So this was covered in The Guardian in October and I thought it might be good for today – the day after perhaps one of the most excessive days for drinking in this country (after Black Eye Friday and New Years Eve). For me Boxing Day was an excuse to keep going and thereby delay the pain of the monumental hangover I had been drinking myself towards. Like a cold shower this piece will sober you up fast as alcohol use disorder remains an urgent issue we can not ignore!
“What is most unhealthy is this identification we have … where we identify having a good time with drinking alcohol, having a shit time with drinking alcohol, being happy with drinking alcohol, being sad with drinking alcohol. It is too much of an ever-present, regardless of our mood.”
Nicola Sturgeon, speaking to Alastair Campbell in this month’s GQ, has a point. Sturgeon was referring to Scotland but her comments could easily be applied to the rest of the UK. Indeed with almost a quarter of men and 18% of women in England exceeding the recommended weekly limits for alcohol consumption, it seems the time has come for an urgent discussion about the implications of our infatuation with booze.
The UK, however, is not alone in this respect. A major new study of more than 36,000 Americans reports that 14% of those interviewed met the criteria for alcohol use disorder (AUD) in the previous 12 months. Scale up the results of this large and nationally representative sample and we’re looking at perhaps 32 million US adults experiencing significant problems with alcohol.
Alcohol use disorder is a new term, introduced in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM used to differentiate between alcohol dependence and abuse. Now it lists 13 symptoms, such as drinking more than intended; being unable to cut down or control alcohol use; craving alcohol; failing to fulfil major role obligations at work, school, or home because of drink; and increased tolerance – ie needing to drink greater amounts of alcohol to get drunk. The more of these symptoms an individual presents with, the more severe their AUD: two to three is classed as mild; four to five as moderate; and six or more as severe.
The US study shows that men are much more likely to experience alcohol problems than women. No surprises there: this is a finding familiar from previous epidemiological surveys. Almost one in five of the males interviewed reported two or more AUD symptoms in the previous year: 9% were classified with mild AUD, 4% moderate and 5% severe. For women, the overall figure was 11%, of which 6% described mild AUD, 3% moderate and 2% severe.
As with many physical and psychological problems, the researchers found that AUD correlates to socioeconomic status. The lower your income, the more likely it is that you’ll suffer from the disorder. Youth is a risk factor too, with rates in the sample highest among those aged 18-29 and subsequently declining with age. From a developmental point of view, if nothing else, alcohol abuse during adolescence is particularly hazardous. Scientists who regularly MRI-scanned 134 adolescents over a period of 12 years found that the natural development of the brain was altered in those who drank heavily. Some areas of the brain had accelerated pruning of excess neurons, others failed to show normal levels of growth.
The long-term consequences of these changes in the brain, and whether they can be reversed by cutting back on alcohol consumption, are unclear. But what we do know is that alcohol is linked to a range of illness, including heart and liver disease and certain types of cancer, and can be a significant cause of injury. In EU nations, one in seven deaths of men aged between 15 and 64 is due to alcohol; for women, the figure is one in 13. Most of these deaths are the consequence of regular heavy drinking, defined as five or more drinks per day for men and 3.33 drinks for women.
Given that the majority of adults in the UK drink, what marks out the people who develop problems? Genes play a part: heritability is thought to be around 50%. (In other words, half of the differences in levels of alcohol disorders across the population are a product of genetic factors.) One of the ways in which that genetic susceptibility exerts itself may be a reduced sensitivity to alcohol. Studies have shown that people with a family history of drink problems report less intoxication after a set dose of alcohol than those without such a background. If you have to consume larger amounts of alcohol in order to experience the pleasurable feelings many of us associate with a drink, you elevate your risk of slipping into abuse and dependence.
Genes aren’t the whole story, of course. Environmental pressures – sometimes in combination with genetics – are clearly hugely influential. A person may, for example, be born with a genetic vulnerability to alcohol abuse. But if alcohol isn’t freely available, or is discouragingly expensive, the risk of that person developing a problem is much reduced. On an individual level, stressful experiences like divorce or job loss can push people into excessive drinking. Similarly, people who have suffered mistreatment in childhood tend to prove more vulnerable to AUD in later life.
Given that problem drinking is so prevalent – and so dangerous – what can be done to help those most at risk? Thinking seriously about the ubiquity of alcohol in our culture would constitute a step forward, as would measures to moderate availability. But we also need to ramp up treatment options for those drinking at risky levels: at present most people get no help at all.
One positive development is the increasing prevalence of primary care screening: this is why your GP asks about your drinking habits. Once a possible problem is detected, the kind of treatment that individuals require will depend on the severity of their particular problem. For some people – especially middle-aged males – just a brief information session with a GP can help.
But this very limited type of intervention doesn’t work for everyone. The consensus among professionals suggests that a “stepped care” approach is probably required, tailoring the treatment to the needs of the individual and providing intensive or highly specialist care only if other approaches are unlikely to succeed. What exactly those levels of treatment might comprise, however, is a matter for debate.
Psychological approaches can be fruitful. For example, helping people to recognise that they may need to alter their drinking habits is a crucial component in any recovery plan. So motivational interviewing (systematically weighing up the advantages and disadvantages of both drinking and reducing drinking) can be useful]. And by employing techniques drawn from CBT, therapists and patients can try to identify the reasons behind their excessive drinking, the triggers that prompt this behaviour, the negative thoughts that keep people locked into their habits, together with strategies to face down cravings, and tackle the depression and anxiety that so often lurk behind alcohol abuse. Incidentally, medication isn’t often prescribed, but it can help people who have been dependent on alcohol to maintain their abstinence.
Alcohol-related hospital admissions in the UK have jumped by 5% in just a year. The ten-year perspective is just as alarming, with an estimated 493,760 alcohol-related admissions in 2003-04 and 1,059,210 in 2013-14. Addressing a problem that’s so deeply rooted is certainly not going to be easy, but for how much longer can we ignore it?
Add to this the desperately disappointing news reported in the BMJ that ‘the supposedly independent National Institute for Health and Care Excellence (NICE) bowed to political pressure from ministers and removed references to a controversial alcohol policy from its guidance on the prevention of dementia, disability, and frailty in later life.’
“The idea that ministers would meddle with supposed independent public health advice to suit their own political agenda is alarming,” said Katherine Brown, director of the Institute for Alcohol Studies “It brings into question whose interests are being prioritised: the public’s or big business.”
So if you’re fed up with your drinking after the excesses of December and would like 2016 to be different let me help you realise that goal. From now until 16th January I’m continuing to offer my Udemy online course at 25% discount so £60 or $99 when the price will increase to £99 or $149 . Just click here: New Years Resolution 2016 or sign up for my next London workshop on January 30th 🙂