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For Anyone Who Loves or Has Loved an ‘Alcoholic’

Is there a kinder alternative to the disease model?

Photo by thom masat on Unsplash

Educating myself about addiction, how alcohol works and the alcohol industry has been a big part of my recovery.

Arguably, it could be the addiction itself, manifesting in a new way; now I can’t drink booze, I read and write about it, endlessly.

To me, it’s a fascinating subject. Important too, since alcohol stops many people from living the way they want to, and colludes with others to ruin their lives entirely. The lessons I’ve learned along the way inspired me to start this blog.

Recently I read a brilliantly empathetic article on addiction by an academic called Lyndsey Moon. Been there, seen that, done it! An auto-ethnographic narrative account of alcohol use.

It starts:

“According to those who believe in an underlying genetic misfortune leading to ‘alcoholism’, my future is not looking too bright. My brother, paternal aunt and grandmother and maternal grandfather all died alcohol-related deaths.”

As someone whose paternal uncle died an alcohol-related death, and for whose family, alcohol is an extremely central component, the genetic element of addiction certainly played a part in my decision to quit.

Still struggling to control my drinking at 33, it occurred to me that this pattern could continue until I was 50.

Lyndsey goes onto describe further ways her family has been blighted by their alcohol use, before explaining what this mode of thinking might mean for her as an individual if she subscribed to it.

“To be frank, a disease model offers me an easy way out, a set script to frame my ‘alcoholism’ as a genetic malfunction that denies me agency for the future.”

Her options, then, would be total abstinence, any detour from which would mean a lapse or relapse, a path, she believes “more than likely to lead to more years of hopelessness and helplessness as [she fights her] ‘demons’.”

There is an alternative, Moon asserts, but it has lost footing in the UK’s alcohol services during the years of continually slashed funding they have faced under this government. It is:

“a social learning model that allows for a better understanding of social context in relation to alcohol use, and suggests that alcohol is a way of coping but has the potential to lead to physiological dependency.”

Moon is in favour of this model, since:

“Twenty years of working with people who had alcohol-related problem has told me that no one woke up one morning and decided to drink until they dropped. Patterns of drinking sit inside social systems that influence attitudes, approaches and understanding about the use and serious abuse of alcohol.”

Growing up in my family, in my part of the world, alcohol was for celebrating, commiserating and everything in between. I learned from the adults I adored that it was a charmed presence, bringing joy and relaxation, and I couldn’t wait to try it.

My uncle, who died of multiple organ failure, caused by alcoholism, simply, ‘drank too much’. The fault was with him. Alcohol had no part in his demise.

Moon refers to this perspective, which vilifies the ‘alcoholic’ too.

“Some argue that very little should be provided [regarding services and treatment] and that people should be charged for wasting the resources of the precious NHS.”

The problem with this way of thinking — besides the obvious breach of care for the suffering human — is that it perpetuates the myth that the individual holds power over alcohol. For me, I felt that so long as I didn’t drink in the morning, like my uncle, I was safe to wholeheartedly abuse alcohol. My education by osmosis entirely missed the part in which alcohol “has the potential to lead to physiological dependency.”

The adults who raised me didn’t mean to put me in danger. It is simply a fact that their: “patterns of drinking sit inside social systems that influence attitudes, approaches and understanding about the use and serious abuse of alcohol.”

The rest of the essay goes onto discuss some of Moon’s experiences with her family and alcohol, from her own perspective and from the perspective of a fictional therapist, which is an amalgamation of the various therapists she has seen over the years. She then follows these two stories with an auto-ethnographic account, which she describes as:

“a reflexive and reflective understanding that I deliberately put together from the social facts as I understand them today, in a way that removes it from a therapeutic narrative to a story that reveals the context of all those involved related to gender, sexuality, age, ethnicity, disability and so on.”

The three stories, in comparison with each other, create a powerful dynamic through which to debate their alternative perspectives. In each vignette, the memory of an unhealthy and harmful behaviour, undertaken by a family member, under the influence of alcohol is described.

A therapist then offers an intervention, often helpful, but sometimes seeming to misunderstand the context in which the incident happened, most notably, relating to a difference in values and sensibilities, as a result of class.

The third story, detailed and empathetic, and taking on the drinker’s perspective, reveals the unhelpful and harmful drinking behaviour witnessed as symptomatic of a long history of unaddressed trauma, induced by unbearable and tragic conditions of inequality related to class, gender and economics.

The effect is an astonishing exercise in humanising the all too often demonised, ‘alcoholic’.

“the vilification of those who use alcohol should be ended.”

Moon’s stories show the way in which alcohol can become a seemingly innocuous part of the tapestry of a family history. Invisible, to an extent, to those accustomed to it.

Therapy can help to pull out the ways in which this perhaps previously under-observed alcohol abuse played a part in wounding the patient who has sought counselling, while not exploring the broader auto-ethnographic structures that these events occured within.

Finally, the humanistic tale that Moon weaves, allows space for the social and historical contexts that each traumatic moment was co-produced by.

She ends the article with the suggestion that if we:

“change the approach to alcohol and allow ourselves to experience a kindness by creating new spaces where there is cooperation and integration, then it can alter the way we understand those who use alcohol and drugs in a more open and loving way.”

This approach would certainly have been kinder on my uncle. In hindsight, I suppose my family subscribed to the disease model (though this was never talked about.) The situation called for a total abstinence that my uncle was not capable of, and we gradually gave up on him. My memory of his predicament, if I gave it any thought (doing so was painful) was that he was killing himself slowly, by drinking.

For some reason, I didn’t question this further. Perhaps, simply, shamefully, it was easier to look away.

Since I got sober, I have come to deeply empathise with my uncle who died. I wish I could have known more about what he was going through as he was going through it. His ‘alcoholism’ and the way that we (as products of the larger society and historical moment) viewed it, meant that his isolation built in tandem with his drinking problem.

At the time, I had little sympathy for his plight, believing it to be his own choice. This now fills me with a remorse I don’t know what to do with. It is part of what drives my education into addiction.

My hope, like Moon’s, is that we can move towards a system that works better for those suffering with Alcohol Use Disorders.

Moon has a number of suggestions for how we can better serve those struggling with addiction. She would:

“advocate more services with a wider range of approaches and funded from the coffers of those who make alcohol so freely available. Far more preventative work needs to be carried out, especially around young children and teenagers, while the vilification of those who use alcohol should be ended.”

Moon’s essay argues that if we can better cooperate with and integrate the problematic drinkers in our society, we have a stronger chance of reaching them. Empathy and kindness are required if we are ever to reach those lost in alcohol’s soothing fog. She ends her article with a question and invitation for us to change our approach to alcohol and those who use it.

“I am willing to do this. Are you?”

Have you lost anyone to alcohol? Are you struggling to reach someone right now? Let me know your thoughts in the comments. We need to have this conversation.

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