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Christmas Survival Guide For A Recovering Alcohol

December 4, 2018admin Alcohol

Christmas parties are very special. We relax. We enjoy ourselves. We make friends with colleagues we hardly know. I do all of that even though I haven’t drunk alcohol since 12th October 1984.

I get heavily stuck into fizzy water. This has a number of very clear advantages. I do remember what I was doing, I don’t have a sore head and I don’t have to apologise to anyone. But, more significantly, I enjoy myself much more than I did in the old days when my reduced inhibitions caused mayhem.

I don’t drink at this time of year, or any other, because I’m not a very good drinker. I drink alcoholically. Once I start I don’t know when – or how – to stop. The drink takes me over.

The festive season is much less dangerous for me nowadays than it used to be. Today all I have to watch out for is the drunken or drugged behaviour of other people. And I have a clear head that enables me to make careful judgement.

I enjoy conversations where I’m not slurring my words or repeating myself. Nobody frowns at me or walks away.

I feel free of the need to make escape plans because there’s nothing I want to escape from. I enjoy being in sociable company until such time as other people, through their alcohol or drug consumption, become unsociable. Then I go home and read a book or play my electronic keyboard (with my headphones on so I don’t disturb anyone else).

Previously, after a splendid party, I might not remember how I got home. And I certainly wouldn’t be capable of reading a book or playing a piano. And I might disturb the neighbours by singing The Hallelujah Chorus or Eskimo Nell at the top of my voice.

I stopped drinking because I wasn’t very good at it. Previously I thought I was a bad man but a good drinker. Now I recognise that I’m capable of being a good man but I’ll always be a bad drinker. So I don’t start.

I spend my time doing things I’m good at. Nowadays I’m a responsible husband and an entertaining companion. I thought I was always that… well… most of the time. But the reality was a far cry from my recollection. In the old days, when I was told by my wife and other people that my behaviour had not been my best, I wondered what they were talking about. Today there is no confusion.

I anticipate having a sober Christmas this year because I’ve had one every year for the last 34 years. I remember them clearly. They’ve been a lot of fun. Nowadays the holiday season usually sees my wife and me in a quiet hotel on a pleasant island, enjoying ourselves in our own special ways, hiking, going to restaurants, listening to music or doing puzzles. We work hard enough during the rest of the year. This is how we relax.

Other people may find this form of relaxation to be a very strange description of an enjoyable holiday. I can assure them that if I were to drink again, I very soon wouldn’t have a wife and I wouldn’t be able to do the happy and rewarding things I do now.

People in continuing recovery from alcoholism or drug addiction tend to have very similar strategies for getting through the Christmas and New Year holiday season.

We spend some special time meeting each other – just to say how grateful we are to be in each other’s company rather than in a hospital or drunk tank or police cell or asleep in the street. I myself have been very fortunate. I’ve never had any of those experiences. This makes me even more grateful to be with those who are alcoholics or addicts like me. I got off the crazy merry-go-round before I fell under it.

If other people find they need a strategy to keep them on the straight and narrow, they might find it beneficial to join my friends and me now, rather than wake up in a few years’ time when they’ve caused themselves – and possibly other people – a lot of damage.

Happy Christmas everybody!

Avoid an alcohol relapse over the festive season

November 29, 2018admin Alcohol

The busiest day of the year in my rehab is January 13th. The hope at home is that everybody will be relaxed, enjoying themselves and having a good time over the holidays. The reality of the Christmas period is that it is often a very stressful time.

Families gather round to have a good fight. Old resentments come bubbling up. The ironic statement that families are for Christmas – and only for Christmas – becomes painfully true.

For alcoholics and drug addicts it can be a very challenging time. If, from previous experience they recognise the need for abstinence, they may get through the break by ‘white knuckling’ it. They clench their fists in determination. That hardly makes for peace and good will!

In the UK we live in an alcohol using society. Alcohol tends to features in all celebrations. It’s in our culture. We comfort ourselves over the past with a drop of the hard stuff. We rejoice in the present with hooch. We toast the future with booze. There’s no getting away from it.

And drugs are more frequently tolerated nowadays. They’re often seen as the alcohol of a younger generation. In the mistaken belief that ‘soft’ drugs like cannabis and amphetamines (speed) are relatively harmless, there is increasing pressure towards legalisation. At a significant level, drug use of one kind of another is becoming a new norm. ‘Substance abuse’ is seen as a term to be used by doctors and social workers, not by people having a toot of cocaine of a bit of wacky backy to enjoy themselves.

The holiday season is a high risk time of year for people ‘in recovery’ from alcoholism and drug addiction. ‘Recovering alcoholics’ and ‘recovering addicts’, as they describe themselves, are abstinent. These people know they are vulnerable to relapse because they’ve relapsed so many times before. This results in them being highly alert and vigilant over the Christmas and New Year holiday time. And then – on January 13th – they relax. And bang! Down they go.

An underlying alcohol addiction or drug dependency does not take holidays. It stays with us wherever we are and whatever we do. And we resent that. We feel that only weak people are alcoholics and addicts. The truth is often the opposite.

Addictive disease is no respecter of persons. It affects prince and pauper, egg-head and air-head, alike. Many people who are absolutely determined to prove to themselves and other people that they are most definitely not addicts in any way, simply defer the day of recognition that they are.

