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Everything you didn't know about alcohol addiction during Dry January | Staying Healthy
Oct 7, 2024
Avoiding alcohol can cause angst, particularly for those already living with alcohol addiction.
Priory consultant psychiatrist Dr David McLaughlan sheds light on the importance of responsible alcohol consumption this Dry January.
He offers top tips to help encourage ‘mindful’ drinking and develop ‘drink refusal skills’ in social gatherings - in particular office parties - where alcohol is prevalent.
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0:00
You don't owe anybody an explanation and if somebody continues to put pressure on you to have a drink
0:05
you can actually always walk away, just take your soda water and lime, head over to the down floor
0:09
start chatting to other folks that are not going to put pressure on you. We're seeing a huge rise of ketamine addiction, so a 35% increase in the number of people coming to us with ketamine addiction
0:20
But sometimes we also see other more unusual addictions as well. So I've seen patients with sex and love addiction
0:27
Why do people put pressure on you to drink and why are they uncomfortable when you don't drink
0:33
I think people feel safer when they're behaving in the same way as all of their peers
0:39
Hi everybody, it's dry January which means it's time to detox. However, there is a bit of temptation to go back into old habits, which is why I'm here today
0:47
with Dr. McLaughlin, who is one of the top psychiatrists at the Priory and the co-founder of the app, Curb
0:53
Thank you, great. So Dr. McLaughlin, can you tell me a little bit about your role at the Priory
0:56
and you know what you do there yeah so I am a consultant psychiatrist and I
1:02
specialise in addiction I do a bit of ADHD work as well and I see people with all
1:07
sorts of kind of mental health problems difficulty struggling stress anxiety burnout and people from all walks of life and what do people come to you the
1:16
most with what are the kind of main addictions that people tend to need help with
1:20
we see we see people with all sorts of types of addictions and the most
1:24
common one 80% of our patients come with alcohol addiction and then the other 20% is
1:29
actually cocaine addiction we're seeing a huge rise of ketamine addiction so a 35
1:35
increase in the number of people coming to us with ketamine addiction but sometimes we also see other more unusual addictions as well and so I've seen patients with
1:43
sex and love addiction and shopping addiction gambling addiction even actually sometimes people come for smoking addiction nicotine addiction
1:54
So all sorts. Can you tell me about the percentage of your patients that do have alcohol addiction
2:00
Is that one of the most popular reasons that they come to you
2:03
So at the Priory overall, 80% of the patients who are on the addiction treatment program
2:09
are there for alcohol addiction. About 20% of them are there for cocaine addiction
2:15
but we're also seeing a huge increase in the number of people coming to us because of ketamine addiction
2:20
And sometimes we see other less common addictions like gambling or, or sex and love addiction, shopping addiction, even nicotine addiction, people coming for support with smoke cessation
2:33
And going back to alcohol addiction, why do you think it's so common for people to kind of go out and, you know, there's just so much kind of social pressure for people to drink
2:43
Why do you think that is? Yes, and we're both Scottish obviously, so we'll have a similar shared experience of growing up where it was a cultural norm to drink
2:53
And there's certain communities that are even more vulnerable. So anybody from, well, it depends on who you're surrounded by
3:02
Actually, it's one of the things that really influences your drinking behavior and also what you've observed your family and your parents
3:08
what their style of drinking has been like. There's a genetic predisposition as well for alcohol misuse as well
3:17
But a big part of it is peer pressure and social pressure
3:23
There's a professor who I'm a big fan of Professor David Nupp, who wrote a paper a couple of years ago
3:28
and he talked about the four different reasons why people drink. And those four reasons are to conform socially, to enhance an experience that's already really good
3:39
for social cohesion, so to have a shared positive experience in a group, but also to cope
3:47
So that could be because of insomnia, anxiety, depression, low mood. So for every individual there's going to be really complicated diverse reasons why they drink
3:58
So if I were to be in a social situation and I said I don't drink, people's usual reaction is why not or why you just have one
4:08
and then when you do end up conforming it's like yes you're drinking now like why do you think that is
4:15
Yeah so it's interesting why do people put pressure on you to drink
4:20
to drink and why are the uncomfortable when you don't drink. I think people feel safer when they're behaving in the same way as all of their peers
4:31
And there's almost like a kind of a group thing, kind of herd mentality for a lot of people that makes them feel safer
4:36
And if you're behaving differently, it forces them to question maybe why they are drinking
4:43
So if somebody says to, you know, why aren't you drinking, then you could always turn the tables on them and say, well, why are you drinking
4:49
That's one of my top tips. Yeah, exactly. But why does it make other people feel uncomfortable when you're not drinking
4:57
