This article is a preview from the Autumn 2015 edition of New Humanist. You can find out more and subscribe here.
So here’s a question for you: how do you tell the difference between someone who’s got a bit of a drink problem and someone who is a chronic alcoholic? Can you differentiate between the person who wakes up down the park, in piss-wet clothes with an empty bottle of Famous Grouse as a pillow, wearing no shoes; who would literally rather die in astonishing agony from organ failure than stop drinking – and someone who is just having a bit of robust English fun?
You’d think the distinction would be fairly clear cut; but, terrifyingly, it isn’t. I say that as a recovering chronic alcoholic who drank heavily nearly every single day for 23 years, despite it nearly killing me several times over. I started drinking when I was 13, was drinking every day by the time I was 15 and was, by any sane standards, a desperate alcoholic – albeit relatively high-functioning – before I hit my twenties. I then drank heavily every day until I was 37. The odd thing about this condition was that not only did no one around me realise I was suffering from it – I didn’t even realise myself.
The trouble with the word “alcoholism” is that there isn’t 100 per cent agreement over what it means. Colloquially it can simply refer to any kind of “drink problem”, although most people would probably recognise it as referring to ethanol addiction. The real problem, however, lies with the fact that not everyone agrees about what the word “addiction” means either. Despite there being little or no evidence to support this theory, some people believe it is possible to become addicted to alcohol and then return to sensible drinking after this period. There are even those who work in addiction services who believe that alcoholics can return to sensible drinking given the right kind of detoxification and cognitive behavioural therapy (CBT).
I have used CBT successfully in the past to help alleviate some of the symptoms of bipolar disorder. I think it could be an excellent way to help some seasoned binge drinkers cut down and adopt a more sensible drinking regime. But, despite this, I feel that using this particular therapy to find a “sensible” level of drinking is a dangerously ineffective treatment for the chronic alcoholic – who, in my opinion, shouldn’t be drinking anything.
I use the word “chronic” about myself to indicate that I believe that I have one choice left in this matter: to not drink and live or to drink and die. As far as I’m aware (and all of the evidence amassed over a couple of decades seems to back me up on this), I’m chronically addicted to ethanol, and always will be. Even though I haven’t had a drink for nearly seven years, as far as I know, if I were to have a couple of pints now or a large glass of wine, the results would most likely be disastrous for me. This would also probably impact severely upon my closest family members. And that word “probably”, when used in conjunction with the words “closest family members”, is enough for me to treat it as a certainty.
I understand why there is confusion and mistrust surrounding the (usually self-diagnosed) status of chronic alcoholism. There’s no blood test for it and it is unclear where the boundary lies. And most of us know people who have cried “chronic alcoholism” yet gone back to drinking after a period on the wagon.
But this boundary between problem drinking and alcoholism is of little importance to someone who finds themselves in the same position I did seven years ago – close to death from liver failure, suffering epileptic fits and hearing voices. It’s no good arguing about semantics when decisive action is needed.
I think it’s easy enough to tell when you’re finally and firmly ensconced in chronic alcoholism: you simply need to look at the large number of failed sensible drinking strategies strewn in your wake.
The many schemes I determined for myself in order to curb my berserk thirst all failed. Some failed within weeks, but most within days. Some within hours. Some within minutes.
Here are just a few: I will never drink between Sunday at midnight and Thursday at 6pm. I will never drink between Monday at midnight and Wednesday at 6pm. I will not drink on Mondays. I will not drink on Mondays before 6pm. I will not drink on Mondays before midday. I will not drink anything stronger than lager. I will only drink real ale. I will only drink clear spirits with fresh fruit juice. I will only drink red wine with food. I will only drink white wine after food. I will only drink tonic wine. I will only drink down the pub. I will only drink outside my own house. I will only drink with friends when it is a special occasion. I will only drink with friends. I will only drink with people I am on first-name terms with in pubs. I will never drink on my own. I will always stop drinking by 10pm. I will never drink before midday. I will never drink before 10am. I will never drink between 4am and 8am. I will have a pint of water between each and every drink. I will not drink because it is January. I will not drink because it is the first week in January. I will not drink because it is before 6pm on 1 January. Every fourth drink must be something lighter, like a pint of lager. I will not have a drink to get me back to sleep if I wake up in the middle of the night, no matter how bad I feel.
Some people blame a lack of willpower for the inability to drink sensibly. And of course, in the most literal and bloody-minded interpretation of the phrase, that is exactly what it is. But these people tend to misunderstand certain things. Firstly, the compulsion the chronic alcoholic feels to drink is overwhelming – it is not comparable to the “need” a stressed out non-alcoholic feels for a few drinks after work on Friday night. The chronic alcoholic’s compulsion to drink would make the need of the unkempt zombies in Walking Dead to go round biting living people seem quite tame.
Secondly, and more importantly, chronic alcoholics can easily kill themselves accidentally by stopping drinking too quickly. Massive, constant doses of alcohol suppress the nervous system, eventually causing tolerance and dependence. When the source of alcohol is removed too quickly, this can cause what is known as “synaptic misfiring”, sometimes leading to tremors, hallucinations and tonic clonic seizures. Commonly, among drinkers, this is just referred to as withdrawal, or the DTs (delirium tremens). So the problems with these sensible drinking strategies go deeper than a lack of backbone.
