Monthly Archives: June 2016

Consumption theory, the four P’s & the Pareto Principle

the four p'sIn April Professor’s Nick Sheron and Sir Ian Gilmore wrote an analysis piece for the British Medical Journal entitled ‘Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales’.  What stood out for me was their analysis of consumption theory, the alcohol industries use of the 4 P’s of marketing and the Pareto Principle.  I’ve chosen to cherry pick and focus on these elements of their analysis as this information and the way it was presented was new to me.  Over to the experts:

Consumption theory:

The population consumption theory1 2 3 links population level alcohol consumption to alcohol related harm, forming a theoretical basis for modern alcohol control policy. As the late Professor Griffith Edwards stated, other things being equal, “the overall level of a population’s drinking is significantly related to the level of alcohol related problems which that population will experience.”2 The factors that drive alcohol consumption apply to harmful drinkers as well as low risk drinkers, and alcohol related harm is dose related, at both individual and population levels.

Patterns of consumption are known to be related to price. Mathematical coefficients, termed “elasticities,” linking the consumption of alcohol to price and taxation are used by the Treasury to model fiscal policy11 and by the drinks industry to lobby the Treasury.12 Further coefficients link alcohol related mortality and morbidity to consumption and price, and are central to the modelling of alcohol policy by the Organisation for Economic Cooperation and Development (OECD), World Health Organization, and the UK government.13 14 15 16 17

The population consumption theory suggests that alcohol related deaths have increased as a direct result of an increase in alcohol consumption.

The 4 P’s:

wkd marketing strategyIn marketing terminology sales of any product are driven by the four Ps—place, product, promotion, and price—and all these factors have changed considerably. Numbers of on-sales (pubs, etc) licences increased from 131 000 in 1980, to 148 000 in 2012; off licences increased from 42 000 to 56 000 and consumption shifted from pubs to alcohol bought to be consumed at home.4 The nature of the product changed as sales of weaker draught beers decreased and sales of strong lager and cider increased. Furthermore, as a wartime generation of whisky drinkers passed away, the spirits industry shifted its target demographic to a younger audience, introducing “alcopops.”24 25 26 Consumption of spirits and alcopops by children aged 10-15 increased fourfold, followed a few years later by a huge increase in sales of vodka and related spirits (fig 3).29 Wine consumption also rose as a result of cultural globalisation and the increased marketing and availability as supermarkets became the major alcohol retailers.30 31 Overall, the trends in alcohol related deaths coincide with trends in consumption of cider, wine, and to some extent white spirits and strong lager, and are consistent with the population consumption theory (fig 4).

The Pareto Principle:

pareto principleThe corporate global drinks industry likes to frame alcohol related harm as a minority problem affecting a small group of “alcoholics” who are unable to control their drinking. The population consumption theory represents an inconvenient truth and on the whole the industry refuses to accept the evidence that links price to consumption and harm.34 35 But another economic fundamental is relevant to the alcohol marketplace—the Pareto principle or 80:20 rule,36 which states that 20% of highest consumers consume around 80% of any product. Combined data from the 2011-13 Health Surveys for England show how the principle applies to the alcohol market (table 1).

Harmful and extreme drinkers comprise a tiny minority, 4.4% of the population, but consume one third of all alcohol sold; the combination of hazardous, harmful, and extreme drinkers provides almost 70% of drinks industry sales by volume. The drinks industry uses its influence on government to protect this market.12 34 This has brought about remarkable changes in affordability—as the ’90s economy boomed and wages increased, taxation of alcohol was reduced in real terms. By 2008 it was possible to buy almost four bottles of vodka for the price of one bottle in 1980—and four bottles represents the weekly alcohol consumption of an average patient presenting with alcohol related liver cirrhosis.38 As the affordability of stronger alcohol increased, so did liver and related mortality (fig 5).  From 2007-08 onwards the affordability of wine fell by 54%, spirits 50%, cider 27%, and beer 22%.

It may be surprising that changes in alcohol affordability could have a rapid effect on alcohol related deaths; it can take 10 years or more of very heavy drinking to develop liver cirrhosis. But this is exactly what would be predicted from experience in other countries. When the minimum price of alcohol increased by 10% in a Canadian province, a 32% decrease in directly attributable alcohol related mortality occurred within 12 months, and most deaths were from liver disease.45 Similarly, when Mikhail Gorbachev introduced alcohol reform in Russia in the 1980s, the maximum impact on mortality occurred within 18 months, including for liver disease.46 Alcohol related liver deaths occur from acute-on-chronic liver failure related to the severity of recent drinking.

