“Hi, I’m Jim and I’m an alcoholic.”

It is not easy to admit being an alcoholic. Many are in denial due to shame, guilt, low self-esteem and to protect themselves from being harshly judged by society.

 Jim is among an estimated 400 million people, or 7% of the world’s population aged 15 and older, who live with Alcohol Use Disorder (AUD), commonly known as alcoholism, according to a report released in June 2024 by the World Health Organisation (WHO). Of this, about 209 million people (3.7% of the adult world population) are alcohol dependent. 

I had a chance to sit in as an observer in an Alcoholics Anonymous meeting in Singapore. For an hour or so I watched the pastor facilitate a multi-ethnic group of eight men and two women in their 20s to 60s. I would have never guessed that the doctor, the chief tech engineer, the teacher and the writer seated in front of me were alcoholics if I met them outside the confines of the small room. While not everyone volunteered to share his/her story that cloudy Sunday afternoon, I saw despair and shame etched on their faces.  

Every alcoholic present in the room had hit rock bottom. Their careers were on a spiral (one was fired from what was once a thriving career, the others’ jobs were shaky at best). They were tormented by their families’ growing resentment and disdain. Some were anxious about their health degeneration. They all came to AA in desperation, hoping to get out of the rut in order to salvage whatever was left of their “pathetic life” as one of them put it.  

But the road to recovery is a long, uphill winding climb. It would take staunch determination, mega faith and strong external support for them to get over the hill. A couple of men that I managed to briefly speak to after the AA session admitted to being “a repeat offender” with a dry laugh.

Repeat offender. Alcohol dependence may not be a crime, but it certainly makes one vulnerable to reach for a glass of wine or beer or whiskey.  The recapitulating “How did I get here?” thought spins in his head almost in sync with the rhythm of the liquor swirling in his glass. 

“Nobody starts drinking because they want to be an alcoholic. They always start drinking because it serves a function. When they drink they feel more pleasant, more relaxed, more sociable with other people like they can talk to the opposite sex when they normally can’t. It‘s also a form of stress release,” says Dr. Munidasa Winslow, a recognised expert in addiction and impulse control disorders (alcohol, substance dependence, gambling, gaming, sexual compulsivity, etc.) in Asia Pacific. His Promises Healthcare practice at Novena Medical Centre in Singapore has seen an uptrend in those suffering from AUD coming to his clinic – more than 1,000 outpatients, some in their teens while the majority are in their 40s to 60s. 

“There are more male than female alcoholics at the moment, but I must say that over the years females have been catching up. Even in smoking and drugs. Equality has meant that more and more females are coming up to the level of alcoholic features,” he adds.

AUD experts say that it is challenging to discern when one’s alcohol consumption transitions from being casual to indicative of  AUD. When is enough… enough?

“Drinking can seem innocuous or harmless. There’s no clear guideline as to how much you drink to be considered an alcoholic. Alcoholism has many definitions depending on the organisations you look at. But there comes a point when a person drinks more than he intends to for longer periods of time, when they find it difficult to cut down or stop when they know they should… so it basically comes with a whole heap of consequences,” says Dr. Winslow.  

He cites recurring worrisome behavioural patterns such as missing work, missing school assignments, difficulty maintaining time and scheduling structure, struggling to keep relationships at home and at work, the inability to think straight and make sound decisions are a few of the telltale signs that one has an alcohol problem.

Consumption of alcohol in excess can damage one’s physical and mental health, and unnecessary harm to others. 

The health risks include developing noncommunicable diseases such as liver diseases, heart diseases, and different types of cancers as well as mental health and behavioural conditions such as depression, anxiety and alcohol use disorders. It also causes harm to others, not just to the person consuming alcohol. A significant part of alcohol-attributable disease burden arises from injuries such as road traffic accidents. In 2019, of a total of 298,000 deaths from alcohol-related road crashes 156,000 deaths were caused by someone else’s drinking according to the same WHO report. Other injuries, intentional or unintentional, include falls, drowning, burns, sexual assault, intimate partner violence and suicide. 

The numbers are sobering. 

The Afflicted

Just like any substance addiction (alcohol is considered a substance), habitual heavy and binge drinkers can’t stop drinking because their lives revolve around alcohol – finding it, making sure they have enough money to buy it. There will always be an excuse to justify drinking.

Dr. Winslow succinctly illustrates it: “A lot of people working on alcoholism talk about the hijacked brain. They say you reach a certain point when you realise that the substance is addictive and it has taken over your brain or taken over parts of your life, when you think you want to stop but can’t … your brain has been hijacked already.”   

Can AUD be cured? 

“Definitely,” Dr. Winslow says. “Like any other behavioural addiction people deciding to be cured must first admit that they have a drinking issue. Once they’ve accepted there’s a problem  then they have to look into ‘What do I do?’”   

Admitting you have an alcohol dependence issue is just the first step. Doing something about it comes next, perhaps even harder than the admission part. You can seek help from a professional or someone who can guide you to look into your messed up life and put it back into place and, if needed, prescribe medication to stop drinking. 

Going to Alcoholic Anonymous meetings is another option. It has its benefits if you buy into AA’s beliefs. It’s a free system. It gives people the ability to model their recovery plan after those before them. It gives you a universal experience that you are not alone when you want to stop. The sharing part, hearing others who have gone through similar experiences, gives more encouragement knowing that if they can do so can you. When you’re fighting alone you’ll find alcohol is a stronger opponent. A relapse is lurking around the corner once you give in. 

