Month: October 2014

They are the problem drinkers missed by government efforts to curb alcohol misuse – women, often middle-class and professional, who share a bottle of wine with a partner over dinner each night, putting their health at risk.

Unnoticed because they do not cause a social nuisance or public disorder, women who quietly drink three or more glasses of wine, or equivalent, a day increase their risk of breast cancer by up to half, research shows. Alcohol is known to increase the risk of several cancers, in both sexes, including bowel cancer. But breast tissue is thought to be particularly sensitive to its carcinogenic effects according to a review of research by Helmut Seiz, of the University of Heidelberg, Germany, and colleagues. Women who consume one alcoholic drink a day have an increased risk of breast cancer of 4 per cent, in line with previous findings, based on an analysis of 113 studies involving 77,000 light drinkers. Among heavy drinkers, defined as three or more drinks a day, the risk is increased to 40 to 50 per cent.

Overall, alcohol drinking accounts for one in 20 cases of cancer in northern Europe and one in 10 in countries such as Italy and France, where drinking is more widespread among women. Breast cancer has soared in recent decades with new cases doubling since the early 1970s, partly driven by the rise in alcohol consumption. It is now the commonest cancer, with almost 49,000 cases and 12,000 deaths a year, despite affecting only one sex. However, it is less common than heart disease and strokes, which together kill 200,000 people a year – and alcohol is known to protect against these diseases.

In women, as little as one drink a week cuts the risk of heart attack and stroke by 36 per cent according to a 2007 European study. The upshot is that light drinking is overall protective – but heavier drinking is associated with rapidly increasing risks. Experts say weighing up these risks is a matter of personal choice. Although heart disease is more common, cancer is more feared. Women with a family history of heart disease may feel differently from those with a history of cancer. Three times more alcohol is now consumed per head as in the 1950s and it is estimated to cause 30,000 to 40,000 deaths a year. In addition to bowel cancer and breast cancer, there is also evidence that alcohol increases the risk of cancers of the liver, oesophagus, mouth, pharynx and larynx. In total, scientists estimate alcohol causes 20,000 cases of cancer a year.

The authors of the latest study, published in Alcohol and Alcoholism, suggest the effect of alcohol on the breast may be hormonal by raising levels of oestrogen. But they show no acknowledgment of the fact that many people enjoy a drink which plays an important part in their social lives.

One glass Increases risk of breast cancer by 4 to 5 per cent.

Two glasses Increase the risk by 25 to 35 per cent.

Three glasses Increase the risk by 40 to 50 per cent.

This behaviour I see on a daily basis. So much money is being put into criminal led alcohol abuse, repeat offenders, the disadvantaged, street drinkers, which is awesome, but my women who are just the average ladies walking through the supermarket, hoping that none of the cashiers notice that this the fourth trip in a week for supplies of wine and vodka, and it’s still only Thursday.  These women are slipping through the net, for they have so much to lose with attitudes to alcoholism, status, reputation, respect and worst case scenario for all, their children. I receive no funding yet have a full diary. It is not black and white in this industry. At one end of the scale you have the wealthy who can easily afford private detox, in my area here in Harrogate, currently costing £3,500 per week,  if you are disadvantaged have no source of income can be treated freely via various charities, or my clients, who are piggy in the middle. They can’t afford financially to take 8 weeks out of their lives for residential rehab and all that it entails, nor can they take advantage of the free services. They are certainly not a minority group and deserve far more in terms of understanding and empathy. My clients are Britain’s hidden alcoholics. My work is marginalized for I am not in this business for awards, ticking boxes or squaring circles and attending strategy/system meetings. I cannot afford the time for pontificating for hours on end about the latest guidelines. The most successful recovery programmes are led by people just like me, who are actually in touch with the needs of clients. Our recovery rates have risen to over 85% after six months. Compared to the highest of 30% within the System, I think the figures speak for themselves. The time surely must come for client led agencies, and not by those who really have no clue at all.