Though the causative link between this changing trajectory of alcohol related deaths and economic factors remains unproved, the deaths are clearly alcohol related (fig 2) and occur in people drinking very large quantities of the cheapest alcohol available; the median alcohol consumption of patients with alcohol related cirrhosis is around 120 units/week, and in other dependent drinkers it is even higher.38 49

And here’s the kicker:

Incomes are starting to rise, and following a fierce campaign of lobbying by the Wine and Spirits Trade Association (WSTA) the duty escalator was dropped in 2014. In the budget of March 2015 alcohol duty was cut by a further 2% for spirits and cheap cider.38 An influential Ernst and Young impact analysis commissioned by WSTA omitted to mention any of the economic costs of alcohol related harm outlined by the OECD12 but appeared to persuade the Treasury that the health of the drinks industry was more important than that of alcohol consumers. Support for the “drop the duty” campaign came from unlikely sources; Jane Ellison, undersecretary of state for public health, was featured on the front page of drinks industry website stating that she had forwarded a “drop the duty” email in support of the duty reduction to the chancellor of the exchequer.50

The whole analysis is worth a read and you can do so here.  How the Govt can continue to deny the impact and link between alcohol, pricing and health when Prof Sheron & Gilmore lay out the evidence so clearly is beyond me.

And this is what Alcohol Policy UK had to say about it:

Price & taxation: new analysis published as Scottish MUP decision expected

And the Institute of Alcohol Studies provided a report to look at the socio-economic costs that the Treasury thought were less important than the health of the drinks industry …..

The economic impacts of alcohol (PDF)

Edited to add: 10/10/16

4 Ps influence on children’s drinking behaviour “mixed”



Are 3 questions enough to detect unhealthy alcohol use?

CAGE questionsThis was a meta-analysis featured on Drugs and Alcohol Findings in April and looking at the questions used to assess and detect unhealthy alcohol use.

Both AUDIT and AUDIT-C are known to accurately detect unhealthy drinking, but is one more accurate than the other? This paper looks for answers in 14 studies from across Europe and in the United States.

Summary The Alcohol Use Disorders Identification Test (AUDIT) was developed in 1993 by the World Health Organization, and is one of the most frequently recommended and researched diagnostic tests for detecting unhealthy drinking, alongside the Cut-Down, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire and the Michigan Alcoholism Screening Test (MAST).

An abbreviated version of AUDIT, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), was introduced a few years later. AUDIT-C is made up of three questions about alcohol intake from the full AUDIT, which also asks another seven questions about alcohol-related problems and symptoms indicative of dependence.

Evidence shows that AUDIT-C can be a useful and valid screening test for unhealthy drinking, as demonstrated in this study with patients in a Brazilian emergency department, and this study in three Veterans Affairs general medical clinics in the United States. Some differences have been found in the performance of AUDIT compared with AUDIT-C, but the authors of the present paper argue that the accuracy of one versus the other has not (until this study) “undergone systematic examination”.

This paper is based on a meta-analysis, amalgamating results from 14 studies which directly compared the accuracy of AUDIT-C with AUDIT for the detection of unhealthy drinking. The authors selected these studies as directly relevant and meeting pre-defined inclusion and quality criteria from a systematic search of six online databases, within a date range of 1998 and 2008.

Main findings

The reported findings focus on primary care, as this was the most intensively researched setting. Eight of 14 studies were based in primary care, compared with four in general population samples, two in inpatient samples, and zero studies in an emergency department. The ‘target conditions’ of the 14 studies varied, but included risky drinking, harmful drinking, alcohol abuse, alcohol dependence, alcohol use disorder and unhealthy drinking (the latter covering the full spectrum from risky drinking to any alcohol use disorder).

Accuracy of the two tests was measured in a range of ways. For the purposes of this account, those easiest to interpret and most meaningful were “sensitivity” and “specificity”. In the current context, sensitivity can be understood as the proportion of respondents identified as risky drinkers by AUDIT or AUDIT-C who really are (normally as judged by a more comprehensive assessment) risky drinkers, while specificity is the proportion found not to be risky drinkers by these questionnaires who really are abstinent or drinking in a non-risky manner. Together these measures tell us how well the questionnaires pick up on risky drinking without also drawing into the net large numbers of non-risky drinkers.

