“Red or white?” Red. “Pinot Noir, Merlot or Rioja?” Rioja. Welcome to sophistication, where knowing your wines is a marker of worldliness, where knowing your vodkas is synonymous with hip and drinking to excess is met with denial. And increasingly, the guilty subjects to whom this excess is attributed are female. Or so says Ann Dowsett Johnston in her new memoir, Drink. “The new reality: binge drinking is increasing among young adults and women are largely responsible for this trend.” This isn’t something we haven’t heard before. It’s all over the place – professionals slapping naughty women on the wrist for encroaching on male behaviour – the insolence of females! But while there is clear sexism surrounding the issue of the female drinker, not many people stop to point out the bitchy discrimination that clings to alcoholics of either gender.
“In our society, would you rather be known as an alcoholic or a person who suffers from depression?” The answer to Johnston’s question can be found overwhelmingly in the use of fake names in her memoir, because that opening line: “Hi, my name is ______, and I’m an alcoholic,” is harder to say than Jerry Blank’s declaration in Strangers with Candy. Scout, an example of the invisible alcoholic, illustrates this. She says: “I wish I could use my real name … But I find anonymity important because people don’t understand about alcoholics. If I were to tell my colleagues that I was one, they would think I wasn’t up to the job. I tell no one – not even my family.”
“For me, coming out is right,” remarks Johnston. “Coming out” isn’t language we associate with closet drinkers, the phrase usually followed by a statement about one’s sexual orientation or gender identity. But like the self-disclosure of sexuality, coming out as an alcoholic is to publically assert yourself as separate from the status quo. It’s a brave admission, and it deserves our empathy if Britain’s drinking problem is to be cured.
“Most people who drink too much aren’t addicted to alcohol.” Johnston’s assertion is valid, but heavy drinking and binge drinking are both alcohol disorders that lead to a needy relationship with the bottle. The NHS defines a binge as three glasses of standard wine (six units) for women and four glasses (eight units) for men in a single session. To drink heavily is characterised by regularly necking more than eight units a day for men, and six units a day for women. Heavy drinking, then, is just the extended cut of binging. And while binging is usually preceded by the words “down it Fresher!” and followed by jagerbombs in vomit-splattered city centres, a bottle of Californian merlot during Downton Abbey is considered perfectly respectful. Drinking heavily at home is met with less social repercussions than knocking back White Lightning on a park bench, but it is still a contributor to the 20 per cent increase in liver disease over the past decade. It is still what Dame Sally Davies was thinking when she said “our alcohol consumption is out of kilter with most of the civilized world”.
But is alcoholism a disease? Johnston is very careful to skirt around this issue without plainly committing herself one way or the other. “Harm reduction is bullshit,” says O’Flaherty of the Betty Ford Centre, “Addiction is a brain disease – if we cross into addiction, there is no going back”. But whether it is technically a disease or not doesn’t really matter. What matters is that we know alcoholism changes brain chemistry, physically altering the dopamine receptors in the brain to numb the stimulation of booze. In this sense, alcohol abuse is medicinal. This is key for understanding the addiction and reworking the stigma that taints it. Johnston cites Patrick Smith of Toronto’s Renascent treatment centre: “social drinkers have a difficult time understanding the physiological realities of alcohol dependence because it’s not part of their lived experience.” Like diabetes patients, or one of the 10 per cent of people in the UK who suffer from depression, we can’t all offer identification of alcoholism, only an understanding.
Britain has a drinking problem, and it’s time we empathised with it. Breathalyser wagons or drunk tanks won’t cure the 9 per cent of men and 4 per cent of women who show signs of alcohol dependence, but merely offer a blue plaster to shield the issue of binge drinking. And like all blue plasters, it will inevitably unstick over time. “Risky drinking is normative in our culture,” writes Johnston, and the health consequences of this risky drinking need to be given a fair public acknowledgement. Heavy drinking at home might be more socially acceptable than catching the 2am booze bus, but it doesn’t detract from the £3.5bn a year the NHS spends on alcohol-related diseases. It doesn’t detract from the fact that drinking heavily makes you 3 to 5 times more likely to get mouth, neck and throat cancer, that you’re 3 to 10 times more likely to develop liver cirrhosis, or that your mental health will suffer as a result. In America, 60 per cent of individuals with drinking problems did not seek help in 2010 due to the stigma of alcoholics, because, and as history has taught us so well, with stigma comes closets.
On Tuesday, Ed Miliband raised the issue of mental health, calling depression or anxiety something “you don’t want to talk about”, but something that needs early identification to avoid unnecessary spending and anguish. “It’s a One Nation issue”, the Labour leader continued, “It covers rich and poor, North and South, young and old alike … we’ve swept it under the carpet for too long.”
When will our party leaders realise that the same applies to alcoholism?
Drink: The Intimate Relationship Between Women and Alcohol by Ann Dowsett Johnston, published by Fourth Estate (1st October 2013)
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