Monthly Archives: June 2017

20 things to replace 2!

So I’ve been having a massive clear out following stumbling across the blog of Be More With Less.  As part of that I was having a good old sort through of my office and came across this list that was clearly written back in the days of my drinking and smoking because of what I called it!  Its ‘replace’ sub-heading was healthy relaxation methods as I was desperately looking for ways to relax that didn’t include booze and fags.

The reason for writing this post is two fold.  Firstly to share the list so here it is:

  1. Aromatherapy
  2. Acupuncture
  3. Hot stone massage
  4. Reflexology
  5. Flotation tank
  6. Reiki
  7. Meditation
  8. Swedish massage
  9. Exercise = running
  10. Music
  11. Chocolate
  12. Mindfulness
  13. Diet + increased water intake/Less caffeine and sugar
  14. Bath
  15. Scented candles
  16. Cup of herbal tea
  17. Reading
  18. Sleeping
  19. Cinema
  20. Yoga

If you’re looking for even more inspiration how about this:

The Mayo Clinic say to get the most benefit, use relaxation techniques along with other positive coping methods, such as thinking positively, finding humor, problem-solving, managing time, exercising, getting enough sleep, and reaching out to supportive family and friends.  They go on to say that by practicing relaxation techniques we can reduce stress symptoms by:

  • Slowing your heart rate
  • Lowering blood pressure
  • Slowing your breathing rate
  • Reducing activity of stress hormones
  • Increasing blood flow to major muscles
  • Reducing muscle tension and chronic pain
  • Improving concentration and mood
  • Lowering fatigue
  • Reducing anger and frustration
  • Boosting confidence to handle problems

And secondly I am pleased to say that I have finally signed up for the one thing on my list I’ve avoided up until now – the body technique at no 20!  I’ve been resisting it because I have sensed it is going to engage me to work on some somatic elements of my recovery that I know is going to potentially be hard so I’ve been procrastinating.  I know how beneficial others have found it and that many in the recovery community are big advocates of it so I’m finally diving in and I’ll let you know how I get on.  If you want to share your experience of yoga in the comments along with any hints and tips please do 🙂

Depression in Recovery


So I’ve talked before about depression and drinking here so this is not a new topic.  However I’ve not really discussed it in recovery.

Often our drinking is a self-medication for depression and keeps us stuck in a place where we don’t look at the underlying driver to our drinking.  However when we stop we remove that coping strategy and also the distraction and suddenly our underlying low mood comes fully into view.  This can be disconcerting when we’ve achieved so much in stopping and are hoping for pink clouds and get dark skies instead.  This is something I’ve experienced in recovery so know you are not alone.

If you’re struggling with low mood can I recommend listening to the brilliant podcast featuring Mandy Stevens which was featured on Bryony Gordon’s MadWorld podcast series in April.

If you wish to read Mandy’s story you can do so here:

From NHS Director to mental health inpatient in 10 days

The podcast is superb because she talks so eloquently about her depression and suicidal thoughts as one with the insight of both mental health professional and also client struggling with this debilitating mental health illness.

Her words:

As I have worked in mental health services for 29 years, one would think I would be immune to mental illness. I am a Registered Mental Health Nurse with 15 years experience as a clinician and latterly 14 years as a manager and then Director. But there is no immunity; mental illness can come out of nowhere and affect anyone at any time.

From initial symptoms of depression to admission to a mental health unit 10 days later via the Crisis Team, depression ripped the rug out from under my feet and emptied my whole being. I have been completely disabled and incapacitated by this illness.

If I had been in hospital with a broken leg, or a physical problem, no doubt I would have been sharing amusing photos of my drip stand, the signed plaster cast and the hospital food; laughing with my family, friends & extended Social Media community. Instead I have hidden myself away, scared of my own shadow and told very few people. Sad to say, I have also been embarrassed, shy, suicidal, phobic, anxious and scared of everything.

She also in the podcast shares some superb resources including:

The Beck Depression Inventory

This is a free self-scoring resource that you can complete, print out and take to your GP to start a discussion with your healthcare professional should you find yourself struggling.