The authors found considerable variation in the results of the tests, and variation in the way the tests were implemented. For example, the proportions of primary care patients identified as risky drinkers ranged from 11% to 35%, and the choice of threshold scores for risky drinking in primary care settings varied between 4 and 8 for the AUDIT test, and between 3 and 5 for AUDIT-C.

Overall, the accuracy of AUDIT and the AUDIT-C did not differ to a significant degree for screening for risky drinking, alcohol use disorders, or unhealthy drinking in primary care settings. However, one of the ways of comparing the tests did indicate a significant if small advantage for AUDIT over AUDIT-C in the identification of risky drinking (ie, above recommended maximums) in primary care settings. This measure was the ratio between the proportion of patients correctly identified as risky drinkers versus those incorrectly identified – the so-called ‘positive likelihood ratio’. The higher this ratio, the better the test is at correctly distinguishing who really is a risky drinker. For AUDIT the ratio was over twice as high (6.6 versus 3.0), a statistically significant difference.

With any such test there is trade-off between setting the threshold high so that nearly all those identified as risky drinkers really are, versus the increased chance that many risky drinkers will score below this threshold and fail to be spotted. This trade-off worked differently for the two tests. AUDIT-C’s ability to spot risky drinkers suffered less when such a high threshold was set that at least 85% of those who scored as risky drinkers really were. An alternative strategy is to set a low threshold, effectively casting a wide net so that nearly all drinkers in need of intervention are identified, while accepting that at the same time more people will be falsely identified as risky drinkers. In this scenario AUDIT was the more robust test, its ability to correctly exclude non-risky drinkers suffering less.

The authors’ conclusions

Although this study found no significant difference between the accuracy of AUDIT and AUDIT-C in primary care settings, this does not mean that it provides evidence of equivalent levels of accuracy of the two tests. It could be the case that with so few studies and with so many variations between the studies, the tests really do differ in accuracy, but research has yet to establish this. Indeed, some results (such as the difference between positive likelihood ratios when screening for risky drinking in primary care) indicated that AUDIT may be superior to AUDIT-C.

There are also some features beyond the degree of accuracy that may influence a practitioner’s choice of a diagnostic test. For example, the authors argue that the full AUDIT may “serve as a starting point for the exploration of the alcohol problem in a general practice situation because of its questions about the consequences of alcohol use. The MAST can provide a detailed description of a potential alcohol problem in settings where time constraints are not crucial. Finally, the CAGE test, with its 4 easily memorisable yes-or-no questions, may be preferable to both the AUDIT and the AUDIT-C, which have several response categories”.

Kriston L., Hölzel L., Weiser A.K., et al.  Annals of Internal Medicine: 2008, 149(12), p. 879–888.

So the study is 8 years old but is a meta-analysis which makes it robust.

I would add that I always used to read the CAGE questions and justify that I didn’t meet the criteria because no one had criticised my drinking and I didn’t meet the eye-opener one because I didn’t drink in the morning.  That said there had been occasions when I’d been up until the small hours drinking (4-5am) and we’d gone to the pub for lunch the next day where a bloody mary had been used to manage a hangover – you know hair of the dog and all that.  I would argue that the time between stopping drinking the night before and a lunch time livener would have met that definition after all ………

Alcohol and Diabetes

alcohol and diabetesAlcohol Concern have done it again!  Producing an excellent information sheet on alcohol and diabetes a chronic life-limiting illness where rates of diagnosis are climbing exponentially in this country partly because of the increasing rates of obesity.
In 2010 as many as three million people were estimated to have diabetes in England.  The condition can lead to a number of serious health conditions. It has been estimated that Type 2 diabetes, the most common form of the condition, costs the UK economy nearly £9 billion every year – a figure which is set to sharply increase in the future.
Here it is:
And the take-away?
Consuming large amounts of alcohol – particularly through binge drinking – may increase the risk of developing Type 2 diabetes. While people who have developed diabetes do
not necessarily need to give up alcohol, those treating it with tablets or insulin should monitor their blood glucose levels whenever they are consuming alcohol.

