Category Archives: Thinking about stopping

Why do humans like to get drunk? You asked Google – here’s the answer

booze autocomplete google March 2016I really liked this Guardian article in March about booze and getting drunk.  None of the information in the piece is new to readers of this blog and I cover this topic in detail within my Udemy course 🙂

Alcohol is a very simple molecule with incredibly complex effects. Although I already knew a bit about the neurobiology of alcohol, I just spent an afternoon reading a dense journal article that described roughly 50 different neural mechanisms it affects. After which I felt like I needed a drink. It’s widely known that alcohol reduces stress temporarily, and many people use it for just that purpose. It reduces stress by increasing the uptake of a neurotransmitter called GABA, the brain’s primary inhibitory molecule. (And by “inhibitory” I don’t mean that it makes you feel inhibited. Quite the opposite, of course.) By sending more GABA to your brain cells, alcohol works much like common tranquillising drugs such as Valium and Xanax. That’s why you start to stumble and slur if you drink too much. But alcohol acts on many other neurotransmitters too.

I’ll mention three important ones and show how they contribute to the joys of inebriation. While alcohol increases GABA, it reduces the uptake of glutamate, the brain’s premier excitatory molecule. Less excitation and more inhibition? That sounds like simple summation, but GABA and glutamate have different effects on different brain regions, and that’s where things get complicated. In the prefrontal cortex, the part of the brain you use for thinking and planning, the net effect is inhibition. That’s why your judgment is flawed, your decision-making is set to “whatever” and your ability to see things from any perspective other than your own approaches nil. The remarkable side effect of this general dimming is that your thoughts seem amazingly clear – which is nice – while in reality they are just amazingly limited. Meanwhile, GABA is also busy turning off the brakes on a system that releases dopamine, the molecule that takes centre stage in all varieties of addiction. What’s that again? Well, when you take off the brakes, the car starts to move. So what you get is a stream of dopamine coursing into the striatum (or reward system), the brain part that generates desire, anticipation and (once you’ve finally brought the glass to your lips) pleasure.

So far, you’ve got physical relaxation, which diminishes stress, reduced judgment, allowing you to talk and behave however you want, and stimulation of the brain’s reward system, which makes you feel like something nice is about to happen. But the fourth neurotransmitter tops the bill: opioids. Sometimes called endorphins or internal opiates, they get released by alcohol too. Everyone knows that opiates feel good, but did you know that you can get your opiates legally by downing a stiff drink? The American martini – which consists of three ounces of gin and little else – feels particularly nice for a very simple reason. The faster the alcohol goes in, the more internal opiates get released. Hence the aaaaahhhhh.

Given all the things that make up an alcohol high, it shouldn’t be surprising that inebriation feels different to different people, feels different from the first to the last drink, and definitely feels different once it becomes hard to stop. People who carry around a lot of stress drink to relax. People who spend a lot of energy controlling their impulses drink in order to let themselves go. The first drink of the night excites you, the last drink of the night sedates, and that isn’t nearly as much fun. College kids indulge in binge-drinking because they’re still bright-eyed novices when it comes to taking chemicals that alter their mood – the more the merrier. Twenty years later, they may drink to feel less, not more, because life has become oppressive, and anxieties seem ready to spring from every train of thought.

But once people become addicted to alcohol, as many do, the fun of the high is eclipsed by two opposing fears. The fear of going without, versus the fear of being unable to stop. That clash of concerns comes from several sources. First there are the unpleasant bodily effects that plague big drinkers when they stop for a few hours or, worse, a few days. Add to that the emotional emptiness, depression, and increased stress responsiveness that overcome the drinker’s mood at the same time. Taken together, these effects make up what George F Koob calls the dark side of addiction. But I think the real bogeyman, the unbeatable Catch-22 when it comes to alcohol and other drugs, is the realisation that the thing you rely on to relax is the very thing that stresses you out the most. It’s hard to find a way out of the recurrent cycle of anxiety and temporary relief, over and over, and that’s the epitome of a losing battle.

People like to get drunk because alcohol smacks your brain around in a number of ways that feel pleasant, or at least different, or at the very least better than going without. And that’s really how all mood-altering drugs work. Which is generally OK, because recreational drug use, including drinking, doesn’t lead to addiction for most people. But for those who get caught, the fun soon disappears.

