Under the Weather – Coping with Alcohol Abuse and Alcoholism: New and updated edition

By John G. Cooney

'A very practical and forthright book.'
Professor Anthony Clare

The abuse of alcohol and alcoholism are among the most corrosive and devastating features of modern societies. The incidence of broken lives and shattered families caused directly by alcohol addiction is now widely recognised. However, as the widespread nature of alcoholism is acknowledged, so too are the significant advances in its treatment.

Under the Weather sets out all the basic facts on alcoholism and alcohol abuse in an accessible yet comprehensive manner. It combines a popular approach with one that is scientifically and medically reliable. Above all this new and updated edition of a well-established and popular book offers hope and encouragement by emphasising the high recovery rates for those who are prepared to assume responsibility for their own recovery and co-operate with properly mounted and comprehensive treatment programmes.

Family and friends concerned about the effect of abnormal drinking will also find it an invaluable source of information and support.

'Few authors can write with such experiences and understanding … warmly recommended to a wide readership.'
Dr Bruce Ritson

'Of the many books written in recent years about alcoholism and problem drinkers this one is outstanding.'
Dr Max Glatt
Under the Weather: Table of Contents
Introduction

- Alcoholism – A Disease
- Alcoholism – Many Causes
- Signs, Symptoms and Cross Addiction
- From Compulsion to Recovery
- Physical and Psychiatric Complications
- Mental Mechanism and Medication
- Overall Treatment Plan
- Relapse
- The Young
- Women
- A Family Illness
- PreventionAppendix A: The Definition of Alcoholism
Appendix B: Treatment
Appendix C: Questionnaires
Appendix D: Alcoholics Anonymous, Al-Anon, Alateen
Appendix E: Help and Advice

• Language: English
• Publisher: Gill Books
• Release date: Nov 1, 2002
• ISBN: 9780717166114

John G. Cooney

Dr John G. Cooney is a psychiatrist who for many years has been prominent in the treatment of alcoholism. A founding director of the Irish National Council on Alcoholism, he has written and lectured extensively throughout the world.

Book preview

PREFACE

Alcohol taken in moderation can be a pleasure and a benefit. Unfortunately, as many discover it is also potentially addictive and a source of widespread physical, social and psychological harm. There are few families who cannot identify a member whose drinking has caused enormous distress to themselves and others. Throughout Europe, North America and many other parts of the world alcohol misuse imposes huge costs on health services, penal systems and social welfare agencies. The damage to the quality of family life is less easily quantified but often more acutely experienced and may have much longer-term consequences.

This book originates from Ireland, a country which certainly shares in these problems but is in no way unique since the experiences described are universal. Under the Weather speaks directly to those who are concerned about their own drinking or distressed by the drinking of close friends or relatives. In addition it will also be very relevant to the many doctors, social workers and other care givers who regularly encounter these problems in their daily practice.

Dr John Cooney brings a lifetime’s experience of listening to and treating individuals with alcohol problems. For many years he was the director of the Alcoholism Treatment Unit at St Patrick’s Hospital in Dublin. The hospital itself is internationally famous for its research and treatment programmes focusing on alcoholism. It was one of the first centres to establish specialist treatment services for alcoholics.

Dr Cooney has an international reputation for his work as a clinician, researcher and advocate for the needs of those individuals who suffer from alcohol-related problems. He is well known as a teacher and writer on these topics. This is the second edition of a book which has already proved its worth. It has been brought up to date, taking into account recent advances in the understanding of the treatment and prevention of alcohol-related problems. Improved investigative techniques have opened up new pathways toward understanding biological and genetic factors in the development of alcohol dependence and these are incorporated into this new edition.

The outstanding characteristic of this book, however, is the way in which the author sensitively brings alive the suffering experienced by individuals who are dependent on alcohol and the hope for recovery that is engendered by the treatment approaches which he describes. Very few authors can write from such a depth of experience and understanding. I am very pleased that Dr Cooney has been persuaded to prepare this new edition and I would like to warmly recommend it to a wide readership.