Relapse is a part of any addiction disorder. One of the key features of recovery is detox or withdrawals. A relapse, going back to doing the same thing over and over again even if you don’t want to, can happen to anyone at any given time. 

“More often than not the people who don’t succeed are the ones who decide to run away or think it’s too difficult for them to continue. However, the recovery success rate is pretty high. About 75% for people who have assistance or help from professional therapists and those who are willing to examine their lives to be able to do all the things necessary to make changes, willing to follow maybe the Twelve Steps programme or any other form of recovery programme, group or individual,” says Dr. Winslow, who served as chief of the Addiction Medicine Department at the Institute of Mental Health (Singapore). He played a pioneering role in the setting up of the National Addictions Management Service (NAMS).

The Affected

While a chunk of our conversation revolved around alcoholics, I couldn’t help but think about the families who struggle just as much as their AUD afflicted loved ones.  

Anyone living with an alcoholic will tell you that mistrust, intimacy issues, mental and physical issues slowly surface and can lead to a relationship breakdown. Just like their life partners, they are often in denial of the changing behaviours they see taking place because they choose to remember what their partners were like before alcohol consumed them. 

Lies, deception, anxiety, uncertainty, difficulty in communicating, intimacy, feeling unloved and neglected seep through their daily lives to a point when the only way to save their sanity many pack up their bags and leave. 

“Unfortunately, alcoholics become duplicitous in a lot of things that they would say or do anything just so that they can continue their addiction,” says Dr. Winslow. “One of the things to learn for those who support their alcoholic loved one is not to support them in their drinking.” 

For example, the anxious wife resorts to lying about her alcoholic husband’s absence from work, giving excuses that he had a bad fall, a headache or some sickness. The lies pile up as days go by.  At some stage the wife has to take responsibility. She has to understand the illness of alcoholism or addiction and learn how to set boundaries and limits so she doesn’t get burned out or frustrated all the time, according to Dr. Winslow, who practices what he counsels his patients.

“I do have family members and really good friends who have alcoholism. It’s learning to set boundaries, to love them but not love the illness of alcoholism, to support them when they’re doing the right things and setting boundaries when they’re doing the wrong things and saying ‘No, I cannot accept that. This is not you. This is not the way that normal lives get lived’.” 

It’s okay for family members, especially partners, to say “I’ve had enough. If you want to kill yourself or end your life by drinking then that is your choice. I’ll make sure that for me and the rest of the family we will look after ourselves. But anytime you want help to stop the drinking we will be there to help you.” Harsh words maybe, but drawing the line could just be what the afflicted needs to jolt their alcohol-hijacked brain.

Carving A Path To Recovery

Having been a psychiatrist specialising in addiction since 1991, Dr. Winslow is now looking at establishing a recovery centre in Singapore, a first for the Lion City when it takes off the ground. 

“Promises Healthcare currently has two addiction psychiatrists and a team of nine addiction counsellors or psychologists taking care of over a thousand patients with alcohol and substance abuse,” he says. “We decided there are people whose lives are so messed up they need a time out to examine their lives, what they are doing, give themselves time for physical recovery as well because there are certain levels of damage in both thinking and functioning physically. We decided that we would like to help people by running a rehab and recovery centre in Singapore.”

There are many rehab centres across Asia. What Dr. Winslow and his team have in mind is to follow evidence-based practices and put on the best medical assistance in psychological and psychiatric care.

“We’ll treat patients as full people, which means that we don’t just treat you as an alcoholic but also look at all the other issues that are going on like relationships with family, work-life balance – all the other things that are needed to recover so that person can maintain the best possible functioning for himself.”

Moreover, the still-unnamed recovery centre will include a space so that Twelve Steps groups like AA can use it. There will also be counselling services for families and loved ones to help them make sense of what has been happening, which is crucial to the recovery of their alcoholic partner.

Recovery period varies in different people. But usually it takes months. People know that they are in a good journey of recovery when they have managed more than a year of sobriety. The first few months are the most difficult. The first 100 days are the times when there’ll be a lot of temptation, cravings because they haven’t learned enough yet about themselves or their addiction illness to be able to control themselves.

“Most rehab centres are modelled after the Minnesota or American treatment facilities. We’d like to see if we can also add Asian elements like care and concern for the family, aromatherapy and TCM [traditional Chinese medicine] to reduce stress and help people in their recovery journey,” Dr. Winslow continues.

Is there truth in the saying “All it takes is a drop”? 

“For people who are full-on alcoholics, yes. Remember how I told you about the hijacked brain? There is a neural part or loop in the brain which automatically tells you that you like this and then reinforces it. So alcoholics have a saying that ‘one drink is too much and one thousand not enough’. To a certain extent this is true because it takes one drink to start your alcohol-hijacked brain running again. I’ve seen it so many times. People sober for a year, two years, 5 years… and then they suddenly decide they’re no longer an alcoholic because they have not drunk for many years. They decide that it’s okay to be a normal person and go back to normal drinking. What they don’t realise is that for them there is no such thing as normal drinking because they don’t have a normal brain, they already have an alcoholic brain.” 

“Hi, I’m Jim and I’m a recovering alcoholic.” Eight simple words. It could take a year, maybe more, to reach this point.

Debbie | ws

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For more information: Promises Healthcare | Phone: +65 6397 7309 | Email: clinic@promises.com.sg