So this image is taken from the book Money Love by Meadow Devor who was interviewed by Tommy Rosen as part of his Recovery 2.0 online conference in September. She was talking to him about financial sobriety and some of the things she said had my mouth fall open in recognition. So I thought I would share a few key points from what she shared about abundance, compassionately observing and noting our thinking and moving on from the ‘please like me discount’.
Although her book focuses on money so much of what she said is applicable to so many other areas of life too, including booze. Interestingly Meadow is also in recovery from alcohol. So without giving away too much – these were my key take-away points from her wisdom.
When you engage in a behaviour whether it is spending, eating, drinking, internet surfing, etc ask yourself:
What are you feeling?
What are you trying to achieve/avoid? Why are you doing this?
Can you afford it? In terms of money, time or emotions
And to weigh up the value vs the cost (again talking about financial, time or emotional).
She also talks a great deal about how we act from either scarcity or abundance as represented by the scale illustrated at the top of the post. I definitely grew up with a scarcity mentality and mindset and have been doing some serious work around reframing how I view the world in a more abundant way. Part of that work was leaving behind my own ‘please like me discount’ which, because of my own issues with co-dependency, was a big thing that I knew I did but had never before heard it put so succinctly into words! I have a post it note above my desk that reminds me:
You do enough
You have enough
You are enough
You can listen to her being interviewed by Laura McKowen & Holly Whitaker on the Home podcast here:
If you are struggling with feelings of worry, frustration or lack how about trying this abundance meditation to see if you can start to shift your way of thinking too? I can promise you if you begin to practise gratitude, and try to engage with the world from a place of empowerment and abundance soon the ‘fake it till you make it’ approach will shift becoming not just a desired hope but your reality. Why not give it a try?
PS As if our cup wasn’t overflowing enough with abundance today this news broke this afternoon too! Go Scotland!! 🙂
There are many things I still haven’t covered on this blog so until I run out of new things to share and say a post will keep appearing, probably on a weekly or two weekly basis, depending on what’s going on. Plus I know myself well enough now to know I won’t be able to keep my big mouth shut about any major news story that breaks in the alcohol and public health worlds!
So today is about psychological escape velocity (the minimum speed needed for an object to escape from the gravitational attraction of a massive body). I had a headf*ck experience recently where I was given the opportunity to see photo’s of a house I lived in when I was a girl. What was really spooky and serendipitous about this was it was via a nursing colleague who had lived in this house about 20 years after me, had taken photo’s and had recently been sorting through them and happened to have them with her in the office then and there that lunchtime! Weird right?
What she didn’t know was that I have really distressing and traumatic memories of this house and time and have spent a good amount of time in therapy talking about it so seeing those images triggered an avalanche of memories. What was so reassuring was that although the memories had only been experienced in the last 5 years (which fuelled a massive amount of drinking back then) my recall of that house was EXACTLY right. Every detail that I had summoned from 40 years ago and discussed was spot on – so if my memory of the place was right so was my recall of the events. This was a major revelation because at the time when I tried to tell someone I hadn’t been believed and I had therefore doubted my own experience and had questioned whether it was all just in my head – that my nightmare’s were just that horrors in my head not real life. Although seeing the photo’s caused intense psychic tremors I was okay and I was able to regulate my emotions and handle the triggered distress. This felt like massive progress to me and as if I had enough emotional and boundary depth to not be pulled back into the psychological pain of that time. These events no longer defined me – I had reached my psychological escape velocity 🙂
When I told MrHOF he said this was not just the end of a chapter but the end of a volume in my life and he felt it was no co-incidence and a sign from the universe (because I believe in such stuff) that that experience and how I managed it marked closure both emotionally and mentally for me and that I wasn’t doing a geographical by planning our move to Australia.
That same day I was contacted by Regina Walker at The Fix who is a psychotherapist. I was reading her writing archives when I came across an article about Dialectical Behaviour Therapy (DBT) a technique used in the UK mainly to treat those with borderline personality disorder. Thanks to my research assistant experience with a Clinical Psychologist who worked with this client group it was something I knew about, knew it was a successful and valuable therapeutic approach and learned from this discovered article that it is being used and applied in addiction!
Here are the key excepts that link my experience recounted above and this technique (the whole article is well worth your time in reading):
“The goal of DBT is to acquire skills to deal with the mental anguish the sufferer experiences and create a life worth living. The tools offered in DBT are meant to aid in the achievement of these goals.