I have been hearing across the social media networks, that we non-drinkers are somehow the New Puritans. That title suggests to me that we have a rather holier than thou attitude. As if we are in some way superior and a bit boring.  Religious nuts, who are either health freaks or incredibly dull.

It’s true that we don’t get roaring drunk anymore or even giddy with the assistance of alcohol. We are giddy enough without it.  It’s also true that we are sharp, savvy and on time, with a straight forward perspective of how life is. We don’t pull sickies nor do we have lost days or weekends. There is no blackout, no embarrassing and shameful covering up to deal with, there is no waking up in strange places with a mouth that feels like the inside of Ghandi’s flip flop.  Women who get their control and lives back have a bucket list which is longer than most because we have a lot of catching up to do and are simply excited.

Do any of us become puritanical preachers? We are really happy with our new lifestyle of clarity but not at all keen to thrust it on anyone else unless they really want to follow suit, just with gentleness and empathy. If you are drinking alcohol happily that’s great too.  All for ‘responsible drinking’, although that phrase that makes us smile (a bit puritanically), in a head to one side sort of way, because we are still not sure how responsible drinking any kind of anaesthetic really can be of benefit in the long run. It certainly didn’t work for most of us.

Pub culture from the olden days seems so romantic and jolly, and if pubs were still like that,  it would be wonderful for the community, especially in rural areas.  No wide screen TV’s showing football, no blaring music, just adult conversation, with a smattering of gossip, no text speak, no twitter.

By and large we really don’t judge anyone, for anything. So why is it, when women like us, who have at last got their lives under control, looking well, feeling well, fitter and more wealthy, some incredibly glamorous, witty and great fun, are judged as boring puritans by drinkers? We faced stigma as drunks, and still face it sober.

There is so much defensiveness and denial with booze and this really comes through on comments following an online newspaper articles about heavy drinkers. They pile in with the usual tirades about it’s our life; we’ll live it our way. Well good. All I hope for is that it never descends into the chaos that ours did.

If sobriety is becoming more fashionable, on trend, then we are delighted. If more women are seen as svelte, savvy Goddesses of a certain age, and as an aside, they don’t happen to drink, then even better. Any woman in control of her life is a force to be reckoned with, and perhaps that might just be frightening some people.

In our less than boring circles, we are very grateful to be a part of the new wave, it’s golden, and you know what, it’s catching on. This is a personal revelation and a revolution.

I started working with Sarah and the Sanctuary at a critical time.  I’d started to change from being a functional heavy drinker, and once the transition commenced to being out of control, I was heading towards and in many ways already in a serious amount of chaos.  The in control career girl façade was starting to slip, the shame of which made me hide more behind the bottle.

I contacted Sarah at a very low ebb, and quickly found a place that was empathetic yet straight talking.  The whole relationship is built on honesty, which was made clear very early on.  The sense of being accountable and responsible started to give a sense of direction and hope.  I started to understand that I was gaining rather than losing, and choosing a better life.

I’d be the first to admit that I haven’t been the quickest to catch on, with some bumps along the way.  However, I feel significantly better and in control of my life for the first time in a long time.  Gradually, the pieces of a positive life that Sarah encouraged me with in tough times have started to emerge.

I can’t praise Sarah enough for being there with patience, wisdom, encouragement and humour.

There is something about touching a designer outfit, examining it let alone wearing it, that gives a feeling of deep joy and appreciation. Catwalk has always been a little beyond me, but the translation of it into wearable beautiful garments is an art and given a bottomless pit of £££s it would be glorious to slip into those private and sumptuous designer houses three or four times a year to do some investment buying. Most especially in middle age when physical form can possibly do with a little help from a great cut of a jacket, or quality jeans. Not forgetting those forever purchases, fabulous bags or shoes.

The key word has to be investment. You know it will last, that it looks good, and it will suit you perfectly for many moons to come.

