Daily Archives: 23/01/2016

Britain on the Booze

alcohol stats Guardian Britain on the BoozeIt’s very rarely that I post twice in one day (apart from Friday Sober Jukebox) but this is so superb and important I’m blogging twice today to make sure you see the coverage.  For those who missed it last night The Guardian did an excellent Society focus on Alcohol and the NHS called Britain on the Booze.

I could have cried with joy when I saw this this morning as it feels like finally a respected broadsheet has picked up in a big way on what we’ve been discussing here on a daily basis for the last two years.  Maybe now there will begin to be some acknowledgement to the size and scale of the issue which we are only too aware of out here in the sobersphere but the rest of the country (and world) seems to want to continue to deny.  Hopefully not anymore …. but I am also aware that today’s news print becomes tomorrow chip paper so my optimism is held in check by a dose of realism.  (As a side note MrHOF saw the start of the coverage last night but I’d just gone to bed and he knew that if he told me I’d have stayed up all night following it so he only told me this morning, and he was right, I would have done so thank you to him for knowing me so well!)

They looked at all aspects which included six reporters in city centres across the country report on one night of British drinking – and its impact on the National Health Service.  There is too much to cover in this blog post so I’m going to supply all the links to their coverage and will pick my edited highlights.

So here goes:

The making of a hangover: the true impact of one night out

Friday night: how it unfolded

Healthcare professionals share their experiences of funding constraints, violent behaviour and drink-related disease and death

I look after a 34-year-old woman who drank three bottles of wine and fell down a flight of stairs. She is visibly intoxicated but starts to become less responsive. Is this due to alcohol or a head injury? One thing I have learned is to never assume someone is just drunk. She falls unconscious and stops breathing. A tube is put down her throat to help her breathe. Scans report various limb fractures, a skull fracture, broken ribs and, more worryingly, a bleed on the brain – a potentially fatal diagnosis.

Staff tell of chaos and abuse, with high volumes of drink-fuelled cases now a daily rather than a Friday night aspect of work

(Exclusive: Firms claim to support responsible drinking, yet data shows those who consume at risky or harmful levels account for 60% of sales in England)

And it’s the same in Australia:

More than 3.8 million Australians average more than four standard drinks of alcohol a day, twice the recommended health guidelines, and these drinkers are targeted by the alcohol industry and branded as ‘super consumers’, according to the Foundation for Alcohol Research and Education.

Although they represent just 20% of Australians aged 14 and above, these excessive drinkers accounted for 74.2% of all the alcohol consumed nationally each year, the report says, making them valuable to the liquor industry (Guardian article)

The great British booze problem: how a few glasses a day has led to an epidemic for the NHS – video

(Alcohol Datablog: Discover how much alcohol people drink, and the burden it places on the NHS)

The Guardian coverage summed it all up beautifully too:

So that just about wraps up our Friday night live. Key conclusions: 1. drink is a problem 24/7 in hospitals, not just in the evenings, 2. for every teenager with a sprained wrist and hiccups there’s a serious recidivist who is on first-name terms with all the triage nurses, and 3. Britain may have its problem drinkers, but it has many great people trying to help them, from the staff in A&E departments to the street volunteers who try to protect people from themselves.

And that’s my view too – this isn’t about demonising drinkers, this is about acknowledging all the people who work behind the scenes to support those who get into trouble because of alcohol.  The public sector workers be they nurses, doctors, police officers, paramedics.  The volunteers be they street angels or street pastors.  All those people who try to keep people safe from themselves and each other when under the influence of this legal, yet highly addictive and toxic, drug which is so normalised in society that we can’t even acknowledge the size of the elephant in the room.  I wrote a piece for The Guardian 2 years ago when I said we needed to change the drinking guidance, which has now recently happened!  Maybe just maybe this is the start of a bigger shift?

