin.  Having substance relapse fantasies in the evening while trying to meditate as have booked tickets for SW4 event in August and this will be the first big gig with no booze or drugs.  Was this because of no sugar or would I have had them anyway?  Another sugar free mint eaten before bed – hangover from nicotine lozenge days I reckon.

Day 3: Had to really resist the Chinese New Year ready meal selection in Saino’s today and if my son hadn’t been with me and been reinforcing the rules I think I would have caved!!  Really tied in with idea of treating myself and felt very deprived when I walked away from the chiller.  Bought fresh baby vegetables to include in home-made thai green curry instead.  Very late lunch and 1 of Davina’s digestives went in my mouth again afterwards.  Baked a batch of her flapjacks and couldn’t help but lick the spoon! Really struggled early evening.  Grouchy and shouty with the kids, tried to do a balance meditation to restore some equanimity but failed miserably as feel so emotionally out of balance!  Gah am not enjoying this one bit :(

Day 4: Slightly easier day to day.  Only had 1 Davina digestive and 1 flapjack as after lunch and mid afternoon snack.  The flapjacks are very sweet and very filling so you wouldn’t want to eat too many of them in one sitting!  Didn’t struggle anywhere near as much as yesterday and wasn’t even looking for ways to cheat :)

IMG_0481

Day 5: Easier again today as my taste-buds become accustomed to less sugar.  Big test of the day was the local village tea which is usually a smorgasbord of cakes and this month was no exception!  Had very late lunch of pitta pizzas and then a Davina flapjack before I went so that I didn’t feel deprived.  Hmm sounds like strategies learned from other substances ….. ;)

Day 6: Craving MaccyD’s again today but polished my halo and had California rolls instead!  Plus as was volunteering today planned ahead and took a Davina flapjack with me.  Again shades of other hangover free learned strategies coming through.  Had some potentially good news so was fidgety in the evening with anticipatory anxiety and wanted to mark the occasion with a treat and felt stumped as couldn’t go for my tried and tested chocolate :(

Day 7:  Easier today.  No cravings as such but did eat 1 Davina flapjack after a late lunch and another one after dinner at about 9pm.   Plus I’ve discovered Ricola Sugar Free Swiss Herbal Sweets that are sweetened with Stevia.  Am I allowed these? ;)  Overall I’m really pleased with how I’ve done on this first week.  Thursday will be the big test – nerves pre-presentation at uni and then post presentation relief/euphoria and no salve for those emotions ……

PS If any of you would like to join me to see Faithless and Fat Boy Slim at the SW4 festival over August Bank Holiday and keep me sober company that would be ace.  Tickets are still available I believe :)

Sugar vs alcohol

So as you know I’m sugar free for Lent and this means I have turned my critical eye away from booze and my public health spotlight is on this substance instead.  I saw this TED talk last Summer and have had it saved ever since as I knew the day would come when it would be called upon.  It’s an American Paediatrician talking and gets good after 8 mins.

So why am I sharing this now?  The news of late has been filled with stories of the current govt looking to cut benefit payments to those who are addicts or overweight.  I cannot begin to express how much contempt I have for this idea.  The similarities between alcohol and sugar in terms of their addictive quality, mass marketing and the govt response is striking.  Plus booze is loaded with sugar so you have a double whammy effect.  Although he makes jokes about alcohol being preferential to sugar I would obviously disagree and would argue that it should be on the list of required public health programmes along with sugar.

This specialist health care professional argues very eloquently why govt and corporate promotion of the ‘personal responsibility’ message ignores the fact that most people have limited knowledge and access and society can’t afford it.  The govt are complicit seeing as they have not challenged the industries that manufacture the sugar filled crap that passes for food these days or the booze that is available pretty much anywhere 24/7 to provide the accurate knowledge, access to healthy alternatives and therefore options to reduce the cost burden on society.  Both of these substances are addictive and yet the public health issue is being dodged because it is OUR fault that we got addicted to booze or are obese and therefore their response is to penalise those people further rather than tackle the corporations.  GRRRR just doesn’t feel adequate enough a close to this post – Yosemite Sam it is then!!

yosemite sam

25/02/15 Edited to add: interesting opinion piece from the London School of Economics that reads: ‘the proposal’s underlying strength remains its principles: that, firstly, sufferers should be actively helped and offered treatment but, secondly, that rejecting such treatment is intolerable.’ Read more here

 

 

Pound pub opens in Liverpool

Wavertree pub will sell beers at £1 for a half and £1.50 a pint

Half pints will be available from £1 and pints from £1.50 when the former Cuffs Bar on High Street, Wavertree becomes the fourth Pound Pub in the country to open in Liverpool.