Friday Sober Jukebox – Charley Says

Charley saysNow this makes me VERY cross & also reminds me of the old Public Safety Announcement children’s animations from the 70’s ‘Charley says’.  In that this new drink should carry a children’s warning GRRRR.  Here’s the new’s story that raised my ire ……..

Netting young wine drinkers takes sweet turn

By Nicholas Robinson+, 09-May-2016

Childhood sweets have entered the wine suppliers’ arsenal of tactics used to entice younger drinkers, following Kingsland Drinks reveal of its sweet-flavoured beverages at the London Wine Fair last week.


Drunk and dry

tony-adams-addicted-1404666175-2237477So I was surfing the interwebs as you do and came across this programme on Youtube that I hadn’t seen before called Tony Adams – Drunk and Dry

As a Chelsea fan writing about an Arsenal player stings (a bit) but he is one of the greats of English football irrespective of his team colours when not playing for our national team back in the day.

I haven’t read his book shown above but it has some great reviews on Amazon.

Although this was screened on C4 in 2002 it was only uploaded to Youtube last year and still really resonant for me.  These were some the things that he said that really captured his experience and rang true of mine too:

“I’m a human being and I forget,  And if I forget that bottom I’m gonna think that I’m cured, I’m gonna think that I’m okay, I’m gonna think that I can drink again.  It’s the illness that tells you you haven’t got it.

I don’t regret the past, I feel I’ve come to the place I am today because of it.  Everyone we meet, every place we go, every experience we have makes us who we are today.”

It really is a good watch because it focuses on his recovery just as much as his drinking history so gives a more rounded view of addiction both while he was stuck in it and looking back from 5 years in recovery.  He was and remains an inspirational footballer and now he is an inspiration in recovery too, as is his fellow team mate Paul Merson who supported him in his early days of recovery and also has an autobiography on Amazon that gets great reviews called How Not To Be A Professional Footballer.

Edited to add 25th July 2016: Tony Adam’s charity Sporting Chance was in the news today as sadly a former England and Chelsea hero has required their support recently

Former England captain tells court he is alcoholic and will abstain from drinking, as he is given four-year driving ban

Alcohol Research UK – 30 year impact report & recent studies

Alcohol studies 30 years of impactThis was an excellent review of the Alcohol Research UK 30 year impact report and evaluation by Alcohol Policy UK I read in April.  Here’s what they had to say and their feature of the important recent studies including CBT, medications & adolescence studies.

Alcohol Research UK has published a report which looks at the projects it has supported since 1982, mostly as the Alcohol Education and Research Council, to review its impact. Based on an independent research project, it gives an overview of the of nearly 900 projects, fellowships and studentships it has funded. The charity continues to release regular grant programmes with the 2016/17 opportunities to be announced in May.

The report identifies the wide scope of work undertaken in the alcohol field, including the development of brief intervention, support for at-risk groups, understanding behaviour and culture, education and prevention, and policy impacts. Fostering new research and Alcohol Research UK’s future ambitions are also detailed. A presentation on the work will be showcased at the forthcoming New Directions conference (which was in late April).

Recent research publications

The following Alcohol Research UK funded research projects have been released:

Cognitive Behaviour Therapy Group intervention for dependent alcohol users

This study led by Dr Christos Kouimtsidis, Consultant Psychiatrist at the Surrey and Borders Partnership NHS Foundation Trust, explored changes in attitudes towards drinking during Abstinence Preparation Groups (APG) – which is based on Cognitive Behaviour Therapy – and considered whether such changes reduced the symptoms of alcohol dependence in readiness for medically assisted detoxification treatment.

Effects of Varenicline on alcohol enjoyment and consumption

This study led by Dunja Przulj from the Wolfson Institute of Preventive Medicine at Queen Mary University of London explored the effects of using varenicline (a medicine mostly commonly used to support smoking cessation) to alter drinking behaviour.

A think aloud study to explore the feasibility and acceptability of a digital intervention for the prevention of alcohol related harm in adolescents

This small qualitative study by Dr. Emma Louise Davies, Lecturer in Psychology at Oxford Brookes University, explored the feasibility and acceptability of using a digital intervention (i.e. the Alcohol Smart Quiz based on the Prototype Willingness Model of health behaviour) for the prevention of alcohol related harm in adolescents.

