Book Preface: Overcoming Alcohol Misuse, A 28-Day Guide

Testimonials: Overcoming Alcohol Misuse, A 28-Day Guide

List of Contents: Overcoming Alcohol Misuse, A 28-Day Guide

Introduction: Overcoming Alcohol Misuse, A 28-Day Guide

How to Use this Book

This book provides a clear step-by-step guide to achieving sobriety. It looks at all the important issues associated with that achievement, and aims to do so in a caring and accessible way.

I have spent many years trying to understand just how an ordinary person can develop an addiction to alcohol. My years in the fi eld of psychiatry have taught me that alcohol misusers are among the most ‘normal’ of people to suffer from mental health issues, and yet they do the most damage to themselves, their lives and the lives of those around them. I have asked hundreds of alcohol misusers over the years how they developed alcohol dependence and the most common answer is that they just drifted into it. A series of tiny changes in habit and attitude to alcohol over years can produce full alcohol addiction. So, a significant part of the book deals with the question: ‘Where am I and how did I get here?’

This book is a series of pointers, guidelines and principles learned from people who have entered recovery, from my own observations of the numerous sufferers I have treated and from research carried out by the best minds in the recovery field. I have been conscious of including information on treatments and techniques that actually work. I have tried to make sure that the principles and guidelines I advocate are not just theories, but are proven methods that are effective.

The book contains twenty-eight chapters, to reflect the standard care plan of twenty-eight days in rehabilitation. The chapters provide background information and deal with the various issues that an alcohol misuser entering rehabilitation might face over the course of the 28-day period. The chapter points at the beginning of each chapter set out the theme of the chapter. The learning points at the end of each chapter indicate what I want the reader to get out of the chapter.

At the close of each chapter I’ve included a case study. The case studies, in most instances, are based on people I have met and helped to treat for their addiction. I’ve also included a couple of cases relating the recovery from addiction of people in the public eye. Each chapter contains an instalment of ‘Joe’s Story’, which relates the day-to-day experience of one person as he journeys from alcohol misuse into sobriety over that crucial fi rst twenty-eight days. Joe’s experiences show just how complex and individual that journey can be. He is not based on any particular individual, but aspects of his journey do refl ect the experiences of different people I have come across in my work.

The book is divided into three sections; however, the sections are not self-contained and feed into each other. The fi rst section (Chapters 1−10) provides basic information about alcohol addiction, including the causes of alcoholism; the effects of alcohol on the body; the effects of alcoholism on all aspects of your life, including family, work and friends; associated problems such as depression; important information on ‘types’ of drinkers; and the importance of treatment. This is useful information for alcohol misusers, their concerned loved ones and interested professionals.

The second section deals with the bridge between alcohol addiction and recovery – that period of change and the beginning of sobriety. Chapters 11−16 look at how the alcohol misuser can be drawn into the recovery process through becoming aware of the damage the addiction is causing to themselves and those around them. A key concept here is insight. Once the alcohol misuser has achieved some insight into their condition, this can be worked on by a professional therapist or counsellor to help them into long-term sobriety. A concerned loved one may fi nd this section interesting from the perspective of gaining insight into the mind of the alcohol misuser and the various forces that infl uence it, including those related to withdrawal and anxiety.

The third section (Chapters 17–27) provides information about the various techniques that are helpful in the recovery process, giving balanced information about different treatments and allowing the alcohol misusers themselves to choose what suits them. This section is also valuable for the family member or friend standing by during the recovery period as it provides insight into what the stages of recovery entail for the alcohol misuser. This section would also be of use to a treating professional, giving the positive and negative elements of each treatment technique along with an update on the latest treatment research.

Chapter 28 provides a summary of the most important principles in treatment, for both the alcohol misuser and their loved ones. Information is provided in the Appendix on professional organisations that can help in guiding someone through his or her recovery process. Like all of the methods described in this book, not all of the organisations work for everybody, but sometimes a range need to be tried out for the alcohol misuser to fi nd what is effective for him or her. It is important to remember that recovery is a work in progress and not a destination.

The book can be read one chapter at a time, one day at a time. It can be dipped into at any stage in the recovery process. As each person’s recovery journey is individual, different issues need to be dealt with at different times. So, some parts of the book may be more relevant than others at any one time. The principles, guidelines, instructions and observations can be used on and off, according to an individual’s needs. The chapters are intentionally brief and the topics dealt with cover all aspects of alcohol misuse and recovery. I wish to reach the largest number of sufferers and their families. I hope that such a broad approach will increase the chances of individuals landing on a treatment that works for them or coming across a story of alcohol abuse and recovery that will resonate with them.