Again, you could turn the tables and you could actually ask them that as well
5:01
You could say, well, how does it change your evening? Why is it necessary for me to drink
5:08
But ultimately, I think it goes back to the idea that people feel safest when they're all doing the same thing
5:15
and it reassures them that their behaviour is also okay and correct
5:20
If I were to be in a situation and I want to say, you know, I don't drink
5:24
what are some good ways to kind of, you know, make that clear, not give in to pressure
5:29
So first of all, if you're in a social situation and you don't want to drink, I think you've already started the right foot because you've said, I'm not drinking
5:36
So you've actually declared your intentions and you've let people know, and it sounds like you've done it in quite a nice way
5:42
And then that probably prevents lots of awkward situations as well where people pour glass into your wine and that happens in restaurants where a waiter will just automatically assume
5:53
So by starting off that situation by making that kind of declaration of your intent known, then you're already on the right foot
6:00
And sometimes you can do things like even removing the wine glass from your place setting
6:06
So you've actually already done the first thing, right? And then the rest is actually about, I guess, how you interact with people if they then apply that pressure
6:18
And I have, I've got four little tricks. And it's almost like personas that you can adopt
6:26
And in my clinic at the Priory, I sometimes do role play with my patients
6:30
And on the app curb we also have interactive exercises to help people to practice adopting these different types of personas because when you practice something you more likely to you not going to be caught off the hoof you not going to have
6:46
to think in your feet, you're more likely to avoid drinking when you don't want to
6:53
So those four non-drinking personas that I encourage my patients and our users on the app to adopt
7:00
One is called the table turner. So I mentioned that earlier where you actually turn the question
7:05
around on the other person or you distract them and say well actually tell me what
7:09
you're drinking or why is it why does it why does it matter if I'm not drinking
7:16
you know and you can do it in a playful way as well but sometimes just taking the
7:21
heat off yourself or asking somebody else around the table of question the other
7:27
one is a little white lie so with the little white lie you could say something like
7:33
I'm not drinking tonight because I'm on antibiotics Yeah, it's my usual one
7:37
I'm driving home tonight. Yeah. And people often don't challenge you and it'll stop there
7:43
Yeah, because it's medical related and it's quite personal, so they don't want to kind of probe at it
7:47
Absolutely, absolutely. And then the other drink refusal of persona that I sometimes adopt as well is The Joker
7:58
So if somebody says to me, David, why aren't, you know, why aren't you having a beer
8:03
I might say something like, I have two break. sales left after the week I've had and I don't need beer to kill off the last two. Yeah
8:11
Get like hearted. Yeah, you can, you can, you can, you can make a joke of it or I'm a terrible dancer
8:19
is if I drink wine, it's just going to get worse. And again, a lot of people will kind of pick up in those cues
8:26
And then finally, if somebody's being really persistent with you and saying, why aren't you drinking, the last approach is
8:35
just to be direct and to be honest and say look when I drink I sometimes behave
8:41
ways I don't want to behave I get really anxious the next day or I'm doing
8:47
dry January or I'm actually running a marathon next month or I'm pregnant you can
8:53
whatever you're the reasons are yeah well I mean that was struck the conversation
8:57
I want it yeah cool and you don't the other thing is you don't owe anybody
9:03
an explanation and if somebody continues to put pressure on you to have a drink you can actually always walk away just take your soda
9:10
water and lime head over to the down floor start chatting to other folks that are not going to put pressure on you good and you don't owe anybody an explanation
9:16
yeah nice can you tell me a bit more about the app curb that you've co-founded
9:21
so curb was co-founded with by myself and Joe Barrow who is Innovate UK
9:26
2003 Women in Innovation Award winner we wanted to make it easier for people
9:34
to change unwanted drinking behaviour. And so there was evolving technology that we were really excited about
9:41
So we won a grant from Innovate UK to take data from wearable devices, digital phenotypes
9:47
and to actually predict when people were most likely to drink alcohol and to have these
9:51
unwanted drinking behaviours. And what that meant is it gave us the opportunity to intervene and to prevent these unwanted
9:58
drinking behaviours. And we're hoping that lots of people will use it
10:02
What is your goal for the app and what do you? and your business partners want to achieve from it
10:06
At Kerb, we're on a mission to celebrate healthy behavioural change and to prevent unwanted drinking
10:12
So we just want to make this app available and accessible for as many people as possible
10:20
to prevent people from actually becoming addicted, and to celebrate this healthy behavioural change
10:26
So for Dry January, we're actually giving away free lifetime access to anybody who download
10:34
the app during January 2020. That's good off you. Better get downloading then
10:41
And I guess for somebody, like during dry, I guess during dry January, maybe some people
