I don’t know how I missed this brilliant piece of writing in The Guardian back in November but I did. Having recently discovered it I’m sharing it here now and the title says it all really – the media has a problem with alcoholism and it’s stopping people getting help. As it’s Dry July here in Oz this feels like a really appropriate time to share his thoughts.
Over to James Morris:
The term alcoholism has long been retired from official alcohol clinical and policy guidance, abandoned as a reductionist and stigmatising label for problem drinking. Instead, alcohol use disorders, some including varying degrees of dependency, reflect the wider continuum nature of alcohol problems. Despite this, inappropriate references to “alcoholics” are ubiquitous in everyday narratives including mainstream media, undermining opportunities to reduce alcohol harms in a number of subtle ways.
One reason for over use of the alcoholism concept may be a lack of a common language to describe the nuances of heavy drinking behaviours. Alcoholism may be assumed to be synonymous with alcohol dependence, but it is inherently bound to stereotypes of hitting rock bottom and beliefs in its nature as a lifelong disease. The media rarely offers alternative problem drinking accounts other than the equally flawed spectacle of binge drinking, and in turn perpetuates an overly simplistic framework for the public to reference their own beliefs and attitudes against.
But the evidence for the disease model’s blame alleviation potential is mixed. Whilst some studies have shown that genetic or disease model beliefs do have some potential stigma related benefits, they have also been shown to increase fearfulness amongst the general public. Further studies show a complex and mixed picture towards alcoholism beliefs and its socio-cultural influences, but at their core disease beliefs create a separation between a healthy “us” and a diseased “them”, potentially even increasing outgroup stigma. Whilst admitting to having a problem with alcohol may often be regarded as the crucial step, for many it is the existence of stigma that acts a major barrier to doing so. Even people who find recovery through adopting an alcoholic identity can find the process a difficult and internally conflicting experience.
While there’s little research into this at present (though it’s currently the subject of my PhD research), other negative impacts of the disease model are better established. Self-efficacy is the belief in one’s own ability to make a change and is a key predictor of recovery amongst problem drinkers, yet is undermined by beliefs in alcoholism when compared to more nuanced “continuum” beliefs about drinking.
In simple terms, alcoholism is typically conceived as genetic and pathological in its nature, thus perceived as uncontrollable and requiring treatment or lifelong Alcoholics Anonymous attendance. When we apply this set of beliefs and expectations to the many drinkers who do not identify with the dominant idea of alcoholism, we undermine both their chances to recognise their drinking as something worth changing, and their beliefs that it is within their control to do so. Over-application of the term reinforces the misconception that all alcohol problems are severe, occur in a genetically distinct population, and require formal abstinence only treatment and medication.
The broad brush stroke of alcoholism appears all too often in public narratives. In 2015 when a controversial drug was made available with the aim of supporting harmful drinkers without severe dependency to cut down, headlines such as New £3 pill to ‘cure’ alcoholism can stop binge boozing were not uncommon.
It is not just tabloid journalism either: the Guardian has its very own alcoholism tag under which the majority of features on dependency are personal accounts in line with disease model, reinforcing this othering of alcohol dependence problems. Earlier this year it published a piece titled Alcoholism continues long after you stop drinking but the content of the article emphasised the extreme complexity and damage problem drinking can involve, while containing nothing supporting the title’s disputed assertion.
Even articles attempting to dispel the us versus them narrative around alcoholism can miss the mark. Earlier this year the established journalist and author Nick Cohen shared an engaging and honest article about his drinking, but the narrative was again fundamentally flawed. Whilst declaring himself “not an alcoholic” and examining the questionable scientific validity of the disease model, Cohen repeatedly returns the reader to a conflated and inaccurate notion of alcoholism. Granted, an alternative language is lacking, but it is the job of good journalism to find ways to responsibly explore and articulate such complex issues.
However to approach all alcohol problems through the lens of alcoholism may be akin to labelling anyone experiencing a period of low mood as clinically depressed. Whenever we choose the language of alcoholism outside of specific recovery contexts, we tar those people with assumptions that may have counter-productive effects. In turn, we reify a false separation between so-called alcoholics and everyone else, enabling othering and driving stigma. Sections of the media should lead the way in resisting the temptation to always reach for the over familiar and too often myopic alcoholic narrative.
So a play on words if you will to accompany the play of England in the World Cup 2018 football semi finals later this week. Of course on Wednesday night (4am Thursday morning here) I will be watching and have everything crossed for a win and a place in the final next week-end. All of this has me quite homesick but happy to be revelling in this long awaited moment of glory for my home country.
“Welsh Government legislation allowing for a minimum price per unit of alcohol has been approved by Assembly Members (AMs) and is set to become law by summer 2019.
