The truth about alcohol

I regularly meet people in my practice for whom alcohol has become an issue. Perhaps, through a particularly stressful time, our volume and frequency of drinking has increased. Perhaps frequency is not a problem, but being able to stop at a few once we have started drinking is. Perhaps there is embarrassment or shame around acting in ways that we do not relate to when sober. In this article, I hope to offer some thoughts on this from the point of view of a therapist who has both had an alcohol problem in the past and, as a counsellor, worked extensively with people facing their own problems connected to alcohol.

We commonly say ‘drink and drugs’, but why do we bracket off alcohol from other drugs? Not only is alcohol a drug, it is the most harmful and dangerous recreational drug of all when harm to others and society is included in the data. You may recall the scandal of Professor David Nutt’s sacking from his position as chairman of the government’s advisory council back in 2009 for presenting his research that unequivocally ranked drugs according to their harm to individuals and society (www.ias.org.uk).

It is still a truth that the establishment refuses to acknowledge, not least as it would be very difficult to frame this in a way that resonated with the general public; the UK has a long history of drinking culture, of seeing alcohol as somehow different to other drugs. One of the reasons, of course, for its place in our culture is its legality, availability and role in almost all of our social traditions. Imagine a British wedding without alcohol...

Alcohol is the only drug that you have to justify not taking.

Science shows that regular drinking of even small amounts causes long-term, chemical changes in our body that affect our thoughts and emotions, particularly an increase in hormones including cortisol. These hormonal changes can cause or exacerbate difficult emotional experiences. Most people who drink know the experience of ‘hangxiety’: the dread and shame that can hit the day after a heavy drinking session. This is caused primarily by a spike in hormones which, in evolutionary terms, would give us a heightened alertness to danger and readiness to act in ways that protect and defend ourselves. Of course, hangxiety is compounded by alcohol’s inhibitory effects that lead us to act in extreme, out-of-character ways, or even to black-outs, with no memory of what we did the night before.

The breathtakingly complex system of the human body works constantly to maintain homeostasis. We release hormones to counteract the effects of any toxin our body detects. Since alcohol is a nerve poison (alcohol is the main ingredient in hand sanitiser precisely as it kills all living organisms), the body releases hormones to counteract its effects in the body. Alcohol is a central nervous system depressant, meaning it slows down brain activity, thus the body releases steroid hormones with a stimulant effect to counter the depressant effects in order to bring the body back into balance (to sobriety).

When the effects of the alcohol begin to wear off, as it is metabolised in the liver into the carcinogenic and hangover-inducing chemical acetaldehyde, the drinker is left with an excess of stress hormones, particularly cortisol in the blood. This is why it is so common to wake up in the night or early hours of the morning feeling stressed or anxious after drinking - it is the point at which the stress response in the body becomes louder than the depressant effects of alcohol.

This brings us to ‘tolerance’. Tolerance is another way of saying that the body has become more efficient at countering the effects of alcohol. As previously described, the body does this by releasing stress hormones. Therefore, tolerance to alcohol means a body that is more efficient at releasing hormones that can make us feel stressed, worried, anxious and depressed.

Due to the way that the human organism adapts, if we drink regularly, the body can even predict when to expect alcohol and release hormones accordingly in preparation. This might be experienced as “It’s Friday night/Thursday night/Wednesday night and I just fancy a drink!” but what’s actually happening is a subtle shift in body chemistry that makes us feel more stressed and in need of something to take the edge off, and what better than a few pints of glasses of wine?

For some people, with otherwise stable, supported, connected lives, regular drinking might not be much of an issue, at least emotionally, at least while everything else is going ok. For others, alcohol can gradually become more and more of an issue, jeopardising physical, emotional and relational health.

If it has become an issue for you, counselling can be an opportunity to slow down and look at your relationship with alcohol in depth. Gabor Maté’s mantra is ‘Not why the addiction, but why the pain?’ and as such, any discussion around alcohol might include the exploration of your experience, past and present, connected to and underpinning your relationship with alcohol.