Society tells us that alcoholics are weak and worthless and that we wouldn’t be in this position if we only exercised more control over ourselves. But this book has described how that control is taken from us. It is taken without our involvement, it is taken without our permission, and we didn’t even know it was happening. Alcoholism is not poor control, poor morals, or weakness and it is not shameful, yet this is what society tells us. The very thought of being an alcoholic is so loaded with shame and failure that we dare not acknowledge the truth of our position, even to ourselves. But the picture society paints is completely incorrect. We do not drink because we are weak and should control ourselves better, we do so because our brain urges us to drink extremely strongly and only rarely motivates against it. But normal drinkers are motivated to drink and to avoid drink in equal measure, and they judge us by that experience.
With respect to alcohol there are four main ways that our brains behave differently to those of regular drinkers.
#1 Our reward system responds differently to alcohol. Our brain greatly values the advantages of drinking over the disadvantages. This causes us to develop a huge number of powerful drinking triggers, but we only create a very few drink-avoiding triggers.
#2 Our memory remembers “do this again” every time we drink significantly and this is reinforced by dopamine but it actively fades the memories of drinking occasions that had a bad outcome. This leads to our recall of alcohol being overwhelmingly positive and the downsides of alcohol are grossly undervalued.
#3 Heightened motivation to drink coming from the reward system makes us drink regularly and heavily over an extended period and our brain changes how it works to compensate for regular alcohol impairment. When we are sober these changes cause us to be anxious, miserable, fearful, agitated, and alone with a sense of impending doom. We develop powerful drinking triggers associated with the negative emotions caused by prolonged and heavy drinking and these triggers are fired whenever we are sober.
#4 Our brain recognises and moves to resolve the conflict between drinking being a good thing (verified by our memory) and a bad thing (supported by direct evidence of bad things happening and what other people tell us). Our brain finds that “drinking is good” is the better supported argument and creates justifications that uphold this position: our brain actively encourages continued drinking.
The unbalanced reward system and the changes that come with alcohol-tolerance lock us into a self-reinforcing feedback loop whereby alcohol-tolerance brings on adverse emotional changes which are relieved by drinking… and these in turn further strengthen the drinking triggers. Any desire or willingness to change our drinking patterns is opposed by our biased memory and the psychological justifications that support why we should continue to drink. These four components trap us in a vicious cycle down into anxiety, fear, depression and hopelessness that left unchecked will kill us.
None of this is chosen. These four components of addiction form, operate, and strengthen entirely automatically and we have no direct or immediate control over any of them. When society tells us that we are making bad choices and exercising poor control they do so from their own viewpoint; they have that freedom of choice, but we do not. For us the choice to drink is made automatically, it is supported by memories that assure us that drinking is a good thing and arguments in our head tell us that drinking now is a good idea; it will make us feel better, we deserve it, everybody does it, and so on. For us to not drink we have to notice and then contradict our own mind’s automatically generated instruction to drink, and we have to do this while our mind insists that drinking is a perfectly reasonable course of action. This is difficult to do once, it is very difficult to do many times in a row, and it is extremely difficult to do day-in, day-out. But to gain lasting freedom from alcohol we don’t just have to do this once, we have to do it many times a day, day after day, over a protracted period, and we must be successful every single time because a single failure will result in relapse. We have to maintain our clarity of purpose even as increasing distance from despair makes the pain of continued drinking fade, and we have to maintain resolve even though the challenge seems never ending. This is what is required to free ourselves from addiction.
This book describes the mechanisms of addiction, but this is far more than just interesting information. This knowledge has direct application for three groups of people in particular; those diagnosing the problem, those assisting in recovery, and alcoholics themselves.
The greatest barrier to overcome in recovery is denial; before this is broken there is no pathway to recovery at all and people in primary healthcare can have a large role in challenging denial. General Practitioners are particularly important in this regard as they are seen as authority figures and their words carry more weight than those of our families or peers. Few alcoholics will present themselves seeking advice for dealing with addiction… it is a shameful thing that we don’t want to share even in the confidentiality of a doctor’s office. If alcoholics visit their doctor at all for this problem then most will seek help for stress or depression. Medication may help those in distress for other reasons but will not help alcoholics in whom the depression is caused by drinking… it may even exacerbate the problem. This gives doctors a dilemma: is the patient suffering this depression because they have become alcohol-tolerant or for other reasons? There is a simple way to test for this. One of the four components of addiction is a heavily biased memory, the unshakable knowledge that drinking is fun and good, and this is not present in those who are suffering stress or depression for other reasons. Addiction as a cause of the distress can be exposed by telling the patient that there is medication that will help, but they mustn’t drink for the whole time they take it… and pay close attention to the reaction. If the reaction is instant shock, confusion and fear then this strongly indicates alcoholism because this is not the reaction of someone whose drinking is not compulsive. Alcoholics typically believe that their experience is unique to them. But when an authority figure presents the various ways that addiction manifests itself, ways that even the sufferer themselves has not yet connected then this is a serious challenge to their denial. Even if this does not immediately lead to the sufferer addressing their addiction it may bring forward the day that they do… and this is a major win.
This book is also written for those directly helping others break free from addiction. Alcoholism is a complex condition that alters our behaviour, memory, emotions and thoughts and we struggle to make sense of what is happening to us. We don’t only struggle with this while we are still drinking we continue to struggle when we stop. We also have difficulty reconciling the actions we are encouraged to take in recovery with what we perceive to be the problem. We are encouraged to do many things in recovery and often the purpose of many of these is not immediately apparent. This book helps counsellors, peer support workers and sponsors explain what part of the problem each recommended action addresses. It allows them to explain what facet of addiction each remedial action is directed at and how it will help.
The last and main audience for this book is alcoholics ourselves. People can give us advice until they are blue in the face but we will dismiss it until we believe that the action they recommend is warranted. We resist doing things we don’t like until we believe they are necessary and understand how they will help us. Nobody else can do what is required to achieve and maintain recovery; we have to do it ourselves… and this requires conviction. While we believe that our problem is down to not trying hard enough to control our behaviour then we focus on precisely that… trying harder. But when we recognise that we don’t drink because we apply poor control, we drink because our brain demands that we do so, then we begin to focus on addressing the real problem which is the destructive way in which our mind is working.
The primary aim of this book is to shatter denial. If you are alcoholic then you will have recognised your condition in the pages of this book and you will now understand that progression of the condition is inevitable: it will get worse if it is not stopped. You are also now able to separate the aspects of your daily experience that are products of the condition from those that are the products of your circumstances and you can see the full reach of the condition into your existence. But this book not only shows how far reaching are the consequences of alcoholism; it also shows which aspects of our thinking are problematic and require correction.
Stopping drinking is not the challenge it appears to be. Our fight is not with the bottle but with ourselves and when we understand all the ways in which our brain is trying to make us drink then we can be objective in how we confront it. This book takes the mystery out of addiction and the guesswork out of recovery.
There is no magic pill or potion we can take that will cure alcoholism and there is no easy route out of addiction. But if we do not find a way out then the condition is fatal. We also cannot simply sit and hope for it to disappear, it will not, it will get worse. Recovery is not a passive process. Our minds are working in ways that will destroy us and we have to change how they work or we will die, it really is that simple. But nothing changes if nothing changes. We have to do things that alter how we think and we have to do them despite what our mind is telling us. This book lays out in detail the problems to be addressed and this in turn allows us to focus effort where it will yield results. But knowledge alone is not enough, we must then apply it. We cannot want ourselves into recovery, we have to act.
If you do not change direction you will probably end up where you are headed.