My name is Sally Marlow and I research alcohol problems in women at the Institute of Psychiatry, King’s College London. I started this blog to communicate the science, psychology and culture underlying drinking problems, and to put right some of the misinformation out there about women and how they use alcohol. All views expressed here are my own.
To those of you unfamiliar with the London School of Hygiene and Tropical Medicine, it’s an unlikely setting for some really quirky films of academic interest, including The Narcotic Farm, which I saw there recently. It’s a historical documentary with footage from the 40s onwards charting the establishment and running of American’s first ever drug treatment facility, The Lexington in Kentucky. There were two types of patients – those who were sent there as a result of criminal charges, and those who referred themselves voluntarily. There was a thriving jazz scene at the Lexington, and Sonny Rollins was just one of the musicians who spent time there. For the first time, those with drug addiction problems were treated rather than simply incarcerated. But for the first time, something else happened for those with drug addiction problems – they began to be experimented upon. Within Lexington was a research facility, but unlike today’s research which looks at treatment as well as causes, this research facility’s main work was observing the effects of drugs, and the way they did that was to give drugs of all types to those in the institution, and watch what happened. It’s an extraordinary documentary, and it’s available in three parts on youtube. The first part is here
I was doing some media work last week with an addiction psychiatrist, and we were discussing no-go areas when talking about addiction. The word “addict” came up. I’ve used the word addict before when talking about food, where those who believe they are addicted to food call themselves food addicts. In those cases I haven’t been using it in the way the pejorative sense the word is often used by the Daily Mail and others. The addiction psychiatrist said she considers the word addict unacceptable, and even if those with addiction problems are using the word to describe themselves, that doesn’t give others the right to use it. I don’t have an answer to this, and don’t know how I feel about it, but I would be interested in getting a debate going. If you’re reading this, and have a view, let me know, and I’ll post all comments up.
I’m in York to present some of my PhD findings to the Society for the Study of Addiction at their annual symposium. It’s a great event – a yearly chance for people from all areas of addiction research to get together, share their work, and talk about how to move the field forward.
York of course is beautiful. I grew up in the North East, and coming to York was always a big event. I feel at home here, in this ancient city with its city walls and cobbled streets, with the rivers running through the city and the presence of the Minster everywhere.
It’s been a full day of presentations, and I can’t do justice to them all here, but three things struck me particularly. Firstly there have been two presentations from colleagues from the USA, Kathleen Carroll on time-limiting treatments, and Katie Witkiewitz on improving treatment outcomes. Both stressed the importance of the individual, and spoke about how individual needs, and improvements for those in treatments, were not well served by looking at what works on average. Human beings are hugely variable, so it should not be a great surprise that addicts are also hugely variable. I loved Katie Witkiewitz’s explanation of her approach to statistical analysis – whereas most researchers treat variability in their data as error, she treats it as the part that could provide the answer. Secondly, there was a section on patient and service-user involvement, and a service-user talked to us about his experience. Conferences such as this benefit hugely from that input from those with the problems we research – they remind us why we do what we do, and that it’s not just pure science for the sake of science, it has real results, and impacts lives. Thirdly, there was a presentation of an exceptional piece of work from Linda Ng Fat, a PhD student at UCL funded by Alcohol Research UK, who has looked at existing data sets to examine the controversy surrounding beneficial effects of moderate drinking. Excellent stuff, and great to hear it from someone who is at the beginning of her career.
The annual lecture was given by Professor Robert West, a world expert on tobacco. I’ll confess, it made me rather wistful for the days when I was a smoker, despite the fact his lecture could not have articulated the harms, and the self-deception of smokers around those harms, any clearer.
I’m looking forward to tomorrow. Fortunately I’m on first, so after that I can relax and listen to everyone else. I’ll post my slides up on this blog after the presentation.
Last week I read two novels about young women who drink. The first was My Name Is… by Alastair Campbell, and was published a few weeks ago. The second was written between the wars by Patrick Hamilton, and is called Twenty Thousand Streets Under the Sky. Both contain the stories of young women who drink uncontrollably – Hannah in My Name Is…. and Jenny in Twenty Thousand Streets.
