In 1751, the great satirical painter William Hogarth produced his famous engraving Gin Lane. At the centre of a crowded street, rife with drunkenness, an intoxicated woman allows her child to fall from her arms, hardly seeming to notice – or care. Gin had become something of a craze in 18th century London, and the consequences were dreadful. Yet, two and a half centuries later, alcoholism remains a scourge.
Around seven per cent of the American population could be classified as alcoholic, while alcohol-related crime, ill-health and lost productivity is believed to cost the UK economy £52 billion a year. Indeed, many physicians argue that if alcohol had only recently been invented it would be classified as a dangerous drug, the equal of crack cocaine.
The Stages of Alcoholism
Alcoholics rarely decide to be alcoholics. And some go to their grave without ever accepting the label or even acknowledging they have a problem. In most cases, it creeps up on people. Imagine a 28-year-old man named Steve. He is married and has a two-year-old son. Steve has started a new job and, to be friendly, often stays behind after work for a drink. He enjoys it and get into the habit of buying cans of beer for the train journey home. Though he loves his new job, it is very stressful and the drinking helps him unwind. Soon, a tolerance builds and he needs larger amounts to get the same feeling. Steve is now in what is known as the pre-alcoholic stage. After a few more weeks he drifts into the prodromal stage: whereas he began as a cheerful, social drinker, he now prefers to drink alone. There is a basement in the house that Steve has converted into an office. He spends more and more time there, claiming he is snowed under with work. His wife knows something is wrong and, when he is out, finds bottles of whisky hidden behind the sofa and at the back of a cupboard. She confronts him and they argue. Steve is now at the crucial stage, even drinking at the station first thing in the morning. He knows something is wrong, but he cannot admit that he has a problem. If he does not admit that he is an alcoholic and seek help, he will settle into the final phase, known as the chronic stage. Alcohol will be the main focus of his life, accompanied by cravings, withdrawal symptoms and, inevitably, physical illness.
The Nature of Alcoholism
As can be seen in the hypothetical example, people become alcoholics gradually. Heroin addicts, by contrast, become addicted very quickly – and the addiction soon becomes obvious to those around them. With alcoholics it is rarely clear when they have crossed the line.
An alcoholic – as opposed to someone who simply enjoys drinking – will crave alcohol. And when he finds himself unable to obtain it (during a spell in hospital, for example, or when staying in the country with teetotal in-laws), he will suffer withdrawal symptoms, becoming irritable, angry, and depressed. Above all, an alcoholic, like any addict, finds it impossible to control his habit. And this is a crucial point. Many people go through a spell of heavy drinking, often to the point of great physical and personal harm; but they realise something is wrong and decide to stop – and they can stop. More generally, an alcoholic builds his life around alcohol: he will know what time the local bars open and close, which stores sell the cheapest, strongest drinks, and so on. If he has an unexpected holiday from work, or if his family leave him home alone for the weekend, his first thought is “I could get drunk.”
People become alcoholics for different reasons. Often, it is used as a form of medication. People suffer a trauma (sexual abuse, for example, or the breakdown of a marriage) and find the pain or guilt impossible to live with, so they blot it out with a pack of beer or a bottle of whisky. Some use alcohol to help them deal with physical or mental illness. Wider cultural pressures can also be to blame. Northern Europe, for example, experiences higher rates of alcoholism than Southern Europe. This could be explained in part by different cultural attitudes. Working-class men in countries like Germany, Sweden and England still see heavy drinking as a sign of manliness – something less common in nations like Italy. Some drift into alcoholism through sheer boredom. People who have retired from an exciting career in professional sport or the armed services, for example, are particularly vulnerable.
Alcoholism as a Disease
One of the big debates among psychiatrists and physicians is whether or not alcoholism should be classified as a disease. There can be no doubt that both the general public and the medical establishment are more sympathetic to alcoholics than they once were. Even in the early 20th century, alcoholics were still regarded as immoral. They had chosen to do something bad and must suffer the consequences; sympathy was reserved for their children and partner. Supporters of the disease theory argue that certain people are pre-disposed, possibly at a genetic level, to becoming alcoholics. While their teenage friends can get drunk, suffer a few hangovers, and eventually grow out of it, they inevitably become addicted. More generally, it is pointed out that alcoholics physically crave alcohol and suffer shaking, sweating and nausea when it is denied to them. It is further pointed out that prolonged exposure to alcohol literally alters the brain, leading to a new kind of functioning.
Nothing guarantees a permanent recovery. When faced with trauma or bereavement, even those who have remained sober for years can slip. Nevertheless, many highly effective treatments are available. First, you need to understand why you are drinking. If you drink to treat depression or to help you to cope with stress, your first priority should be addressing these things. Many people avoid slipping into full-blown alcoholism by quitting a high stress career and moving to the countryside. For others, it isn’t so simple. Therapy can help. You may find that a good therapist can help you to understand the causes. Organizations like Alcoholics Anonymous offer not only advice and support but the opportunity to share experiences with those going through the same thing. In recent years, several different types of medication have also been developed. Both the effectiveness and danger of such medication is hotly debated, however, and people should carefully discuss it with a physician before deciding.
Whereas most people are aware of the misery caused by heroin addiction, alcoholism is too often treated as a joke. And this has always been true. Hogarth’s engraving has a comic element to it, yet it was inspired by a woman who had strangled her child and sold his clothes in exchange for gin. Even today, stand-up comedians get endless mileage out of their drunken exploits. But the life of an alcoholic is rarely fun. On the contrary, his life, not to mention those who love him, is often lonely, painful, degrading – and short.