It was in the middle of a bender at Berlin’s world famous nightclub Berghain that Alex*, now 31, realised he was out of control.
At the time, he was 25 and regularly drinking until he passed out. Thousands of people make the party pilgrimage to the former power station every weekend to dance to electronic music and briefly lose themselves. For Alex, that weekend in 2012 was a crucial wake-up call that, potentially, saved his life.
“I started drinking at 16 - the same time I came out as gay,” says Alex. “I thought I needed alcohol to be the person that I wanted to be. When I wasn’t drinking, I was very anxious. I didn't think I was an alcoholic because I had these type of 'rules': I'd eat salad, go to the gym every day, and hold down a good job. I didn't drink in the morning - unless - I hadn't been to bed.”
Despite making these 'rules' for himself, the warning signs were present that Alex's relationship with alcohol was having a negative impact on his life and his health. His messy benders were becoming more regular, and he had even started turning up for work still drunk.
He increasingly felt like he couldn’t function without booze - whether that was on a big night out or during a quiet dinner with friends. And he regularly found himself out trailing the streets looking for somewhere he could still get a drink long after his friends had gone home.
"I developed a constant aching pain in my side," he says. “But I convinced myself that it was a pulled muscle from the gym.” He'd been to see a doctor six months before going to Berlin, but, once they started talking, Alex says he was "so embarrassed" he ended up asking about the symptoms of liver damage "for a friend". When the doctor said that, yes, what he was describing did sounded like liver damage, Alex cut the appointment short before being examined – and left.
Trapped in a state of denial, Alex carried on drinking, but that weekend, in the middle of the club surrounded by sweaty ravers, he says, “everything hit home”. He’d been drinking and taking drugs for three days straight, the hot ache on his right hand side was impossible to ignore, and he could no longer deny the emotional turmoil he was feeling. “I’d lost control,” he says. “I had become a stranger to myself; my entire life had started to rotate around drinking."
When he got back to London, he went straight to his nearest Alcoholics Anonymous meeting. A friend, who happened to be a doctor, also expressed his opinion that it was likely that he was suffering with the early stages of liver disease, which can led to the fatal condition known as cirrhosis. This occurs when the liver becomes damaged by the chemicals in alcohol, which stops it from doing its job of clearing the body of toxins. The throbbing pain in his side was a red flag that this was something far more serious than a pulled muscle.
His friend told him to stop drinking immediately, which he did. And, although it wasn't easy, Alex says the the support of AA helped, although he is aware that it doesn't work for everybody. Horrified and ashamed that he had been ignoring his health for so long, Alex also says he knew subconsciously that his drinking was an issue. "It was only when I started going to AA that it really hit me. I’d been damaging my friendships and family relationships.”
The troubling thing about Alex's story is how relatable elements of it are. How many of us have had a boozy night out, taken things too far, felt hideous the next day and, maybe, even carried on? How many of us have then joked about “hair of the dog”? How many of us have woken up with a hangover and not remembered what happened, perhaps finding the only clues are a smashed phone screen and a cab receipt we can’t bring ourselves to look at?
But at what point does wanting another drink start to take its toll on our bodies and bank balances - and become an addiction?
Dr Ben Sessa, a psychiatrist and drug researcher, says that it’s difficult to define alcohol dependence because how our body and brains react to sustained heavy drinking depends on many things, including our stature and genetic make-up. “Some people can drink a bottle of vodka every day and not experience the symptoms of dependency, while others can drink three pints a day and experience them,” he says.
In Britain, alcohol is ubiquitous. Sometimes, it’s even a rite of passage with getting totally wasted and pushing the limits of your body cast as an accepted part of growing up.
You might be thinking - “but we keep hearing that younger people are increasingly going off booze, right?” And, while it’s true that where once we read headline after headline lamenting "binge drink Britain" and the fact that excessive drinking appeared to be more widespread among young women, now we are just as likely to see articles about how young people are increasingly rejecting alcohol. The number of 16 to 24-year-olds who do not drink increased by 11% between 2005 and 2015, meaning that around a fifth of young people today are teetotal.
But, amongst Generation Z’s slightly older peers, millennials, who are currently in their late twenties and early thirties, there has actually been a sharp rise in cases of cirrhosis in recent years. Last year, Public Health England described chronic liver disease as a “silent killer of young adults”.
This is something that 29-year-old Amy, knows all too well. Last February, her sister Carys died of complications associated with liver disease just before she turned 28. “It really shocked me how quickly she deteriorated,” Amy says. Carys started drinking seriously in her early twenties after a break up at uni, says Amy, and it slowly spiralled out of control.
Amy isn’t sure exactly how much her sister was drinking, but says it was “way above the recommended amount”, and adds that she would “put alcohol in fizzy drink bottles and hide her empty bottles from us".
During her mid-twenties, Carys went to rehab on more than one occasion but she wasn’t able to stop drinking. Her liver damage gradually worsened until, one-by-one, her organs started failing. “Two years before she passed away doctors told us that she was terminally ill,” says Amy. “They said nothing could be done to save her and told us that, going forward, it was just about managing her treatments.”
In the end, Amy says, Carys died in her sleep. “Her heart just stopped; it gave up because her organs were too weak.” But the two years leading up to this moment were not so peaceful.