An alcohol rehab like mine focusses on accurate diagnosis on an addictive nature. Over-diagnosis (labelling people as alcoholics when they are not) is just as dangerous as under-diagnosing (failing to pick up the early signs of a progressive illness). My questionnaires on this website make clear distinctions between people who are addicts of any kind and those who are not.

Addiction treatment has to be targeted towards long-term addiction recovery. The goal is to avoid relapse. This is not achieved by the three things families most often believe in and fervently put into practice: love, education and punishment. The approach that is successful in gaining continuing relapse prevention is daily commitment to working the Twelve Step programme, first introduced by Alcoholics Anonymous.

The love that works is the love that people in recovery give to each other. The effective principle is that ‘we keep what we give away’.

The education that works is through gaining an understanding of addictive disease as a condition that is probably genetically linked, affecting some families in particular.

The punishment that addicts learn from is the punishment we give to ourselves. We get sick and tired of being sick and tired.

Staying clean and sober during the holidays is no different in principle from relapse prevention and staying abstinent and enthusiastic at any time. Working the Twelve Steps of the AA programme each and every day takes very little time but the benefits are lifelong.

Using the support group of AA, or another anonymous group for another addiction, maintains contact with people who understand the nature of the problem instinctively. A sober friend is a friend indeed – and often has a cracking sense of humour: alcoholism is a serious malady but members of AA know very well how to poke fun at themselves when they are fully aware of their previous insanity.

I last used alcohol, or any form of addictive substance, on 12th October 1984. Nobody has to pick up the pieces after me these days. That adds up to many many happy holiday seasons, not only for me but for my family as well.

Addiction and the Holidays

November 23, 2018admin Addiction

Holiday times are good times. Aren’t they? Nowadays, with air travel, the holiday season can be at any time of year. The good times don’t need to fade away into distant memory. We can have them again whenever we want. A holiday gathering can be a family gathering with any number of family members. Or it can be a fun time meeting new people and making new friends in holiday parties day after day. The sweet life, la dolce vita, is ours for the taking.

Or is it?

My experience, from running my own treatment centre for 23 years, is that holidays can be grim times for addictive families. Addicts let their hair down at other people’s expense. What they call ‘fun’ can be a wretched time for people close to them.

Getting ‘smashed’, ‘wasted’ and ‘out of it’ can be literally true. I did exactly that, in one way or another, many times.

And then I wised up to what I was doing to my mind, my relationships and my life. I was destroying them. My mind was besotted by chemicals. My close relationships were with addictive substances and processes rather than with people. My life was a mess.

Eventually I lost my genuine friendships and found fair-weather friends instead. They weren’t going to criticise me or, worst of all, tell me how much they carefor me. They would leave me alone to get on with my life in my own way.

Until the only person left in my life was me.

I wasn’t aware of what I was doing to my mental health. I knew I didn’t have mental illness, as defined in psychiatric text books. Therefore it never occurred to me that I might not have mental health.

As an active addict, my primary quest in life was to find the next ‘magic fix’, something or somebody to lift the sense of inexplicable inner emptiness that accompanied me wherever I went and whoever I was with.

I thought the terms ‘alcoholism’ and ‘drug addiction’ applied to other people, not to me. I genuinely could not see what I was doing to myself. In my psychological state of ‘denial’, I thought I was in great shape. In this respect I told my truth. But I could not see that my truth was wrong.

I didn’t see that my ‘drug dependence’ was no different in principle from that of any addict, even though I was not using the particular drugs that some other addicts used. I looked always for the differences between us rather than the similarities.

I was just as much a drug addict as any other. My substance abuse matched the addictive process of any other person hooked in a dependency.

Certainly, regardless of the precise nature of my various addictions, I got many of the addictive characteristics that caused havoc in the lives of other addicts. I damaged every aspect of my life and I didn’t see that I was doing so.

Because I was having a great time, a wonderful time, a fabulous time. Wasn’t I?

Eventually, when everything fell apart as it inevitably does with alcoholics and addicts of any kind, I asked for help. For my wife! I wanted her back. I couldn’t understand why she would walk out on me. I was fun to be with. Wasn’t I?

I simply did not see that I was an addict of any kind or that I needed addiction treatment of any kind. A treatment programme, treatment centre or rehab was for other people. Not for a sane and sensible person like me, still in full-time work, earning my living and paying my way.

And then the most extraordinary thing happened. I met people who were just like me in the Rake’s progress they described. But they were having really happy lives, not the pretence that I put on for show. And they weren’t using any addictive substance or process.

I hadn’t believed it was possible to be happy without using something to ‘make’ me happy.

They describe themselves as ‘recovering addicts’. They still acknowledged they have addictive natures but they don’t give in to them. I was amazed. I’m pretty tough. I’ve been to British private school, done time in the army, and been a junior hospital doctor. But I had never been tough enough to beat my addictions. To be sure, they must have superhuman powers!

But they seemed to just like me, coming from the same emotional ‘pod’ even though our social backgrounds differed considerably.

And they appeared to be having a lot of fun, not in a forced way but genuinely.