Drugs, including alcohol, fashion neural habits: get it, take it, lose it, then get it again. And those habits narrow the brain’s focus to a very singular goal, at the expense of everything else. The striatum – the brain’s reward system – is responsible, not just for pleasure, but more seriously, for feelings of desire. And desire isn’t fun, unless you’re just about to get whatever it is you want. Then, the more you get it, the more your striatum gets tuned by that surge of dopamine, modifying its synaptic wiring a little bit at a time until other goals just don’t count for much.

But alcohol has one advantage over drugs like heroin and cocaine. It’s legal, and socially sanctioned. In fact drinking has become deeply enmeshed with themes of social engagement, joyful celebrations and all the rest of it.

Drinking doesn’t make you a bad person – in fact it seems to put you in good company and thereby make you a good person – if you can resist its addictive lure. The problem is that people who start to drink too much get pulled by two conflicting emotional beacons: feelings of connecting with those around them and feelings of shame that toxify those relationships. That’s a conflict of interest that gets increasingly difficult to resolve. So, just as they say in the fine print on the back of the bottle: “know your limits”.

Know your limits and when to ask for help if for you the fun has disappeared ……

PHE One You

PHE One YouIn March Public Health England (PHE) launched their brand new health campaign One You. They reported that the response so far was fantastic and they were delighted to see such a positive reaction in the media, from our partners and from the public online.

The image is a screen grab of what it looks like and here are some of the categories and areas for information around drinking.

Drink and you

It may seem like you don’t drink much, but a drink or two most evenings can do harm to your body. From making you gain weight to increasing your risk of cancer, alcohol can have serious effects on your body.

The more you drink, and the more often, the greater the risk to your health.

It has further information headings covering being drunk, booze and your body and other health worries.

Why cut down?

If you regularly drink above the lower risk guidelines, cutting back on alcohol can help your general wellbeing. Once you start cutting back, you’ll probably notice the benefits. The biggest benefit is the reduced risk to your health, but there are lots of others, too.

Medical warning: If you have physical withdrawal symptoms (shaking, sweating or feelings of anxiety until you have your first drink of the day) you should take medical advice before stopping completely – it can be dangerous to do this too quickly and without proper advice and support. Call Drinkline free on 0300 123 1110 for more advice.

Further subheadings look at: Be healthier, save some cash and feel full of beans.

Drink less

It’s important to know how much you are drinking and that there are easy ways you can cut back, without cutting alcohol out completely.

You could try making some simple swaps when you’re out, or, if you drink every day, having at least a couple of booze-free nights each week.

And further advice entitled: Tools to cut down, top tips to drink less and need more support.

Read more at https://www.nhs.uk/oneyou/drinking#3ojU5h2PDSQRhXjK.99

It looks really good and is an improvement on the Change for Life campaign in my opinion.  Thanks Public Health England! 🙂

PS New header image time – the Great Barrier Reef in preparation for our summer 1000 day reward 😉

The Drink Less Alcohol research app

UCL drink less appA new app with added research benefits!!  This app shows how your drinking is changing, how close you are to achieving your goals and some simple things you can do today to drink less.  It’s been developed by the UCL Centre for Behaviour Change, London

Drink less alcohol app

FAQs

So what’s this experiment you’re running?

We’re testing which app components are most effective at helping people reduce their drinking. We know that certain techniques work when delivered face-to-face but we don’t know how well they work when delivered by an app. The findings will form the core part of the PhDs that David Crane and Claire Garnett are completing at UCL and will hopefully help other researchers understand more about this important area.

Do I have to take part in the experiment to use the app?

No, all the app’s features will work regardless whether you participate in the experiment or not and you can opt-out of it at any time. However, we’d greatly appreciate it if you took part fully, as the information you give us will help us understand which techniques are most efective at helping people drink less.

Do I have to give you my email address?

No, and you can use the app fully either way. If you give us your address all we’ll do is email you with a brief questionnaire, the answers to which will help us learn which techniques have and haven’t worked. Plus, you’ll be entered into a draw to win a £100 voucher.

Is my information safe and am I anonymous?

Yes and yes. We treat your data with the greatest respect and make sure it’s both anonymised and stored securely.

What else can I do?