The Public Health (Minimum Price for Alcohol) (Wales) Bill passed the latter stages in the Senedd – the final 45 votes to five – leaving lawmakers to consult on the price level by the end of 2018.
Health officials have stated the aim of the Bill is to cut the annual number of alcohol-related deaths (463 in 2015–16) and hospital admissions every year (approximately 54,000), and they see pricing as a ‘missing link’ in public health efforts.”
Junior Health Minister Catherine Byrne announced that the Bill would most likely enter its final stages in the Oireachtas main chamber (Dáil Éireann) in the autumn.”
So with Scotland, Wales & the Republic of Ireland now implementing supportive legislature around public health and alcohol England is looking increasingly isolated particularly as changes to NHS funding seem to be going backwards too.
By next year, councils will be spending £95m on smoking and tobacco-control services, 45% less than they were in 2014-15. The next biggest cuts over that period will have occurred in drug and alcohol services for under-18s, down by 41% to £40m, and the equivalent services for adults, which will have fallen by 26% over those five years.
Shirley Cramer, chief executive of the Royal Society for Public Health, accused ministers of “confused thinking” over health. “These figures demonstrate a frustrating contradiction from the government, whereby welcome extra money is given to the NHS with one hand, while the other generates more strain on NHS services by draining public health and prevention.”
I am utterly dis-‘May’ed (pun entirely intended) at how on the back foot the current English Government seem to be on this issue. The only information I have read is this: “Junior health minister Steve Brine has told the Commons that the government is “committed to tackling all alcohol-related harms” and has commissioned Public Health England to review evidence for introducing a minimum price in England. (The Grocer).
I am so proud of the NHS as a person who was trained by and worked within the service since 1989 (co-incidentally the year before the last time we played in the semi’s in the World Cup!). It has just celebrated 70 years and to not be pursuiting positively beneficial public health legislature and withdrawing supportive funding from the drug and alcohol sector seems short sighted at best and disastrous for the nations health and the NHS at worst.
So as I spend more time back in a hospital setting more of the diseases and illnesses I used to care for previously in the UK return to my awareness. This is one I’d met before but it was only in seeing it again that I was reminded. So what is Hepatic encephalopathy? Over to Wiki:
More than 40% of people with cirrhosis develop hepatic encephalopathy. More than half of those with cirrhosis and significant HE live less than a year. In those who are able to get a liver transplant, the risk of death is less than 30% over the subsequent five years. The condition has been described since at least 1860.
Signs and symptoms
The mildest form of hepatic encephalopathy is difficult to detect clinically, but may be demonstrated on neuropsychological testing. It is experienced as forgetfulness, mild confusion, and irritability. The first stage of hepatic encephalopathy is characterised by an inverted sleep-wake pattern (sleeping by day, being awake at night). The second stage is marked by lethargy and personality changes. The third stage is marked by worsened confusion. The fourth stage is marked by a progression to coma.
More severe forms of hepatic encephalopathy lead to a worsening level of consciousness, from lethargy to somnolence and eventually coma. In the intermediate stages, a characteristic jerking movement of the limbs is observed (asterixis, “liver flap” due to its flapping character); this disappears as the somnolence worsens. There is disorientation and amnesia, and uninhibited behaviour may occur. In the third stage, neurological examination may reveal clonus and positive Babinski sign. Coma and seizures represent the most advanced stage; cerebral oedema (swelling of the brain tissue) leads to death.
Encephalopathy often occurs together with other symptoms and signs of liver failure. These may include jaundice (yellow discolouration of the skin and the whites of the eyes), ascites (fluid accumulation in the abdominal cavity), and peripheral edema (swelling of the legs due to fluid build-up in the skin). The tendon reflexes may be exaggerated, and the plantar reflex may be abnormal, namely extending rather than flexing (Babinski’s sign) in severe encephalopathy. A particular smell (foetor hepaticus) may be detected.
I can attest to patients coming onto the ward moribund in a coma with this but making a partial recovery following the administration of lactulose. I can also attest to the particular odour that accompanies this disease process. This is not something you want to end up with I can assure you.
Here are some key excerpts from the piece that felt very prescient to this blog:
Set up by the government’s Independent Inquiry into Child Sexual Abuse, the project gives individual victims and survivors a chance to be heard; to share stories in confidence, helping inform the inquiry’s investigation into the widespread failure of institutions from churches to boarding schools to halt abuse. So far it has collected more than 1,000 stories (and remains keen to hear more), and while the details are often harrowing, they are striking in what they reveal about the lifelong consequences. As one survivor says in the report published this week by the Truth Project, it’s “like pebbles thrown into a pond; the ripples keep on getting bigger”.