They taught me how to value my weaknesses rather than my strengths. They showed me how to avoid ‘trigger’ substances, processes and relationships that might lead me back to a life of superficial bonhomie hiding an inner loneliness. I didn’t want to trigger relapse. I’d done that too often, when my determination and willpower were insufficient.

Well, it seemed to me that relapse prevention seemed to be a lot more sensible than continuing to pick myself up after one relapse after another.

So I asked them how they did it. They told me. And I followed their example. And now I call myself a ‘recovering addict’, I do what they do and I help many addicts of one kind or another. Along with other people ‘in recovery’, I help people to put their days of active addiction behind them, often by using support groups to counter the inner sense of emptiness that had dogged us for so long.

And then – guess what? – we have the life of our dreams. Holidays were never as good as this!

Addiction and Intelligence

September 4, 2018admin Addiction

Some addicts are highly intelligent. They use this natural gift to ‘prove’ to themselves and others that they are not addicts. As with mediaeval monks discussing how many angels dance on the head of a pin, they argue over the precise nature of addiction until the cows come home. Intelligence doesn’t protect them from mental and behavioural stupidity. And mental health is not merely the absence of mental illness. Intelligent people are just as prone to mental illness and addiction as anyone else.

Other people are as thick as the proverbial two short planks. This does not lead to them being either accepted or rejected by other addicts in their surroundings. For many individuals their intellectual struggle and their addiction are just the way they are – without any direct connection between these two aspects of their lives.

A lack of emotional intelligence, an inability to learn from practical experience and take sensible action, is not directly connected with intellectual ability or its absence. But emotional instability is a common feature in all addicts. Unpredictable feelings can come out of nowhere and go all over the place.

When A (an action) directly and always leads to B (a specific end result) a simple cause is established. More complex, conditional, causes occur when C or D need to be present for A to lead to B. Background influences, X, Y and Z, may result in A leading to B more commonly than in other circumstances. Understanding concepts of causation and mathematical probability are functions of the intellect. If that skill were sufficient to prevent addiction, no intellectually clever people would ever become addicts. IQ tests should then demonstrate their invulnerability. But that is manifestly not the case.

But now let’s look at this the other way round. Hard core addicts of any kind – alcoholics, drug addicts, compulsive gamblers, sufferers from eating disorders, any of them and many more – eventually become utterly self-destructive. That isn’t very clever. Their alcoholism, drug abuse, drug addiction or compulsive behaviour of any kind steals their greatest assets – their capacity to reason and ponder – and turns them into tools for intellectual and social self-delusion.

‘Turn on, tune in, drop out’ was the exhortation of a highly intelligent man – Timothy Leary – but he took many members of the flower power generation down with him into intellectual oblivion when they turned to drugs. Substance abusers may believe they are exercising free will when they turn to drugs. The truth is the opposite. Addiction destroys free will. The fanciful musings of abusers and addicts are mentally bizarre. Their creativity is corrupted. Their youthful enthusiasm is diverted by drug use into cul-de-sacs of banality. Drug and alcohol use tended to make them indistinguishable from each other so that if you’ve seen one addict you’ve seen them all. The only feelings long term addicts are left with are blame and self-pity. They have no residual individual personality. Many of them need addiction treatment if they are to recapture any sense of hope, trust, honour, appreciation, innocence and beauty.

Oliver Wendell Holmes, one of the sharpest minds who ever lived, discovered the secret of the universe after inhaling ether: he said ‘A strong smell of turpentine prevails throughout’.

Aldous Huxley, another fine intellect, experimented with mescaline (first cousin to LSD) in order to open the doors of perception. He wrote that taking the drug led to ‘a gratuitous grace’ and that the person having this experience ‘will be transformed for the better’.

In 23 years running my inpatient treatment centre I worked with over 5,000 addicts of one kind or another. I do not recall any of their lives being transformed for the better by any addictive substance or process – other than temporarily in their own mental confusion.

One important study showing what addicts of any kind have in common demonstrated to us that having other addicts in their families was the most predictive factor in addiction. High intelligence, or the lack of it, was not a factor. Whatever the level of intelligence, the risks of addiction are the same.

But addicts like me are often too clever for our own good. We may have high levels of intellectual attainments but our intelligence can become an enemy rather than a friend. As suggested by Dr Bob, one of the co-founders of Alcoholics Anonymous, we need to ‘keep things simple’.

Don’t hit rock bottom. Avoid it. Get skilled and experienced help

August 21, 2018admin Addiction

Many people die before they hit rock bottom addiction.

They think they can manage their ‘habit’, use sensibly, and have a bit of fun. Then one morning they wake up dead.

Addiction isn’t a habit. For one in six of the population, it’s a compulsion, probably driven by faulty neurotransmission systems in the mood centres of the brain. Constantly they feel a desperate sense of inner emptiness for no obvious social reason. They feel down even when everything in their lives seems up, in the judgement of other people.

When they discover substances, processes and relationships that lift the mood, they feel an immense sense of relief. For that reason they continue to use them. These ‘magic fixes’ work.

But there are damaging side effects. People with addictive natures accumulate problems in every aspect of their lives. They lose jobs, marriages and friendships. Their health suffers. Their social, professional and economic life deteriorates.