Dr Sessa has noticed an increase in the number of young people with alcohol addiction at his practice, and believes the problem lies with a lack of public education around the perils of drinking, and the fact that alcohol is cheaper and more accessible than ever. “When I was growing up, you couldn’t get booze easily. Now it’s in every petrol station and corner shop,” he says. “People can buy six-litre bottles of high strength cider for £1.99 or multiple bottles of wine for a tenner."
It’s hardly surprising, then, that though young people say they drink less often, it seems that when they do drink, they do it to excess.
Last week, this issue hit the headlines again with the inquest into the tragic death of first-year Newcastle university student Ed Farmer, who died from the "toxic effects" of drinking excessive alcohol on an "initiation-style" bar crawl.
Dr Varuna Aluvihare, a consultant at King’s College Hospital’s Institute of Liver Studies, says that he’s noticed a similar trend. His clinic is “increasingly assessing people with irreversible liver damage in their twenties and thirties. It’s a disease that, until recently, we mostly saw in people in their fifties and sixties.”
Dr Aluvihare explains that our liver, which recognises alcohol as a poison, contains enzymes that convert alcohol into other chemicals, including one toxic substance called acetaldehyde. “If you stop drinking as soon as you experience inflammation, forever, your liver can recover," he says. "But, the more you drink, the more toxic substances are made resulting in permanent damage to the liver and DNA."
Unlike Alex who managed to recover from the early signs of liver disease through abstinence, Amy's sister Carys sadly developed cirrhosis. However, she was not eligible for a transplant because regardless of how unwell a person is, the NHS will only consider a liver transplant for people who have developed complications of cirrhosis despite having stopped drinking - and Carys hadn’t stopped.
Towards the end, Carys was in and out of hospital. “She got weaker, her liver and kidneys were no longer functioning and she was jaundiced,” says Amy. “She was so lethargic and suffered internal bleeding, which was obviously very scary for all of us.”
Studies have found alcohol is more likely to cause chronic liver damage in women because they are generally “smaller in stature” and have “less body water”.
Despite this, Amy says most people didn’t realise the severity of Carys’ situation because she was so young, had gone to a good uni, and because she had a stable family. “People would think we were making a big deal out of it. My friends would say things like, ‘Oh she just had a big night out’. They didn’t understand that she was an addict”, she reflects.
Amy is still grieving. “Our parents used to call us ‘the girls’ because we were so close in age and I feel like part of me is missing now.”
Dr Sessa says treating alcohol-related liver disease is about more than simply tending to the physical symptoms. “Alcohol acts on the brain to dampen and depress thoughts, emotions and behaviours,” he explains “this creates a pleasurable, soporific effect.” It is this effect that can be so appealing if you’re self-medicating with alcohol. “For me, alcohol became a way of not feeling anything,” says Alex. “Once I stopped drinking, all the emotional stuff I’d been pushing down suddenly surfaced.”
It’s dangerous because, regardless of why you’re drinking, if you drink regularly – every day – Dr Sessa explains that the “brain and body will build up a tolerance to the drug, which means higher doses are required to get the same effect".
According to both Alex and Amy, there is a stigma that surrounds alcohol addiction that urgently needs to be addressed. “There's a real lack of sympathy surrounding being an alcoholic,” says Amy. “Even though my sister was desperately ill, I didn't feel that I was able to share her illness with the people around me. I quickly learnt that if I opened up about it, people were eager to judge, which only made an already difficult time harder, so I stopped talking about it."
Adds Alex: “The issue is that people don’t question drinking in the way they question other things. There’s a huge conspiracy of silence surrounding it."
Comparing Instagram photos of himself before he stopped drinking with images of himself now, Alex notes: “I looked like a corpse. I just don’t know how I didn’t see it.”
Now that Alex is sober, he says he no longer feels the intense pain in his side, but he is yet to find out the current state of his liver. He’s hopeful that since he quit drinking the cells will have started to repair themselves.
Both Amy and Alex say that their experiences of alcohol addiction and its effects have completely changed the way they see drinking. Amy is not an alcoholic, but she doesn’t drink unless it’s “a glass of wine at a work function” and, even then, it’s a rare occurrence. “I think there’s a huge awareness of the dangers of smoking - because of the pictures of diseased organs on packets and the smoking ban - but I don’t think people see or understand the impact of alcohol abuse, unless they’ve seen it first hand."
So where does the solution lie? With increased awareness of how addictive alcohol can be? With challenging our perceptions of who an alcoholic is and what they look like? With more real talk about the physical and emotional repercussions of drinking?
Amy also thinks people need to “be more aware of addiction as well as the physical dangers of alcohol”, and says she is “sharing Carys’s story because people need to know.”
For Alex, it's about keeping the mental health conversation around alcohol abuse going. “There is still some shame when it comes to talking about our emotions, for men especially," he says. "I think alcohol gives you the illusion of being connected to other people - regardless of whether you’re an alcoholic or not. But for some people it goes too far and becomes an addiction. Addicts tend to be unhappy people, and unhappy people can behave badly. I think that’s part of the problem. People don’t understand that and it makes them unsympathetic.”
It’s been six years since he last tasted alcohol. “I genuinely think I would be dead if I hadn’t stopped drinking,” he says. “My experience shows that once I start drinking, I can’t stop - and that leads me to a very dark place. While I now know that addiction is a disease, that’s not what keeps me sober. I’ve stayed sober because my life is just so much better without alcohol. I can’t even put it into words how much I want to keep it that way.”
*names have been changed to protect identities
For help and support with alcohol abuse, click here
This article was originally published on 30 October 2018.