Great British Drinking Epidemic

British Drinking Problem

The Panorama programme “Dying for a Drink” reminds us of the dreadful increase in liver damaged patients over the last 10 years. The programme showed us graphic images of the horrors of disease due to severe jaundice and liver failure. The escalating harm is not only a product of today’s negative drinking culture but also yesterday’s.

The producers didn’t make this very clear, but there has been a doubling of consumption over the past 40 years. For every pint our grandparents drank – we have two! So given the fact that the greatest increase in alcohol consumption has been in the last 20 years – the problem of alcoholic liver disease is only going to increase as time catches up with our country’s drinking epidemic.

Although the programme makers mentioned a slight decrease in alcohol consumption over the last couple of years, this is likely to be explained by the increase of bootlegged booze rather than any cultural shift. The real news for the next generation is that throughout the last decade, the number of drunk children admitted to hospital has risen by 40%. These are the liver damaged patients of tomorrow.

Alcohol abuse in Scotland

And what about Scotland? The programme  focused on the problems in England, but Scotland has already had its diagnosis. Peter McCann, Chairman of Castle Craig – who has been studying and comparing the Scottish and English addiction landscapes for the past 25 years spoke to me about the figures in Scotland that show a trebling in chronic liver disease over the past 15 years. In fact as a rule of thumb, Peter McCann believes that when it comes to alcohol – whatever problems England are having – Scotland’s problem are consistently 60% worse.

It is clear that change is going to have to be dramatic. Peter McCann has long offered such a solution – slap another £10 tax on a bottle of whisky. Yet, remarkably, Gordon Brown in all his years as chancellor and Prime Minister, suppressed even  tax increases on alcohol in line with inflation, meaning that in real terms alcohol became cheaper. The programme also showed how the new government is falling into the lap of the drinks industry, the same way that all other governments seem to do.

Politics and the drinks industry

Unsurprisingly the drinks industry is employing the same pernicious argument of the past 30 years  – blaming “minority groups” who are spoiling the fun for the rest of us. Yet in Scotland, enough recorded alcohol is sold each year to allow every single adult over 16 to exceed their recommended weekly limits. Despite this the drinks lobby insists that voluntary measures from retailers are what is required – and quite shockingly the government swallows this.

It is disheartening that Alcohol Concern and other medical voices and charity groups are being ignored. They must be sick of being wheeled in to give the same advice to ministers before being routinely ignored. They are perfectly correct to repeat the mantra of “price, marketing and availability”. These are the only variables that can be altered by the government to bring alcohol sales and consumption under control. But we also need a shift in public tolerance to drunkenness. It is still an offence to be drunk in a public place – but it’s a tolerated offence – by publicans, the police and by the public as a whole who see drunkenness as more comic than tragic.

Tough message for patients

Away from the politics and back to the hospital wards, there is a tougher line that medics could be taking. We heard one doctor in the programme tell his patient that “if you keep going like this then eventually you could kill yourself.” From another patient we heard that his doctor had told him, “you are dying.” It is clear which is the stronger message – and the programme demonstrated a fact that that many working in the field know – which is that those very hard words such as, “You will be dead within a year,” or “you are killing yourself,” – are often the clincher – the trigger words that people need to hear before really changing their habits.

So, in order to get sober – there has to be a radical message to patients. But it also follows that if patients are to stay sober then there has to be a radical change in their lifestyles. And so it was sad to see one of the patients , following his liver transplant , was back in the pub with his friends. He was drinking a pint of orange juice – but how long will it be before he’s drinking beer again? Experience suggests this is inevitable. Elsewhere in the programme we heard nothing about any effective support services for the liver damaged patients being discharged from hospital.

Alcoholic liver disease

This is another untold story. Liver specialists, gastroenterologists and others in the medical field need to appreciate how the disease of addiction links in with alcoholic liver disease. A lot of their patients will be alcoholics and any form of treatment that doesn’t begin with addressing their underlying addiction will most likely be futile. The human body – and most especially the liver – has a remarkable ability to recover provided the patient remains abstinent and forgoes all alcohol, and this is where addiction treatment centres such as Castle Craig have a role to play.

A Distorted View of Rehab and Addiction Treatment

Amy Winehouse died 23rd july 2011What can we learn from the tragic death of Amy Winehouse? Perhaps the most striking lesson is that the public’s perception of rehab is formed almost entirely by the media ““ through celebrity scandal and, in this case, death.

Detox is not the same as rehab

Amy’s short stints in the Priory, or the disgraced (and now closed) Causeway clinic, can only have allowed enough time for a detox. A detox is the initial ““ and sometimes very tough ““ stage of rehabilitation when a patient gets the poisonous drugs out of his system.

