Alcoholism among doctors – when does drinking become harmful or addictive?
This is the second blog in our new series: "Let's Talk About...", and today we're continuing the theme of talking about alcoholism in doctors. It’s January, often a time when people are thinking about how much they're drinking and their other habits, and whether they're healthy or not. I wanted to share some information about how you can tell the difference between harmful use of a substance and dependence on that substance. When do you cross over that line? When does having just a couple of glasses of wine a night become an addiction?
There are diagnostic criteria that are used across the world by doctors to diagnose both harmful use of, and dependence on, substances and behaviours. Typically the things that tend to point towards a dependent syndrome are things like increasing use over time, not being able to stop, and getting uncomfortable symptoms when you do stop that substance or behaviour.
What addiction looks like day to day
Diagnostic criteria are all well and good but we live in the real world and we don't use ‘diagnostic criteria’ in our day-to-day language do we? So I find it helpful to think about what it's like for people with addictions in their every day lives... and what I have found from talking to lots of other addicts and alcoholics like me, is that for quite a number of dependent drinkers, they knew from their very first drink that something wasn't right, that their response was somehow different to other peoples’.
For me, I was certainly aware from my early drinking days that I would always be the first one to start drinking. I would do a little mental calculation as to how much alcohol there was and how many people there were to make sure there was enough for me, and if there wasn’t enough I would feel hard done by. I would be the last one drinking, the last one standing, and I became known for being quite fun and outgoing, but it was all hiding a deeper, darker need to keep drinking.
Some alcoholics and addicts know from their first use of a substance or a behaviour that it's just not right. For others it takes a little longer. They might have a relatively normal relationship to alcohol or drugs throughout their life, and then suddenly something will trigger them into a more dependent pattern. For example, somebody who might normally share a bottle of wine with their partner at the weekend, enjoy an odd gin and tonic now and again, and an extra few drinks at Christmas, suddenly finds themselves reaching for a beer at the end of the day after work. And that then turns into the next day, and the next day, and it creeps up, and within just a few weeks or months the pattern changes. It can be helpful to think about the pattern of your drinking over time, whether the pattern has changed or not, and how you feel about it.
How long could you go without a drink?
It can also help to think about how you would feel if you couldn’t drink. Would you struggle with the idea of not having a drink for a certain amount of time? A lot of people struggle with the idea of just one month without drinking in January when they try Dry January. Imagine, could you not drink for six months? Or a year? How would that feel for you? Does that ring warning bells? I knew for me, when I was thinking about stopping drinking, it was like: ‘there's no way, absolutely no way I'm going make it to six months or nine months without picking up a drink’. I just knew in my heart of hearts that I would have a bad day at work and need to pick up a drink, or I'd have a celebration that I'd really struggle to not have a drink for. Often, like me, addicts just know they are addicts and they can’t bear the idea of living without the substance. Ask yourself - could you live without it?
What does it feel like to be a doctor and an addict?
When you talk to addicts they use different words and different ways of describing what addiction means to them and it can be a very personal thing. For me, addiction is all about the fact that I find it hard to feel my emotions and to deal with my emotions in a healthy way. I will use substances, or behaviours like working too much, to try and change how I feel. Essentially, at the bottom of all addictions, there is a difficulty coping with our emotions as human beings. I find that a more helpful way to look at addiction and to understand why it is that someone like me who, to the outside world, could look as if they're completely happy and together, have a family, and a job, and have lots of wonderful things going on in their lives but still be coming home and drowning their sorrows in a bottle of wine every night, unable to tell anyone they are struggling.
Essentially I never really learnt, like many addicts, how to exist in the world, how to feel things - how to feel angry, sad, disappointed - and how to deal with people and things. I went into medicine and suddenly, like many doctors, I found myself confronted by lots of incredibly difficult situations on a daily basis. There were children dying, there were people being diagnosed with awful, debilitating illnesses, and everywhere I looked there was pain and suffering, and I couldn't always do something to help. It was no wonder looking back that I had so many difficult emotions and all of that emotion had to go somewhere. I wasn't dealing with it healthily. I wasn't going down to the gym and taking it out on a punch bag or going and talking to my friends or family at the end of day. I was driving home from work thinking about that first glass of wine. I would be willing the car to go faster because I just wanted to get home so I could get that sense of relief that you feel when you just open the bottle. A sip hadn't even passed my lips and yet I felt somehow this great sense of relief from those overwhelming, overbearing feelings that I was having, knowing that I could just get out of it for another night. I could block it all out.
Addiction can be a very effective coping mechanism in the short term. We think they're helping us to feel better. Of course they end up having harmful consequences. You start to get more hangovers and your physical health starts to suffer. I know people who are doctors who have lost their driving license and their license to practice medicine. There can be severe consequences. You can lose your relationships and the roof over your head, and yet, we addicts persist in drinking, or using that drug, or gambling, or using sex, or whatever the addiction might be. When most people would stop and change their behaviours, addicts will keep going despite those awful consequences.
The biggest consequence for me was on my mental health. I became really depressed. I have bipolar disorder and throughout my twenties, and early thirties, I was drinking to cope with my mood and that really didn't help. It certainly made my mood lower and I had many dark periods where I thought about ending my life. This kind of suicidal thinking is common amongst addicts. Because, although you're using your addiction to try to feel better, it doesn't really deal with the underlying problem which is being human and having feelings. So you stay stuck with all these difficult emotions and on top of that you're getting the negative consequences of the addiction to deal with as well.
People often describe addictions as progressive illnesses - i.e. they get worse over time. This has certainly been my experience, both personally and professionally. They tend to cycle round and then gradually, or sometimes very rapidly, get worse. The cycle starts when you first start to realize something is wrong. Maybe you think "my drinking's a bit out of control, "I'm drinking a bit more than I'd like to". Then you think about stopping for a bit or you think about cutting back. Addicts will try a whole range of ways to cut back rather than have to stop completely - I certainly did. I tried alternating my alcoholic drinks with non-alcoholic ones. I tried drinking on certain days of the week. I tried only drinking certain drinks. I tried stopping for short periods and having breaks. You may be able to identify with this. You may be one of those people that is yet again finding themselves in dry January thinking "hmm, I'm not sure this is just about January anymore’, or “maybe there's something a bit longer term going on here...”.
There is help available
If you are thinking you may have a problem with alcohol, or you know you do for sure, please know that there is help out there for you. It's incredibly common to struggle with both harmful use and dependence to drugs, alcohol and other behaviours, and it’s very common amongst doctors. You are not alone, there is help out there. We have a list of confidential and free professional services for doctors on our free resources page
At the Joyful Doctor we offer 1:1 support; therapy and coaching, online courses, in person training and workshops and can point you in the direction of other resources and services which can support you. Please get in touch by emailing firstname.lastname@example.org or calling us on +44 (0)1932 922 100
Thank you for taking the time to read this article. Please do share far and wide, with anyone who you think may benefit from hearing this message; your colleagues, your friends, or a family member.
It is our mission, here at The Joyful Doctor to reach as many doctors as we possibly can. No doctor needs to suffer in silence. We are here to help.