Extract: Overcoming Alcohol Misuse, A 28-Day Guide

Chapter 11: Realising the Need to Change

Every alcohol misuser has a vulnerable point that can help them to realise their need to change.

When we decide to change anything significant in our lives, from changing a car to ending a relationship, we usually go through a process of evaluation of the reasons for the change, the arguments against it, the difficulties involved and whether we will be able to stick with that change.

When contemplating changing your drinking pattern to become a lighter drinker or a non-drinker, the same criteria apply. It is a serious decision, maybe life changing, and it deserves careful evaluation. But first the alcohol misuser must recognise that he or she has a problem.

Refusal to Acknowledge and Reluctance to Acknowledge

It is possible for an alcohol misuser to be in a state of precontemplation, denial or what I term RTA1: Refusal to Acknowledge. There really is no such thing as denial, despite that term being used frequently in the field of addiction. No one goes through alcohol addiction without being partially aware of what is going on and of what alcohol is doing to them. Refusal to Acknowledge is not the same as complete unawareness and a total inability to see. Unless someone with alcohol dependence is severely brain damaged, he or she must have some level of awareness of the issue, albeit with a lack of appreciation of its extent. The use of the word ‘refusal’ signifies that it is important to recognise that this state is a voluntary one; it is the result of a choice. Most sufferers from addiction are in a state of proud RTA1.

If a person moves from the state of RTA1 to the state of Reluctance to Acknowledge or RTA2, then progress has been made. This stage is different from RTA1. It implies at least a possibility of change; it suggests that someone is prepared to consider the issue, albeit without making up their mind. The change from RTA1 to RTA2 is never a simple process, but the states are not too far apart. Most people who proudly proclaim that they are in RTA1 are partially in RTA2; they just don’t say so. Their refusal is a public stance, an angry one, a determined one, but never a complete one. There is always an evaluation taking place at the back of the brain, there is always questioning and there is always an internal back-and-forth dialogue going on. Unless there is brain damage or continuous intoxication, there is always the possibility of acknowledgement, the possibility of change.

Outside pressure can be both helpful and counterproductive. Outside pressure is often required to encourage some people from the RTA1 to the RTA2 stage. However, outside pressure also allows some people to stay in a state of RTA1 because of their pride. Pride and obstinacy block the process of change. Most people with an addiction find swallowing their pride incredibly humiliating and difficult. Like an ageing dictator who refuses to believe that the time to step down has come, so the alcohol dependant clings to the last vestiges of the old system of self-belief and self-delusion. Acknowledging your difficulty with an addiction means letting go of what has become an entire way of life and an entire way of thinking, and puts paid to the belief, ‘I am in charge and not the addiction.’

Facing Reality

Everyone has something of which they are proud – an achievement, a relationship, a talent or ability. Everyone has a plan, a desire to achieve in some way. Everyone has a dream, however farfetched it may seem to the outsider. The change from RTA1 to RTA2 involves not just acknowledging the addiction but admitting to reality. This means giving up the illusion and admitting to the sordid reality of day-to-day addicted life. It feels like giving up hope, to the alcohol misuser. It involves giving up a unique personal way of thinking.

Everyone, when growing up, creates a set of core beliefs about themselves that determine their life choices: ‘I believe I am good looking; I believe that I am a talented artist; I believe that I am a good and kind person; I believe that I am intelligent; I believe that I am in control of my life.’ We all build our lives on these beliefs about ourselves. You wouldn’t become a model if you didn’t think you were good looking. You wouldn’t become a scientist if you didn’t believe you were intelligent. You wouldn’t strive to work as a carer if you didn’t think you were kind. Some of our core beliefs are built on the idea that we differ from others in a particular way. We all want to excel at something and to set ourselves apart. We want to be acknowledged, loved and admired for that talent, ability or achievement. We all want to be different to those around us, to be proud of ourselves because of that uniqueness.

To an alcohol misuser, acknowledging their addiction means being humbled and acknowledging their sameness; it means giving up their core beliefs about themselves. Acknowledging your addiction involves a massive change in your dreams and goals. It means admitting that your core beliefs are wrong, and that your dreams and goals have to be changed. Everything you have built your life on has to be altered. It is like being reborn. You start off at the age of twenty, forty or fifty to try and reconfigure your future in some new and unattractive universe, while having to admit that a lot of the past ten or twenty years has been wasted time. Let’s face it, that’s a big ask. You might say that the alcohol misusers stuck in the RTA1 stage are akin to Wild West heroes, stubbornly refusing to change and sticking to their addictive guns despite everyone being against them. They will defend the ‘small town’ of their own core beliefs against the ‘outlaws’ of reality. But this attitude is ultimately destructive.

