We can avoid alcohol’s mental health icebergs

A brain-centred approach will enable millions of us to avoid the alcohol icebergs we know are out there. 

The latest smudge on the radar screen in was made in February by 10,000 extra cases of early-onset dementia lurking in French medical data. Alcohol factored in 57% of them, tripling the risk of all dementias. This mass suffering must be mourned, as is the fact that the risks are not widely known, as I discovered investigating my book Alcohol Companion.

Other investigations are poised to confirm the dementia statistic, which is almost certainly an underestimate. “No surprise,” say many in the psychiatric and mental health professions on reading this week’s dementia statistic. For them alcohol damage is is a commonplace of working knowledge. 

There are more statistical icebergs are out there too, simply waiting to be given wider recognition. There is already an undisputed correlation between drinking more than a little alcohol and depression and anxiety. So too post-traumatic stress, problems with decision-making abilities, cognition, memory and impulse control.

Some of us may know this on paper or have found out from experience, but how many of us really act on what we know? It is already known that drinking no more than 14 UK units (140ml) of alcohol a week will minimise our chances of problems. If we take our mental health seriously, as surely we should, we need to follow this guidance.

Our brains are not just the fall-guy in our relationship with alcohol either, they also initiate it. We drink alcohol because we like how our brains make us feel after, feelings informed by our beliefs. We often imagine it boosts our confidence, our mood and or helps us relax, all understandable ideas, but also inaccurate enough to backfire.

The brain-centricity of this week’s news make it a turning point, but real change will not happen overnight. As if to illustrate, a story ran alongside it peddling the “good news” that alcohol may prolong our lives. No matter, it seems, these reports were slammed by experts in alcohol and longevity as misleading speculation.

But these lapses of collective reason do not spoil the real good news about the path of our relationship with alcohol. The ice has been broken about mental health which has gone from taboo to borderline trendy, with young people drinking less. The internet, for all its problems, has put us in touch with our psychological quirks, both good and bad. And we can inform, organise and support each other better than ever.

There are still formidable alcohol icebergs out there which will come to wider recognition in due course. We can be sure of that. But we also have the knowledge and tools to minimise risk. It can only get better, even if it is sometimes a bumpy ride.

Update: Alcohol strategy rift remains over conflicts of interest

 

There was no narrowing of the rift in the UK’s bid to tackle alcohol harm, which sprang open on Monday when a government health agency went into partnership with an alcohol industry-funded campaign, despite hearing strong opposition to the conflict of interests.

The “drink-free days” campaign will be entirely paid for by Drinkaware, an organisation receiving 92% of its £5.4m annual income from alcohol producers and others with interests in selling alcohol. It has committed to spend over £1m on the campaign this year.

“We will work together with any partner that speaks to the evidence and shares the same commitment,” Public Health England (PHE) told Alcohol Companion. “We brought our public health expertise and track record on delivering behaviour change campaigns.”

Drinkaware says it shares the same “aims and principles” as its new public sector partner. But it did not answer when asked if it would risk donors’ business interests to achieve public health goals? Critics conclude this is because of a conflict of interests.

Head of the Wine and Spirits Trade Association Miles Beale also would not say if his association’s members would continue to contribute to Drinkaware if the organisation’s work threatened their business interests. The alcohol industry wants “long-term customers”, he says.

PHE head Duncan Selbie said he would be “fiercely vigilant” about Drinkaware’s governance. Many, however, remain horrified. “As a profession, this potentially brings public health into national ridicule,” wrote one commentator on Twitter.

Sir Ian Gilmore, PHE adviser no more

A group of 40 health organisations, led by the Alcohol Health Alliance, objected to the deal last month. “We hoped they would see sense,” said one insider. AHA head Sir Ian Gilmore resigned as a PHE adviser this week and his tobacco counterpart John Britton may yet follow.

Drinkaware “misrepresents evidence and frames alcohol harms as solely an individual responsibility issue”, says Mark Petticrew, a long-time critic. The new venture “normalises the role of the alcohol industry in influencing public health”.

In particular Petticrew says Drinkaware downplays cancer risk as part of a wider strategy to neuter health advice to protect shareholder returns. A PHE evidence review has acknowledged potential problems of this kind.

PHE and Drinkaware say they will do separate evaluations and peer reviews of the campaign. Portman, the alcohol industry outfit which created Drinkaware, drew conclusions at odds with the findings of a joint health labelling study this year.

This site revealed Portman unilaterally dropped official health guidelines from its voluntary labelling standard in October. The attempt to restore them is led by the Department of Health and Social Care, but the PHE looked at the evidence and came down in favour of health labelling.

“Using labels to include information about the health risks and harms associated with alcohol can be implemented with relatively low-cost and will have a wide population reach,” the PHE’s review said in its 2016 review.

Few health professionals quibble with the idea behind “drink-free days”. Having two or more days a week without drinking alcohol may help older, steady drinkers cut down. It is already part of the Chief Medical Officer’s drinking guidelines.

A PR campaign for the idea began on Monday. This will be backed up with national radio and digital advertising which will direct people to a dedicated site. The Drinkaware board has yet to decide on budgets for 2019 and 2020.

Among the reasons the PHE gives for its partnership with Drinkaware is that the alcohol-business backed site had 9m unique visitors in 2017, an unaudited figure taken from Google Analytics. Most, it says, arrive from an organic search for an alcohol-related term.