Last week, the World Health Organisation formally recognised the existence of complex post-traumatic stress disorder, a condition from which it is thought many survivors of childhood abuse suffer. It differs from other forms of PTSD in that sufferers tend to have “a completely pervasive and rigid negative belief about themselves”, says the inquiry’s chief psychologist Bryony Farrant. They may struggle with managing their feelings, trusting others, and with feelings of shame and inadequacy holding them back in school or working life. An analysis of Truth Project participants found that 85% had mental health problems in later life, including depression and anxiety, while almost half struggled with education or getting a job. Four in 10 had difficulties with relationships, with some avoiding sexual intimacy altogether, while others had multiple sexual partners; some suffered difficulty eating or sleeping, were dependent on alcohol, or were drawn into crime. One in five had tried to kill themselves.
Farrant stresses that not every survivor’s story ends badly, and that their fates are certainly not set in stone. “I feel very hopeful and positive that people can recover, and certainly in my clinical work I’ve seen that,” she says. “The brain is far more plastic than we’ve previously understood, which means there are far more opportunities for people to repair some of the impacts from childhood trauma.”
Survivors can choose how and where they talk to the Truth Inquiry as a way of returning the control that was brutally denied them as children. They are asked beforehand about objects that might trigger disturbing memories, and staff adapt accordingly; if an abuser carried rosary beads, nobody in the room can wear beaded jewellery. Some people can’t ultimately go through with it and that’s fine, says Farrant. It’s no good rushing people who aren’t ready, since the impact of a “bad” disclosure can be immense. The inquiry has heard over and over again from survivors saying that being disbelieved or rejected was “just as, or in some cases more, traumatising” than the abuse itself.
Support workers will call before and after survivors share their stories to see how they’re coping and, if necessary, refer them on. Farrant is pleased that complex PTSD was officially recognised by the World Health Organisation, potentially leading to more research and better treatment for sufferers.
“When we know these things underpin the problems so many people are suffering, we’re really treating consequences, not causes,” says Dr Mark Bellis, director of policy research and international development at Public Health Wales and a leading expert on ACEs. “We don’t think about what’s driving people towards drugs; we might think about regulating access, when actually it’s the consequences of something that happened to someone as a child.”
Abused children often become hyper-vigilant, Bellis explains, knowing survival may depend on seeing trouble coming; and that affects both neurological development and hormone levels. “If your experience of life is fear, it’s not unusual to develop a more cautious approach to things. But there are physiological changes, too. The way I explain it is if you set any system on a high alert, it wears out more quickly. If it’s permanently running on high alert, it’s producing particular immunological responses or proteins which seem to be higher in people who are exposed to these traumas in early life.” Since these are also linked to higher rates of diabetes and cardiovascular disease, survivors’ risk of physical illness increases.
But that chemical response may also help explain why abused children who had at least one adult they could trust and relax around – leaving behind that state of high alert – seem to have better prospects of recovering. Other protective factors, he says, include feeling connected to a wider community or “if you can see a way out of things, being able to set your own destiny; if you feel you’ve got a pathway out, maybe through school”. It is important for survivors to know, he says, that there is hope. “The more we understand about things like resilience, the more we know there are things in children’s and in adult lives that can counteract this. You are not on a set course.” Children and adults do not have to be broken beyond repair. And it is not beyond society’s means to mend them.
Share your experience with the Truth Project at truthproject.org.uk, call 0800 917 1000 or email email@example.com.
So in a couple of days Dry July starts here in Australia – the Oz equivalent of Dry January. This felt like the perfect opportunity to talk about Hello Sunday Morning who I’ve talked about before here. I’ve been in touch with them since I arrived in Australia and recently was given free access to their support service Daybreak. I asked them to introduce themselves and their service and this is what they said:
Hello Sunday Morning is really making a difference in the health promotion space around alcohol. The charity has grown to be the largest alcohol behaviour change program in the world and has a large international membership. The movement is all about empowering and supporting people to change their own relationship with alcohol, whether that means quitting drinking completely or just cutting back on consumption. They believe that drinking should be an individual choice and not skewed by social expectations.
Hello Sunday Morning developed Daybreak as program to help those who need it join a community of like-minded people all working towards the goal of changing their relationship with alcohol. The program offers tailored experiments for you to replace old habits with healthier alternatives, like taking a bath instead of turning to the bottle of wine. You can also speak to trained health coaches on a chat feature and you have access to peer support whenever you need it, right at your fingertips. The community of Daybreakers has been proven to help members stop acting on urges in the first 7 days of downloading the program.