GO HERE TO ACCESS THE TEST

She also shares many tips including those for managing panic attacks and some excellent mindfulness resources.  It is well worth your time and I thank her for it.

As she advocates if you are struggling please reach out to someone – anyone be it family, friend or supportive stranger.  You can find a supportive stranger at the Samaritans here 🙂

 

Friday Sober Insight: The Addiction Game

So continuing on reading John Bradshaw he discusses Transactional Analysis and mentioned a Life Script I’d not heard of: the ‘no feel’ (addiction) script also described as Joyless.  In deeper exploration I found further talk of the addiction game.  The image to the right explains the script types further and this excerpt below from the core Transactional Analysis text explains the Addiction Game:

The drama triangle can be illustrated with the Addiction Game. (I’ve discussed the Karpman Drama Triangle before here.)  In the Addiction Game, the addict playing the role of the Victim of addiction, humiliation, prejudice, medical neglect and even police brutality seeks and finds a Rescuer. The Rescuer plays the role by trying to generously and selflessly help the addict without making sure that the addict is invested in the process of giving up drug abuse. After a certain amount of frustrating failure the Rescuer gets angry and switches into the Persecuting role by accusing, insulting, neglecting or punishing the addict. At this point the addict switches from Victim to Persecutor by counterattacking, insulting, becoming violent and creating midnight emergencies. The erstwhile Rescuer is now the Victim in the game. This process of switching goes on endlessly around the Drama Triangle Merry-go-Round.

To avoid the drama triangle in psychotherapy, transactional analysts insist on establishing a contract in which the person specifically states what he/she wants to be cured of. This protects both client and therapist: the therapist knows exactly what the person wants, and the person knows what the therapist is going to work on and when therapy is to be completed. In any case, the best way to avoid the Drama Triangle is to avoid the roles of Rescuer, Persecutor or Victim by staying in the Adult ego state.

SCRIPTS: Transactional analysts believe that most people are basically OK and in difficulty only because their parents (or other grown ups and influential young people) have exposed them to powerful injunctions and attributions with long-term harmful effects.

People, early in their lives come to the conclusion that their lives will unfold in a predictable way; short, long, healthy, unhealthy, happy, unhappy depressed or angry, successful or failed, active or passive. When the conclusion is that life will be bad or self damaging this is seen as a life script.

The script matrix is a diagram used to clarify people’s scripts. In it we see two parents and their offspring and we can diagram the transactional messages–injunctions and attributions–which caused the young person to abandon their original OK position and replace it with a serf-damaging not OK position.

When life is guided by a script there are always periods in which the person appears to be evading his or her unhappy fate. This seemingly normal period of the script, is called the counterscript. The counterscript is active when the person’s unhappy life plan gives way to a happier period. This is, however, only temporary and invariably collapses, giving way to the original scripting. For an alcoholic, this may be a period of sobriety; for a depressed person with a suicide script it may be a brief period of happiness which inevitably ends when the script’s injunctions take over.

In the Script Matrix of Joseph, a drug addict we see that the script injunction “Don’t think, drink instead.” goes to Joseph’s Child from his father’s Child. This powerful message influences Joseph’s life dramatically, when he follows his father’s injunction with drugs instead of alcohol causing him repeated drug abuse episodes through his young life and adulthood. The counterscript message “You should not  drink to excess,” motivates him to make repeated but ineffectual efforts to cut down on drug abuse and it goes to Joseph’s Parent from his mother and father’s Parent.

The Script message: “don’t think, drink instead” delivered from Child-to-Child-is more influential than the Parent-to-Parent counterscript message to abuse moderately: that is why the script messages will usually prevail unless the person changes his or her script. When scripts are not changed they are passed down the generations, like hot potatoes, from grown ups to children in an uninterrupted chain of maladaptive, toxic behavior patterns.

You can read more about TEN CONCEPTS IN TREATING ALCOHOLICS WITH TA written by Stephen Karpman:

10Alc

I’ve been wondering to myself whether the “hot potato” of the no-feel script, leading to addiction issues, is present in the UK because of our cultural tendency to a “stiff upper life” approach to life.

