Alcohol tips the reward system into a runaway state that constantly increases the intensity of the compulsion to drink, our memory becomes biased to favour drinking, then our brain adapts to offset the impairment caused by regular drinking and this changes our mood. These are the direct ways that alcohol affects our body and brain. But this book is not about alcohol, it is about alcohol-ism and alcoholism isn’t just a set of hidden mental processes and chemical changes in the brain, it has psychological consequences too: alcoholism radically alters how we feel about ourselves and our place in the world.
Holding two beliefs that contradict each other causes an inner distress known as “cognitive dissonance”. Our minds need information to be resolved and orderly because lack of certainty in the wild can be fatal, so when we have two contradictory pieces of information then our mind tries to remove one or other of the conflicting ideas. The way our mind deals with unresolved information is to bring it to the forefront for further consideration; worry isn’t some haphazard occurrence, it is our mind trying to clarify unsatisfactory information. When we worry about something then all related information is compared to the problem to try and resolve it, but when it comes to alcohol our mind tries to reconcile the irreconcilable. The inner distress comes from the contradictory ideas “drinking is good” and “drinking is bad”. Both are completely verifiable but they can’t possibly both be true. Information supporting “drinking is bad” is real and demonstrable; people tell us (directly or indirectly) that our drinking isn’t normal, and we know ourselves that what they say has some truth to it. We also know within ourselves that our drinking is causing us to do things we wish we didn’t and is causing bad things to happen. The idea that “drinking is bad” is entirely evidence based but it is totally at odds with “drinking is good” which has been incredibly deeply learned over a long period of time because it is fixed in place by elevated dopamine levels that accompanied the drinking sessions. But “drinking is good” is flawed memory; it is an amplification and fixation of the brief respites that alcohol gives us from the distress that is itself caused by alcohol. Drinking might once have been a genuinely enjoyable experience but those days are long gone. Once we start to become alcohol-tolerant then our mood lowers and we need to drink increasingly more before we experience any lift in our spirits. Eventually our mood becomes so depressed by alcohol-tolerance that we can’t drink enough to become happy. But even though drinking no longer brings real happiness that elevated dopamine level still reinforces the memory “drinking is good” because life is better than it was before we drank. The memory is shared across a plethora of places, times and occasions but the consistent theme linking them all is that drinking is a good thing and this becomes something we come to know more firmly than anything else. The power of this feeling and the absence of supporting detail are simple to demonstrate. If we went to a Doctor for some problem and they prescribed a medicine that meant we had to stop drinking for three months then we would be completely horror-struck. There is no supporting reason or rationale for this reaction, there is only instant and overwhelming fear. All logic and information support taking the medication but this doesn’t prevent the instant reaction of horror: the strength of the emotion associated with stopping drinking overwhelms the logic. The difficulty our mind has in resolving the conflict between “drinking is good” and “drinking is bad” is that only one side is negotiable. As we drink more the evidence that “drinking is bad” mounts and becomes irrefutable but the inner knowledge that “drinking is good” is still being reinforced. As our circumstances worsen the two positions become even further polarised and the stress caused by this dissonance becomes increasingly severe. But this internal turmoil is only one source of alcohol-related distress, there are others; secrets, lies, guilt and shame.
The stress we suffer with secrets is that for every secret there is the worry that it will be discovered; fear we will be seen somewhere we’re not supposed to be, fear our hidden drink supply will be found, fear we will be discovered drinking secretly and so on. But we don’t just accumulate secrets from trying to hide our drinking we also make them from the consequences of drinking. While we are drunk our judgement is so impaired that we do things we would never normally do, we do things we are deeply ashamed of, and we add these guilty secrets to the ones we already have. Holding secrets is its own mental burden but concealing these secrets also involves lies, and these too have to be guarded. As our secrets and lies grow in number and magnitude so does the effort involved in keeping them, and this burden builds into a persistent sense of fear; fear that our secrets and lies will be discovered and fear that we will be exposed as not the person we present ourselves to be.
