Would you take a pill to stop you craving ANOTHER glass of wine?
SEVEN o’clock: that’s meant to be the rule. Often, it’s 6.30pm — sometimes even 6pm — but never, I like to think, earlier. That is the moment I open the door of my large fridge in the utility room and select a bottle of chilled white wine.
My wife, Lynn, is an academic and is often away for work or not home until later in the evening. If she is home, she’s inseparable from her computer screen in her study.
So that first glass of wine feels like a friend, and another couple of glasses will keep me company as I cook our dinner.
Over the meal, we’ll share some red, too, so by the time I get to bed I will, invariably, have drunk a full bottle, if not a tad more.
This has been the case for more years than I care to remember.
I rarely drink anything else, but I rarely drink in the day and I am convinced I am not an alcoholic. But I would be a fool to deny that I have something of a drink problem.
While I do not get drunk in any obvious way, I am reliably informed that I can become annoyingly bombastic, a little intolerant and too quick to take offence after a glass too many.
The fact is that I am like tens of thousands of late middle-aged men (and women) in the UK with a wine habit. I bet a fair proportion of us are dealing, as I am, with the loss of purpose and companionship that comes with retirement — I am 69 and, for decades, travelled the world as a radio journalist.
On one hand, wine represents pure enjoyment and reassurance, and I cannot imagine living without it. But on the other, it causes me serious rows with my wife, who thinks I am blind to its possible impact on my long-term health.
It also costs me lots of money — and, so the Government bends over backwards to tell me, will cost the nHS lots of money in the future if I do not cut down.
‘You gave up smoking — surely you can give up the booze?’ people say to me, pointing out that nicotine is more addictive. But the two are not comparable. One is all about sociability, while the other is close to becoming the preserve of social pariahs.
There seems to be little doubt 20 cigarettes a day are more likely to kill you than a daily bottle of red wine. And, in any case, no one has come up with a wine-replacement gum.
So detox programmes, aimed at abstinence, never seemed relevant, and I never seriously tried to cut down.
But what if there was something that could help me drink less?
eighteen months ago, I thought I’d found just the thing: a new drug called Selincro that was said to reduce one’s desire for alcohol.
It doesn’t make you ill from drinking (unlike Antabuse, the drug given to treat alcoholics), just dulls the need.
MADE by danish pharma company Lundbeck, it is an ‘opioid receptor antagonist’ — it works on the reward mechanism in the brain to take away the pleasurable effects of alcohol.
After going through all the necessary phases of clinical trials, Selincro has been approved by the national Institute for Health and Care excellence (nICe) for use by the nHS as a treatment for reducing alcohol dependence. nICe is known to be a strict gatekeeper when it comes to approving new drugs, therefore it must work.
So, not long before Christmas 2014, feeling a touch self-satisfied that I was doing the ‘right thing’, off I went to see the GP.
I made an appointment with a doctor I’d never met before — not ideal when dealing with a sensitive personal subject, but it is what we now have to accept as the norm. Courteous enough, he agreed I was drinking too much, but was entirely unsympathetic to my request for Selincro. He claimed ignorance of the drug and insisted dealing with problem drinking was a question of character, not of chemistry.
‘don’t expect a pill to do the work for you,’ he said, his finger wagging away. It is a phrase I was to hear all too often over the next few months.
My next step was to see another GP at the same practice whom I had known, and liked, for 25 years.
But my request fell on equally reluctant and moralistic ears.
even though I’d seen him recently at a social event with a large glass of red in his hand, his first response was to suggest I give up booze entirely. ‘don’t expect a pill to do the work for you,’ he added, the finger again wagging away.
He also said that nICe’s guidelines for Selincro made it necessary for me to sign up for ‘psychosocial counselling’ with the local substance misuse service.
This I did — though, I admit, with great reluctance — and, a few weeks later, found myself talking in the most banal terms to a pleasant enough woman about my drinking and why I wanted to cut down.
I am all in favour of proper psychotherapy, but this poor relation counselling stuff can be infantilising. My ‘counsellor’ was not, it seemed, entirely opposed to Selincro, but she was uncomfortable talking about it.
And of course she reached for what I was beginning to recognise as an obligatory phrase for anyone in the local nHS dealing with these problems — ‘don’t expect a pill, etc, etc’. I do not remember now, but I imagine her finger was wagging.
We made an appointment for a fortnight later and she gave me some literature to read.
I was incensed by it. It was all about total abstinence detox programmes and how, if I followed one, I would start to feel ‘more healthier’. Is it snobbery to question the advice of a service that uses such a phrase in print?
I never saw my substance misuse counsellor again. By the time of our next appointment, the service had been privatised.
She herself had not been kept on, and she failed to pass on my details. I was never offered an appointment by the new ‘provider’ and, when I later inquired about this, it said that it was ‘looking at what its psychosocial counselling intervention will look like’. In other words: it didn’t exist.
So this privatisation meant the finger-wagging detox wallahs down at the surgery were off the hook. even if they wanted to, they couldn’t prescribe Selincro.
The more I read about the drug, the more furious I felt about my local nHS’s attitude towards it.
THE pill’s whole raison d’etre is to provide an alternative to the detox route, and clinical trials suggested it could reduce an individual’s consumption by up to 60 per cent after six months’ treatment.
The pressure group Alcohol Concern deemed its introduction ‘a useful addition to the clinician’s toolbox’, while Jonathan Chick, a consultant psychiatrist and honorary professor at Queen Margaret University in edinburgh, said the drug ‘would help people cut down drinking when they have no medical need to give up alcohol altogether’.
As for the mandatory counselling, one will soon be able to do it to oneself — the manufacturer has revealed it is developing an online ‘psychosocial support tool’.
Like any drug, there can be sideeffects — most commonly an initial period of nausea and insomnia. But most accounts say this passes quite quickly, and that the desire to drink is definitely weakened.
Selincro’s only real threat is to the finger-wagging industry.
For my part, I suppose I could have gone online and bought Selincro at £3.48 a pill. But you still have to get a prescription and submit yourself to a ‘consultation’.
Besides, I never really feel safe getting medication from a website, rather than a qualified person.
And, in any case, I have since followed a different route to cutting down on my drinking.
Firstly, I sought help from a private psychotherapist to make me less anxious and fearful about where I am in life and to develop positive strategies for what might lie ahead.
She has helped me to understand why I turn to drink, which, in turn, makes it easier not to.
Secondly, we got a dog. She’s a poodle/border collie cross called Tallulah and is now 18 months old. She’s had no training as a counsellor, but somehow does a great job.
She can’t see the point in getting up in the morning without a clear head and she hates a raised voice.
I have now almost halved my wine intake but, if I find that my strategies start to fail, then I will certainly consider looking to Selincro again.
I just have to hope that, for a change, my local nHS will treat me as a grown-up.