From Wiki:

One who has a stiff upper lip displays fortitude in the face of adversity, or exercises great self-restraint in the expression of emotion.[1][2] The phrase is most commonly heard as part of the idiom “keep a stiff upper lip”, and has traditionally been used to describe an attribute of British people in remaining resolute and unemotional in the face of adversity.[1]

And it’s not just me who’s been questioning the value of our stiff upper lip approach to life recently either:

The stiff upper lip: why the royal health warning matters

Just a thought.

Guest Post: Recovering from Your Alcohol Addiction

More guest content this time courtesy of James and image courtesy of www.pixabay.com about recovering from alcohol addiction.

What’s the first thing that comes to your mind when you hear the word addiction? I mean, there are different types of addiction. There are people who are addicted to reading. Others are addicted to the internet or computer games. There are even people who are addicted to studying. Well, the thing is, they’re not all the same.

Different types of addiction have different degrees. Some people might even argue that other types of addiction can be a good thing. Let’s say, for example, is being addicted to studying. How can too much studying be a bad thing? But, reality strikes again.

There are bad sides to studying too much. One example would be not having a social life. When you’re too engrossed on academics, not having enough time for your friends, then you might find yourself at the mercy of a mental illness called depression anxiety.

So, what’s my point? What does it have anything to do alcohol addiction? Well, everything. I mean, when you’re addicted to studying, you don’t really see anything wrong with it. Good grades make you happy, but pretty soon you are going to have your sessions, and then suddenly being too engrossed in studying wasn’t such a good idea after all. Well, it’s pretty much the same with alcohol addiction. Drinking is a social activity. At first, you don’t see anything wrong with it. I mean, if drinking makes you happy, it can’t be that bad, right? But apparently, at some time of your life, the negative sides of being addicted to alcohol starts to show, and you’re going to wish you were never addicted to it in the first place.

But the thing is, just like any other addiction, getting through it is hard. It’s not an easy feat. It’s not something you can do overnight. It’s going to take time. You need to familiarize yourself with all the correct steps in order to overcome it, and in this article, you’re going to find out just how by answering the following questions:

What do you get out of it?

Try to list down all the benefits that you get out of drinking alcohol. It’s not just about getting to know the benefits. It’s also about trying to think up alternatives. I mean, if drinking makes you feel better about your problems, this could be a phase where you’ll be writing down possible alternatives. Get to know other hobbies that will give you the same benefits.

How much does it cost?

Now that you have a list of all the things that you get out of drinking alcohol, you can now begin to ask yourself, if it’s all worth the cost.

I mean, if you’re drinking to forget about your problems, perhaps, you’ve to find a different hobby that helps you do the same. Perhaps, reading on your spare time would also help you forget your problems.

You can now evaluate if you’d rather spend for alcohol or just read for free, in order to forget about your problems.

Set goals

Getting over your alcohol addiction doesn’t start when you say so. It starts when you decide. Action can only start when you have goals. So, starting today, you should list down some of your goals. These are the goals that you should list down:

  • The date when plan to launch your call to action
  • Whether you’re going to eradicate drinking completely or just regulate it

Remove temptations from your life

Abstain from everything that reminds of drinking.

All the planning would be of no use if one beer poster is just going to tempt you back to being a drunkard.

Tell your friends about your goal

No matter what you do there will always be temptations all around you. Self-control won’t always be enough. There will be times when you’ll fall into the pit.

So, what now? Do you just quit? Well, of course not. What you should do is to tell your friends, family, and everyone you know. That way, you’ll have all the support you can get. When you have the entire family or friendship circle rooting you to get better, it’s impossible for you to not abstain from alcohol.

Author Bio

James R. Robinson is an essayist for hqassignments.net. Needless to say, he has a passion for words. Most of his relatives are quite obsessed with science. His family is a streak line of businessmen, architects, doctors, and lawyers. He, on the other hand, chose art. He chose to write. Even so, he doesn’t think he’s that far off. Being a writer isn’t all art. It’s a part science and half art. So, he’s sort of in between them.

Thank you James!

Friday Sober Inspiration: Shame and The Squirrel Cage

So I’ve been reading John Bradshaw’s Healing The Shame That Binds You and oh my goodness when I read the section on Shame as The Core and Fuel of Addiction I almost fell off my chair!  It’s called The Squirrel Cage and is so reminiscent of this post I wrote it is spooky …..

