Category Archives: Preparing to stop

20 things to replace 2!

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

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

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

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

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

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

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

Dutch trial of web-based treatment programme for problem drinking

This was featured on Findings in December and looked at the use of a web-based treatment programme for problem drinking as part of a randomised trial within the Netherlands.

Web-based-addiction-treatment-services-2The trial had included 156 adult problem drinkers who on the project’s web site (now also available in an English-language version) had identified themselves as drinking at least 150g alcohol a week for women and 220g for men (about 19 and 28 UK units respectively), but no more than 670g for women and 990g for men. They were among over 500 who had responded to adverts and other invitations to join the study who said they had not recently been in alcohol treatment and were not suffering a psychiatric disorder. Just over half were women, 82% were employed, and they averaged 45 years of age. About 8 in 10 self-assessed as dependent on alcohol, though 86% had never received professional help. The women averaged 352g alcohol (44 UK units) a week and the men 419g (about 52 UK units).

Half were allocated at random to immediately gain access to a 12-session web-based treatment programme. The other half formed a control group who had to wait three months for access, during which they were kept in touch with through fortnightly email messages from the research project.

The web-based programme involved patients being allocated their own personal therapist with whom they communicated in writing via the project’s web site. Rather than online ‘chatting’ in real time, communication was analogous to email messages, responses following some time after the initial contact. The programme was based on cognitive-behavioural therapy and motivational interviewing. The first part involved assessment, assessment feedback, a drinking diary, and identifying situations which for that individual risked heavy drinking. This part culminated in advice from the therapist on how the patient might change their drinking habits. Part two was the change phase, involving setting a drinking goal and formulating a plan for maintaining the new drinking behaviour.

The authors’ conclusions

Post-therapy improvements in drinking and health and in quality of life were sustained over the next six months. The decrease in alcohol consumption was substantial and clinically meaningful. These results suggest web-based alcohol interventions with intensive personal support from a therapist can help reduce problem drinking. However, support of the kind offered in this trial requires more resources than less intensive web-based interventions such as brief interventions or self-help programmes. Professional therapists available at least twice a week are needed to maintain communication with participants, and technology and security requirements are greater because personal information is sent between clients and therapists. Despite these costs, web-based alcohol interventions of this kind are legitimate additions to the range of treatment modalities as they attract new groups of problem drinkers and extend the accessibility of interventions.

Web-based treatment particularly attracts women and better educated and employed drinkers, groups under-represented in face-to-face therapy. Anonymity means participants no longer need stay away from treatment because of shame, fear of stigmatisation, or other barriers to professional help. Participants are helped in their own environments at times of their choosing, making therapy more accessible and convenient. These are also why email type communications have an advantage over ‘chat’ sessions which require client and therapist to be available at the same, set times. An advantage over self-help is the added value of personal contact with a professional therapist. The main challenge seems to be keeping participants involved until the end of the programme.

As part of my online course 1:1 support is available via email – and as this study shows it can be very successful 🙂

More ‘How to Quit’ workshop dates in collaboration with Club Soda!

Back in May I ran my first ‘How to Quit’ Workshop in partnership with Club Soda.
It was a huge success and if you want to see how some of those who attended are getting on with their new hangover free lives you can do so here 🙂Club Soda image
We are running 3 more dates in 2015:

Saturday 4th July

Saturday 26th September

Saturday 14th November

11am – 5pm
Kingly Court, 49 Carnaby Street, London, W1F 9PY

Here is some of the feedback received:

Just to say thank you SO much for today. Meeting you and Laura was life changing. I’ve just got home from a house party and drank only tonic water and cordial! Very proud and pleased to start my new alcohol free life!

Thank you so much for the workshop it was really fantastic.  It was lovely to spend time with people who understand and not feel abnormal.   I learnt so much and found your story truly inspiring.  I have done a lot of reading and the Allen Carr workshop but yours was really the best for me.  It has given me the boost I needed to carry on with my choice not to drink.  I know I have given up 3 times before and started drinking again but I really hope I have cracked it this time.  She’s now over 100 days hangover free 🙂

I attended your workshop on Saturday and found it very helpful. My goal at the beginning of the day was to cut out drinking completely during weekdays, but I have decided to take a complete break . The “drinkaware” cup which you showed the group was, for me, a key visualisation : the “safe” amount is really very small, and represents barely the beginning of an evening for me and something I have previously paid absolutely no regard to whatsoever.  I have to get to grips with why I want to numb the edge of my day. Drinking wine is definitely not the answer, and although it remains to be seen how quickly I can dismiss it completely, I feel so much better equipped than before to try. Your own story, your professional perspective as a medic and the resources you provided were very helpful, as is learning how many other people share my concerns about the disproportionate and totally undeserved role alcohol plays in so many people’s lives.  Thanks again, and I will let you know how I get on.