DBT, for people struggling with substance abuse problems, is a way to achieve self-acceptance while simultaneously accepting the need for change. There are four basic aspects to DBT: mindfulness, interpersonal relations, emotion regulation, and distress tolerance.
The emotion regulation aspect of DBT teaches how to identify, regulate and experience emotions without becoming overwhelmed and acting on impulse. The skills aim to reduce vulnerability and increase positive experiences.
The fourth area of DBT is distress tolerance. This area is focused on the development of skills to cope with crises when emotions become overwhelming and the individual is unable to immediately solve the problem (a death, sickness, loss of job, etc.) but needs to persevere and live through the crisis without making it worse by impulsive actions (for example, getting high or drunk).
Dr. Linehan acknowledged that the self-harming behavior she saw in suffering patients made sense and had a purpose. But she also recognised that this had to change and that the person had to accept themselves.
She referred to this as “Radical Acceptance”—acceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it. These seem to be opposites: on the one hand, you have to take life as it is; on the other hand, that change is essential for survival. But for real change to happen, both self-acceptance, and acceptance of the need for change have to come together. This blending of two seemingly opposite views is called a dialectic—and it’s the vision behind the name of Dialectical Behavioral Therapy.
So after 3 years of living life sober, and ‘in the raw’ as Mrs D would say, I have both accepted myself and what happened to me as a child and shown myself self-compassion. I have taken life as it is but recognised that change was essential for my survival. My psychological escape velocity from my past, and as part of that alcohol, has reached a critical juncture 🙂
In the past those photo’s would have rocked my world in a very negative way and triggered the most almighty bender. Now I just feel peaceful and content that I can trust myself to take care of myself as I tried to as a young girl.
So with a week to go before I hit 1000 days I’ve become very reflective and the recent news that Sally Brampton walked into the sea not to return made me both profoundly sad and introspective. This image is taken from her blog and I believe it is her sat on the stones and pebble beach near where she lived. I used to love reading her column in The Sunday Times Style as she was so full of wisdom and compassion. Her own ongoing struggle with depression and her past battle with alcoholism was known and added to, not took away from, her ability to offer comfort and advice.
She renounced alcohol in 2003. ‘It would take three years and a 28-day spell in rehab for alcoholism, as well as attendance at AA meetings, for Sally to recover completely.’ (Daily Mail)
This is the post that remains on her website and resonates so strongly for me:
“This is where I write about pretty much everything I love; usually emotion, because I think that’s where we all connect. I write about depression because I have depression, and I think it’s good to talk about it. Sharing can bring us out of the dark and into the light. That’s why I wrote a book about it; Shoot the Damn Dog, and I am pleased and honoured that it helps so many people, who write to me sharing their experiences. I wish I could reply to every letter, but I simply can’t, because there are so many, but sometimes, it’s just good to get our thoughts down on paper. It makes us feel less alone and I hope it helps you as much as it helps me to know that we are in this together, and that there are people who truly understand.”
But the most poignant was the page dedicated to her in The Sunday Times Style magazine a few weeks ago which shared some of her gems of wisdom from her column that ran for 8 years to ‘celebrate her infinite wisdom.’
This was on BuzzFeed in February sharing the experience of being the adult child of an alcoholic.
My dad was an alcoholic.
Not the suave chain-smoker who drinks whiskey from die-cut glasses, nor the sardonic barfly in khaki trousers whom everybody keeps around because they’re just so loveable.
My dad was the kind of alcoholic who fell over in the street, kicked down the front door, and woke the neighbours. He was the kind of alcoholic who hid his cheap beer in the bedside cabinet. If you passed him in the street, you’d have seen a drunk. He had a job, a wife, and five children. I’m one of them.
1. Nobody believes you.
The image of Ireland being a nation of pissheads is largely a stereotype. But it’s true that we do like a drink. Everyone we grew up with drank, and we mostly saw them in situations where drink was plentiful – weddings, funerals, Christmas. Everyone was pissed – including my dad.
He also held down a job. Every morning his alarm would wake us up, followed by the “pssst” of a can being opened (a sound that still freezes my heart, years later). He’d drink in bed, then brush his teeth, get on his bike, and cycle to work. When we bumped into his colleagues, they talked about how funny and friendly he was.
So nobody believed that my dad would be pissed before we turned up at whatever social occasion. And his minty-fresh breath hid the sour, apple-y edge of alcohol. Everyone has one too many and kicks a door in occasionally. Don’t they?
