Giving Up Drink: on alcohol, livers and transplants
Illness is an opportunity, though a dangerous one. To seize this opportunity I need to remain with illness a little longer and share what I have learned through it.
Arthur W.Frank : At the Will of the Body (2002: p1)
As many seasoned researchers through the years have demonstrated, substance abuse and addiction are never independent of the complex web of social relations within which they are embedded. Addiction can never be reduced to a mere pharmacological determinism that reifies the power of chemistry over the human spirit. Robert Granfield & William Cloud: Coming Clean: Overcoming Addiction Without Treatment 1999 NYU Press p96
see also: transplants
For roughly three years between 2004 and 2007, I was seriously ill with end stage alcoholic liver disease. I was a very sick person indeed, with some considerable chance (up to one in three) that I would not survive. When I was diagnosed, I learnt that roughly eighty per cent of my liver had become non functional. It had what they call ‘scar tissue’- the damages had been covered up by a kind of skin that does not perform the usual liver functions. The liver is the largest organ in the body, and performs over 500 functions. It keeps my system pure and provides energy. It is a critical life giving organ, but it is one of the few internal human organs capable of natural regeneration of lost tissue. I am told that as little as 25% of remaining liver can regenerate into a whole liver again; but whatever the level, I was well beyond it!
There are many pathways to liver disease, but mine was the common one of excessive alcohol. No doubt about it, I drank too much. And I had done for many, many years. When I was young I used to be a Methodist and ran alcohol abstinence church stalls; but by the time I was in my early twenties, I was enjoying large quantities of beer most nights. Until I was 60, I guess I drank some beer most nights; and increasingly this was accompanied by wine. After a glass or two, I could find myself easily drinking back whole bottles! I was a cheerful, jolly social drinker – but a pretty heavy one. I drank initially because I was gay and shy: I looked extravert but I was intensely scared of social situations (and sexual encounters). In latter years, and jokingly, I called myself a non-diseased alcoholic! I was never aggressive or violent, and I did not meet the requirements of any alcoholic/ addict check list: in my later years I did not drink spirits, never drank in the mornings, and I never missed a day’s work due to drink. Nevertheless, drink was central to my life – not a day went by without drinking for thirty five years. And slowly it was working its ways on my body.
The paramount need to give up drink
Problems of excessive alcohol loomed large. Liver transplant procedures will always require giving up alcohol – it is a requirement of both surgery, and subsequent care management. And it seems to me to be a very reasonable requirement. There are many pathways into cirrhosis, but if its direct cause can be linked with excess alcohol, it does not take much to see that this minimally has to be stopped.But for many this may not be easy. In my case, as it happens, and for reasons I now want to ponder a little, it was easy. My story can be told simply. On the night I was diagnosed in Santa Barbara. I was told that I would have to give up drink. On that very night, I said to myself in a loud and declaratory manner (with tones of Scarlet O’Hara in Gone with the Wind), ‘I will never, ever drink anything alcoholic ever, ever again, ever’. It was an absolute with no room for any kind of negotiation, ever. And from that vow on my own in the hospital bed to this day, I have never touched a drop of alcohol in any form. Curiously, I can only really say that it was not hard to do. I just stopped. It was total, absolute, unswerving. I gave myself no choices or room for manoeuvre around it. It was a one hundred per cent, non-negotiable new fact of my life. If I wanted to live, stopping alcohol in any of its forms was an absolute requirement. And so I lectured myself in a dramatic fashion. As far as I can recall, from that moment on I have had no further desire to touch even the smallest drink: indeed my most common response is one of nausea at the smell of alcohol. If I did experience the classically labelled ‘withdrawal symptoms’ then they must have been so bound up with my more general cirrhosis symptomology that I could not detect them.
This had to have been a critical turning point in my illness trajectory. For me it was sudden and absolute: but I am aware that for many this may become a long processual part of the illness career – giving up drink may take months, or years, and the pathways to my recovery may be cluttered with counselling, placebos, clinics, self help groups – and relapses. There is a widely held sickness model of alcoholism which has detailed all this. It truly does seem very difficult to many people. I have to say at this stage that it is a model of conduct that I have long been deeply suspicious about. The classic AA model might simply work because people come together in groups for strong support and engage in rituals of self declaration. Whether there is deep down a sickness really at work is quite another matter. I can see the power of labelling; and in a way this was the path that I followed. I labelled myself as a person who would never ever drink again. And I looked to friends for support in not doing this.
