These are worrying times for us all, full of uncertainty and dread. Where will this end, and who might we lose along the way, and what awaits us on the other side? So many unanswerable questions.
Most of us find such uncertainty uncomfortable, and anxiety inducing. So we may look for an escape in alcohol. Many people are drinking more because of coronavirus. This need not be a sign that you’re developing an addiction of course, however, you might well be concerned about your alcohol consumption. Especially as we all need our immune systems to be healthy right now. And alcohol will directly reduce the health of your immune system, so you’re right to be concerned.
On top of the need to escape from worry and anxiety, you’re probably feeling trapped in your own home, perhaps with family members who are also getting ‘cabin fever’ – bored teenagers particularly. This becomes an extra need to escape, to get a holiday at home via alcohol.
What you might need is to get out away from the pressure of home, somewhere you can temporarily be soothed without resorting to drinking more. Nature and open spaces are a perfect choice, so if you have access to that then it would seem the obvious choice. If you’re in a city and such green space is not so easily accessed, then maybe setting aside some time for yourself in the house could work? Agreeing with other family members that you’re each allowed some time in your room when you are NOT to be disturbed.
There are no easy answers here, but at least if your shops and stores are anything like ours right now, there might not be much alcohol on the shelves anyway.
Public Health England are today launching their ‘Drink Free Days’ campaign to encourage people to reduce their alcohol intake. It’s sometimes easier to have occasional sober days than trying to cut down the amount once you’ve started drinking.
Try to make a plan for when your regular sober days are going to be, that way they can be part of your routine. Maybe plan to do something slightly different on those nights instead, something not compatible with drinking.
If you currently drink every day, then start out with an achievable target of 1 or 2 drink free days. If you already have occasional sober days, then try adding a couple more. The point being, you might be more likely to achieve your goals if you don’t make then too ambitious initially. If you drink every day and suddenly expect yourself to stay sober Monday to Friday, you might find that difficult, and hence will feel disappointed in yourself.
There’s an NHS phone App to help you monitor your progress, available here.
A recent study by researchers at the University of Liverpool has found that smaller serving sizes can reduce the overall amount people drink during a session. This reflects research on food consumption – people will also eat less overall if food is served to them in smaller portions (but they are also allowed 2nd and 3rd courses).
The study discovered that serving drinks in smaller glasses (but still allowing people to have as many drinks as they wanted to) contributed to people drinking less alcohol overall than people served with larger glasses. The effect they recorded was a 32-39% reduction in a real world setting (a pub).
This seems a very simple change that anyone could make – so why not try it?
Start drinking from slightly smaller glasses this week, and see if you notice any difference in how much alcohol you drink overall.
I often hear people refer to their alcohol problem as ‘a weakness’, or a sign that they are weak people. But I don’t think this is a helpful view, as it labels the person negatively and discourages change.
Mental health issues like depression, anxiety, or alcohol problems, can be thought of not as a weakness, nor a defect, but merely as a sign that someone is not functioning at their best. Very few people function perfectly, most of us function well enough, and some of us don’t function that well; it’s a sliding scale.
If instead we consider mental health problems, including alcoholism, as a sign that a person is further down the scale of functioning than they would like to be, perhaps there is more room for manoeuvre.
Similarly, people who are emotionally ‘strong’ can still struggle, or have periods when they’re not functioning well, or have faults.
Many of us will have grown up with the belief that if we don’t achieve certain standards, then we’re not acceptable, or not worthy of love. But that would make most of the human race unacceptable; so perhaps we can consider that we are still worthy of love and acceptance despite our flaws, our bad habits, and our difficulties.
Check out the monthly sober challenge threads on our forum.
You’ll find plenty of people on there, similar to yourself; some may never have tried a sober October before, some may have been trying to control their drinking for much longer.
Either way you’ll get some extra support to help you through any difficult days.
Most of the clients I talk to are not at ‘rock bottom’, to use the AA phrase. Their drinking is not causing many crises in their lives. Sure, there are consequences from their alcohol consumption, but quite often they are manageable. They might be termed ‘high-functioning’ alcoholics.