My aim was to get the motivation to stop drinking completely (which I have tried doing a number of times) and then pick up tips to help me remain sober.  The day did this and I have not had an alcoholic drink since Saturday evening.  In addition to this I found the following really useful…

  • Hearing other people’s perspectives and that they were in a similar boat.
  • Hearing from non-drinkers that life was “infinitely better” without alcohol.
  • Hearing how I might feel over the next few weeks, months and years.  It is so much better to be prepared.
  • Hearing how non-drinkers dealt with feeling tired and unwell eg just going to bed.
  • Hearing about non-alcoholic beers and wine.

If you’d like to join us you can register for a place here: https://www.joinclubsoda.co.uk/workshop-how-to-quit-drinking or click this image to the right of this blog post 🙂

How to Quit Drinking Workshop ad

Seeing through the glass darkly?

Whilst studying the Kings College Understanding Addiction MOOC recently a commentator in the discussion thread linked to this research which was a qualitative exploration of GPs’ drinking and their alcohol intervention practices called ‘seeing through the glass darkly’.  Granted the research is almost 10 years old but I felt it gave a great window into the dilemma for healthcare professionals who are advising patients about drinking when they themselves may be drinking harmfully.

Booze IV's

This would have been me prior to my stopping and one of my many motivators to quit was the hypocrisy of my own actions and advice giving – and with smoking it was no different either!  How do you expect people to take your health advice seriously if you don’t even follow it?  Less ‘do as I say not as I do’ and more social role-modelling.

The whole published article is worth a read as its qualitative nature means there is some really rich data to observe.  I’m only going to share the discussions which is exceptional on its own.

Alcohol has long been regarded as a ‘difficult business’ for primary care23 and indeed alcoholism the dirty work of medicine.31 Part of this difficulty derives from the fact that problem drinking is ill-defined, multifaceted and surrounded by arbitrary notions such as ‘social drinking’ and ‘safe limits’.25 Thus it may be difficult to establish clear boundaries between what is safe or unsafe and what constitutes alcohol use or abuse. Moreover, uncertainty surrounding sensible drinking limits plus differences in patients’ physical and social circumstances requires clinical judgement in determining when drinking moves from being a social pursuit to risky behaviour.

However, alcohol intervention work may be further complicated by clinicians’ own alcohol use. Most GPs in this study drank and many reported minor adverse effects. Several respondents also referred to more serious drinking problems in colleagues. A serious concern raised was the perceived lack of care facilities for clinicians with substance-use problems. Nevertheless, some GPs in this study reported drawing on their own drinking experience to initiate discussions with patients about alcohol. However, other GP-colleagues were more reticent. A number of GPs described problem drinking as something that exceeded or was different to their own pattern of alcohol use. Such bench-marking by GPs drinking at higher-risk levels would mean that some risk-drinking patients might not receive the care they required.

Primary care nurses have reported overlooking patients whose drinking behaviour was similar to their own.22 It is interesting that primary care nurses, most of whom are women, were less likely to deliver brief alcohol interventions to women rather than men.12 For GPs, brief alcohol interventions tend to be under-delivered to better-educated, higher social-status patients; individuals much like themselves.8,13 Thus the mechanism underpinning inconsistent delivery of alcohol-related care may be perceived social-distance from patients.

Clinicians’ personal and social characteristics are likely to influence their own health behaviour and risk-taking activity. However, our data suggest that clinicians’ personal and social characteristics may also influence their perception, or indeed recognition, of health risks in others and their tendency to deliver preventive care to different ‘types’ of patients. The latter is little explored in the healthcare literature and requires further careful research including whether inconsistent delivery of preventive care extends beyond alcohol to other lifestyle issues such as obesity or smoking.

It would seem that if we are to tackle alcohol as an issue within wider society we need to address it’s usage and abuse within the healthcare profession.  If we within healthcare can’t acknowledge and resolve our own issues leading to poor advice giving to those who come to us for our professional support what hope do we have?

At the same time as this research this news story was covered by The Telegraph and the BBC stating:

The British Medical Association has called for action over alcohol and drug abuse among medics after a BBC survey showed the problem was widespread.