Then the flip side of the fashion coin. Primamarni mania. Cheap, quick fix, 500 hundred paces, a dark night and less than 20/20 vision you could probably see some resemblance to the original designer idea. Rather than just have one good blouse, you can have a couple of dozen, they look fine once or twice, then the buttons fall off or the seams split. Jumpers are never warm like natural wool, and bobble after the most precise setting on the washing machine. So it gives us the opportunity to have lots of up to date gear that we just dump and replace. Size 10’s can be 14’s and 14’s can be 10’s, pink looks washed out, and jeggings bag. All safely excused because they were cheap.

Taking the decision to become a non drinker is comparable to the above. Do you just try the quick fix, read a couple of books, listen to some podcasts, and become addicted to Dr Google and other stories that litter the internet, or do you make an investment for wellness, liberation and long term guilt free living?

High Street shopping takes the same view as drip feed drinking. The odd fiver or tenner there is unremarkable, slips out of the wallet unnoticed, and justifiable in terms of reward pathways that have been entrenched over decades sometimes of easy fixes and quick buzzes. When the fourth decade looms, does it really make any sense at all to keep up with the short cuts or temporary highs that seem to have taken on a very sinister twist that is not remembering them? A bit like a cropped jacket bought for £20 and now sits lamely at the bottom of a wardrobe, never being able to be revived for the next season let alone remembered as a good buy or even where it came from. Cutting labels out of high street brands is always a good idea, their scratch and are meaningless.

There are also the cheats that is buying designer buttons perhaps to sew onto a suit, just so it pretends to be something it never can be.

A piece of work we like clients to do when they are over the initial fear of becoming a non drinker or controlled drinker, is an honest appraisal of all those fivers and tenners spent over the years of heavy drinking, and seeing more or less how much those cheap little numbers in bottle form really cost. The average, including some wild online shopping after a glass or five, taxis and other associated costs, financial that is, not emotional, comes to over 5k per annum. Over only ten years we are looking at a decent sum, a deposit, wonderful holidays, deeply meaningful quality outfits or just a nest egg. None of the money was spent wisely or with care, just a sod it button moment, of I want it and I want it now.

Spending on becoming well has to be seen as a good investment. If I had had access to appropriate care back in the day, potentially, it could have saved me a fortune, quite literally. I would have moved heaven and earth to find it, as would my beloved.

So take a view, do you really expect high street to give the same reward as designer when you are not at an age of being able to get away with cheap and cheerful anymore? Do you keep going in the hope it might work, one day? If you tweak and twirl, diet or change your hair? It doesn’t and if it did, this epic problem would never have surfaced, and keep growing year on year. We are unique, and deserve to value ourselves in a much more considered way.

Mr Gray, a liver specialist pulls no punches. ‘Until about 10 years ago, my patients with alcoholic liver disease were mostly middle-aged men. But women now make up about half of my caseload.

‘It used to be that patients were in their forties and fifties when I first saw them. But I’m seeing sizeable and rising numbers of women in their twenties. Some have irreversible liver damage.’

One 26-year-old female patient died of liver cirrhosis. ‘And we’ve got a 29-year-old on the ward now who has been in hospital through drink for several weeks,’ says Gray. ‘She’s been drinking heavily for 10 years and her liver has packed up. She has a partner and a two-year-old child but she says, “I prefer wine to tea”, even though she knows the harm it’s causing her.’ The woman’s future looks gloomy. ‘She will probably get over this illness. But if she continues to drink after getting out, she will die. I’ve told her that.’

Many of his patients have been drinking excessively for years. ‘These are the steady drinkers. Typically they have a half-bottle of wine with their meal every night, or at lunchtime, and another drink at dinner. They are never drunk but they drink in a sustained manner. They don’t realise they’ve got a problem because they think alcoholics are down-and-outs, or pub regulars. They have wine with their meal and because of that they somehow think that takes away the harm, or they say, “but I don’t drink spirits”. These misconceptions are very common. I suspect there are thousands and thousands of women who are drinking at risky levels, all over the country.

