All posts by lucy2610

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! 🙂

The ‘rich tapestry’ of alcohol consumption: insights into heavy drinking

Oh yes a ‘Wine Decor Tapestry Wall Hanging’ actually does exist! :s  So this was an Alcohol Policy UK blog post bringing our attention to a report that was published late last year.

Over to James Morris:

Understanding alcohol consumption trends, especially among heavy drinking groups, is undoubtedly central to alcohol policy debates across the UK, but unveiling the complexity and nature of alcohol use across society is no mean feat. Recent research, however, provides new insights into what and who lies behind recent consumption shifts and how to interpret these in the context of ‘drinking types’ and ‘cultures’.

A new analysis of ‘heavier drinkers’ in Great Britain from 1978-2010, funded by ESRC and published earlier this year, urges against relying on headline consumption data when considering alcohol problems and policy. Rather, we need to recognise the ‘rich tapestry’ of alcohol consumption: the patterns of use and culture that are spread not only across the whole population but within a range of drinking ‘sub-groups’. The research explored ‘typologies and dynamics’ of heavier drinkers, identifying four ‘stable clusters’ during the period, with each group showing characteristics that were distinct from both the other heavy drinking groups and the general population.

Between 1978 and 2010 consumption mainly rose, with what has been described elsewhere as ‘peak booze’ being reached around 2004. This increase in consumption was driven in part by higher levels of wine drinking amongst women, including ‘baby boomers’ born in the 1940s and 50s.  Over this period wine has been increasingly ‘democratised’: drunk in greater quantities not only by women but across a wider range of income groups. Wine sales increased by 184% between 1980 and 2007 in the context of increasing affordability and availability through supermarkets and the off-trade. A later generation of women, reaching early adulthood in the 1990’s, also significantly contributed to rising consumption. However whilst the older ‘baby boomer’ generation of women fall firmly within the ‘wine and spirit cluster’ (the only female dominated drinking group), women’s drink choices have more recently diversified alongside growing choice in the market.

Importantly, the authors suggest that shifts in overall levels of consumption tend not to occur as a result of new distinct groups or styles of drinking, but rather develop within existing drinking cultures. For instance, while the increase in heavy drinking by younger women during the 1990’s and early 2000’s was frequently portrayed in the media as ‘ladette’ culture, this overlooked the still heavier rates of drinking by men whose consumption styles remained largely unchanged. Equally, the much talked about invention of ‘alcopops’ received disproportionate attention in relation to overall rising consumption, which was more substantially driven by increased home drinking across all drink types, particularly women’s wine consumption.

The study’s lead author, Dr Robin Purshouse, said:

“Over the last 30 years of social change, the styles of drinking adopted by heavier alcohol users have stayed remarkably consistent. The rise in heavier drinking over the 1990s in the lead up to ‘peak booze’ was driven by increasing numbers of women and older people adopting these styles. Our findings emphasise the importance of cultural factors, such as drinking styles, as key components in the policy debate surrounding heavy alcohol use.”

The study overlaps with research exploring drinking cultures published last year (also led by members of the Sheffield Alcohol Research Group), which also described a more complex picture than that often portrayed in the media. That study found nearly half (46 per cent) of all drinking occasions ‘involved moderate, relaxed drinking in the home’, potentially indicating the context in which the majority of ‘low risk drinkers’ do so. Certainly there is relevance to further understanding low risk drinking nuances too, especially when considering how heavier drinkers tend to describe their drinking as in line with the norm. However the SARG findings also support evidence of ‘pre-loading’, and 10 per cent of all drinking occasions involved groups of friends moving between home and pub drinking, consuming the average weekly recommended guideline of 14 units on one occasion. Other identified patterns included drinking at home alone (14 per cent of occasions), light drinking at home with family (13 per cent), light drinking at home with a partner (20 per cent) and heavy drinking at home with a partner (nine per cent). See here for Conversation article by SARG researcher John Holmes.

And new insight into under-estimation in national survey data

A recent study has explored to what extent national consumption data based on surveys may under-represent heavier drinkers due to ‘non-response bias’. It has often been shown that heavier drinkers may be less likely to be respond, or may require more extensive efforts to recruit to surveys. The study analysed how the number of contact attempts to reach participants varied by drinking status and socio-demographic characteristics, identifying evidence for a significant ‘non-response bias’ among heavier drinkers. When modelled, it was estimated that accounting for non-response bias may lead to a 12.6% increase in men’s weekly drinking and 20.5% in women.

