A Specialist’s letter to someone recently diagnosed with alcohol problems

Nobody has the right to diagnose you, but I can help you, if you want, to diagnose yourself.

If you are having problems – any problems – as a result of drinking alcohol, then you might be interested in seeing how you can help yourself to turn them around.

The first thing to recognise is that these problems tend to affect every aspect of your life. Whereas cancer in its early stages tends to be a physical problem – as with diabetes or heart disease – problems with alcohol dependence tend to start with social or professional problems. Then they spread into family and financial problems. Finally, they spread into physical and mental health problems. There is no other clinical condition that is quite so widespread and devastating in its effects on all aspects of life.

If someone has lost a spouse, a job and a driving license, it is superfluous to ask questions about alcohol consumption. But problems, of one kind or another, will have appeared long before that. The diagnosis can be made partly on seeing the consequences. We may not see the ‘elephant’ itself but we can see where it has been and we can deduce that only an ‘elephant in the room’ could have caused all that widespread damage.

I do not use the terms ‘alcoholic’ or ‘alcoholism’ because these name the condition after one of its treatments. In the same way, we should not name a sore throat ‘Penicillinism’.

Some of us are born with a sense on inner ‘emptiness’. We discover for ourselves the things that fill it. Alcohol will do that. So will nicotine, caffeine, sugar, cannabis and other ‘recreational’ drugs and also tranquillisers, antidepressants, sleeping tablets, painkillers and other mood-altering prescription drugs. So will gambling and risk-taking, shopping and spending, work, exercise, sex and love. Anything will do – provided that it ‘works’ and hits the spot.

We use these mood-altering substances and processes because they work: they do make us feel good, they do hit the spot and do fill up our inner sense of emptiness, if temporarily.

But then the effects wear off and we have to go back to them again in order to stay feeling normal, rather than low. We come to trust one or two substances or processes more than others because they seem to work particularly well for us.

We may become dependent on them for our good feelings and we may even need them in order to function satisfactorily in our daily lives.

Looking back to our parents and grandparents, and across to our brothers and sisters, we may see relatives who are like us in this particular respect. They may not use exactly what we use but they will have similar dependence on mood-altering substances and processes in order to feel, not necessarily on top of the world, but at least part of it.

What we may have is a genetically inherited defect in the mood centres of our brains. There will be nothing wrong with the thinking part of our brains – other than a belief that we have no problems at all and that most people are like us. In fact ten to fifteen per cent of other people are like us – and that’s a lot of people. But it isn’t everybody. We are special and different in this tiresome way.

There are particular questions that differentiate us from the – rather boring – herd. People like us tend to use alcohol in special ways:

We tend to drink quite often on our own.

We tend to be pre-occupied by alcohol, often having it on our minds, thinking about using it or planning not to use it for a time.

We use it primarily for the mood-altering effect rather than merely for the taste.

We use it as a medicine, as a tranquiliser, antidepressant or sleeping tablet.

We protect our supply, making sure that we don’t run out, whereas we are not as concerned about having the money for the rent or for holidays or even for food.

We find it difficult to predict what will happen in any day once we start to drink. We can go dry altogether for a time and sometimes we can stop after one or two drinks but, at other times, we go off into a binge.

We have a higher capacity than other people for holding our drinks without getting obviously drunk and incapable – although eventually we lose this tolerance.

We continue to drink even after we get damaged by alcohol’s effects in our lives.

We tend to find other mood-altering substances and processes as ‘first reserves’.

We become dependent on it for normal functioning.

We tend to go looking for it when we run out. We don’t like waiting.

We continue despite the repeated serious concern of other people.

If we have any four of these characteristics then our problems are likely to get worse, rather than better, in time. They are all dependent upon why we drink, rather than what or when or how much, and the ‘why’ doesn’t change in time.

I myself would not have been able to write this letter to you if I did not have these characteristics myself. In other words, I know the way out.

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