Do I have a problem with alcohol part 2 – self medication

One question which isn’t included in either the CAGE or AUDIT alcohol questionnaires is, ‘Do you ever use alcohol to self-medicate?’ – and I think it is one of the most important questions I ask my clients.

Have a think about this for a moment…alcohol is, supposedly, there to help us enjoy ourselves, to experience the rush of booze and to create a sense of social cohesion when we’re at a party or gathering (or so the theory goes). But the number of people using alcohol as medication is huge. Do you ever come home from work after a stressful day and feel you ‘need’ a large glass of wine to help you relax? Do you ‘need’ that gin after you’ve finally got the yelling kids to bed? Do a few glasses ‘help you get to sleep’? When you’ve had a truly awful week and your depression is at it’s worst, do you reach for some of the strong stuff to help you keep going? Break that down a bit and you’re using alcohol to help you relax, destress, get to sleep and cope with anxiety and depression. Isn’t that what medication does?! Perhaps you pride yourself on rarely going to the doctor, taking few medications and not requiring therapy – but what you’re doing is medicating yourself with alcohol.

This is a bit of a tricky concept to get your head around (I know – I’ve been there!). I spent many years coping with my crippling anxiety by drinking, blocking out the day and numbing the worst of my symptoms. When I was sad, overwhelmed and stressed that bottle of wine at the end of the day would cure me, allowing me to take a deep breath for perhaps the first time that day. Bliss! Of course, the booze was making my anxiety far worse and affecting my health in all sorts of other ways, but in the short term it seemed like the best medication out there (and it didn’t involve going to a doctor). I guess I KNEW that I was self-medicating, but I thought it was better than putting up with the symptoms.

If you are using alcohol to destress, sleep or deal with anxiety or depression, you are using it in an unhealthy manner and you’ll find it hard maintaining control over your drinking. IF there were no side effects, then self-medicating wouldn’t be so harmful. But there are HUGE side effects when you choose booze as your medication of choice.

Firstly, you’re creating a very powerful association between a certain state or condition (such as feeling stressed or depressed) and a ‘cure’ (alcohol). Addiction isn’t just physical. If you medicate with alcohol every time you feel a certain way or experience a certain symptom, you will become dependent on alcohol to solve that particular issue EVERY SINGLE TIME YOU EXPERIENCE IT. Every time you feel bad, anxious or whatever it is, you will feel a very strong desire to reach for the cure. No matter whether you have a good job and get up every day, if you use alcohol as medication, you are dependent on it – and this goes for everyone who has a glass of wine to ‘destress’ every night to the person who opens a bottle of vodka in the morning because they cannot live with their severe depression.

Secondly, it’s a really harmful medication! Most medications tend to have side effects and, if you can find a healthier, more natural way of dealing with a condition you’re best to do so. Using alcohol as a medication is, in the minds of many, less harmful than taking a prescribed medication. But we categorically KNOW that alcohol is associated with a whole host of health problems and diseases, including cancers, liver disease, high blood pressure and thinning bones. Don’t kid yourself that self-medicating with alcohol is ‘natural’ or preferable to taking prescribed medications – it’s not.

Thirdly, when you continually rely on alcohol to deal with your problems, you are avoiding finding the strength and resources which will allow you to overcome your issues and have a better life without the need for any interventions. If your life isn’t satisfactory you need to find solutions to improve the situation. Alcohol will stop you doing that. Finding ways of dealing with problems in life involves going through them – looking at them, sitting with them and working with them. Alcohol just allows you to take a detour round the difficulties. This is really tempting! But you’re never going to move forwards in a positive way if you continue to use alcohol in this way.

Finally, alcohol makes most of these issues – including stress, anxiety and depression – far, far worse. Alcohol is a depressant. Alcohol also creates a whole lot of anxieties around how, when and how much to drink. Instead of being able to enjoy yourself when you’re out and about you’re always thinking about getting home and drinking You’re planning your days and your outings around booze. It creates anxieties and makes existing anxieties worse. Add to this the negative situations it creates with loved ones, colleagues and family and you can see how the ‘medication’ is actually responsible for making you ill.