Lead author Dr Sadie Boniface said:

“Our recent paper presents one way of looking at the likely impact of non-response bias on survey measures of alcohol consumption, similar to previous studies in New Zealand and Canada. Our findings agree with other studies, finding that people with a more hazardous or harmful drinking pattern are harder to reach for surveys. This study underlines the importance of extended efforts to recruit and follow-up participants in research studies in order to reduce the impact of this bias.”

Looking forward?

Overall, recent findings such as these remind us that while the overall level of consumption across the population is an important indicator of trends, within any society drinking behaviours are varied and diverse. Harmful patterns may emerge among one group, or within one set of drinking environments, while trends may improve elsewhere.

Understanding the contexts and multiple factors at play is therefore important in developing and refining responses to alcohol harm. Individually targeted interventions may be generally considered effective, but still face significant delivery challenges within the current limitations of research, policy and practice. Indeed the paper states that the need for more nuanced understandings and responses does not itself call into question models that suggest a ‘structural relationship between overall population consumption levels and harmful consumption’. Indeed there are many complex questions facing the many levels of alcohol policy and interventions – see here for selected events in 2017 that will be attempting to further answer some of these.

I kept the true nature of my drinking hidden from view, even from my GP, so it stands to reason that when drinking surveys are completed people like me either deny or minimise our drinking or avoid getting involved altogether.  Would you have been honest about your drinking if asked as part of a drinking survey?

A letter to … My wonderful mother, who drank herself to death

This photo is from our time in Australia last summer and shows the HOF family at play on the beach at sunset.  It was my sons birthday this week and I read this in The Guardian recently and two thoughts came to mind.  I didn’t want to be recalled by my children like the mother detailed in this letter and it also resonated with me about my father and the loving bond we had despite his drinking.

I hate it when people who didn’t know you ask me how you died. As soon as I tell them you were an alcoholic, I know exactly the kinds of thoughts running through their heads. That one word conjures a vivid, stereotypical picture. You were violent. You were neglectful. You weren’t a good mother. I had a horrible childhood. You damaged me.

But that’s not how it was. You were a wonderful mother and I had a golden childhood. You gave me everything a child needs and more. You loved me, supported me, invested your time and money in me and cultivated a deep mother-daughter bond between us. I miss waking up in the middle of the night to find you kneeling by my bed and stroking my hair. I miss the way you took care of me when I was ill. I miss your cuddles and kisses and the strong, heady scent of your expensive perfume.

You really did lead a charmed life. You were married to a good man who provided for you and took care of you. You were never short of money, attention or love. You were the life and soul of the party and people flocked around you. You were strikingly beautiful and unfailingly kind. From the outside, you had it all.

Yet appearances can be deceptive. You weren’t happy and it’s taken a long time for me to understand why. You always said you loved me more than I could ever understand and you would die for me. But then you did die and it wasn’t for me.

When you started drinking, it was a bit funny. “Oh, Mum’s drunk again,” we would giggle at parties, as you stumbled around talking nonsense. As the years rolled on, it became increasingly less funny. You changed beyond recognition and when you were drunk you became nasty and spat out horrible, unforgivable words. It wasn’t like you at all. I became accustomed to compartmentalising my feelings – the love and respect I had for my mum and the fear and loathing I had of this drunken stranger.

Things progressed badly and the drunken stranger took the steering wheel. My beloved mum gave up the fight. Your marriage fell apart and you lost your home. You were irreparably broken. I was young and selfish and, more importantly, I understood nothing of life or loss.

I’ve spent many years feeling guilty because I didn’t do more to help you. If this happened today, things would be very different. I’m a mother now and used to putting others before myself. I know what I should have done to understand you and help you. If only I could turn back time and be the daughter I should have been, perhaps you would still be alive today. At the time, I did nothing except feel sorry for myself. I blamed you. I was at a loss to understand what you had to be so deeply unhappy about. You had a perfect life and you chucked it all away.

Today, I see you with the compassion of a fellow mother and wife. Life experience has provided me with valuable perspective as to how you really felt. I am able to piece together all the little clues you subconsciously gave me until I can see the whole picture. I have suffered some heart-breaking losses, the first of which was you.