For therapists to say that they need to ‘hit rock bottom’ before they will get well is false. In the Twelve Steps and Twelve Traditions of Alcoholics Anonymous it says that it is a matter of rejoicing that some who were scarcely more than potential alcoholics had joined their number. It would appear that these therapists are unfamiliar with the basic texts of recovery.

The art of intervention is to help addicts and people with drug and alcohol issues, or other forms of substance abuse or chemical dependency or compulsive behaviours of any kind, to get off the downward spiral a long time before they hit rock bottom. The experience of hitting bottom is a choice, not a necessity. The rock bottom myth should be put to the sword. Why wait until they have lost absolutely everything before getting off that calamitous ride?

Intervention can be very successful when people with alcoholic addiction are still in full time work, are married and still have their driving licences. All they have to see is the ray of hope that life can be better than it is at present. They have to be attracted towards recovery – possibly in an alcohol rehab either in an inpatient or outpatient treatment programme, rather than frightened away from disaster.

For drug addicts to wait until they have hepatitis of one kind or another, or take repeated overdoses, or have liver failure, or complications with their mental health, is crazy. Addicts, or people suffering from drug abuse in any form, can get completely well and never suffer any of those fearful consequences if they are helped to turn themselves round as soon as it is clear that their daily lives are getting progressively more troubled.

For people with eating disorders, despairing that there is no escape from the cycle of bingeing, purging and starving, the new dawn breaks when they meet those of us who have been in that lonely state but found the way out. They can learn from us how to avoid the rock bottom of hospital wards and the shame of looking in the mirror or knowing that truth and lies don’t mix.

Compulsive gamblers tend to lose all their possessions and have mountains of debts before they ask for help. That can change.

Breaking through the denial, in which the addictive disease ‘tells’ addicts that they don’t have it, takes belief – and experience – that it can be done. A rock bottom moment doesn’t need to happen for anyone struggling with addiction. All that is necessary for a turning point is for the addict to see that, in a progressive and destructive disease, the future will be worse than the present. And recognise that determination and willpower will work no better in the future than they have in the past. The experience of personal rock bottom, in human spiritual terms in any addicted person, will vary from one addict to another. Our lives are individual but we share the same general addictive characteristics that imperil us.

The motive for change is pain. Taking away the pain – by paying off debts, telling lies to employers, soothing down partners and landladies and generally being kind and considerate to addicts – makes them worse rather than better. Compulsive helping, doing things for others that they could and should do for themselves, is a vice, not a virtue. Family members – and people in the helping professions who happen to be compulsive helpers – need help for themselves before they damage anyone else. We do not have to cause addicts pain but we do need to leave them in the pain they cause themselves. Without the pain there will be no gain. Recovery changes your life and theirs. All of it.

Dry January and beyond. The benefits of long term sobriety.

January 16, 2018admin Alcohol

There are people who simply overindulged over Christmas. They see a dry January as a good way to detox. That’s fine. A party every day is no party at all. It becomes the norm – like the Queen going to yet another banquet. Surely the fun in life is in its contrasts.

But these people sometimes wonder how much better they would feel if they were to abstain for longer than a month. Would they keep feeling better and better?

Certainly, in my case, I did and I still do. I never did drink excessively, in the way some of my medical school contemporaries did, but their subsequent experience was a preliminary wake-up call to me. Or should have been. The heavy drinkers are dead.

I stopped drinking alcohol – and using other addictive substances like nicotine, caffeine, sugar and refined grains – because, at the tender age of 47, I could at last see where I was going.

Other people – my wife in particular – had seen my Rake’s Progress for many years. But I was blind to it until it was causing me so much pain that I had to change. Somehow.

But then I found that I didn’t know how. As a doctor, I had been trained to observe the consequences of a high alcohol consumption and I did. In other people.

I also saw the results of cigarette smoking. In other people.

And of over-eating. In other people.

What I had not been trained to observe was the common addictive process behind these behaviours.

Nor had I seen that the most common feature of determined efforts to control compulsive behaviour is relapse.

And, of course, I didn’t see that any of this applied to me. I was fine. Just fine.

But I wasn’t fine at all. I earned my living and provided for my family. And everything in my external life was hunky-dory.

By contrast, my internal life – my relationship with myself – was a mess. I felt empty for no obvious reason. I felt I was in a ‘minus one’ emotional state. So – perfectly logically – I went looking for ‘plus ones’. And when I found them I stuck to them.

Why ever not? They worked. They lifted my mood so that I felt normal. Yes. That was it. I wasn’t looking to get high. I just wanted to feel at peace with myself.

Alcohol achieved that happy state. So did nicotine, caffeine, sugar and refined grains. They hit the spot.

Potatoes and carrots had no emotional effect on me. So I didn’t bother with them.

But in time, as my addictive nature progressively took over my life, I got progressively more damaging consequences.

It would have been smart of me to have recognised that, if I was on a slippery slope, I should get off it as soon as possible. But I wasn’t that smart. I went on, determinedly trying to prove to myself and other people that I was in good shape when I clearly wasn’t.

The only thing that turned me round was pain. When other people bailed me out from the negative consequences of my compulsive behaviour – such as when my wife took on more work to pay my gambling debts – I got worse.