Will Self had something similar to say himself last week-end

My Christmas night in A&E accompanying someone on a vodka bender brought home the reality of what we ask of our guardian angel health service

Thank you again to The Guardian for such brave (and detailed) journalism – which it is when you are potentially beholden to the drinks industry for your advertising revenue ……

Edited to add: 24th Jan 2016 and their coverage continues!  Ooh I could kiss you Guardian editors!!

Hepatologists in Southampton are seeing more young, middle-class and female alcoholics – some even in their teens

Most of us who drink alcohol won’t die from liver disease – but it still kills more of us than diabetes and road deaths combined

I find out a 35-year-old client died last week. Her drink of choice was cheap wine. I wonder why advertisers don’t use the people who actually drink their products. The woman I knew looked 70, with dead eyes.

Chris Owen, who developed alcohol-induced epilepsy, tells how the health service picked him up after every injury

The NHS is not perfect, show me an institution that is. I’ll say this though: I’m 100% certain I would not have even got to a place where I could begin to get better without it, and I certainly wouldn’t be walking around today.

And more: 25th Jan 2016

The secret old age psychiatrist’s diary: ‘She’s on a downward spiral with alcohol’

I go to see a patient in her 70s who is drinking at least a quarter of a bottle of spirits a day. Over the last five years, she has developed a neurological problem and can hardly stand as a result. Drinking started off as a habit to pass the time, but she is now dependent on alcohol. She has started to develop an alcohol-related dementia that will progress if she doesn’t cut down, and her liver is somewhere between abnormal and cirrhosis. She’s on a downward spiral. To get through to her, I explain her blood test results and say that her existing memory problems will get worse and threaten her independence. She looks at me in disbelief and agrees to cut down.

Thank you again Guardian – welcome to my world as a nurse ……..

PS The Telegraph also had similar coverage on Friday night with this:

Manchester police live tweeted a night of 999 calls and this is what happened

Officers recorded every drunken fight, row and missing person during an alcohol-fuelled night in and around the city’s nightspots

Alcoholics Anonymous saved my life, but now I’ve lost my faith

This was in The Guardian in November and is an interview with Jon Stewart from Sleeper (second from left).

sleeperMy first day of sobriety was the first day I prayed. I’d always been a staunch atheist; I grew up in Yorkshire during the miners’ strike, and was raised on left-wing politics. When I went to my first Alcoholics Anonymous meeting, 15 years ago, God was and always had been the opium of the people. But AA’s 12-step programme demanded, or at least strongly suggested, that I relinquish myself to a higher power. It didn’t have to be God per se, but I was assured that, if I didn’t find something, I’d probably drink myself to death. I was in my early 30s. I’d spent the previous decade as the guitarist in Sleeper, a successful band, touring, partying and, well, drinking. By the early 2000s, I was so desperate to get sober that that “something” could have been anything. I would’ve prayed to Lord Xenu, if that’s what it took.

I had just been your regular steady drinker. In AA, they call it “topping up”. I started when I was a teenager. It was nothing particularly out of the ordinary – I discovered booze, I started going to parties, I had a good time. Although I always seemed to be having a slightly better time than everyone else. I now know that this is to do with the way my brain responds to reward chemicals. Around 10% of drinkers, it’s thought, are overly sensitive to the pleasure stimuli in alcohol, and I happen to be one of them.

It’s generally, though quite simplistically, understood that before you start AA you need to hit rock bottom. Most people with a drinking problem have moments where they wake up and think to themselves, “I’m never doing that again.” I’d had hundreds of them.

But if I were to pinpoint my absolute low, it would be in the summer of 2000. My band had split up and I was living in Los Angeles, playing with other bands and doing session work. It was around this time that I realised I needed, and very much wanted, to stop drinking. In my mind though, I was still on tour, and I was behaving as such. I went along to a couple of AA meetings in the area, but I couldn’t get on board with the God thing. It grated. At the same time, I was coming into contact with people who had been just like me and were now 10 years sober. And that was seductive. Or perhaps just inspirational.

