Is alcoholism a physical addiction?
Alcoholism is due to a physical defect in the mood centres of the brain. So in that sense it is a physical illness. This is important because it indicates that alcoholics are not responsible for having the illness of alcoholism, even though they are always responsible for their behaviour as it affects other people.

Alcoholism affects physical, mental, emotional, social, financial, marital and many other aspects of life. Making this observation is an accurate way of making the diagnosis of alcoholism. If someone has lost a job, a spouse and a driving licence, it is superfluous to ask about alcohol consumption. Those consequences do not occur in cancer, heart disease, diabetes or other ‘acceptable’ conditions. However addiction to nicotine or sugar often lies behind cancer, heart disease and diabetes. The boundary between ‘physical’ and other illnesses is therefore very debatable.

The important recognition is that almost all the damaging consequences of a high consumption of alcohol resolve when people stop drinking. Personal relationships may be irretrievably damaged but the liver can regrow to a remarkable degree and many other damaged organs can also return to healthy function.

In this respect alcoholism is only secondarily a physical illness.

What is considered to be an alcoholic level of consumption?
Loss of control is the defining feature. In alcoholics, the first drink in any day triggers the impulse to take another. And then more.

The age at which that observation and diagnosis are made varies enormously. Doctors and families and the drinkers themselves are very reluctant to use the term ‘alcoholic’ whereas they would have no hesitation in referring to appendicitis, asthma or diabetes by those names. But ‘alcoholics’ are thought to bring the problem on themselves, whereas the other conditions are seen as blameless. To refer to alcoholism as an illness becomes understandable when it is recognised that it is what drives people towards the use of alcohol, rather than the consequence of using it.

Doctors and Coroners giving post-mortem verdicts are very reluctant to say that someone is alcoholic. This term may be seen by distressed individuals and families as pejorative and rude. Therefore the true incidence of alcoholism is under-recorded. This will change only when the UK follows the World Health Organisation and the American Medical Association in recognising alcoholism as an illness that is beyond the power of the patient to achieve control on his or her own.

What is considered a heavy drinker?
‘Someone who drinks more than his or her doctor’ is the old joke and there is truth in this. Doctors are just as prone to alcoholism as anyone else. Doctors who have a high alcohol consumption will tend to see that as normal even if they have abnormal liver function tests.

However, doctors in general would be unwise to use the term ‘heavy drinker’. It tends to be used by alcoholics and their families in order to avoid facing up to reality. Curiously, being a ‘heavy drinker’ (stupid) is seen as being less shameful than ‘alcoholic’ (ill).

There is no level of drinking that accurately defines heavy drinkers. The clinical dividing line between ‘normal’ and ‘heavy’ is one of damage. But surely if someone is being damaged by the use of alcohol, the sensible thing to do is to stop. The term ‘heavy drinker’, trying to differentiate that from ‘alcoholic’ is a camouflage, a dangerous one.

In some occupations – publicans, the armed forces, people who have expense accounts – a high alcohol consumption is the norm. That is dangerous in itself because ‘normal’ may be ‘too high’ and therefore damaging.

How many units of alcohol a week is dangerous?
It depends who for. Total abstinence is recommended in patients with some medical conditions and for alcoholics.

For the rest of the adult population anything above 21 units a week for men, and 14 units a week for women, is potentially damaging. Both men and women are recommended to have 2 or 3 alcohol-free days each week.

However, giving standard advice to the entire population is misconceived and can be potentially damaging.

People may use these numbers as reassurance when underlying medical conditions would indicate that total abstinence would be preferable. And alcoholics lose count when the first drink has the effect of making them crave for more. People who stick to rigid rules on moderation may be impossible to live with because they drive themselves up the wall in frustration.

Governments give recommendations on quantities because they have to do so in a society in which they, rather than individuals, are seen as the prime source of responsibility for healthcare and welfare issues.

A much better principle for governments and individuals  is not to count units but for people not to drink at all if alcohol causes any problems in life. There are other pleasures.

Can alcohol affect fertility?
Yes, very much so, through direct chemical action on the reproductive organs.

Testosterone, the male sex hormone, is made in the liver. When the liver is damaged by alcohol the hormone levels are reduced. Drinking acohol also damages sperm formation.

In women, drinking alcohol even in moderate amounts reduces fertility. The precise cause for this is not known. The best advice for women who are trying to conceive is not to drink at all. This helps them and their subsequent babies as well.

Drinking alcohol increases the desire for sexual gratification, and lowers inhibitions, but it reduces the performance. In men it can lead to loss of libido and impotence.

If fertility is an important consideration for a man or woman or both when finding it difficult for the woman to conceive a child, the simplest course of action is for both to give up alcohol. They can always drink it again after the baby is born. But they may find that they no longer wish to do so. They may be happy enough with the baby in their lives and don’t want to do anything that might disturb that happiness. Anyway, they might want to have more children.