I’m going to quote this section from his book but will share a series of Youtube video’s you can watch where he speaks about shame and this book’s premise.  There are 5 video’s in total and I’ll link the first one below.

Over to John:

Neurotic shame is the root and fuel of all compulsive/addictive behaviours.  My general working definition of compulsive/addictive behaviour is “a pathological relationship to any mood altering experience that has life-damaging consequences.”

The drivenness in any addiction is about the ruptured self, the belief that one is flawed as a person.  The content of the addiction, whether it be an ingestive addiction, or an activity addiction (such as work, shopping or gambling), is an attempt at an intimate relationship.  The workaholic with his work and the alcoholic with his booze are having a love affair.  Each one alters the mood in order to avoid the feeling of loneliness and hurt in the underbelly of shame.  Each addictive acting out creates life-damaging consequences that create more shame.  The new shame fuels the cycle of addiction.

The image at the top of the post is taken from Dr Pat Carne’s work, giving you a visual picture of how internalized shame fuels the addictive process and addictions create more shame, which sets one up to be more shame-based.  Addicts call this the squirrel cage.

I used to drink to solve the problems caused by drinking.  The more I drank to relieve my shame-based loneliness and hurt, the more I felt ashamed.  Shame begets shame.

The cycle begins with the false belief system shared by all addicts: that no one could want them or love them as they are.  In fact, addicts can’t love themselves.  They are an object of scorn to themselves.  This deep internalized shame gives rise to distorted thinking.  The distorted thinking can be reduced to the belief, “I’ll be okay if I drink, eat, have sex, get more money, work harder, etc.”  The shame turns one into what Kellogg has termed a “human doing” rather than a human being.

Worth is measured on the outside, never on the inside.  The mental obsession about the specific addictive relationship is the first mood alteration, since thinking takes us out of our emotions.  After obsessing for a while, the second mood alteration occurs.  This is the “acting out” or ritual stage of the addiction.  The ritual may involve drinking with the boys, secretly eating in one’ s favourite hiding place or cruising for sex.  The ritual ends in drunkenness, satiation, orgasm, spending all the money or whatever.

What follows is shame over one’s behaviour and life-damaging consequences: the hangover, the infidelity, the demeaning sex, the empty pocketbook.  The meta-shame is a displacement of affect, a transforming of the shame of self into the shame of “acting out” and experiencing life-damaging consequences.  This meta-shame intensifies the shame-based identity: “I’m no good; there’s something wrong with me,” plays like a broken record.  The more it plays, the more one solidifies one’s false belief system.  The toxic shame fuels the addiction and regenerates itself …..

I would really recommend the book but if you’re a visual and auditory learner instead watch here:

Changing Scotland’s Relationship to Alcohol

Coverage from Alcohol Policy UK of the new report from Alcohol Focus about changing Scotland’s relationship to alcohol and recommendations for further action.

A new report has been released by Alcohol Focus Scotland (AFS) calling for bold action by the Scottish Government as it prepares to refresh its national alcohol strategy.

Download Changing Scotland’s Relationship with Alcohol: Recommendations for further action (PDF)

The report is intended to inform the next phase of the Scottish Government’s alcohol strategy and was developed with the BMA Scotland, SHAAP and Scottish Families Affected by Alcohol & Drugs. It outlines a comprehensive range of actions that it wishes to see the Government prioritise, including a target to reduce national consumption in Scotland by 10%. It argues the fall in consumption could potentially deliver a 20% reduction in deaths and hospital admissions after 20 years, based on University of Sheffield modelling.