Adolescent alcohol use and school disengagement 

Drawing on ten years of longitudinal cohort data from the Belfast Youth Development Study (BYDS), this research study led by Dr. Tara O’Neill from the Institute of Child Care Research at Queen’s University Belfast aimed to investigate how differing patterns of alcohol use in adolescence are associated with their disengagement from school from 11-15 years and pathways to being NEET (Not in Employment, Education or Training) at 20/21 years old.

Thank you James for an excellent summary and definitely my picks of the research too 🙂

Edited to add 22nd July 2016:

Alcohol addiction and treatment over 40 years: NDSAG 2016 FEAD videos

A new series of videos covering expert presentations on addiction, recovery and treatment are now available from the Film Exchange on Alcohol and Drugs (FEAD) | Alcohol Policy UK, UK

Big Alcohol’s Playbook

Big alcohol's playbookLoved this blog post by Katherine Brown Director of the Institute of Alcohol Studies (IAS), about Big Alcohol’s Playbook or how to market alcohol where alcohol marketing is banned, featured in April by DrinkTank in Australia.

An article published on the alcohol industry website provides an interesting insight into how alcohol companies may respond to increased restrictions on alcohol marketing in order to “continue to connect with consumers and achieve brand saliency in these so-called ‘dark’ markets”.

The advice offered in the Just-Drinks article is directed at alcohol companies wishing to promote their products in countries where ‘the lights have been turned off’, that is, where traditional forms of advertising have been banned.

In recognition of the substantial evidence linking alcohol advertising to underage drinking, several countries have restrictions on alcohol marketing in place. France for example, under the rules laid out in its ‘Loi Evin’, bans alcohol sports sponsorship, TV and cinema advertising.

While the author acknowledges alcohol marketing restrictions have been introduced “in response to public health concerns about over-consumption and underage drinking”, the focus of the article is limited to circumventing regulations and no reference is made to the protection of children.

Sponsorship is suggested as a suitable alternative vehicle for promotion, where it is allowed, because “it offers an opportunity for players with deep pockets to sustain awareness and connect meaningfully with fans”. In countries where alcohol sponsorship is not permitted, companies are encouraged to explore the promotion of “logical brand extensions like low/no-alcohol ranges”. It will be interesting to observe the promotional presence of such products during the forthcoming European Football Championships, to be held in France this summer.

Another pearl of wisdom on offer is to pursue “cleverly-negotiated product placement”. Here, references are made to James Bond movies and the US hit series Mad Men as examples of effective brand promotions through product placement.

While many of these recommendations will stir up memories of tobacco company tactics in the early days of tobacco advertising restrictions, perhaps the most contemporary similarity can be found in the advice to “innovate in packaging… ensure your brand stands out on the back bar or the supermarket shelf”. Tobacco packaging has been labelled the ‘final frontier’ for tobacco marketers operating in ‘dark markets’, an example being pink, shiny cigarette boxes emulating perfume packaging, seemingly targeting young females. Australia has led the world in tackling such promotions through the introduction of plain packaging for tobacco products in 2012, with the UK set to follow suit later this year.

So how can community and public health groups face up to the challenge of Big Alcohol trying to cheat the system?

Common sense would tell us to ask tobacco control colleagues to share their experiences. If the alcohol industry is adopting the tobacco industry playbook, surely we should be exploring tactics used by anti-smoking campaigners.

The World Health Organization has long recognised the subversive activities of the tobacco industry and has established a framework for action on defending the public interest from tobacco tactics. Activities within this framework include monitoring the tobacco industry, informing and involving the public about their activities. Continued monitoring of alcohol industry activities and sharing findings must remain a core duty for public health groups.

Of course, our job is made so much easier when Big Alcohol gives us a sneaky peak at its playbook.