In fact, detox is just the first step of a long process of physical and psychological rehabilitation. During rehab the person needs to look honestly at their alcohol and drug use and understand the seriousness of their condition. Every alcoholic or addict is, to some degree, in denial. In many cases the root causes of addiction, such as trauma, must be addressed if there is to be any chance of recovery.

So detox isn’t rehab, even though the media often present it as such.

Rehab is not about exclusivity

Another popular misconception about rehab is that it is something luxurious. The media often paints a picture of an overworked celebrity escaping into an exotic retreat where they can swim, relax, do some gentle therapy and catch up with their sleep. But if you speak to people who have gone through residential rehab they will tell you that it’s one of the toughest experiences of their lives, as they have to face their own demons.

Full and proper rehabilitation happens when you start looking into your self, when your therapist and group enable you to deal with the deep psychological reasons that drove you to drink or drugs in the first place. It’s not easy, comfortable or luxurious but it can be the turning point for the addict, the point when things start going right.

Residential rehab is best

The other fallacy about rehab is that it can be managed at home on an “outpatient” basis (Amy Winehouse was receiving outpatient care at the time of her death). This approach works for some but is dangerous for hard core addicts whose lives are totally controlled by drugs or alcohol.

Experience shows that rehab only works when people are within a closed community, where rules apply and where the triggers and temptations of “usual routines” are not visible. It is only within a structured “residential” setting that hardened addicts have any chance of full recovery.

Addiction is a disease

Behind the sad story of Amy Winehouse’s death is a greater tragedy – that of thousands of other drug and alcohol addicts who are caught in the same trap. They are dying every day. The health services need to face up to the terrible impact the disease of addiction has.

Old People Told to Cut Drinking

Furore over drinking rights for the elderly

The fuss started after the Royal College of Psychiatrists issued a report called Our Invisible Addicts. The report stated that increasing numbers of elderly people are becoming addicted ““ to alcohol and prescribed drugs in particular ““ and GPs should screen and advise patients about addiction issues. But many newspaper commentators treated the advice with scorn.

Writing in the Daily Telegraph, Oliver Pritchett wrote “if we are all to be screened for substance abuse, why not create a branch of the drugs squad specifically to deal with the over-65s? There could be dawn raids, with officers snatching extra-strong mints from elderly ladies, rummaging in the knitting wool for illegal substances, or sniffing the hot water bottle for hidden cherry brandy.”

Alexander Chancellor wrote in The Daily Mail that it is “intolerable for the Government to boss us around in this way. If you can’t drink what you want at the age of 65, what’s the point in staying alive? You have worked hard all your life “” and now you are free to relax and have fun. One way to do this is to meet friends for a drink in the pub “¦ Old age brings trials enough without the added humiliation of being told by the Government to drink much less than what is considered perfectly all right for a teenager.”

An 84 year old patient at Castle Craig Hospital

But this is a serious issue and it is true to say that elderly people are more at risk from alcohol than younger adults.  It is also true to say that this problem is not really recognized by society or the NHS, in effect it is ignored.  We are acutely aware of the problem at Castle Craig and we welcome this report.  We are also delighted to have recently admitted a patient who is 84 years old ““ opening up the opportunity for a new lease of life for this individual. Too many people in this country end their days in nursing homes with early cognitive decline that has been brought on by excessive drinking.

An unpalatable truth

“As people get older they should be careful” said Peter McCann, Chairman of Castle Craig Hospital, “as you age you start to lose grey matter in the brain and drinking alcohol speeds up this process. The sad truth is that excessive drinking in elderly people results in premature dementia. It’s unpopular and unpalatable to say that alcohol is a real threat to the health of the elderly, but it’s true.  People tend to point to the exceptions ““ the Queen Mother, perhaps, or their own relatives who drank frequently and lived to 100 ““ but people talk about such cases just because they are the exceptions.”

Prime Minister David Cameron Supports Abstinence

David Cameron and Julian Huppert debate in parliament

29th June 2011: Prime Minister David Cameron answered a question from Dr Julian Huppert, Liberal Democrat MP for Cambridge, on the UK’s failed drugs policy. David Cameron stated “we have spent too much time on heroin replacement and methadone rather than on trying to get people clean and clear up all the things in their lives that perhaps cause them to take drugs in the first place.”

Peter McCann, Chairman at Castle Craig commented: “The Prime Minister’s statement in Hansard is in line with sentiments and policy of the Scottish Government. Unfortunately, like in England, the policy is simply not being applied at grassroots level.”

29th June 2011, recorded in Hansard 954.

