Why alcoholism, being an alcoholic or being alcohol dependent is a progressive illness

A personal perspective

So I thought I’d write this for (myself) you to tick off what the common reasons for why the consumption of alcohol is a ‘progressive illness’. It’s a belief I very much share, statistically it seems to be true, clinically it’s been my experience as a shrink treating addicts. But personally I thought it’d be an idea to get away from the theory and share biographically how it ‘got’ me. How the tail started to wag this dog. (Woof)

With ‘alcoholics’ there’s always seems to be this question: ‘why me?’ When was the ‘tipping point’ the threshold I crossed that ‘made me’ an alcoholic. And that’s a tough one to answer because it’s as complex as a cat’s cradle of different influences which, frankly, science is still trying to unpick. For example, let’s just assume one biological origin of addiction may be genetic (hence the statistical heredity link to my dad and his before him) … it turns out those genes don’t always get switched on. Epigenetics tells us even if you had a gene (assuming there is one) to become a raging alcoholic it may stay dormant.

So unfortunately getting to the why’s of an ones alcoholism is going to remain shrouded in mystery. A smorgasbord of uncertainty which isn’t helpful if you’re trying to uncover your origin story. But whatever blend of nature or nurture, it’s progressive. Somehow it builds on a predisposition (nature) folds into a person’s life experience (nurture) within the context of a society that holds alcohol in such high esteem (environment / context). And this leads addiction leads to chronic physical, psychological, and social problems.

What makes alcohol the most dangerous drug (Nutt 2010) is the ‘boiling frog’ is partly due to this very nature of progression. Part of the challenge (and this is definitely what caught me out) is that the journey from enjoying a glass of wine to being unable to manage ‘life’ without one seems so subtle. It ‘progresses’ by accretion over time; forty years in my case, but with others less than five.

Any list of factors you ‘Google’ will include the usual suspects increased tolerance, dependence, cravings, neurological changes, and social isolation. And yes, while these factors can all be included, the precise emphasis upon each varies wildly from person to person. It’s entirely subjective. ‘Hyper personal’ if you will.

For me it was this subjectivity that was the challenge for my own self-diagnosis. ‘I’m not like that’ (e.g. socially isolating) became a wonderful excuse to suspend judgment on yourself and remain in ‘denial’ (and remember, ironically I was a shrink for a good part of this). It was quite possible for me to achieve a superb 18 out of 20 in a ‘Am I an alcoholic’ questionnaire, and come up with the answer ‘no’.

Tolerance is one of the key factors that make alcoholism a progressive disease. As a person drinks more and more alcohol, their body becomes increasingly tolerant to its effects. This means that they need to consume larger amounts of alcohol to achieve the same level of intoxication they once did with smaller amounts (broadly the dopamine hit). This leads to a cycle of escalating alcohol consumption that can ultimately result in addiction.

That was my experience of tolerance. I started out drinking at weekends with friends at the Bull and Bush, The Cricketers and The Princes Head (if you want to picture it, it’s all the pubs on Richmond Green featured in the TV show ‘Ted Lasso’).Three pints of ESB and off to a party someplace. Brilliant social drinking, What. A. Laugh. And ended up thirty years later, miserable, banging off several bottles of wine (plus spirits) each day just to get through. How did I get there? Short answer: I don’t know and, as mentioned, I doubt I ever will.

But that tolerance towards industrial level of alcohol consumption was definitely required to keep the hangover at bay. To function as a responsible employer, husband and as a parent. And much of that ‘industrial’ level of consumption was secretive so I must have known in my addled brain that it was increasingly… outlandish behaviour. I refused to admit it. The word ‘tolerance’ is the flip side of ‘dependence’ and I needed more booze to get to the ‘click’.

Dependence is another important factor that contributes to the progression of alcoholism. Regular alcohol use can lead to physical dependence, which means that the body has adapted to the presence of alcohol and requires it to function normally. When a person stops drinking, they may experience withdrawal symptoms such as anxiety, tremors, and seizures.

Tick. So one handmaiden of tolerance is dependence. I always knew what was waiting for me if I stopped for any length of time. That godawful hangover. And yet I tried to bargain with myself. If I managed to stop for a period of time it ‘proved’ I was in control, that I wasn’t alcohol dependent, alcoholic, suffered from AUD …(whatever todays ‘woke’ label is or shouldn’t be). And occasionally I did manage to get through the three day hangovers into an alcohol free space for a few days or a couple of weeks, even a few months. And that ‘proved’ I was OK. I was hanging by my fingernails off a (p)ledge to myself.

The hard won periods of sobriety were an illusion, I was dependent on alcohol. NOT drinking alcohol was simply living my life without booze, but also not addressing any of the underlying issues of why I drank in the first place. It left me very exposed to relapse. The physical dependence may have been in abeyance temporarily but the psychological aspects of my dependence were never addressed. I was dependent on alcohol to navigate my life, to make myself feel better when life threw me any ‘crap’ to handle. It was just a matter of time before I picked up again. Which inevitably happened. My takeaway: ‘If you want to find out why you drink you have to stop drinking. And then deal with that’.

