Am I an alcoholic?

Effects of alcohol

The 2010 study from the Independent Scientific Committee on Drugs (1) showed that alcohol ranked as the number 1 most harmful drug in the UK when combining harm to users and harm to others. There can be lots of arguments around this and obviously alcohol use is far more widespread than most other drugs, so this will affect the statistics, but let’s just compare it to smoking. We all know smoking is bad for us and most smokers would like to quit. But smoking only ranked 6th most harmful and had less ‘health damage’ than alcohol. When we’ve seen what smoking can do to us physically, that’s quite a scary thought.

So just some quick facts about the effects of alcohol.

Alcohol Change UK (2) says that in the UK 20 people a day die as a result of their drinking and it is the biggest risk factor for death in 15 – 49 year olds. Alcohol is also implicated in many crimes, sexual assaults and road accidents. In terms of health, the NHS (3) lists the risks involved in drinking from accidents, violence and homelessness to heart disease, stroke, and a whole array of cancers.

Am I an alcoholic?

For the next section I apologise to anyone who has found the term alcoholic helpful for their recovery. As with everything, do what feels right for you. These are just my thoughts and feelings on the subject.

This is a question I asked myself and asked Google many, many times. The problem is that it is such a huge spectrum, that most drinkers are on somewhere, that it is difficult draw a line and say – that side is the alcoholic and that side isn’t. ‘Alcoholic’ has so many negative connotations, and I have felt myself cringe since writing this blog as my parents, aunts, and others have all whispered ‘is she an alcoholic?’  But I think this negative attitude is exactly the reason why many people fail to say anything when they are struggling and don’t ask for the support they need.

When I worked in A&E a while ago, one of the questions we were supposed to ask every person who checked in was do you drink 6 or more units (8 for men) more than twice a week?” Right people, that’s two large glasses of wine twice a week or 2-3 pints twice week. If they answered yes, we were to put in a referral to the drug and alcohol team. Hahahahahahahahahaha!!! So, as you can tell we never asked that question. Firstly, people massively lie when they are asked how much they drink – society shaming us again. Secondly, nearly every single bloody person who worked there or walked through the doors would have needed a referral. What a joke! 

The scoring systems you can get from the NHS, Alcohol Change UK, Drink Aware and similar places are also not especially helpful. I scored High risk drinker on all of them, which is true I was. But they skip so nimbly from ‘Do you feel guilty about drinking’ to ‘Do you drink in the morning’. I’m sorry, but there is a huge part of the spectrum that comes between feeling guilty and drinking in the morning. So the stigma attached to being a ‘morning drinker’ puts high risk drinkers, like myself, off trying to do anything about it because you don’t want to be labelled an alcoholic.

Also, if you tell yourself you are an alcoholic, that often takes the power away from you do to do anything about it. ‘It’s an illness’, ‘It’s something genetic’, ‘Once and alcoholic always an alcoholic’. I find these phrases so massively disempowering and unhelpful. Like when I was told that once depressed, always depressed, I refuse to believe that. Yes, there may be an underlying propensity to slip back that way if I don’t pay attention to my thoughts, feelings and circumstances, but that in no way means that there is a daily battle not to be those things. You can help yourself to get out of the vicious alcohol loop, so don’t disempower yourself before you’ve even started. 

When looking at the symptoms of withdrawal they name physical symptoms of shakes, sweating, nausea, hallucinations and seizures, and psychological symptoms as depression, anxiety, irritability, restlessness and insomnia.  Now, as you may have guessed, I also have a problem with this (4). So I have seen withdrawal, and it’s not pretty. I have no argument with the physical symptoms because they are what they are, but my issue comes with the psychological symptoms. Many people who drink suffer with depression and anxiety so it’s not really a withdrawal symptom – I’ll talk more about that in a bit. Personally, I was massively irritable when I was quitting, but that’s because I was hugely pissed off that my cravings weren’t being met not because I had the irritability and restlessness that accompanies withdrawal – they look, and I imagine feel, very different.

The point I’m trying to make is there is always hope! You can help yourself! Do not disempower yourself and admit defeat before you have even started.  Be proud of yourself and what you are doing, it is strong and brave. Acknowledging you have a problem is hugely important, but don’t label yourself and alcoholic with all its negative connotations, unless you find it helpful. You are a survivor and a warrior. 

So for the purposes of this post I am talking to all those people on the spectrum before physical dependence. If you are trying to quit and suffering from shakes, sweating, or fever, nausea, stomach troubles, hallucinations or a restless irritability that cannot be distracted, then please seek professional help.

Bit more than a habit

I said in my previous post Why do people drink?, that to describe my relationship with alcohol, habit is too weak, but addiction is to strong.  So I was intrigued by this and wanted to find out why it is harder to quit drinking than it is to change other habits. I wondered if I was completely wrong and maybe you were immediately addicted to alcohol and that was that. So, this is what I discovered. A habit has 4 stages that follow the same route every time. I have taken this from James Clear, who wrote Atomic Habits  – a book about building good habits and breaking bad ones (5).

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These stages are

  1. Cue
  2. Craving
  3. Response
  4. Reward

If you do something repeatedly, your brain associates the reward with the cue, so the next time you see the cue, it will trigger the craving, your response and then the reward. It is continual loop. Your brain is scanning all the time for rewards and the cue shows your brain that a reward is coming. For example, when I was drinking I always drank in the kitchen while cooking. So every day, opening the fridge and starting to cook was my cue. I then craved the drink, my response was to reach for it or go and buy it, and then my reward was drinking it. It was a very well used loop. If I didn’t get my reward I was a bad tempered cow until I was away from the cue and the craving subsided.

