A ground-breaking book has tackled a UK health crisis head-on. And, using medical fact and psychological theory, it’s managed to do it in under 120 pages. The crisis the book tackles? Alcoholism. And it’s a subject I know only too well.
The Canary does not endorse any of the treatments or analyses in the book. If you are experiencing problems with alcohol, your first point of contact should always be your GP. If it is a medical emergency, call 999.
I’m an alcoholic who lives with mental health issues. I’ve been struggling to deal with it for over a decade. While I’ve used Class A drugs in the past, I’ve never become addicted to them. But alcohol is different. My GP considers me a “high-functioning” alcoholic; that is, I am capable of pouring two bottles of vodka down my neck and still ‘operating’.
My addiction has led to a very turbulent life. I’ve been bankrupt, had my house repossessed, had to turn my back on a good career, been sectioned under the Mental Capacity Act, seen the breakdown of a 12-year relationship, and lost many friends along the way. As I previously wrote for The Canary, addiction is a highly complex, individualised issue. But it’s also one that unites every addict. For example, Amy Winehouse’s story and my own are wildly different. There was, however, one unifying aspect: we were both addicts trying to escape something. And Dying for a Drink provides a fascinating insight into the reasons for, and consequences of, this escapism. One which I was nodding my head in agreement with as I read the book.
A concise guide
Dying for a Drink is by Dr Tim Cantopher. It is a practical and comprehensive guide to alcohol and alcoholism. The book deals with the reasons people may drink and the harm heavy alcohol consumption can cause. But it also offers advice on reducing or cutting out drink altogether. And Cantopher does it all with a warm narrative and injections of humour. The book was originally released in 2011, but has just been updated.
Speaking to The Canary, Cantopher says he intentionally made the book very accessible. This is because of the way alcoholism had previously been dealt with in other writing:
I wrote this book because it seemed to me that the existing literature was either Alcoholics Anonymous (AA) based (Hazeldon), dense and abstruse, or patronising and simplistic. I think the psychological roots of addiction are worth understanding in order to be able to deal with it long-term. And I see no reason why sufferers and their families shouldn’t be able to use this theoretical knowledge, if it’s explained clearly and accessibly. I think Dying for a Drink fills this gap in the literature.
I’m of the opinion that there’s an underlying reason why every addict becomes lost in the mire of their issues. There’s always an underlying feeling inside of you; a torment; a profound sadness and wrench in your gut that just cannot be tamed. I imagine the majority of people, if asked, would say they all have demons that haunt them. But most people don’t have to take excessive substances to keep those demons at bay.
Causes of alcoholism
Dr Cantopher told me he broadly agrees. But sometimes, he believes the issue is simpler:
Not every problem drinker has reasons related to past experience for their drinking, but many do. All you need to develop a drink problem is to drink enough for long enough, or in the wrong setting. I give the examples in the book of an old man living alone, without responsibilities, drinking a bottle of scotch a day and eventually succumbing to his drinking, versus a young man who drinks only five pints of beer a week, on a Friday evening before driving home from work, who knocks over a child with his car one Friday evening. It’s not just about the amount, but also the context.
Cantopher also says that people may not need psychological intervention if they are doing well in other areas of their lives at the time that alcohol becomes an issue. In Dying for a Drink, however, there are chapters that deal with the possible causes of alcoholism.
These sections cover how the effects of alcohol, people’s past experiences, their personalities, and their family relationships may have led to their alcoholism. And while it doesn’t lay the blame directly at any one door, the book lays out pertinent examples of how people’s past may well have shaped their future.
Dying for a Drink outlines numerous theories as to why people are alcoholics. ‘Social Learning‘ theory, Sigmund Freud’s ‘Life Drive/Death Drive‘ psychoanalysis and Eric Berne’s ‘Transactional Analysis‘ theory are all touched upon. But one section stood out for me. It is on ‘OK-ness’.
Dying for a Drink’s OK-ness theory is interesting. Cantopher is essentially dealing with the issue of low self-esteem. He says in the book:
The principle is that it is crucial to be able to see yourself as ‘OK’ as a person, whatever the ups and downs of your life may do to you. Failure to have this view of yourself firmly embedded may lead to depression, problem drinking or a number of other unpleasant consequences. It is not possible to enjoy good relationships unless you see both yourself and others as OK.
Cantopher goes on to explain that OK-ness is, in some respects, cognitive dissonance. He writes that:
A person without OK-ness will depend a lot on others’ approval; he will only feel as good as the last thing someone said to or about him. If he is praised, he will feel great, but if he is criticised he will be totally deflated and lose all self-confidence. He is a cork on the ocean, being buffeted up and down by people’s comments and actions.