Nowadays, as a result of avoiding all mood-altering substances, I feel better and better. And I’m happier and more creative than I’ve ever been. I’ve given up nothing of any lasting value. And I’ve gained a great deal.

I like the taste of fizzy water, tomato juice and freshly squeezed orange juice. I like chicory, aubergines and avocados. I like risotto. I like grilled prawns. I like lots of drinks and foods. I don’t need alcohol, sugar or refined carbohydrates. They provide a shot-term lift but a long-term drop.

I no longer enjoy drinks and foods that other people say are fun or even vital. I don’t smoke cigarettes or drink or eat anything that contains caffeine. Those substances wouldn’t be fun for me nowadays. If I were to start using them again, I fear I might go on and on and not be able to stop before I got myself into difficulty.

So I don’t start. And I work the Twelve Step programme as a daily preventive. I use it as a vaccine, not as a treatment. I’m not particularly concerned over my last drink. It was a long time ago. But I am worried about the prospect of my next one. I don’t want to relapse and go back down into the pit of despair again. I want to live and love. And I do. My life really does get better and better.

Why Do I Keep Choosing To Drink When I Want To Be Sober?

January 16, 2018admin Alcohol

People often ask me why they keep choosing to drink when they genuinely want to be sober.

I asked myself that same question many times for many years. My diets and periods of abstinence ended in binges, time and time again.

Already, after a couple of weeks, there are many people who have tried to have a dry January but have failed. They have openly admitted this.

These people don’t necessarily drink a lot in total but they do tend to rely on a glass of wine emotionally in an evening to help them relax and switch off.

They see themselves as sensible drinkers. They use mood-altering substances and processes to help them deal with the stresses and strains of their lives. That seems rational enough to them. It may work for them in their lives. And it did in mine for many years.

Nowadays I make different choices. I move away from unrewarding relationships. I change my work if it no longer gives me the pleasure it once did. I stop doing things that I find damaging. And I continue to do things that are self-enhancing.

For example, I loved being a doctor but I haven’t worked as a doctor for the last nine years. Regulations and restrictions took away all opportunity to innovate. I want to be my sort of doctor, doing work that I value, not being merely a unit of production in someone else’s Grand Design. So I work nowadays as a counsellor. I am not able to prescribe drugs and I don’t want to do so. I like personal contact with human beings, not zombies.

And, for similar reasons, I no longer want to run an in-patient rehab. I did that for 23 years and loved every minute. But the imposed administrative and financial burdens have taken away all the creative stimulus. Today I enjoy working on an out-patient basis on my own. And my patients benefit from receiving my undivided attention.

My life belongs to me. I do what I choose to do with it. I no longer choose to drink – or use any mood-altering substance – because I’ve learned that I don’t have the gift for doing so without damaging myself and the people close to me.

There are still various external stressors in my family life and professional life. Of course there are. But stress would be the internal reaction in how I react to those stressors. I choose to accept them as they are if they are generated by other people. I can’t change them. But I can change myself and I do.

I’m not the same person I was last year, let alone a decade or more ago. I learn new things and I incorporate them into my understanding. Then I make decisions on whether or not I want to change my actions and reactions.

I doubt I shall choose to go back to drinking alcohol. I would risk losing my marriage, my work, my friendships and social activities. That would be a huge amount of loss in exchange for minimal – if any – benefit. Reflecting on that prospect, it strikes me that surrendering my abstinence – and all that goes with it – would not be a rational or positive choice.

But I’m an addict. I have an addictive nature. That’s my natural state in the same way that I’m short-sighted, allergic to bee-stings and have osteoporosis. I can’t change any of those things. I have to learn to live with them and minimise their potential to cause me damage.

I follow exactly that principle with my addictive nature. I acknowledge it. I don’t say I have ‘a bad habit’ or ‘a bit of a problem’. I’m an addict. I can say dammit, if I want to do so, but that won’t change anything. I have to change my behaviour.

I do that by remaining abstinent and by working the Twelve Step programme every day. My addictive nature is still there. I know that. But it has no effect on me nowadays precisely because I do accept it. Far from using determination and willpower to keep it at bay, I simply acknowledge it, work the Steps, and get on with my life.

The end result is that I’m reliable – to myself and to other people. That saves an enormous amount of hassle and grief and gives me choice. I do the things I want. I never find myself in the position of doing things I don’t want to do. I have a simple, straightforward, loving and lovely life.

Dry January

January 15, 2018admin Alcohol

If you want a delicious meal and a pint of an excellent real ale, go to see my nephew, Michael, who owns and runs The Kings Arms in Trowbridge. By contrast, if you have repeatedly drunk too much on occasions, you might be better off seeing me.

A dry January helps some people but not others. It’s a good idea if it helps some people to recognise that they have a bigger problem than they thought. It’s a bad idea if it encourages people to believe that one month of abstinence proves anything at all.

There are four distinct populations:

Total abstainers often do so for medical, religious or family reasons. Or because they discover they don’t have the gift for using mood-altering substances and processes regularly without going too far on occasions.

Moderate users do so for the taste or for a transient lift to their spirits.

Regular heavy users may do so in a particular social culture.

Alcoholics find it difficult to control their further use once they start to drink in any day.

The concept of a dry January doesn’t really address any of these groups. It tries to treat the four different populations as if they were one.