Secrets cause us to accumulate anxiety and fear but the extent to which we are troubled by our existing concerns also grows. The flight-or-fight response heightens our alertness and focusses attention to identify the danger for which our body has been prepared. But our senses find no apparent danger so our brain trawls through unresolved issues and brings them forward to see if these are the source of the alarm. Our mind cycles through all the unsatisfactory issues in our life, past and present, and attempts to bring then to a better conclusion. As we dwell on our problems our mind reaches out to find to other information that might help to resolve them and this makes our problems beget more problems; but most of them remain unresolved. Many of these concerns happened in the past so can never be changed but we still replay the scenes over and over in our mind desperately trying to find a better conclusion. These worries not only persist, we also strengthen them. Constantly re-visiting and replaying scenes from the past makes the neural pathways containing these memories firmer and faster to access and they come back into mind far more easily. Anxiety caused by our alcohol-tolerance causes issues with unsatisfactory outcomes to churn endlessly and every time we dwell on one we re-build all the emotions associated with it; guilt, shame, fear, anger, and resentment.
While the stress from secrets, lies, and worry are consequences of our own actions there are also stresses from external influences; they are in response to how we think other people see us. Normal drinkers have a completely different daily experience to us when it comes to alcohol. They do not have an out-of-control reward system, their memories are not hopelessly biased in favour of alcohol, their mood hasn’t changed in response to regular drinking, and their ability to freely choose to drink or not drink is intact. This has a direct bearing on how people judge us. Things like praise, guilt, sin, and shame are only applied to actions that are freely willed. I.e. only actions that are freely chosen are seen as deserving of credit or blame. Normal drinkers expect that we have the same free-will regarding alcohol that they do, so they believe we have chosen this course of action and therefore deserve condemnation. The consequence of this accusation for the recipient is shame: being accused of drinking too much heaps shame on us. We recoil from it aggressively and we begin to change our behaviour to avoid this disgrace.
We evolved to live in communities and a part of that evolution is that we adopt the standards and behaviours of the community. We aid our survival by being in a group, so we serve the aspirations of the group as well as our own; this is how we win the support of the group. The way we evolved to make our behaviour to conform to that of the group is that our minds punish us when we fail to meet the group’s standards. We feel regret, guilt and shame when our behaviour is not aligned to that of the group and our drinking definitely does not meet that standard. Bizarrely one part of our brain compels us to drink and then another part punishes us for doing so. The emotional discomfort evolved to encourage us to change our behaviour to conform to that of the group, but when it comes to our drinking we cannot. We can’t because we can’t do what is expected of us: we can’t control our drinking. We can’t stop drinking but the shame it brings is so painful that we find ways to get around the problem. If no single person ever sees the full extent of our drinking then our drinking can appear to fall within acceptable norms, so we adjust our behaviour to create this illusion. We drink somewhere and then move onto somewhere else for more, we drink in different places on different days, we buy alcohol in different places on different days, we lie about where we go, when, and for how long, we dispose of our empties discretely, and we hide alcohol and drink it un-seen. This last point is further encouraged by one of the changes that came with becoming alcohol-tolerant: diminished social confidence. We hide alcohol and drink secretly because when we drink like this then nobody sees us; therefore we aren’t shamed for it. But this can have a terrible cost. If we avoid social contact completely then the circumstances for being shamed don’t arise and in this respect hiding away is successful. But this leads us to becoming increasingly socially isolated and ultimately we feel safer alone than we do in company: the prospect of meeting other people becomes confronting. This social withdrawal is not caused by alcohol, it is driven by shame.
We pursue a broad range of actions to hide the extent of our drinking in an effort to avoid shame but doing this increases the number of secrets we hold and it also increases the cognitive dissonance we suffer. All these manoeuvres divert other people’s attention from how much we are drinking, but this also means that we actually recognise within ourselves that our drinking is problematic. Our actions are attempts to avoid attracting the shame of being labelled an alcoholic, but the very act of pursuing them adds weight to our own body of evidence that we probably are, and this increases the dissonance even further.