There’s always a reason to feel not good enough
This hit home with my own personal experience. I think I can trace the roots of my addiction back to childhood. Bullied and ostracised at school, struggling with my sexuality. Lonely, with a problematic family life, social anxiety, and rock-bottom self-esteem, I never felt good enough. I barely had any friends, and spent much of my time seeking the approval of others, which I rarely got. And always, I just wanted to feel ‘normal’; to belong. I always wanted ‘OK-ness’.
But when I was 14 I found alcohol. And it immediately gave me the release I craved from these demons that shadowed me. As Sarah McLachlan wrote in the 1997 song Angel, a haunting ballad about being a heroin addict:
Spend all your time waiting
For that second chance
For a break that would make it okay
There’s always some reason
To feel not good enough
And it’s hard, at the end of the day
I needed “some distraction, a beautiful release“. And alcohol gave me that. But it has only been the past few months that I’ve come to realise that my addiction has been caused, in the most part, by my childhood experiences. And the reason for this awakening is through dual diagnosis.
Dual diagnosis is where medical professionals treat both the patient’s addiction and the surrounding, often underlying, mental health issues. I am under the care of a wonderful psychiatrist. She firstly helped me stop drinking; then prescribed a strong dose of Mirtazapine (an antidepressant) to prepare me for working with a therapist using Cognitive Behavioural Therapy (CBT). I’ve tried every treatment under the sun, including AA. And for me a dual diagnosis, and the ensuing treatment, worked. For the first time in my life.
Cantopher says he agrees that dual diagnosis is crucial. He told me:
Dual diagnosis is a very important area. An alcohol history should be part of every mental state examination. But one thing is clear to me: when someone suffers from a mental disorder, say major depression, and alcohol dependence, you should always treat the drink problem first. Treating the depression without dealing with the drinking almost always fails, whereas in my experience treating the drink problem successfully often leads to resolution of the depression, even without specific therapy for the depression.
My CBT is not for my drinking. It’s for high-functioning social anxiety and low self-esteem; the causes of my drinking. Therefore I agree with Cantopher, who told me:
CBT for alcohol dependence, AA and twelve step programmes, and all the other effective alcohol dependence strategies, tend to automatically deal with the problems underlying the mental health issues, too. If antidepressant medication is needed, in my view it’s worth waiting until drinking has either ceased or is under control, as it won’t work anyway in someone still drinking to excess.
Life and death
But I was lucky. This time round, I caught my drinking just in time. Back in May, when I last relapsed, I knew I was staring over a precipice. I sat and cried and cried to my psychiatrist, begging her to help me because I knew that was my final relapse. I knew I didn’t have any fight left in me, and that if I gave in again it would kill me.
Cantopher outlines starkly in Dying for a Drink the physiological and psychological effects alcohol has on a person. And while most people know how damaging heavy drinking can be on a person’s liver, kidneys and heart, the effects on the brain are less well-known.
This is one of the best parts of Dying for a Drink, in my opinion. Cantopher explains, firstly, the effects of withdrawal; something which society is very good at stereotyping, but not so good at understanding. For example, everyone knows alcoholics shake when they haven’t had a drink. Most people think this is Delirium Tremens, known as the ‘DTs’. But it’s not. As Cantopher explains:
The first signs [of the DTs] are the same as… common withdrawal symptoms. However, the sufferer becomes progressively more frightened and shaky, and then starts to become muddled. Typically, a little later he starts to suffer visual hallucinations… He may see spiders crawling over the wall, or the shapes of other animals, or indeed any object at all. He may hear voices or other sounds. Commonly he is terrified by these experiences. At this point he will probably start to feel threatened and may feel that people around him are trying to attack him. He may retaliate in self-defence… This is the point a person may collapse, and if he is not under medical supervision, he may die. The cause is shock. He dies of fright.
Dying for a Drink goes on to detail more, often overlooked, effects of alcohol abuse. These include Wernicke’s Encephalopathy (caused by a thiamine deficiency), alcoholic dementia and hallucinosis, pathological (morbid) jealousy, and the severe cerebellar damage that heavy drinking can cause. Again, Cantopher explains all these conditions in a wonderfully accessible and succinct way; at no point does the theory or jargon feel overwhelming.
And it’s the accessibility of the book which, for me, makes it such a compelling read. Its clear and concise nature means you don’t need a medical degree to understand it. And when you look at the sections of society which are affected the most by alcohol abuse, accessibility and a clear picture are key.