2. You don’t believe yourself.
I don’t blame anybody for not believing us. They didn’t see the worst times. But even seeing isn’t believing. Even when you’re there, cowed under drunken rages, binning cans, helping getting the younger ones ready for school while your dad drinks a beer, part of you doubts it’s really happening. We’d beg our dad to stop drinking and he’d respond by telling us he barely drank – while slurring, with a can in his hand. He’d occasionally say he was an alcoholic and I’d internally hope it was a confession, a turning point. But living with an alcoholic is life within a hall of mirrors, of warped reflections and dead ends. It was no confession – just an excuse for why he could continue drinking. He was an alcoholic, so he drank.
It becomes tediously, painfully normal. You go to school, you see your friends, your dad is drunk, you come home, you have your dinner, your dad is drunk, there’s a massive fight, you go to bed, you lie awake, the staircase creaks, your dad is drunk. Life goes on, and nothing changes. I started to second-guess every emotion I had – every time I cried or felt sad, I told myself I had no reason to cry or be sad. That maybe if I didn’t cry and if I wasn’t sad, he wouldn’t drink. It wasn’t that bad.
3. The best and worst of times are often one and the same.
There were nights my dad would wheel his bike into the house (when he could still cycle) and hanging off the handlebars with a four-pack of beers would be a takeaway for everyone. We’d scatter across the living-room floor watching TV, eating chips, and chatting, just like a normal family. Sometimes he’d cook a steak, avalanche it in pepper, then cut bits off it and give us a piece each with a slice of bread. I cherish the memories of those nights.
Throughout Christmas 2005, he stayed sober and it was wonderful. He was the man we knew was buried beneath the booze – the sarcastic man who had a riposte for everything, the sweet man who leaned against the fireplace with a half smile as you opened your presents (in the years before, he’d have hidden them, with gymnastic squirrelling, in eaves and cupboards you didn’t even notice, let alone could reach), the silly man who always wore the paper hat from the cracker, and the shy man who didn’t want you to take a picture of him wearing it. He’d had days off the drink before, but we hoped this would be the last time, the time it was forever. We had hoped before, but we still hoped.
When it was time for me to leave for my flight, my dad said he’d come and get the taxi with me. I hadn’t had any time alone with him over Christmas so I was happy to have him to myself. We had five minutes before he kissed my cheek hastily, then abruptly got out of the taxi. He crossed the road to the off-licence without turning back. I waved goodbye from the window.
4. It’s not always OK.
That was the last time I saw my dad outside of hospital. He died five months later, on 17 May 2006, at the age of 47. Even now, nearly a decade later, I still think he’s just “somewhere else”. In my dreams he appears in the strangest of places – a caravan on a petrol station forecourt, at the window of a childhood home. Because despite everything, I never believed he would die. In everything I’d ever read or watched (and I hungrily consumed anything I could find about addiction), they were always OK. You’d turn the book over and there they were on the back cover, golden, smiling, and healthy. And I believed, until the end, that’s what would happen to him, too.
But it didn’t.
5. You become jealous of strange things.
Losing any parent is devastating. But I feel a stab of envy for people whose parents die of an illness or of natural causes. Because they have years of memories where the person they loved wasn’t ill, and because they died of something other people can empathise with.
One of the first times I broke down after my dad’s death was while watching an advert about cancer. A bride turns to the camera and says, “I wish my mum was here.” I sobbed and took my tears on to a bus and sobbed there, and then carried them into the work toilets, where I shut the door and sobbed there, too. Because my dad wasn’t going to be at my wedding, or meet my children, or ever again pick up the phone and then pass it to my mum. He wasn’t going to be there, and nobody cared that he wasn’t. There were no adverts about us, no Races for Life, no rattling collection tins. No one fought for him – he was refused a liver transplant, so nobody even tried to save him. There was nothing but condemnation, disdain, and ridicule for people like him, and few shoulders and little sympathy for people like us. People like my dad were heckled on Jeremy Kyle, not held in hushed memorial.
You probably hate me for saying that, and I hate myself for it. No death is easy, no illness is kind. And cancer is brutal, horrific, ugly, and soul-destroying. I hated him, too, for dying in a way that locked us in our grief, that meant we couldn’t even reach out to an awkward shoulder for fear of being blamed, for collapsing under the weight of shame that we couldn’t save the one we loved, with our love.
It’s hard to know what to say when someone dies. It’s hard to write the obituary, to comfort the loved ones, to retell the stories faithfully. In our case, there weren’t any phrases like “he lost his battle” or “he fought hard” – but he did.