10:47
don't want to just cut out booze completely because, you know, I guess it can't be avoided
10:51
in some situations, you know, work events and, you know, just, I guess
10:55
they just want to cut down a bit. So how would you, what advice would you give to someone
10:59
that just wants to cut down a bit rather than giving it up completely
11:03
This is a really great. question because a lot of people find the idea of quitting drinking really
11:08
really frightening even if it is just for one month and I think if it is really
11:14
frightening to give up alcohol for one month I think that's a really interesting thing in itself and that's something probably to explore however I
11:22
am always really really willing to talk to people about how they can reduce
11:27
their drinking it doesn't have to be about quitting drinking and so actually
11:31
that's why with with curb we talk about changing unwanted drinking behaviours and in my clinic at the Priory again I am very I work with people
11:39
who've got all sorts of different drinking goals I think what is key is to reflect on
11:45
your drinking behavior what's your what is your relationship with alcohol like
11:48
where when why with whom do you drink what purpose is alcohol serving for you
11:55
are you know are you drinking to enhance an experience or are you drinking to cope with something like anxiety or insomnia what purpose to
12:04
does alcohol serve you? I think once we've had this kind of conversation with ourselves
12:09
or with somebody like me and addiction psychiatrist or a counsellor or even a friend or a family
12:14
member, then you can set yourself your goal. What is it that you want to change? And so that's
12:25
when I would work with an individual at the Priory, for example, and I would say, well, look, if this is your goal
12:33
how is it going to happen? Then the other thing as well
12:37
if somebody tells me they want to cut down their drinking, I would say, okay, so what will your new boundaries be
12:46
Because often people who drink too much is because they don't have clear boundaries
12:51
So there's no rules as to where, when, why, with whom, how much
12:56
and why they will drink alcohol. And one of the features that you see is this total loss of control
13:02
and actually they're not in control of their drinking. The drinking is in control of them
13:07
So boundaries and having those rules about where, why, when, with whom you will drink
13:14
is one of the things that really important if you looking just to reduce your drinking Good Do you have any inspiring stories you can tell me about anybody that you helped while working at the Priory I have so many inspiring stories
13:28
And I don't want to cry on camera, because sometimes I do that
13:32
But there are so many inspiring stories. Because I think the thing is with when people drink
13:37
and it's not even addiction, it's just even just kind of misusing alcohol
13:42
just getting too drunk or binge drinking. It doesn't just affect that one person
13:45
actually affects everybody around them. There's a ripple effect, so it can affect their partner
13:50
their family, their colleagues. And it can be really emotional when that person
13:57
sees the benefits that quitting drinking has on people around them. And they have this sudden realization of all the harm
14:06
that they've been doing and everything they've missed out on, but also this joyful celebration of everything
14:11
that they're getting back. So sometimes people will talk about saying, When you stop drinking, you quit drinking, but you regain your life
14:20
Oh, that's nice. Very true as well, because drinking does, I guess, it's not just you that affects everyone around you
14:27
So yeah. Can you tell me about a client whose journey has inspired you the most
14:36
I actually have a couple of clients who have had similar journeys
14:42
Often they come to me in my clinic when something really bad has happened
14:47
They have had an issue with their relationship. Maybe they've had a big argument, or they've crashed their car, they've gotten to trouble
14:54
of police, or they've gotten to trouble with work, and it could be something really significant
14:59
for misconduct at work. And actually, their whole life just feels like it's fallen apart because of something that
15:06
has happened, there's been a trigger event, and they come to me in crisis
15:11
But what I've seen repeatedly as well is that people find it so terrifying to give up alcohol
15:17
And so I have had many patients where I work with them to help them to put boundaries in place
15:23
so that they can regain control of their drinking. So having rules, like, how many days per week are they going to drink
15:31
With whom are they going to drink? What type of alcohol will they drink
15:35
And what is the maximum that they allow themselves on any one day
15:39
and I'm always happy to have that conversation with people and work with them according to their goals
15:47
But I'm open-minded and I also ask my patients to be open-minded
15:52
and often people will give up alcohol for a couple of weeks or a month
15:57
and they actually realise their life is so much better. So those patients I've told you about where they've come to me in crisis
16:03
because they've actually lost their job or their husbands threatened to leave them
16:08
or they've gotten to trouble with police and they feel like their life has fallen apart
16:14
I've seen them work with me and regain their life and consolidate their relationship
16:22
see their career, get back on track and actually get a lot physically fitter and healthier
16:28