There’s a good few options in the app itself. Have a play around, you probably won’t break anything.

Any other questions? Please get in touch.

Edited to add: back from the seaside and these news stories appeared relating to this app last week!

New brain-training tool to help people cut drinking

An internationally-renowned LSE expert on happiness and behaviour has launched a free online tool to help people who want to cut down on alcohol | LSE, UK

Drink Less: Get help reducing the amount of alcohol you consume – free app

Are you looking to cut down how much you drink? If so, we can help. Drink Less is a super-easy to use app that allows you to keep track of how much you drink, set goals to drink less, get feedback on whether what you’re doing is working and access some unique and fun ways of changing your attitude towards alcohol |  Susan Michie, UK

Pour Me A Life

pour me a life aa gillSo I was lucky enough to be lent a signed copy of AA Gill’s new book Pour Me A Life by a fellow Cambridge student who happens to be a friend of his and was at the book launch *thank you lovely person!*  I’ve been busy reading it and have devoured it in between our course texts.

AA Gill has been in recovery for over thirty years and this book talks about one particular year between his wife leaving and entering rehab – but that’s not entirely true because this is an autobiography so we learn a great deal about him and his life leading up to that point.  The book was an education where I learned about something I had experienced and couldn’t put into words – until now, Stendhal’s syndrome: being overcome by beauty.  This happened to me at St Peter’s Church in the Vatican City in Rome …..

There were a couple of passages that really resonated so to wet your appetite (and not risk infringement of copyright!)  I shall share just those and then links to some of the other reviews that have been written.

“It was for those whom the licensed day was not long enough to fit in the required pintage, for those of us who did alcohol overtime”

This next passage is beautiful and explains my experience of drinking so well:

“Booze is a depressant, a close relative of anaesthetic.  The symptoms of getting drunk are like those of being put out for an operation – initially, fleetingly, it offers a lift, a sense of transient joy, of confident light-headed freedom, it’s a disinhibitor; relaxes your shyness and natural reserve so you can feel socially optimistic in a room, can make a pass, tell a joke, meet a stranger.  But this is just the free offer to snag a punter.  Drink is, at its dark, pickled heart, a sepia pessimist.  It draws curtains, pulls up the counterpane.  It smothers and softens and soothes.  The bliss of drink is that it’s a small death.  The difference between you and us, you civilian amateur hobbyist drinkers and us professional, committed indentured alcoholics is that you drink for the lightness, we drink for the darkness.  You want to feel good we want to stop feeling bad.  All addictions become not about nirvana, but maintenance.  Not reaching for the stars but fixing the roof.”

This is what The Guardian had to say:

He delights in his own similes; they are produced one after the other as if spotlit and accompanied by canned laughter.

And The Telegraph:

And yet his inspirational passage on the joy of the English language, a thing “of peerless beauty and elegance”, should become a school-curriculum essential.

However, almost despite himself, his post-drinking life cannot fail to give hope to “those who still stagger” and despair.

A book that began by discussing lost time becomes one of recovered time, of a new way of life that is worth not only living but also celebrating.

And you can read Mrs D is Going Without’s review here.

Hear hear!  I love AA Gill’s writing & completely concur about his use of similes and that passage which displays his obvious delight in the English language.  This book is well worth your time and money 🙂

Edited to add: 10/10/16

AA Gill dies weeks after revealing he had cancer in restaurant review

RIP AA Gill – you will be missed.

 

Friday Sober Jukebox – Weapon Of Choice

Sober jive time!

So one of my sober buddies recently had an article published on Medium which is worth a celebratory sober jive don’t you think? 😉  It’s called ‘how and why I decided to live alcohol free’ and is the first part of a series.  We felt that this tune reflected the sentiment seeing as booze is no long our weapon of mass destruction choice 🙂  Congrats on being published lovely & more importantly on 2 years AF!!

Sometimes, I feel that I am a freak of nature as a Person Who Doesn’t Drink. I’m Irish, so, you know, what are we most famous for? (I’m not talking about red hair and fiddle-playing).

I was a teenager in the tail end of the 1980’s and the start of the clubbing 90’s. We were supposedly “ladettes” who drank in fields at rural discos before moving to underage drinking in unpopular pubs that turned a blind-eye to the fact that its new patrons were all 16 or 17.