Do you seem to be getting away with your drinking, most of the time? If you’re feeling a bit below your best at work the next day, does anyone really notice? When you drink, do you tend to be amiable, not argumentative or belligerent? Are you one of those people who would never drive a car once you’ve had more than one drink?
Like most people, you’ve probably never noticed any major health problems due to alcohol, although also like most drinkers, you’re aware of the risks and concerned about them. Maybe you’ve even noticed some subtle costs to your health – weight gain, poor skin condition, troublesome digestion, disturbed sleep? But perhaps you try to ignore those.
Perhaps your partner has repeatedly expressed their concern about how much alcohol you drink? But they haven’t left you because of it, so you dismiss their concerns.
Lots of people drink way more than is good for them, yet manage to deal with the side effects. As such they can convince themselves that their alcohol consumption isn’t out of control, that they aren’t an alcoholic.
But as with most things, alcoholism is not a discrete category that you’re in or not in, it’s a sliding scale, with various degrees along the way from someone who is abstinent at one end, to a dependent alcoholic at the other. A functional alcoholic might be at about 70-80% on the scale, lets say.
Whereabouts on the scale are you?
For many people, the decision to change their drinking habits is not clear-cut. The pros and cons of your drinking might seem quite evenly balanced; occasionally the negative consequences might increase, you have a binge and do something embarrassing perhaps; but then at other times those costs can seem more tolerable, more manageable.
When you’re feeling concerned about your alcohol consumption, this back and forth swing of apathy and motivation can go on for years. The truth is, most people find alcohol to be a pleasure, they enjoy the effects, the relaxation of emotional pain, the reduction of anxiety, the dissolving of barriers with those around us, the warm glow of not caring about the pressing issues in our lives. We tend to view many choices about our lives in this way – a simple weighing up of the pros and cons.
When we drink, we just dont care any more, and that is such a delightful state of being, it seems worth the high price of admission. Most of the time. Until you’re woken by indigestion and anxiety again, until you wake feeling retched again, full of guilt, shame and regret. Many people are aware that their drinking is a problem, but not enough of a problem to do something about it. The idea that we can just force ourselves to change our behaviour, commonly referred to as ‘willpower’ is just not supported by reality – willpower comes and goes unpredictably.
Eventually though, the scales tip slowly but surely towards a point of action. By reading this, does it suggest your motivation is tipping towards making a commitment?
A recent study, published in the Journal of European Neuropsychopharmacology demonstrates that the drug Baclofen is actually not as effective at treating alcohol dependency as was previously thought.
It had been marketed as the new wonder treatment, but a fully randomised, placebo controlled trial conducted in the Netherlands showed no significant difference between patients who took a high dose (150 mg/day), a low dose (30 mg/day), or those who took a placebo (both groups were also receiving counselling). Relapse rates were effectively the same across all three groups.
The study authors conclude quite rightly that the widespread ‘off-label’ prescription of Baclofen for alcohol dependence should be reconsidered.
Cognitive Behavioural Therapy (CBT) is an effective, practical solution backed by extensive research. It can be used for any number of mental health problems or behavioural issues, including of course, alcoholism.
So how does CBT work in relation to alcoholism, what is the process? And, as you’re probably wondering, how will it help you to solve your own alcohol problems?
Alcoholism is different for everyone; the reasons why you drink are not the same as the reasons someone else drinks. So the first step in solving your issues with alcohol is to explore where your drinking fits into your life, what contributes to it, and what might be maintaining the problem? CBT is a method for helping you to examine your thinking styles, your beliefs, and your interpretations of the various aspects of your life, to see if they are unhelpful for you, and particularly to see which ones are fuelling your alcohol consumption.
Once we’ve established a few priority issues to focus on (like work stress, or relationship problems, worry, or depression perhaps) you can practice some pragmatic changes to see which ones are most effective for you, and which ones help you reduce your alcohol intake. Part of what makes CBT so effective is that it’s individually tailored to you and your specific problems, it’s not just a set of instructions to follow.
Alcoholism is a difficult problem to solve though, so the best intentions don’t always work out as you expected. Dealing with mistakes and learning from them is key to this, without criticising yourself. As such, predicting your most likely triggers for drinking is vital, so plans can be developed for how to handle such situations differently.