I used to be angry with you for hurting me and then leaving me. I then spent many years feeling guilty and blaming myself for your demise. Finally, I am now able to disentangle myself from all these feelings and treat everyone involved in your story with compassion. If I could have just two minutes with you today, I would take both your hands in mine and say: “I love you and I understand.”

Over 3 1/2 years sober and I continue to be so grateful for every day since I stopped.

Friday Sober Jukebox:  Don’t Look Back In Anger + Tony Walsh’s Manchester poem ‘This is The Place’

 

Peers back minimum price per alcohol unit if Scotland scheme works

This was in The Guardian in April: Introduction of 50p base rate should go ahead if it is shown to reduce excessive drinking, says Lords select committee peers.

Minimum unit pricing for alcohol should be introduced across the UK if it proves a success in Scotland, a Lords committee has said.

If the decision to introduce a 50p base rate per unit of alcohol is shown to reduce excessive drinking, it should to be rolled out nationwide, the Lords select committee on the Licensing Act 2003 said.

The plan means a 70cl bottle of whisky would cost a minimum of £14.

In December, the Scotch Whisky Association said it would appeal to the UK supreme court against a Scottish court ruling that plans for a 50p minimum price were compatible with EU law.

The coalition government pledged in March 2012 to bring in minimum unit pricing but made a U-turn in July 2013, earning condemnation from medical organisations and arousing suspicions that it had caved in to alcohol industry lobbying.

A government report released late last year found that alcohol is now the biggest killer of people aged between 15 and 49 in England, accounting for 167,000 years of lost productivity annually and a factor in more than 200 illnesses.

Peers have also called for a major overhaul of how licensing decisions are made after hearing evidence that some councillors were guilty of a “scandalous misuse” of their powers.

In addition, the Lords committee called for the Licensing Act to be redrawn to abolish local authority licensing committees and hand their role to planning watchdogs at councils instead.

The committee’s chairwoman, Lady McIntosh of Pickering, said the act was fundamentally flawed and needed a major overhaul.

“It was a mistake and a missed opportunity to set up new licensing committees when the planning system was already available to regulate the use of land for many different purposes,” she said.

“The planning system is well suited to dealing with licensing applications and appeals, and the interests of residents are always taken into account.”

The committee was shocked by some of the evidence it received on hearings before licensing committees.

“Their decisions have been described as ‘something of a lottery’, ‘lacking formality’, and ‘indifferent’, with some ‘scandalous misuses of the powers of elected local councillors’,” McIntosh said.

Referring to evidence that councillors had refused to listen to arguments at hearings, or to stand down when family members were involved in the situation, the report said: “These are scandalous misuses of the powers of elected local councillors, and they are not the only ones we were told of.

“The Derbyshire police wrote: ‘It has become too political with councils being frightened of making a tough decision for fear of an appeal against them by big brewing companies, etc. On two occasions I have had councillors state that they have agreed with the police, however, sided with the pub company for fear of an appeal.’”

The Lords committee said: “The evidence received against local authority licensing committees was damning and the committee was extremely concerned by what it heard. Planning committees are much more effective, reliable and well-equipped to make licensing decisions.”

McIntosh also called for relevant legislation to apply at airports: “We cannot understand why the government has decided not to apply the Act to sales at airports. This can lead to dangerous situations, and must be changed.”

The committee also warned regulations covering late night opening do not work.

“The night-time economy needs regulating; even in these areas of cities, residents have their rights. The current systems are not being used because they do not work.”

The report also called for establishments to provide a disabled access statement when applying for a licence.

The piece went up at midnight on Tuesday 4th April and by the time I read it at 8:45am it  already had 298 comments – which I found both interesting and telling as did several commenters, included below:

Vagabondo: “The industry PR machine can be observed flooding these comments with misinformation about a measure that has been shown to cut youth alcohol abuse requiring medical intervention in other jurisdictions. This is part of the same sadistic campaign that has been waged to preserve profits at the public expense in the Scottish media and courts, and so far successfully in the UK Parliament.”

Hirpling: “Absolutely amazing how the same false assumptions are just churned out over and over and over on this thread. Or maybe not so much amazing as deliberate…?

