Drunkeness is a social disease

1. Introduction:
Some years ago while I was working as a health care assistant in operating theatres a student nurse from Ireland consumed alcohol excessively during her 21st birthday party. The next day she attended the accident and emergency department but was sent away diagnosed with a hangover. Normal doses of self-administered paracetamol overloaded her liver due to her dehydrated state and she subsequently underwent a liver transplant. Unfortunately she then had a stroke and died in the intensive care unit. Her 18 year old sister who was also a student nurse went back to Ireland in a state of distress. My last shift in theatres before I departed to University ended with an alcoholic man bleeding to death. I still remember the distinctive smell of blood which at first could not be seen. The surgeon tried to look for the source of his bleed with an endoscope, but there was so much blood that his view was obscured. As his blood pressure dropped we put him in a head-down tilt. That was when I first saw the blood as it gushed out of his mouth looking like chopped liver. I was at his waist level when we turned him on his side to clear his airway and I found myself covered with blood as he was bleeding from his rectum too.

I soon forgot these experiences while at University, where I myself resorted to getting drunk to escape the huge mismatch between my achievements and what I knew to be my potential. It was an easy way to escape the feelings generated by being underestimated and disrespected. With the luxury of hindsight I know I was foolish for risking a good life for a few moments of escapism. I chose to moderate my alcohol consumption after a couple of near misses. I woke up one morning face-down in my own vomit, with no memory of having been sick. I must have vomited while unconscious, and if I had been lying on my back, perhaps I would have died of asphyxiation. Shortly after I started my current University course there was news of a man being beaten to death in the city[1]. I wonder whether alcohol played any part in the killing. I know a student nurse here that has been to hospital twice so far in a state of intoxication though we are still only first year students. The first time, it was due to unconsciousness after a drunken person sat on her head and the second it was due to the intoxication itself. I also know a lesbian woman that flirts with men when she is drunk and a student occupational therapist that wanted to sleep with me while she was intoxicated but changed her mind when she was sober (this has also happened to me once before with a student occupational therapist that is now qualified). During my first year of training, a fellow student occupational therapist jumped fully clothed into the river Thames on a winters night because in a drunken state she decided she wanted to get away from her date. She is lucky to be alive. Only yesterday one of my flatmates suffered bereavement. His friend had been missing for a few days[2]. A Facebook memorial states he “lost his life all because of a few to many drinks”[3]. As I type this there are several drunk people in my flat, seemingly oblivious to the suffering of our absent flatmate and the cause of his unfortunate loss. Condoms were left out for people to make use of and in their state of drunken stupor they opened the packets and threw the condoms on the floor needlessly wasting British taxpayers' money during a time of recession. Those condoms were worth more than I can afford. My humility is being tested to its limits and I find myself judging those around me. I believe life is too short and valuable to lose moments in intoxicated stupor. I now see my disregard for life as an undergraduate and the behaviour of those around me as a symptom of social disease; an occupational disease with potential occupational cures.

2. Why do people get drunk?
Adolescent alcohol abuse has been linked to negative thinking, anxiety sensitivity, impulsivity and sensation seeking[4]. Looking around me now it is easy to find examples of these traits. Negative thinking accurately describes my state of mind as an undergraduate when I chose to get drunk. At the time I globally attributed negativity to life in general. Anxiety sensitivity may be the reason some people feel unable to socialize unless they are drunk. A key occupation underlying this is dancing; many people have told me that they feel unable to go clubbing unless they are under the influence of alcohol. The animalistic behavior exhibited by drunken people can be intolerable for sober people, creating occupational alienation[5]. Unfortunately clubbing seems to be a keystone in British youth culture and if people feel unable to dance without alcohol, alcohol consumption may be a determinant of social inclusion. While studying occupational therapy I regularly socialized with several Irish female occupational therapy students and one Irish female student social worker. They advised me that the best way to get a girlfriend was to snog drunk girls, because according to them, girls feel too shy to show sexual or intimate emotions while sober. I told them that I did not feel right about taking advantage of girls with diminished mental capacity due to alcohol intoxication. They told me the best solution to this was to get drunk too because apparently it is acceptable to take advantage of intoxicated girls as long as you are drunk yourself at the time. This attitude occupationally alienates non-drinkers with respect to sexual and perhaps romantic relationships. Nowadays my working solution is to let drunk women snog me but then carry out a mental capacity assessment before letting them do anything more. This strategy saved the student occupational therapist mentioned in section 1 from potentially regrettable sexual activity.