If you need help in finding alternative ways of dealing with your issues, perhaps you should consider life coaching, counselling or visiting a GP in the first instance to see what support is available.

Do I have an alcohol problem?

If you’re worried about whether or not you might have a problem with drinking, there are various tests which are commonly applied by therapists and other health care professionals. Two screening measures which are commonly used are the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE questionnaire. The AUDIT asks ten questions, concerning questions around the amount you drink as well as the impacts of your drinking behaviours, whereas the CAGE questionnaire focuses more on your subjective understanding of the impact of your drinking on yourself and those around you.

I prefer the CAGE questionnaire as, when I was a drinker, I found tests like the AUDIT test quite overwhelming. Simply answering the questions made me realise that, yes, I did have a problem! It didn’t necessarily make me want to do anything about it though. I remember the first time I took a test along those lines – it was when I was about 20 and it was featured in a newspaper article – and at the end, my score was as high as it could be for ‘Do you have an alcohol addiction?’. At that age, I found it quite amusing that I’d scored so high – I was a full on drinker! As I got older, and the addiction was less fun, I took similar tests over the years – always aceing the ‘heavy drinker’ score. They made me feel bad, but that was about all. Is that to say that the AUDIT test is bad? No – but I can see it’s limitations for some people.

Instead of bomarding you with yet another questionnaire, I’m going to go through some of the questions on these forms, one by one. Instead of skimming over a list of questions and feeling overwhelmed in the process, perhaps you can take a few moments to consider the question I’m posing. The question isn’t designed to judge you or categorise you – it’s just something to have a ponder over for the rest of the day.

The question – taken from the CAGE questionnaire – is, ‘Have you ever felt you should cut down on your drinking?’. Instead of a ‘yes’ or ‘no’ answer, let’s really look at this question (if you’ve got a pen and paper, you could write a list – or take some notes on your phone!). I’m going to expand this question out a bit.

What incidents have contributed to your feeling you should cut down your alcohol intake?

What feelings have contributed to your feeling that you should cut down your alcohol intake?

How do you feel you would benefit by cutting down your alcohol?

When you think about cutting down your drinking, what is happening in your body (if you can, take a moment or two to close your eyes and just focus in or how you’re feeling RIGHT AT THIS MOMENT).

This one question, ‘Have you ever felt you should cut down on your drinking?’ is a huge question which demands way more than a yes or no. Don’t rush the question. Let it sit with you. Note what comes up for you. Not the positives and the negative feelings which you experience as you ponder this question. I’ll be looking at the other questions in both the CAGE and AUDIT questionnaires in future blogs and I’d encourage you to go through, one by one, to address the question, ‘Do I have an alcohol problem?’. fff

3 ways to kick start sober living!

When I stopped drinking, it was the first fortnight which was the hardest – and the first few days were downright horrible. I remember walking from my house to the bookshop, which was about a mile away, feeling grim – but determined to see if I could get hold of a book on going sober (which turned out to be a really good idea). I was about day 3 in to my alcohol free adventure, and it felt like more of an ordeal than an adventure at that point. I came home, lay on my bed, shed a few tears of self pity and then opened up the book.

When you’ve been drinking pretty much every day – even if it is just half a bottle or a bottle of wine – your mind and body craves it. It takes a while for the alcohol to leave your system, so even if you’ve not been a heavy drinker you feel a physical craving to top up those levels. You might feel exhausted and your sleep may be very disturbed. You might have aches and pains. The temptation to have a drink to alleviate all this is huge! Here are three tips to help you kick start things.