6. You develop a strange attitude to alcohol.
You’d think that after seeing alcohol destroy my dad’s life, I’d be a preachy teetotaller. Sometimes I am. When I’m not drinking, I hate being around people who are. I feel panicky when I hear a can open, I feel disgust when someone slurs a gust of booze into my face. I try to avoid hanging out with people I know are heavy drinkers (and I’m pretty good at “spot the alcoholic”).
But sometimes I see people with a beer and they’re laughing and relaxed and happy. And I so violently want to be normal, to be someone other than the girl whose dad died of alcoholism. I’m searching for that ease – of the steak nights, of the takeaways – so I have a beer, hoping to find it. I want to prove that I’m just like everyone else.
But I’m not – I’m my father’s daughter. I find it hard to stop once I’ve started. The ease doesn’t come, because it didn’t come from the beer in the first place. So in the past, I have swung from puritan to pisshead – sometimes within the space of an evening.
7. You’ll live through this.
I have a baby. He’s tiny, beautiful, and hilarious. When I look at him, I can see the ears I inherited from my dad, and our untameable Northern Irish hair. There have been times I’ve held him and wondered how our dad could leave us.
But most of the time, I understand that he didn’t leave us willingly. From the depths of grief it can be hard to see the way out. As the years have passed, I have been able to remember more of the joyful times too. They are the same ones I share with my son – reading a book, chasing each other around around the floor laughing, singing Bowie songs.
I see my son and realise that, just like when I have feelings of sadness that are nothing to do with him, so my dad’s feelings were independent of us all. It was out of our control, and it always was. We didn’t cause it, we couldn’t change it. In his case, it had tragic consequences, but it doesn’t doom us to following the same path.
My siblings are some of the most compassionate people I know. After everything we’ve been through, what we’ve learned is that everyone can struggle – you can have a family, a job, all the trappings of a normal life, and still struggle. That you should try to be kind to everyone, to see them in their entirety and not just as whatever they’re struggling with. To not give into judgements. That happy moments exist, even within the sad times, and that you can be OK, and when you’re not, you are still worth being loved. These are the lessons I want to pass on to my son – that the ease is from inside, and that you are perfect and loveable as you are.
Strangers may have passed my dad and seen a drunk. But he was also the Python devotee and Bowie fanatic who taught us all how to read, bought us our first microscopes, was proud of everything we did, and who photographed the oddest minutes of our lives so now we have a path back to those joyful minutes, to remember and to honour them, and to repeat them.
This is not the first time I’ve written about mental health and alcohol dual diagnosis and the failure of the NHS to treat appropriately. You can read my other posts here.
This is what Professor Liz Hughes had to say in The Guardian in December.
People who have mental health along with substance use problems (known as dual diagnosis) have multiple needs, and yet struggle to find services to help them.
Those with complex needs have often experienced a great deal of adversity in their lives, including childhood abuse and deprivation, loss of close family, and poverty. As an adult, having multiple needs brings consequences such as homelessness, unemployment and exploitation, and there is a high risk of poor physical health, suicide, self-harm and of perpetrating violence. Those with dual diagnosis are also unpopular, partly because of society’s entrenched attitudes to substance use problems, which are perceived as a lifestyle choice rather than a health condition deserving of care and treatment.
Dual diagnosis is one of the biggest challenges facing mental health and substance use services, but after 15 years of a variety of initiatives it’s hard to see how things have changed on the frontline. I still hear about the same challenges that were around in the 90s. Mental health services can often exclude people if their problem is perceived to be substance-related and, conversely, substance use services exclude people if their substance use doesn’t fit their criteria.
One of the solutions put forward is to train staff in mental health and substance use with transferable skills and knowledge. Dual diagnosis is the norm, not the exception, and therefore is everyone’s business. Dual diagnosis training has been rolled out, but though it can improve knowledge and skills, it doesn’t always change perceptions and values.
One particular incident stands out from when I was a dual diagnosis worker. It was a Monday, and I arrived at the local psychiatric inpatient unit to see if there were any referrals for me. The nurse in charge greeted me with a “we’ve got one of yours” and a roll of the eyes. A single utterance speaks so much. It demonstrates an absence of compassion – that nurse did not see this person as deserving of care.
My heart sank. I spent a while chatting to “one of mine” and he told me of the trauma, homelessness, desperation, and hopelessness that had led to his suicide attempt at the weekend. He told me that staff at A&E and the mental health team on the ward had treated him with disdain; he did not feel welcome, and so was unlikely to want to stay in treatment and access the help he needed.