A former lawyer, I cut my teeth in the City of London in the work hard / play hard days of the late 1990’s when it was cool to match the boys, bottle for bottle, on an empty stomach – whatever the consequences.

I’m now a mother in my early 40s – so that means the only way of wading through the supposed horror that is modern-day parenting is by counting down the minutes until I can open a bottle of wine (according to a slew of Facebook graphics I see shared day on day). A middle-class, urban parent, living a Netflix / box-set marriage which surely goes hand in hand with a nice Pinot Noir and some artisan, organic chocolate.

So why do I find myself, aged 43, approaching the end of my second year of having consumed no alcohol whatsoever? (Not counting the odd tiramisu made by a chef who’s heavy-handed with the liqueur).

I don’t think its a coincidence that I stopped drinking not long after I turned 40. It’s a cliché, but there is something about that milestone that turns so many of us towards introspection. We look at the life we are leading now, painfully aware that the years don’t stretch infinitely beyond us any more. This is it. This is the life we have.

In my particular case, I couldn’t escape the fact that my own beloved mum died when she was only 56. Turning 40 I was entering the decade in which she had first been diagnosed with breast cancer. The medical link between excessive alcohol intake and cancers of all type was becoming harder and harder to ignore, no matter how much finger-in-ear “la la la-ing” I did.

So I had to start thinking about whether I was living the best life that I could. When I turned the icky, uncomfortable inward gaze towards the reality of how I spent my days, I could not avoid the annoying, inconvenient truth that I drank more than I wanted to drink. Sometimes a lot more.

This was something that had gnawed at my sub-conscious before turning 40 of course. For quite a few years I’d made various attempts to reduce drinking, keeping it to weekends, only on nights out and so on. Sadly, when your mind associates relaxation with alcohol above all else, it doesn’t take much (a particularly stressful day, a child that has a meltdown, a friend coming over) to allow you to make an exception to whatever “rule” is in place. I justified drinking more over a weekend than the weekly recommended amount by the age-old saw “everyone is doing it” (despite the fact that I am always telling my pre-teen that this is not a reason for doing anything at all ….).

One of the most surprising conclusions I found when I examined life after turning 40 was just how boring it was to be in the continuous habit of drinking wine to excess on a Friday, Saturday and Sunday night. Both literally and metaphorically, mind-numbingly, boring! It’s also not conducive to following complex narrative box-sets like Game of Thrones or House of Cards – which really should, by law, only be watched first thing in the morning, armed with a notebook, a bullet coffee and a Rolodex of character names and sub-plots…

As I aged, I also found the physical effects of excess booze to be increasingly unpleasant. Even two glasses (although two glasses can be a good half a bottle!) left me crotchety and (even more than usually) impatient with my kids. My sleep was really badly affected. Waking dry-mouthed and thirsty with a thumping head at 2am isn’t much of a trade-off for passing out the minute your head hits the pillow. On a pure vanity basis, I hated what my sister and I called “wine-face” (a kind of puffy, small-eyed look that was nobody’s friend, especially post 40).

Like so many people though, I couldn’t imagine what life without alcohol would look like. It seemed impossible to even consider. What would other people think? They’d think I was an alcoholic wouldn’t they? How could I socialise with friends? (My memories of nights out when pregnant and not drinking were of boredom and resentment that everyone else could get wasted). How would I relax? How could I even consider going on holiday?

I didn’t know a single person in my circle of friends who didn’t drink (cf Irish, parents, mid-40s). Then I came across on Facebook a blog https://lifeafteralcohol.com/ written by an Australian woman with a very similar background to me – young children, lawyer, interest in writing and so on. She described how she had stopped drinking – and her life had improved. It wasn’t easy, she wasn’t outlining a sudden transformation to the life of her dreams. But lots of things got much, much better for her.

This opened the floodgates (because of course that’s how the whole internet rabbit-hole works) to a whole world of blogs out there, written by many wonderful men and women who have chosen to live without alcohol. For me, this seemed to be the trigger I needed to realise that it WOULD be possible to live a happy, sociable life without drinking more wine than I wanted to, week in and week out.

