Now that I am sober, I see that we are too tolerant of alcoholism and too indifferent to the suffering it bringsby Nick Cohen / August 14, 2017 / Leave a comment
Hi, my name’s Nick and I’m not an alcoholic. At least not anymore. For most of my life, I have been what the British euphemistically call a “heavy drinker.” On 1st January, I stopped and that seems to be that. I fell off the wagon late one night. But it was just a slip rather than a descent into perdition. I got back on, and have been sober since.
Anyone who quits alcohol risks turning from a drunk into a prig. The redeemed sinner forgets that among the many reasons people drink, smoke and binge on sugary food is the desire to escape life’s miseries. I have no way of knowing if circumstances will push my hand towards the bottle again. But as things stand I don’t drink and don’t want to drink. Someone else can take my place at the bar. I’ve been there long enough.
I didn’t stop because I found myself face down in a ditch or locked in a police cell. I didn’t lose my job or my relationship—although I guess there were moments when I could have lost both. I went through several dry Januarys. At the end of January 2017, I could not find a good enough reason to start drinking again. I still remembered the allure of alcohol, its promise of comradeship, love and simple pleasure. For me the most romantic lines in English poetry are from Edward Fitzgerald’s Rubaiyat of Omar Khayyam:
Here with a Loaf of Bread beneath the Bough,
A Flask of Wine, a Book of Verse—and Thou
Beside me singing in the Wilderness—
And Wilderness is Paradise enow.
But after too many years and too many flasks, neuroticism replaces romance. No one who hasn’t experienced it can appreciate the obsessiveness of the determined drinker. Questions build up as the evening approaches. Where am I going to drink? Who can I hassle into a pub? Can I sneak another one in without anyone noticing?
By the time you wake up in the morning, obsessiveness has metamorphosed into paranoia. What did I do? Why can’t I remember? Who did I offend? How did I get home?
If you find yourself asking these questions too often, the best answer is: “I give up.” How best to give up is, like everything else to do with alcoholism, infuriatingly hard to pin down.
I ought to admire Alcoholics Anonymous (AA), one of the world’s most successful examples of self-help and mutual aid. Instead, I left my first and last AA meeting because I found the overpowering air of Bible Belt sanctimony repulsive. American researchers, meanwhile, tend to support a disease model that classifies alcoholism as a hereditary affliction. It can certainly feel as if you are genetically predisposed to drink. But if the drunk blames everything on his genes, he can duck the need to find the strength to stop. Equally, if alcoholism were a disease, the “cures” offered by pharmaceutical companies would fix it as they fix or at least control other diseases. In reality, sometimes they help, and sometimes they don’t. There is no clinical consensus on either the causes of alcoholism or its cure, assuming there is a cure. The best guess is that drinkers stop when they have the usual prospects of happiness to fight for: a life worth living and the love of others.
I acknowledged what had been obvious for years. I could manage drinking until I fell over. I could manage drinking nothing at all. It was the bit in between I found trickier. If I have one drink, I want another and so on ad nauseam (literally so on occasion). I have no right to generalise from my experience particularly on a subject so tied to individual misery and pleasure. But for what it is worth, I would advise anyone in my position not to let the determinist notion of hereditary disease overwhelm you. I found the physical costs of drying out were not too high.
Users who take a drug every day inevitably suffer when they stop. In the case of alcohol, the neurotransmitters it suppresses rebound, resulting in irritability and agitation. These normally pass in 72 hours. Chronic alcoholics are a different matter. In their case, the pain of not drinking is greater than the pain of drinking. Tremors and seizures become likely. The only safe place to even think of coping with the DTs is a hospital.
Most drinkers, however, should be able to manage the physical symptoms of withdrawal on their own or with the support of friends and family. Psychological withdrawal is another matter entirely. You have to break the power of two illusions, which can exist simultaneously even though they come from separate stages of a drinker’s life. The memories of when alcohol was magical and made you and everyone around you glow persist long after the possibility of hitting the early highs has gone. The habitual drinker, with a hangover every morning and a thirst every night, doesn’t drink for pleasure but to ease the pain. Alcohol seems the only medicine that can knit their mind together and make them feel whole. It has seeped into every part of their identity. They fear that they will become a washed-out version of themselves if they stop. For instance, I was convinced that I had to drink to write. If I stopped, my creativity would vanish. A stupid idea, of course, for no one can write when they are drunk, but it is an illusion many writers still share.
