By Robin Roberts
Chances are you raised a glass of something bubbly during a toast to a Happy New Year. Chances are you followed that toast with a resolution to make the year ahead better than the one before. And chances are one of those vows included cutting back — or out — on the very cheer you used to ring in a happier, healthier future. Why? Maybe because you’ve spent one too many nights praying to the porcelain god, one too many mornings wondering what you did the night before, one more wasted day nursing a wicked hangover. Maybe it’s because you’re afraid. Afraid you’re becoming — gulp — an alcoholic. But how can you know for sure?
Signs and Signals
Dr. Jurgen Rehm, PhD, Director of the Social and Epidemiological Research Department at Toronto’s Centre For Addiction and Mental Health, says there are a number of psychological signs (see sidebar for details) of “alcohol dependence”, a term he prefers over “alcoholic”. These include preoccupation with the thought of drinking, drinking alone or in secret, drinking despite knowing the risks and harm. Withdrawal and tolerance are two of the most important biological criteria. Tolerance is defined as needing more and more alcohol to satisfy the craving; withdrawal includes symptoms such as tremors, restlessness and agitation. If you recognize yourself in any of those symptoms, you could have a problem.
The archetype of the bum slumped curbside cradling a bottle inside a brown paper bag is just one, albeit uncommon, example of an alcoholic. The other is of a perfectly ordinary person who consumes copious amounts of booze with seemingly no effect, as depicted by the titular characters in the TV series Mad Men and Jessica Jones. “The majority of people who are alcohol dependent in our society are what you would call functional alcoholics,” says Dr. Rehm. “You would be surprised to learn how many qualify.”
According to Health Canada, four to five million of us engage in high-risk drinking. Other studies estimate 10 percent of us use alcohol to the extent that it’s a hazard to our health or relationships, and disrupts work and school. In fact, Canadians drink a staggering one-and-a-half times the global average, confirms Dr. Rehm. Since more than half the worldwide adult population abstains from alcohol completely over their lifetime, we’re obviously working hard to keep the numbers up. And, says Dr. Rehm, “A lot of people from those populations are immigrating to Canada. So if we have the same level of drinking, that means the drinkers drink more per drinker because the immigrants are most often abstainers.”
So why are we knocking back so much booze, anyway? It’s expensive. It’s bad for our health. It ruins our sleep, hurts our relationships. Hangovers are hell. So what gives? A lot of us reach for the bottle as a way to cope with stress and anxiety. It is, in fact, the most common way we self-medicate for depression. But it so often backfires, because alcohol is a temporary salve. Once we’re sober, the problems are still there. So we pour another, and the cycle continues. It’s not a particularly viable coping strategy, since it doesn’t get at the core of what’s causing the depression or anxiety. Yet you’d be forgiven for thinking drinkers are perennially happy and carefree: the cocktail culture is omnipresent in marketing and advertising, TV and movies, where imbibing is depicted as not only socially acceptable but often encouraged and rewarded.
But while we’re helping boost the bottom lines of the big booze companies, our bodies are breaking down under the toxic effects of too much hooch. Alcohol affects brain function, including memory, focus, mood and behaviour. It harms the heart, the liver and the pancreas, and increases your risk of cancer. Dr. Rehm, in fact, outright calls alcohol a carcinogen. Worse, it’s a factor in seven percent of all deaths in Canada. Not to mention a burden on the public health system, as well as on friends and families. There are no better reasons to rethink the drink.
How Much is Too Much?
Canada’s Low-Risk Alcohol Drinking Guidelines stipulate a maximum of 10 drinks per week for women, 15 for men (a drink is defined as 12 ounces of beer/cider/cooler, five ounces of wine, or one-and-a-half ounces of liquor), with no more than two a day, and with a couple of drink-free days a week. Pregnant women, anyone on certain medications or with a family history of alcohol abuse, of course, should abstain completely.
Dr. Rehm acknowledges the research that some moderate drinking — one a day or one every other day — can be beneficial, since it raises good cholesterol, which lowers the risk of coronary heart disease. “If you religiously drink just one a day, I don’t think health would be a big concern,” he says. “Unfortunately, less than 1 percent of Canadians would drink only one a day, so it’s very rare that people would actually drink in a way that would be beneficial to their health.”
In fact, some experts say alcohol-associated health risks outweigh any benefits. And if you’ve never been a drinker, there’s no reason to start based on any perceived advantages. Exercise and a healthy diet are, as always, far better options for thwarting illness and disease.
Last Call For Alcohol
Even if you’re the slightest bit concerned you’re drinking too much, you might want to put a cork in it now. After all, New Year’s resolutions don’t come out of the blue. Chances are you’ve been mulling the idea long before January 1. Heed the inner voice before it’s too late. It won’t be easy: you’ll have to face some hard truths; you may feel guilt, shame, weak. But admitting you have a problem truly is the first, perhaps hardest, step. The rest will range from difficult to hell, and will determine whether you go it alone or seek help. “If there is a manifest dependence or problem, it would be good to consult a specialist,” says Dr. Rehm, “and there are a lot of therapies that don’t require that you go overnight or quit your job.”
The important thing is that you do something. Just one out of 10 problem drinkers in Ontario goes into treatment, says Dr. Rehm, because it’s so stigmatized. “It’s the lowest of any chronic disease. With diabetes, nine out of 10 get treatment.” And yet both conditions are self-inflicted. “We don’t stigmatize someone who has blood pressure over 140, but where do you think high blood pressure comes from? Surely not from eating correctly or having enough exercise.”
So what does modern detox look like? Will you be strapped to a gurney? Swaddled in a straight jacket? Will you writhe and sweat and foam at the mouth inside a padded room? Well, maybe in the movies, but in real life, Dr. Rehm says a combination of psychotherapy, motivational enhancement therapy and cognitive behavioural therapy will likely be suggested in order to identify why you drink and teach you how to avoid triggers. Anti-alcohol drugs might also be a part of the treatment to block the effects of alcohol and/or ease withdrawal.
For mild or moderate dependence, urges and cravings are often short-lived and controllable. If you can distract yourself long enough for them to pass, you’re ahead of the game. Adopt the “recognize-avoid-cope” approach used in cognitive behavioural therapy to change harmful patterns: “Recognize” your triggers; “avoid” tempting situations; employ “coping” mechanisms when the first two fail. While you wait for the urge to pass, try meditating, calling someone, going for a walk, diving into a hobby, taking a bath, having a bowl of ice cream or cup of tea. Remind yourself why you’re making this change, and applaud yourself for it. Before you know it, the hankering will fade and you truly will have a happy (and healthy) new year. And that’s something to celebrate.