Alcohol – pleasure or poison

I think a lot about alcohol. This is inevitable, given that I work on an in-patient unit in a psychiatric hospital, treating people who have become alcohol dependent, but my views are less clear than you might think. When I talk about mental illness, I do so from the perspective of both psychiatrist and patient, which can throw up conundrums. When I talk about alcohol, I do so from the point of view of psychiatrist and consumer, which is very different and rather more complicated. I tell my patients not to drink, yet I continue to do so – a good example of do what I say, but don’t do what I do.

I have always enjoyed drinking alcohol, and remember thinking, guiltily, that I would need to make sure it never became a problem because then I would have to give it up. It’s hard to know how to think about something that can change so easily from nectar to poison, especially as you may not spot the point at which it changes. For anxious introverts, like me, a small amount of alcohol can change a social situation from exquisite torture to rather a laugh. I believe it can genuinely help with bonding and communication and friendship – but it can also so easily make them all go horribly wrong.

Alcohol is everywhere for most of us. If you think about it, you will notice it, if you don’t already. I’m not sure it’s particularly glamourous, just ubiquitous. I think you could say that, as a nation, we are dependent on it, quite apart from the many dependent individuals. It causes all sorts of harms for us, most obviously to those who drink it, but also to us collectively. It causes accidents and illness, but it also costs money, to health, social care, the police and more. I see the devastating personal results on a daily basis, yet still I drink myself. I’m genuinely not sure why.

Looking at it differently, life for many is unrelentingly hard. Most of us will have times when things are difficult, but deprivation and misfortune will make this far worse for many. It is natural to try to make oneself feel better, and, for this reason, humans have used both alcohol and many other substances over thousands of years. The problem is that nothing really works, at least not in the long-term. Alcohol can work magnificently in the short-term, which is why it is so addictive, but it wears off. For some people, they then pursue it continuously, with the result that they can never change their lives, and may eventually be destroyed. Many other substances will be similar, although it has to be said that alcohol is particularly toxic and nasty.

Not everyone likes alcohol, though, with some completely uncomprehending as to why others drink to excess. I believe that this is innate – I don’t mean that there is a special alcohol gene that you either have or don’t have, more that the effect you get from it will dictate your later behaviour. You may not enjoy your very first drink, but there is a theme to what many future problem drinkers say about their early drinking. If you feel anxious, invalid, unconfident, disliked, even, and alcohol takes that away – well, then why wouldn’t you drink? And then drink more. If it just makes you feel unpleasantly woozy, why would you bother? It’s easy for some people not to drink.

There is a morality around drinking that can be difficult to understand. People cause terrible pain, to others as well as themselves, and yet they continue to drink. For those who have no desire to drink, this can seem bizarre and destructive, perhaps particularly when mothers cause harm to their children through drinking. There is also increased awareness of foetal alcohol syndrome, caused by drinking during pregnancy, and it is very easy to condemn these women. But the pull of alcohol to feel better is far stronger than most of us can imagine, and what we don’t understand, we shouldn’t simply condemn.

Many women that I have met are so ashamed of their drinking that they will deny it, or at least underplay it, even in the face of incontrovertible evidence. They fear censure, and often further rejection, and it makes it even harder to help them.

Ultimately, I feel that I am a doctor to people who drink because it has, at least initially, made their lives easier to bear, whether this was because of trauma, illness or unhappiness. And it is so much better that they cannot stop, or get enough, and then it starts to poison their bodies and lives. The tragedy is that when they do eventually stop, all their old problems come back, perhaps even more intensely, and the physical damage can also be life changing. Most, if not all, people need more and longer support than we are able to offer – it is a whole process of retraining, recommunicating, and learning new ways of living, which can rarely be done alone. Rehabilitation should be the norm, rather than the exception.

So if alcohol suddenly vanished from the world, would that help? I’m not sure; there is an awful lot of unhappiness out there, and it is possible that low levels of drinking may enhance some people’s lives, and make them better. But I am aware that perhaps I am saying this because I, personally, would not want it to happen. And the fact that I like alcohol, that I am socially anxious, and that I have a mood disorder – I think all of these put me at potential risk of harmful drinking. I can’t ever be complacent. I am also rather neurotic about it, which is probably protective.

But I am conflicted by alcohol – by its pleasures and its terrible harms. The two are inextricable, and I suppose it’s possible to think of them like weighing scales. The problem is knowing where your tipping point is, and recognising it well before you reach it, as by then it may be too late. And if you happen to be someone who is relatively indifferent to alcohol, be kind to those who aren’t.