Mike stressed: “It’s not a pound a pint as some people seem to think. And it’s not all about cheap beer because we are selling non-alcoholic drinks at £1. It’s a no frills business, that’s the best way to describe it. There will be no Sky Sports, karaoke or DJs which a lot of pubs round here have.”

Mike, who is hoping to attract more students to the pub, added: “We are not trying to encourage alcoholism or binge-drinking. It’s about people who might only have £10 being able to have a good night out. We know money is tight and people are on a budget, while this is not a high income area.”

The £1.50 pints will include John Smith’s, Foster’s, Strongbow, Budweiser and a changing cask ale, while £1 bottles include Foster’s and Carlsberg.

If you’re a stout drinker, it’s £2 for a pint of Murphy’s and £3 for Guinness.

The £1 soft and non-alcoholic drinks include large Pepsi, large R. White’s lemonade, J20 and Becks Blue.

Other Pound Pubs – which are run by Here For Your Hospitality Ltd of Leigh, Greater Manchester – operate in Atherton, Greater Manchester, Stockton on Tees and Newark in Nottinghamshire.

Joe White, operations manager with Here For Your Hospitality, said: “All our other openings have gone well so we are hoping for a busy first day.”

Regarding concerns the business could encourage irresponsible drinking, he added: “You can drink at home cheaper than you can in a pub, and you are not monitored. Here there are people to say ‘You’ve had enough’.”

Mike Wardell, director of Here For Your Hospitality, meanwhile, has already described the operation as “a quality product in a well managed, controlled environment”.

As for the 9am opening (closing time will be 11pm), this might be put back if few customers come in at that time in the early days and weeks – and Joe White said: “It’s about giving people more choice.”

Mike Dring added: “We do want to attract new customers, including students, but we also want to keep our existing customers.”

Right – so it has a range of alcohol free products so they argue that it’s product range isn’t designed to encourage irresponsible drinking but it opens at 9am – to give people more choice ………

In other news in Worcestershire, the county to the East of Merseyside:

Council slashes drug and alcohol abuse funding £500,000 in ‘pay by results’ deal

Worcestershire County Council is having to defend criticism it is “taking risks” with vulnerable people by looking to save money.

Taxpayers currently fork out £4.79 million a year on services to help wean people off deadly drugs and alcohol abuse.

It will be cut £493,000 to £4.3 million in April due to huge pressure on the council’s budget, with around £25 million needing to be saved over the next year.

So more availability of alcohol via pubs who are targeting lower prices and wider opening hours vs reduction in services that pick up the pieces.  I can’t see a problem with this picture can you?? 

A comprehensive list of alcohol’s harms and benefits in a cost-benefit diagram

The now defunct Government Cabinet Office Strategy Unit once attempted to capture a comprehensive list of alcohol’s harms and benefits in a cost-benefit diagram

Here it is (click to enlarge)

costs_of_alcohol_m_3167181c

What I find interesting is that there are 17 above the line costs and only 5 below the line benefits.  Feels like a lot of risk for not a great deal of reward wouldn’t you say?

This graph was included in an article in The Telegraph which ran in January and was looking once more at Professor Nutt’s chemical compounds that have been muted as solutions.

He has finally cracked a chemical conundrum, which has allowed him to develop new drugs that could wean people off alcohol, while allowing them to enjoy the feeling of being “tipsy”.

The first drug, which he calls “alcosynth”, is a drink that mimics alcohol. It a non-toxic inebriant that removes the risks of hangovers, liver toxicity, aggression and loss of control. A benzodiazepine derivative, the substance is in the Valium family, but without being addictive or causing withdrawal symptoms, he claims.

The second is a so-called “chaperone”, which would attenuate the effects of alcohol. Take a pill with booze, and it’s impossible to become drunk to the point of incapacitation. The price point would be set quite high, to stop the drug from being abused, but this “sober up pill” could be popped on the way home, reducing drink-driving accidents, and other alcohol-related incidents and crime.

Both drugs would be available in high-end cocktail bars at first, claims Nutt. The alcohol substitute would be marketed as a companion to a regular tipple and relatively cheap to buy.

