Breaking up with alcohol

We were first introduced over a family meal. I was still a boy, and although just a passing touch on the lips, I felt like I was taking my first tentative steps into adulthood. With a name I couldn’t quite pronounce, and an exotic aroma, I was left feeling slightly giddy and definitely giggly. After a few more random encounters, it became relatively commonplace to be given a glass of wine with Sunday lunch. I began to develop a limited appreciation for the commoner red and white wines. Never more than a glass, and under the watchful eye of parents, it was legal to drink in the household from the age of 14 in Scotland.

Then came more surreptitious encounters, around the age of 16, typical school-leaving age at that time. Vodka and orange in local night-clubs, experimenting with rum and coke or Southern Comfort and lemonade as a prelude to pints of cider and beer at university. Part of the thrill was partaking in a forbidden fruit, alcohol the common thread between new student friends, a social lubricant, with exploits in excess providing a growing collection of eye-watering tales, some of which became legendary. During our junior doctor years many of us were happy to oblige in fulfilling the stereotype to work hard and play hard, facilitated by alcohol.

As children came along and families grew, alcohol use became more controlled and mature, with emphasis on the provenance of the wine, terroir of vineyards or the maturity of the malt whisky, establishing a more refined and cultured approach to drinking – less about getting drunk and more about the mystique surrounding its various forms.

And in truth alcohol is woven through the fabric of communities, often adding more colour, fun and laughter to social gatherings. We do know that alcohol helps people feel less stressed, lifts their mood and in small doses causes a degree of euphoria, as well as helping people feel more sociable and relaxed. So, what’s the problem?

There is some evidence to suggest that a small amount of alcohol, around a unit per day, may reduce risk of death. Data published in the New England Journal of Medicine in 1995 looking at death rates in men between 1982 and 1991, and the graph displayed what is known as a J-shaped curve – surprisingly the group drinking around one unit per day had a lower risk of death than those who completely abstained as well as those drinking more heavily. Interesting, but there may have been other factors at play, including for example that some people abstain completely following health problems or addiction.

We do know for certain that alcohol causes harm to the body and mind on various levels, and that the small minority who drink heavily cause outward ripples which impact on families, friends and communities. Alcoholism has been identified by the World Health Organisation as a ‘global health emergency’ which affects an estimated 4% of the adult population, with around three million associated deaths every year. It is known that people who suffer psychological distress and rely upon alcohol to relieve their stress are more likely to develop alcohol abuse and dependence.

It is already well documented that alcohol increases risks of heart disease, stroke and cancers. But given that its desired effects arise from changes in the brain, a group of researchers looked specifically at the undesirable effects on the brain, using functional MRI scanning and chemical testing. They found that lifetime consumption of alcohol had an increasing effect on loss of brain cells, especially grey matter where thinking takes place, especially in younger adults and adolescents. In addition it is linked with reduced thiamine levels, resulting in early brain cell death and damage to brain pathways. Acetaldehyde, a breakdown product of alcohol, causes weakening of heart muscle (cardiomyopathy), behavioural changes and is very carcinogenic due to damage of cell DNA. When it builds up it causes the classic symptoms of intoxication and hangovers – flushing, dry mouth, nausea and headaches.

Men are often particularly vulnerable to injury with alcohol, with excess leading to increased car crashes, injury due to falls or fires, and violent outbursts linked to reduced emotional regulation.

So…currently alcohol and I are taking a break. We have been separated for the past year, and like any break-up there is some sadness and regret there. I miss having a nice glass of red wine with my meals, or sipping on a Scottish malt whisky, or just having a beer with my mates. However I don’t miss waking up with a fuzzy head or indigestion, and it’s great being able to have a great night with friends and drive home whenever it suits.

Each to their own, and I don’t suggest anyone needs to follow my example. However during Alcohol Awareness Week, it helps to step back and consider how and why you use alcohol, and whether that’s right for you, now or in the future.