Women and alcohol

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Think about the image of an alcoholic. A late middle aged man perhaps, unshaven, asleep in a shop doorway with his empty bottle by his side. A couple of scruffy looking individuals sitting on a park bench each with can of strong lager. The truth is that alcoholics, or problem drinkers come from all walks of life. 

Nowadays, women are just as likely as men to have problems with alcohol. Increasingly women are using alcohol just as their male counterparts do. They may be juggling the demands of stressful managerial positions with running the home and looking after the children.

How many of you reading this will be looking forward to cracking open that bottle of wine? Whether we are cooking, sighing a collective sigh having just got the children to bed, trying to come down from 40.000 feet to relax at the end of the day. Or whether we are just enjoying a glass of wine or two over dinner at home. Having is drink is such a part of our culture.

In my private practice I see women from many different backgrounds and from all walks of life and help them to overcome addiction to alcohol. There are many reasons why women drink to excess. Naturally, how much you drink will depend on a number of factors; Personal circumstances, upbringing, family background, genetic make-up, family and friends’ drinking habits or just simply lifestyle. When it comes down to it alcohol gets a lot of bad press, but it has probably been used as a self prescribed “medication” for as long as it has been used as a vehicle to have fun. Whether it used as a painkiller, tranquilizer, sleeping draft, a relaxant or something to provide dutch courage, it has many uses. Many of the women I see drink as a way of coping with stress or to block out painful emotional issues and give themselves a lift. The downside though, is that alcohol can only provide short-term relief as it will in the long-term magnify depression and anxiety. Many people use alcohol to assist with sleep and while it may help you to get off to sleep, the result will be poor quality and often broken sleep.

Because women are generally smaller than men their capacity to drink is less. The major organs too, are smaller. The stomach, intestines and in particular the liver which plays a major role in breaking down alcohol, is also smaller. The result is that alcohol concentration in the body tends to be higher than that of males consuming the same volume. Also the effects of alcohol will also be much greater during menstruation and in the premenstrual phase as it takes longer for the body to break down alcohol. Taking oral contraception may also have a bearing on the ability of the body to break down alcohol.

The other big downside is that alcohol is very high in calories and can lead to weight gain. But even more worrying is that being inebriated can put women at risk of dangerous situations that ordinarily they could avoid. The risk of accidents is greater as is the increased risk of health problems. Heavy consumption can lead to cognitive impairment, liver damage, eyesight damage, stomach problems as well as increases to blood pressure, which may also lead to heart disease, strokes and certain types of cancer. Some research even links increased alcohol consumption to increases in breast cancer. Families too, can be ripped apart as a consequence of alcohol. From arguments to assault, excess drinking can have a major effect on family relationships.

If you want to get your drinking under control, here are some useful tips:

  • Keep a diary. Over the course of a week keep a note of the amount and type of alcohol you consume (one unit of alcohol is roughly the equivalent to half a pint of ordinary strength beer, one single measure of spirits or one small glass of wine). This will show how much you are drinking and when.
  • Switch to lower strength alcoholic drinks over several weeks and record your success.
  • Sip your drinks, don’t “glug.” and do not try to match other people drinking. Slow down and put down your drink between sips.
  • Deliberately have a fruit juice, coke or other non alcoholic drink between alcoholic drinks.    
  • Add into your week some other activity such as swimming or jogging and explore ways to relax and socialise which do not include drinking alcohol.
  • Set a drinking goal and limit the amount you drink. For example one alcoholic drink per day if you are a woman, or two drinks if you are a man.
  • Eat before you drink as food will help to absorb alcohol. Eat before you go out for the night and have a good meal first. Snack while you are drinking.
  • Have at least one alcohol free day per week, ideally two. This will give your liver a chance to recover.

If you are concerned about your drinking and would like help, talk to your doctor. Alternatively, find out if there is a local voluntary agency who may be able to provide you with counselling and support you while you take steps to reduce your drinking.

Here are a number of voluntary agencies specialising in providing advice and support:

www.action-for-change.org

www.alcoholics-anonymous.org.uk

www.ncadd.org

www.niaaa.nih.gov

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

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How to overcome social anxiety

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Do you feel overwhelmed with shyness, fear going to parties or gatherings where you worry about meeting people? Are you afraid that they will be judging you or find you boring? Do you freeze at the thought of talking to others and feel sick at the very thought of social contact? If so, then you may be suffering from social anxiety.

Social anxiety or social phobia as it is also known can be very distressing and have a major impact on quality of life. Perhaps you long for a boyfriend or girlfriend, but find talking to a member of the opposite sex makes you feel so self-conscious? Or dread the thought of going to work each day, just in case you are asked to lead a meeting. Maybe just walking down the street is enough to make you feel embarrassed or awkward.

Whatever it is that you fear, it is possible to overcome it.

Do many people suffer with social anxiety? 

The answer is a resounding yes. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) it affects somewhere between 3% and 13% of people. It affects both men and women, but is more prevalent in men.

What symptoms might I experience?

Essentially there are three main components of social anxiety – physiological (bodily), cognitive (thoughts) and behavioural (actions).

Physiological – Typical symptoms are those of anxiety, but in particular sufferers may sweat profusely, find themselves blushing, shaking and experience a dry mouth and sometimes inability to speak.  Often they will be aware of increased heart rate, shortness of breath, loss of appetite, dizziness, upset stomach, shaking or trembling.

Cognitive – Symptoms include fear of being judged, saying something wrong or being the centre of attention. Often sufferers will have thoughts and feelings of inadequacy.