start sleeping better at nighttime, feel less anxious, their skin clears up
16:34
It's still getting better, yeah. There's so many health benefits. benefits of drinking less
16:42
Yeah, not smashing up your liver. It's like, oh, I can't actually have normal skin
16:46
and like, I don't feel anxious all the time. I think the carrot is always much more effective than the stick
16:51
So I talk about my patients how much better their life is going to get
16:55
and I'm going to help them get there. And it's about looking towards the future
16:59
it's going to be so much better. And I know it's scary, and it is frightening to change any behavior
17:07
especially when alcohol is actually giving you something. So it's always worth of acknowledging what alcohol
17:11
how is alcohol serving them? And what I do is I try to understand that
17:15
And then I will replace that with something that's better. So if the alcohol is helping them kind of manage their boredom
17:23
I'm going to give them something more exciting than alcohol. You know, I'm going to introduce them to CrossFit or
17:27
Yeah, get that thrill from something else. Like, yeah, healthier habits, like healthier addictions
17:32
So I'm so we need to do it. Yeah. And just touching on like, I guess, how alcohol affects
17:37
work life you know I guess you know people in London you know it's normal for them
17:41
to kind of go out for drinks like you know after work and are there any kind of
17:45
scenarios where people do just over drink at work and they get into trouble and work and how would you kind of help them out in that situation yeah over
17:51
drinking at work is really really common and it's a really common reason why people
17:55
will will come to see me in a priory and that could be because of misconduct or
17:59
just embarrassment and I I'm always really sympathetic because often there's many workplaces and industries where alcohol is really
18:07
encouraged and it's difficult to say no if it's your boss that's encouraging you
18:12
drink or if it's a client. Will I get fired if I don't drink this? Like yeah so
18:17
people people worry you know will I get my bonus if I turn down a beer from the
18:22
boss. Yeah. So it's a really common problem in the workplace and that's
18:29
something that you know it would be great to work with employers to see if we can try
18:34
and change that. Yeah that sounds good. And I guess like any tips in those situations as well, like in work situations, how would you kind of decline, you know, your boss putting a beer like in front of you
18:46
What would you say in that situation? So, again, if it doesn't matter who's offering you a beer that you don't want, if you don't want that beer, you don't have to drink the beer
18:56
And again, going back to those drink refusal perci of osonas, you could be the Joker, you could be the little white liar, you could be the diplomats of reasoning with them, you could be the table turner
19:07
so you turn the question back onto them or distract them with another question about somebody else
19:12
or you can just be really direct and you can just say, I'm just not drinking and you don't ignore
19:16
any further explanation. Yeah. And come to see me in the priority
19:20
and we can practice those drink refusal skills or you can also get free access anytime you want 24-7 day
19:26
on the app curve. So you mentioned earlier that AI was quite a big part
19:31
of your app curb. So can you go into more detail about that please
19:36
Over the last year, So we've been lucky enough to be being supported by the government's research and innovation
19:42
body Innovate UK and they've awarded us grants which has enabled us to integrate data from
19:49
wearable devices like your Fitbit, your digital phenotype from your phone and also some
19:56
user inputs into the app and actually start to learn when you are most vulnerable to unwanted drinking behaviours So one of the things we find was that you more likely to be able to be able to be in the app and actually start to learn when you are most vulnerable to unwanted drinking behaviors So one of the things we find was that you were more likely to binge drink when you were
20:08
sleep deprived and you hadn't slept or when your heart rate variability decrease and that's
20:13
a measure of how stressed you are. And also actually how many, if your step count reduced as well
20:18
so if you're inactive, that predisposed you to binge drinking. And I mean this stuff really
20:25
excites me because I want to live in a world where we can prevent people from getting sick
20:31
and prevent people from being unwell and developing mental health conditions or addiction
20:36
And one of the best ways that we can predict is using AI machine learning to understand
20:42
when you're most vulnerable, offer you that in the moment support and that the intervention
20:49
that's going to stop you from drinking. And what's the process of the app then, I guess
20:55
people, they've got the app and then do they communicate with like, you know, your team as well
20:59
Like do they message you? Like how would they get in touch or get the support
21:03
This version of the app, we actually haven't integrated any of the AI or machine learning in it yet
21:08
That's actually still in development and that's what was funded by Innovate UK
21:14
But the version of the app just now, it's got loads of tools, tips, exercises
21:20
We also allow people to track and celebrate their success. but also to compare themselves against national averages as well
21:28
which people find really interesting. It's all about giving people kind of a sense of awareness