My Name Is…. is very good in so many ways. It captures many of the aspects of drinking which spirals out of control which are so difficult for those who don’t have problems with alcohol to understand. I was sceptical that Campbell would be able to capture what it’s like for a young woman who drinks, but he does, partly because every chapter is written from the perspective of different people involved with Hannah’s life, until the last chapter, where the voice is, of course, Hannah’s. In particular I think he understands and communicates how for many young women drinking and its related problems are actually rather passive: they drink because the alcohol is there; and they end up in relationships where they are exploited and where they do the exploiting because these are routes to further drink and a way to continue the life they’ve found themselves living. The other thing I think Campbell shows us brilliantly is how others are drawn to young women who drink, and how they become entangled in their problems. There is something about many young women who drink which burns more brightly – the perceived danger and the deviance is attractive, and women whose inhibitions are loosened through drink are rarely without company, at least not until their drinking starts to impact others negatively. Then of course there is the desire in others to scoop up and rescue the drinker, elevating themselves to hero, saviour and benefactor. My Name Is… contains others in both these categories. Where the book is not so good is that at times it is a bit of a blunt instrument, telling us what it’s like for this young woman, rather than showing us. Having said that, I have read comments in reviews and on twitter which claim this book should be required reading, and there is a part of me which agrees with that. For some, a blunt instrument is absolutely necessary to get the message across.
Twenty Thousand Streets Under the Sky does it differently. Patrick Hamilton presents us with a trilogy, in which his woman drinker, Jenny, is a prostitute. She appears in the first section as the object of someone else’s affections, and we watch as she exploits his infatuation with her and systematically takes him apart, until he is left with no money and no option but to leave his present life and start again elsewhere. However, in the second section, Hamilton takes a step back, and tells us how Jenny got there, and the way alcohol grips Jenny from the first drink is vividly told. She loses her job as a maid almost immediately, as a direct result of her drinking. She is mortified from her very first drinking session, waking up in a strange bed and not knowing how she got there, with hazy memories of car rides and accidents. She deals with the shame by accepting another drink, and another, and another – passivity again. Her situation is made worse by her uncommon prettiness – as with Hannah, she attracts people, although in Jenny’s case this is predominantly men. Some want to save her, and these she exploits to pay for her drinking, but the majority want to exploit her, and this she lets happen, in return for more drink. I loved this book. Even the pub a lot of it is set in, the Marylebone Bell, feels like a living, breathing character, and there is an accompanying cast of smaller characters which are beautifully drawn. Hamilton does the minutiae and desperation of everyday life brilliantly.
Reading the two consecutively (Campbell first, Hamilton second), I was struck not only by how there are different ways to tell the same story, but by how those different ways will speak to different people. Campbell will reach an audience Hamilton never could, not only because of who he is, but also because of how his book is written. Hamilton gives us a harder read – it’s longer, it’s dense, and it requires more emotional involvement, but the payoff for the effort is well worth it. Hannah and Jenny are two sides of the same coin, albeit that the futures for the two women look very different. Jenny is lost to poverty, and no-one is looking out for her. For Hannah however, there is a chance of recovery, although Campbell knows enough about drinking problems to leave the ending hanging.
A great discussion of the role and remit of Drinkaware has just been published in an academic journal called Addiction. Drinkaware is a body which provides information about alcohol and harms, and it is funded by the alcohol industry. Jim McCambridge and colleagues have written a damning critique of the information Drinkaware chooses to provide to the public, and how it chooses to provide it, but also, how Drinkaware sites are routinely used by the NHS, amongst others. This is a scandal waiting to happen.
I don’t usually post up academic articles, but this one is worth a read.
Yesterday I gave my first ever talk to a school group about addiction. There were upwards of 100 14-15 year olds gathered together in a school hall, and on the way in one of them muttered “not another talk about drugs”.
There is little evidence that school information and education programmes change student behaviour when it comes to drugs and alcohol, although Patricia Conrod and her team have shown that personalised interventions with children and young people who may be particularly at risk can have some promising results.
Knowing this I set out to devise a presentation which at least might tell the audience some things it didn’t already know. There is not a lot of guidance available from official sources on how to tackle the subject of addiction in a school setting. I had a huge amount of information which had to be distilled down into 50 minutes, on addiction generally, on various drugs, on alcohol, on nicotine, and on behaviours like sex and the internet. Holding the attention of 100 young people in the last period before lunchtime is not easy. I wanted to inform without patronising, so I talked about how ecstasy can make you love everyone, cannabis can make you laugh, and alcohol can make you relaxed and uninhibited. I also talked about how ketamine can cause irreversible bladder damage, the links between cannabis and psychosis, and alcohol and aggression, and the problems with buying what you think is ecstasy when there is no guarantee that what you end up with is what you thought you were buying. I described what can happen when recreational use and experimentation tips into something more sinister, and becomes addiction, and the importance of looking after your friends if they were in trouble on a night out. The feedback from the teachers was good, but from the students? Hopefully it made some of them think.
