When does alcohol become a problem?

9:43Dr Kevin Vento:Yes.

9:43Kimberley Wilson:And we have these increases in these negative psychological effects of anxiety, of increased depression. And that can be a really vicious cycle for people with depression. You know, they drink to try to feel better and then actually it kind of compounds the problem. And then I think a lot about brain health itself. And we know that a lot of dementias are associated with excess alcohol consumption.

10:08Dr Kevin Vento:Alcohol is one of those chemicals that quickly passes across the brain blood barrier and can really impact on the brain development. And it's more pronounced in younger people as well. So if people do start drinking at an earlier age, then that does increase their chance of developing dementia later on.

10:28Kimberley Wilson:If we were asking someone a few questions to help them identify their relationship with alcohol, things that stand out for me are things like, do you want to cut down? Have you tried to cut down and you've been unable to do so, that kind of compulsion? or have you continued to drink when it's had a negative effect either on your mood or on your ability to function? Has someone told you that they're worried about your drinking?

10:54Dr Kevin Vento:I think when people maybe notice that it impacts on their sleep or there's a compulsion to drink in order to manage difficult feelings, maybe manage anxiety, maybe to sort of cope with social situations, then I would say that what I see in the clinic is the breakdown of relationships. So when someone has a drinking problem then it makes it much harder to kind of maintain those family relationships and those friendships and that's when people start noticing that actually they need to do something about it.

11:33Kimberley Wilson:I've certainly worked with people for whom their strongest, safest most controllable relationship has been with their alcohol they found interpersonal relationships too difficult to manage and so the dependency on alcohol isn't simply a physical or chemical one it really is a psychological relationship as well i suppose

11:54Dr Kevin Vento:one of the things i often look out for when people turn up in my clinic is if they are drinking on their own and I suppose that's a real sort of sign that alcohol is a real problem.

12:07Kimberley Wilson:And thinking about the emotions and the psychology associated with drinking, two big emotions that come up in my mind are denial and shame. What do you think?

12:19Dr Kevin Vento:I'd agree. I think it's sometimes quite hard to ask for help. So it's easy to brush off, easy to deny as a difficulty and a lot of people who do drink a lot if you ask them can you stop drinking they would confidently say yes yes it's not a problem i can i can control it but then when it actually comes to actually controlling it they

12:41Kimberley Wilson:may struggle yes i think a lot of people say to themselves if i can do dry january i don't have a problem yeah there is a big difference between not needing to drink and waiting for a drink yeah And dry January can be a really, really helpful reset for some people. But it actually takes, in my experience, a longer window of time to see those deeper-seated changes in our relationship with alcohol.

13:12Dr Kevin Vento:Yeah. I mean, a lot of evidence shows that you need about 90 days, really, in order to reverse that dependency. and for lots of people one month doesn't really make as much of a difference.

13:30Kimberley Wilson:So I feel like we have a comprehensive lay of the land in terms of the definition and the problem. Let's try and give some context for listeners. So if people are listening and they want to know whether they should be worried or whether they can be reassured, if we were to put alcohol consumption on a scale when does the prosecco you have at brunch

13:53Dr Kevin Vento:become a problem i suppose it's when you struggle to cope without prosecco at brunch so at the mild

14:00Kimberley Wilson:end we'd be thinking i have a glass or i don't have a glass i'm still going to have a good time

14:05Dr Kevin Vento:with my friends yes okay so you don't need that glass in order to relax and to have a good time as you said. Whereas when we kind of feel like, oh, actually, I need to have a drink to get through this, then that's when it might kind of suggest that there is a bit of a problem and you are becoming a bit dependent on having a drink in order to connect and to cope.

14:32Kimberley Wilson:Or maybe when the alcohol is the thing you're looking forward to, you know, I'm going out with my friends for brunch, but actually the thing I'm most excited about is having six mimosas.

14:41Dr Kevin Vento:Yeah, a real indicator often is when the people that you're drinking with are able to stop and you still feel that you have to carry on or you haven't quite had enough so you continue to drink. Yes, and I wonder then whether the person with a potential problem

14:57Kimberley Wilson:also starts to try and encourage other people to keep drinking?

15:01Dr Kevin Vento:Yes, that would be, yeah. And that could also interfere with relationships as well.