Behavioural – Here sufferers may find that they cannot do things they normally would be able to. For example, carrying a cup filled with tea across a room without shaking, or talking to people fluently.

What causes social anxiety? 

There can be many reasons why people become socially anxious. Often it starts in childhood perhaps brought about by being bullied, teased or ridiculed. Sometimes child abuse and humiliation can underpin symptoms. Sometimes stressful life events can provoke it. I commonly see teenagers who come to me when it starts to interfere with their lives. Perhaps they have decided they have had enough of being a recluse, or avoiding situations that others are enjoying such as parties or social gatherings and now want to do something about it.

Why won’t it just go away?

Often one of the things that people with social anxiety tend to do is avoid. This tends to make the problem worse. Avoidance of places or situations where you fear you will make a fool of yourself, making excuses and turning down social invitations leads to isolation. Not doing things leads to a lowering of confidence and self-belief. We miss out on opportunities to learn the skills needed to communicate with people, friends stop asking us out (or may never ask us out) and we begin to believe our negative thoughts about ourselves. Sometimes people avoid talking to others, other than at a very superficial level and engage in what we call “safety seeking behaviours.” 

What are safety seeking behaviours? 

These are actions we engage in, because we believe they will help us. In the very short term they might, however, they are simply ways to avoid (the very things we need to face). Examples include:

  • Wearing a baseball cap with peak turned down over eyes
  • Wearing sunglasses
  • Letting hair fall across face
  • Avoiding eye contact
  • Avoiding conversation with people
  • Reading a book or newspaper to avoid having to talk
  • Listening to music with ear phones to avoid having to talk
  • Tidying up at parties and keeping on the move
  • Crossing the road to avoid people
  • Never answering the phone

What you can do to help yourself

There are three key areas that you need to tackle to overcome social anxiety. If you successfully face your fears by addressing the following, then you will overcome your difficulties – promise.

  1. Focus outwards not inwards.
  2. Change the way you think.
  3. Act differently, behave differently.

Canadian psychologist Danny Gagnon offers a selection of useful tips to overcome social anxiety: 

  • Change the way you think, dropping ideas like “I have to say something intelligent all the time” or “I want to be funny” just before talking to someone. Such criteria are really unattainable. After all what does intelligent or funny mean? This is just unrealistic and sets us up for pressure and fuels performance anxiety. Instead make the goals more achievable, clear and measurable. For example, “I will go somewhere where there are people joking around and laughing” rather than “I want to be funny” or “I will speak to two new people.” 
  • Anxiety is normal, everybody experiences some anxiety before an important meeting or presentation or when meeting someone for the first time. Zero-percent anxiety is unattainable. So accept that you will have some anxiety, safe in the knowledge that anxiety usually decreases once you start presenting or talking.
  • You may be putting yourself under a great deal of pressure to appear interesting to others and not boring. Stop trying to be “interesting,” instead try to be “interested.” People like talking and being listened to. Relieve your social anxiety by being interested. Keep the following question in mind when socialising: “What can I learn about this person?”
  • You may worry about having poor social skills. Well don’t! Research has shown that when you factor anxiety levels in, there is actually no difference between people who report social anxiety compared to those that do not. So remember, your social skills are as good as the next person’s.
  • Next time you are at a social event or have an interaction with someone, don’t ruminate afterwards. It is very common for people with social anxiety to keep going over and over the events afterwards. There will always be room for improvement, just as there will always be something we could have done better. That’s human nature! Stop being yourself up and tell that critical inner voice to go away. By all means reflect a few times, but then let it go.
  • A key component in the treatment of social anxiety is to shift the focus outwards and not inwards. Imagine if you were on stage with an audience of twenty and the spotlight was suddenly put on you. There is a very good chance your anxiety would sky-rocket. If you focus on yourself when socialising your doing just the same, putting yourself under the spotlight. All  those anxious thoughts, “What should I say? How do I feel? Will they notice me trembling? Will they laugh at me?” just serve to shift the focus inwards. So next time you find yourself focusing on yourself or your thoughts, try to shift your focus outwards and redirect it to what the other person is saying.
  • Challenge and change your negative inner self-talk. For more information on this particular topic, visit my October 12 blog – “Self- Criticism.”
  • Begin to tackle the problem by facing it, gradually facing your fears one at a time. This is known as “exposure therapy” and it involves challenging yourself to face anxiety provoking situations, starting with the least anxiety provoking first and then moving onto the next in a series of steps. It is important not to skip steps and to take the next step only when you are ready. Danny has more information on his website about this.
  • Take risks, face your fears by testing them out. It is very common for people with social anxiety to be afraid of embarrassment or humiliation. In our minds we tend to exaggerate how difficult situations will be, this is very normal. However, testing out our worst fears holds the key to overcoming them. Try this as an experiment, grade yourself on an imaginary 0-100% embarrassment scale, with 100% representing absolute maximum embarrassment. Go into a shop, choose a magazine and pay for it. When you have left the shop return and say something like, “I just bought this for my Dad when I remember he bought it yesterday, May I exchange it please?” Alternatively, you could ask a stranger for the time or go into a shop and ask for directions. Again rate yourself on the embarrassment scale and you will notice if you repeat this experiment several times your anxiety is likely to diminish as you do so. 

I hope you find the information helpful. If you require further advice you should discuss it with your GP who will talk to you about treatment options and local services. Alternatively feel free to drop me a brief email via our website contact page and I will respond as soon as I can.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

www.stevecliffordcbt.com

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