Sunday, 9 August 2015

The phenomenon of craving

I was in a meeting yesterday in which the chapter The Doctor's Opinion (from the book Alcoholics Anonymous) was being discussed. There was reference to the 'phenomenon of craving', namely the observation that alcoholics, once they have the first drink, have more and more, beyond the bounds of reason, and despite the consequences.

Now, it is extremely common for speakers (and writers) within AA to cite this example: whilst others stop after a glass or two, 'because they're beginning to feel it', 'feeling it' is precisely the point, which is why they continue.

There are several problems with this. Firstly, there are very few drinkers who do not drink in order to feel it. In fact, most moderate drinkers and certainly all heavy drinkers do, like us alcoholics, want an effect. To compare alcoholics with those who drink grudgingly, out of compliance with perceived obligation, habit, or social convention, teaches us nothing. They are effectively non-drinkers who happen to be drinking alcohol.

There is another problem with this, but I shall have to return to that once a fresh comparison is drawn.

The difference between the moderate drinker and the heavy drinker is not one of category but one of degree. Both enjoy the effect. The moderate drinker enjoys the effect to some extent, but his cut-off point is earlier during the progression into drunkenness. The heavy drinker enjoys the effect considerably more, and the cut-off point is later or may even coincide with oblivion or physical incapacity to continue.

A further point to observe with moderate and heavy drinkers is that the risk/benefit calculation is operative. Whilst outsiders or others they affect may disagree with their decisions, their drinking is kept within bounds they have set, in terms both of quantity and frequency, by a desire to avoid certain undesirable effects (hangovers, inability to get up for work, etc.) Moderate and heavy drinkers are thus both moderated drinkers. One might assert their drinking foolish, but they are subject to no internal tension, because they drink, as a rule, what they want to drink and when they want to drink it.

To explain this feature of alcoholism—the phenomenon of craving—by talking about how much we enjoy (aspects of) drinking teaches us nothing because in this regard we are not greatly dissimilar to moderate or heavy drinkers. The precise psychological effect of alcohol (and thus its idolisation whilst we are between drinking bouts) does differ and goes a long way to explain the return to harmful drinking after periods of abstinence. It does not adequately explain the dogged compulsion once we start. Heavy drinkers love the effect and thus drink. So do we.

The point of deviation in the comparison between (moderate and) heavy drinkers, on one hand, and alcoholics, on the other, is the fact we continue drinking even when we are not enjoying it.

I don't know about you, but once I'd had three-quarters of a bottle of gin, or two bottles of red wine, I was not 'appreciating' the effect of the next gin or the next glass of wine. It could have been water or Paraquat for all I knew. There was no marginal effect (or marginal utility as economists would call it). I did not enjoy it greatly (at least not like the first dozen or so drinks). To the extent I had been transported into a glittering and insulated world free of concern and liberated from time, another half-dozen drinks were going to achieve nothing. Sure, to remain there for another few hours, I might have to top up a little, to prevent slipping back into dreaded sobriety. But by no means did I need to continue drinking 'full steam ahead'.

Two analogies:

Imagine two people who sunbathe whilst on holiday. Both acquire a wonderful tan. But one stays far longer than necessary to acquire a tan and burns himself scarlet, on top of the tan. All he would need to do to keep the tan would be to top up under the sun for a few minutes here or there. The hours required to acquire the tan in the first place are not needed to remain tanned.

Imagine a space rocket expending huge amounts of  energy to get into orbit. Once in orbit, a small amount of energy only is needed to remain in orbit. If the same amount of energy were expended again, the rocket would leave orbit and fling itself out into deepest space.

These are far more appropriate images for alcoholic drinking: the pleasure of drinking or the attractiveness of moderate drunkenness explain why we get as drunk as 'normal' heavy drinkers. They do not explain why we drink past the heavenly zone of relief and joy into realms of darkness, violence, hatred, and sick oblivion, not through occasional miscalculation (a good man's fault) but apparently deliberately (if one judges by the quantities drunk and the speed at which they are drunk).

One example, and I shall wrap up. I recall a Saturday evening in my drinking when I decided I wanted to watch a favourite Ibsen play on the television, featuring a favourite actress. Of course I would drink, and I aimed to drink steadily through the play, then let the hounds loose once it was done, in the ample portion of the evening that would then remain.

What happened was this; I drank myself into a near stupor in about 45 minutes, and went 'hunting', as it might be called, out and about, drinking and looking for heaven-knows-what. As I left the house to begin my joyless rampage, it was with incredibly heavy heart. I wanted to stay at home and drink quietly and reasonably slowly, enjoying what I had looked forward to all week. The drinking and the associated activities had nothing to do with enjoyment or effect; they were despite the lack of enjoyment; they were despite my own horror at the effect.

No, I was obeying an order from deep within me, one I could not countermand: continue drinking, rapidly, come what may. No risk/benefit calculation is operative, and it is this that separates us from moderate and heavy drinkers.

When I look honestly at my drinking, it was this order that was issued every time I drank, regardless of emotion, regardless of circumstance, and no exertion of the will could resist it.

The phenomenon of craving is just this: a blind obligation to continue drinking—fast and hard—triggered by the first drink.

Leave the 'pleasure' for another discussion: that of the 'great obsession of every abnormal drinker'. That is for another day.

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