Indeed Katherine indeed 🙂

Research to support

Immediate effects of alcohol marketing communications and media portrayals on consumption and cognition: a systematic review and meta-analysis of experimental studies

[Open access] Viewing alcohol advertisements (but not alcohol portrayals) may increase immediate alcohol consumption by small amounts, equivalent to between 0.39 and 2.67 alcohol units for males and between 0.25 and 1.69 units for females. The generalizability of this finding beyond students and to other marketing channels remains to be established | BMC Public Health Journals, UK

And one step forward

Blackpool considers ban on alcohol adverts by 2018

Alcohol advertising could be banned in Blackpool in the next two years in a bid to reduce the town’s drink-related crime and health problems. Councillors will be asked to consider imposing a ban near pubs, shops and off licences in a new Alcohol Strategy | BBC, UK

Followed by two steps back

Plan to ban drink ads changed after job losses claim

Plans to ban billboards and hoardings advertising alcoholic beverages near schools were watered down after advertisers warned proposed changes would have a devastating impact on businesses and lead to job losses | Independent, Ireland

Alcohol Concern Wales say weekly guidelines can be bought for almost £2

alcohol and walesThis excellent piece by Alcohol Concern Wales reported by Alcohol Policy UK says it all about the new weekly guidelines and minimum unit pricing ……

Alcohol Concern Cymru have released a new report highlighting the widespread availability of cheap alcohol in Wales and reiterated calls for minimum unit pricing (MUP).

The report highlights findings from a snapshot survey of supermarkets and off-licences in six towns and cities across Wales, which found alcohol on sale for 15.5p per unit in one area. Alcohol Concern say that the recommended weekly guidelines of 14 units per week could therefore be purchased for little more than £2 in Rhyl, where a 3 litre bottle of Frosty Jack’s cider (22.5 units) was on sale for £3.50.

The survey identified 113 different alcoholic drinks, including ciders, beers, wines and spirits, on sale under 50p per unit – the MUP level proposed in a consultation by the Welsh Government last year. A 50 pence MUP has been sought in Scotland since passing legislation in 2012, but has since been held up by a legal challenge lead by sections of the alcohol industry.

MUP: time will tell…

The release reflects the significance of pricing in the role of alcohol policy; MUP and taxation remain key levers health groups wish to see utilised to reduce alcohol harms. Battles between pricing advocates and opponents have been hard fought, especially over work to model the impact of MUP and exactly which groups will be affected how. Sheffield have assessed that MUP would target the heaviest drinkers, so would not ‘punish the sensible majority’, but lower income heavy drinkers would be affected most. However still arguably beneficial to reducing health inequalities given deprived areas suffer disproportionately from alcohol harms.

A broader argument in favour or pricing measures has been based on the significant shift to cheaper off-trade alcohol for home drinking and in some contexts ‘pre-loading’. Indeed the gap in extra consumption seen in Scotland is made up almost soley of off-trade sales. Pubs may be regarded on the whole as well run regulated environments, potentially playing a positive role in local communities, and crucially where prices typically sit way above posed MUP levels. Health groups recently argued that the freeze in beer and spirits duty would actually harm pubs, whose numbers continue to decline amidst a larger than ever gap between off-trade and on-trade prices.

Opponents may counter that consumption has now been falling for over a decade, though arguably a squeeze on incomes has played a significant role. There are also signs that consumption could soon be back on the up, although a large downward shift in young people’s drinking could temper any future rise. Regardless, health advocates hope to see the kind of prices found in Alcohol Concern’s survey a thing of the past. If the Scottish Government’s MUP bid gets the green light, Wales could soon be able to follow. An EU exit would also raise an interesting questions for MUP implementation issues.

And for £2.50 in Scotland:

Week’s worth of alcohol available for just £2.50 in Scots supermarkets, campaigners find

Scots can buy their weekly recommended alcohol intake for £2.50 at supermarket off-sales, a survey has revealed. A report by Scotland’s national alcohol charity has found that two and three litre bottles of cider were selling in shops and supermarkets for between 18 and 24p per unit | Herald, UK

Shame the Govt is intent on leaving alcohol as a crime issue ………

Edited to add: 8th October 2016

Welsh Government attempts to set a minimum 50p per unit (MUP) have been blocked by Westminster in a move criticised by Doctors – BBC News. MPs refused to devolve pricing powers to the Welsh Government who would seek to stop alcohol being sold “cheaper than water” | Alcohol Policy UK

Edited to add: 6th Feb 2017

Almost 8,000 people in Wales died from alcohol-related causes between 2005 and 2014, a third of which were aged under 50, reported the BBC. An alcohol treatment assessment was recorded for less than a quarter of those deaths even though most deaths are after years of heavy drinking. Public Health Wales said this was down to “cultural and service barriers”.