Channel 4′s series about health care seen through the eyes of ambulance workers has a programme dedicated to alcohol this evening at 9pm http://www.channel4.com/programmes/999-whats-your-emergency. For anyone who has never been in an A&E department on a Friday or Saturday night, this should be required viewing.
It’s easy to watch this stuff and be horrified and to feel nothing but sympathy for the ambulance staff, the police, and the A&E nurses who have to mop up the damage. It’s less easy to watch this stuff and put yourself in the shoes of the drinkers, but aren’t we all just a hair’s breadth away from them? Nobody sets out on a night’s drinking to end up in A&E, just like nobody with a serious alcohol problem set out to become dependent on alcohol.
I’ve now submitted my PhD and am waiting to hear the date of my viva. For the uninitiated, the way you pass a PhD is not just by writing thousands of words on your subject (79,961 in my case, to be precise, and I didn’t know I had it in me), but by having two copies bound into two blue books with gold lettering on the side, which are then sent to examiners, who read it. So far so good. But the pass/fail does not come on the reading only. You have to meet your examiners, face to face, to talk about your thesis for 2 – 3 hours, and justify why you did what you did, and why you chose that way to do it. This is known as the viva. So, I’m waiting to hear when my viva will be.
Since submitting I’ve had a week of rest, and now I’m looking forward to blogging again, and have committed to myself to write at least three posts a week. I’ll also be tweeting when I post, so if you haven’t already followed me on Twitter, please do, and then you’ll get an alert and a direct link whenever I put up a new post @sallymarlow2013.
I have lots of ideas for posts already – over the next few weeks I want to write about the role of alcohol in child protection cases, “addiction transfer” where people move from one addictive substance or behaviour to another, and I’d like to put up a few posts on the roles of free will and determinism in addiction. There will of course be the usual news feed – stories about alcohol come thick and fast and the media don’t always get it right – and I’ll comment on these too. If there’s anything alcohol or addiction-related you want me to cover, or to look into, do get in touch.
Thanks for your patience while finishing my PhD thesis knocked me out of circulation for a few months.
There have been some big stories about alcohol in the press in the past couple of weeks, and as I’m working on my PhD (it’s nine days until I hand it in, and I’ve had to re-do a load of stats), I’ve resisted the urge to blog about them. But, here’s a short summary, and in October I’ll revisit some of these things and talk about them in more detail.
Firstly, the proposal by the police that drunk people should be scooped up off the streets in drunk tanks, and pay a fine to cover the cost of medical treatment. In the news coverage I don’t think I’ve ever heard the words “responsible” and “irresponsible” uttered so many times. Leaving aside the logistics of deciding who’s drunk enough to be fined and thrown into the drink tank, which would be tortuous, let’s think about the motives for doing this. There is absolutely no evidence that it would stop people from drinking large amounts and getting into trouble. It is also the thin end of a large wedge – do we charge people who like scones and cream for heart problems, or those with mobility problems for not doing enough exercise while they were younger? So what does that leave us with – the motivation of punishment for using a substance society is happy to condone and governments are happy to take taxes from. Maybe that’s enough for some people, but it’s not enough for me.
Secondly, minimum unit pricing for alcohol reared its head again, with a representative from the drinks industry on BBC News saying “the evidence isn’t there” – it is actually, in the shape of over 100 peer-reviewed academic studies, including evidence from countries where they’ve tried it, and guess what, it works – less accidents, fights, liver disease, domestic violence… He also said the debate is behind us. It’s not. Saying something doesn’t make it true, however much you wish it. The debate is still alive and kicking, mainly because the evidence is so overwhelming.
And thirdly, Alastair Campbell has a novel out called My Name Is… about a woman who drinks. Brave for a man to have a go at this, even if he has a history himself with alcohol. I’m looking forward to reading it, and will review it here. It’s second on my list when I’ve handed in my PhD, after Cracked: why psychiatrists are doing more harm than good by James Davies – okay it came out six months ago, but I’ve been busy. It winks at me from time to time from its spot by the bed, saying “read me, read me” and soon I will be able to do just that. I’ll review this one too, particularly in terms of what it implies for alcohol and addiction.
Thanks if you’re still checking in and reading the posts. More to come….
To those of you who visit this blog regularly, firstly thank you for reading, and secondly, I wanted to explain why I haven’t been posting much recently. I’m in the final few months of writing up my PhD thesis, and this has been taking up most of my time and focus. I will keep blogging, and am aiming for one a week until my thesis is handed in, when I’ll up the frequency again. Normal service will resume in October.