Abstainers have already made this choice and don’t need to prove anything to themselves or anyone else.

Genuinely moderate users can abstain if they want to, but there is no pressing need in January or at any other time.

Regular heavy users may benefit from changing their social culture rather than from making sporadic, rather than sustained, changes in their drinking behaviour.

Alcoholics – people who have a progressive and destructive relationship with alcohol – can abstain in January or at any other time in the early stages of their illness. They are delighted to join an abstinence campaign in January. When they succeed in maintaining their abstinence without going up the wall, they believe they are proving to themselves and to everyone else that they may have ‘a bit of a problem as a result of particular stresses in life’ but they certainly don’t believe they are addicted. Sadly – and dangerously – that belief is false.

The very fact that some people believe they should cut down indicates that they know they have a problem. They do not have as much control as they might wish. That’s worrying.

The human brain is delicate. It doesn’t like being abused. It tells us so when we are hungover, wasted, stoned, smashed. And yet these states are called fun and believed to be a necessary part of normal life. We may think it amusing when we can’t think or even walk straight. Our brain tissue does not share our sense of humour. It gets damaged. So do our livers and hearts and many other organs. And that’s where the idea of a dry January comes from.

But let’s have a look at that. Are we saying that if we give our minds and bodies a reprieve for a month we can then go back to damaging them? Are we saying that we can’t be causing ourselves any real damage if we can stop for a week, a month or even more? Are we saying that we have to use something in order to relax and enjoy ourselves? If so, we’re in much bigger trouble than we think we are.

It’s only a matter of time before other people notice that sad truth. We ourselves are often the last people to accept it.

We consider changing our behaviour only when we’re in so much pain that we feel we’ve got to do something. But by that time it may be impossible to turn the clock back on some of the physical and social damage we have caused. And, in time, we may find it increasingly difficult to acknowledge this damage. We may believe we are in trouble with our personal and professional surroundings, rather than with ourselves.

I never suggest that my patients should have a dry January.

If they want to find out if they have an addictive nature, rather than persuade themselves this couldn’t possibly be true, I suggest that they should drink a couple of glasses of alcohol – no more, no less – at lunchtime, with none before or afterwards, every day for a week. If they can do that, I suggest they go to see my nephew, Michael. If they can’t, they might benefit from calling me on 07540281820 to talk to me before they accumulate even more damage than they have already.

I haven’t drunk alcohol for over 33 years. It doesn’t agree with me.

But I don’t miss it at all. I’m far more creative and productive – and happier – than I ever was in my drinking days.

Let me tell you what does suit me very well: I love music in general and opera in particular. I write novels and sonnets. I take photographs and make them into picture story books. All in addition to earning my living and paying my way.

In the last month, on top of doing my counselling work, I’ve been to two operas, four musicals, two plays and a film, I’ve completed setting out a book of photographs and I’ve edited a novel.

I’m flying, buzzing, having a ball, happy as… Yes, well, there’s no need to make comparisons. Let me just say that, despite being totally abstinent, I’m having the time of my life.

Why is cocaine so addictive?

November 29, 2017admin Uncategorized

Ali G, a character created by the comedian Sasha Baron-Cohen, was interviewing the Drug Tsar. He asked him about the effects of cocaine. The Tsar replied that it caused dilated pupils, blurred vision, a runny nose, agitation, disturbed sleep patterns and… ‘Yes, yes’, said Ali G. ‘But has it got any bad effects?’

I tell this story to illustrate the nonchalance of addicts in taking various symptoms for granted. They feel they’re a price worth paying in the quest for the euphoric rush they get from drugs.

As I see it, there are three causes for addiction.

The antecedent cause is genetic. Some of us are born that way. We may resent that, or try to deny it, but it makes no difference. We are what we are.

Then the contributory cause is emotional, physical or social trauma. This leads to a craving for mood-alteration.

Then the precipitant cause is exposure. We discover something that lifts our mood. Therefore we use it.

All three of these causes must be present for addiction to take off.

My wife, Meg, had a dreadful childhood. But she inherited what I saw as her mother’s compulsive helping – doing too much for other people and not enough for herself – rather than her father’s addictive nature.

My childhood was odd rather than significantly more abusive than that of any other boy in private school at that time. But I inherited my mother’s addictive gene along with osteoporosis. I also inherited the short sight that affected all my family. So I do the things that I need to do on a day-to-day basis to counter the influence of my genes. Meg never needed to. She just got on with playing her piano.

Any pleasurable sensation releases dopamine, a brain hormone. Meg got it in her natural way. I got it through the artificial stimuli of various addictive behaviours. About 1 in 6 people are like me in this respect, using one or another – or several – mood-altering substances, processes or relationships to change the way we feel. I felt ‘minus 1’ even when there was nothing wrong in my life. So I went looking for a ‘plus 1’. And I found several. Having made that discovery, I saw no reason whatever why I should give up my new-found pleasures. After all, I didn’t see – at that time – that they harmed anyone else.

Using cocaine exaggerates the normal pleasure response in the brain. In normal circumstances, dopamine is re-circulated so that it can give another dose of pleasure when stimulated again. Cocaine blocks that re-uptake process so that the pleasurable feelings stay switched on. Whoopee! That’s a result. Isn’t it?