15:05Kimberley Wilson:So you're feeling like you want to continue drinking, you need it, feeling compelled to extend the drinking session, wanting more people to accompany your drinking. That's when we're getting more towards the kind of severe end of the scale.

15:21Dr Kevin Vento:Yeah, so that's often where you might notice people having blackouts, memory lapses, maybe they end up having more altercations, maybe more falls, more injuries, and it stops them from being able to carry on with their lives the day after. So they're probably unable to go to work, they're unwell, they have maybe quite severe hangovers and other illnesses that might be linked to that.

15:47Kimberley Wilson:And if this is you and you're worried about yourself or someone close to you, please be reassured that there are lots of sources of support that you can go to directly or anonymously. And we will provide more details of that later on in the show.

16:06Kimberley Wilson:We have had a lot of emails into our inbox about addiction and specifically about alcohol addiction. And one listener, I'm going to call him Jamie to protect his identity, sent in his experience. And I'd like to read that out to you, Kevin, because I think it really does bring up a lot of the ways in which we might start to think about confronting a reliance on alcohol. So Jamie says, I've just listened to the episode on lying. Great, as always, by the way. Thank you very much, Jamie. and I recognised a lot of features of addiction, including from my own past as an active alcoholic and my many interactions with alcoholics and addicts in the years since then.

16:49Kimberley Wilson:Lying was a habit I had to break, but one of the easier ones once I'd noticed just how much lighter my load felt when I was honest with myself and with others.

17:04Dr Kevin Vento:I suppose when we talk about lying sometimes we talk about lying to others but actually in a lot of cases with addiction they're lying to themselves that's one of the biggest difficulties because people are unable to make changes unless they're able to accept that this is a difficulty this is a problem that needs to be addressed so it is that concept of how much is too much and sort of considering how that impacts on you because for some individuals, two glasses of wine is more than enough.

17:40Kimberley Wilson:It's a cliche, but awareness really is the first step to change, isn't it? We can't change what we don't acknowledge. And the thing about lying is that it does become one of those barriers between you and other people.

17:55Dr Kevin Vento:often when people are confronted with other people that lie then relationships break down it often leads to anger and actually the more resistance that someone shows often the more challenging that relationship becomes tell me more about resistance what does that mean i'm using that term because one of the things that we have to do as therapists is work with people's ambivalence we need to be able to not do what everyone else probably in their system is doing which is just telling them off and telling people that they need to change we need to understand what those barriers are to change and work with the ambivalence that they may have yes and so the

18:45Kimberley Wilson:ambivalence is the part of the person that wants to stop drinking alongside the part of them that enjoys it or has used it as a coping tool or relies upon it yes we know that there are harms yes we know that it's not good for your brain or your liver or your physical health but somewhere along the line you believed thought discovered that this helped you in some way and there's going to be a part of you that's going to really struggle to relinquish whatever you think this thing is doing for you. Yeah, that's it.

19:19Dr Kevin Vento:I suppose there are some small steps that people can take, especially if they notice that actually drink is becoming a problem and impacting on their relationships and their health. So the first steps is about being honest with ourselves around how much we are drinking and how the amount that we're drinking does impact on our relationships and our health and so noticing might be simply about counting up the number of units not necessarily

19:48Kimberley Wilson:changing it but just being aware of how much you are drinking yeah and when you're drinking yes so that you as you say start to be honest yeah with yourself i remember working with someone who

20:01Dr Kevin Vento:would be working their way through a bottle of wine whilst cooking and what they would do is just top up and carry on drinking and topping up and they would actually lose count and not be aware of how much they drank and one of the first things that we had to do is really agree that right you're not going to top up until your glass is completely empty and then we're going to count and see how many glasses you do consume in that cooking period and actually that increased that person's awareness and was a bit more mindful as to how much they were drinking.

20:37Kimberley Wilson:Yes. So you managed to get around the corner of their denial in this really quiet but important and powerful way.

20:43Dr Kevin Vento:The word curiosity kind of jumps to mind where it's about being a bit more curious about how much am I actually drinking and how quickly am I drinking and what's the impact on my health and my relationships.