21:33
helping them to set goals, set their intentions, about how they want to change their relationship with drinking
21:38
but also celebrate with them because it's something that you should feel really proud of
21:42
You know, just like if you've been on Strava, Peloton, and you've got these health and fitness achievements
21:48
I think if you've managed to quit drinking for a month, that's something that you should be really proud of
21:52
And we also help you to track things like, how much money you've saved
21:57
Jeez, I wouldn't want to think about that. Exactly. Yeah, night out
22:01
I guess as well it's good in the sense that maybe people are a bit embarrassed about getting like face-to-face help and talking about it
22:08
So the app's a good tool just for people to kind of, you know, do it themselves. This is, do you know what
22:13
This is the other thing actually that when we were when we were developing this app
22:18
I spoke to so many different different people like doctors, therapists. patients, just my friends, my family, employers. There's so much stigma about unhealthy drinking
22:33
and addiction, that's a word I actually don't even know how I feel, but that word addiction
22:38
So for me, this is about celebrating healthy, positive, behavioural change. And one of the things
22:48
I have found when I spoke to employers, potential customers, an employee well-being market, so many
22:55
employees have harmful problematic drinking, but they don't want anybody else at work to know
22:59
they don't want HR to know, they don't want occupational health to know, because they're worried about losing their jobs. So you have police officers that don't tell their line manager
23:07
but they still go to work with a hangover. And, you know, you could have a surgeon who could
23:12
have a hangover. People are frightened of losing their job. You know, if you work in the traffic
23:19
if you work in transport, people are frightened of the stigma, losing their job. You know, if you work in the traffic, if you work in transport, people are frightened of the stigma
23:25
their job by asking for help. But this is why having a really discrete app you could have it
23:29
in your phone, nobody needs to know about it, getting access to that help or support, not having
23:35
to go to an NHS drug and alcohol clinic where you maybe don't relate to those people
23:42
it's just another way to make help and support more accessible and to celebrate that positive
23:49
healthy behavioural change. Because I guess if people did go through the NHS, how long would it take for
23:54
them to get the right support do you think? So I actually love the NHS and I worked in the
24:01
NHS for 12 years and they do so much amazing work. I think there's lots of people find it
24:08
very difficult to get the support they need in the NHS because the waiting list times
24:11
are very, very long and the threshold for getting access to support is actually quite high
24:18
So there's lots of people who are still drinking in harmful ways that don't get help from
24:22
the support and support from the NHS because they're not meeting the threshold. or their waiting list times are too long
24:28
Or they're just flying under the radar and they don't realise it's a problem
24:31
they don't think it's a problem, they don't ask for help. So before you go, I would like to know a couple of tips
24:36
that you have for anybody that might be doing Dry January this year. Okay, so my first top tip is to check in in yourself
24:44
How much are you drinking at the moment already? Why are you drinking with whom
24:49
And what is your relationship with alcohol like? Have a really honest reflection with yourself
24:53
with yourself, maybe you ask for feedback from people around you. Then if you're doing dry January, declare your intentions, tell folk that you're doing it
25:03
They're less like to put pressure on you. They're more likely to support you. They might even do it with you as well
25:08
And that makes things easier if we do things in a group as well. So let people know that you're doing it
25:14
Thirdly, set your, as well setting your goals, set your intentions. I suppose understand what are
25:23
the risks, when are you most likely to slip up, understanding your drink triggers and the drinking
25:31
cues for you? And then, oh, I've kind of merged this all together, but having a plan, so if you
25:39
encounter any of these drink triggers or drink cues, how are you going to manage them? How are you
25:43
going to handle it? Because if you have a plan, you don't have to think on the spot, you can just
25:48
follow the plan. You can go on autopilot and it makes it much easier to avoid drinking
25:53
that you don't want. Good. And one more, just so it's five. Yeah
25:58
And then I guess my final tip is to be really proud of your success or any healthy behavioural change
26:08
I think people should shout off the top of the rooftops and, you know, if you're doing something
26:14
that is improving your health and wellbeing, you should really celebrate that
26:18
It's hard and it's, and when you've done something really hard, you deserve to be rewarded and that to be recognised
26:22
than that to be recognised. So if you're doing Dry January, tell everybody about it
26:27
Thank you so much for your time, Dr. McLaughlin, and giving me all your tips for Dry
26:31
January and changing drinking habits. It's a pleasure. Thank you for having me. So if you're curious about changing your drinking habits, we've got all the links in the description for the Priory and Curb the app
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