The theory goes that you have to break the loop somewhere and you can break the habit. No one is forcing you to respond (pick up the drink) other than yourself. That all sounds lovely in theory but anyone who has tried to break any habit, let alone alcohol, knows it’s a bit harder than that!  You also have to break the habit consistently. Studies claim this can be anywhere from 18 to 245 day of consistent loop breaking (6)! This is where despondency comes in, as people believe they just need willpower.

But something wonderful that is becoming more accepted is that there is no Day 1! On social media particularly I see people so devastated because they had a drink and feel like all their effort has been wasted and they are back at the beginning. I was completely the same, and every time I drank I felt like a monumental failure. But studies are showing that when forming a new habit, if you slip up one day, you do not go back to the beginning.  As long as you start again with forming your new habit, all the hard work you have done to this point is still there (6).

We have all tried to break a habit, so why does breaking the alcohol habit seem so much harder?

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Alcohol and the brain

The neurochemical changes are what make alcohol a harder habit to kick.  

We have seen from the habit making that what we are craving is the reward. So with alcohol, this has a few factors.

  1. Endorphins – we’ve heard of these right? The happy hormones.  Drinking triggers the release of these happy hormones making us relaxed and euphoric (7) 
  2. Dopamine – alcohol releases dopamine into the ‘reward centres’ of our brain making us again, feel great (8)
  3. Serotonin – this is the chemical we use to have those nice feelings of wellbeing. When we drink alcohol, we temporarily boost those nice wellbeing feelings (9).
  4. GABA – this is an inhibitory neurotransmitter. Alcohol mimics the GABA signalling in the brain meaning that it inhibits brain activity, giving those feelings of inhibition, relaxation and sedation (10)

Our brain is continually creating neural pathways. The more often these pathways are used the easier it is for the brain to send signals down the same pathway. The brain is constantly looking for rewards so it is going to use the neural pathway that will reach this goal the quickest. With alcohol, it is not just the reward from satisfying the habit that we are chasing, it has added a whole host of other nice things above to make it even more rewarding.  The more we satisfy the habit and the more alcohol we drink, the easier it is to follow this neural pathway.

No wonder it is harder to kick the alcohol habit!

The problem when we drink far too much for far too long is that the body starts adapting. This is the land of physical addiction so I won’t go into too much detail but briefly, your body gets used to the increased GABA sedation effect so produces glutamate to excite brain activity. This will make it harder for the person to get the same sedative effect, so they will have to drink more. Too much glutamate causes those withdrawal effects when there is no alcohol to mimic the GABA effect (7).  

With long term drinking the effect of dopamine is practically non-existent and serotonin levels are reduced. This leaves the drinker chasing rewards that they are not going to get (8,9).

Why does alcohol make anxiety worse

Anyone who has drunk too much for too long will be able to attest to the awful feeling of anxiety that accompanies drinking. I read an interesting article that explained why this could be (9). It suggested that low blood sugars, caused by the body producing insulin in response to alcohol, lead to dizziness, confusion and shaking which can mimic and trigger anxiety attacks. It says that symptoms of dehydration can trigger anxiety as they mimic the symptoms of illness.

Long term drinking leaves the body with higher levels of stress hormones. It also depletes vitamin B6 and folic acid which help the body manage stress and reduces certain neural receptors that would normally help the calm the mind.

Not a good combination! This is likely to be why my anxiety, which was getting worse as I got older, is virtually non-existent at 14 month sober.  I would say that alone, is well worth quitting for!

Reroute neural pathways

The hugely positive thing is that we can change all this! Our brains are so clever that we can retrain them to stop our destructive behaviour. Neuroplasticity is the brains ability to find new neural pathways to follow (12, 13). The more we use the new pathway, the more secure it becomes and the easier it is for the brain to use it.

In the next post I will look at how to change our habits, start to create new neural pathways and overcome the effects of alcohol. But the amazing thing is, the more we understand what is going on inside us – physically and psychologically, the more likely we are to be able to put a stop to it once and  for all!

References:

  1. https://www.bbc.co.uk/news/uk-11660210
  2. https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics
  3. https://www.nhs.uk/conditions/alcohol-misuse/
  4. https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mental-health/alcohol-withdrawal-symptoms/
  5. https://jamesclear.com/three-steps-habit-change
  6. https://www.theguardian.com/lifeandstyle/2009/oct/10/change-your-life-habit-28-day-rule
  7. https://drugabuse.com/alcohol/alcohol-addiction/
  8. https://www.forbes.com/sites/daviddisalvo/2012/10/16/what-alcohol-really-does-to-your-brain/#2994b58c664e
  9. https://www.goodtherapy.org/blog/negative-effects-alcohol-anxiety/
  10. https://www.therecoveryvillage.com/alcohol-abuse/alcohol-and-gaba/#gref
  11. – telegraph – alcohol resleases addcitiev endorphins article
  12.  https://www.mentalhelp.net/addiction/changes-the-brain/
  13. https://www.psychologytoday.com/gb/blog/ending-addiction-good/201302/neuroplasticity-and-addiction-recovery?quicktabs_5=0

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