Dr Bruce Ritson MD, FRCPsych, FRCP

Chairman, Medical Council on Alcohol

Edinburgh

March 2002

INTRODUCTION TO SECOND EDITION

In Western society, the new millennium has brought a growing concern about the problem of excessive alcohol consumption. The concern is well justified. Surveys show an alarming rate of increase in alcohol consumption in a number of countries. At the top of the league in the EU are Luxembourg, Portugal and the Republic of Ireland where the per capita consumption of alcohol, at over 11 litres or 14 litres per adult shows a marked rise, particularly during the latter half of the 1990s, and is now perceived to be at crisis point. The figure for the UK is 8.4 litres per capita. In the case of countries like Spain, Germany and Italy, data reveal 10.0, 10.5 and 7.5 litres of alcohol per capita consumption, while figures for France reveal that the country is getting to grips with the problem of the overuse of alcohol with per capita consumption now down to 10.7 litres.

Data in relation to youth drinking indicate especial cause for concern with the increased prevalence of binge drinking in this age group particularly disturbing. In response, both the World Health Organisation and the Council of the European Union, in 2001, issued detailed recommendations designed to protect the young from alcohol induced harm.

Governments are spending large sums of money and considerable effort to increase our knowledge of the disease of alcoholism. Researchers continue to investigate a subject about which much remains to be learned. Areas of recent interest include the heredity factor, specific areas of the brain directly affected by alcohol and cross-cultural studies.

All of these initiatives are essential to developing an understanding of a disease that has frightening consequences for individuals, families and whole societies. The financial costs are enormous. So too is the suffering brought about by the misuse of alcohol, not merely socially and vocationally, but also at the family level. In addition, its adverse effect on the physical and psychological well-being of people, can scarcely be overstated.

Since the publication of Under the Weather in 1992, additional new strategies and approaches to the ever-increasing prevalence of problem drinking often culminating in alcoholism, or severe alcohol dependence, are now actively employed. These are based on recent research on the brain and its chemistry, as well as on clinical appraisals of different forms of intervention.

This new edition of Under the Weather takes into account not only preventative measures, but also provides an update on strategies and techniques appropriate for the management of alcoholism and alcohol misuse which remains the main focus of the book and is applicable worldwide.

CHAPTER 1

ALCOHOLISM – A DISEASE

The Disease Concept

In practical terms, alcoholism is best regarded as a primary, chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterised by: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. For a fuller definition see Appendix A.

An argument often advanced against this notion of the disease concept is that if it is too vigorously pursued, in effect one is giving the alcoholic a licence to drink again: ‘Doctor, I could not help taking that first drink because I suffer from the disease of alcoholism.’ This is not a valid objection. A properly conducted programme for the treatment of alcoholism will emphasise the fact that the primary responsibility for recovery rests with the patients themselves.

When alcoholics come for treatment they should be furnished with what is in effect a contract, in which it is clearly set out that (a) it is recognised and accepted that nobody consciously sets out to develop alcoholism, but (b) once the condition is established – and this fact is spelled out to the individuals concerned – then they must take the primary responsibility for their own recovery. The contract makes it clear that every possible help will be afforded to patients and their families to achieve this objective. At the same time, it is stressed that their chances of success are high, provided they are prepared to apply themselves wholeheartedly to the treatment programme.

Over the years, I have never met one alcoholic among the many thousands with whom I have been in contact who has consciously set out to develop the condition. This is a basic fact which is often overlooked.

If one takes a representative sample of ten persons suffering from alcoholism, one would expect to find 7–8 men and 2–3 women in such a group. There will be in this sample old people, young people, clever people, people with lower intelligence, rich people, poor people, some from rural areas, some from the city or town, people of considerable importance in their own community as well as those with a relatively low profile. And yet, if one takes an individual history from each of these ten people making up the group, it is soon apparent that every one of them, in effect, is telling the same story, allowing for some individual variations. In other words, here is a disparate group of people with different backgrounds, levels of intelligence, affluence, etc. volunteering similar signs and symptoms and displaying a common pattern of behaviour brought about by their drinking habits.

For the moment, let us consider the proposition that alcoholism is not a disease but merely a bad habit, self-inflicted. It follows that one is no longer dealing with victims of a disease but rather with persons of poor character or moral weakness. This means that we have now reverted to the ‘sin’ model of alcoholism prevalent up to the 1930s when AA (Alcoholics Anonymous) came into being. Under that model alcoholics can no longer expect to receive the understanding to which they are entitled.

I recall one evening, many years ago, having a conversation with a recovered alcoholic. He rarely spoke of his own drinking days, but on this particular occasion he surprised me by stating rather bitterly, in a fashion which was quite out of character for him, that in his ‘bad days’ he did not look for sympathy from anyone but did expect understanding, particularly from the doctors whom he consulted and who failed him for so long in this respect.