Another key difference with CBT for alcoholism is that abstinence is not the only option (unlike AA for instance) – most people find they can successfully cut down how much they’re drinking, once they start handling some other aspects of their lives a bit better. Equally, CBT allows you to learn new approaches to problems, without solutions being ‘implanted’ in you, as in hypnosis.
If you’re curious about how CBT can help you, make an initial enquiry with our contact form in the top menu.
Unfortunately, drinking too much alcohol can make people feel ashamed, especially if you believe that drinking excessively suggests there is something defective about you. Or you believe it is something that needs to be hidden from other people, as you fear their judgement. This is the nature of shame, it is a particularly negative feeling, and is often a factor in depression. It is usually tinged with regret of course, at having done things while drunk that we would never do sober – perhaps hurting other people or behaving inappropriately.
How can we reduce the effects of shame then, or minimise it’s impact? How can you feel less ashamed of drinking alcohol? The first thing to consider is compassion. These are the feelings of nurturing, caring and forgiveness that we normally feel towards a child or a loved one, but we also need to apply to ourselves. Most of us are our own harshest critic, and when feeling ashamed about drinking that tendency can go into overdrive.
So forgiving yourself is an important aspect of reducing shame. Some will have concerns here, that if they forgive themselves then they’ll lose control of their drinking entirely. But this is not to suggest that the behaviour itself is forgiven, just the person is forgiven; “I did something I regret, but that does not make me a bad person”, for instance – taking responsibility for your actions, rather than berating or blaming yourself. Many people find the idea of self-compassion awkward, it’s not something we’re accustomed to, but most therapeutic approaches recognise the importance of it for mental health.
Some might say that the easiest way to avoid feeling ashamed is to stop drinking so much. But that is overly simplistic, because many people find they cannot do that easily, they may have tried many times, but without success. A vicious circle can develop, whereby someone feels ashamed of their drinking, becomes self-critical and starts to feel depressed as a result. This can then be a trigger for further drinking, as alcohol often lifts your mood. But again, the important thing to distinguish is that drinking too much is a regrettable habit, not a sign of a personality defect.
Research just published in the journal BMJ Open, studied the alcohol consumption levels of UK residents over the age of 50.
Overall, levels of drinking in this age group are increasing, the report concludes (although binge drinking has reduced, suggesting more regular drinking patterns). Although for men, the peak is at 60, after which their drinking tends to diminish. They found that higher income is associated with more harmful levels of alcohol consumption in women, but strangely not so with men. Those who smoke, and those more educated also tend to drink more, for both genders.
Unfortunately the harmful effects of alcohol on our health are more pronounced the older we get, so these results have some alarming implications.
Theres been a lot of media attention on Mindfulness lately, but not so much on how useful it is for dealing with an alcohol problem. So how does mindfulness help us deal with mental health problems generally, and with alcohol issues specifically?
There is very little research into how it achieves its effects, however my own mindfulness practice leads me to believe that one of the main mechanisms by which it is helpful is the development of an observer view on your own mental processes.
This observer view occurs largely as a result of focusing on clearing the mind and concentrating on the breath. When the mind inevitably wanders off this focus, a key part of mindfulness is to notice that you have started thinking about something, then calmly return to focusing on the breath again. Its the noticing what the mind is doing that is helpful I believe. From that we can learn to observe our own thoughts more generally, when were going about the rest of our day, not practicing mindfulness necessarily. If we can be more aware of when patterns shift in our inner landscape, it can only be a good thing. If we therefore become more self aware, rather than reacting automatically to our thoughts, we can have more choice in how we respond, in whether we have a drink, or choose something more helpful for us.
Another effect of mindfulness, or meditation as it used to be called, is in allowing the ever-active mind to take a break. To just perceive and be aware, without any labeling or inner commentary on whats happening, even if its only for a few seconds at a time. A pause for breath, in both a figurative and literal sense. This allows certain neurons to rest and re-balance their associated neurotransmitters (the chemicals which our brain cells require to communicate with each other). If this allows us to de-stress, or for the mind to cope with stress more effectively, then again we can be less likely to reach for alcohol.
If you are drinking as a reaction to anxiety or worry, you can easily see how having a moment to step away from those concerns could be very calming, and potentially help to avoid the urge to calm yourself with a drink instead.