  1. Find a replacement habit (big clue, it doesn’t have to be a ridiculously healthy habit!). When you stop drinking alcohol, there’s a gap. For me, it was a huge, cavernous hole. Eventually you want to get to the point where you can sit with that gap, explore your life and be able to stay with the discomfort of your feelings but in the very early days, it’s useful to replace your drinking habits with another habit. The mistake some people make is thinking that this habit has to be super healthy. ‘I’m no longer going to drink every night at 6.00 – I’m now going to have a detox drink and go to the gym’. If that works for you, fine – but for many people this is too much of a leap, too soon. My replacement habit during my early sober days was mug collecting (exciting, I know!). I figured that I was saving at least £5 a night on wine so I would go to the supermarket and buy a mug. Sometimes I’d treat myself to something else – a scented candle, some flowers or some nice soap – and these little treats made me happier about stopping the wine. Some suggestions include having nice long baths, finding a good yoga class, going to the cinema one evening or getting out and having a coffee. It’s up to you to fid your things and – as long as it’s better for you than drinking booze – go for it. doesn’t matter if it seems silly or pointless (or if you end up with an awful lot of mugs) – use it as a means to replace one behaviour with another and reward yourself into the bargain.
  2. Be selfish. Sober living is a huge step – one which is going to allow you to live a life you didn’t even know was possible. You need to put yourself first while you make these changes. Being selfish has a whole load of negative connotations but think of it like this – you are looking after yourself and putting your own needs first. What could be wrong with that? You might feel empty and grumpy when you stop drinking. Make sure you look after yourself. You might hurt and offend other people with your decision to stop and they may be people who are close to you. Don’t let yourself be made to feel bad or be manipulated. This is your life. Other people are free to act in the way they want to. If you choose to stop drinking, that’s up to you. It is no one else’s business except yours. You need to stick to your ground and do what’s right for you. If that means avoiding certain social activities for a short while then that’s what you have to do. If it means offending someone, then feel free to offend. This is too important to ignore your own needs.
  3. Nurture yourself. Whilst your coming to terms with the physical and mental changes which are taking place, you might feel like giving up sober life – because it’s so much easier to keep drinking alcohol. Sleep deprivation is a very common problem for people who have stopped drinking. Although alcohol severely affects the quality of sleep you get, you’ll have been used to sleeping in a certain way for a long time. When you stop drinking, there’s a complete overhaul in your sleeping patterns. Many people find they’re hardly getting any sleep in the early days. If this is you – make sure you rest when you can. If you’re so tired you can’t cope with work, treat it like a sick day and have a day to catch up. Remove those responsibilities which drag you down. Curl up under the duvet with a good movie if you need to. Share with your family and friends what you’re going through. Read inspiring books. Find a tribe which will support you – there are some great Facebook groups out there such as Dry January and Beyond. Find a life coach or counsellor who specialises in working with alcohol addiction – reaching out for help isn’t a sign of weakness. It’s a sign of strength, bravery and commitment.

The part that keeps you drinking

Over the years – before finally being able to take control – I wanted to stop or reduce my drinking more often that I can remember. A night out which resulted in an argument with my partner, waking up with a furry tongue or being too tired to go to work often made me seriously question the amount I was drinking. And I would resolve to do something about it. And then…

I wouldn’t. Despite waking up that morning feeling full of the joys and motivated enough to take action, by the time the sun was going down (or well before, depending on the time of year), I’d cave and get the wine in. Why?

Psychologically, it’s called ‘cognitive dissonance’ – an internal conflict which kicks in strongly when a person’s beliefs contradict with the situation and evidence which is in front of them. Cognitive dissonance is stressful and it’s often easier to go with the old ways and beliefs than to go for a full on challenge. When you add the addictive nature of alcohol to the mix, and the strong psychological and physiological drive to continue with drinking, you can understand why it’s very difficult to resolve this conflict by simply going with the ‘positive’ or sensible decision.

With the help of my therapist, I managed to have a good look at the part which kept me drinking – despite how many alcohol free options I had in my fridge. This drinking part believed that life was difficult and that I found it difficult to cope. It believed that alcohol was a magical fuel, which could allow me to work harder and faster than other people – whether I used it to help me paint a room, get through the really boring task of preparing the family meal or access my creative side when I wanted to write something. Alcohol also acted as my red medicine, numbing me to the depression and anxiety which crept up on me on a daily basis. This drinking part not only believed that I couldn’t get through the day without booze, it also believed that I wasn’t really good enough to get through life without booze. I would look at other people and feel ‘different’. Despite having a great mix of experience, qualifications and good feedback from people, I had an underlying belief that I couldn’t really have THAT great a life – and I used alcohol to keep me down, where I belonged.