1000 days & sublimation :)

1000 daysSo here we are from day 1 to 10 to 100 to 1000 🙂

This is equal to 2 years, 8 months, and 27 days, 142 weeks and 6 days, 714 weekdays and 286 weekend days, 24,000 hours, 1,440,000 minutes or 86,400,000 seconds since booze passed my lips (intentionally!) or I awoke with a hangover.

And the word sublimation came to mind which means:

  1. Psychology. the diversion of the energy of a sexual or other biological impulse from its immediate goal to one of a more acceptable social, moral, or aesthetic nature or use.
  2. Chemistry. the act, fact, or process of subliming (def 9).
  3. a purification or refinement; ennoblement.

According to Wiki:

In psychology, sublimation is a mature type of defense mechanism where socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse.

Sigmund Freud believed that sublimation was a sign of maturity (indeed, of civilization), allowing people to function normally in culturally acceptable ways. He defined sublimation as the process of deflecting sexual instincts into acts of higher social valuation, being “an especially conspicuous feature of cultural development; it is what makes it possible for higher psychical activities, scientific, artistic or ideological, to play such an important part in civilised life”.[1] Wade and Tavris present a similar view, stating that sublimation is when displacement “serves a higher cultural or socially useful purpose, as in the creation of art or inventions”.[2]

These definitions fit for me how recovery feels.   Plus I love the word sublime as it is so descriptive and not as over-used as many other words of exquisiteness which is what it means to me.  And it describes both the act of stopping drinking and the feeling engendered by overcoming the obsessive compulsion to drink.  OK so my desire wasn’t sexual as in Freud’s interpretation (although it did lead to perhaps unwise events of that nature when I did drink!)  My drinking displacement has resulted in this blog, my e-bookresources and courses which I hope has served a higher socially useful purpose and I do consider them my unique inventions and creations of sobriety.

And that’s looking externally.  The biggest refinement or enablement has been internal – both within my immediate and close family and within myself.  Just thinking about writing this sentence makes me start to well up with tears the change is so profound.  Only last night we had a sleep-over for my daughter & I was present both during the evening, overnight (they didn’t settle until gone 1am!!) and this morning.  I commented to MrHOF that in my old life booze would have been an easy way to soften the edges of a potentially stressful event & all the noise & mess.  But what if something had happened overnight?  Or how would I have been the next morning with a hangover?  All of these are thought experiments as they no longer apply to me or my life.

I have changed so much as part of the recovery process.  As the quote at the top indicates 1000 clear and present hangover free days meaning no more looking around with worry about what I might have done under alcohol’s influence, looking back in fear for past misdemeanours  or looking down in shame and guilt ……  I only look forward with anticipation, excitement and contentment.

1000 days deserves not one tune but two!! I’m a different person and I couldn’t have done it without MrHOF <3

Over to the Shapeshifters  😀

And no more time warps for me – although this song and it’s joy remains one of my fav’s whether I’ve been drinking or not 😉

And I can’t even begin to count how much I’ve saved (and I’m not just talking about in terms of my dignity and self-respect!).  When we drank and smoked we were spending £10 a day so by that calculation it’s £10,000 but that was with old pricing.  It’d be more like £15-20 a night now which makes it probably closer to £25K and change conservatively 😮

Finally  I need to thank ALL of you.  Every single one of you who reads and comments or lurks.  Thank you for being here, for supporting me, and if you’re reading this and wondering if you can achieve this too – to you I say abso-bloody-lutely.  If I can do this you can do this! 🙂

My Struggle With Alcohol: Why I Said Goodbye

40th bday cardSo I was busy spring cleaning and letting go of things that should have been let go of a long time ago when I came across this card.  Yep given to me by MrHOF from the kids believe it or not!  As I reach 1000 days tomorrow it feels like a great segway into that milestone and this piece which could have been written by me as it expresses so well my struggle and why I chose to let go of booze too and say goodbye.

When I quit drinking, outer appearances said I still had it all together. My life, family and career were intact and fully functional. Like so many problem drinkers—especially mothers—I didn’t fit the alcoholic stereotypes.

And yet, I came to the painful decision that if I wanted to live a healthy life and continue to be a good mother to my children, I would have to say goodbye to alcohol. Who would’ve though that I would actually come to love living a sober life? I loved drinking so much that this is still incredible and kind of amusing to me. It’s just another way that life is full of surprises.