Eventually, my American work visa ran out and I moved back to the UK. I couldn’t seem to organise anywhere to live. I had money, but it seemed like my whole life had ground to a halt. I’d run out of options and, acting on the advice of my doctor, I decided to give AA another try.

In the beginning, I went every day for a month, but I still couldn’t stop drinking. Then at one meeting I met a guy who’d been sober for five years. I asked him to help me and he agreed to be my sponsor. AA has an informal system of “sponsorship”, where newer members are buddied up with more senior ones who look out for them. My sponsor asked me if I was praying. Of course, I wasn’t. He reassured me that AA doesn’t expect you to find God straight away and that I should just keep an open mind. So, initially, I accepted music – something that seemed accessible to me – as my higher power. Then, more specifically, the Beatles became my deity. When I heard that Ringo Starr had “found God” while struggling with his own addiction, I started exploring more structured forms of faith. Eventually, I accepted God myself.

From that point onwards, I was a 12-step evangelist. I prayed every day for 14 years. And I was also sober. I’d be lying if I said that AA didn’t save my life, but it also – towards the end – left me in a state of overwhelming cognitive dissonance. When you’re a hardcore believer in AA, as I was, it’s very easy to block out other possible solutions to your problems. In meetings, seeking outside help is encouraged when necessary, but it’s often another spiritual method, such as mindfulness or reiki. Sometimes, in the more doctrinaire pockets of AA, methods other than the 12 steps are frowned upon.

In AA I met lots of other people who, like me, couldn’t cope with life without a chemical support. This has its pros and cons. There was an intense feeling of camaraderie, which is something I truly needed at the time. These were people who understood this very strange and contradictory thing about alcoholism. That is, when you have a drinking problem, you feel like the drink is the only thing holding you together. I now realise that the rush I felt from being in a room full of people in the same boat as me – the sensation of peace, of God entering in through the ceiling – was simply oxytocin (the human bonding hormone) triggered by the familiar rituals of the meeting. I was mistaking a chemical experience for a religious one.

Then again, I was sober, I felt spiritually awakened and I was spending time in the company of loving people who understood and cared about me. Eventually, probably inevitably, I hit a brick wall in recovery.

AA was founded off the back of a 1930s Christian revivalist movement in the United States. Its doctrine hasn’t changed since that time, meaning that its approach to mental health is now, in my view, severely outdated. The AA programme makes absolutely no distinction between thoughts and feelings – a key factor in cognitive behavioural therapy, which is arguably a more up-to-date form of mental health technology. Instead, in AA, alcoholism is caused by “defects of character”, which can only be taken away by surrender to a higher power. So, in many ways, it’s a movement based on emotional subjugation. The first of the 12 steps insists that you recognise that you are “powerless over alcohol and your life is unmanageable”. So, anything you achieve in AA is through God’s will rather than your own. You have no control over your life, but the higher power does.

AA is still the default treatment for alcoholism in the UK, the US and many other parts of the world. Thousands of people struggle every day with this condition, tragically some even die, without ever hearing about the alternatives. During my 14 years in AA, I saw people come and go largely for two reasons: either they “couldn’t get the God bit”, or they couldn’t maintain abstinence. It’s well known that the 12 steps aren’t about learning to drink in moderation; they’re about never drinking again, one day at a time. Actually AA has somewhat hijacked the word “sober”. To most people the idea that you could have one drink and remain relatively sober is completely reasonable. After all, in most countries you can still legally drink a small amount before you drive. For members of AA, however, “sober” actually means completely “abstinent”. In fact, that’s the only requirement for membership, a desire to stop drinking. The majority of alcoholics, those who may never be able to give up the booze entirely, desperately need to be made aware of the other options now available.

