Living in the grip of alcohol
Concerns are growing for former England footballer Paul Gascoigne who has been struggling with an addiction to alcohol.
The 45-year-old was shaking and slurred his words on stage at a charity event in Northampton on Thursday and his agent, Terry Baker, says he now fears for Gascoigne's life.
Alex Best, widow of football legend and recovering alcoholic George Best who died in 2005, is also concerned.
She told The Sun newspaper: "Seeing Gazza in such a bad way brings back the most horrible memories of George when he was in the grip of the drink that eventually killed him.
"It's heartbreaking to see Paul so deeply gripped by his addiction again."
End Quote Julie Rogers Substance misuse manager
Relapse can be part of recovery. That's when they really learn to move on. I've worked with people who have relapsed 20 or 30 times and have got there in the end”
NHS figures suggest nine in every 100 men and four in every 100 women show signs of alcohol dependence.
Drinking alcohol becomes a focus in daily life, meaning the person no longer has control over their drinking and depends on it to get through the day.
You don't necessarily have to be rolling around drunk to have a dependency on alcohol - people may be able to hold down a career and drink in a way that is damaging.
Dependency mean you are physically and psychologically tied to booze - you feel compelled to drink and this takes its toll on your physical and emotional health.
Julie Rogers has been working in the addiction field for 12 years, helping people who are hooked on alcohol.
Ms Rogers, who works with the charity Foundation 66, says problem drinking is a complex and incredibly difficult behaviour to break. No two people are the same and there is no single approach that is guaranteed to work.
"Alcohol addiction does not have any boundaries. It affects all types of people alike. It doesn't matter if you are wealthy or poor.
Warning signs of alcohol dependence
- Worrying about where your next drink is coming from and planning social, family and work events around alcohol
- Finding you have a compulsive need to drink and finding it hard to stop once you start
- Waking up and drinking - or feeling the need to have a drink in the morning
- Suffering from withdrawal symptoms, such as sweating, shaking and nausea, which stop once you drink alcohol
"And there are so many different reasons why people drink. But the thing they do have in common is that, for them, alcohol has become more than just a drink.
"It becomes something that you need to do to cope and get through. That's when it becomes a problem."
For some, the trigger is stress or anxiety - a demanding job or a traumatic divorce, for example.
She said for others it is a learned behaviour - something they have been exposed to during their childhood and have grown up to follow the same path.
Genetics can also make some people susceptible, experts suspect.Breaking the cycle
Regardless of the cause, the first step to tackling addiction is the same.
Ms Rogers said: "Recognising you have a problem and then seeking help is the first step.
"It sounds simple but, in reality it's not. It can be hard to admit you have a problem and actually do something about it."
The former Newcastle, Tottenham and Lazio player has tried hard to fight his addiction, spending repeated spells in rehab over the last decade.
- Short term health risks include alcohol poisoning and accidents and injuries
- Long term health consequences include an increased risk of heart disease, stroke, liver disease (which can cause jaundice), pancreatitis and certain cancers
- Drinking too much can also affect your relationships and your ability to hold down a job
- It can lead to anxiety, depression and suicidal feelings
Gazza's drinking problems started during his playing days.
In 1998, shortly after his divorce from wife Sheryl, he was admitted to the The Priory Hospital in Marchwood, near Southampton, to receive treatment for stress and drink problems.
In 2001, whilst playing at Everton, Gascoigne admitted himself to an alcohol rehabilitation clinic in Arizona on the insistence of his then manager Walter Smith.
Four years after retiring, in 2008, he was arrested in Newcastle and detained under the Mental Health Act and was later sectioned following reports that he was acting strangely in Hemel Hempstead.
More recently he has been treated at The Priory again and the Providence Projects treatment centre in Bournemouth.
Ms Rogers says relapses are incredibly common, and they shouldn't be seen as a failure.
"It's important that we do not judge relapse because that just compounds the shame and guilt people feel about it.
I took my first drink in my early teens. There were consequences from my drinking from the beginning, very small at first: arguing with friends, turning up late for social appointments, losing keys, urinating in alleyways, and general behaviours I would not engage in when I wasn't drinking. As I reached my 20s I had destroyed a marriage by now, and I was well on that alcoholic slippery downhill slope. I was starting to lose jobs as I could not be trusted to turn up for work. Into my 30s, my drinking very subtly but progressively got worse; the dry spells between my binges got shorter and shorter. I had started too waken up in strange places and also in A&E hospitals and couldn't remember how I got there. The last 10 years of my drinking, I had tried many avenues of escape in order to stop drinking completely and failed every single time. At 40 years old I was truly beaten by alcohol. I had heard and of Alcoholics Anonymous (AA) and had visited AA meetings in the past but nothing else, I would visit and then leave and eventually always drink again. I did not know what it was to be an alcoholic, and I had not fully admitted to myself that I was an alcoholic. Now, through AA's 12-step recovery programme, I have a productive, contented life with complete abstinence from alcohol.
"Relapse can be part of recovery. That's when they really learn to move on. I've worked with people who have relapsed 20 or 30 times and have got there in the end.
"Even if it is your thousandth relapse, it can still be the last. It's important not to give up."
She said in order to break the cycle some people need to hit a critical point where it's "stop drinking or die".Help on hand
But for others, abstinence is never an option.
Instead, they might work towards curbing their intake, even if it means they are still drinking far too much for good health.
"Some people reduce the harm rather than stop drinking.
"Some relapse every few months but still lead a fulfilling life. Even if you get a month of sobriety at least it's a month."
She said there is plenty of help available to anyone struggling to keep their drinking under control.
"Your first port of call should be your GP who can direct you to your local alcohol services."
Support may include home-based and community detoxification programmes, counselling and group work.
Friends and family also have a role to play.
Friend and former England player Alan Shearer has said: "It won't be easy, but he [Gazza] needs to dig deep and find the energy and the will to do it.
"What he needs to know most of all is that he is loved."