The report’s recommendations include:

  • Implementing a 50p minimum unit price as soon as possible
  • Developing a strategic approach to reducing the availability of alcohol, and improving existing licensing regulation
  • Reducing exposure of children to alcohol advertising and sponsorship
  • Protecting every child’s right to an alcohol-free childhood
  • Clearer information for consumers about the health risks associated with drinking
  • More investment in alcohol prevention, treatment and support services

The report states that whilst per capita alcohol consumption in Scotland declined by 9% between 2009 and 2013, since 2012 the amount of alcohol sold and number of people dying as a result have increased. In 2015 the amount of litres of pure alcohol sold was 10.8 per adult in Scotland; equivalent to 20.8 units per adult per week. Alcohol misuse is stated to cost £3.56 billion a year in health, social care, crime, productive capacity and wider costs, whilst the cost to the NHS in Scotland is £267 million. The cost of alcohol-related crime in Scotland is £727 million a year, and the total costs to society equate to £900 for every adult in Scotland.

Alison Douglas, Chief Executive of Alcohol Focus Scotland said Scotland was “awash with alcohol” and that “widespread availability, low prices and heavy marketing are having a devastating effect.” Dr Peter Bennie, Chair of BMA Scotland said doctors see “the first-hand the damage that alcohol misuse does to patients and their families” and that the country could not afford the costs of alcohol upon the health service.

Health Secretary Shona Robison welcomed the report and said the government would consider all of the recommendations. Last year the final Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) report was released, indicating the Scottish Government’s alcohol strategy has had a positive impact over the past 5 years despite minimum unit pricing (MUP) not having been implemented.

Scotland: evidence first?

In 2015 a report was released exploring the extent to which alcohol policies across the UK nations were evidence-based. The report rated Scotland as having the strongest approach based on policy detailed in ‘Health First’, an independent alcohol strategy proposed by a coalition of independent health bodies in 2013. Scotland’s main weakness was rated as its involvement of alcohol industry in policy decisions – public health groups argue industry should only be involved as producers, retailers and distributors, and not be permitted to influence policy.

Meanwhile Scotland’s infamous long running effort to implement MUP has been repeatedly challenged by sections of the alcohol industry led by the Scotch Whisky Association. The most recent appeal was described as amounting to ‘delaying tactics’ by AFS and others who remain hopeful that MUP will finally be authorised to commence this year.

Certainly it appears the Scottish Government support an alcohol policy approach that public health groups deem largely evidence based. Many including PHE suggest the same approach is needed in England, albeit that MUP has not technically been ruled out. However given the broader political context, those wishing to influence alcohol policy may feel now may not be the most opportune time. Equally, alcohol and related health policy debates may still be considered relatively high profile and with many MPs now routinely involved in a number of alcohol-related issues.

We are cheering you along from down here Scotland!!

Friday Sober Jukebox: I’m Free

So here I am once again reeling from insight after insight triggered happily by reading another Pete Walker book!  Finding that I’m free – or continuing to work myself free from old constraining ways of thinking around my shame from drinking and other perceived weaknesses which is often represented by the voice of our inner critic.  It’s just too good not to share and once again I strongly advise you to go read the whole book! 🙂

14 Common Inner Critic Attacks (He kindly provides a therapeutic thought-correction response with each attack/programme) and these are a great addition to my posts looking at Drinking Thinking errors.