View the exchange on BBC’s Democracy Live (30:38)

Dr Julian Huppert (Cambridge) (LD): Does the Prime Minister believe that drugs policy has been failing for decades as he said in 2005 and does he agree that the Government should initiate a discussion of alternative ways, including the possibility of legalisation and regulation, to tackle the global drugs dilemma, as he voted for in 2002?

The Prime Minister: I do not believe that we should legalise any drugs that are currently criminal, but I do believe that drugs policy has been a failure over recent years. There has been insufficient attention to the two key areas of education”“”“warning people of the dangers of drugs”“”“and treatment. One of the ways to collapse the drugs market is to have a more effective treatment system. In this country particularly, we have spent too much time on heroin replacement and methadone rather than on trying to get people clean and clear up all the things in their lives that perhaps cause them to take drugs in the first place.

A Walk In The Park Could Save Millions

A leading mental health charity says that going for a walk could save the NHS millions of pounds a year. According to MIND, British doctors wrote out 31 million prescriptions for anti-depressant drugs in 2006 ““ and the charity believes that doctors should prescribe more ecotherapy (in other words, regular walks in a green park) as it is a highly effective treatment for mental health patients.

Low Cost Treatment with No Negative Side Effects

In a report called Go Green to Beat the Blues, the leading mental health charity MIND wrote Unlike drugs, ecotherapy is low-cost, has no negative side effects and is available on most people’s doorsteps.”

The study reported that “71% of those surveyed reported decreased levels of depression after a green walk”

“Castle Craig is delighted to see that there is a growing emphasis on green therapy” saidour Chairman Peter McCann, “at Castle Craig we have the considerable advantage of woodland and plenty of space for green walks. Many of our patients take full advantage of this.” 

Exercise Beats Depression

Studies have already been conducted into the therapeutic value of exercise and ecotherapy. For example this report from Harvard Medical School asks the question “How does exercise relieve depression?”

An extract from the report gives some of the answer: “For many years, experts have known that exercise enhances the action of endorphins, chemicals that circulate throughout the body. Endorphins improve natural immunity and reduce the perception of pain. They may also serve to improve mood.

Ecotherapy at Castle Craig

We are currently studying the effects of ecotherapy and would like to hear from former patients and anyone else who is in recovery. We are keen to find out if you participated in walks, jogging or other outdoor activities, and if this helped your recovery.

If you can help us with this research please comment below or write to us at (mark it for the attention of Dominic).

Art Therapy | Art & Painting for Alcohol & Drug Addiction

In the 1940s psychiatrists and psychoanalysts began to recognise the therapeutic value of art as both a creative outlet and a significantly useful means of conveying states of mind. This led to artists being invited directly to work with patients in hospitals and other clinical establishments – Art Therapy was born.

Art and Addiction Treatment

Castle Craig introduced a dedicated art therapy facility surrounded by beautiful countryside in January 2009 and invited me as a professional artist to design and implement an ongoing six-week programme for resident patients at the hospital.

The outcome of this Art Therapy Programme has been extremely successful and far-reaching with many patients continuing to use art as a creative outlet after leaving treatment.

From week one, patients are introduced to myriad ways of working with the materials provided. There is also an educational element to the course, with an introduction to artists dating from the 1900’s to the present day. Tutorage covers demonstration techniques and a wide variety of mark making suggestions, ranging from free, expressive, bold mark-making to more methodical and structured approaches.

In effect a creative recipe book is offered, giving infinite possibilities, and although the outline task suggested each week is the same for each patient, the outcomes are as individual as the patients and their circumstances and moods.

Increased Self-Esteem through Art Therapy

The carefully thought-out exercises offer patients a new means of expression, unbound by language in which the unconscious is brought forward, enabling new insights as well as a sense of relaxation and achievement.

Patients involved in these creative activities often report increased self-esteem and self-awareness. My own methodologies for facilitating creative expression are clearly evident in these paintings produced by patients with little or no painting experience.

Insights into the Mind through Art Therapy

As a practicing artist, I am constantly looking for new ways of working and try to encourage a free-thinking and liberated approach for attendees to the art group. I am constantly amazed by the work that patients produce during Art Therapy and the relationship between the outcome and the person’s state of mind. Henri Matisse once remarked that ‘drawing and painting is the direct and purest translation of my emotion’. A range of art books, including Matisse of course, are available at the group.

Our Art Therapy Online Exhibition

Our Art Therapy Programme is constantly moving forward and we are currently implementing an ongoing rota exhibition of patients’ work in and around the hospital. You can read more about the programme here. You can also see further works from our patients on the Art Group’s Facebook page.