Wednesday, 16 August 2017

Are we all alcoholics now, or is none of us?

This post is really a reflection on a recent article by Nick Cohen in Prospect, prompted by an exchange on Twitter between Andrew Brown and James Morris about whether the use of word ‘alcoholic’ is accurate or helpful.

So before I launch into something of a critique, I should say that the article itself is definitely worth reading.  It’s brilliant at identifying how drinkers are so adept at deflecting criticism of their own drinking (though they’re not unique in this – think of how we all seem to think we’re above-average drivers).

But he’s also great at conveying the emotions linked into drinking with a more personal perspective.  I’m going to quote at length here, which I hope isn’t a breach of copyright:

At the end of January 2017, I could not find a good enough reason to start drinking again. I still remembered the allure of alcohol, its promise of comradeship, love and simple pleasure. For me the most romantic lines in English poetry are from Edward Fitzgerald’s Rubaiyat of Omar Khayyam:
“Here with a Loaf of Bread beneath the Bough,
A Flask of Wine, a Book of Verse—and Thou
Beside me singing in the Wilderness—
And Wilderness is Paradise enow.”
But after too many years and too many flasks, neuroticism replaces romance. No one who hasn’t experienced it can appreciate the obsessiveness of the determined drinker. Questions build up as the evening approaches. Where am I going to drink? Who can I hassle into a pub? Can I sneak another one in without anyone noticing?
By the time you wake up in the morning, obsessiveness has metamorphosed into paranoia. What did I do? Why can’t I remember? Who did I offend? How did I get home?
If you find yourself asking these questions too often, the best answer is: “I give up.” How best to give up is, like everything else to do with alcoholism, infuriatingly hard to pin down.

All of that resonates probably a little too much with me.  I feel that ‘allure of alcohol’ and its ‘promise of comradeship’, but equally feel that these are, in reality, pretty illusory.  From a personal perspective I have asked all those questions at various times – though more recently I’ve decided that I don’t mind if anyone notices I’m having another drink; it’s no longer a question of ‘sneaking’ it in.

But from a professional perspective, one point is particularly resonant – perhaps without Cohen realising it.  He suggests that if we’re asking those questions too often we should just ‘give up’.  And I’d respond in the same way: if ‘everything to do with alcoholism [is] infuriatingly hard to pin down’ then I suggest we ‘give up’ using the word too.  It can’t possibly be helping, given that the purpose of a concept like this is to make sense of world – or at least create some useful questions – not simply ‘infuriate’ the interested thinker.

This is particularly odd when Cohen goes on to critique the disease model, emphasising that this is really a problem of behaviour (at which point I should plug the New Directions group and the (even ‘newer’) Addiction Theory Network, as well as this excellent blogpost on the disease model of mental health.

He challenges the idea that ‘alcoholics’ are this special breed, easily identifiable – because we are so bad at pointing the finger at the other easily identifiable groups: “The true alcoholic is always someone else. The old man in the park no one wants to know, the young woman sprawled on the pavement. Anyone and everyone, except you.”

And yet he goes on – just after criticising industry involvement in alcohol policy – to write that “Most drinkers are fine and healthy and good luck to them. Public policy needs to concentrate on helping alcoholics” – a line straight out of the industry playbook.

Of course, as I’ve written many times before, simply because something is said by an industry spokesperson, doesn’t make it untrue.  But as Cohen’s just pointed out, “the line between the heavy drinker and the terminal drunk is as blurred as your vision after a “good” night out.”  And if that’s the case, aren’t we really better talking about ‘heavy drinkers’ in general?  That would catch the attention of the right people without the risk they’ll ignore the message.

Of course the case could be made – as Andrew Brown did – that ‘alcoholism’ is a good way to grab attention for an important issue.  This is more about journalism than technical accuracy.

But again, he’s just told us that ‘alcoholic Calibans always see someone else’s face in the mirror’, so if someone talks to us about ‘alcoholism’ then we won’t be thinking of ourselves.  I just don’t think trying to redefine and re-purpose an ‘infuriating’ and indefinable concept is a good marketing or communications tactic.

The article seems to be trying to have its cake and eat it: we define ‘alcoholic’ too narrowly, seeing them as a special breed when in fact lots of us have problems and don’t acknowledge it; but equally most people drink safely and happily and we just need to focus on that special problematic group of ‘alcoholics’.

I think the biggest problem in this argument is that concept of alcoholism, which takes us down blind alleys of trying to define it in an effective way when, as I suggested at the beginning, we’d be much better off if we just gave it up.

The most important insight in the piece is perhaps about moving forward from problems.  Cohen writes, “The best guess is that drinkers stop when they have the usual prospects of happiness to fight for: a life worth living and the love of others.”

The problem, and therefore the solution, lies in a broader understanding of what makes life worth living – and although there are similarities, we all have our unique challenges and issues with this.  To go back to that lengthy section I quoted at the beginning, that’s why it’s an ‘infuriating’ task to define exactly how best to give up: each person is unique.  ‘Alcoholism’ as a concept, for me, just skims over these differences and challenges and encourages us to think only about the booze.  As Cohen would surely agree, there’s a lot more to life than that.

1 comment:

  1. Will of course I agree, we should drop alcoholism for all the reasons you (and Nick Cohen) raise. But also for others, notably the intrinsic stigma and knock on effects of this, as well as the undermining effect on people's belief that alcohol problems are something that can be changed.

    The million dollar question comes back to a viable alternative that has potential to replace the ease and appeal of alcoholism. A construct that inherently acknowledges the wider influences and continuum nature of alcohol problems. Heavy or harmful drinking doesn't cut it, but what simple alternatives are there?

    Until we can offer a feasible but more nuanced replacement for alcoholism, it will probably stay rooted as the go to frame of reference for problem drinking for some time.

    I'd recommend a read of this in terms of how the current narratives feed the problem: