Claire had been sober for two years when she began a relationship with another
recovering alcoholic. One evening at his house he made a suggestion. “How do
you think we would react if we had just one drink?” he asked.
“I couldn't resist the challenge,” says Claire. “Within minutes we had downed
the first glass of whisky and then another and another until the bottle was
empty. That was the start of a two-day bender that ended up in hospital
after I knocked myself out. I understand now that I can't ever have just one
drink. I never could stop at one.”
What Claire discovered the hard way - and there is no other way for someone to
acknowledge the extent of their dependency on alcohol - is the received
wisdom that only abstinence will enable her to control her drinking. For
those who are dependent, just one drink is not an option. They must stop and
never start again.
This is the mantra of Alcoholics Anonymous (AA) and its 12-step programme, and
such is its prevalence that you will hear it again and again from recovering
alcoholics who have successfully stayed dry over a period of years, and from
those who treat and support them.
Not that this removes the temptation to experiment with alcohol, as Robert
Teed admits below. After five dry years he has taken a few surreptitious
slurps of Rioja, and this is precisely the slippery slope that he must
avoid, says David Bremner, medical director of Winthrop Hall, the addiction
treatment centre in Staplehurst, Kent.
“For someone who is dependent on alcohol, one drink leads to the rapid
reinstatement of the habit to the point where they were when they stopped,”
he says. “There is biological evidence to support this, and even evidence
that babies born to actively drinking alcohol-dependent mothers can remain
abstinent throughout their childhood, but when they start drinking in early
adulthood they rapidly return to the level of alcohol to which they were
exposed in the womb.
“Stealing slurps is dishonest and hidden, it's guilt-laden, it's not normal
social drinking and although the quantity might be small, this is alcoholic
drinking. It's high up there as an indicator of relapse.”
But if someone with a high dependence on alcohol must accept that he or she
can never return to moderate social drinking, does this apply to others who
misuse drink? It's a relevant question given that one in four of the UK
population drinks more than twice the recommended weekly limits of 21 units
of alcohol for men, and 14 for women. (A bottle of wine contains nine
units.)
When surveyed for a 2008 NHS report, almost 23 per cent of the male and 15 per
cent of the female respondents in England said they had drunk twice the
daily limit at least once in the previous week. These people are not
alcoholics because they are not dependent on alcohol and they certainly
don't need a swig of vodka to kick-start their day, but healthcare
professionals regard them as heavy drinkers, and they include those within
the middle classes who think nothing of polishing off a bottle of wine on
Friday or Saturday night. Or both.
Nick Heather, professor of alcohol and other drug studies at Northumbria
University, admires the support that AA gives to those dependent on alcohol,
but says that its unscientific approach to addiction can be confusing to
those who are less dependent but who still drink to harmful levels.
“The term recovering alcoholic, as used by the AA, loads the dice,” he says.
“They believe that alcoholism is an incurable disease and that one is never
recovered but always recovering, and that one drink leads inevitably to
suicide or death. That's not true. It's a gross oversimplification.
“What is true is that for people at the highest level of dependence involving
delirium tremens, hallucinations and fits, it's extremely difficult to
maintain a pattern of controlled drinking. The much easier option is for
them to rule alcohol out of the equation.
“The problem with the AA approach is that it focuses attention on the
relatively few people with a high level of dependence, whereas an enormous
number of people damage their health or the welfare of others through their
drinking - eight million in England alone.
“For these people much the best option is to tell them they can continue to
drink, but in a less harmful fashion. The evidence is overwhelming that at
lower levels of dependence controlled drinking is an option, and it doesn't
deter people from seeking treatment, whereas the prospect of lifelong total
abstinence would.”
Health professionals, from GPs to hos- pital doctors, nurses and probation
officers, are primed to identify these people and to refer them where
necessary: the Government calls this programme brief interventions. All of
which makes it sound as if millions of weekend imbibers will be chastised
and booted off to therapy the second they take their tennis elbow to a GP.
Obviously this isn't going to happen - the NHS couldn't cope with the numbers
- though as the psychologist Oliver James explains, it can be worth
examining the reasons why so many of us often pour second or third glasses
of wine that we don't need. Once this is understood, he suggests, it is
feasible to return to “normal” drinking with impunity.
“Most people have some kind of what would generally be referred to as a vice,”
says James. “In my case it's nicotine that has played a role in keeping my
moods stable. For a lot of people it's eating or shopping. Or there is the
middle-class person who finds themselves drinking two glasses of wine a
night and has been heavily criticised by the Government.
“People find all sorts of physical methods of boosting their cortisol and
serotonin levels, of finding a place where they feel comfortable or
balanced.
“For the person drinking a bottle of wine a night, the chief medical officer
is right that it will shorten their life, and good psychoanalytic
psychotherapy could help them to drink to safe levels. What you would have
to do is learn what's going on in your contemporary life and what went on in
your childhood history that means one glass is not enough.
“Are you working too hard? Are you lacking proper intimate relationships? You
can sort yourself out in ways that mean you don't need that second glass of
wine.”
CASE STUDY: On the wagon: I can't have a single drink
I've been riding this wagon for five long years now. I wouldn't call it
thirsty work - it means a lot of fizzy water and ginger cordial - but it is
a lonesome trail. There have been times when I've had to ask the driver to
pull over, but he's ignored me. Sometimes, I've even been tempted to fling
myself from the wagon's swaying roof on to the booze-sodden earth below. But
I never have - not quite.
The temptation is growing, however. It's stronger now than when I first gave
up, which might surprise some people. Five years ago my friends' comments
were all of the “I don't know how you do it” variety; nowadays those who
know me don't question it, and those who don't know me just think I'm
driving.
Maybe that's the problem: this wagon trail is taken too much for granted, by
myself and others, so it doesn't feel special any more. For when I started
it did feel very special: I was kicking a lifetime's habit, and doing it
through pure willpower - there were no pills, no meetings, no stomach
insertions to make you heave at the smell of wine. Friends and family
continued to drink freely while marvelling at my strength of will, and I was
happy to let them do both. Now, however, no one bats an eyelid, while I have
started to covet their Rioja. I have even taken to sneaking slurps. Is this
a slippery slope? Will the odd sip lead to the odd glass, and then to two,
and so on to oblivion? Or could I stop at that first glass? Maybe I should
experiment - pour that glass of Rioja and call it mine. See if that staved
off my craving.
And if it did, surely that would be the sign that I am “cured”, to have had
that one drink and no more - that must be the holy grail for any wagon
trail? Perhaps. But it would be dangerous and foolish to pour that Rioja. It
would mean that I had forgotten the reasons I was on this trail in the first
place - the amnesiac drunkenness, the annihilating self-disgust, the
disaster zone of my relationships.
Better, then, to stop moping on the top of the wagon and to climb back inside
its button-backed, sumptuous carriage, pour myself a ginger cordial and
enjoy the ride.
Robert Teed
Drinking by numbers
6 per cent of men and 2 per cent of women in England are alcohol-dependent
40,000 people are members of Alcoholics Anonymous in the UK
1.7 million men drink more than 50 units of alcohol a week in the UK and
600,000 women drink more than 35 units a week. Drinking at this level, which
is labelled harmful by the Government, puts them at risk of cancer and liver
disease
22,000 people die prematurely each year because of alcohol dependence
alcoholconcern.org.uk
Drinkline: 0800 9178282