In Daybreak we have combined the top 7 non-medicated approaches for alcohol behaviour change, and the outcomes have been amazing, our preliminary data has that 16% of members are reporting positive alcohol outcomes within 35 days, this is 2-3 times better than Alcoholics Anonymous. The average in-person treatment success rate in the U.S. is around 20%, we are within 30% of that number and gaining ground fast.
We are with working universities to get these results independently tested and validated.
I love what the HSM community are doing here in Oz. Daybreak offers a supportive community for those who are taking on the challenge of changing their relationship with alcohol. Fantastic print ads too which you can see above and an awesome TV advert as you can see below!
HSM | Hello Sunday Morning - Vimeo
In support of Dry July I’ve teamed up with HSM & Daybreak
I have five free licences to giveaway to those who think Daybreak could be something that would help you change or maintain your current relationship with alcohol. To redeem please email firstname.lastname@example.org for your free licence, first five to email will receive the licence
Edited to add: mention ahangoverfreelife in your email to them so that they know it is this promotion that is prompting the request!
I’m honoured to share another guest blog post from Andy. His story of recovered hope. Over to Andy:
The first-ever AA meeting I went to was in prison, and I didn’t speak. I didn’t stand up, didn’t say my name, and certainly didn’t tell my story. I did one thing though – I listened. I listened to other inmates telling the story of their life before that day. And, in my own way, I allowed myself to hope that my story was unfinished, that there was more to my being here, and my being alive than this.
At that point in my life, for what it was, I had no idea if there was any more to my story, anything that would one day be worth telling, to be worth sharing. As a famous writer once said, “It is the tale, not he who tells it.” So, here it is – this is my story, my tale.
My name is Andy and I’m an alcoholic and a drug addict.
I guess where your life begins is a lottery, and mine began in the murder capital of the world – Medellin, Colombia. The daily homicides, violence, and fear prompted my parents to get us all to the U.S., and, by hook or by crook, they managed it. I swapped streets filled with drug cartel
murders and shoot-outs to ones bathing in the southern California sunshine. My childhood? Nothing to complain about and nothing to predict the path I would eventually follow.
If you know anything about Colombians, you know they love to party, to rumba, salsa, and fiesta with the best of them. One such occasion (I was about 9 years old) stands out. All the family was there, along with our American friends and neighbors. The aguardiente, a strong Colombian alcoholic drink with an anise taste, was flowing. I managed to sneak my first ever shot from a worse-for-wear uncle, and I was gone – I loved the taste, the relaxed feeling and the glow it gave me. I loved the escape, and, yes, I fell in love.
As I grew, so did my desire for that escape, that high. At 13, I smoked my first joint, and, by 19, I was hooked on meth. And when you reach that point, you’ll take and do anything to stay on the rollercoaster ride, to keep that buzz going and going. Cocaine was no longer my party drug of choice, it was breakfast, lunch, and dinner. And it was no surprise to my saddened family when my sorry self-was threw in jail at the age of 22.
My initial sole purpose for going to AA and NA meetings while incarcerated was simple – to get out of my cell. For the first couple of months, I never contributed, never answered any questions, or even spoke. But, like I said at the beginning of this tale, I listened.
Every so often, someone would share something that hit a nerve or that I could really relate to and understand. One day, this old guy stood up and shared his story of alcohol addiction. One look at his face told you all you needed to know about the cards he was dealt, even the kind of card games he played in. There had been a woman, one who loved him dearly, had tried to help him with his addiction, nursed and comforted him when he’d been beaten, and made his excuses for him.
He woke up from a blackout one day, and she was gone. No note, no clothes in the wardrobe, no makeup on the sink. The only person who ever had his back had made her choice. Anything but this.
Why did this resonate so hard with me? My parents, who I love dearly. He spoke of this woman with the same regard I thought I gave them. Yes, it didn’t take very long to see that I had done very little in my life to make them proud of their son. This man and woman had risked everything, probably even more than that, to get their children away from a city riddled with violence, hate, corruption, and murder.
And how had I shown my love? This. Booze, drugs, prison. If you can put your recovery down to one moment of clarity, that was mine. From then on, in my meetings, I started to speak up and to share.
I’m an agnostic – I can’t believe in a God I have no experience of. Did that cause a problem when considering the existence of a higher power during all those jail-time meetings? Quite simply, no. That old guy I mentioned above? He’d had the Big Book printed out by a friend outside, and he gave me Chapter 4 of it to read. When I had finished it for the third time, I tried to give it back. He wouldn’t take it.
I have never found God, let’s make that clear. I have, however, found a spiritual belief that is the higher power, my higher power, that I need to continually help me overcome my drug and alcohol addictions every single day.
Life in prison got easier. Every day, I would read more of the Big Book (my Mom visited me with a copy as soon as I summoned up the courage to tell her about the meetings I was going to), and I was trying my best to work the 12 Steps. Funnily enough, I started to fear my release date.
