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