One of the consistent messages from service users I have talked to over the years is that they want people to listen, to be with them “where they are at” (as opposed to pushing their agenda on them), not to judge them for their choices, and to have hope. Engaging patients is critical, as we know that loss of contact with services is typically associated with worse outcomes and in some case, increased risk of suicide, self-harm and violence.
Much of the dual diagnosis development in the noughties was supported by the national dual diagnosis programme at the Department of Health. Since the localism agenda of the coalition government, and now the Conservative government, and the cuts to government central budgets, many of the national programmes have disappeared. This is further complicated by the almost complete transfer of substance use services to the third sector and the absence of mental health staff in these new services. Currently dual diagnosis work is based on postcode lottery, and is piecemeal at best.
Testimony must be paid to Progress, a consortium of consultant nurses in dual diagnosis who work locally and as a collective, for free, to keep a resources and information website going, as well as to lobby for better services at government level through the all party parliamentary group for complex needs.
In addition, there are some fantastic examples of where service providers and users work together to improve provision. Leeds is a particular example. An active service user involvement group (the Zip Group) is able to influence the city services at all levels. A vibrant network of users and service staff meet regularly and a funded lead person coordinates the venture.
We face two clear challenges: changing the perceptions of service providers to recognise the complex needs of people with dual diagnosis (which includes a shift in attitudes to substance use), and being able to provide effective services to people with high needs, in a time of unprecedented crisis in mental health provision and loss of mental health expertise within the substance use sector.
The UK dual diagnosis scene is running on nothing but goodwill by a few enthusiastic champions – how long can anything be sustained on this basis? With the increasing need to provide evidence for commissioning, it’s time to harness the data that we have at our finger tips to lobby service providers and commissioners for new roles and new initiatives.
Hear hear Professor Smith hear hear!
Edited to add: 17th Feb 2016
My friend Veronica also had a guest blog post looking at this issue in the US
This was covered in The Telegraph back in October and was an excellent response to the reader question about concerns about a work colleague and their drinking.
I’m worried about a colleague and would like your advice. He’s known in the office as a bit of a party boy and often arrives late looking like he’s had a big night out – it’s become a standing joke. But I’m concerned the problem is worse than people think; I recently went on a week-long business trip with him and when he did show up for meetings – he missed most – he either seemed drunk or badly hungover. I’ve been asked by our mutual boss to give feedback on how he performed, but don’t know whether to tell the real story. He’s had one warning already for poor performance and I really don’t want him to lose his job – but I think he needs help. What should I do?
The wider problem
Alcohol and substance abuse in the workplace can create challenges for employers, the employee concerned and their colleagues. There is no ‘one size fits all’ rule for how such issues should be handled.
If a concern is identified, firms can approach it as a disciplinary, health or performance issue (or a combination) with support likely to include specialist counselling, referral to occupational health practitioners, a formal professional intervention – and/or the use of internal disciplinary procedures.
Employees with an alcohol problem have the same rights to support and confidentiality as they would if they had any other medical or psychological condition.
And the problem is huge. The TUC’s Worksmart initiative estimates that up to 17 million working days – between three and five per cent of all absences – are lost each year due to alcohol, while sickness absence due to alcohol is estimated to cost the UK economy over £7.3 billion a year.
In a 2007 survey by the CIPD, Managing Alcohol and Drug Misuse at Work, four out of ten respondents identified the consumption of alcohol as a significant cause or very significant cause of employee absence and lost productivity.
Where to start
You think that your colleague is drinking too much and that it’s impairing his ability to work, based on your recent experience of being on a business trip together.
Your concern for his health and your fears for his job security are absolutely understandable – although it’s important not to make assumptions. Heavy drinkers aren’t necessarily alcoholics.
If your question has been purely about how to act on these concerns, I’d have advised you to have a quiet and tactful talk with your colleague, with the aim of being collaborative rather than confrontational – remembering that if he is in denial then he may quickly become defensive.
However, you’ve been asked explicitly by your boss to comment on his performance – and you need to respond honestly.
Don’t feel guilty
Your fundamental dilemma here arises because you cannot dictate your employer’s response to this issue, and you need to accept that. Once in receipt of new information, your manager will need to take it forward and you will likely be left out of the loop in order to protect your colleague’s right to confidentiality.
While it may feel uncomfortable to ‘hand over’ responsibility, please keep in mind that you cannot and should not deal with this on your own – and shielding your colleague from the consequences of his actions out of kindness may actually do more harm than good.