BBC One’s Real Story found over the last 10 years 750 hospital staff in England had been disciplined over alcohol and drug-related incidents.  The BMA estimates one in 15 medics have a problem with drugs or alcohol at some point in their life-time.  But the figures, obtained via the Freedom of Information Act, may seriously under-represent the scale of the problem Real Story reported.  Ethics Committee chairman Michael Wilks said the profession was in denial.

Doctors are known to be at least three times as likely to have cirrhosis of the liver – a sign of alcohol damage – than the rest of the population.

 

In the research I found this opening sentence very telling Alcohol has long been regarded as a ‘difficult business’ for primary care and indeed alcoholism the dirty work of medicine.  If this is how it is still perceived then this is where we need to start first and if we don’t then I’m not sure that healthcare is the right place for substance misuse issues.  One of the reasons for the success of AA is because of the non-judgement and support of others who understand.  If we can’t develop that same level of non-judgement and understanding in medicine then I am saddened and disappointed in my own clinical profession, particularly as one of those who needed that help, and is now trying to offer it but from outside the healthcare system …..

Booze aversion therapy

This is something that feeling has mentioned on her blog as I believe the Dutch have a study programme that works on and as alcohol aversion therapy.

Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations in order to stop the specific behavior (wiki)

One of the drugs used to manage alcohol dependency Antabuse works on the principle of booze aversion therapy as it gives you many unpleasant symptoms including nausea and vomiting if you drink having taken it.

So while trawling Youtube I came across this video published in March 2014 which uses the same principles and I thought I’d share it here to see what you thought.

There is something quite powerful about images of booze followed by images of bleach and feeling if you’re reading this I’d be really interested in hearing in the comments if this helped you when you stopped?

What do you think?  Does this help or would it have helped you stop?

Edited to add: feeling has very kindly written a whole post in response to my question – which talks you through how to access and use the Dutch programme that she has used.  She says ‘I did a free alcohol desensitization training which is still in its test phase but I think it works’ so if you’d like to have a go at it go here: https://feelingmywaybackintolife.wordpress.com/2014/12/12/alcohol-desensitization-training-alcohol-top-training/

Thank you so much feeling 🙂

I’m Done Drinking Counter

This was an app that Sharon mentioned in a comments discussion on her blog.  As soon as I read it I went scuttling off to the iTunes store looking for it and you can find it here.

The designer says that it was inspired by their ‘I’m Done Smoking’ App and this app was requested by many to track how many days and how much money you can save by not drinking.  And that’s what it does!

You programme in your quit date, how many drinks you drank per day, what was your choice of poison and the cost per drink was and it does the rest 🙂

It shows your quit date and time in days, hours and minutes since your last drink.

It shows the number of drinks not consumed in number of drinks, bottles/packs and cases.

It shows the calories saved (calculated using 125 calories for a 5oz serving of wine for me) and $$ cash saved.

A nice touch on the ‘About’ page is that the designer says ‘I started this app with the idea of just saying I’m Done and use it as daily motivation to prove that if I could stop drinking I could do anything, even create an iPhone app’ 🙂

I have it downloaded on my iPad and it cost $0.99

At the time of writing this post I was at 171 days since my last drink, had not consumed 686 alcoholic drinks, had saved a whopping 82,372 calories and £1024 in cash (x 2 as Mr HOF has also stopped) therefore meaning a combined total of £2048!!  It’s a great motivator 😉

Edited to add: the app has now been updated with a range of drinks from beer to spirits to wine to cocktails to chose from.

Sober safety plan

It is standard practice in my day job that if there is a worrying behaviour being demonstrated by a young person or they are involved in a difficult situation we would implement a safety plan to help them manage it and to ensure that we have assessed any risk to them posed by this.

For my drinking I have this ‘safety’ plan in my head but you could easily commit it to paper much like the changing behaviour contract detailed in this post.  This is a plan of action for when the cravings strike.  Obviously the best scenario is that you manage your triggers, as detailed here, so that it doesn’t reach a craving crescendo but sometimes it is just unavoidable.

My safety plan if a craving strikes is:

  1. Use the 15 minute rule which you can find here
  2. If that didn’t working, I’d talk to my husband (who is 6 days ahead of me)
  3. If that didn’t work I’d email my sober penpal Belle
  4. It that didn’t work I’d blog about  it
  5. If that didn’t working go to bed, irrespective of how early it is, and see how it is tomorrow
  6. If that didn’t work I would then find an AA meeting.  I haven’t yet reached this point and know from my fellow bloggers that this can be a saving lifeline and I would use it.