The Big Book (AA’s core text) says: “there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.” Well, actually it has. In the mid-1990s, an American doctor, David Sinclair, began using an opiate blocker called naltrexone to treat alcoholics. Naltrexone inhibits the euphoria alcoholics get from drinking and allows them to drink normally. This is called “pharmacological extinction”. It means that, eventually, the drinker no longer associates alcohol with a high. (According to AA, that association is never lost.) What became known as the Sinclair Method has now been used to treat thousands of alcoholics in Finland, where he worked. In the rest of the world, naltrexone is largely unheard of (although nalmefene, a similar treatment, is available on prescription in Britain). What’s more, it’s out of patent, which means it’s unattractive to pharmaceutical companies who can no longer profit from it – so they’ve no reason to promote it. Sadly Sinclair died earlier this year, without the international recognition he deserved.

Right now, in the US, a debate is raging over the effectiveness of AA, largely inspired by Obamacare (the Affordable Health Care Act) and its implications for the funding of a “spiritual” remedy for alcoholism and addiction. This in a nation where church and state are constitutionally separated, yet the overwhelming majority of rehabs use 12-step methods.

Last year, retired Harvard psychiatry professor Lance Dodes released The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. In his book, Dodes examines data surrounding AA’s success rate and concludes that the programme is effective for as few as 5-8% of people. We’ll probably never know the real figure, but it’s certainly less than that of naltrexone. In 2001 Sinclair reported a 78% success rate in reducing and, sometimes, cutting out patients’ alcohol consumption altogether.

AA’s apparent ineffectiveness isn’t the only aspect of the fellowship now being called into question. This year Monica Richardson, an American filmmaker and ex-12-stepper who was sober in AA for more than 30 years, won best documentary at the Beverly Hills Film Festival with The 13th Step – a feature-length critique of hidden sexual predation in AA, and the fellowship’s apparent inability to do anything about it.

“Thirteenth stepping” is AA slang for seducing a fellow member. This is usually, though not exclusively, practised by men who take advantage of their immediate access to vulnerable women. There is no formal safeguarding in AA, and everyone is anonymous so there’s no vetting process. Consequently an innocent young women trying to come to terms with a drink problem can find herself sitting in AA next to a man with a serious criminal history, whose record might include violent or sexual offences, and who has in some cases even been court ordered to attend meetings.

So, while AA certainly offers inspirational guidance to help separate the alcoholic from what ails them, it also faces a number of difficult “21st- century problems”. I quit AA when I realised that, for some people, the 12 steps are perhaps no longer the most reliable route to sound long-term mental health. My last meeting was in early January 2014.

Aside from no longer believing in a higher power, I’d developed chronic OCD. My doctor told me that AA wasn’t helping. Fourteen years earlier, a medical professional had suggested that I needed AA. Now one was insisting that it was damaging my health and, what’s more, that I should leave. Soon after, I discovered cognitive behavioural therapy. Whereas AA actively encourages obsessive thinking, CBT challenges it. I finally realised the extent to which AA had in fact been nurturing my anxiety. SMART Recovery is a group that helps alcoholics using CBT rather than the 12 steps. It’s slowly growing here and in America but, unfortunately, is still dwarfed by the size of AA because so few people have heard of it.

It may seem like I’m anti-AA. That’s not true. I prefer to consider myself pro-choice when it comes to treating alcoholism. I owe my life to AA, but that puts me in a very small and very lucky minority. What so many alcoholics don’t know is that there are other options when it comes to treatment. I don’t regret joining AA, but 14 years of it, I now believe, may have been unnecessary. We need to look at why, when our fellowship’s success rate is apparently so low, it still dominates the public discourse on alcoholism and recovery.

The media’s near universal uncritical endorsement of AA may be a factor in this, although things are gradually beginning to change thanks to the power of the internet. It’s never been so easy for people with shared interests to connect, and many bloggers and online activists are working to promote progressive secular options in recovery. I’d encourage anyone with an alcohol problem to try AA, but also to spend time researching the secular alternatives.