‘Any liver specialist would tell the same story,’ adds Gray grimly. ‘Alcohol is a totally classless disease. It may be more discreet among the upper and middle classes, because they do a lot of it at home. But it causes harm across all social classes.’

Stephanie was an 18-year-old fresher at university when she realised she enjoyed heavy-drinking sessions: champagne mostly, often around 10 glasses a night. Friday, Saturday and Sunday evenings would usually follow the same pattern: alcohol-fuelled revelry at a party or nightclub, total intoxication, home at 2am – then a bad hangover. Unlike most young people, though, Stephanie kept on drinking like that for much of the next 17 years, despite her growing respectability as a senior teacher. She recalls with horror bumping into some 18-year-old pupils she taught when she was out with a group of girlfriends at the weekend. ‘They saw me early in the evening, thank God, not later on, when I would have been hopelessly drunk,’ she says.

Between the ages of 18 and 35, Stephanie’s drinking habits depended on whether she had a boyfriend. When she was in a relationship, she drank normal amounts. But when single, weekend excess was routine. ‘I needed alcohol to relax and meet guys. I did some pretty risky things, and had some wild nights and a few one-night stands. We all did,’ Stephanie recalls. ‘Looking back, I know I was doing it because I was desperate to meet someone significant, especially when I reached my early thirties and wanted to settle down.’

Her years of regular binge drinking came at a price, though. ‘The next day, I wouldn’t get out of bed until 11 o’clock and I would vomit, cry for a long time and feel, not suicidal, but depressed, frustrated and angry with myself for having gone out and got very drunk, yet again,’ says Stephanie, who is now 42 and drinks only moderately.

In a way, Stephanie is lucky. The worst side-effect from her drinking was an ultimately successful battle with depression. Many suffer much more direct damage. Eight women a day die from chronic liver damage, often younger than men with the same condition, because they are physically less robust. As alcohol consumption has risen, so the gap between the amounts consumed by women and men has been closing.

While much media attention has been devoted to young ‘ladettes’ out binge-drinking, the real medical harm is being felt among middle-aged women. The number of women aged 35 to 54 dying as a result of alcohol-related damage more than doubled from 7.2 per hundred thousand in 1991, to 14.8 per hundred thousand in 2006. The numbers are rising at an alarming rate.

London property lawyer Leonora Kawecki died in 2003, aged 39, soon after being diagnosed with cirrhosis of the liver. ‘Like many other young professional women, Leonora had a busy social life and alcohol was very much a part of that,’ says her sister Julia. Treatment in a clinic could not save Leonora and she eventually died of internal bleeding – a complication of end-stage liver failure. Health experts warn that many other women like Leonora, who regularly consume well over the recommended ‘safe-drinking’ limits, and who often believe they do not have an alcohol problem, will be receiving a wake-up call before too long.

So why are more women drinking more? ‘Men and women have historically drunk in different ways, but that’s changing, partly because of the equality issue,’ believes Gray. ‘Some women think, “men can do it, so we can do it.” There’s also more disposable income and when women do go out, there doesn’t seem to be any inhibition.’

Recent years have seen profound changes in women’s drinking habits. Siobhan Freegard, the co-founder of a website for mothers called Netmums.com, was surprised by quite how many of her members were consuming well over the recommended safe-drinking limits when Netmums polled 4,000 of them last year. Despite having children, domestic responsibilities, and often jobs too, many mothers drank well over the 14-unit limit. ‘I’m a half-a-bottle-a-day girl and I know that takes me well over the recommended level. But because it seems a civilised quantity and it’s at home, it doesn’t seem so bad,’ says one mother-of-three.

‘Quite a few mums have this concept of “wine time”, that they’re entitled to have a reward drink in the evening. To some “wine time” is eight o’clock. But quite a lot of mums get their children to bed at seven and drink, and some even think, ‘school pick-up – only two hours to wine time”,’ says Freegard.