  1. Perfectionism.  This is a self-persecutory myth.  I do not have to be perfect to be safe or loved in the present.  I am letting go of relationships that require perfection.  I have a right to make mistakes,  Mistakes do not make me a mistake.  Every mistake or mishap is an opportunity to practice loving myself in the places I have never been loved.
  2. All-Or-Nothing & Black-and-White Thinking. I reject extreme or over-generalized descriptions, judgements or criticisms.  One negative happenstance does not mean I am stuck in a never-ending pattern of defeat.  Statements that describe me as ‘always’ or ‘never’ this or that, are typically grossly inaccurate.
  3. Self-Hate, Self-Disgust & Toxic Shame. I commit to myself.  I am on my side.  I am a good enough person.  I refuse to trash myself.  I turn shame back into blame and disgust, and externalize it to anyone who shames my normal feelings and foibles.  As long as I am not hurting anyone, I refuse to be shamed for normal emotional responses like anger, sadness, fear and depression.  I especially refuse to attack myself for how hard it is to completely eliminate this self-hate habit.
  4. Micromanagement/Worrying/Obsessing/Looping/Over-Futurizing. I will not repetitively examine details over and over.  I will not jump to negative conclusions.  I will not endlessly second-guess myself.  I cannot change the past.  I forgive all my past mistakes.  I cannot make the future perfectly safe.  I will stop hunting for what could go wrong.  I will not try to control the uncontrollable.  I will not micromanage myself or others.  I work in a way that is ‘good enough’, and I accept the existential fact that my efforts sometimes bring the desired results and sometimes they do not.  A serenity prayer moment 😉
  5. Unfair/Devaluing Comparisons to others or to your most perfect moments. I refuse to compare myself unfavourably to others.  I will not compare ‘my insides to their outsides’.  I will not judge myself for not being at peak performance all the time.  In a society that pressures into acting happy all the time, I will not get down on myself for feeling bad.
  6. Guilt.   Feeling guilty does not mean I am guilty.  I refuse to make my decisions and choices from guilt.  Sometimes I need to feel the guilt and do it anyway.  In the inevitable instances when I inadvertently hurt someone, I will apologize, make amends, and let go of my guilt.  I will not apologize over and over.  I am no longer a victim.  I will not accept unfair blame.  Guilt is sometimes camouflaged fear.
  7. Shoulding‘. I will substitute the words ‘want to’ for ‘should’ and only follow this imperative if it feels like I want to, unless I am under legal, ethical or moral obligation.
  8. Over-productivity/Workaholism/Busyholism. I am a human being not a human doing.  I will not choose to be perpetually productive.  I am more productive in the long run, when I balance work with play and relaxation.  I will not try to perform at 100% all the time.  I subscribe to the normalcy of vacillating along a continuum of efficiency.
  9. Harsh Judgements of Self & Others/Name-Calling. I will not let the bullies and critics of my early life win by joining and agreeing with them.  I refuse to attack myself or abuse others.  I will not displace the criticism and blame that rightfully belongs to my dysfunctional caretakers onto myself or current people in my life.
  10. Drasticizing/Catastrophizing/Hypochondriasizing. I feel afraid but I am not in danger.  I am not ‘in trouble’ with my parents.  I will not blow things out of proportion.  I refuse to scare myself with thoughts and pictures of my life deteriorating.  No more homemade horrors and disaster flicks.  I will not turn every ache and pain into a story about my imminent demise.  I am safe and at peace.
  11. Negative Focus. I renounce over-noticing and dwelling on what might be wrong with me or life around me.  I will not minimize or discount my attributes.  Right now, I notice, visualise and enumerate my accomplishments, talents and qualities, as well as the many gifts that life offers me, e.g., nature, music, film, food, beauty, colour, friends, pets, etc.
  12. Time Urgency. I am not in danger.  I do not need to rush.  I will not hurry unless it is a true emergency.  I am learning to enjoy doing my daily activities at a relaxed pace.
  13. Disabling Performance Anxiety. I reduce procrastination by reminding myself that I will not accept unfair criticism or perfectionist expectations from anyone. Even when afraid, I will defend myself from unfair criticism.  I won’t let fear make my decisions.
  14. Perseverating about Being Attacked. Unless there are clear signs of danger, I will thought-stop my projection of past bullies/critics onto others.  The vast majority of my fellow human beings are peaceful people.  I have legal authorities to aid in my protection if threatened by the few who aren’t.  I invoke thoughts and images of my friends’ love and support.

1 – 9 are what Pete Walker describes as ‘perfectionism attacks, fueled by toxic shame, create chronic self-hate and self-flagellation’ and 10-14 ‘endangerment attacks, fueled by fear, create chronic hyper vigilance and anxiety‘.

Aren’t these just the best?!  What a freeing list to read 🙂

And if you’d like to work on easing your inner critic voice here is a meditation from Melli over at MrsMindfulness

Alcohol dependence: insights into prevalence, children & intention to change

Another brilliant blog post from Alcohol Policy UK looking at new research published about alcohol dependence, prevalence, impact on children and expressed desire to change.  Over to James:

New research has been released assessing the prevalence of alcohol dependence in England, including the first estimates of dependence by local area. The analysis also explores the number of children likely to be living with dependent adults and the proportion of dependent drinkers wishing to reduce their alcohol use.