There are feelings of excitement, confidence, being energised and sexually aroused. And if that isn’t a result, I don’t know what is.

Corticosterone (Cortisol), the stress hormone, is also involved in cocaine use. High stress levels in cocaine users lead to greater sensitivity to the drug.

The reason people take cocaine is simple: it makes them feel good. Very good. Without having to work for it.

Some people use it as self-medication for pain, anxiety and depression. It modifies thoughts, feelings and behaviour and it enhances performance in school or work or sports. Yet more results!

Using alcohol and cigarettes and drugs may also be a response to pressure to fit in with peers and to distance adolescents from their parents.

Eventually there is no need for reasons. They just do it. But, by that time, the first use of a mood-altering substance, behaviour or relationship in any day triggers the need for more. It is as if there is a ‘more’ button in the brain of some people like me. Stimulate it just once and the cravings begin.

The survival/pleasure response in the brain is the same for cocaine as it is for sugar, alcohol, cannabis, gambling and sex – and anything else that has a mood-altering effect. By contrast, nothing happens in response to eating potatoes or beans. We addicts discover for ourselves what ‘works’ and what doesn’t.

Dopamine stimulates the limbic system in the mood centres of the brain. Then we feel good. This leads to a feed-back loop: the more we do it, the more we want it. And then we want to repeat these magical experiences yet again. The build-up of dopamine when cocaine blocks its re-uptake causes continuous stimulation of neurons and a euphoric feeling. Addiction occurs when this process becomes compulsive, repetitive and damaging.

The brain quickly adapts to the rush of feelings produced by cocaine.

The nature of a particular ‘high’ feeling depends on which way cocaine is used but one effect is guaranteed: it reduces the natural secretion of dopamine in response to everyday happy experiences. This means that cocaine becomes the only pleasure. And that gets progressively weaker. Increasing the dose is the solution to this problem – but that brings more trouble.

Over-confidence, coupled with decreased regulation of behaviour, results in aggressive, inconsiderate and careless actions.

Addicts will hide their use from other people by hiding themselves. They suddenly disappear and then return in a different mood. That is certainly something to look for but there could be many other possible reasons for this behaviour.

They have a reduced appetite, constant sniffing and recurrent nosebleeds and damage to the septum between the nostrils. They may have burns around the mouth. They may be distressed for no apparent reason. They lose their commitment to their friends, family and work. Putting all these signs together makes cocaine addiction a progressively more probable diagnosis. The magic is dying.

Finding crack pipes and tiny plastic bags around the place makes the diagnosis a near certainty.

Mental and physical deterioration is seen when anxiety, depression, irritability, apathy, disturbed sleep and nightmares are coupled with damage to the heart and blood vessels, kidney damage and progressively more frequent minor or major illnesses.

The prefrontal cortex of the brain, just behind the brow, is often damaged in cocaine users. The brain in that area loses much of its white matter. Hallucinations and loss of self-control present a very disturbing picture.

I’m sure Ali G wouldn’t laugh at that. Nor would Sasha Baron Cohen’s brother who is a consultant neurologist. There is a time for humour – even on this issue – but not when seeing as much destruction from cocaine use as I have seen.

The body does not have an inexhaustible supply of neurotransmitters and they take time to produce. The body and mind take time to heal. Giving up using the drug is only the beginning of the road to recovery.

If you want to get on that road, or want a friend or family member to do so, I know how to help. Call me on 07540281820 and we’ll get the show on the road.

How addictive is cocaine compared with other drugs?

November 9, 2017admin Drug abuse

All mood-altering drugs are addictive to anyone who has an addictive nature. Cocaine is highly addictive. So are some individuals. The combination of an addictive drug and a highly addictive person is deadly. Focussing solely on the drug sends healthcare and education professionals and law enforcement authorities down the wrong route.

To identify adults with an addictive nature, we need to look at five specific risk factors that are common:

Coming from an addictive family.
Having wild mood swings for no apparent reason.
Being easily upset, frustrated and bored.
Being determined to control everything and everybody through being highly manipulative.
Having repeated difficulties in relationships of one kind or another.

Even so, these people may be charming and highly successful professionally and socially. They tend to be imaginative and creative and are super-charged with energy. Eventually their wheels come off when they become dependent on addictive substances and processes but not before they have been wildly adventurous.

The genetic pool of potential addicts is probably only one in six of the total population. But they often breed with other people – compulsive helpers – who also come from addictive families. So the relatively small genetic pool ticks over. Society benefits from their imagination and enterprise but also suffers from the effects of their compulsive behaviour. In time that leads to big trouble.

When individuals express concern that their own problematic behaviour might be addictive in origin, my questionnaires – on this website on all aspects of addictive behaviour – should settle the matter. Here’s the one on recreational drugs, including cocaine:

‘Recreational’ (street) drugs

Do I particularly enjoy getting a really strong effect from recreational drugs?
Do I have a sense of increased tension and excitement when I know that I have the opportunity to get some drugs?
Have others expressed repeated serious concern about some aspects of my drug use?
Do I find that getting high tends to result in my going on to take more drugs?
Do I tend to use drugs as both a comfort and strength?
Do I often find that I use all the drugs in my possession even though I intended to spread them out over several occasions?
Do I tend to make sure that I have drugs, or the money for drugs, before concentrating on other things?
Do I get irritable and impatient if my supply of drugs is delayed for ten minutes for no good reason?
Do I tend to use more drugs if I have got more?
Do I use drugs before going out if I feel there might not be the opportunity to use them later?