As our drinking becomes increasingly compulsive we reach the point where the distress of not having alcohol in our bloodstream is itself a driver of our behaviour: being sober brings on cravings. As we spend an increasing proportion of our time drinking we spend less time on activities we that used to enjoy. We stop doing things that don’t involve drinking and we avoid doing things that require us to not drink for any significant part of the day. As there becomes less and less of our day that we don’t drink, and as we do less and less of anything that makes us feel good apart from drinking, then alcohol becomes the only perceived goodness in our lives: not only do we believe that “drinking is good”, over time it becomes the only thing that is good. More and more of our time becomes committed to drinking and to being functionally impaired as a result of that and our place in the world begins to slide backwards. We start failing to meet the standards society expects of us, and we start failing to meet the standards we expect of ourselves. By our own judgement and that of others we are failing as individuals; at work, at leisure, and at home. We accumulate regrets, and we do (or don’t do) things that have increasingly significant consequences. Where once our drinking might have resulted in us feeling foolish and embarrassed there are now more serious consequences; lost jobs, lost opportunities, and lost relationships. There may also be problems with the law.
As our standing in the world declines the damage to our self-image is huge. How valued we think we are, how capable we think we are, how worthy we think we are, and how loveable we think we are all in decline. While we show the world a façade of confidence we are full of doubt internally and everything in our lives seems to be falling apart. Our problems churn endlessly in our mind but never get solved and we become haunted by a fear of failure. We don’t understand how things have become like this and we can’t shake off the incessant feelings of fear and anxiety. Nobody seems to understand how difficult things are for us and we feel desperately alone. If our minds go to the past we see the occasions we’ve been unfairly treated and if we look to the future we see only inescapable darkness and despair. We begin to feel that our problems are insurmountable and being constantly on edge looking for danger brings on a sense of impending doom. There seems to be no escape. Ultimately we feel like complete failures, utterly worthless, and life itself seems pointless. In response to all these stresses our minds scream at us to drink; it is the only thing that brings some relief.
Our addiction began with the reward system in a runaway state, was compounded by the changes in our brain that came with alcohol-tolerance and is then worsened by our psychological response to these. The inner stress caused by the conflict between “drinking is good” and “drinking is bad” becomes enormous and the shame, guilt and stress caused by holding secrets steadily accumulate. The stress caused by our day-to-day concerns is heightened and our fear of the judgement of others pushes us into isolation. We know we shouldn’t drink so much; it would be good if we drank less, but all our other issues appear so demanding. We try to limit what we drink but our efforts seem to be completely ineffective and we struggle to understand this, but we have so many other concerns too and this is not our biggest. All of this builds into a torrent of distress that we experience when we are sober and when we feel these emotions we are triggered to drink to relieve them… and that drink makes us feel better. This gives us a bizarre perception of alcohol: we don’t see alcohol as the cause of our problems; we see it as a solution to them.
There have been numerous occasions when we intended to not drink, or only have a couple, but the roaring demand to drink overwhelmed us… the cravings induced by our triggers are too powerful to resist when our whole mind screams “a drink will make you feel better!” This insistence is even more compelling because it is true; we will feel better if we have a drink; we will become happier, we will feel less socially isolated, we will feel more care-free, and we will feel calmness replacing the tension and stress. But as soon as we are sober again we are once more consumed by fear, anxiety, confusion, frustration, and loneliness and drinking is the only relief from them that we know. Our reward system builds triggers for all our anxieties and we are compelled to drink to relieve our discomfort. Once we begin drinking then we are compelled to continue. This means that we increasingly invest our time and money in drinking. We drink when we should be doing things with and for other people, and we spend money on alcohol that should be spent elsewhere. It appears to the onlooker that that we are indulging ourselves before considering others, but this is not how it seems to us. They see us wasting time and money on drink, but for us, without exception, every single time we that drank we were earnestly motivated to do so and the reasons our mind gave us to do so seemed perfectly convincing. To us our drinking is not self-indulgent; there is always a perfectly reasonable justification for having a drink. Our altered reality becomes that drinking is always warranted and the burdens of our decline continue to mount.
As it becomes increasingly necessary to change the way we are drinking it also becomes increasingly difficult to do so. There is no sudden dividing line at which somebody either is or isn’t alcoholic. Alcoholism is progressive and develops very slowly; it creeps on so slowly that we are unaware of the changes within ourselves. Also, because it is a progressive illness, not all alcoholics experience or exhibit the same severity of symptoms; some are sicker than others. But in general terms the longer we have been drinking heavily then the more entrenched our addiction becomes and the more our brains adapt to offset the regular presence of alcohol. But we aren’t directly aware of any of this. We can only recognise a long term trend of a gradual increase in the amount we drink. We do not see the change in our mood, we do not notice the increased pre-occupation with thoughts of drinking, and we do not directly link our anxiety, stress and depression with alcohol. The way our brain works and the thoughts that dominate our mind have shifted, and these shifts cause changes in our behaviour. What we don’t recognise is the extent to which this changed thinking and behaviour is caused by our drinking.