Remember too, that it’s in your firm’s interests – business as well as human – to offer proactive support. Addiction is a disease, and it can be treated successfully. Ideally, your company should have a clear policy on drug and alcohol use, which would set out the support mechanisms in place for employees. It’s likely to be more cost-effective for them to allow him time off to obtain expert help rather than trying to replace him.
If they ignore the problem, there are likely to be implications on team productivity and morale, as well as your colleague’s health.
Disciplinary action should be a last resort, and indeed a dismissal could be deemed unfair by a court, if an employer makes no attempt to help someone whose work problems are related to alcohol abuse. And if he does eventually lose his job because of this, remember it’s not your fault, and it could be the trigger he needs to seek help.
What to say to your boss
You can try set the tone for your firm’s initial response by emphasising your concern and personal support. Your boss may simply be expecting you to send a quick email summarising what happened on your business trip.
Don’t do this.
Instead, meet face to face, and explain verbally and compassionately why you’re concerned about your colleague. Try not use to judgemental, accusatory or labelling language – at this stage focus on what you observed, rather than expressing any assumptions you’ve made.
If you feel your boss may not handle the information well – he’ll need to be aware of your company’s policy but may not necessarily be – you could bring HR into the conversation too, so they can take it forward together.
For more information about spotting signs of alcohol and substance abuse, and managing these issues in the workplace, check out the following sources:
So much to learn from this poem about presence and being afraid. Beautiful just beautiful.
When I turned 2 years sober I said: Prim shared an excellent guide to recovery that year one was physical, year two was emotional and year three was spiritual. I’m still wading through the emotional stuff so we’ll see how I go with the spiritual!😉
I’m finding with mindfulness and its grounding in Buddhism I am working on my emotional and spiritual growth at the same time. Win:Win! To help you do the same I’m attaching a gift from Tara Brach I received earlier this month – enjoy 🙂
This was a great piece on Addiction.com written by an addiction psychiatrist and I’m sharing it because I think it is an important piece of grounding information that all of us look for in the early days to answer the question – why me?
How is it that one person can enjoy a couple of beers or a glass of wine now and then and go on with their life, while someone else becomes an alcoholic? If there were a single, simple answer to this question, addiction might well be a thing of the past, because we’d likely be able to respond with one single, simple treatment. Instead, we must deal with addiction as it is: a complex and chronic brain disease that can get its start through multiple pathways and which almost always requires a variety of strategies to bring under control.
But why is it that many use alcohol or experiment with drugs but only about 10% become addicted?
First, it’s important to realize that whether or not a person becomes dependent on a substance has nothing to do with moral failings or willpower. It has to do with how the brain and body respond to the substance. Some people are more vulnerable to addiction than others, and their vulnerability can spring from a variety of interrelated factors rooted in both nature and nurture. Among them:
Genetics. It’s long been understood that addiction runs in families; advances in the field of genetics are helping us understand why. There is no single addiction gene, but researchers believe there are likely several genes or gene combinations that influence whether a person starts using substances, how rewarding they find it and why some continue to use despite negative consequences. Genes also probably explain why one person finds alcohol thrilling while another can take it or leave it. Genetic factors are believed to make up about half of a person’s addiction risk, but it’s important to remember that genetics are not destiny. The science of how genes are expressed, called epigenetics, and whether they are, in a sense, turned “on” or “off,” is influenced by our environment and lifestyle, meaning making healthy choices can help to minimize the negative impact.
Brain structure and chemistry. Imaging technology allows researchers to look inside the living brain in a way that was once impossible only a couple of decades ago. So we now know that brain changes and abnormalities can be both a cause and an effect of addiction. For example, a 2012 study of a group of identical twins — one of the twins had an addiction history and the other didn’t — found that both twins had brain abnormalities such as less dense white matter in the front of the brain, which suggests less self-control, and more gray matter in the brain’s mid regions, which is connected to an ability to form habits. This finding is seen as strong evidence that some brains predispose people to addiction, if the person chooses to use substances. Why one twin chose to do so and the other was able to resist substance use is still being studied, but life experiences are thought to play a role. In short, our brains can set us up for addiction, but we do have power to overcome those deficits.
Environment and lifestyle.Circumstances such as whether a person was raised by loving caregivers or not, how well they were taught resilience and coping skills, how safe they feel in their home and neighborhood and whether they are victims of violence or abuse all play a role in addiction risk. Such stressors can lead the person to turn to alcohol or drugs to soothe disturbing emotions. The relief, though, is temporary, and the more the substance is used, the more the brain needs to achieve the same effect. This escalating use can change brain chemistry in ways that rob the person of their ability to choose. A negative environment can also put a person into contact with people who drink or do drugs, meaning substances are more accessible and use is more socially acceptable.