Hanging around with friends who might encourage me to drink would be to like hanging around death: with people who clearly were not really friends. So patterns of behaviour had to be changed, immediately and forthrightly. If I wanted to live, going routinely to bars and pubs had – for the time being anyway – to be stopped. One day I could return (and I have to a little extent) to drink my tonic waters and diet cokes. But for that key moment: avoid, avoid, avoid was my golden rule. I started to discover that there were vast aisles in supermarkets devoted to soft drinks: I really never noticed them before!
Many friends supported me in this. In fact, I have noticed over the past few years that many of my old drinking friends do not even seem to have a glass of wine in front of me. I encourage them now to drink – as it no longer remotely bothers me – but they seem to have slowed down or given up (some have commented both that I had been a warning to them, and that growing older brings this anyway!).
At the very heart of my giving up alcohol was my life partner Everard’s response. One day after my personal abstinence decision, he followed suit. He gave up drink in all its forms for life. Together we entered the cheerful world of soft drinks. This was one act of love, possibly more than any other, saved my life. No greater love exists than that a man who lays down the bottle for another man!
Some people have suggested that I must be an oddity in all this. It was a long struggle for people to give up the demon drink and it is usually very dramatic. Well, I have seen the films, read the books, know the social science. And I agree that this is what ‘alcohol’ is made to look like. It is a heartbreaking tragic story. A sad tale. A tale told by an alcoholic full of gloom and doom. But all I can say: this is not my story in any shape or form.
My drinking life
Ah ha, people say. You were not an alcoholic then. And I suppose that this must have been the case. Jokingly for many years I had called myself ‘a non diseased social drinker’. But drink a lot I certainly did, as any friend would tell you. Here are some facts of my drinking life:
- I drank every day of my life for nearly forty years. A day without drink was very rare.
- Some periods, especially when I was young, would be almost uncontrolled in my drinking quantity. I simply did not count how many pints or bottles I drank. I just went on drinking and speeded it up – the more I drank, the more I could drink.
- In the latter years, my standard daily intake would have been minimally two pints of lager and a half a bottle of red wine consumed between seven and eleven at night every day, with food. On weekends and at ‘events’, it could be a lot more. In the language of units, this would have been between 8-10 units a day at least, 60-70 a week.
- Drinking was thoroughly and routinely integrated into my life. It was always social – it involved centrally going to the pub most nights, for a selected time. It was a clear marker of the time when I was not working. It did not leave me with hangovers, and I never missed a day of work because of it. I was always there bright and breezy in the morning getting on with whatever had to be done. I had no conception of my drinking as a problem, except I knew that so much drinking might well catch up with my body one day! (I joked a bit about how when they opened up my brain upon my death they would find it pickled: ‘and this man was a professor’, they would ask?).
- I did not engage in solitary drinking at all, nor did I drink at odd hours (lunch times were taboo during the week; at weekends though, lunch time drinking could continue for the rest of the day!).
- I believe I was a good social drinker. Friends say that I became a bit silly and a bit argumentative, but violence and aggression never appeared.
I have checked up on definitions of alcoholism and abuse. On the definitions of the Royal College of Psychiatrists, I clearly drank far, far too much. Their list of ‘warning signs’ of addiction included:
- you do not feel right without a drink, or need a drink to start the day
- you get very shaky, sweaty, and anxious/tense a few hours after your last drink
- you can drink a lot without becoming drunk
- you need to drink more and more to get the same effect
- you try to stop, but find you can’t
- you carry on drinking even though you can see it is interfering with your work, family and relationships
- you get “memory blanks” where you can’t remember what happened for a period of hours or days
On this list, I could tick items 3, 4 and 7. I could drink without getting drunk; I certainly always need to drink more; and I know I had memory blanks. Later, on the web site of Alcoholics Anonymous, I did their test : I said ‘no’ to all their questions. But if I am being truthful, I can say that over the forty years of my drinking I did have a few blackouts – maybe five or so; and I did from time to time think I should cut down a bit – though never that seriously. Once I went to work and someone commented that I smelt of alcohol. And at weekends, we would start lunch parties that started at mid day and went on till three the following morning. A lot of alcohol was washed down with a lot of food.
I have tried to be as frank as I can about this; because most people think of heavy drinking as alcoholic. And heavy drinker I was. Likewise my medical problems of the cirrhosis were clearly linked to alcohol. But the fact remains that I stopped immediately – with no problems and no obvious (to me) side effects. It sounds like I am a medical oddity – but I believe that in my case, not going to a therapy group saved me from being an alcoholic! Some recognition needs to be made of really heavy social drinkers who enjoy their social drinking, but for whom it does not pose social or interpersonal problems. I was a happy drunk: but my body could not take it.
