So, as mentioned in passing before, I may have had the odd little problem with alcohol.
These odd little problems mainly consisted of doing things like drinking vodka before work, drinking vodka on the way to work, drinking vodka in the toilets at work, drinking vodka on the way home from work, and drinking vodka after work. Sometimes I’d wake up in the middle of the night, and drink some vodka.
Incredibly, I kept this up for well over a year undetected before being told to go home. I’ve no idea how, apart from the fact that my tolerance was so high that I could have more alcohol in my blood than haemoglobin, and still be able to demonstrate Excel-Fu that would cause all to gasp in astonishment. I could comport myself with all due decorum and professionalism, even though on the inside I knew I was hammered. Essentially, I’m a damn good actor. Nonetheless, taking my bag to the gents a couple of times a day, and coming out smelling strongly of Lynx and Listerine – a bit sus, surely?
But finally the day came when the game was up. I’d misjudged how much I needed to keep the shakes, sweats, and fits away, and was visibly pissed in an important meeting with the third most senior person in the entire organisation of about 11,000 employees. My boss wasn’t particularly pleased about that. I feel remorse for the embarrassment it must have caused her, but at least my guilt is assuaged a little by the fact that the NHS got damn good value out of me during the decade I worked for them. I was a legitimate force for positive change, and always an advocate for patient care being by far the most important consideration in any decision. I managed to improve clinical practice, made life easier for nurses, porters, and junior doctors, and saved a hell of a lot of money whilst doing it.
I can’t fault my former employers one jot. They recognised it as a clinical problem from the start, rather than a disciplinary issue, and supported my sick leave on full pay for about a year. When they finally canned me, it was because I’d been missing my mandatory appointments with occupational health. Appointments I’d only missed because I’d gone kite-surfing.
Nah, just kidding – I was drinking vodka.
So, I was given a year to sort myself out, during which I had two stints in rehab to safely detox me and educate me on my condition. And yet I still continued to punch myself repeatedly in the face with alcohol. I had frequent seizures. I soiled myself on a couple of occasions. I fell in the bathroom, knocked myself out on the toilet bowl, and left a pool of blood worthy of Tarantino in a bad mood.
Not to boast, but I don’t appear to be especially stupid. I’ve also worked in mental health, and have a fair understanding of that sphere. I wasn’t abused as a child, and have generally been very fortunate in the hand life’s dealt me. So why on earth would I insist on going back to the hellish existence of a drinking alcoholic again and again?
This is where I coin the term Self-Medicating GAD Alcoholic
See, throughout my life I always felt that something wasn’t quite right. Even when everything was objectively okay, there was always a sense of impending doom. There was a nebulous, creeping unease that ran through my every waking moment. Tasks of everyday life that other people found a minor inconvenience at worst, would fill me with dread. This was the case a long time before I started drinking – probably from about eight years old at the most.
And when I drank, all that went away.
At first, anyway.
Then when I went to the docs and talked to them about it, they said it was depression because I was drinking too much. So I’d stop drinking, and it was still the same. They gave me an SSRI anti-depressant. It did sod all. They tried a different one. Same. They’d try an SNRI. Didn’t do anything. Tricyclics? Nope, nothing doc. May as well have prescribed me homeopathic sprout milk.
And once you’ve admitted you have an alcohol problem, you’re stuck in a Catch 22 situation. If you’re drinking, it’s down to the booze. If you’re not drinking, then they’ll tell you it can take about a year to recover, mentally.
And all this time, there’s a disconcerting crackling in the back of my head, never leaving me alone for a moment. Something vague and unformulated, prodding at the base of my mind like a particularly irritating toddler trying to get attention.
‘Depression’ appears to be the go-to diagnosis for anyone who goes to the doctor saying that their head’s not quite right. But as it happens, I didn’t have depression. No wonder the anti-depressants didn’t do anything for me; I had a broken leg and they were putting my arm in a sling.
More recently, for the first time in my life, I’ve been given a diagnosis that fits.
Generalised Anxiety Disorder, or GAD. I’d seen a psychiatrist a couple of times before, but the third one was the first to spend enough time talking with me to finally work out what my problem is. He talked to me about GAD, and I could swear blind a perfumed choir of cherubim appeared above his head singing Handel’s #1 smash hit.
And he prescribed pregabalin. Within a few days, for the first time in about 30 years, the crackle in the back of my head just… stopped. My regrets and fears are all still here, but now I decide what I want to think about, instead of the gremlins in my brain deciding for me.
It feels similar to benzodiazepines, but it doesn’t turn me into a zombie, fog my perception, or send me to sleep the way that they do. In fact I’m able to focus far better now that I’m not dealing with the distractions of a seething shark-infested whirlpool at the back of my mind.
I remember sitting there in wonder, realising that this must be what normal people feel like. As I said near the start, whilst being good at stuff, I’ve always been a bit shit at daily life. I always felt pathetically inadequate because of it, and perplexed as to how people who should be no more capable than me seemed to deal with things like opening the post without turning into a writhing maelstrom of anxiety. Now I know why.
Pregabalin promotes the production of GABA, which is an inhibitory neurotransmitter. “It plays the principal role in reducing neuronal excitability throughout the nervous system” I read on the unerringly infallible Wikipedia.
Reducing neuronal excitability. The crackle in the back of my head. From a neurological perspective, that fits entirely with my experience.
It’s also far less addictive than diazepam or other benzodiazepines, and for most people with far fewer (if any) side-effects.
Unfortunately, few GPs are familiar enough with it to be comfortable prescribing, and it’s relatively expensive (£64.40 a month according to the BNF) – so your standard family doctor (as opposed to a consultant psychiatrist) is less likely to script it. Some will though.
I’m not a one-off case. It was me who tentatively mentioned it to the psychiatrist, because I’ve had several friends on Urban who’ve had their life changed by it, some after being literally housebound with anxiety for years.
And you know what? Without the anxiety, I’m not often really feeling the urge to drink, and when the thought does cross my mind it’s far more manageable.
My drinking was self-medication for my GAD. Unfortunately that doesn’t change the fact that I’ll now remain an alcoholic for the rest of my days, always at risk of relapsing, always needing to go to meetings and work a programme into my life.
But you know what? Without that incessant scratching of nails down the blackboard of my psychological self, that doesn’t sound too bad. I can enjoy the meetings, and enjoy being with the good friends I have there. I can enjoy rebuilding my life with consideration for other people, thinking about what I can put back as well as what I can receive. I can enjoy the journey towards being a proper person, a functioning member of society again, one day at a time. A grown-up.
But it makes me wonder just how many others like me there are out there. Self-medicating GAD alcoholics, drinking themselves slowly but surely towards the prison, the hospital, and the morgue.