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.
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.
“I don’t know what’s right and what’s real anymore I don’t know how I’m meant to feel anymore. When do you think it will all become clear. ‘Cause I’m being taken over by the fear.”
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.
“Big Daddy: What click?
Brick: A click that I get in my head that makes me peaceful
Big Daddy: I sure in hell don’t know what you’re talking about, but it disturbs me.
Brick: It’s just a mechanical thing.
Big Daddy: What is a mechanical thing?
Brick: This click that I get in my head that makes me peaceful. I got to drink till I get it.”
Tennessee Williams, Cat on a Hot Tin Roof
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.
“Alcohol is the only drug on Earth you have to justify not taking.”
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.
“As a person in recovery, I can assure you that if I could drink like a normal person I’d drink ‘normally’ 24 hours a day, seven days a week.”
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.
“Sobriety is not about giving something up. It’s about taking everything back.”
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.
“With gratitude, optimism is sustainable.”
Michael J Fox
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
Benefits of animation
- Animation is creative and accessible, especially via social media. It’s completely free to air for people who require it (via mobile phones).
- Animation can reach cohorts who struggle to read and write, e.g. those with a neurodivergence (20% of the population) and/or SEND (15% of the population).
- Animation can be translated to reach people for whom English is not the first language.
- Waiting times for CAMHS and community mental health services is typically months.
- From script to screen, an animation can be created in two weeks, making it ideal for ‘disaster’ work.
- The voiceover on an animation can be quickly translated and revoiced in any language at a rough cost of only £1000.
- While the initial animation can cost up to £10k, subsequent digital copies are completely free (unlike print). Small amendments to ‘end slates’ to, for example, to localise helpline numbers cost very little. This means one animation can be duplicated 10,000 times nationally at pretty much no extra cost.
- Animation works brilliantly across all social media channels. It’s instantly and freely accessible and provides a ‘language’ for a person and their caregivers to understand what’s going on.
- Still images can be taken from the animation and used within other collateral. For example, a dozen still images can be laid out in front of a child, enabling them to choose which image from the animation spoke to them (a good way to introduce tricky subjects, e.g. sexual abuse).
- Alcohol has up to 60% co-morbidity with depression, anxiety, trauma and schizophrenia (National Institute Alcohol Abuse and Alcoholism 2022)
- Record delays for care and uncertainty for patients about when they would be seen are leaving people ‘feeling helpless and forgotten’ (Prof Kamila Hawthorne Chari Royal College GP’s May 2023).
- The relapse rate in addiction recovery is around 40–60% (National Institute On Drug Abuse)
- The risk of relapse decreases by about 7% for each year of abstinence from alcohol (Alcohol: Clinical and Experimental Research)
- The introduction of the Health and Social Care Act 2012 saw the abolition of the Alcohol Education and Research Council and means responsibility for alcohol treatment now rests with local councils, not the UK government. ‘Austerity’ has led to these services seeing funding cuts of £170 million