My Core Puzzle
My core puzzle since i have up my drinking – now seven and a half years ago- is this:
How can I explain the major fact of my illness and life that I was able to give up drink overnight – after a forty years engagement with alcohol as a ‘heavy drinker’ – with no apparent problems; and then continue from that night to this day (now seven and a half years) with no relapse, problems or recourse to any kind of official help or therapy or AA groupings of ideologies? How did giving up overnight happen with relative ease and against all the standard models of alcoholism and treatment?
Seven Key Factors
I speculate there were seven key factors that played their role in my transformation. I have no way of knowing at present whether they were necessary, sufficient or simply contingent factors in my own story but informal research beyond myself and wider reading suggests that although they do not all have to be present for this transformation to take place- they do nevertheless flag significant features. So here are those seven factors:
1. A momentous and fateful moment – in my case life the diagnosis that my illness was life threatening. Life will never be the same again, if indeed I even have one. I am not at all sure I would ever have stopped drinking if this had not happened. I needed a major epiphany, critical/fateful moments to make me change.
2. A dramatic self-labelling event – in which I announced to my self that ‘I will never ever drink again’. For me this was not a public event, but a private self story said with drama and ritual. I know about theories of self labelling and their power ,and I did this to myself. Whatever else I do, I will never ever drink again, ever!
3. The role of significant others – my partner, Everard, (my ‘co-dependent’) also gave up drinking- the night after I give up. And a circle of friends and support gradually emerges. It is important see drinking behaviour like all of social life being connected to a circle of friends and significant others. It is not an isolated personal thing.
4. The transformation of habits and routines – my illness necessitated a fundamental reworking of all my life habits. Illness shifts the everyday. Everything changes – including eating and drinking habits. So this is a good time for change! Illness becomes a major disruption of all routines – and creation of the possibilities of new ones. Changes in friendships and social activities (e.g. I stop going to pubs routinely!).
5. Awareness of key neutralizing stories – the stories we tell ourselves really matter. And here it is the stories we tell ourselves about our drinking. Stories have consequences. I knew the dangerous old stories as I had seen friends die telling them. Stories like like (a) ‘just one drink a day is OK, everything in moderation’; (b) ‘Doctors say a glass of red wine a day is OK ‘; (c) ‘we all have risks – and drink is just one of them’; (d) ‘giving up drink is too a high a place to pay.. live life to the full, man!’ (e) ‘Look at all the other who drink and are OK’ (f) and ‘well you’ve got a new liver now – why not?. But I was aware of many who had died telling these kinds of stories. I can link here to the writings of C.W. Millis, Matza, Lyman and Scott on the neutralization, normalization, accounts, vocabularies of motive, sad stories, and the pragmatics of story telling: careful the tale you tell – stories have consequences.
6. The rewards of giving up – I undoubtedly started to get a sense of a major achievement or reward by stopping the drink: most notably, I could see that I could save my life along by stopping drinking – with the help both doctors & donor.
7. Refining a worldview:illness gives you time to think: I developed a philosophy of the present in an existential world of human insignificance. Illness becomes an opportunity – my story talks of the confronting the whole life. The importance of making sense of the past but living in the present. I engaged in a life review at my putative death bed and decided there was n room for drink in any new life.
Background writings that have shaped by thinking include:
Alfred R. Lindesmith Opiate Addiction (1947) and reprinted in 2008 as Addiction & Opiates (Transaction)
Howard S Becker Outsiders: Studies in the Sociology of Deviance (1963) New York: Free Press (and in print ever since in a number of editions)
Norman K Denzin The Alcoholic Society: Addiction and the Recovery of the Self (2009) Transaction. This is a compilation of his earlier works. I must stress that I do find some of his assumptions truly peculiar – for a world leader in interactionist thinking & research, it is odd that he does not problematize the very term’ alcoholic’ and he bypasses his own very significant auto/ethnography. But his ‘six theses’ raises many key issues.
Erving Goffman Asylums (1961) New York: Doubleday – one of the most influential works in sociology of all time. His ‘moral career’ paper can be so widely and usefully applied.
See also: Robert Granfield & William Cloud Coming Clean: Overcoming Addiction without Treatment.(1999) New York University Press