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One little glass can't hurt an alcoholic, can it?

Can a recovering alcoholic still have the occasional drink, or is it the road back to oblivion?

Claire had been sober for two years when she began a relationship with another recovering alcoholic. One evening at his house he made a suggestion. “How do you think we would react if we had just one drink?” he asked.

“I couldn’t resist the challenge,” says Claire. “Within minutes we had downed the first glass of whisky and then another and another until the bottle was empty. That was the start of a two-day bender that ended up in hospital after I knocked myself out. I understand now that I can’t ever have just one drink. I never could stop at one.”

What Claire discovered the hard way – and there is no other way for someone to acknowledge the extent of their dependency on alcohol – is the received wisdom that only abstinence will enable her to control her drinking. For those who are dependent, just one drink is not an option. They must stop and never start again.

This is the mantra of Alcoholics Anonymous (AA) and its 12-step programme, and such is its prevalence that you will hear it again and again from recovering alcoholics who have successfully stayed dry over a period of years, and from those who treat and support them.

Not that this removes the temptation to experiment with alcohol, as Robert Teed admits on the right. After five dry years he has taken a few surreptitious slurps of Rioja, and this is precisely the slippery slope that he must avoid, says David Bremner, medical director of Winthrop Hall, the addiction treatment centre in Staplehurst, Kent.

“For someone who is dependent on alcohol, one drink leads to the rapid reinstatement of the habit to the point where they were when they stopped,” he says. “There is biological evidence to support this, and even evidence that babies born to actively drinking alcohol-dependent mothers can remain abstinent throughout their childhood, but when they start drinking in early adulthood they rapidly return to the level of alcohol to which they were exposed in the womb.

“Stealing slurps is dishonest and hidden, it’s guilt-laden, it’s not normal social drinking and although the quantity might be small, this is alcoholic drinking. It’s high up there as an indicator of relapse.”

But if someone with a high dependence on alcohol must accept that he or she can never return to moderate social drinking, does this apply to others who misuse drink? It’s a relevant question given that one in four of the UK population drinks more than twice the recommended weekly limits of 21 units of alcohol for men, and 14 for women. (A bottle of wine contains nine units.)

When surveyed for a 2008 NHS report, almost 23 per cent of the male and 15 per cent of the female respondents in England said they had drunk twice the daily limit at least once in the previous week. These people are not alcoholics because they are not dependent on alcohol and they certainly don’t need a swig of vodka to kick-start their day, but healthcare professionals regard them as heavy drinkers, and they include those within the middle classes who think nothing of polishing off a bottle of wine on Friday or Saturday night. Or both.

Nick Heather, professor of alcohol and other drug studies at Northumbria University, admires the support that AA gives to those dependent on alcohol, but says that its unscientific approach to addiction can be confusing to those who are less dependent but who still drink to harmful levels.

“The term recovering alcoholic, as used by the AA, loads the dice,” he says. “They believe that alcoholism is an incurable disease and that one is never recovered but always recovering, and that one drink leads inevitably to suicide or death. That’s not true. It’s a gross oversimplification.

“What is true is that for people at the highest level of dependence involving delirium tremens, hallucinations and fits, it’s extremely difficult to maintain a pattern of controlled drinking. The much easier option is for them to rule alcohol out of the equation.

“The problem with the AA approach is that it focuses attention on the relatively few people with a high level of dependence, whereas an enormous number of people damage their health or the welfare of others through their drinking – eight million in England alone.

“For these people much the best option is to tell them they can continue to drink, but in a less harmful fashion. The evidence is overwhelming that at lower levels of dependence controlled drinking is an option, and it doesn’t deter people from seeking treatment, whereas the prospect of lifelong total abstinence would.”

Health professionals, from GPs to hos- pital doctors, nurses and probation officers, are primed to identify these people and to refer them where necessary: the Government calls this programme brief interventions. All of which makes it sound as if millions of weekend imbibers will be chastised and booted off to therapy the second they take their tennis elbow to a GP.

Obviously this isn’t going to happen – the NHS couldn’t cope with the numbers – though as the psychologist Oliver James explains, it can be worth examining the reasons why so many of us often pour second or third glasses of wine that we don’t need. Once this is understood, he suggests, it is feasible to return to “normal” drinking with impunity.

“Most people have some kind of what would generally be referred to as a vice,” says James. “In my case it’s nicotine that has played a role in keeping my moods stable. For a lot of people it’s eating or shopping. Or there is the middle-class person who finds themselves drinking two glasses of wine a night and has been heavily criticised by the Government.

“People find all sorts of physical methods of boosting their cortisol and serotonin levels, of finding a place where they feel comfortable or balanced.

“For the person drinking a bottle of wine a night, the chief medical officer is right that it will shorten their life, and good psychoanalytic psychotherapy could help them to drink to safe levels. What you would have to do is learn what’s going on in your contemporary life and what went on in your childhood history that means one glass is not enough.

“Are you working too hard? Are you lacking proper intimate relationships? You can sort yourself out in ways that mean you don’t need that second glass of wine.”

On the wagon: I can’t have a single drink

I’ve been riding this wagon for five long years now. I wouldn’t call it thirsty work – it means a lot of fizzy water and ginger cordial – but it is a lonesome trail. There have been times when I’ve had to ask the driver to pull over, but he’s ignored me. Sometimes, I’ve even been tempted to fling myself from the wagon’s swaying roof on to the booze-sodden earth below. But I never have – not quite.

The temptation is growing, however. It’s stronger now than when I first gave up, which might surprise some people. Five years ago my friends’ comments were all of the “I don’t know how you do it” variety; nowadays those who know me don’t question it, and those who don’t know me just think I’m driving.

Maybe that’s the problem: this wagon trail is taken too much for granted, by myself and others, so it doesn’t feel special any more. For when I started it did feel very special: I was kicking a lifetime’s habit, and doing it through pure willpower – there were no pills, no meetings, no stomach insertions to make you heave at the smell of wine. Friends and family continued to drink freely while marvelling at my strength of will, and I was happy to let them do both. Now, however, no one bats an eyelid, while I have started to covet their Rioja. I have even taken to sneaking slurps. Is this a slippery slope? Will the odd sip lead to the odd glass, and then to two, and so on to oblivion? Or could I stop at that first glass? Maybe I should experiment – pour that glass of Rioja and call it mine. See if that staved off my craving.

And if it did, surely that would be the sign that I am “cured”, to have had that one drink and no more – that must be the holy grail for any wagon trail? Perhaps. But it would be dangerous and foolish to pour that Rioja. It would mean that I had forgotten the reasons I was on this trail in the first place – the amnesiac drunkenness, the annihilating self-disgust, the disaster zone of my relationships.

Better, then, to stop moping on the top of the wagon and to climb back inside its button-backed, sumptuous carriage, pour myself a ginger cordial and enjoy the ride.

source:  The Times

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