Mental illness. About half of those living with mental illnesses such as clinical depression and bipolar disorder develop a substance use disorder. It often grows out of an attempt to self-medicate the symptoms of the illness; the person is not seeking pleasure as much as fleeing pain. In the long run, however, alcohol and other drugs only make the problem worse, research shows. The result is often a vicious cycle in which the mental health issue and the addiction feed each other. These co-occurring issues must both be treated for long-term healing.
Onset of use. The sooner a person starts using alcohol and other drugs, the greater the addiction risk. That’s because the brain is still forming up until about a person’s mid-20s, and drugs disrupt reward circuitry in ways that impair control. Research finds that those who start drinking before age 15, in fact, are about five times more likely to abuse or become dependent on alcohol than those who waited to drink until they were 21 or older.
From Risk to Recovery
Whether or not a person takes that first drink, then, is a matter of choice, but whether or not it becomes a problem is a matter not of character but of the combined power of genetics, lifestyle, environment, brain chemistry, mental health and age. Although the odds may seem stacked against some, the good news is that change is possible, even at the genetic level, and addiction treatment can not only provide needed support but actually help heal the brain — although it may always retain an increased vulnerability to relapse.
So, when asked why some become addicted and others don’t, I remind my questioners that, to a large degree, it’s the luck of the draw. Addicts often face contempt for their alcohol and drug dependence and the trouble it brings to their lives and the lives of those around them. But for those who face the hard reality that they can’t take a drink and walk away, a more appropriate response is compassion.
Well said Dr David Sack, well said 🙂 And perhaps if you have a family member or friend who is struggling to understand why you can’t have ‘just one drink’ then maybe sharing this with them might help them understand too?
This was an interesting read particularly as the workplace concerned is very close to home for me ……
An NHS Trust recently hit the Employment Tribunal headlines following the judgement of McElroy v Cambridge Community Services NHS Trust.
In this case, the Tribunal held that Mr McElroy, a healthcare assistant, was unfairly dismissed after it was reported he had attended for work smelling of alcohol. Mr. McElroy claimed that he had only drunk a few alcoholic drinks during the previous night and was not still “under the influence”. Despite the fact that there was no suggestion that Mr. McElroy was drunk, he was suspended pending a disciplinary hearing. During the investigation, an Occupational Health report revealed that he had recently been treated for oesophagitis, which can be associated with alcohol consumption and this was not the first time colleagues had raised concerns about a boozy odour emanating from him.
The Tribunal found that the decision to dismiss was unfair since the Trust’s substance misuse policy did not expressly ban the drinking of alcohol during breaks or even before coming to work. The Tribunal judgment decided that it was out-with the ‘band of reasonable responses’ for the NHS to assume that the smell of alcohol meant that the employee was automatically unfit to perform his duties. It was also noteworthy that when similar concerns had been raised on previous occasions, the employee did not even receive a warning.
A key lesson for employers to take from this case is the need to ensure policies are carefully drafted, understood and followed. Phrases such as ‘under the influence of alcohol’ are potentially subjective and open to interpretation. The effects of small amounts of alcohol may be significant in one type of workplace or occupation (e.g. health and safety critical environments or where the employee operates machinery or drives) and may arguably be less significant in others.
If an employer wishes to impose a ‘zero tolerance’ policy it should specifically say so, even to the extent of making it expressly clear that alcohol in an employee’s system ‘the morning after’ will be deemed a disciplinary offence as well.
Testing is equally important. Making assessments as to whether an employee has any alcohol in their body at all, never mind whether it is at or above proscribed limits, is very difficult and open to challenge. Employers are well advised to set out how they will test employees for alcohol (or other drugs, for that matter), ensure that the testing process is reasonably accurate and followed, while at the same time balancing against making it so unwieldy as to be practically useless.
If McElroy’s case tells us anything it is that employers should scrutinise carefully their current Drug & Alcohol Policy. The alternative may mean waking up one day soon to the hangover of unwelcome litigation.
And then another news story appeared the same day with a similar theme but more blunt headline!
It is seemingly a licence to behave badly at office parties – and keep your job. The bad news for Australians is that such parties are likely to become sober affairs | Independent, UK
So HR depts seem to be in a bind about the issue of booze and need to do some serious reviewing of policy because it seems the law is on the side of the claimant in both of these cases irrespective of the individuals consumption or issue with booze …… I prefer the more compassionate approach of TFL. What do you think?