I fear that if the disease concept of alcoholism is rejected, the enlightenment and understanding of the condition, which have been so painfully and laboriously gained over the years, will be lost, and public support for the proper and compassionate treatment of alcoholism seriously eroded.

The Alcoholic

Those who suffer from alcoholism are called alcoholics. This is a term which is often misunderstood and gives rise to much difficulty. The longer I work in the field of alcohol abuse the more reluctant I am to use the word ‘alcoholic’, until I am certain that those with whom I am attempting to communicate define the term as I do myself.

The working definition which I employ is that put forward by Marty Mann in her book Primer on Alcoholism (Henry Holt and Co., 1950, New York). She defined an alcoholic as anyone whose drinking caused a continuing problem in any department of his or her life. This problem has to be continuing. There is no point, for instance, in the irate wife castigating her husband as an alcoholic because he went out one night with ‘the boys’ and drank too much. Next day he missed work and scolded everyone in the home in a most unreasonable manner. This one fall from grace, so to speak, would not make the errant husband an alcoholic. Equally, successful business or professional men or women who are drinking abnormally cannot claim that they are not alcoholics merely because they still hold down jobs or still have some degree of standing in their families or community lives. It is often found that the financial position of such people is not nearly as sound as it should be, given their income, while the family relationships are almost invariably undermined because of the drinking pattern.

Therefore, when we talk about an alcoholic we are not making any moral value judgment. We are merely stating that the individual concerned, man or woman, lay or cleric, young or old, rich or poor, clever or not, has reached a stage where alcohol is causing a continuing problem in some department of his or her life.

The Folklore of Alcoholism

The confusion over the definition of the term ‘alcoholic’ reflects a wider and more deep-seated misunderstanding of the nature of alcoholism itself. This is bound up with what I term the ‘folklore of alcoholism’, made up of myths and fallacies which have gradually been accepted over the years. Their existence has interfered considerably with a proper appreciation of the true nature of alcoholism and they need to be vigorously debunked.

Each of us is conditioned to a lesser or greater extent by values and beliefs which we learn and accept early in life within our family circle. In turn, these have constantly been reinforced by our education and by our social circumstances. No matter how intelligent, discerning or perceptive we consider ourselves to be, each of us is the victim of this conditioning to a greater extent than we may appreciate.

There are many myths and fallacies surrounding alcoholism; the following are some of the most frequently heard:

(a) I could not be an alcoholic because I don’t drink very much. I associate consistently with five or six other people, all of whom drink much more than I do. By any standard, none of them is an alcoholic and, therefore, since I drink less than they do, I could not be one.

It is not the amount of alcohol consumed which is the determining factor in diagnosis, but rather one’s reaction to whatever amount one drinks. I have seen many ‘true blue’ alcoholics who have drunk relatively little alcohol, by comparison with the more common picture of the heavy-drinking characteristic of the majority of alcoholics, and yet these people have been as truly victims of the disease as those who drank a great deal more. Hence, the importance of not making comparisons, but rather assessing everybody’s drinking pattern on an individual basis.

(b) I could not be an alcoholic because I drink only beer and very rarely drink spirits.

This too is a myth. All forms of intoxicating liquor contain a drug called ethyl alcohol. Essentially, alcoholism is addiction to ethyl alcohol which is not present in soft drinks. Apart from flavouring agents, the important difference between alcoholic drinks is the amount of ethyl alcohol present. For instance, beer contains 4 per cent to 5 per cent ethyl alcohol, table wine up to 13 per cent, sherry approximately 15 per cent to 16 per cent, while spirits have in excess of 30 per cent. It therefore follows that if one drinks a number of bottles of beer one is consuming as much ethyl alcohol as if one drank several glasses of Scotch or Irish whiskey.

(c) I could not be an alcoholic because I can go for periods of time without taking a drink. Last year, to placate my wife who was being very difficult about my drinking, I gave it up for six weeks!

This means nothing in terms of diagnosis. Indeed, one might query why such a big fuss is made of giving up drinking. After all, the ordinary social drinker does not make an issue of it. One is reminded of Mark Twain’s assertion that smoking was never a problem for him since he had given it up on hundreds of occasions!

It is important to remember that most alcoholics can exercise a certain degree of control over their consumption of alcohol for much of their drinking careers, even when they have progressed from social drinking to abnormal drinking. However, as alcoholics age, as they become more advanced in their alcoholism, as their physical health deteriorates because of abnormal drinking, the less likely are they