From observation I believe impulsivity and sensation seeking are most common precursors of drunkenness amongst my peers. I live with cheerleaders for whom drunkenness seems to be a normal and regular part of life. Some of my friends in high-powered jobs, living lifestyles I can only dream of with a health service income, get drunk every Thursday night with their work colleagues. At the last doctors’ mess party I went to I saw medical students that were unable to walk unsupported and probably had little idea of where they were going. I have seen one medical student lose the ability to sit on a chair or speak on two separate occasions. This particular person revealed to me that he has a problem with anxiety, but rightly or wrongly, I suspect these high achievers to exhibit less negative thinking and anxiety sensitivity than less advantaged subsets of society. This leads me to believe sensation seeking may be the dominant motivation. Sensation seeking may be a symptom of occupational imbalance. Modern British society seems to be characterized by some people living off the state and enjoying family life[6] while others work too hard just to maintain what they consider to be survivable lives.

" Binge Drinking. I hate the fact the government are trying to tell all of us how much we should drink. They say we should all limit ourselves to 10 units on a night out, F*** that I say, that's a measley 5 pints, if I want to have a good sesh, I'll have a f****n good sesh, if I want to be chucking my guts up in the middle of Reform st then I'll do that, if I want to get totally legless then I'll get totally legless. I don't need them c**** in government telling me what I can or cannot drink. I work a 50 hour week, so don't tell me that I shouldn't go out & let my 'hair' down that one night a week."[7]

3. How much is unhealthy?
According to the British Department of Health, women should consume no more than 3 units of alcohol per day, while men should consume no more than 4 units per day[8]. Last week my next-door neighbour boasted about drinking more than 40 units in one night. Binge drinking is classed as 6 or more units per day or 35 units per week for women and 8 or more units per day or 50 units per week for men[8].

4. Is it a disease?
Drunkenness seems to be a cultural part of the society I live in. I think of it as a disease, but it might be wrong of me to activley look to treat it, as by doing so I would be imposing my cultural values on other people, for whom drinking pathological amounts of beer while watching rugby or stupifying volumes of spirits on a night out with the girls is a defining characteristic of their culture. If pubs and clubs stopped serving alcohol in the United Kingdom how would the majority of young people socialise? The rest of this blog entry is therefore just a theorectical, academic and speculative exercise applying my own cultural values. According to Ayurvedic theory fermented products such as alcohol express the nature of intertia, predisposing people to laziness, selfishness and ignorance whereas stimulating foods such as spices and meat predisopose people to anxiety or passionate, impulsive behaviour[8]. Anxiety and feelings of insecurity are generated by material consciousness while sensation craving is generated by bodily consioussness[8]. Drunkenness may therefore be a maladaptive compensation stratergy for occupational deprivation of the material or bodily centres of consioussness. In the society I live in I see material consioussness deprived due to consumerist culture generating a high cost of living, and bodily conscoussness deprived due to chronic occupational imbalance between work and leisure or family life due to the high cost of living. To maintain occupational balance I would ideally like to practise 2 hours of meditation and 1 hour of yoga postures every day. Working 9 to 5, commuting for 1 hour, spending 2 hours per day on self-care and domestic tasks, sleeping for 8 hours and then practising yoga would only leave me 1 hour for family and social life. Few people I know have that luxury. Student nurses I know here are working 12 hour days on clinical placement and as a medical student my back-log of study seems ever-increasing.

How did this situation come to be? I blame uncompensated feminism and collective insanity. Working has reduced the occupational injustice suffered by women but subjcted them to the same occupational imbalances traditionally suffered by men, creating a norm characterised by both partners in heterosexual relationships working full time[9]. I wish society had evolved to allow both partners to work part-time (instead of one working while the other stays at home), thus maintaining healthy family life. I do not believe both partners working full-time has increased quality of life at all because the cost of living has simply increased on a par. This brings me to the point of collective insanity. Could house prices currenlty be so high if people were unwilling to spend their lives in slavery to mortgages? What would happen if people simply stopped buying and opted for freedom from slavery to materialism, or preferentially migrated to countries with more sensible enconomies and less materialistic lifestyles? The final straw is sexual repression. Why are sexual words considered to be swear words? Why did I feel the need to censor the sexual words in an above quote? Why do many people have to get drunk before they can express romantic or sexual feelings? In short, the society I live in predisposes people to occupational imbalance charaterised by feelings of insecurity, pleasure deprivation and sexual inhibition that leads to maladaptive sensation seeking. It is a society ripe for drunkenness.