The key findings indicate:

  • There are 595,131 adults with alcohol dependence in England, which represents 1.393% of the 18+ population
  • The majority of these (313,753) are displaying mild dependence, followed by those with moderate severity (173,399) and severe dependence (107,979)
  • 120,419 alcohol dependent adults are estimated to have children living with them in the household, with a total of 207,617 children thought to live with an adult with dependence
  • 57% of alcohol dependent adults are estimated to have a desire to cut down their drinking, including 41% who intend to do so in the near future

The analysis was conducted by researchers from the University of Sheffield and King’s College London using a range of data sources including the recent Adult Psychiatric Morbidity Survey (APMS) 2014, the Alcohol Toolkit Study (ATS) and hospital admissions data. The estimates are mainly based on a combination of alcohol assessment instruments the AUDIT and SADQ. The AUDIT is considered the gold standard alcohol assessment tool for identifying risk levels amongst those scoring 8+, but with scores of 20+ indicating a level of probable dependence. SADQ however is specifically geared to assessing severity of physical dependence.

In addition to estimating national prevalence, significant variations were found by area, sex and age as would be expected based on existing research. Higher severity of alcohol dependence was most likely to be seen in those who had higher AUDIT scores, of younger age and male, white and living in more deprived areas. A sixfold difference in alcohol dependence was found between the lowest and highest Upper Tier Local Authorities.

Measuring alcohol dependence: where to draw the line?

Those with a close eye on prevalence data may note the significant differences in figures cited for alcohol dependence in England. Last year a PHE resource on harmful drinking and dependence stated there was an estimated 1.6 million adults in England who ‘may have some level of alcohol dependence’, though highlighted not all would need specialist treatment.

A discrepancy of around one million dependent drinkers though does not represent significant changes in actual prevalence, rather than how it may be defined. Figures of around 1.6 million were also cited in the extensive 2011 NICE guidance, suggesting over 1.3 million mildly dependent drinkers scoring 16+ on AUDIT and a low score on SADQ (<16). The recent estimate however excludes those scoring 16-19 on the AUDIT as dependent, unless they also scored 16 or more on the SADQ (see above).

Essentially the revised estimate sets a higher threshold for dependence, particularly given the SADQ as a tool is geared towards identifying physical dependence. Indeed mild dependence is largely associated with psychosocial rather than physical signs, as may be better reflected by the Leeds Dependence Questionnaire (LDQ).

Ultimately, drawing a distinct line between any categories of alcohol use is artificial to a large extent, and a strict reliance on exact scoring cut-offs can be ill-advised in practise. However seeking to understand the numbers of people who may benefit from the various interventions that may be offered is important from commissioning and policy perspectives, particularly with regards to assessing optimum levels of treatment capacity.

How many dependent drinkers want to change?

Debates over what level of alcohol treatment should be made available have been long running as the mooted 15% capacity target has not yet been seen in England. As such, new data indicating the possible extent of motivation to cut down alcohol use will be of relevance for treatment capacity and possible interventions to increase uptake. The report describes ‘amenability to treatment’ for the 57.3% of dependent drinkers who indicated they wished to reduce their drinking and the 41.2% who intended to do so in the near future.

Higher motivation to change was associated with higher AUDIT scores and was also more likely amongst women, those aged 35+, of non-white ethnicity, and also by region. Harmful drinkers scoring AUDIT 16-19 were three times more likely to express motivation to change than those scoring less than 16, whilst those scoring AUDIT 20+ were at least six times as likely. Indeed a wealth of previous research has demonstrated severity of problems as a significant indicator of readiness to change, whilst many at-risk drinkers who may not yet be experiencing or aware of harm do not consider their drinking problematic.

Dependence in Primary Care: an issue of detection?

A separate study has also been released exploring alcohol dependence in Primary Care, though identifying far lower prevalence of 8.3 and 3.7 per 10,000 male and female patients respectively. The study used a specific criteria for identifying records of Primary Care patients, though acknowledged the likelihood of it only detecting those with more moderate or severe dependence. Indeed significant questions over the identification of less severe alcohol problems in Primary Care have been raised, particularly in relation to efforts to embed brief intervention (IBA); less than 10% of higher risk drinkers report having been asked about their alcohol use compared to over 50% of smokers. 