What makes a person an alcoholic?
Alcoholics are born rather than made. There is a defect in the mood centres of the brain so that the alcoholic feels low for no reason. This is relieved by using alcohol. In this way ‘alcoholism’ is a bad term. It names the illness after one of its potential ‘treatments’, like calling a sore throat ‘Penicillinism’. But alcohol is a very bad treatment because it has so many damaging side-effects.

Cultural and environmental influences have some significance but they are not the precise cause. Even so, they need to be taken into consideration and countered if possible if they are a bad influence.

The appropriate diagnosis is ‘neuro-transmission disease’, indicating the nature of the problem in the brain.

The appropriate treatment is to use the mood-altering process of reaching out to other alcoholics on an anonymous basis continuingly one day at a time. Medicinal or other behavioural treatments merely lead to another addiction.

Even total abstainers can cause just as many problems as alcoholics if they pick up drugs or gambling. They need to put their entire addictive tendency into hibernation (it never goes away), rather than give up one or two addictive substances or processes and declare oneself to have cracked the problem.

How can you get help for an alcoholic?
As with addicts of any kind, alcoholics will ask for help only when they are in pain. Through ‘denial’, the psychopathology of an addictive nature, the alcoholic does not see the internal problems but believes them all to be caused by external issues. Therefore ‘help’, bailing the alcoholic out from the painful consequences of use, prolongs the agony. Genuine help is possible only when one alcoholic reaches out to help another. The giver, not the recipient is the one who is helped. The secret of the alcoholic is therefore to take one’s mind off one’s own difficulties and put it onto helping other alcoholics. In this way, we keep what we give away. It is not possible for other people to help alcoholics other than in short-term ways.

The most effective intervention technique is to say,

‘I love you’ (or ‘You’re important to me.’)

AND (not but)

‘I observe these 3 things’ (give facts, not opinions)

‘I recommend…’ (Be specific and firm, accepting no compromises.)

‘If you do do not agree, I shall…’ (Be specific and stick to it.)

What is the definition of a recovering alcoholic?
Someone who works the Twelve Step programme of Alcoholics Anonymous on a continuing basis, one day at a time. Abstinence from alcohol and all other mood-altering substances is merely the beginning of recovery. I define full recovery as peace of mind in spite of unsolved problems; happy and mutually fulfilling relationships; and spontaneity, creativity and enthusiasm. I want a lot more for my patients than mere abstinence.

Using prescription medications, such as tranquillisers or antidepressants or sleeping tablets, to suppress some of the symptoms of alcoholism simply causes another addiction. People taking these medications sometimes say that they are in recovery. They, and their doctors or other helpers, may forget that the thinking brain knows the difference between one mood-altering substance and another but the feeling brain – which is where the trouble is in alcoholics and other addicts – does not.

People commonly give up one addictive substance and then promptly pick up another. Nicotine and sugar tend to be common cross-addictions with alcohol and drugs. Full recovery is seen when people become abstinent from all addictive and compulsive behaviour and work the Twelve Step programme of Alcoholics Anonymous on a continuing basis.

Why does a person become an alcoholic?
First there is a genetic pre-disposition. Then there is emotional trauma, waking up the need for mood alteration. Then there is the exposure to this substance that magically improves the mood. Once that discovery is made, it is difficult to put the process into reverse.
People generally, including many doctors, tend to believe that alcoholics sleep on park benches or in shop doorways. The truth is that those people are in the final stages of an illness that began many years previously. Most alcoholics are still in full-time work. They tend to describe themselves as ‘social’ drinkers, even though they tend to socialise with people who drink in the same way as they do.

Alcoholism is a progressive illness. It goes on and on. It can be halted but not cured. This is why people, including doctors again, instinctively shy away from the diagnosis. They tend to see it as a weakness of willpower and a degradation of moral values, rather than as an illness. Yet many alcoholics are highly talented professionals. As with many illnesses, alcoholism doesn’t care who it affects.

The good news is that the illness can be put into full remission by working the Twelve Step programme of Alcoholics Anonymous. People, including doctors yet again, are often reluctant to recommend AA. But the Steps work for those who work for their recovery by following the suggestions of AA.

What Is An Alcoholic?
Someone who cannot predict what will happen after taking the first drink in any day. On some occasions alcoholics find it possible to have one or two drinks but on others, for no particular reason, they go off into a binge.

There appears to be a haphazard switch in the mood centre of an alcoholic’s brain. Sometimes the first drink in any day turns it on and the alcoholic craves for more. At other times it does not. This unreliability causes great confusion in the alcoholic and in everyone concerned for him of her. Congratulations turn to disappointment. Then hope reappears only to be shattered again.

The overall progression of alcoholism follows a wavy path of deterioration in mood, behaviour and damaging consequences. At some times the problems level off or even slightly improve. At others they plummet down again. As time goes on these pits become deeper and they occur more frequently. The true situation is therefore seen by averaging out the deterioration over a period of time, rather than looking at one particular moment.

Eventually it is vital that alcoholics diagnose themselves. This happens when the pain of staying as they are is greater than their perception of the pain they would experience in giving up alcohol altogether.