I found it important to try and contingency plan a worse case scenario because I did not want to drink under any circumstances and I knew that wolfie would strike if I wasn’t sure of what my ‘in case of emergency’ action plan was!

Committing to stopping

winebottlesmilkcartons

Like the postcard above I had always made stopping drinking a joke.  That was my defense mechanism to what I knew was a pretty serious problem, even if none of my friends or family saw me as any worse than any of them.  But now I wanted to take it seriously and so I made a contract with myself.

This contract is modelled on the making changes worksheet taken from the centre for smoking cessation and training here in the UK.  It could be used for any change that you are considering making.

It detailed the change I wanted to make to my drinking, and could just as easily be used for moderating for a specified length of time if you are not ready to stop completely.

It considered; how changing/not changing made me feel. how changing/not changing might affect how others viewed me and the consequences to myself and other people

It listed the advantages and disadvantages of both making the change and not making the change and the conclusions that I had come to.

It then listed a ratings scale of how motivated I was about the change and how confident I felt about the change.  Finally at the bottom it had a section for other considerations. So for me previously when I used it to give up smoking I included the risk of drinking alcohol while quitting smoking as for me the two went hand in hand.

Critically I completed it when I was really hungover and my desire to change was at it’s highest. I then posted it up on the front of my fridge so when ever I was tempted to consider having a drink it was there as a reminder of the deal I’d made with myself.

You can use this with yourself progressively as you moderate or stretch your duration of non-drinking to longer and longer time frames.  You can keep former contracts as a record of progress and to see how your motivation and confidence changes over time and what influences them as you learn more skills to manage your drinking.

If you would like a print friendly pdf version it is included in a guest feature article that was published on Soberistas yesterday here 🙂

Managing triggers to drinking

It is important to know and understand when and why you drink.  For me the danger time was always anytime between getting home from work and the kids going to bed, so 5 till 8 pm.  If I could get through that window of time without drinking I would be okay.

For the first couple of weeks of stopping I shook up my routine so that I was doing something different between those hours, particularly on a Friday and Saturday.  I would go out and do the weekly shop, go for a run, go to the cinema, have a bath, go to bed – anything to get through the witching hour unscathed.

You could keep a diary before you stop writing down what time you drank, what you were doing at that time and rate between 1 and 10 how much you wanted to drink at that time.  Also keep an eye on what emotions trigger your desire to drink.  Is it happiness, sadness, boredom, loneliness?  For me stress and anxiety was and remains a big trigger, whether it is social anxiety at going out and meeting new people or stress prompted by an incident within my job.  I now find myself shovelling chocolate biscuits into my mouth when I get home after a difficult day so I know that this remains an issue!

What do you drink instead of booze?

When I gave up smoking there was a plethora of widely available and nationally promoted advice and support guidelines and a raft of nicotine replacement therapies that I could choose from to help me stop. Patches, gum, microtabs, lozenges, inhalator, nasal spray and drugs.

As for replacements for alcohol you find your own through trial and error.  These are the things that have helped me:

Tea, coffee, herbal teas – particularly Twinings, Pukka and Clipper brands.

Soft drinks  and cordials – particularly San Pellegrino, Belvoir and Bottlegreen.  Elderflower cordial is really popular and delicious.

Mixers – if you liked a G&T like I did, then just have the tonic water, ice and a slice.

Alcohol-free beers and wines – now this is a contentious subject and I can only speak for myself but I like the option of these.  Others are understandably cautious about drinking these and I completely respect that.  You should do what is right for you and err on the side of caution if unsure.   I have tried Becks Blue, and some supermarket own brand de-alcoholised wines, either in red, rose, white or sparkling.  The drinks industry are waking up to the fact that there is a growing alcohol free market and are beginning to cater for it.  Good websites for a wide selection of beers, ciders, wines, spirit and cocktail substitutes can be found here and here.

I have also tried kava, which is a drink made from the roots of a plant of the Western Pacific and is consumed by the Pacific Ocean cultures of Polynesia.  It has a sedating effect and is primarily consumed to relax without disrupting mental clarity.  This can be bought online via stores like this one.

These are not recommendations just alternatives that I have tried and this list is by no means exhaustive!  I’m interested to hear any other suggestions that I might try 🙂

Edited to add: 14th March 2016

Kava and the Rise of Healthy New York

In an increasingly health-conscious New York, some would-be boozehounds are turning to kava, made from a South Pacific-originated plant, as a substitute for alcohol | New Yorker, USA