Remembering ‘stepped care’ models: where next?

Evidently a tension exists between the real world complexity of alcohol problems and the need to identify distinct groups of problem drinkers for policy and commissioning purposes. Nonetheless, falls in population consumption since 2004 have been identified as largely confined to increasing risk drinkers rather than amongst those with harmful or dependent levels.

In 2006 ‘Models of Care for Alcohol Misusers’ (MoCAM) described the ‘stepped care’ model in the context of commissioning alcohol interventions. The provision of IBA as key brief intervention approach has been widely sought since and looks set to continue, as with hospital based alcohol care teams. However the questions over actual extent of IBA delivery are largely unanswered, whilst significant regional variation in treatment capacity has remained.

Whilst those with more severe levels of dependence tend to have significant impacts on a range of public services, arguably a gap for larger numbers of harmful or mildly dependent drinkers who are less likely to seek or receive help exists. Many such drinkers may not consider their problems serious enough to seek formal treatment, but may benefit from further behavioural support than ‘brief advice’, though the addition of pharmacological support in the form of Nalmefene has been controversial. However few roles outside of treatment services offer extended brief interventions (EBI) or brief treatment packages as outlined in the stepped care model and advocated by the NICE CG115 costing report.

One indirect response to this may have been the rise in popularity of digital interventions, online peer support groups and potentially Dry January. Certainly an emerging evidence base seems to suggest digital IBA approaches can have a small but significant effect, whilst the information age has significant advantages for the many people who decide to self-help. Nonetheless, face to face interventions are still considered the gold standard, though treatment services have continued to face ongoing pressures in the context of cuts to local authority public health budgets. Questions have also been asked over the issue of parental alcohol misuse and the impact on children, with a recent campaign calling for specific local level strategies.

As such, few may be expecting any positive trends in the prevalence of alcohol dependency in the near term, albeit that most dependent drinkers reportedly wish to cut down and many thousands do receive statutory help each year. However wider population consumption and harm trends will continue to be subject to intense policy debates, whilst any movement on minimum unit pricing would be expected to have implications for future dependency rates.

 

Sober inspiration: Emotional Hunger and Addiction

So I’ve been reading Pete Walker’s second book Complex PTSD: From Surviving to Thriving.  This is not the first time I’ve talked about Pete’s writing which has been revolutionary for me in deepening my understanding of the emotional recovery aspects of addiction and you can read them all here.  In this book he digs even deeper into recovery from emotional trauma and I felt compelled once again to share what he wrote specifically about emotional hunger and addiction.

He writes “The emotional hunger that comes from parental abandonment often morphs over time into an insatiable appetite for substances and/or addictive processes.  Minimization of early abandonment often transforms later in life into the minimizing that some survivors use to rationalize their substance and process addictions.  Fortunately, many survivors eventually come to see their substance or process addictions as problematic (*raises hand in acknowledgement*).  But many also minimize the deleterious effects of their addiction and jokingly dismiss their need to end or reduce their reliance on them (*raises hand again*).

When the survivor  has no understanding of the effects of trauma or memory of being traumatized , addictions are often understandable, misplaced attempts to regulate painful emotional flashbacks.  However many survivors are now in a position to see how self-destructive their addictions are.  They are now old enough to learn healthier ways of self-soothing.

Accordingly, substance and process addictions can be seen as misguided attempts to distract from inner pain.  The desire to reduce such habits can therefore be used as motivation to learn the more sophisticated forms of self-soothing that Cptsd recovery work has to offer.

Grieving work offers us irreplaceable tools for working through inner pain.  This then helps obviate the need to harmfully distract ourselves from our pain.

If you’d like to listen to someone talking about their experience of PTSD can I recommend the recent interview of Will Young on Bryony Gordon’s Mad World.

I appreciate that not all of those who visit this blog or read these posts come from traumatic or emotionally abusive childhoods, but equally some of us do.  As AA advocates ‘take what you need and leave the rest’ and hat tip to Anne over at ainsobriety who gets a mention in the recovery piece linked to this AA wisdom! 🙂