5. Solutions:
5.1. Education: In the words of one Students’ Union Welfare Officer candidate:

“I think people are smart enough to decide how much they are going to drink, I cannot control the amount people drink and I don't want to . I hope people will keep it under control and are in control enough to decide when they ahve had enough...”[10]

I guess she has never been to Accident & Emergency on a Friday or Saturday night. The pubic in general seem to be aware of risks associated with alcohol consumption. In 2007 7 out of 10 people surveyed by the Department of Health thought a reduction of alcohol consumption reduction would make Britain healthier and 78% of people perceived alcohol to be more damaging to health than illegal drugs[11]. Despite this, few people monitor their own alcohol consumption[11] so education may not be effective for reducing drunkenness, except for with people that already wish to reduce their alcohol consumption[12].

5.2. Cognitive Behavioural Interventions: If knowledge of the risks does not inspire reduced alcohol consumption, the next logical step might be cognitive behavioural interventions. Primary determinants of future drunkenness are thought to be one’s intention to get drunk, perceived control of drunkenness, positive or negative evaluation of the state of being drunk and one’s perception of other people’s opinions of one’s drunkenness[13]. The last component of this may be socially determined and therefore difficult to change in some environments, such as Universities where drunken antics are often applauded. I find perceived control of drunkenness easy to challenge amongst my peers but difficult to shake their positive evaluation of drunkenness as a state of being. Amongst University students anticipated regret is the biggest determinant of intention[13]. People seem to perceive greater risks to others than themselves[11]. Students may therefore be balancing the potential regret of a decimated social life (motivating them to drink) against the potential regret of a hangover, rather than the potential regret of serious health and lasting health problems. Manipulating the consequences of drunkenness may therefore be an effective intervention. Increasing alcohol prices would increase the negative financial consequences of excessive drinking and tougher law enforcement against alcohol related antisocial behavior might act as a deterrent[11]. My neighbour that boasted about drinking more than 40 units in one night said he only drinks that much because alcohol is so cheap. Brief motivational interventions are known to increase readiness to change, but this does not correlate with decreased alcohol consumption[14]. Cognitive behavioural interventions alone may therefore be inadequate to reduce drunkenness.

5.3. Occupational Therapy: As an occupational therapist I am biased towards the belief that occupational therapy could play a huge role in reducing drunkenness. The occupational risk factors identified so far in this blog are occupational imbalance and occupational deprivation with respect to leisure and pleasure and occupational alienation with respect to social, romantic and sex life. I wonder if abolishing these risk factors would effectively reduce drunkenness. Various established conventional occupational therapy models could be used to approach this, but I prefer to reflect with one that is culturally appropriate to me. Applying Ayurvedic principles I look at this from 2 angles. One is the three modes of material nature: essence, activity and intertia[8]. The other is 7 domains of consciousness known as chakras[8].

5.3.1. The three natures: Alcohol abuse is associated with other high-risk behaviours such as drug abuse, risky sexual practices and violence. According to Ayurveda, alcohol has the nature of intertia (tamas) and would therefore be expected to make people withdraw, become depressed and go to sleep[8]. Perhaps the behaviours associated with alcohol abuse are concurrent symptoms of an underlying occupational disease, rather than problems caused by the alcohol abuse itself. I see people excessively exposed to the nature of activity (rajas) by work-pressures, caffeine, excessively flavoured foods, music, sexual imagery, other media and association with other over-stimulated people. Expression of this nature is often not socially acceptable. Alcohol provides a maladaptive coping mechanism for this in two ways. Firstly, alcohol is used as an excuse for behaviour (such as violence or sexual assertiveness) that would normally be deemed inappropriate. The second student occupational therapist that tried to sleep with me for example, told me at the time that her behaviour was acceptable because she was drunk but she thought it was creepy that I was sober. Secondly the nature of alcohol (tamas) counterbalances the nature of over-stimulation (rajas). Yogis traditionally deal with this by cutting over-stimulating products out of their diets, meditating (relaxing) to maintain occupational balance and associating with other yogis to avoid occupational alienation. As a medical student on a university campus the yogis I come across seem to have much more time on their hands then I do and the socials they arrange are usually too time consuming for me. Despite this, I can use the internet to find other people that disapprove of drunkenness:
http://www.facebook.com/group.php?gid=47813614445
http://www.facebook.com/group.php?gid=52491475539