Many people are put off the idea of mindfulness practice because they believe it requires long sessions of sitting cross-legged in front of a candle, chanting certain special phrases. Thats more like the traditional form of meditation, whereas modern mindfulness can be practiced for 1 minute at a time, several times during your day, even while youre sat at your desk working perhaps. The key is to allow your mind to focus on the breath, or a pleasing view perhaps, and try to just perceive it, without discussing it in your mind. You might only be able to sustain that for a few seconds at first, but thats fine.
Worry is a normal human activity – we all do it from time to time. But for some people, it dominates their life. So how can you stop worrying? The initial answer is that it’s unlikely you’ll be able to stop completely, but you might be able to reduce it. Before we proceed, lets define what worry is.
Worry is a mental activity where we speculate about potential negative outcomes in our future; those outcomes feel threatening, which produces anxiety. This speculation often arises from uncertain or unpredictable situations in the present day, anything we might feel is out of our control.
That lack of control or predictability is very uncomfortable for some people, so they attempt to reduce the uncertainty (and increase control) by speculating about what might happen.
If you speculate about what positive things might happen, then you’re lucky, because most people are drawn to speculate about the negative possibilities, the threatening or unpleasant outcomes which they would rather avoid. If your thoughts often begin with “What if…(something negative) happens?” then you’re probably a worrier. The common themes for worrying are almost universal – family, relationships, work, health, finances or being negatively evaluated by others, for instance.
Some forms of worry are about planning strategies to avoid these potential negative outcomes, or how to deal with them if they’re unavoidable. But quite often people are so anxious about the imagined outcome that they don’t even get to the planning stage, they just turn away from the unpleasantness, and try to avoid thinking about it. This is where alcohol comes into the picture for a lot of people – it is very effective at silencing worries (in the short term at least).
Now we’ve got a working definition of what it is, so how do you stop worrying?
People who worry excessively tend to make threatening interpretations of ambiguous circumstances – and unfortunately life is full of ambiguity, uncertainty and unpredictability. Additionally, worriers often lack confidence in their decision-making or problem-solving abilities, which can lead to doubt about their own ability to cope. As such, an objective evaluation of your coping ability might be helpful – if you think back to a few crises you’ve experienced in your life, ask yourself how you managed to cope with them, did you work out a solution to the crisis, did you get through it eventually? You might be able to recall a few situations where you didn’t handle things so well, but it’s probable that overall, you’ve managed to deal with everything in your life thus far. This suggests you’ll be able to handle everything else that might happen too, doesn’t it? That’s not to say that you can avoid all unpleasant situations in your life, but that you’ll be able to deal with them when they occur, you will cope. This could mean that speculating about hypothetical outcomes is unnecessary.
How could you learn to tolerate uncertainty better? How could you reduce the need to control your life so rigidly? Is it possible to accept that the future is unknowable, unpredictable, and be ok with that? In fact, is uncertainty unavoidable in life? Ask yourself if there are certain scenarios you never worry about. For instance, some people worry about paying for their children’s education, yet they don’t worry about war breaking out. Why is that? Why don’t you worry about nuclear war? The answer to that question might provide useful insights about the issues you do worry about.
We need to look at what processes maintain your worry, what beliefs you hold which give your worries strength. What purpose do you think your worrying serves? Why do you do it? What might potentially go wrong if you didn’t worry? Does worrying help you in any way at all? Does being a worrier say something good about who you are even? These are important questions to consider, because these beliefs may be unhelpful for you, and may need some adjustment if you want to stop worrying.
If you’re someone who avoids thinking about solutions for imagined negative outcomes, then those outcomes remain threatening, and continue to pop into your mind to make you anxious. A way to deal with this is to actively imagine the unpleasant scenarios occurring, and then consider how you would react, how you would deal with the situation, what support you would call on, and what options you might have available. It’s not a pleasant exercise to engage in, for sure, but the idea is to expose yourself to the imagined threat, and then imagine yourself solving the problem, coping with the situation somehow.
Again, you probably won’t be able to stop worrying completely, but it might be possible to reduce the amount you worry to a more tolerable level.