One of the biggest resources I found was Belle and her blog http://tiredofthinkingaboutdrinking.com/. Belle is pretty much the Ariana Huffington of the alcohol-free world (of course she’s much too modest I’m sure to accept that comparison). Her 100 day challenge gets thousands of people on the road to a life without alcohol. One of Belle’s biggest themes is just how exhausting it is to be thinking about alcohol all the time (if you are a person who drinks more than they want to). Thus her blog title.

Armed with a hundred personal stories from the blogosphere, I made the decision in June 2014 to abstain from alcohol. I made the decision on a Monday and decided to stop that coming Sunday as I had a very large event to attend on the Saturday. I had no alcohol until that Saturday – and didn’t even cane it on that night. That morning, flying back to London I felt relief to know that for the next 100 days at least I wouldn’t have any booze whatsoever. In the very back of my mind though, was the hope and determination that it wouldn’t be 100 days, but “forever”. Rather than scaring the bejesus out of me, that thought filled me with joy and optimism, for a life that wouldn’t be wasted in the endless cycle of booze-fog and regret.

If you’ve found this article in any way useful or have any questions, please let me know! This is my first foray into writing and I would love to have your feedback.

I am planning to write the next article about what it was like when I first stopped – what was hard, what helped me – and most importantly, what life is like now, nearly two years on.

For anyone struggling with alcohol or who would just like to explore the possibility of life without the boring booze, I’ve listed some blogs and resources that were useful for me. Are there any others you would recommend?

And now over to the full Christopher Walken big beat boutique jive delight …..

PS You might want to watch this on Sunday night – BBC2 9pm

Louis Theroux: Drinking To Oblivion
Louis Theroux spends time at King’s College Hospital in London, a specialist liver centre, where he immerses himself in the lives of patients in the grips of alcohol addiction and the medical staff trying to make them better.
Edited to add: 23rd April 2016
Louis Theroux’s ‘Drinking To Oblivion’ Reveals The Terrifying Reality Of Alcohol Abuse

I had to learn to love my dad again – once he sobered up

alcohol chaosThis was in The Guardian in January about family and it’s impact while they are still drinking and once they have sobered up.  Presented without comment.

I wasn’t around to witness my dad’s rapid decline between 2005 and 2007, I would hear stories by the time it was too late to do anything about them, but my conscience finally crept up on me, and with news coming in that perhaps he might not make it beyond the next year, I went back home to visit him for lunch.

It was the first time I’d seen him for two years. He’d been a functioning alcoholic all his life, but now he was unable to do anything but drink, and I was so, so nervous. I felt like I was meeting a ghost. I had convinced myself that he didn’t exist any more.

I felt uncomfortable during the short walk to the Chinese restaurant we’d decided to eat in, but nothing could have prepared me for the next wave of emotions. My dad could barely walk or talk. It seemed that he was under the influence of a terrible mix of both medication and a lot of alcohol. Walking into the empty restaurant that quiet lunchtime, I saw a reaction I didn’t expect from the staff: they looked on with utter fear. My heart sank. My pride fluttered away in front of me, and I felt nothing but embarrassment. I was so ashamed of my dad. I didn’t even want to call him that.

My dad had completely vanished. In his place was somebody who had no idea what day it was, and it broke my heart. When the waiter came over, with a glance in my direction that showed nothing but pity, my dad asked if he could order some poppadoms. He was trying so hard to act sober – in that way drunk people do – that he took about three minutes to pronounce the word “poppadom”.

Without ordering anything, I told my dad I was leaving, that I wanted to go home. The worst thing was that he never questioned why. There was no protest, because I know that he knew what he’d done. He was living in darkness, surrounded by it. As we walked up the road to where I was about to leave him, I pleaded with him to remember who he used to be. But his eyes were glazed over. He wasn’t listening. I ran off and cried my eyes out in private.

I saw him once more after that. It took another few years of zero contact before I could muster the courage to put myself through it again. By this point, he was very unwell. We were aware that he was drinking at least a bottle of neat vodka a day and barely eating – sometimes soup if he could remember to buy it. We went round on Boxing Day for a late Christmas dinner. He fell asleep halfway through our conversation and we all left.

Then, after a few failed attempts, he agreed to live in a rehab centre, thanks to the will of my oldest sister. For the first year, my dad sent me texts I didn’t reply to. I blocked his number so he couldn’t call me. I had convinced myself that I had no dad any more. That man had gone. It made me feel lost, scared, like a little child, to tell myself that, yet I still did. It was my way of coping, I suppose.