As our addiction develops we step through a series of observable behaviour changes:- morning shakes becomes regular, we start to drink before a drinking occasion, and we want to continue drinking when it’s time to leave. We drink at inappropriate times, we lie about how much we drink, when and where, and we don’t want to discuss our drinking. We miss work or family obligations, we hide alcohol, we agree to drinking limits but don’t keep to them. We behave out of character when drinking, drinking becomes more important than eating, we surround ourselves with heavy drinkers, we drink early in the morning, and we attempt periods of abstinence.
While these are changes that might be noticed by others, we keep far more to ourselves. In the face of mounting distress, anxiety and depression we carry on pretending that nothing is wrong, but inside we have a growing sense that everything is wrong, and while there is a progression of indicators visible to those looking on there is another private escalation of changes that we are aware of but conceal from public display:- we find we’ve lost the ability to control how much we drink once we’ve started, we are irritable, nervous or uncomfortable when not drinking, and we routinely experience memory loss or blackouts. We sneak drinks and lie about how much we actually consume. We get anxious when people talk about those who drink too much, and we drink to relieve uncomfortable emotion and distress. We are uncomfortable in situations where there is no alcohol, we drink as a reward for even small achievements, our waking thoughts are of alcohol and we need the first drink of the day. We have unreasonable feelings of resentment towards other people and the world, we think of getting away as way to stop drinking, we regularly drink alone and our guilt extends into constant remorse. We think about alcohol all the time, we lose our moral compass (we start doing things we wouldn’t have considered previously), we become angry when our drinking is discussed and we have a reflex denial that our drinking is a problem. We experience fear that is not attached to any apparent threat, we can’t imagine a life without alcohol, and we feel desperately alone, irritable, confused, depressed and scared. We suffer extremely low self-esteem, we have a sense of complete hopelessness and impending doom and we have suicidal thoughts.
As our addiction progresses so too does our mental un-wellness. Deep down we know that something is wrong with our drinking but we have other problems too. Every aspect of our lives is unravelling and in addition to that there is a mounting burden of shame and guilt. We drink secretly, hiding it from the sight of others; this is the only way we can drink as much as we need to without being shamed. We do things that offend our own consciences time after time and the list of our regretted actions is beyond counting. We are completely confused as to how we’ve reached this point and the massive burden of secrets, lies, guilt and shame keeps increasing. We can’t stop thinking about our troubles unless we have a drink. Our brains are so adapted to the presence of alcohol that there is a massive oversupply of glutamate and a deficit of GABA. This has become essential in order to keep our brain functioning adequately when we drink, but when we are not drinking our mind is a roaring and tumbling torrent of unresolved issues, bad outcomes and guilty secrets. We play and re-play scenes in our mind to try to find different resolutions, but they do not come, so the issues spin and twist and churn endlessly. We feel impossibly alone and scared; scared that our secrets will be found out and scared that this is it… this is all our life has amounted to.
Our social confidence becomes so low that we feel detached and apart from other people and this aloneness is crushing. Even though we are surrounded by people, at home and at work, no-one seems to see how hard our life has become. Alcohol is the only thing that gives us relief from our problems and it is the only thing that makes life bearable. No-one understands and no-one is coming to help; we are on our own. We can’t control or limit our drinking; we’ve tried many, many times and failed completely. Stopping drinking is impossible; we’ve tried to stop for periods but usually only managed a few days so it seems like we are trapped with no possibility of escape. Our position is completely hopeless; that is, we are without hope. Permanently stopping drinking might improve our position but a life without alcohol is utterly unimaginable… it is the only thing that relieves our suffering; it is the only thing that makes life worthwhile.
For its addicts alcohol steals the joy, meaning and purpose from our lives in exchange for an empty promise of fun, and it appears to be completely inescapable.