The 10 things I learned as a surgeon and a recovering alcoholic

Many Brits will have used Dry January as an opportunity to review their drinking habits. Dr Charles Knowles, 57, is a former NHS surgeon and a recovering alcoholic who knows only too well the costs associated with heavy drinking.

Dr Knowles, professor of surgery at Queen Mary University of London, gave up drinking 10 years ago, which probably saved his life and certainly his 24-year marriage. His new book Why We Drink Too Much intertwines his own drinking journey with scientific evidence to explain why humans consume alcohol at all – and why a minority of people like him go on to develop serious problems. The book contains a blueprint for change based on the science behind alcohol and addiction.

“When applied to my recovery this could work for anyone – from the social drinker with sober curiosity through to those who are genuinely worried about their ability to control consumption,” he explains. “I am not a zealot about alcohol, and these are simply suggestions rather than strict guidance.They are also not a substitute for seeking medical advice, especially for more problematic drinking and its consequences for your health.”

1. It’s not about stopping, it’s about not restarting

Imagine you are holding a drink in your hand – you have taken a sip and put the glass down. You have now stopped drinking, but the question is now whether you will pick it back up again. This may seem obvious, but it makes clear that when we talk about stopping drinking, we are really talking about not restarting. We can all stop drinking very easily, but it is whether we stay stopped that defines our ability to remain alcohol-free. The same might be written about moderating consumption. We can all transiently control consumption by increasing the interval between drinks, but it is whether we maintain it that defines real control.

2. The problem is in your head, not the glass

I remember one day complaining to a friend in long-term recovery that it was difficult for me to stop drinking because it was a cultural requirement after work. His response that he was a publican quickly put paid to this excuse (he was also Irish). It is all very well blaming the alcohol industry, society, the proximity of the pub or your best mate for your current predicament, but the problem is not one of the glass put in front of you.

Our drinking habits are learned, reinforced and memorised in the brain. Ancient biology in the guise of the reward system can push the “just one more” button even when cold logic might lead you to call it a day. You need a change in thinking to change your drinking. It is only a change in thinking that can provide neutrality around alcohol – willpower never lasts. Steering yourself away from temptation for a period while you work on this is, however, a good idea in the meantime.

3. One size does not fit all

As a surgeon, I become concerned when I hear colleagues saying they always do a certain operation for a certain condition. Humans are not a pure breed of laboratory mice. In the same way that we don’t all wear the same size clothes, we do not have the same biology, whether it’s for a surgery or our response to alcohol. If anyone tells you their approach always works, give them a wide berth. This is particularly true when considering the boundary between what I call reliance (a hallmark of grey area drinking) vs addiction (dependence). Most experts agree that a medical diagnosis of alcohol dependence means we can never safely drink again – and this was certainly my experience. For others, moderation may be all that is required and/or desired.

4. Start by putting down the glass

Regardless of your eventual goal with drinking, a predetermined period of abstinence comes highly recommended. This is why initiatives like Dry January are so important. The period allows us to evaluate how life looks with no alcohol and to start a new learning process – one where we learn to not drink. This is because we cannot unlearn to drink any more than we can unlearn to ride a bike – it is memorised. Instead, we must recognise all the positive aspects of being alcohol-free – not just the absence of hangovers but the increased energy, clarity of thought and time for other pursuits. This will not happen by counting down the days to February 1.

5. Don’t got it alone

For anyone with much of a problem around alcohol control, scientific evidence shows that all successful approaches incorporate some form of human support – be it a spouse, friend, therapist, or one of many online community programmes. The problem has to be shared. In an ideal world, sharing starts with those closest to home. But my own story illustrates how this may not always be easy. Men may tend not to open up about mental-health problems and there may be familial resentments caused by alcohol too. Community programmes now cater for anyone and are vital when someone’s social network has retracted to a small group of diehards or worse, complete isolation (this is a core principle of AA).

6. Education

In western society, we are conditioned to associate having a drink with almost any celebration, to reduce stress after work and any manner of other reasons. It is normalised and often expected. With a clear head, we can start a thorough reflection of what I call the 3Cs. How much we were Consuming? What are the Consequences – not just what has already happened, but what might happen to our physical and mental health, relationships, work and wallet. And, finally, Control – how hard are we finding it to stop? We can then start to address the question posed by my book. Why do we drink too much? We may start the process of addressing psychological drivers that pushed our drinking in the first place. Community support groups focus on such education. More formal medical or psychological treatment may be warranted – for example, 10 years sober, I continue to be treated for depression and have also had treatment for ADHD.

7. willingness

A colleague who ordered my book mistakenly had it delivered to his parents. His father was not happy with the insinuation. Deciding to review our relationship with alcohol is a decision only we can make. It requires a personal willingness to have a chance of success.

8. It’s not your fault

Development of problems with alcohol has nothing to do with weak willpower, low moral fibre, or an “addictive personality”. In fact, the risk of developing more serious problems like dependence has little correlation to the amount consumed – rather it reflects biological and psychological differences to start with. We have not drunk our way to our problems. Shame is a barrier to progress, so don’t go there.

9. Don’t fight a battle on multiple fronts

When you drink, you consume many more calories and more fluids than you would otherwise. It is wise to replace these in the early stages of abstinence. It is also ill-advised to try to give up anything else at the same time. Smoking and excessive caffeine consumption are classic examples. In more problematic drinkers, these are the very least of your worries.

10. Never stop trying

I have met people whose attempts at stopping drinking have been undermined by a core belief that their chances have been permanently dented by initial failure – often because someone told them this. When you change any habit (giving up smoking is an example), the more times you try, the better your eventual chance of success.

• Professor Charles Knowles is author of Why We Drink Too Much, The Hidden Science of Just One More, published by Macmillan priced £20 and available now