It is, as with most things in society, the poorest that are coming off worst regarding alcohol abuse. Rates of A&E admissions due to alcohol poisoning were nearly four times higher among those living in the 20% most deprived areas of England than those in the least. And the gap is widening. Across the seven defined socioeconomic statuses (SES), 24% of all alcohol-related deaths were in the bottom category (‘routine occupations’). Also, these individuals are nearly three times more likely to develop alcohol-related liver disease than those in the top.
A study for the British Medical Journal showed that people with the highest SES consumed alcohol more regularly than the most deprived. But the pattern of consumption showed the poorest were the most frequent and heaviest binge drinkers; that is, consuming at least double the guideline limits in a single day. And binging accounts for the majority of alcohol-related A&E attendances, of which over 50% are at weekends.
Seeing the light
Cantopher agrees it’s the poorest who are at the sharpest end of alcohol abuse. He told me:
Alcohol dependence, like all other health problems, is most harmful in those at the bottom of the socioeconomic scale. One major reason for this is that economically disadvantaged people tend to eat poorly. Many of the worst effects of alcohol abuse come from nutritional deficiency, in particular lack of thiamine (vitamin B1). While people with a good diet are not immune from alcohol-related harm, they are at less risk than those who eat poorly, given the same rate of alcohol consumption.
But in Dying for a Drink, there is light at the end of the tunnel. Cantopher concludes the book with advice on how to reduce your drinking, or stop altogether. It includes tips on sleep and relaxation, keeping a drink diary, time management and drug treatments. The sections that resonated the most with me were those on psychological methods. Most notably ‘thought stopping’ (often described by therapists as challenging ‘hot’ thoughts), ‘thinking styles’, which is the basis for CBT, and ‘staying present’; that is, not focusing on bad past experiences.
Sadly, I don’t agree with all his assertions. Specifically, one of the book’s final sections is on AA. And while Cantopher doesn’t overly praise the organisation, he does treat it sympathetically.
AA or not AA?
For me, AA is flawed. I agree that letting go of blaming others is crucial; something I only managed to do, admittedly, through AA, as it is a notion underpinning the 12 steps. A support network is also vital, something AA provides. And knowing that, as an alcoholic, you can never touch a drop again is crucial; AA fervently believes this. But I struggle with the notion that you, as a person, should put your addiction in the hands of a “higher power” (God, or your understanding of him) to manage. For me, this removes the responsibility you have to manage your addiction. It almost says “Don’t try too hard! AA and God will help you!” And I believe that only you, and you alone, can fight your alcoholism. Putting crutches in place, when you already had a crutch in alcohol, is not the answer.
AA also encourages an unquestioning faith that the programme works. You never really address or ask why you’re an alcoholic, and are merely encouraged to know that you are, and that the 12 steps will help you deal with it. Again, for me, this is wrong. Until you deal with what has caused your addiction, all you’re doing is glossing over it. AA merely lets you exist in a bubble of meetings, other people’s stories, repeating of steps, and more meetings. Living in a bubble is something AA is very good at encouraging. I find this dangerous, as bubbles tend to burst when you least expect them to.
No longer dying for a drink. Not yet, anyway…
All that said, where I, Cantopher, and AA do agree, is that there is no such thing as ‘recovery’. Once you’re an alcoholic, that’s it. It’s a life sentence. I believe you never recover; you learn to manage your addiction on a daily basis. AA use the thinking that recovery is a lifelong process, and you deal in “Just for Todays“. And Cantopher told me:
There is no such thing as ‘recovered’ in alcoholism. I like the term AA use, that is ‘recovering alcoholic’. This makes it clear that recovery is an ongoing lifelong process. It’s an interesting exercise to work out which 10 people you have met in your life you admire most. I’ve taken this exercise and determined that five of my 10 are alcoholics or addicts in recovery. You don’t have to be a recovering alcoholic to become a wonderful person, but it sure helps!
Overall, Dying for a Drink is a compelling read. Whether you are an alcoholic, a friend or relative of one, or just someone who wants to understand the subject more, Cantopher’s approach in the book is masterful. It’s the no-nonsense, often amusing but totally relateable style that’s so endearing. And the amount of information Cantopher has condensed into Dying for a Drink is impressive. I’d be lying if I said it didn’t upset me at times, as my battle with alcohol is still very raw, and so much of this book hit home with me. But Dying for a Drink is a stroke of genius. One which, at under 120 pages, is an essential for anyone who is dying for a drink.
– If you, or someone you know, are living with alcoholism you can call Drinkline on 0300 123 1110 (Mon-Fri 9am-8pm, weekends 11am-4pm).
– If it is a medical emergency call 999.
– Buy Dying for a Drink.
Featured image via Flickr