1. Its a tax. FALSE. Minimum pricing. Read that bit again.
2. It affects ordinary people drinking ordinary booze. FALSE.
3. It doesn’t cure alcoholics. NOT AIMED AT THEM

The low-grade, low price crap is a recent introduction to the UK market to get kids drinking young and hooked at pocket-money prices.  There was no need for this “differential” as there were already three: it was a new price point to get a new market — a new set of addicts in training.  The kids can go back to buying enough to get drunk on as before, instead of enough to give themselves alcohol-poisoning and (or other people) a trip to A&E.”

Tenthred: “I’d like the SWA to be liable for government legal costs when they finally lose. Disgusted that they’re taking it back to the Supreme Court yet again. And then, if the measure does improve public health, I’d like the SWA to be sue for damages for the public health cost of the years of delay.

They call themselves the Scotch Whisky Association, but they aren’t doing this because of anything to do with Scotch or with consumers in the UK. This is all about their parent companies’ huge global interest in cheap booze.”

Agree completely with each comment.  As I oft say here, watch what they do not what they say …….

Sober Friday Jukebox: STAIR-way to heaven

So it feels like all the reading I’ve done of late has been heading to this point.  I recently received an email from Mind the Brain about Complex PTSD, STAIR and social ecology that you can read here.

STAIR is the acronym for Skills Training in Affective and Interpersonal Regulation.  It’s a training programme that has been developed in the US by psychologist Dr. Marylene Cloitre.  Here’s  how the programme is described on the US Department of Veteran Affairs website:

STAIR is an evidence-based cognitive behavioral therapy (CBT) for individuals suffering from PTSD, including chronic and complicated forms as well as for individuals with PTSD and co-occurring disorders.

Complex PTSD results from repetitive, prolonged trauma involving harm or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic .

“Anger directed against the self or others is always a central problem in the lives of people who have been violated and this is itself a repetitive re-enactment of real events from the past. Compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one’s current life, rather than repeating trauma in action, mood, or somatic states, is the goal of healing” (Bessel A. van der Kolk)

Using STAIR will allow you to teach your patients skills in:

  • emotion regulation
  • interpersonal functioning

This online STAIR training consists of 8 modules covering several core treatment components. STAIR can be provided as a standalone therapy or as a complement to trauma-focused therapies.

Goals and Objectives

  • To become informed about the impact of trauma on emotion regulation and social (interpersonal) functioning
  • To be able to identify at least one strategy that increases emotional awareness
  • To be able to identify at least three strategies that improve emotion regulation in PTSD patients
  • To be able to formulate interpersonal schemas related to problematic social and interpersonal functioning
  • To be able to develop and test alternative interpersonal schemas with client
  • To learn at least two strategies for effective assertiveness behaviors
  • To learn at least one strategy for improving flexibility in interpersonal expectations and behaviors

What I found so striking about this is it mirrors the process I’ve been going through as part of my emotional recovery and particularly in my recent discover of the brilliant book The Tao of Fully Feeling by Pete Walker.

Here’s more detail on Session Two: Emotional Awareness:

  • Emotions, emotion regulation, and the impact of trauma on emotion regulation.
  • Why feelings are important, the influence of trauma history on feelings, how to use a feelings wheel to help label feelings.
  • How to use a self- monitoring form to identify the relationships between thoughts, feelings, and behavior.

And Session Three: Emotional Regulation:

  • Recognize that all of their behaviors are efforts to cope with their feelings and environment.
  • Evaluate current coping strategies, their efficacy, and alternative strategies.
  • Learning physiological, cognitive, and behavioral channels of mood regulation

Link to full course content pdf here.

Maybe it’s just my experience and I am generalising wildly but I think many of us boozers struggle with emotions which is part of the reason why we drank how we drank.

There are well researched links between substance misuse and trauma (74% sexual abuse, 52% physical abuse & 72% emotional abuse in this research)  and sources estimate that 25 – 75 percent of people who survive abuse and/or violent trauma develop issues related to alcohol abuse.

All of these skills seem so applicable to a life lived well in sobriety as we learn to deal with all those pesky emotions and renegotiate relationships and learn about boundaries and agency without our crutch.  I’m sharing these resources here in case you would like to research further because to me they feel like a stairway to (emotional) heaven 😉