The hardest thing I’ve noticed for anybody who’s hurt a lot of people is that even when they accept that they’ve done wrong, they still can’t understand why you haven’t forgiven them yet.

It just felt to me like he was getting away with it. That if I just suddenly forgave him, I’d be the fool. It made me angry. I would swear and say nasty things about him. I would feel ashamed by what he’d become. I’d envy anyone with stability in their home life. There’s the shame; the shame of letting the outside world know that your father has a problem, that you feel he has failed you, or that others might look down on you because of what he is.

That feeling doesn’t go away, but it does subside. There were still unhappy times; The first time I saw him in the rehab centre, he terrified me. But as each Christmas visit passed, I started seeing glimmers. Gone was the skinny, hard-working grafter of a dad I once knew, but there was in his place a jolly, pot-bellied man who still loved me more than anyone else in the world.

Every time you see them, you know it may be the last. Because you can’t see inside their body, can’t see the damage that’s been done that the doctors have told you is irreparable. Even though the future might look bright on paper, there will always be that fear of relapse or worse in all of us – most of all him.

It’s a strange feeling to have to learn to love a parent again; somebody you thought was beyond help; someone you felt let you down so badly that you couldn’t call them for help in times of real need. Someone who had made you feel so alone you couldn’t ever imagine having a relationship with them again.

But, at the same time, life really is short. So I’m going to make sure that he’s rewarded for the hard work he’s done, if only by making sure there are never any more regrets between either of us. Because more darkness cannot drive out the darkness. Only love can do that.

How many drinkers should be in treatment?

alcohol treatment referral sourcesThis was a Drug and Alcohol Findings hot topic in January looking at drinkers and treatment numbers and follows on nicely from the recent post about blocking of FOI data requests regarding MP’s & treatment!

How well are we doing in getting people who need this help into treatment for their drinking problems? It’s a question whose importance was signified by an estimate for 2004 that there would have been 794 fewer deaths had one in five dependent drinkers been treated with medications versus a zero treatment rate. Numbers avoiding illness would have been considerably greater. As we’ll see, depending on where you draw the line, England’s performance in ensuring needy drinkers enter treatment can look anywhere from an abysmal 7% to an excellent 44%. Line-drawing is a matter of judgement and perhaps too of motivation – of how you want to portray performance, and in turn whether you want to argue for more services or that need is already largely being met. But at least we can be as clear as possible about the facts on which these judgements are made.

The following analysis focuses on England which has both the best figures and dominates the UK population; Scotland seems to doing much better at meeting treatment need. The analysis also glosses over complicating factors including trends in dependent and harmful drinking since 2007, conflating estimates for different years. It is presented as a ball-park indication not necessarily of absolute numbers and proportions, but of the degree to which these alter under different assumptions of what counts as being ‘in need of treatment’.

How many in need of treatment?

Let’s start with how many are in treatment, using England as our example. There about 115,000 adults were in specialist alcohol treatment during 2013/14. Based on a 2007 survey which still seems the latest source, this amounts to about 7% of all 1.6 million drinkers experiencing harm from their drinking.

We can narrow this down further to the approximately 1 million adults who according to NICE, Britain’s official authority on health interventions, also score as at least mildly dependent on alcohol. On this basis, numbers in treatment represent about 11% of dependent drinkers who might need this help. One serious concern over this estimate is that by design, the questionnaire used to assess dependence was not based on clinical criteria.

Putting that concern to one side, results from this questionnaire can be used to narrow down further to the numbers who perhaps really ought to be in treatment. In 2011 NICE calculated that in England 260,000 adults were not just ‘mildly’ dependent or drinking in ways which were harming them, but were moderately dependent or worse. Accepting this figure as the in-need population suggests that numbers in treatment represent 44% of those whose condition ‘really’ justifies intensive help.

Now we have a range from treatment capturing numbers equivalent to just 7% of harmful drinkers to capturing nearly half of those also at least moderately dependent. The lower figure can be justified as the percentage of all those who might need help, the higher as perhaps closer to those who really do need treatment to overcome their dependence. That higher figure gains support from US findings that three-quarters of dependent drinkers remit without treatment and just 10% most clearly need and most often access this kind of help. NICE also appears to draw the line nearer to (and perhaps even above) the moderate dependence level, which would imply that England has the capacity to treat over 40% of the in-need population.