The traditional greeting of speakers at AA meetings cannot be true. If you have been off alcohol for months, let alone years, it is simply incorrect to announce “Hi, my name’s Nick and I’m an alcoholic.” If you can stop taking a drug, you aren’t a drug addict. No one who has given up cigarettes would think of saying: “Hi, my name’s Nick and I’m a smoker.” But, while AA’s teachings are medical nonsense, they help the ex-alcoholic cope with the psychological withdrawal symptoms, and indeed the social toll.
Drink is the only drug you must apologise for not taking. Unless you want to shut yourself away, you must prepare yourself before every party or visit to the office pub. Someone will press a drink on you and look surprised or affronted when you say you are off the booze. One won’t hurt, they will say, for they must defend their own drinking. And they are right. One won’t. I found that for my first few months I had to arrive at the party with the thought fully formed in my mind that it was not the first glass of beer that would be a problem, but the second I would want afterwards and then the third and the fourth.
I make a living from expressing opinions but I am not remotely evangelical about teetotalism. I buy drinks for my friends. I am scrupulous in ensuring that my wife does not suffer on my account. I am not, I hope, a born-again prude, sniffily objecting to pleasures I once enjoyed.
Yet stop drinking and you are struck by the extraordinary latitude alcoholism is given in modern societies. In nearly every other respect we are Victorian in our censoriousness. Yet with drunkenness we are so tolerant we find it hard to admit that alcoholics even exist in Britain, let alone that we may be among their number.
The Chief Medical Officer recommends four alcohol-free days a week and a maximum weekly limit of 14 units. Drink more, and the risk rises of developing liver disease, high blood pressure and some cancers, as does the risk of meeting a violent death. Fourteen units, I should warn you, amounts to six or seven pints of beer a week, depending on its strength, or six or seven glasses of wine.
Maybe it’s because I work in journalism but I do not know anyone who believes that if you drink more than 14 units you are on the way to alcoholism. It’s not just journalists. The Office for National Statistics estimates that around 2.5m people in Great Britain—9 per cent of drinkers—consume more than 14 units on their heaviest drinking day. I’m sure they don’t think of themselves as drunks either. I didn’t when I knocked back the same amount. What marks alcohol addiction from tobacco addiction is that the majority of smokers know they are addicts and want to stop, while the majority of heavy drinkers lie so they can keep on drinking.
Dylan Thomas (killed by the booze at 39) summed up our thoughts on the subject when he said that an alcoholic is someone you don’t like who drinks as much as you do. John Sutherland, whose memoir of alcoholism Last Drink to LA is a classic of boozer literature, says alcoholic Calibans always see someone else’s face in the mirror. The right-wing press says an alcoholic is a young woman sprawling in the streets with legs invitingly akimbo but not the respectable man in the bar bullying his friends to stay for another. Raymond Chandler (who hit the bottle after his wife died and contracted a fatal case of pneumonia) reassured his readers (and himself) that this mind-altering drug didn’t alter sound minds. “A man who drinks too much on occasion is still the same man as he was sober.” By contrast, “a real alcoholic is not the same man at all. You can’t predict anything about him for sure except that he will be someone you never met before.”
“The majority of smokers know they are addicts and want to stop, while the majority of heavy drinkers lie so they can keep on drinking”
Chandler was right that a heavy drinker can manage the hangovers, the late nights and the blackouts, and still keep a job and a relationship. You are still the same person you were the night before the morning after: for who else could you be? But the line between the heavy drinker and the terminal drunk is as blurred as your vision after a “good” night out. We set the bar so low, you can be off your head and still leap it. The true alcoholic is always someone else. The old man in the park no one wants to know, the young woman sprawled on the pavement. Anyone and everyone, except you.