Any four positive answers indicates the need for further assessment.

Assessing someone else’s behaviour for the possibility of addiction is more challenging. Many people – perhaps all of us – can do stupid things at times. But addicts tend to do them more frequently and therefore pile up more damaging consequences. Observing the recurrent crises in their lives is the most accurate way of seeing an addict behind the bluff and bombast.

But, first of all, it helps to understand a bit about cocaine itself.

When snorted or inhaled, cocaine enters the blood stream via the nasal tissues. Injecting cocaine puts it directly into the blood stream. Mixing it with water and baking soda or ammonia causes it to crackle when heated. Smoking ‘crack’, as it is then called, leads to a shorter but more intense high. It is sold in small ‘rocks’ the size of raisins. The effect of smoking crack is immediate, the same as when cocaine is injected, but the ‘high’ lasts for only five minutes.

Crack has a powerful stimulating effect on the nervous system by raising the level of dopamine, the neurotransmitter associated with pleasure. Cocaine blocks the re-uptake process of dopamine that enables it to be recirculated. So it stays around and gives an artificial dramatic high in place of natural pleasures that have to be earned.

Physical ‘tolerance’ of the drug occurs through repeated use. An increased dose is required to get the same effect as before. Loss of behavioural control, obsessive thinking and altered priorities come as the result of continued use.

The younger people are when they start to use cocaine, the bigger the problems in store. Adolescents often take drugs in order to conform with the behaviour of their peers and break away from their parents. Individuation is a necessary process but it doesn’t have to be done this way.

The brain initially responds to cocaine in the same way as to any pleasurable sensation. But then it rapidly adapts to the new level of perceived pleasure. It needs a greater stimulus for the same effect. The euphoric feelings don’t last. The talkativeness often does. So does the poor decision-making, diminished attention span and confused thinking. The collapse of previous inhibitions results in addicts doing things that make no sense – even to them. But memories of previous highs still drive them on. This pleasurable feedback loop means that recurrent relapse is likely.

People born with temperament problems may be drawn to use cocaine. It counters shyness but at the price of foolhardiness. A quick high appeals to many people, particularly in party situations. But eventually cocaine takes over the whole of the addict’s life. Restlessness, nervousness, depression and severe mood swings are common symptoms. But the addict shrugs all this off in an attempt to recapture the initial dramatically profound high.

Cocaine is the addict’s ultimate sweetheart. It stimulates the brain immediately after use. This new experience for the brain leads to heightened sexual arousal. Trying to recapture that feeling makes cocaine particularly addictive. But it’s a false lover. It takes much more than it gives. Eventually money problems, damaged relationships and physical symptoms illustrate the personal price behind the high financial price and superficial glamour of initial use. A Binge/Crash cycle is a dreadful experience.

Addicts often combine cocaine with other drugs in order to pick and mix the effects. Alcohol, benzodiazepines, amphetamines, opiates and cannabis are frequent partners in self-inflicted damage.

Addiction affects motivation. The body’s natural reward systems become corrupted. Previous pleasures no longer satisfy. Cocaine dominates all other concepts of happiness and fulfilment. It becomes the only ‘real’ friend. As the addiction takes hold, there is a constant sense of ‘needing’ the drug.

Other addictions offer occur at the same time. Co-existing mental problems are common. Cocaine gives feelings of invincibility. The mind and body take the consequence of that tragically false belief. It is also frequently used for self-medication for physical or emotional discomfort. It modifies thoughts, feelings and behaviour. It enhances performance. It’s magic! But at a fearful price. Addicts often say they intend to quit. But they fail. The addiction wins every time until the individuals are utterly defeated and washed up.

Psychological withdrawal symptoms are worse than physical symptoms, which hardly exist at all in the early phases of drug use. This used to lead people – doctors included – to believe that cocaine is not addictive. How wrong they were!

The important lesson from this observation is that only those of us who are addicts of one kind or another ourselves know what addiction really is. And we know what needs to be done about it in order to achieve long-term abstinence, peace of mind and mutually rewarding relationships.

There may be a genetic predisposition in the size of the basal ganglia in the brain. Future addicts have this feature even before they take cocaine and other substances and processes of addiction. But, with persistent use of cocaine, family and social influences, social pressures, exposure to stressful circumstances, emotional or physical trauma and susceptibility to impulsive behaviour all make the situation appear hopeless.

But it isn’t. I’m an addict and I haven’t used anything addictive in over 30 years. There are lots of people like me. We enjoy each other’s company in ways we never dreamed of in the bad old days.

If you want what we’ve got you need to do what we do. We tried all sorts of other ways but they didn’t work until we were given what we call ‘the gift of desperation’. That turned us round and gave us the rewards we have now.

If you want to know how to get them – for yourself or for a family member or friend – please call me on 07540281820 and I’ll be glad to listen and maybe suggest some things that could be helpful.

Dr Robert Lefever's Recovery Blog