“This is the first step in reframing our relationship with the alcohol industry,” PHE said its head, Mr Selbie. Some are finding the route being mapped out a more enticing prospect than others. ■

 

Is there “no safe level” of alcohol drinking? | BBC World News

Is there “no safe level” of alcohol drinking? I spoke to BBC World News about a Lancet report which reinforces much of what I say in Alcohol Companion. ■

Alcohol linked to nearly one-in-ten deaths among under 50s


There is no safe level of alcohol drinking, something linked to almost one-in-ten deaths in adults under 50 globally, says a study published today in 
The Lancet. Continue reading “Alcohol linked to nearly one-in-ten deaths among under 50s”

Low/no-alcohol World Beer Awards winners 2018

Germany remains a country kilometre ahead of the rest of the world in low-alcohol brewing, scooping up 17 of the 34 awards given to beers of this type at the World Beer Awards 2018 (see table). Continue reading “Low/no-alcohol World Beer Awards winners 2018”

Be wary of “persistent hangovers”

Feeling crummy more than a day after an alcohol session should give us pause for thought.

The alcohol response of our brains changes depending on our alcohol exposure over the past few hours and days and, less obviously, that over the last few months and years.

In our student days and early twenties, for instance, many of us might drink enough to move our brains into the outer regions of dependency, where our neurons misbehave when alcohol free.

No klaxon accompanies this shift so we may never know it happened. And our recovery from it can happen without us knowing too, with our drinking levels falling as our circumstances change.

But we can also inch into dependency at any time if we drink heavily for long enough, perhaps triggered by friends, a trauma or Christmas. We can unwittingly inch out of dependence again too. But we can’t rely on it.

So how do we know where we stand? It is not easy. If we drink less than the UK guidelines of 14 units (140ml) of alcohol a week for months, there is little chance of a problem. If not, we can’t be so sure.

We can look for clues, however: If we binge-drink, the classic pattern of the enthusiastic “social drinker” in northern Europe and North America, then our recovery after a heavy one is a good place to look.

Overlong aftermath
Having routine hangovers means we are not looking after our brains very well and could eventually face difficulties. But discomfort within the first 24 hours is a normal reaction to an alcohol overdose.

But feeling meh more than 24 hours after an alcohol session is something else. We might think it is a “prolonged [or delayed] hangover”, but it is not an overdose rebound, but a reaction to absence.

We have, in other words, some degree of withdrawal. We might sweat, have headaches, feel grumpy, tense, forgetful or nauseous. If we have anything more than the mildest discomfort we should go and see our doctor.

“Two-dayers”, as this phenomenon is sometimes dismissed, are potentially a sign we are flirting with alcohol dependency. Nobody wants to find this out, but the sooner we do, the easier it will be to reverse.

Avoiding heavy alcohol use for three months to a year is typically enough to be rid of it. Making this change on purpose is not always easy, but we can get help from our doctors and online and offline support.

If we stick to it we can reasonably expect clearer thinking, better memory, improved and more stable mood and better sleep. And, on a more practical level, we can substantially cut costs and so improve our finances.

Looking out for “persistent hangovers” or “two-dayers” can enable to look past unhelpful folk wisdom and misinformation to identify a potential problem, a crucial step in improving our long-term wellbeing. ■

Continue reading “Be wary of “persistent hangovers””

Alcohol: Take courage from competence

Like England’s footballers, who overcame a decades-long inability to win on penalties, we are better off finding our courage through practice, not through alcohol.

Sports sponsorship, like Budweiser’s backing of the World Cup, and thrilling advertising images reinforce the phoney link between alcohol and courage, despite codes barring it being done explicitly.

Alcohol plays no part in the confidence of sports people, or anyone else. We all know it, but facts are not what advertising is about. Advertising connects feelings, not facts, in this case tension and alcohol relief.

Our pre-scientific alcohol lexicon provide a flimsy barrier to prevent this powerful emotional linkage. The phrase “Dutch courage” contains only an oblique reference to the Netherlands to trigger suspicion.

Own goals
Lingering misgivings about the Low Countries, alas, do little to prevent our behaviour from being influenced, so we often turn to alcohol to cocoon ourselves from anxiety and even use it to assuage our excitement.

This is doubly ironic, if not more. We watch sport stars perform feats of skill with amazing calm, focus and concentration, while consuming a substance which interferes with our ability to emulate them.

Alcohol inebriation slows our brain function, reducing our competence in activities requiring us to use our brains. This includes practically everything, even sleep.

And, of over the long term, using alcohol tends to fuel our fears and anxieties and lengthen jumpiness after stressful events, whether they end badly or well.

Practice kills nerves
The competence we developed in our jobs and sports mean we are rarely gripped by nerves. Experience teaches us, like professional sportspeople, to know our limits, estimate risk and gauge the chances of success.

Our biggest worries typically revolve around the more haphazard world of our social lives. We often worry about our ability to converse, make friends, find partners and, heaven forbid, give a speech.

We are often first faced with these types of challenges at the same time as we have our first chances to drink alcohol. And they often remain paired thereafter, seemingly inextricably linked.

Alcohol reduces our awareness of distractions which might interrupt our flow, but it does not give us any new skills. We can make fluent, jovial, spontaneous conversation just as well without alcohol. Even dancing is possible.

Social situations which do not enforce alcohol drinking are a help, though not necessary if we can slip under the radar. Like practising penalties, socialising without drinking will eventually bring results.

Liberty includes the freedom to think clearly

Restricting alcohol use can dramatically improve our decision-making, the key to our personal freedom.

Our choice to consume alcohol is often coerced, through social pressure and misleading ideas. And alcohol reduces our ability to assess our options. Continue reading “Liberty includes the freedom to think clearly”