So despite my logical voice telling me that I could achieve more if I didn’t drink, that I would be healthier and have more opportunities and that I had loads of good reasons to stop, I kept drinking because I believed I didn’t REALLY deserve that amazing life and I couldn’t cope with what life repeatedly threw up at me.

During the early days of stopping it was very hard to override that part. It needed a lot of reassurance that it would be ok, that I would look after it and that I didn’t hate it. I appreciated that it had tried to help me overcome earlier difficulties from my childhood by identifying a substance which it thought helped me cope. There were days when I was exhausted from the effort of communicating with this part instead of using alcohol to feed it or shut it up.

Eventually, I learned that it was possible to get through the day without alcohol. That it was ok to be upset or anxious without having to drown these feelings. I learned to communicate and comfort that part of myself, to listen to it and to look after it in ways which were healthy and nurturing. By increasing my awareness, the self-destructive drinking part slowly transformed into a part which could express when it was sad or stressed, and which was responded to with kindness and attention.

Alcohol and transactional analysis

There are loads of reasons why I used to drink too much. Every interaction between myself and another is a transaction. And alcohol can be part of these transactions. A couple of years ago I was meeting up with an old friend (and my first drinking buddy ever) for the start of a weekend together. I got a text, “I’m on the plane. Are you getting a drink on the train? I’m only going to if you do!”. At the time, I didn’t fancy a drink, but here’s what I did. I texted straight back with, “Of course! Can’t have a journey sober. Enjoy your wine!”.

This happened at a time when I was trying to moderate, and I genuinely didn’t want to start drinking at 3.00 on a train…but I did. So what was going on? I opened that mini bottle of wine because I wanted to create a positive social transaction between myself and my friend. I guess I felt that I was showing her I was that same, fun old person she’d always known. That I hadn’t changed. And I was showing her that I would join in with her desire to drink on the plane in order to make her feel happy.

We get so used to acting in certain ways that we don’t stop to think, what the hell am I doing here? These ingrained social behaviours can have a major impact on our drinking. It may be that we have heavy drinking friends who we feel might shun us, or feel disconnected from us if we refuse a drink. It might be that we’ve been programmed to think that we can only be a fun person to be around if we’re drunk. We use alcohol in social ‘transactions’ all the time – to make other people feel happy, to create social cohesion and to retain the status quo, amongst other things. Without even wanting to, we find ourselves engaging in drinking behaviours simply because drinking is so entwined with these transactions.

I was aware over the course of that weekend with my friend that I wasn’t enjoying drinking. I’d been managing to cut down quite a bit, and found it a chore to drink so much. I knew I’d have a raging hangover. I’d moved on from that type of binge drinking. But I hadn’t been prepared and I couldn’t think of another solution to do anything other than what I’d always done – which is drink.

Within transactional analysis, changing your transactions with other people can have a major effect. Sometimes the people accept your changed behaviour and sometimes you lose that person as a result of those changed transactions. One of the most difficult things about stopping drinking is the fear of the effect it could have on those near and dear to you, whether it’s boozing every Friday night in a group or snuggling up with your partner over a couple of bottles of wine and a box set. If alcohol is an intrinsic part of your relationships, it’s difficult to focus in on what YOU need while you still want to have the same positive transactions you’ve experienced before.

If stopping drinking is important to you – whether for health reasons, self esteem, or simply because it’s preventing you from living your fullest life – you need to start focusing on you, and not how your drinking may effect some social relationships. I can’t guarantee that some relationships won’t fall by the wayside. But I can guarantee that you’ll learn about what you want and how to look after yourself instead of putting other people’s needs above yours.