To summarize, I got out, got a job, did very well, made some money, and relapsed to the point of near death. My parents got me into their car and into a rehab in the next state over. I have no doubt that they saved my life with that decision.
Rehab gave me exactly what I needed to help me begin my alcohol and drug addiction recovery. With the help of daily AA and NA meetings, the whole 6-month experience gave me the opportunity to begin again, to deal with my demons, deal with my fears, and deal with living my life in a different way.
When I left, the first thing I did was find a sponsor. He pulled no punches – he only agreed to be so on the condition I went back to college, studied hard, found something I was good at, and that I could make a positive life from. I liked the whole concept of simple communication (telling a story people could relate to) and I chose digital marketing. He also said I had to attend one meeting a day for the next 90 days, and gave me a little diary to record them in. I did as he asked.
Nine years down the road, and I’m back in Medellin, a successful entrepreneur running a successful digital marketing agency. We have a lot in common, this city and I. We’ve both grown up considerably in recent years, we’re a lot safer to be around, and we’ve learned. We’ve learned that you can make fundamental changes for a better way, and you can change your direction with hard work and a new attitude. Most importantly, I feel at home here. One day, my parents will join me (my brother already has), and they will live in a house I bought for them, and simply enjoy being back home themselves.
So, that is my tale – a Colombian immigrant child, a drug addict and alcoholic, an ex-convict, and a successful digital marketing entrepreneur and businessman. Most of all, I’m this – I’m another person in addiction recovery, who, with the help of loving parents, drug rehab, the ongoing support of both my AA and NA meetings and the friends I have made there, will stay this way – in recovery. The only other option for me is one I will not entertain.
How has AA or NA changed your life? What has been its best way of helping you? Does anything in my story resonate with you? Please, feel free to put a comment below and share a little yourself.
One last thing. If you, like me, are agnostic or have trouble with the higher power element of fellowship meetings, let me say this. If you are an alcoholic or an addict, there already is something in your life more powerful than you. Find a better one.
From this week-ends Guardian looking at the issue of being a sober mother: “after the birth of her second child, Amelia Hill gave up drinking. Little did she realise that her simple lifestyle choice would carry such a social stigma”
I’ve got a dirty little secret: I’ve stopped drinking. I’m not an alcoholic. I don’t have an addictive personality. I’m in robust good health. I enjoy drinking. But after the birth of my second child three years ago, I became a sober mother. It wasn’t an obvious progression: I drank with the usual wanton enthusiasm before I became a mother. I continued drinking moderately throughout both my pregnancies and while breastfeeding my firstborn – sticking to the government advice that served previous generations perfectly well, that one or two drinks, once or twice a week, was OK. Advice that was suddenly changed in 2007 to a dictate of complete abstention on the basis of no scientific rationale at all.
When my first child was weaned, my friends brought round a few bottles and we celebrated with a “normal service has been resumed” party. Coping with the sleep deprivation caused by one baby wasn’t that different from coping with a hangover, I reasoned, so coping with both was just more of the same. With one child, this approach worked reasonably well.
Without thinking about it, though, I was buying into the pro-drinking mothering zeitgeist, alien to my mother’s generation, but so prevalent in my own. It is typified not only by the slew of entertaining, slummy-mummy blogs (Sippy Cups Are Not for Chardonnay, Mommy Wants Vodka), books both fictional (Why Mummy Drinks) and biographical (Hurrah for Gin) and films (Bad Moms, Bad Moms 2) but by its all-pervasive presence on the internet, too. I never joined the nearly 630,000 members of the Facebook group Moms Who Need Wine, but I didn’t need to sign up to absorb its message. Nor did I have to buy one of the jaunty coffee mugs, bags, T-shirts, cards or towels emblazoned with cheery, sassy messages about how raising children requires mothers – and these products are exclusively targeted at mothers – to maintain a steady state of semi-inebriation: the wine glass engraved “You’re not really drinking alone if your kids are home” or the flowery fridge magnet chuckling “The most expensive part of having kids is all the wine you have to drink.”
Women do not become fools when they become mothers. We get the knowing nudge of the alcoholic version of the “You’re Worth It” advertising strapline but at the same time, it seems we can’t entirely slough it off. The joke reverberates in our ears long after we’ve shut down the browser, closed the book or switched off the TV.
Gabrielle Glaser, author of Her Best Kept Secret: Why Women Drink – and How They Can Regain Control says that wine has become “normalised, expected and then reinforced by popular culture, social media, advertising. The volume and ubiquity of the pro-drinking message has made it infinitely more likely that even mothers who know it’s a caricature, will immediately think of pouring themselves a drink as a release valve once the children are in bed – and then do it.”
