Health

Thursday 18 September 2014

Meet the middle-class 'sophisticated alcoholics'

A new book is turning our concept of alcoholism, and how to treat it, on its head

Struggle: memorials to the singer Amy Winehouse, who lost her battle with alcohol in July

Are you just a 'normal' person who maybe enjoys a few drinks after work or a few glasses of wine at home -- it's all part of unwinding, just a bit of harmless letting off of steam. You're in control though -- it's not as if you can't get up for work in the morning or forget to pay the mortgage.

However you may be part of a new breed of 'sophisticated alcoholic', which is also the title of a new book by an English therapist, David Allen, who specialises in alcohol dependency. Allen's book focuses on a group of people who have been dubbed 'middle-class drinkers'.

"These people don't really see themselves as having a problem with alcohol -- they have a normal life and would be considered Mr and Mrs Normal," Allen says.

"But they are drinking excessive amounts of alcohol -- well above the recommended limits. They drink in an organised and managed fashion. They're not the ones who crash the car because they were drunk but they do have an alcohol problem."

The book addresses this group of people and provides strategies to reduce their drinking. Allen himself once belonged to this group and says he could easily put away 60 to 70 units of alcohol a week.

"I saw myself as being in control of my drinking -- I wouldn't drink when it was going to affect the things that I do." But Allen's drinking had become a big part of his life and he had formed friendships purely on the basis of a shared drinking habit.

"One of the things that influenced me to deal with the problem was that a friend of mine died from cancer of the oesophagus. He was a heavy drinker and the cancer was alcohol related. His death stopped me in my mental tracks."

Allen developed a hypnotherapy audio CD and believes that listening to it over and over during the editing stage helped him with his alcohol dependency.

'The Sophisticated Alcoholic' also breaks free from the decades-old theory that alcoholism is a disease. Instead it maintains that it is a behaviour, which has become a divisive issue for health professionals.

"I don't believe that alcoholism is a disease -- it's a behaviour," Allen says. "Saying it is a disease can become a convenient excuse for people dependent on alcohol.

"It's a behaviour and it's a choice and both are caused by something that's going on emotionally. There's no question that some part of alcohol dependency does become a physical condition and the person may need medication to help them with their withdrawal symptoms while the body gets used to not consuming alcohol.

"But I think it's unhelpful to refer to alcoholism as an illness except in the sense that it causes serious illness."

Allen points out that the advantage of calling it a disease is that it removes some of the shame for alcoholics. But he argues that, at the same time, it strips them of some of the responsibility they have in their own addiction.

Addiction

It's a point of view that psychologist Colin O'Driscoll, who is the course director of the BA in Addiction Counselling at ATI Psychology Institute Dublin, agrees with.

"There has been a very strong association with the disease model but this dates back many years and we know a lot more now about the way that addiction works," he says.

"I would categorise alcoholism more as a behaviour. There is a movement away from the medical model of alcoholism which focuses on it being a disease and nowadays addiction studies include lots of different models.

"The assessment criteria for a disease don't fit with alcoholism -- if you think about how every day people stop drinking, that's not like a disease.

"The problem with treating it like a disease is that it tends to become a self-fulfilling prophecy. If people dependent on alcohol are told that they have a disease and it's primary, chronic and progressive, it will start to act like a disease because they think of it that way," says Colin O'Driscoll.

In another break with tradition, David Allen believes that alcohol dependency can be overcome but that this doesn't necessarily mean abstinence for life.

He says in the book, "I am not a recovering alcoholic, I am fully recovered.

"I will occasionally drink for social reasons -- particularly when I'm away in another country. But I drink very little and it's quite amazing that it's now normal for me.

"The relationship I had with alcohol has completely changed. Looking back, there was one point when I couldn't go a day without having a beer."

Colin O'Driscoll believes that as a psychologist he is there to help guide a person to make that decision but he can't decide what will work for them.

"There are two main approaches -- harm reduction, which means drinking less, or abstinence. Alcohol addiction is more complex than the disease model makes it out to be and people behave in different ways."

Alcoholics Anonymous, which is the world's most popular addiction recovery programme, is firmly based on the idea that alcoholics should abstain from alcohol.

While David Allen acknowledges that some people find Alcoholics Anonymous (AA) useful in their recovery, he says the programme has its limitations.

"The 12-step process of AA is about creating bigger reasons not to drink than the reasons to drink and to provide ongoing support for the person concerned," he says.

"Now for some people, there's no doubt that this approach is necessary to begin with. If you've hit rock bottom and have no job or nowhere to live, you're going to have to start all over again and stopping drinking may very well be a part of that.

"But if alcoholism is caused by behaviour and behaviour is driven by emotions, then any recovery programme has to deal with the underlying feelings and desires. It has to work on the subconscious level.

"The conventional approach, which is AA, doesn't do that at all. It focuses on the idea of not drinking rather than getting to the root of the problem and I think that's why people in AA end up relapsing.

"When you look at people who depend on alcohol, they think things like, 'I'm no good at relationships -- I screw it up ever time I meet someone.'

"There is a long-term insecurity of who they are. Alcohol works in the short term -- it's a mind-altering drug that changes the way they think about themselves. It anaesthetises them and provides an escape from reality."

Allen says the AA model is self-perpetuating: "It helps people to stop drinking but part of that involves keeping going to meetings. The model is saying, 'You can never live without us' so the model is perpetuating the organisation.

"I don't think the model works consistently enough to be a convincing model and I think some people replace their dependency on alcohol with their dependency on AA.

"People will abstain from drinking as long as the reasons to not drink outweigh the reasons to drink. The problem comes when a set of circumstances in their life -- a marriage breaking up, the loss of a child and so on -- upset this fine balance and the emotional desire to drink takes over."

Colin O'Driscoll says that around 90pc of treatment centres use a 12-step model.

"Whatever works for people is what they should do. If going to an AA meeting helps you stop drinking, that's good. But it is clearly a way of managing alcohol dependency and it's organised by a peer group rather than by health professionals.

Meetings

"People who are engaged in AA tend to need to stay engaged in AA. Once they start missing meetings, they may find they are having problems with their addiction and they may relapse."

AA, which began in Ireland in 1946, said it couldn't provide a spokesperson for this article. It cited one of its 12 traditions: "Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never to be drawn into public controversy."

It seems that the best way to handle alcohol dependency is to nip it in the bud.

"If you can catch an over-reliance on alcohol in its developing stage and do something about it, it means you're not getting to the stage where you have to even start thinking about recovery programmes," says Colin O'Driscoll.

"People may not even be fully aware of how much they are using alcohol in their life. Wine, in particular, is featuring much more as the alcohol of choice and women are more represented in treatment centres as opposed to men.

"When drinking wine in the evening becomes a way of coping with things, that's a signal that you might be in trouble. You can test your control by saying you won't drink for three days. If you quickly break that and find an excuse to do it, you may be developing a problem with alcohol," says Colin.

David Allen's clients come to him because they've made the decision themselves that their consumption of alcohol is too high.

"They're people with good jobs -- sometimes very good jobs -- and often a family life too. They're just normal people for whom alcohol has become a large part of their life. They would see themselves as being in control of their drinking.

"That's where the word 'sophisticated' comes from -- the idea that they follow the rules and feel they are in control of it, even if they're drinking a bottle of wine every night. Unfortunately they're not in control but that doesn't mean they can't be in control again though."

'The Sophisticated Alcoholic' is published by O Books on Nov 25. www.thesophisticatedalcoholic.com

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