“There is no such thing as alcoholism”, claims Laurence Inman
By Laurence Inman.
Only someone living on Mars for the last five years could fail to notice that alcohol consumption is increasing and that increased consumption (and availability) are leading to ever more serious problems.
For those of us who don’t want to get completely legless and start a pitched street battle over somebody pushing in at the kebab-house, our city-centres are effectively no-go areas.
But the problems caused by drinking on the night (violence, mess, the cost of policing drunken crowds and treating injuries) are as nothing compared to the price paid later in terms of days off work, domestic violence and chronic illnesses, both mental and physical, which claim, at a conservative estimate, a quarter of a million lives every year.
As a nation we seem unable to think along a straight line on this issue. We know there are huge problems with alcohol, that things are likely to deteriorate, and at the same time adopt a sniggering boys-will-be-boys attitude when we hear about someone we know ‘having a few too many’ or ‘pushing the boat out’ or ‘painting the town red.’
Here is part of the problem: the lexicon of clichés we have come to rely on to diminish the size of the monster. Nice happy drinkers are ‘revellers’ until they pass a certain point and become ‘boozers’, then ‘drunken yobs.’ Their antics are ‘alcohol-fuelled’ and so not entirely their fault. Famous drunks, like Oliver Reed, are ‘hell-raisers,’ so that’s okay.
The scale of your drinking is carefully graded using pre-packaged phrases. ‘Social drinking’ can turn into ‘frequent drinking’, then ‘heavy drinking’ and finally ‘binge-drinking’. But this is still all right, because you have not yet reached what everyone agrees is the worst stage: alcoholism.
We should think seriously about this word.
What is an alcoholic? Someone who is addicted to alcohol, is the conventional reply. We have a full cast of characters in our heads who fit the bill: the tramp on a park-bench, the middle-aged divorcee who swigs whiskey before breakfast, the bored housewife on a bottle of vodka an afternoon. Films and books have also given us plenty of material: think of Ray Milland in The Lost Weekend.
How do you become an alcoholic ? By drinking too much too regularly, we think. You gradually just turn into one, in some mysterious way. It doesn’t happen to everyone, of course, so it’s probably just a matter of luck.
These are comforting thoughts, but more and more doctors and health-professionals are coming round to the idea that there is no such thing as alcoholism, and that alcohol is not an addictive substance.
They point out that true addiction has four characteristics: uncontrolled craving, increasing tolerance, physical dependence and harmful effects on the subject and society.
Only the last of these applies to alcohol. The increasing tolerance which many habitual drinkers feel they have (‘I can take my drink’) is largely an illusion; they just become better at acting more soberly and will modify their speech and behaviour so that the effects of their drinking are not so obvious. In fact, a lethal dose is no higher for a big drinker than a total abstainer, whereas a long-term heroin addict can take enough smack to kill an ordinary person many times over.
Similarly, the ‘craving’ for a drink is not physical; heavy drinkers feel better when they stop; the insistent desire to be down the pub in familiar surroundings is purely psychological.
Likewise, there is no real ‘dependence’, in the sense that alcohol becomes an integral part of a modified chemical process in the body’s systems. The fact is that the body, from first drink to last, rejects alcohol as a toxic substance. Many of the physical consequences of drinking arise from the inflammation which the digestive system puts in place to protect itself.
Even the supposed ‘withdrawal’ symptom, Delirium Tremens, as seen most graphically in The Lost Weekend, is now known to be a consequence of simple damage to the nervous system through heavy and prolonged drinking, not sudden abstinence.
These ideas are not new. Writing in 1913, Jack London, who destroyed himself through drinking, retained enough insight to realise the truth: Drinking, as I deem it, is practically entirely a habit of mind. It is unlike tobacco, or cocaine, or morphine, or all the rest of the long list of drugs. The desire for alcohol is quite peculiarly mental in its origin. (John Barleycorn, Ch 34.)
It’s a pity that London, along with Scott Fitzgerald, Hemingway, Dylan Thomas and Louis MacNeice, are remembered as much for being drinking ‘characters’ as for their writing. It is just possible that they could all have lived longer, and written even better, without the drink.
Most doctors will tell you that the patients they see with drinking problems alternate between total abstention and gross excess. In other words, they are binge-drinkers.
This pattern is totally unlike true addiction. The disturbing fact appears to be that there is no such thing as alcoholism, only drinking, more or less. Even more alarming is the likelihood that there are literally millions of people in this country for whom the phrase ‘problem drinker’ might have been invented, but who can comfort themselves with the idea that because they do not conform to the stereotype of the alcoholic which has been fed to them all their lives they are safe.
So, whose interests are best served by this hugely misleading idea ? The drinks industry of course. The people who are selling your kids bottles of vodka that taste like orangeade and assuring them that they have nothing to worry about, because they are not living on a park-bench.