Denial being one of the hallmarks of addiction, I was very good at finding logical reasons why I couldn’t possibly be an alcoholic. My drinking had not created any crises in my life and I had plenty of alcohol free days (although if I were honest, most of them were due either to my work schedule or to appease my increasingly worried husband). I didn’t quite fit the progressive disease mold. My wild party girl days were long gone. I had settled down in my thirties, got married, had two kids, got a master’s degree, and drank moderately without much thought. I was a real grown-up now, taking care of all my responsibilities. I was just having some wine in the evenings with (and before, and after) dinner. That’s normal, right?

Except that now, in my early 40’s, it was pulling at me and beckoning to me more and more by the day. On the nights I didn’t drink, it had become a “thing.” It took conscious, deliberate effort—forcing, almost. I became increasingly preoccupied with thoughts about when and how much I would drink. Which nights this week? How many would I allow myself on those nights? Would I be able to stick to that number?

I often started in the early evening while making dinner, but I did my heavier drinking after my kids went to bed. I could still call myself a good mom because my kids never saw me drunk. And I was a good mom, for the most part. But in retrospect, I know my kids felt the effects of the irritability and anxiety created by my struggle with alcohol.

During the last couple years of my drinking, while I had acknowledged that this was an “issue” in my life, I thought it was purely a symptom of other problems. I thought if I learned to deal with stress better, I would surely be able to drink in moderation without struggle. So I did more yoga and meditation, more exercise, journaling, therapy and read countless self-help books.

At the same time, I began a series of moderation plans to control my drinking (I even tried “mindful drinking”). All of them failed eventually, but I had some temporary successes with my moderation attempts, which fed my denial. For a while, I would be able to stick to my self-imposed limits. If I really had a problem, I wouldn’t be able to do that, right? Obviously, I just needed more practice to make it stick!

Wrong. All the trying and failing, the growing knowledge of what that must mean, and the sheer effort of keeping some sort of lid on this thing created mounting anxiety I could no longer ignore. I had to accept that my drinking problem was more than just a symptom of other issues. It was its own animal, and I felt it steadily gathering strength and momentum right alongside all my moderation and personal growth efforts.

I would have to deal with the elephant in my room. I decided I ought to do that before it started trampling everything, rather than after, for my family’s sake if not my own. I had too much at stake to wait and see how bad it could get.

Thankfully, the occasion of my last drink was nothing dramatic or disastrous. I stopped at the liquor store after work on a Friday night, planning to have a glass or two of wine. My husband put the kids to bed and fell asleep himself. By the end of the night, the whole bottle was gone, and I wanted more—I had to force myself to stop there. I had decided long before that this was unhealthy and I didn’t want to do it anymore. And yet, I had done it. Again.

The next morning, I woke up with a hangover. It struck me how ridiculous and sad it was that I would be unable to enjoy a beautiful summer Saturday with my family. I had written in my journal a couple months before that this moderation attempt was my last chance, and if I couldn’t stick to it this time, I would have to quit entirely. The jig was up. I read everything I could find online about quitting drinking and called an old friend who I knew had been sober for many years. That was a year and a half ago and I haven’t had a drink since.

Why do some people travel farther down the rabbit hole of addiction than others? There are a lot of complex factors, no doubt, but I know something about two of them—shame and fear. Admitting addiction means facing shame from the inside and social stigma from the outside. How long does this keep people desperately clinging to the hope that they will be able to figure out a healthy relationship to alcohol, despite all evidence to the contrary?

Then there is the fear of life without alcohol. How many people put off doing something about their drinking problem because they’re convinced that living without alcohol is going to suck indefinitely? I know I thought so. In the beginning, I viewed sobriety not as a path to a happier, more meaningful life, but simply as the necessary lesser of two evils. Now I wish I had quit sooner.

It did suck for a while, for sure. Those first weeks and months, I was raw and disoriented and weepy. I grieved hard for the loss of my trusty old friend. I’ve always eschewed labels, and this one was a doozy—I hated that “recovering alcoholic” would now become part of my story. On brief, rare occasions, I still hate it and wish it were not so. Mostly, it’s OK now. And I’m more than OK.

There is difficult work to do when all the feelings previously numbed by alcohol come to the surface, but it’s worth it. I’ve gained so much more than I’ve lost, and I have more to give to others. And I am not unique. With time, a sober life can become not something to endure, but something to gratefully embrace.

Tomorrow is a BIG day 😉