Perhaps it’s because there’s truth in the joke: lots of mothers I know encourage each other to drink. It’s a shorthand for empathy and sympathy – a euphemism for just taking a break. We smile at the despairing mother whose children are bouncing off the walls and tell her that she deserves a large glass of wine after the kids have gone to bed, and that we would do the same. Or we “jokingly” bring a bottle of wine to the NCT picnic. Or we arrange “prosecco playdates” where the adults bring carrot sticks for the children and wine for each other, to be enjoyed in the kitchen while the children play down the hall.
It is a statement of the blindingly obvious to say that we Brits live in an alcohol-dependent culture. We can trace our fondness for drink back to the Anglo-Saxon mead hall – Norman invaders writing in the Anglo-Saxon Chronicle remarked on how drunk the English soldiers were – via Chaucer to Shakespeare, when drinking became a demonstration of loyalty to the crown and the church, proving that you weren’t a puritan.
Nevertheless, female drinkers have traditionally been criticised for neglecting their roles as wives and mothers. They have been portrayed as sexually promiscuous and lacking in characteristics associated with “femininity”, such as being caring, concerned about appearance and health-conscious. But, says Glaser, times have changed.
“The pressure on mothers to drink to prove themselves modern is a relatively new one,” she says. “When I gave birth to my third child, I was given bottles of wine by friends alongside – or even instead of – gifts for the baby. It was generous and kind of my friends, but I couldn’t help being struck by how times had changed. That didn’t happen with my first two children.”
I’m not saying the modern mother is a gin-swigging inebriate, forever dropping her baby down the steps of Hogarth’s Gin Lane – but when Kelly Clarkson, a singer and mother of four, recently told People magazine that “Children are challenging. Wine is necessary,” she was the latest in a long line of voices across all layers of popular culture to give currency to the image of the modern mother as one who is knackered, chardonnay-swilling and unrepentant. So entrenched is alcohol in our culture that being a sober mother is nowadays to be fundamentally out of step. The image of a mother with a large glass of wine has become an almost feminist face of motherhood, putting two fingers up at the pressure of being a perfect parent and making it unmistakably clear that we are very much not part of those oft-mocked tribes, the tiger and helicopter mums.
It is impossible to track the exact point at which, as Glaser says, times changed, because there is no long-term research on mothers and drinking. But something had already happened by 2009, when a systematic review concluded that an increase in drinking among women was “one of the most important trends in alcohol consumption in the United Kingdom”. By 2012, according to the ONS, a similar proportion of women aged 16-24 years, 25-44 years and 45-64 years were reporting as exceeding the UK government’s daily drinking benchmark (three units for women) on a single day in the previous week.
In 2015, a study in the International Journal of Drug Policy found that a significant number of mothers were saying drinking enabled them to “assert their identity” beyond the roles and responsibilities often associated with being a woman in early midlife. Mothers with young children described to researchers the “transformative effects” of “excessive drinking” which, they said, allowed them to return temporarily to a younger, carefree version of themselves.
The researchers concluded that women’s drinking in early midlife “revolves around notions of ‘idealised’ femininity but simultaneously represents a way of achieving ‘time out’ from traditional female responsibilities such as caring for others”. This reflects the thoughts of one of my NCT friends, Lucy. “A glass of wine – or to be more honest, half a bottle a night – connects me to other mothers who also struggle with their identities,” she says. “An example is when other mothers call me on the phone and ask: ‘Hello, is this Sophie’s mum?’ After a drink, I no longer feel trapped to be in this world where I’m just someone’s mum, even when that someone is someone I utterly adore.”
One of my best friends, Gina, credits alcohol with helping her survive the isolation, anxiety, lack of certainty and responsibility of motherhood. “Raising children is one of the most important and difficult tasks given to human beings,” she says. “Combine that responsibility with the sleep deprivation, anxiety, stress and eradication of virtually all adult life as you know it, and alcohol is a wonderful shortcut: a way to feel calm and warmer.”
It also, she notes, connects her to other mums she’s just met – with whom she has no history and perhaps nothing in common other than their children, but on whom she is “dependent for advice, understanding and, in the early months of motherhood, sanity-saving adult company.”
So does it matter if mother’s ruin has become mother’s little helper? I think it does: a report in the Lancet earlier this year found that every extra glass of wine we drink over the recommended 12.5 units a week shortens our life by 30 minutes. Drinking, researchers concluded, is as harmful as smoking. The Alcohol Harm Reduction Strategy for England states that there are between 780,000 and 1.3 million children living with an adult abusing alcohol.