We might further constrict the population in need of treatment if we accepted the view that diagnosing an alcohol use disorder requires not just harm from drinking, but evidence that rather than having freely chosen this penalty, the individual is pathologically impaired in their ability to control their drinking. Compared to standard clinical criteria for dependence, applying this ‘harmful dysfunction’ diagnosis to US figures slashed the numbers calculated as potentially in need of treatment, and the proportion whose need had not yet been met by treatment services – the latter from 34% over their lifetimes to just 4%.

All these estimates of unmet need are based on access to specialised treatment for drinking problems. One reason why unmet need is not necessarily as large as it appears is that structured specialist treatment is not the totality of support available to problem or dependent drinkers nor the only way out of even severe drinking problems.

What is a reasonable target?

Fortunately we have specific guidance on what counts for Britain as good record for getting in-need drinkers into treatment; less fortunately, its provenance makes it of doubtful validity.

In 2009 the UK Department of Health estimated that provision should be made for 15% of dependent drinkers to access specialist treatment, a figure accepted by NICE. The origin of this figure was a Canadian model of treatment demand based on a model published in 1976 and developed for the US state of Nebraska.

Though perhaps of local applicability, this model does not seem to warrant elevation to an international guide. Its denominator for the population in need of specialised alcohol treatment was derived not from an assessment of harm or dependence, but purely of consumption – the number aged 15 or over who drank at least 475g of alcohol a week, about 59 UK units. The top part of the fraction – the target number for treatment during a year – was not based on an assessment of the proportion of these drinkers who might profit from treatment, but on the relapse rate (defined as return to drinking) after treatment and the annual increase in the prevalence of alcohol dependence, in the source study estimated respectively as two-thirds and 10%. To keep pace with relapse of treated alcoholics and the expanding population of newly dependent drinkers, it was estimated that 15% of the population in need of treatment would have to be treated each year.

‘Need’ is not the same as ‘demand’

So while we may suspect that capturing 115,000 of England’s problem drinkers in treatment is not enough, there is no clear way to determine whether and the degree to which this is the case. Good waiting time figures have (in respect of drug addiction treatment) been used as an indicator that treatment supply is keeping up with demand. Good waiting times for alcohol treatment may mean the same, but perhaps only because need is not reflected in demand because dependent drinkers are divorced from routes to treatment – much as a hungry population may not result in demand for bread if they can’t find their ways to the bakers or don’t like the bread they bake.

That this is at least partly the case was suggested by a report on alcohol treatment in England in 2011/12. It expressed concern at how few people had successfully been referred to specialist treatment by GPs or accident and emergency departments, despite the fact that around one in five people seeing a GP is drinking at risky levels, and an estimated 35% of emergency attendances are alcohol-related: “An aim for the coming years is that these two key routes will become more active in identifying and referring people who need treatment for harmful drinking and alcohol dependency”.

If there was cause for concern then, there was even more cause in subsequent years. Referrals from GPs fell from 14,330 in 2011/12 to bottom at 13,541 the following year, only partially recovering to 13,864 in 2013/14 chart. From 22%, since 2008/09 the proportion of all treatment entrants accounted for by GPs seems to have fallen each year, ending at 17% in 2013/14. Accident and emergency department numbers and proportions are both up, but from a very low base, peaking in 2013/14 at 1268 patients, equating to 1.6% of all referrals – still a small proportion of the potential. From a peak of 15,900 in 2009/10, in 2013/14 these two sources accounted for 15,132 treatment starts in 2013/14; as a proportion of all treatment starts, the trend has consistently been down from 23% in 2008/09 to 19% in 2013/14.

The bit of this that really jumped out at me I’ve bolded.  Assessment criteria was based on consumption of approx 60 units a week!  That seems a really low ball number when I know many who regularly drink a bottle a night which would be 70 + units particularly if we are depending on self-reporting where people are prone to under-estimate their consumption.

Prim sent me this link when the new drinking guidelines came out in January and seems pretty apt here 😉

Men to tell doctors they now drink just 14 units a week

What do you think?