The overall cost of alcohol misuse is difficult to calculate because of alcohol’s ubiquity. Its combination with fatty food and sedentary activities make the mathematics tricky: estimates for the overall cost of alcohol to the British economy range from £21bn to £55bn per year.

The Prime Minister’s Strategy Unit has pegged the cost to the NHS of “binge Britain” at £3.5bn – higher than smoking at £3.3bn. Add on the £11bn for crime and £7.3bn in lost productivity from hangovers, absenteeism and poor performance and alcohol increasingly appears economically destructive.

Nutt has been working on synthesising his alcohol mitigation drugs for a decade. The effects of alcohol are devilishly hard to mimic because of its complex effect on the human body.

Ethyl alcohol (C2H6O) is unique in the universe of narcotics. Most drugs operate by hijacking one molecular receptor: tetrahydrocannabinol (THC, the active component in marijuana) impersonates our own endocannabinoids. Psilocybin (the chemical contained in magic mushrooms) mimics serotonin. Cocaine messes with the dopamine networks.

Alcohol uniquely masquerades as a number of neurotransmitters. Booze is the ultimate molecular maverick, which explains why so many of us are hooked. “Alcohol is a promiscuous drug,” says Nutt. It is also called the “dirty drug” because of its capacity to invade every cell in the body.

Nutt has applied for patents on 85 new chemical compounds in the alcosynth and chaperone families, which would be licensed to DrugsScience, and the Beckley Foundation, both independent organisations dedicated to research on drugs and drugs policy research.

Getting alcosynths and chaperones to market will not be easy. Licensing such drugs could take between three and five years, Nutt says – if they pass the UK’s stringent drugs laws at all. He has also courted controversy by working with a chemist, known as Dr Z, who was behind the creation of a mephedrone, also known as “miaow miaow”. That drug that was connected to a number of deaths in the UK last year and was subsequently banned.

“Some see him as the ‘new Shulgin’ [the chemist who gave us MDMA, 2-CB, 2-TI and 200 other psychoactive compounds],” says Dr Nutt. “Others see him as evil incarnate. He polarises people.”

The cost of human trials and legal bills for Nutt’s new chemicals will top £1m, he claims. He is hoping to secure a backer from the big pharma world. Danish pharmaceutical company Lundbeck recently launched Selincro, a drug that reduces the craving for alcohol, proving that there is market interest, he says.

The £1m figure doesn’t scrape the surface of the investment required to change our social and cultural relationship with alcohol. Not to mention our economic reliance on the industry, which generated £39bn for the UK, according to Nielson data.

“If alcohol was treated as a toxic compound in the same manner as benzene or other lethal chemicals, the maximum amount you would be permitted to consume would be one wine glass a year,” says Nutt. “But it is exempt from toxic control measures because we like to drink.”

Nutt says the Government must take drastic action to generate results, as all attempts to mitigate alcohol consumption have so far failed.

“We are incapable of killing alcohol’s allure,” he warns. “This is a battle we cannot win.”

This is an interesting premise and has been discussed by me here and here.  As before I’m not sure that replacing alcohol with a benzodiazepine based product is really helpful and the alcohol attenuator sounds just like Selincro, which I wrote about in these posts here.

What do you think?

PS Am now in the process of organising the next Club Soda Social in Cambridge.  The plan is Sunday 22nd March 5-8pm at Brown’s Restaurant and Laura assures me they have a great mocktail selection ;)

More than half of British public unaware of alcohol’s link with cancer

More than half of the British public are unaware of the link between alcohol consumption and cancer, according to a survey from the Alcohol Health Alliance UK (AHA).

“Alcohol has long been a scientifically established cause of cancer.” – Sarah Williams, Cancer Research UK

The UK- wide poll found that just 47 per cent of people were aware of any connection between alcohol and the disease.

But an overwhelming majority (83 per cent) would back further nutritional and health information on alcohol labelling.

Sarah Williams, Cancer Research UK’s senior health information officer, said: “Alcohol has long been a scientifically established cause of cancer, but there is surprisingly low awareness among the public of this link.

“And it isn’t just a risk for heavy drinkers; regularly drinking alcohol puts you at greater risk of seven different types of cancer, including breast and mouth cancer”

Alcohol is currently exempt from the EU legislation that makes it mandatory for food products and soft drinks to carry nutritional value information, despite alcohol being classed as a group 1 carcinogen by the World Health Organisation.

The AHA’s chair, Sir Ian Gilmore, says the lack of health information on many alcoholic products is “indefensible”.