Two years ago a research project found that British mothers-to-be were among the most likely in the world to drink during pregnancy and harm their unborn baby as a result. The study, conducted by the Canadian Institute of Mental Health Policy and Research, found that four times more children in the UK suffer alcohol-related birth defects than the global average. For the proportion of children with foetal alcohol spectrum disorder (FASD), Britain came seventh out of 195 countries and sixth in Europe. A report commissioned by a crossbench group of MPs and peers – some of whose parents were themselves alcoholics – found that more than one in three deaths or serious injuries suffered by a child through neglect or abuse is linked to parental drinking. The research also found that 41% of those in the problem category were female – previous studies have also found that women are more likely than men to finish a bottle of wine alone – of whom 61% came from the highest ABC1 professional classes.
But then we have the recent research, published at the end of last year, and reported in the press with predictable headlines such as “Breastfeeding mums rejoice!” claiming that not only can new mothers indulge in a hard-earned glass of wine without harming their baby, they might actually be helping it because “babies who were breastfed by mothers who drank in moderation had more favourable results for personal-social development”. However, the report goes on to say that breastfeeding women who consumed alcohol were more likely to be born in first world countries, be tertiary-educated and have higher household incomes. Most drank at low levels and employed strategies (such as the timing of alcohol use) to minimise alcohol passed on to infants via breast milk.
The researchers also noted that as a child’s social development is likely to be greatly influenced by their environment, a child’s social advantage could also be a result of their mother simply heading out for a drink. In this case, surely, for those who choose to abstain, just going to a festive gathering could be good for the baby. Child psychologist Dr David Carey had reservations about the study. “There are many factors which influence social and emotional development, the most important among them being family and school. So it is highly unlikely that maternal alcohol consumption is a significant factor.”
I stopped drinking after the birth of my second child simply because I had too much stored-up energy at the end of the day to want to sedate myself with alcohol. Prior to becoming a mother-of-two, I had been a keen runner. I continued to run during both my pregnancies, but with two small children, I barely had time to find my running shoes, much less put them on. Without intense exercise to whisk the wine-calories from my body and the fumes from my head, drinking seemed a far less attractive option than before. My energy levels were still high though and, after the kids were finally down for the night, I craved not oblivion but stimulation. Parents of small children become inured to leaving shards of unfinished conversations scattered in their wake, and I would metaphorically grab my husband by the lapels when he came home from work and demand unbroken adult communication.
The craving for alcohol did take a while to disappear: my association of wine with relaxation was deep-rooted. But once I realised how much healthier I felt for not drinking – how much less painful it was to be woken early and often by squalling children if I didn’t have a head full of cotton wool, and how much more energy I had during the day for the child-rearing equivalent of herding cats – I decided the itch was not for scratching.
I feel frustrated that a harmless personal decision should put me at odds with mainstream society. Perhaps it’s because women are now expected to ape the drinking habits of men, that non-participants feel peripheral. Whatever the reason, I tend to keep my new-found teetotalism schtum. I often avoid invitations to the pub because I don’t want to be thought of as a party pooper or – the horror! – be mistaken for a tiger/helicopter mum. If I do go, I nurse a tomato juice made up to look like a Bloody Mary. If questioned, I prefer to mutter exaggerated stories about fractious, insomniac children rather than come clean.
“It’s very hard for the modern mother to talk about not drinking in the current climate,” says Glaser. “Alcohol has embedded itself into modern motherhood so deeply that unless you have an addiction problem, it’s difficult to talk about it without sounding sanctimonious. The attitude is: ‘If you don’t have a problem with it, why do you have a problem with it?’” But if we don’t talk about it, how do we know if we have a problem?
Stefanie Wilder-Taylor, an American author, stand-up comic and mother was at the forefront of the boozy mother wave with her blog, Make Mine a Double: Tales of Twins and Tequila and her book, Naptime Is the New Happy Hour, published in 2008. But a year later, she took her audience by surprise: she outed herself as an alcoholic. Her confession seemed to unstop a dam: there has been a tidal wave of books since by women who have given up drink, confessing to their alcoholism.
Wilder-Taylor still writes and blogs, but now she helps both stay-at-home and professional parents – usually mothers in their early 40s – who have crossed that fine line from merry boozing to functional alcoholism, which in her case was when her nightly wine became a compulsion and it was an emergency if there was none in the house.
“I wanted to be the best mom I could,” she says, “and I felt like I was failing every day. I was drinking to be kind of present, just not all present.” During one hospital scare with her daughter, she remembers thinking, “This is a really great place for a bar: right here in the ER.”
