(Top photo: VICE)
If a doctor draws a breath slowly and audibly just after you've told them something, it's usually not a good sign.
I'm on the phone to Adam Winstock, a consultant psychiatrist, addiction medicine specialist and founder of the Global Drug Survey. Fifteen minutes ago I had a go on Drinks Meter, a free app Adam helped design, which was devised so people could anonymously analyse their alcohol intake and habits, and get advice on the damage it might be doing to their body and wallet. The app gives you a score out of 40, which it garners from assessing your drinking in a variety of ways, including using the World Health Organisation's Alcohol Use Disorders Identification Test. I got 18, which is quite bad, and was what piqued Adam's clear concern. For context: under eight is good. Over eight is a worry. Over 15 a big worry. Over 20 is suggestive of being dependent.
Of course, the reality is that I know I drink too much but had never really flagged it as potentially problematic. Plus, I like drinking! I'm good at it! It's fun! I don't booze at home much, but it's true that pretty much my entire social life revolves around drinking-friendly activities. So at the turn of the year I – for the first time ever – vowed to cut down before I had to give up. And I wanted it to be for good, not just another Dry-ish January stint. So I called up Adam – for the second time in a week – to find out how to do that.
VICE: When I first read my score, I basically thought, 'Fuck, that's not good.'
Dr Adam Winstock: I think your response is probably appropriate, but it's good that you're thinking like that.
I didn't consider my drinking that abnormal. Basically everyone I know is a big drinker.
There are certain universal fairytales that we tell ourselves. One is: "I just do what everyone else does; I'm just like my mates, and they're fine." You try to prove to yourself that you have elevated levels of invulnerability. If you think you're special, then of course you don't need to take precautions against yourself. Plus, naturally, you gravitate towards people with similar interests as you.
So should I, and other people who want to cut down, just avoid people we drink with?
No. You can't aways say no, and if you do your life will become miserable. Be honest. Say, "I'm just trying to ease off a bit, so I'm letting you know that over the next few months I'm going to be trying to drink less when we go out." Avoid the really big nights; skip the round of shots when they come out. Instead of going out at 8PM, go out at 9.30PM. Don't buy any drugs because that increases the effect of everything. It's common sense strategies. Friends should have your back. I actually think this can be very helpful in starting to shift the norms among your peer group.
Some research last year said that how pissed you feel isn't so much related to how much you absolutely drink, but more to do with how much other people around you are drinking. For example: if you go out and drink five pints, and you're with ten mates, but you drank the second least amount out of everyone – you would actually feel relatively sober. If, however, you went out and drank five pints but you drank more than everyone else you'd feel a bit pissed. So that says a group can have as much fun as they normally would if they nudge their drinking down a bit.
That's interesting. One problem, though, is that it's all very well saying "just drink less", but isn't it sometimes about more than willpower?
Well, people with alcohol dependence are the least treated group of people with psychiatric problems in the world. Around 10 to 15 percent of people with alcohol dependence are treated, but the majority of people with alcohol dependence are floating out there in the community. Something else we did a couple of years ago is look at whether or not people drinking at dependent levels thought they were doing anything unusual. In the UK, one in three people who were at risk of alcohol dependence thought their drinking was average or less than average. It comes back to the whole idea of thinking you're just like everyone else.
So am I alcohol dependent?
Well, I don't know you other than the conversations we've had, but at the level you are talking about, with my doctor's hat on, it might be harder [to cut down] than you think.
(Photo: Bruno Bayley)
It's strange having this conversation, because work is going better than ever.
You work in a high risk industry. The media, journalism, entertainment, hospitality and construction industries are all high risk. People are more likely to see this sort of behaviour as normal, so there might be a Friday night culture of going out and getting lashed. Or, if you were in advertising, you might have a job where you were expected to take clients on boozy lunches twice a week. These things are normalised. You think you're not doing anything out of the ordinary. But you are.
I mostly love my job, but what about people who are really stressed in theirs and rely on drinking at night to unwind?
I had one patient – a single professional in her early thirties – who was a successful businesswoman but would drink three big glasses of wine at home most week nights, then go out on a Friday, then have a boozy lunch on Sunday. She loved cooking, so most of her drinking was done in conjunction with food, and she was a pretty functioning human being, but was drinking four times the recommended amount a week.
We devised a strategy where she didn't give up entirely, but instead had four alcohol-free days. She went to gym classes two nights and did activities with another friend who didn't want to drink. She got down to two bottles a week, which is still a bit much but a huge improvement. It's actually only a few minor tweaks, but the effect on her life has been huge.
What about the effect of relationships on drinking habits? I feel like dating and Tinder-ing lends itself to drinking.
We haven't got any data, but I think you are probably right. If you're not out with your girl you're probably out with your mates. There's less nights getting cuddly on the sofa. But then, of course, there are people whose relationship is based around taking drugs and getting drunk. Or conversely, if you're in a terrible relationship, maybe that will lead you to drink.
Is it all a matter of happiness or peace with one's self?
Well, people who develop drinking problems are much more likely to have underlying mental health conditions. If you're in an unhappy relationship or you're drinking too much at work, you can justify drinking too much as a way of dealing with that. But there's also the truth that as you drink more there's the chance of you developing depression, anxiety and impaired relationships. But then I see a lot of patients who say they're drinking because they're depressed, but give up for a few weeks and improve immeasurably because they're brighter, they sleep better, they look better, they lose weight. But I also think Drinks Meter has huge value. It makes you sit back, take notice, maybe for the first time, like you have. Also: it's not asking you to quit. It knows you like drinking and it still wants you to enjoy drinking, but just challenges those fairytales you tell yourself.
Agreed. Cheers Adam!