Moving from RTA 1 to RTA 2

Trying to get someone to move from RTA1 to RTA2 involves two things: identifying a consequence of that person’s addictive behaviour or lifestyle that upsets him or her and, frankly, ‘beating them up’ about it. This vulnerability may be the fear of the personal health consequences, as outlined in Chapter 4; it may be the fear of losing a core relationship with a spouse or child; it may the shame of the damage being caused to loved ones; it may be the fear of a loss of status and finances due to potential job loss. It can be anything that the alcohol misuser cares about, and the trick is to make that potential loss or shame as real as possible. I discuss the point of vulnerability in more detail in Chapter 12.

Getting the alcohol misuser to commit to change involves showing an understanding and appreciation of just how difficult the change will be for them, and how much pride and self-belief are being destroyed, and offering the addict support as they make the transition. Because this duality of tasks is often too difficult for a close family member to do correctly, and because it involves being harsh at some times and supportive at other times, it is often best to have the help of a professional in order to achieve that balance. Most spouses or others close to the alcohol misuser either end up being too harsh or too supportive (enabling), simply because they are too close to the situation and its consequences to be emotionally objective.

The process of undergoing change involves a simple equation: when the pain gets too great for the alcohol misuser, therein lies the motivation to change. If there is no pain, or if the pain is too little, then there is no motivation, or at least not adequate motivation, to change. This implies that motivation to change will not come from minor stresses, but from major ones; it won’t come from minor emotional upsets, but from significant emotional threats. The threat may or may not be real, but it is vital that the alcohol misuser perceives it as real. Since addicts are masters at reading the difference between a verbal threat and real intent, and it often takes real intent to force an addict to listen, benign goodwill will not do the trick.

What are the Reasons to Continue Drinking?

Part of any process of change is to assess the reasons for and against a particular activity. In this case, it involves looking at reasons to drink and reasons not to drink.

Reasons to Continue Drinking:

• I like it
• It is not causing me any harm
• What else can I do with my time?
• I enjoy getting drunk; I get a thrill from it
• I can afford it
• It makes all my problems disappear, right now
• It really diminishes my anxiety and makes me more sociable
• It makes me forget my depression
• I really crave a drink
• I really need alcohol
• Nobody cares for me and so it doesn’t matter
• I only take some every now and again so it doesn’t matter if I drink or not
• It doesn’t affect me so why shouldn’t I?
• I have lost everything due to drink, so what does it matter if I do?
• I love drinking so much that I simply cannot do without it

The main thing to note about the above points is that the subject is consistently ‘I’ and ‘me’. There is no reference to anyone outside of the individual, and so all the reasons to continue drinking are selfish. The pride of the drinker is a selfish pride. There is little room for others in the drinker’s reasoning. Thus, the question to ask is: what about other people?

What are the Reasons to Change

This list of reasons to change is endless, and there is nothing on this list that applies to everyone. Everyone is different, and everyone has unique aspects of their lives and their relationship with alcohol that makes drawing up a sensitive and specific list for everyone impossible. However, perhaps some points might make sense to the individual alcohol misuser.

Reasons to stop drinking:

• My life is a mess and if I don’t change I will have nothing
• I can aspire to better things
• I have hope that things can be better
• I will lose my marriage if I don’t stop drinking
• I will lose my children if I don’t stop drinking
• I will lose my job if I don’t stop drinking
• My health is suffering due to drink and it will get worse if I don’t stop
• I am disgusted with myself
• I want to be in control of my life and not under the influence of any stupid substance
• My life hasn’t moved on since I started to drink heavily, and I am stuck in the past
• I am so depressed and anxious, and drinking is making it worse
• I am only drinking to stop the effects of withdrawal
• I will die from drinking if I don’t stop

The important thing about the motivation to change is that it is a journey from a dreadful place to a much better one. If the bad place isn’t bad enough, there is no reason to move on. Equally, if there is no better place to move on to, there is also no reason to move on. As a sufferer moving towards getting help, you must revise your goals and change your ambitions. If you don’t, you will not move on, no matter how horrible the current situation is.

What if There Is No Desire to Give Up Drinking?

This is probably the most important question in this book. What can you, as a relative or spouse, do if the addicted person has no expressed desire to actually give up alcohol? What can you, as an alcohol misuser, do if you are drinking too much and yet you feel the task of giving up impossible? What if you, as an alcohol misuser or a concerned person, are banging your head against a brick wall again and again and nothing is happening to change the pattern of alcohol misuse?

