6 1GT Monday August 3 2020 | the times

life

Scrubs

This British medic

wanted to get away

from it all. It took

six years, he tells

Damian Whitworth

Q

NN

QQQ

I live alone. I am

financially OK, but

alcohol has had a

strong hold on me for

decades. I have had

several episodes,

including the most dramatic one

when I turned yellow and was

itching. My stomach had to be

relieved of litres of yellow stuff. After

the last episode in the hospital —

which was a week of detox — the

staff were wonderful. I just don’t

understand why the first thing I did

was to go to a shop and buy booze.

Chris

A

NN

A

I am sorry to hear how

unwell you’ve been,

which, as you clearly

understand, is related

to your drinking and

from what you

describe sounds extremely serious for

your health. You managed a detox,

which is an achievement, and your

body clearly needed that rest from

alcohol. However, that you left rehab

and went straight out to buy alcohol

suggests that you need further

intensive treatment to enable you to

remain sober and not relapse.

Stopping harmful behaviour is the

first part of behavioural change, and

many would say it is the easiest part.

As many relapsed compulsive eaters,

smokers, drug users, gamblers and so

on would attest, stopping the addictive

behaviour can be achieved for short

periods (and is a success in itself), but

maintaining the cessation of the

behaviour is a whole other challenge

and one that requires intensive and

continuing support.

From what you describe it sounds

as if you have alcohol-related liver

disease, where the liver becomes

inflamed and swollen after years of

excessive drinking. This can cause

scarring of the liver, which is called

cirrhosis, complications of which are

portal hypertension and (less

commonly) alcoholic hepatitis,

which can lead to a build-up of

fluid, called ascites, in the abdomen

and around the intestines. This

may need to be drained and there is

the risk of infected fluid, which can

cause an increased risk of kidney

failure and death.

Another complication is peritonitis,

which is an infection of the inner

stomach lining where the pus-filled

swellings (abscesses) need to be

drained with a needle under local

anaesthetic; this is also life-

threatening. See: tinyurl.com/y36s5lxh.

Cirrhosis, the final stage of liver

disease, causes 5 per cent of all deaths

globally and is the third leading cause

of premature death in the UK, killing

40 people a day, an increase of 400

per cent since 1970. This will seem

shocking and I’m surprised you

haven’t been given sufficient support

to understand fully how seriously your

drinking has affected your health and

the significant risks you take every

time you drink. However, 90 per cent

of liver disease is preventable, and it

isn’t too late for you to tackle your

drinking, find treatment and support

to become sober (for life) and improve

your health and wellbeing.

Reversing alcohol use disorder

(AUD) takes more than willpower

bcause there are many factors beyond

habit that underpin the need to drink.

Outside the addictive qualities of

alcohol, where regular drinking is

needed to stop physical withdrawal,

there are also significant psychological

and emotional factors that take longer

to understand and address.

Alcohol, like other drugs, numbs

pain and narcotises us from the reality

of life and painful memories. Given

the unhelpful judgment that people

who struggle with alcohol often

receive, it is important to recognise

that AUD is a chronic brain disease

that affects the reward system, causing

serious harm in a number of ways,

including compulsive behaviour

around alcohol, increased alcohol

abuse, high-risk behaviours while

intoxicated and death.

For many, alcohol abuse becomes

an automatic part of lifestyles, so

evidence-based treatments, which

focus on detoxing from the drug and

changing behaviour via therapeutic

rehabilitation programmes, show good

outcomes. After detox you had a lapse

(the first time you walked into a shop

to buy alcohol after leaving hospital),

which I suspect turned quickly into a

full-blown relapse.

Relapse is a feature of many chronic

illnesses, but those with AUD can

struggle to look for continued support

because of the stigma associated with

their condition and the impact of guilt

and shame on self-esteem. Your

experience when you left the detox

is extremely common: it is estimated

that 40 to 60 per cent of people in

treatment for AUD will relapse. If you

had the other chronic illnesses you

would keep seeking professional

support to adjust lifestyle, provide

medication as necessary and enable

you to develop your own self-

management and relapse-

prevention skills. For those with

AUD, this also requires a

considered understanding and

processing of the underlying

psychological factors that

cause drinking: eg history,

present circumstances,

emotional states, mental-

health difficulties and

triggers to drinking.

If you have coped with life

by self-medicating with

alcohol, the challenge you

face is how to cope in

other, healthier ways. You

may be aware of this, but

feel helpless to know how

to do it, or you may be in

denial of the extent of

your drinking and the

serious health risks you

are taking every time you

drink. Given that alcohol

has been so present in

your daily life, living

without it might seem

impossible. Yet a well-

structured relapse-

prevention plan,

continuing therapeutic

My drinking has put me in hospital, but I

still can’t stop and I don’t understand why

support, networks of support from

those also in recovery and, if indicated,

medication to support your recovery

process can enable you to live a sober,

healthy and longer life.