I had my first epileptic fit in Manchester in 1994 when I had just turned 23. I do not suffer from epilepsy per se. It’s just that some of the symptoms of alcohol dependence and withdrawal can mirror other illnesses temporarily – the symptoms of epilepsy and schizophrenia being two that plagued me on and off during my career as a drinker. Alcohol withdrawal seizures are one of the commonest forms of tonic clonic – or grand mal – fits in adults, except they usually tend to happen to people in their 50s and 60s rather than their early 20s.
The dark irony about alcohol dependence is that you often can’t do good for doing bad. Kicking booze can kill you. Carrying on drinking can kill you. The only sensible course of action, once you’re sodden with the stuff, is a slow decrease in intake of alcohol over a period of time. And if you do stop too quickly, well... your body lets you know that it is displeased with that course of action.
But such are the pernicious effects of alcohol dependency that I viewed the DTs as simply part of the trials of youth, and even the colour that made me an “authentic” and “less shallow” person. I decided that it was preferable to simply get used to this horrific new sub-life that I had slipped down into. And this was because the other option – quitting drink – was unthinkable. The trouble with this plan, however, is that withdrawal increases in severity every time it happens. Due to a process called kindling, the hallucinations get worse. The levels of fear and anxiety get ever higher. The regularity and severity of seizures increase. And all the time, as your head cracks open wider and wider, nightmares seep out of the other place and into your daily life; into your field of vision.
Even by the time I was 25, I knew there was only one last stage left for me to plunge to: alcoholic psychosis. To drive myself into permanent and profound madness. I wasn’t afraid of dying as long as I had a drink in my hand, but I was afraid of going mad and being locked up somewhere I couldn’t drink. If I wanted to avoid psychosis I only had two options – to stop drinking for good, or to stop drying out.
So by my mid-20s there was a “correct” amount of alcohol I literally needed to drink each day. This amount only increased over time. The minimum entry level for a night’s sleep that wasn’t both terrifying and dangerous became ridiculously high. There were nights where I would try and “take it easy” by only having five or six pints of lager and a couple of shorts. But then I would be thrust into a nightmare realm, where I would spend the entire night awake, wreathed in sweat, spasming, staring bug-eyed at the imaginary insects crawling all over me, all soundtracked by a non-existent playlist of power-electronics and harsh metallic noise.
On such long dark nights of the soul, strange things happen. One night I heard terrifyingly loud explosions, and, fearing the house was under attack, flew out of bed and fell down a flight of stairs. It was only then that I realised that these colossally loud noises were all in my head. And from the foot of the stairs it was only a few yards to the bottle of wine and glass in the kitchen. I came to realise that if you have a glass of wine after waking up in the middle of the night, by the time you actually get out of bed the next morning it’s almost like it never happened.
When I finally “reached my bottom” in 2008 and resolved to quit, I had an evangelical zeal for the project and was determined to try anything that might help keep me sober. Within the first week, I ended up in Alcholics Anonymous (AA). Like most people I know who have been to any kind of 12-step programme, I was uncomfortable at first with the “religious” nature of the organisation, not having any spiritual beliefs myself. (I tried Atheists And Agnostics Al Anon for a while, but went back to regular AA because they had better biscuits.)
I immediately recognised myself and my problems in the many testimonials I heard there. I realised that as a man with no religion I had to take a leap of faith in order to aid my own recovery and trust that this organisation could be useful to me. And it turned out that it was. Is AA perfect? No, of course not. But it helped me, even though I didn’t do any of the 12 steps. I’m doing okay these days. I have various jobs as writer, editor and occasional broadcaster – and those keep me so busy I don’t have that much time to worry about drinking. I rarely go to AA meetings any more. But I’d never be stupid enough to think of myself as recovered. I still need constant vigilance because I’m only ever really a couple of drinks away from auto-destruction. But I think I can say I’m okay.
Let’s return to that idea that there is no such thing as chronic alcoholism. If we presume that to be true, is it possible for people like me to learn how to drink sensibly? After all, I’ve had a seven-year break. Surely that should have set some of my dials back to zero? I guess in theory it must have. Say, for example, there was a person assigned to stay with me every hour of every day, who was ordered to shoot me dead if I drank any less than one and a half beers a day but also to kill me if I drank more than four. There is a chance that it might eventually become normal for me to drink sensibly. However, even under such abnormal circumstances, I cannot imagine for a second the gnawing, all-encompassing, monomaniacal desire for more alcohol abating, even if this person with a gun stayed put for a decade or two. The idea of retraining might sound logical. I remain sceptical simply because I have to.
I met someone via AA when I first quit alcohol in 2008. He left the fellowship not long afterwards to try a more modern approach to controlled drinking. The last time I spoke to him he informed me gleefully: “You lot are idiots. Living in the dark ages. All that talk of God and higher powers. You need a scientific programme like the one I’m trying that trains you how to drink sensibly, that gives you tools to use to cope with your urges and proper cognitive behavioural therapy… not this fucking dark ages, Moonie cult thing you’re into.”
I’d love to tell you how that guy was doing okay as well, but I can’t because he’s not with us any more.
For advice on addiction, visit addaction.org.uk
John Doran's memoir, Jolly Lad, is out now.