“We’re bombarded with images of women drinking wine together, with stories of wine-infused play dates, with husbands and wives enjoying each other with alcohol at the end of the day,” she says. “But I’ve spoken to so many mothers who say they never drank so much as they did after having children. I talk to women all the time who look completely normal and put-together from the outside but are drinking and driving, and putting their lives and their families’ lives at risk every day because they’re too afraid to tell someone they have a problem.”
I struggled writing this article. I examined and cross-examined every sentence, fearful of appearing sanctimonious. But I decided to press “send” on the article, because really, it’s crazy that talking about something that’s actually a perfectly reasonable choice to make, should be so freighted with anxiety and stigma. The fact I’ve felt any sort of pressure to keep quiet about a sensible – and moderate – lifestyle choice says so much about modern motherhood and drinking, that I reckoned, at the very least, it was worth seeing if I could start a conversation about it instead.
From Alcohol Policy in the UK published in April. In this guest post, Dr Claire Garnett, a Research Associate in UCL’s Tobacco and Alcohol Research Group, discusses the findings from a recent systematic review of digital interventions for alcohol reduction.
Digital interventions are those delivered via computer technology, which includes smartphone apps, websites, computer programs, wearable devices, and telecommunications, that aim to promote behaviour change. Digital interventions for alcohol reduction have a number of advantages over the traditional face-to-face brief interventions such as: having a low cost per user, greater reach, can avoid the stigma associated with receiving help in person and are highly convenient in that they can be used as and when the individual wants. However, there is little evidence as to whether digital interventions are effective at reducing alcohol consumption.
A recent systematic review aimed to answer whether digital interventions are more effective at reducing alcohol consumption compared with no intervention controls. The review included 41 randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions for reducing hazardous or harmful alcohol consumption in people living in the community (the studies included people in workplaces, colleges or health clinics, and internet users). The primary outcome measure was the quantity of alcohol consumed in grams of alcohol per week (a UK unit is 8 grams). Participants were followed up between one month and one year later, and everyone was asked again how much they were drinking. The majority of digital interventions were web-based, though some trials involved a computer program and one used a smartphone app. The no-intervention control groups included assessment only, waiting list control groups and standard health-related information.
Do they work?
The 41 studies included in the review had 42 comparisons between a digital intervention and a no intervention control, and had 19,241 participants in total. The review showed that participants using a digital intervention drank 22.8 g alcohol weekly less than participants who received no or minimal interventions at end of follow up. This is equivalent to about 3 UK units. This evidence was classified as “moderate-quality” as the true effect is likely to be similar to this estimate of the effect size, though there is a possibility it is substantially different.
What BCTs are used in digital alcohol interventions?
Are particular BCTs associated with the effectiveness of the digital alcohol intervention?
A median of nine BCTs were used in the digital interventions and the five most frequently used BCTs were: Feedback on drinking behaviour; Social comparison; Information about social and environmental consequences; Feedback on outcomes of behaviour; and Social support.
Three BCTs were significantly associated with the effectiveness of the digital intervention (i.e. the reduction in alcohol consumption). These were:
Behaviour substitution: Prompt substitution of the unwanted drinking behaviour with a wanted or neutral behaviour.
Problem solving: Analyse, or prompt the person to analyse, factors influencing the drinking behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators.
Credible source: Present verbal or visual communication from a credible source in favour of or against the behaviour.
Why do they work?
Behaviour change theories explain why a behaviour does or does not occur. Applying theory to the development and evaluation of interventions can increase their effectiveness and provide an understanding of why interventions do or do not work, which can inform future interventions. However, few interventions report this. This systematic review also answered the following questions:
What theories or models have been used in the development and/or evaluation of the intervention?
To what extent is theory use reported by the digital alcohol interventions?
Is there an association between intervention effectiveness and use of theory?
The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory, Transtheoretical Model and Social Norms Theory. Over half of the interventions made no mention of theory and about only 40% used theory to select or develop the intervention content. The limited reporting of theory use was unrelated to intervention effectiveness.
What this all means…
Digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) units per week compared with control participants. This means that there is good evidence for the use of digital interventions to help people reduce their alcohol consumption. Although the changes are not quite as large as those seen in face to face interventions in primary care which have shown average reductions of closer to 5 units per week.
Anyone designing future digital alcohol interventions should consider that the BCTs of behaviour substitution, problem solving and credible source were associated with intervention effectiveness. For researchers, clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behaviour change theories. Meanwhile, policy leads or practitioners may view this emerging evidence as tentative support for the role that digital alcohol interventions can play as part of the wider ‘intervention mix’ in helping drinkers reduce hazardous or harmful alcohol consumption.
Woohoo is all I can to this research! If you can help people digitally to access support and change behaviour around drinking as a adjunct tool and it helps with alcohol consumption harm reduction then that has got to be a good thing in my view. What do you think?