I suggest that you talk to your GP

or alcohol dependency service about

going into an in-patient rehabilitation

service so that detox is accompanied

by the longer-term therapy you need

to prevent relapse. See also: the NHS

at tinyurl.com/yyzudkhd. If you can

self-fund, there are private facilities.

See: UK Rehab (tinyurl.com/

y48d2mjc) and rehab4addiction

(tinyurl.com/y2ffa9m7).

In rehabilitation you will receive

individual and group therapy to enable

you to understand your psychological

and emotional needs for alcohol and

look at other ways to meet those

needs. You will learn the signs of

relapse, understand your particular

triggers, practise new skills (such as

mindfulness, meditation, exercise and

regular peer support) and coping

mechanisms. A therapist will help you

to create a relapse-prevention plan

and daily schedules to support your

psychological wellbeing, including

sleep, diet, exercise and social contact

with those you trust to know your

challenges and to be there to support

you in a non-judgmental way.

While you look to arrange this I

advise you to join Alcoholics

Anonymous immediately and find

local groups that you can attend (in

person or online) every day, maybe

more than once a day. Here you will

find a non-judgmental community of

peer support and friendship, a 12-step

programme to work through and a

sponsor (a person also in recovery)

who will be available to contact when

you feel vulnerable or close to lapsing

(see alcoholics-anonymous.org.uk).

Also, Drinkline runs a free,

confidential helpline on 0300 123 1110.

For inspiration, read The Unexpected

Joy of Being Sober by Catherine

Gray and This Naked Mind

— Control Alcohol by

Annie Grace.

I hope your recent

hospital stay and the

removal of the pus in

your stomach lining has

underlined for you how

seriously you need to

address your alcohol

addiction. I hope your

lapse experience has

highlighted how much

you require intensive

in-patient support to

learn to live without

alcohol. This is all

possible and could

herald a brighter

future for you.

I believe that by

attending regular therapy,

making peer-support groups

part of your daily life, finding

new enjoyable activities that

don’t involve alcohol, getting

emotional support from friends,

and finding ways to manage stress

and avoiding triggers to drinking

you will be able to live a happy,

healthy and sober life. I wish you well.

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Ask Professor Tanya Byron

F

or the past few months

Stephen Fabes has

been on the front line

of the coronavirus

response, working in the

emergency department

of St Thomas’ Hospital in

London. Boris Johnson

may have missed a trick in not making

the doctor the poster boy for his new

health-through-cycling campaign.

His method involves cycling all day

every day for six years. After riding

more than 53,000 miles across Europe,

Africa, South and North America,

Australia and Asia and Europe (again),

you can expect to be a vision of

muscle and to have worn out 26 tyres,

16 chains and 12 sets of pedals.

At 29, when he set out on his world

trip, Fabes had a sense of time

“plunging away, a fear that I’d wake up

one morning with erectile dysfunction

or, worse, a passion for quilting and

jigsaws”, he writes in his new book

about his journey. “I needed more

of almost everything: more space,

more time, more risk.”

He says, as we talk by video call,

that there was no deep, psychological

reason for the expedition, although

there was “a slightly obsessive quality

to it”. Living frugally in London for

two years, he put aside enough to have

$10 a day for living on the road. After

three years the money ran out, and he

paid his way with travel journalism

and talks at international schools.

Everything he needed was crammed

into panniers on his touring bike, a

Santos Travelmaster. In the quest to

consume enough calories, he ditched

items of his medical kit and filled one

pannier with biscuits.

Fabes didn’t take a phone, but relied

on internet cafés to stay in contact

with his family and friends. He filled

and posted home 23 journals.

At first Fabes was concerned to find

that he was drawn to empty spaces on

the map, such as a roadless corner of

Ethiopia. Then he realised he had a

fascination with risk and sought out

moments of “sparkling fear”. He

writes: “I enjoyed living on the edge...

the sense of control drifting away.”

He cycled through lion country in

Botswana, dipped into war-torn

Afghanistan and cycled across a frozen

lake in Mongolia after opting to cross

the vast steppe in winter, where the

temperature dropped to minus 40C.

“I suppose it was quite an extreme

situation to put myself in,” he admits.

When he stayed in hostels they were

the grimmest, bed bug-ridden places,

or turned out to be brothels. Mostly he

camped. This could mean a Jordanian

clifftop, a Californian sea cave, or the

ramparts of a ruined Ottoman castle,

but also an Egyptian buffalo shed or

the verge of a Chinese highway that

turned out to be a makeshift latrine.

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