My rule of thumb is that if you cannot get through 48 hours without a drink or a craving for a drink you are by any reasonable standards an addict. Most doctors use the World Health Organisation Audit (the Alcohol Use Disorders Identification Test). You are scored on your answers to questions—how often do you drink, binge drink, feel guilt, black out, find yourself unable to work normally, and so on. An alcohol consumption of 50 units a week—five bottles of wine—is usually enough for you to have a “problem.” Depending on where the bar is set, some 695,000 people in Britain are alcoholics, according to the latest strict definition, or 1.6m according to the Department of Health’s broader classification. That is a lot of suffering. And that is before you think about the otherwise sober people who end up as the abused or the abuser after a binge. According to NHS England 1.1m hospital admissions were due in some part to alcohol related violence, injuries or diseases in 2014/15.
Compare alcohol with other drugs and you will see that the advantages it enjoys can only come from a society that is so steeped in drink it cannot confront its consequences. Tobacco remains a legal drug, just about. But it is not socially acceptable. In middle-class circles, it is politer to drop your pants than light a cigarette. “Hard” drugs are illegal but socially acceptable. The rich world’s hunger for cocaine has turned Mexico and central America into free-fire zones, corrupted politics, and allowed the rise of gangster lords so violent we would call them war criminals in another context. Yet there is no stigma attached to the recreational drug use that funds the violence.
Alcohol is both legal and socially acceptable. Cigarette packets come with health warnings. Cans of beer do not. Tobacco and hard drug advertising is banned. Alcohol advertising is not. You cannot smoke in pubs, even though no one has ever died in an attack driven by a tobacco-fuelled rage, and no police officer has ever said that tobacco is involved in half of violent crimes. Britain even tolerates a drinks-industry-funded body, the Portman Group, giving advice on “responsible” drinking. Imagine if the government accepted advice on responsible cocaine use from the Sinaloa Cartel. Even more than the gambling industry, the drinks industry dictates policy. It is local and national government’s partner. They work to promote the “night-time economy” as a tool to pep up flagging economic growth.
In The Politics of Alcohol, his history of the British and drink, James Nicholls explains why temperance movements always fail. Most drinkers are not drunks. They don’t recognise themselves in the prohibitionist picture of violence and disease. When they have a glass of wine, they don’t assault their spouses or crash their cars. Instead they find a pleasure that statisticians never measure, and can see no good reason why the state should take it away from them. The prohibition of drugs will fail for this reason. Moderate drug users, like moderate drinkers, know from experience that recreational use does not condemn them to a life of addiction followed by a squalid death. Recreational users set the terms of the debate about alcohol as one day they will about cocaine and marijuana, and maybe even heroin too.
I have no objection to their liberalism. In a strait-laced society, where managers at work and censors on the web police language and morals, drink is a respite. It allows you to bond and make friends, have sex and fall in love. (After studying the English, the anthropologist Kate Fox suggested we were so embarrassed about sex we would never pair off unless alcohol gave us the courage to invite each other to bed. She may not have been joking.)
Most drinkers are fine and healthy and good luck to them. Public policy needs to concentrate on helping alcoholics and on protecting their victims. I am not arguing for a new prohibitionist movement. It is just that having lived first inside and outside the pub, I have learned that we are too tolerant of alcoholism and too indifferent to the suffering it brings not just to alcoholics but to those who must endure their company. You do not need to be a prod-nosed puritan to complain that national and local government have torn up alcoholic treatment programmes to save a bit of money. You do not have to be a prude to notice that the alcohol industry makes most of its money by selling to alcoholics—69 per cent of its sales, according the Alcohol Health Alliance.
In circumstances when men and women in hospital liver wards are admitted drinking 140 units a week or more, it is not being a killjoy to insist that England follow Scotland and impose minimum prices or hefty tax rises on cheap, high-strength beers and ciders. Nor are health warnings on cans and bottles and a ban on alcohol advertising miserablist attempts to spoil other people’s fun.
Persuading drunks to admit they are alcoholics is hard enough. But it is easy in comparison with the task of persuading the rest of this tipsy country that alcoholism is something more than a bit of a laugh.