Too many of us know someone struggling with addiction, and wonder why they don't want to change.
It seems crazy: booze is making him ill, everyone can see that. Her friends don't like being around her, and she can't see that.
Why can't they see what everyone else sees so clearly? Why do they seem incapable of recognizing that there is a problem at all and that it is destroying them? With all these signs of a problem, why do alcoholics not stop drinking?
To anyone who lives with, works with, is friendly with or associated with an alcoholic, it's baffling, infuriating, frustrating, incomprehensible.
And unfortunately, unless you have experienced addiction of some sort, it may stay that way. I was an addict. I struggled with alcohol, assorted drugs and tobacco, and at times even I find myself unable to fathom the behavior of some alcoholics.
Alcohol in large quantities on a regular basis is a poison that can have life threatening effects on the drinker's body. One of the more acutely life threatening conditions is esophageal varices (this is where the veins in the throat swell up like varicose veins). This condition occurs because alcohol affects the liver and the liver can no longer cope, so the blood supply gets backed up and swells the blood vessels like balloons.
The problem is that the veins can burst and the alcoholic can bleed to death very quickly. Drinking any alcohol in this condition is fatal.
I once sat all night with a patient of mine with a bad case of these esophageal varices until he could be admitted to hospital in the morning. His liver was so badly affected that he was bright, almost day-glow, yellow. I don't know how he felt that night, but it terrified me.
The emergency equipment was all laid out and I knew exactly what I had to do, but that didn't reduce my terror one bit. It may seem callous, but I just prayed that morning would come soon and I could hand him over, alive, to someone else's responsibility. Morning eventually did come and I did hand him over, alive. An ambulance arrived to take him to a general hospital where he would have medical attention.
That patient only lasted a short time, which was no great surprise to anyone. However, it was the manner of his death that was most memorable.
One evening after being in hospital for a couple of days, he dressed himself and walked out of the hospital and straight into a pub that was directly across the road. He never made it back to the hospital.
So, what would drive a man to an apparently suicidal act like that? He was not a stupid man, we had chatted at some length the night that I had sat with him and he told me about the successful business he had built. You might suggest that he had a death wish, but there were no signs of depression.
The bottom line was that he didn't believe that it could happen to him, despite doctors, nurses, therapists, counselors and his family telling him what could happen.
About 25 years ago, I was a research fellow in the psychology department at Glasgow University. The main thrust of most people's research in addiction at that time was "How do people change?"
Researchers saw this as a great way to improve treatment for alcoholism and drug addiction, and it has led to some interesting and better treatment approaches. I, however, thought differently.
The question that I was most interested in was "Why do people not change?"
The short answer that I found to the question is that they get so many good things from alcohol or drugs that they don't have a rational view of the bad effects.
So, am I just saying that they drink because they like it? No, it is so much more complex than that.
Mostly, alcoholics are not completely blind to the problems, but the gains are so valuable.
In my own life of addiction, alcohol and drugs made me feel alive and in control. Without them I felt weak and insignificant. The longer I was drinking as an alcoholic the worse this feeling of worthlessness became and the more dependent I became on alcohol or drugs to make me feel alive.
I could see that there were problems — of course I could. However, I minimized them and I always thought that I would sort them out — tomorrow.
So, why do alcoholics not stop drinking? It is not because they love the taste of alcohol, although they may do. It is not to make them sociable, although many will say it is.
It is because alcohol fills the hole that self-worth, confidence (or whatever) should occupy.
It does it quickly and it does it perfectly and, for a short time, there are no problems. Everything is right in the world even though everyone, but the alcoholic, can see that these feelings are false and won't last.
So, am I saying that alcoholics never change?
Absolutely not. A great many of them come to a moment of clarity when there is a real desire to change. The moment is individual to the person and is sometimes something dramatic or profound, or they may even seem small and trivial.
For me the moment was a doctor telling me I had 6 months to live if I continued, for someone else it's the look of disappointment on his little son's face, for another it's when he loses control of the car while drunk.
The point is that these moments change the balance between the benefits and losses of drinking, so that drinking is no longer as attractive. Later, when the alcoholic gets into recovery they can see that what alcohol gave them was counterfeit and fleeting. It is in recovery that they can build real self-esteem as they are no longer reliant on alcohol.
If you know someone who is struggling with drug addiction, visit this site to get help.