A study published last week in the Journal of Epidemiology and Community Health found a concerning increase in the number of women in their 30’s and 40’s dying from alcohol-related conditions (in UK cities at least).
This is contrary to the general trend, which has shown no increase in deaths from alcohol for the population as a whole in the period studied (from 1980 to 2011).
Explanations vary for this unusual result for younger women, but many are blaming cultural factors for the acceptability of heavy drinking amongst women recently. Whatever the explanation, policy-makers should perhaps take note that action needs to be taken.
There is often some misunderstanding of what it really is, so we should perhaps briefly describe what the medically agreed symptoms of depression are:
- low mood most days (feeling sad or empty)
- lack of pleasure in activities
- low motivation
- inability to concentrate & poor memory
- lack of activity and energy generally
- feelings of guilt & worthlessness
- appetite changes
- sleep disturbance
The causes of depression are different for each person, of course, but certain similarities occur:
Early life events:
Some people are more predisposed to depression than others, as a result of their life experience “ certain events may cause the development of low self-esteem, poor problem-solving skills or hopelessness.
Depending on what messages people have been given in life (by peers or parents for example), they may develop a range of dysfunctional, rigid beliefs about themselves, other people, or life generally, for example –
- “I’m weak”,
- “I’m unloveable”,
- œif other people don’t approve of me then I’m worthless, or
- œif I need people they wont help me, or
- œIm not strong enough to cope if unpredictable things happen.
How we make sense of our life has a big influence on how we feel. An example of this is attributional style. For instance:
- If a negative event occurs, perhaps a mistake with significant consequences, and you attribute it to an internal, enduring cause (e.g. considering yourself useless), then of course it would tend to make you feel low.
- If you attribute the same event to an internal but transient cause (œI wasnt paying attention right then), then you might feel less depressed about it.
- Were you to attribute the event to external factors beyond your control (œanyone would make mistakes under this sort of work stress), then you might barely feel down about it at all.
This is a simple example of the many attributions we make for what happens in our lives, all of which are just opinions, subjective views, not facts. Depressed people might counter œyes, but I AM useless, but again this is only an opinion, not a fact.
If, on top of these predisposing vulnerabilities, current life events occur which deplete emotional energy or make coping difficult, then depression can develop. Some examples of such events might be:
- A loss of some sort (not just of a loved one, but perhaps a loss of some important aspect of life such as status or health for instance).
- Prolonged stress – the perception that the demands being made of you exceed your available resources; if this is chronic then a state of helplessness (“I’ll never escape”) or hopelessness (“what’s the point”) can develop.
- Periods of anxiety can also precipitate depression, as the feelings of vulnerability, unpredictability and lack of control can create pessimistic beliefs about the future.
Once depression develops, what maintains it?
Another aspect of our selves is our moment-to-moment stream of consciousness; the linguistic content of our thoughts. These have an immediate effect on our mood, so depression can be maintained by Negative Automatic Thoughts which take the form of unhelpful styles of thinking.
There are three main themes: “
- the self (eg. – Im defective or inadequate)
- the future (eg. – its hopeless and pointless)
- the world/life (eg. – its difficult, uncaring, cruel)
- Over-generalisation (using words like: always, never, everyone, no-one, everything, nothing)
- All or nothing, categorical thinking (if youre not perfect then youre a failure)
- Negative filter (only seeing negative evidence about yourself, ignoring any positives)
- Mind reading (œI know they dont like me)
- Catastrophising (œthats it, Ill never succeed at this now)
- Labeling yourself based upon your behaviour (œI did something stupid, therefore I am stupid)
Lack of compassion for yourself is often a factor in maintaining low mood – even if we are capable of being compassionate and caring towards others, we believe that we don’t merit the same compassion or forgiveness for ourselves. Thus guilt and self-recrimination can become entrenched.
Lack of activity:
Once low mood sets in, energy levels and motivation drop, and as a result people do less. Their opportunities for having fun, for feeling a sense of achievement, for sharing experiences with friends, all diminish. Thus a feedback loop is established, potentially leading to further drops in mood.
And finally of course, alcohol is a well-known depressant, a substance which many people turn to in times of difficulty, thus compounding the problem.
In the next article, we’ll look at the treatment of depression based upon the causes we’ve identified here.