I was drinking a bottle and a half of wine a night after my husband walked out

wine binThis was in The Telegraph in December and much like Xmas can be a flash point for relationships (like a husband walking out)  so can Valentine’s Day so this article felt appropriate for today.

Champagne used to be the highlight of my Christmas,  but this year I raised a glass  of non-alcoholic wine – something I never thought would happen. I used to believe that alcohol helped me cope with a difficult marriage; now I think it kept me there.

My husband was unfaithful for eight years.  I felt worthless. I was taking antidepressants, knocking them back with a bottle of  wine every day. We worked in the same law firm, but he struggled and was asked to leave. I became the main breadwinner. I thought if I tried hard enough, it would be all right.

I was desperate to save our marriage.  I’d always taken alcohol  a little bit further than my friends. It was the means by which I was able to feel confident in social situations. The first time I drank, I got drunk. I was 15 and it was at a friend’s party. Her mother was ladling out home-made punch – I thought it was fruit juice. 

You kid yourself it’s fine because you’re not sitting on  a street corner. I’d entertain friends; the wine would flow and flow, and once I started  I couldn’t stop. The next day friends would say, ‘I’ve got  a serious hangover.’ Not me.  The more I drank, the more  I was able to drink. Four years ago, after 26 years, my husband left.

After the divorce, I gained two stone.  I could drink a bottle and a half of wine a night. My personal trainer said, ‘All the exercise in the world won’t help if you drink all those calories every night.’ She was right. I was frightened about my health, but I couldn’t stop.  

My son had always liked that I was good fun, but that changed last summer. He lives in New York, had recently got engaged, and invited me to hear him sing solo in his choir. I flew out from London, and went out with a friend the night before the concert.

The next day I went to the wrong concert hall, and missed it. I claimed it wasn’t because I was drunk.  He replied, ‘But you were. All you want to do is drink all day.’  I felt deeply ashamed. The turning point was when I went away with him, his fiancée and her parents, and I could see that he was on edge in case I drank.  I thought: enough. 

I had the details of a counsellor who offered a cognitive behavioural therapy-based programme for women worried about their drinking, but I hadn’t contacted her because that would mean I was an alcoholic. When I rang, she said, ‘You’ve done the hardest thing, and now it will be fine.’ 

She changed the way I see alcohol. I started asking, ‘Would this situation have been better or worse with alcohol?’ Giving up had always felt like deprivation but I realised that everything I’ve regretted, from staying too long in a miserable marriage to upsetting my son, was because of drinking.

Recently, I attended his wedding. People said, ‘Why don’t you have a glass of champagne?’ I said, ‘I could. But I don’t need it any more. I’m having a great life without it.’

If booze has become your bad lover – maybe it’s time to kick him into touch too? 🙂

Putting lipstick on a pig

VinturiSo in the run up to Christmas last year I was reflecting on previous years when I’d been drinking and clues that things were not as they should be.  And then I remembered this: the vinturi.  Our attempt to put lipstick on a pig!

We had discovered this device courtesy of my parents who had retired to France and they thought it was the best thing since sliced bread.

Here’s the manufacturing blurb about the product which is a wine & spirit aerator : Simply hold Vinturi over a glass and pour wine through. Vinturi draws in and mixes the proper amount of air for the right amount of time, allowing your wine to breathe instantly. You’ll notice a better bouquet, enhanced flavors and smoother finish.

The joy about this device at the time was that it turned water into wine.  OK well not quite but it boosted cheap ropey French wine into something resembling not bad quality.  For those of us who were drinking a high monetary value’s worth regularly and were looking for ways to save money this was manor from heaven! (and we were drinking the equivalent of about £250-£300 a month).  Plus I figured if I thought I was drinking better quality wine I would drink less of it <yes I know!>.

So the connection to what turned out to be one of our last drinking Christmas’s?  We bought one of these for every family member & close friend thinking we’d struck wine gold!!  I think we got a bulk discount we bought so many.  How I shake my head now at my own level of denial ……

When we moved over the summer we gifted our vinturi away with the last of the bottles of wine we had.  If we wanted to save money, rather than drink cheaper poorer quality wine, all we had to do was stop completely!

Lipstick-on-a-pig1

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 🙂