“It’s not right that labelling is mandatory for a box of corn flakes but not for alcoholic products which can seriously harm health,” he said.

Gilmore urges the Government to start listening to public opinion on this issue rather than the demands of big businesses.

The results from the survey of 3077 people showed that nine in 10 (91 per cent) think that clarifying the health impacts of alcohol is important. But when challenged over their current knowledge, just under one in three (31 per cent) of people successfully acknowledged the links between alcohol and breast cancer.

This stretched to half of people being aware of the links in relation to mouth or throat cancer.

The AHA is calling for health labelling to be made a legal requirement for alcohol products.

Its campaign is pushing for every alcohol product to clearly describe its nutritional, calorie and alcohol content as well as make it clear through labelling that the safest option for pregnant women is to avoid alcohol consumption entirely.

Cancer Research UK supports the campaign for clearer labelling so everyone can make better choices about their drinking, said Williams.

“Cutting back on alcohol can help cut the risk, so you could try having more alcohol free days or making every other drink something soft,” she added.

War on Drugs and Wales

I’ve called this post what I have not to incite the Welsh but to make a point.

Substance misuse in Wales 2013-14

When I looked at this graph what I was struck by was how the substance that the Welsh  have the biggest issue with is alcohol.  Our war on drugs focuses heavily on all the other substances bar this one and yet this is the one causing the biggest problem in terms of substance abuse.  Something is wrong with this picture and with our policies and strategies.  Yes we could argue that this is the successful result of the war on drugs but booze isn’t considered a drug in the same way and yet this is the one creating the havoc for people.  I’ll say it again – something is wrong with this picture ……….

It doesn’t even have to be tackled in quite such a dramatic way as drugs do – just implement minimum unit pricing.  After similar analyses for England and Scotland, the simulation of what a minimum unit price for alcohol would do for health, crime and workplace absence in Wales predicts it would substantially save lives and reduce social impact by making (especially poor and heavy) drinkers cut back (read more here).

What’s your poison?

whats your poison

Edited to add: this news headline grabbed my attention too and you can read the full story here

Drink-related deaths up by nearly 50% since start of the millennium, new figures reveal

Alcohol-related deaths among men in Wales have soared by nearly half since the start of the millennium, new figures have revealed.

A report published by the Office of National Statistics found that there was a 46.4% increase in deaths caused by alcohol between 2000 and 2013, up from 209 to 306.

Four men aged between 25 and 29 died due to alcohol in 2013, including one from alcohol-induced pancreatitis and one from alcoholic liver disease.

And the news isn’t much better for women, with the number of alcohol-related deaths increasing from 131 in 2000 to 161 in 2013.

Since 1994, the number of deaths in men and women combined has nearly doubled in Wales.

Defining Addiction

I read this on the Castle Craig blog and really liked it as it blends older beliefs from older recovery methods with some of the newer knowledge on the subject and is written by Dr Margaret McCann CEO and founder of Castle Craig Hospital, an alcohol and drug rehab clinic in Scotland.  It is how she defines addiction.

The view I have taken for many years is that addiction is a complex illness involving many factors.

These factors include:

  • the effects of the drug itself;
  • the response of the brain to the drug – with resultant neurochemical and biological changes after prolonged exposure;
  • the hereditary and genetic makeup of the individual – there is strong evidence that genetic factors predispose an individual to addiction and increase the person’s vulnerability;
  • psychological factors;
  • and socio-cultural factors. 

In order to simplify the message, I think of a triangle where the three points are the drug, the person (biology; psychology) and the environment (price; availability; peer influences; education; occupation).

In this way, according to a previous definition, addiction is a biopsychosocial disease. I think there is no doubt that it also has a spiritual dimension (dishonesty, selfishness, the moral and spiritual consequences of the lifestyle).

Understanding addiction as a disease is not a cop-out for taking responsibility for one’s recovery. In fact because it is a chronic progressive and potentially fatal condition it is all the more necessary that the individual take full responsibility.

Alcoholics Anonymous itself has always spoken of an illness but there is a greater understanding now of how the brain’s reward centre’s and neural circuits are hijacked by long exposure to significant drug levels.

So to summarise:

  • Addiction is a biopsychosocial disease.
  • “I think of a triangle where the three points are the drug, the person and the environment.”
  • Understanding addiction as a disease is not a cop-out for taking responsibility for one’s recovery.

For further reading on this subject I recommend the American Society of Addiction Medicine’s definition of addiction.