First, you will recall those three personality traits that the alcohol misuser may have (see Chapter 3): alcohol misusers can be more adventurous than other people; they continuously seek out pleasurable things; and they don’t always learn from negative consequences. That particular combination of personality traits lends itself to the alcohol misuser not paying attention to outside circumstances and only responding to internal personal triggers. Thus, outside circumstances are going to have to be on a pretty large scale to register with the alcohol misuser.

Second, no one can take anything on board when they are intoxicated or in withdrawal from alcohol, and thus someone who is drinking heavily needs to have the alcohol out of their system before anything can register at all.

Third, there is no single factor that can be made register with the misuser of alcohol. An individual can only react to personal circumstances and pressures. In general, it is impossible to say what that individual’s point of vulnerability is, but it is true to say that most people have at least one. The objective is to find the point of vulnerability and direct the alcohol misuser’s focus to it. What an outsider thinks may register with the alcohol misuser may not register at all; he or she might have a completely different set of motivations from what would be expected by others.

Balance of Forces

As a relative or friend trying to encourage an alcohol misuser towards abstinence, ascertaining the balance of forces in that individual’s mind may be helpful. That is, trying to understand the forces that are pulling the person towards drinking and trying to fathom the forces that are pulling the person towards sobriety. These forces are completely individual and cannot be predicted simply by guessing.

From the inside, an alcohol misuser needs to try and focus on the negative consequences of drinking in order to increase the pull of sobriety. In general, this means focusing on long term goals and issues rather than short-term goals. Most of the benefits of sobriety are long term and most of the problems (even those caused by alcohol) are immediate, and alcohol may provide an easy escape route from current reality. Thus, moving the alcohol misuser’s thought pattern from immediate benefits to negative consequences is vital, and needs to be an ongoing struggle. Short-term pain and long-term gain is a lot better than short-term gain and long-term pain.

The alcohol misuser may slowly realise that alcohol is the boss and that there is a need for change. Change may take time. Things may get bad before they get better. Personally, I have seen the most appalling situations turn around with persistencye and I have seen impossible situations resolved. If the intention is there, the situation will eventually be resolved.

Finally, motivation is not an unchangeable and unitary condition; it is composed of various competing forces and these forces can change over time. Motivation, one day, may be focused on getting rid of powerful anxiety symptoms associated with withdrawal (perhaps by drinking), and a few days later it could be focused on trying to avoid relapsing. One day’s priority may be to remain sober and make up for the past; the next day, motivation may be affected by having to deal with strong cravings for alcohol. The particular reasons that got a person to stop drinking may need to be revised and reassessed daily to get that person to maintain abstinence.

If an alcohol misuser’s suffering is their motivation for recovery, then it is vital that this suffering is put to good use and that a recovery journey is plotted for them to follow. It is vital that the alcohol misuser learns techniques to deal with the addiction so that their suffering is not in vain.

There are more reasons to give up alcohol than not.

Case Study: The Famous Alcohol Misuser

Reginald was born into a small working-class family in the suburbs of a medium-sized town. His father deserted the family at a young age and, as he grew up, Reginald’s mother was the mainstay of his life.

His passion was music and he listened to all sorts of music throughout his teenage years. He learned to play the piano, and started playing in banks to try and earn some sort of a living. He wasn’t able to compose lyrics of any quality, but found he could compose songs if he had lyrics to compose to. He teamed up with a poet and song lyricist and, after a few false starts, he starting writing and recording songs. He released a few songs that made no commercial impact, but attracted the interest of music critics. He finally released a successful song, and it became a worldwide hit.

Over a period of ten years he released record after record, toured constantly and became famous. He knew from a young age that he was homosexual, or bisexual, but failed to acknowledge this fully to himself or to the public, and this led to a number of disastrous relationships, including a failed marriage.

As part of the endless cycle of performing and recovering, and partly to deal with his troubled personal life, he became addicted to alcohol and other drugs. He was addicted for the best part of twenty years, despite being recurrently and highly successful.

He met a young boy with AIDS named Ryan and the boy’s loving mother, which changed his life. After the boy died and he observed the extraordinary courage and dedication of the boy’s mother, who continued to campaign to raise funds to research AIDS after her son’s death, he decided to admit to his problems and get help. In part, he empathised with his own mother’s struggle to cope with his problems, and he understood the hurt he caused her. He also felt guilty because those problems were self-inflicted and the pain she suffered was caused by him.

He openly says that he felt worthless at that time, that his life was ‘shit’ and the only thing he had going for him was his career. He checked himself into rehab. He hasn’t used alcohol or drugs since. He is more commonly known as Elton John, but his fame and money didn’t help him with his addiction. That was both a very common and a very personal struggle.

Joe’s Story: Day 11