5.3.2. Seven domains of consciousness: Earlier in this blog entry, links were made between drunkenness, anxiety and sensation seeking. Anxiety is believed to be seated in material consciousness (1st chakra). My bereaved flatmate told me that he would like to avoid getting drunk but feels unable to talk to new people unless he has been drinking. He admitted that alcohol is a temporary solution to low confidence. Occupational therapy could play significant role in coaching people for confidence in communication and interpersonal interactions thus displacing the maladaptive strategy of alcohol abuse. I believe this would best be done prophylactically with people of school age, rather than reactively once drinking culture has been ingrained as a social norm. Though anxiety can be chemically mediated by the action of corticosteroids on the brain, I believe it is usually associated with attachment of one kind or another. The beliefs that one needs a house, a car, a romantic relationship, popularity, or to have children can all lead to anxiety. Alcohol consumption, other“health-damaging behaviours and violence, for example, may be survival strategies in the face of multiple problems, anger and despair related to occupational insecurity, poverty, debt, poor housing, exclusion and other indicators of low status”[15: p.iii]. It is questionable whether any of these things are needed. Inequity may be a stronger predictor of poor health than poverty[15] and if so, people’s perceptions of their relative wealth may be a bigger determinant of their health than their actual wealth.

“In terms of happiness and peace of mind, we were much better off as a world society in former times when every family had some land and a cow and easily got all their eatables by planting in the spring and harvesting in the fall.” (Sankarshan Das Adhikari 2009)

The “relentless pursuit of economic growth is not environmentally sustainable. What is now becoming clear is that current economic and fiscal strategies for growth may also be undermining family and community relationships: economic growth at the cost of social recession”[15:p.iv]. Detachment is the yogic way of maintaining healthy material consciousness and escaping consumerist slavery.

Sensation seeking impulses are believed to come from the bodily centre of consciousness (2nd chakra). This is thought to be the source of the human sex drive. It has even been suggested that risk taking and self harming behaviours are motivated by a need to display hardiness indicative of genetic superiority, thus increasing sexual attraction[16]. Unfortunately in British society it seems the human body[17, 18] let alone sexuality is taboo and even some healthcare professionals fear to approach the subject[19]. When sexual expression is repressed bodily consciousness will express itself in other ways. Sensation seeking may be a product of this. Sensation seeking itself can be repressed through processes of reasoning[4] but emotional repression can itself have negative health consequences[20]. Research on sunbathing has shown that when risk-taking is associated with perceived increased sexual attraction behavioural changes based on knowledge of health risks are unlikely[21]. Extrapolating this to alcohol consumption in young people, if drinking is seen as an essential aid to socialising (as with my bereaved friend), socialising is seen as necessary for meeting sexual partners and drunkenness is seen as an essential justification for initial sexual activity (as with the student occupational therapist mentioned earlier) it is unlikely that people will avoid drunkenness at the cost of their sex-lives. An Ayurvedic solution would be to challenge and break sexual taboos in society. Occupational therapists have a role to play in this. I believe as long as words like ‘penis’ or ‘vagina’ are seen as less acceptable for everyday communication than ‘cup’ or ‘fork’, and occupational therapists find sexuality more difficult to approach with their patients than washing and dressing or eating, maladaptive responses to sexual repression, such as binge drinking will continue to be left inadequately treated.

6. Limitations:
This blog entry may seem a little off the wall. That is because it is based on my personal, unqualified opinion. I am aware that therapists working with people that misuse substances read MetaOT blogs. I hope they will be kind enough to enlighten me with their feedback.

7. Conclusion:
Until people are empowered to escape consumerist slavery to restore healthy occupational balance, interact socially with confidence and high self-esteem and engage in healthy, pleasurable leisure occupations and sexual occupations without fear or taboo, I believe drunkenness will be a persistent problem in society. Occupational therapy could play a huge proactive role in reducing this.

References:
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