The guidelines, based on findings from a three-year Economic and Social Research Council (ESRC)-funded project, suggest that those left bereaved after a drug or alcohol related death often receive poor, unkind or stigmatising responses which can exacerbate their grief.
The study interviewed 106 bereaved adults, the largest known qualitative research sample of its kind, and held focus groups with 40 members, mainly practitioners (some also bereaved), whose work brings them into contact with this group.
While some bereaved people reported positive experiences, the study has identified much poor practice resulting from practitioners not understanding this kind of death and the issues involved.
Why such bereavements are complicated
It found that such bereavements can typically be complicated by the stress of living with the persons’ substance use prior to the death, the difficult circumstances surrounding the death and how these are sometimes reported in the press, a belief that the death was premature and could have been prevented, and feelings of guilt in not having being able to intervene.
Deaths from substance use can occur in various ways ranging from a young person who dies after experimenting with drugs to an older person who dies from liver failure after long-term alcohol use. Both the substance use and the death may be considered taboo, leaving the bereaved person feeling alienated at a difficult point in their life.
Dealing with a complex web of organisations and individuals
The researchers also highlight how bereaved people can be daunted by the myriad of different individuals and organisations they encounter after the death and propose steps for better cross-agency working. In other cases, where an individual has died in unusual circumstances, families may be offered a family liaison officer or victim support, but there is no such single point of support for people left bereaved through alcohol or drugs; something the researchers suggest could be considered.
The guidelines were developed by a working group of practitioners, including members of the police, the coroner’s court, drug and alcohol services, a paramedic, a GP, a funeral director, clergy, and a trainer / counsellor who chaired the group.
“The fact that many of us feel uncomfortable or unsure about how to respond to these bereaved people, how we talk about these deaths and the limited support offered, are all symptomatic of the fact that, so far, this group, though sizeable, remains hidden and neglected by research, policy and practice.
“Our research has found that, while poor responses from services adds to their distress, a kinder and more compassionate approach can make a real difference. Our hope is that these guidelines – developed for practitioners by practitioners – will provide a much needed blueprint for how services can respond to these bereaved people.”
Key report messages
Professor Linda Bauld from the University of Stirling added: “Our findings are drawn from interviews with family members in England and Scotland but are likely to have relevance across the UK. There is much more that can be done to support bereaved family members and consider their needs rather than focus on the stigma that drug and alcohol use can carry.
“Drinking and drug use is something that cuts across all sections of society. These guidelines are relevant for a diverse range of organisations and we hope they can now be tested in practice.”
Among the report’s key messages it suggests:
– Always show kindness and compassion when interacting with a bereaved person. First impressions make a huge impression and can greatly help or hinder a person’s response to grief.
– Think about the language you use. Avoid using labels like ‘addict’; instead talk about drug use and alcohol use. Use language that mentions the person before describing their behaviour. Avoid saying ‘I know how you feel’ and ‘You shouldn’t blame yourself’.
– Treat every bereaved person as an individual. Do not make assumptions about the person who died and about how this kind of death may affect those left behind and how they will react.
– Whatever your role, do what you can to protect the bereaved person’s well-being in a difficult and stressful situation. Do not be afraid of speaking to them about the death – it is often worse when it is not acknowledged. Ask the bereaved person what will help and what they want of you. Be willing to really listen.
– Be aware of and work with other organisations dealing with this kind of death, so you can advise bereaved people about what they need to do, who they need to see next and what is going on. There may, for example, need to be a post mortem, inquest or police investigation.
The scale of the challenge
According to Alcohol Concern, alcohol-related deaths have increased by nearly 20 per cent in the past 10 years. In 2012, there were nearly 6,490 alcohol-related deaths.
The latest ONS figures highlight that 2,955 drug-related deaths were registered in 2013 for England and Wales. According to the National Records of Scotland, there were 526 drug related deaths registered in Scotland in 2013.
The authors hope their Guidelines can now be rolled out across support services.
Both the substance use and the death may be considered taboo, leaving the bereaved person feeling alienated at a difficult point in their life. This is so true that so much is taboo around the issue of substance misuse, including bereavement support, so this is vital research and guidance. What are your thoughts?
PS Dryathlon is back for the month of September so if you would like to participate and raise money for Cancer Research go here. This is what a month off the booze can do for you 🙂