20:57Kimberley Wilson:And if someone listening is concerned about somebody else, their partner, their friend, their parent, a work colleague, what can they do? Because it is quite hard just to kind of say to someone, I'm worried about your drinking or you've got a drinking problem. So what would you advise?

21:17Dr Kevin Vento:I think it is difficult because, you know, relationships are very important and we don't want to damage those relationships. But then I think it is also important to try and raise some curiosity around how much someone is drinking or how quickly they're drinking oh you know is this your third pint or are you ready to go home or just being curious about when someone maybe has reached their limit as opposed to telling them to stop because as i said that could sometimes raise some resistance in that individual whereas actually you're just shining a light I think that could be really helpful because as I said it's quite hard to make those changes if you're not quite aware of it.

22:04Kimberley Wilson:I know it's very very difficult but I do always think it's helpful to try to say something yeah and that might plant a seed for them

22:12Dr Kevin Vento:yeah later on. One of the things I often am curious about is what's the function of the drinking so if it is that maybe there's a stress or a trauma or something that's happening in that person's life and and it might be more useful for loved ones to create spaces to talk and so we're

22:34Kimberley Wilson:thinking about how we start but also it's worth saying that it is hard to stop it can be incredibly hard to stop and if you are a very heavy drinker it can actually be dangerous just to stop cold

22:45Dr Kevin Vento:turkey yeah and actually the medical advice is to gradually reduce and one of the things that i often share is that it's a journey so it's a journey towards abstinence and that sometimes people might relapse might have a blip and actually that's part of the journey and it doesn't mean that if you have a relapse then you give up absolutely i think that's so important for people

23:11Kimberley Wilson:to hear is that actually those occasional lapses, we understand to be part of that process of recovery, not a sign that you're failing. And I think when people think about giving up drinking, they feel like it's going to be kind of very heavy and difficult, isolating. And I actually attended with my friend, one of her alcohol anonymous meetings. And what really, really struck me was how supportive and how inclusive and how caring, almost separately from the alcohol, People were just like, it's great to see you. You're really welcome here. We really care about you. And I was really left with the feeling that this kind of compassionate gathering was something that we could all do with, actually.

23:54Dr Kevin Vento:Yeah, I think you're right. I often think that one of the reasons why people maybe get into drinking is because of that social connection. And actually, we could also use that social connection to get out of drinking as well.

24:12Kimberley Wilson:Thank you, Kevin, again, for a really wonderful conversation and one that I think is not just necessary, but really illuminating.

24:23Dr Kevin Vento:It's been a great pleasure and I hope that the listeners have found it helpful.

24:28Kimberley Wilson:And thank you to everyone listening. As you can hear, I am on a mission to add some clarity and clear up the mental health space. and I would love it if you were part of our conversation. So tell me what you want me to talk about. Email your stories to the team, a couple of paragraphs to complex at bbc.co.uk. But please note that I can't answer you personally. So if you have a concern about a medical or mental health issue, I strongly urge you to seek expert help.

25:01Kimberley Wilson:And that just leaves me to say thank you to the lovely production team at Loftus Media. and at BBC Sounds, Assistant Commissioner Izzy Lee Poulton and Commissioning Editor Rhian Roberts.

25:16Kimberley Wilson:I'm Kimberley Wilson. Thank you very much for listening. Take care and go gently.

25:29Dr Kevin Vento:Political language can seem archaic.

25:32Kimberley Wilson:It's like the light from one of those stars that actually died.

25:35Dr Kevin Vento:Sometimes bamboozling.

25:36Kimberley Wilson:It's a theme park with a five-foot log flume from one thought to another.

25:40Dr Kevin Vento:And very often beyond words. I don't know how to describe the language I use. I'm Amanda Iannucci. I'm all reset and turbocharged to stress, test to destruction. Used and abused buzzwords and phrases from the world of politics. I come with a dazzling array of guest presenters and I'll be exploring the verbal tricks of the political trade, the intentions behind them and the effect they have on all of us. The new series of Strong Message here with me, Amanda Iannucci, from BBC Radio 4. Listen now on BBC Sounds.

26:32Dr Kevin Vento:independent journalism and storytelling. It all starts with a subscription to bbc.com and the BBC app. Find out more at bbc.com slash unlimited.