Professor Ian Gilmore, a liver specialist at the Royal Liverpool Hospital and the president of the Royal College of Physicians, points out that female heavy drinkers are being even more reckless than their male peers. ‘Women are more susceptible to the effects of alcohol. They are smaller, they metabolise drink less well and it affects their vital organs more.’

‘I’m not a sociologist,’ says Gilmore. ‘But the rise in women’s drinking is likely to be related to the fact that women are competing on more equal terms in the workplace and that many are holding down jobs, while bringing up a family. I suspect a lot of the increase is women who have this dual role using alcohol to unwind, to reduce the stress they’re normally under. But it is frighteningly easy,’ says Gilmore, ‘for a woman to go from having a glass or two at night, to drinking larger amounts and developing problems.”

Sarah Turner is a leading expert on women and alcohol. ‘Women are drinking more now than they have done for more than a century. There’s no doubt that the way young women are drinking now will mean that our health services will be burdened by middle-aged women with alcohol problems in years to come. It’s happening already, but it will get worse,’ warns Sarah.

In her view, the usual explanations for more women drinking more heavily – such as alcohol becoming both cheaper and more readily available – do not tell the full story of what are hugely significant changes in behaviour and social attitudes. ‘Historically, women have been the informal social controllers of men’s drinking, but women now, especially young women, are no longer playing that role and are becoming as outrageous as young men in terms of their drunken behaviour.’

Sarah relates a conversation she had last year with a taxi driver in York. She asked him which sorts of drunk passengers were most troublesome. ‘He told me that the scariest people he gets in his taxi are groups of drunk, middle-aged women. A group of drunk, young men may wind the window down and shout obscenities but usually stop if he says, “lads, I’ve had a long night, can you give me a break?” But he couldn’t calm down, or reason with, the groups of thirty- and forty-something women because they were more overtly aggressive,’ says Turner.

She pinpoints the rise in all-female groups, all out drinking heavily, as significant. ‘These are women who are staying single longer, are divorced, or whose kids have already left home. They have fewer responsibilities and more disposable income,’ says Sarah. ‘The fact that it’s all women gives a sense of empowerment and control, but with an aggressive edge to it. When they end up in the company of men, they start challenging the men, usually sexually, and by doing so are putting themselves at risk of sexual violence. Young women did not use to behave like that.’

Sarah is torn. She believes women’s emancipation over recent decades is hugely welcome. ‘And I’m not saying that women don’t have the right to behave as outrageously as men when they have been drinking.’ But she is troubled by the harm that some women who drink heavily are doing to themselves and the risks that they are running.

‘Some people say that women are paying the price of having their freedom, but I don’t agree with that,’ she says. ‘If you’re going to give people fewer responsibilities and more money, you have no guarantee that they will behave wisely – and that’s a major cause for concern.’

Now coupled with the economic downturn, there becomes even more excuses to drown their sorrows. All misusers of alcohol need ongoing support, the women she treats do not want to sign up to a life of meetings in draughty chapels and halls, but few are prepared to be open with their sobriety. Attitudes have to change says Sarah, and that can only come in the first place from clinicians, who up until now, have shown no desire to de-stigmatize this illness.

Alcohol: the facts

• Men still drink more than women, but women – especially teenagers – are catching up fast.
• Women are advised to drink no more than three units on any one day and not to exceed 14 units a week.
• Following a recent reclassification, a small 125ml glass of wine counts as 1.5 units, a medium 175ml glass is two units and a large 250ml glass as three.
• Under the new measurement system, women now drink an average of 9.4 units a week.
• 13 per cent of women consume alcohol at least five days a week.
• In 1992 girls aged 14 in England drank an average of 3.8 units a week; by 2004 that had risen to 9.7 units.
• Women’s average alcohol consumption has been increasing since the early Nineties.
• The highest proportions of people who drink ‘hazardous’ amounts – 15-35 units a week for women – are found in well-off areas, for example Surrey and HARROGATE.
• British women aged under 25 drink more than their peers in other European countries.
• Office for National Statistics; Liverpool John Moores University; ICM; Datamonitor