Cravings are also a key feature of alcoholism. Over time, alcohol can alter the brain’s reward system, making a person crave alcohol even when they know it is causing problems in their life. These cravings can lead to continued alcohol use despite negative consequences, such as relationship problems, financial difficulties, and health issues.

The word ‘cravings’ seems so innocent when read on a page. It’s too similar to ‘desire’ to be taken seriously as in: I have a craving to be in the warm embrace of Kylie Minogue, on a sheep skin rug, in front of a roaring log fire. Craving is ubiquitous I can (and do) have a persistent craving for a doughnut. But as an alcoholic, what cravings meant for me was what I came to call ‘The Fear’ after the Lily Allen song my daughter used to play.

For starters that meant waking up at 2am and feeling absolutely petrified. Sweating, anxious and unable to get back to sleep. Nausea would often come to play and that meant vomiting and dry retching. I knew what would fix the craving of course, the only question was when I could allow myself (read ‘capitulated’) to have it. And so the countdown began to that first drink of the day.

Chronic alcohol use can damage the brain, leading to a range of cognitive and behavioural problems. These changes can include memory loss, impaired decision-making, and difficulty controlling impulses. These neurological changes can further contribute to the progression of alcoholism.

And without getting too ‘high highfaluting’ this ultimately becomes a philosophical problem. Because where does the brain end and the mind begin? I know I was experiencing blackouts, could not remember large chunks of time, and still can’t. But was my decision making impaired? Surely I was a ‘functioning alcoholic’. I was still driving a car, running a company holding down a marriage. Yes, I was impulsive but that ‘spontaneous’ right? Life’s ‘fun’ … you have to make your own ‘fun’ or it’s called ‘entertainment’. Impulsivity is part of that. Was it impulsive to bang off a half bottle of white wine at 8am from the boot of the car, or just ‘fun’?

Social isolation is also a factor that can exacerbate alcoholism. As alcohol use becomes more central to a person’s life, they may begin to isolate themselves from family and friends who do not approve of their drinking. This can lead to a sense of loneliness and despair, which can further increase the desire to drink.

‘People who mind don’t matter and people who matter don’t mind’ was where I got to on this. My social circle got smaller in direct proportion to Quint becoming a ‘social hand grenade’. I had to hide my drinking to keep up the ‘fun’ guy that made me popular but I’d peak too soon and basically turn into Oliver Reed. I didn’t ‘isolate’, so much as people just didn’t want to expose themselves, or their friends, or children to me. My coterie of friends became people who drank as much as I did.

In conclusion, alcoholism is a complex condition that is often considered a progressive disease. Tolerance, dependence, cravings, neurological changes, and social isolation are all factors that contribute to the progression of alcoholism. However, with the right treatment and support, many people are able to recover from alcohol use disorder and live fulfilling, sober lives. Yep ‘the road of excess leads to the palace of wisdom’ (Blake). Life turned around very quickly (a year) for the better and life now is incomparably more ‘fun’ interesting and rewarding than it was. Though I’d never have acknowledged it at the time, desperation was a gift for me and I’m grateful for it. And ‘with gratitude, optimism is sustainable’ as my dear acquaintance Michael J Fox has just said on IG.

Which brings me to animation. So, I thought I knew about alcohol, I really did. My dad and several family members were alcoholic. I wrote my MA thesis ‘The Occluded Body’ on addiction and was considering a Phd. I had hundreds of hours under my belt doing voluntary work for organisations such as Turning Point and Quit. And yet I hadn’t scratched the surface of alcoholism or the dynamics addiction. If I supposedly knew so much, and still got caught up, what fleeting chance do others have?

So here’s my pitch:

The dynamics of addiction are complex and deadly. It causes havoc for the individual, those around them and society at large. Voice over led animation is a brilliant way to convey the complexity of addiction in a creative and relatable way. It’s cost effective, once the first animation is produced it can be duplicated 10,000 times. Its free to air: the animation can be posted on social media. It will reach those people who are most in need, when and where they need it, nationally, – for free. It’s a perfect comms medium for local authorities, the NHS, as part of occupational health for organisations with thousands of ‘hybrid’ workers working globally.

But back to ‘progression’. The metaphor of a lift going down is one of those ‘fridge magnet philosophy’ sayings that I’ve found really packs a punch with clients. You’re in that lift / elevator it’s going down whether you like it or not. The only choice left to you is where to get off. It’s elegant in its simplicity.

That choice has to be made before ‘life’ makes the ‘choice’ for you: by failing health when you get ill from it, or the legal system when you get nicked for doing something stupid or much, much worse. Starting to sound a bit doom and gloom and ‘preachy’ … don’t mean to. I’m ‘recovering loudly’ to say there’s another way to that life you aspire to. Problem is, you can’t walk through the door to it, and carry that bottle of vodka with you at the same time.

Good luck X