One example Jernigan supports: “France’s Loi Évin, which is a just-the-facts approach to advertising, without lifestyle features.” France passed this law, named for its then minister of health, Claude Évin, in 1991: advertisers may not use images of drinkers or depict a drinking atmosphere. Only the product is advertised—a refreshing approach.
In Canada, the national broadcast regulator used to review all alcohol ads. Since 1997, guidelines have been essentially voluntary. However, much of what is seen by young people does not qualify as traditional advertising. And there is no policing of YouTube or Facebook. Says Jernigan: “Social media is all about engagement, and it’s all unregulated. Marketing through social media is so cheap, and it’s so targeted. Tobacco companies have been forced to restrict their activities there—the alcohol industry should take a page out of the tobacco books before someone else takes the page out for them. If it’s going to police itself, then police itself. Right now, the industry has set the agenda, and it’s a race to the bottom. It’s public health’s job to set the floor. At a minimum, I would say to the industry: do no harm. I would ask them to refrain from digital marketing, and I would not let it be voluntary. We have a natural experiment happening—and it’s gendered.”
Beyond the three key levers of change, there are many other endeavors that could have an impact on how we view and consume alcohol. One excellent idea: annual report cards at the national, state, and local levels, using common indicators to measure acute and chronic alcohol-related harm: alcohol-related assaults, emergency room admissions, morbidity, family violence rates, impaired driving charges, outlet density per capita, and more. Jurisdictions need to monitor the impact of harm to others. Taking this tally is key. “FAS or FASD is just one example of harm to others,” says Rehm. “Drunk driving—which is typically a male problem—is another. Ethically, morally, the point of both is that no matter your politics, there is a certain responsibility concerning your impact on others. There is no freedom or right that an individual has that will excuse harm to others. If you agree with that, it follows that any kind of measurement is a top policy item.”
With respect to treatment, countries need to fully endorse and invest in an integrated strategy. In North America, only 10 percent of those with alcohol dependence issues end up getting treatment help. In Europe, the figure is closer to 8 percent. Of course, not everyone with an alcohol problem needs treatment: Rehm estimates that 40 percent would be ideal. We need significant, targeted reinvestment in addiction services, addressing the vast gaps in availability and accessibility, with special attention to isolated, rural, and remote regions and vulnerable populations. Primary care needs to do its part, but that’s just part of the puzzle. A broad spectrum of tiered and networked services is imperative—and an excellent investment. “The potential is there now, with the Affordable Care Act,” says Susan E. Foster, vice president and director of policy research at the National Center on Addiction and Substance Abuse at Columbia University in New York. “We know that two-thirds of people in prison meet the criteria for addiction, and only eleven percent in the criminal justice system get any sort of care. There is a giant disconnect here. Addiction is not a moral failure—in most cases, it’s a developmental disorder. It’s a complex brain disease, and it’s treatable.”
At the same time, we need to expand each nation’s capacity to do screening and brief intervention. In the past two decades, studies have shown that early intervention yields extremely beneficial results. Systematic access to screening and brief motivational interviews should extend to all emergency departments, university health clinics, public health sites, and other points of contact. Short in duration, these can be handled by a primary care practitioner, a nurse, a social worker, or any allied health professional. The challenge? Pressed for time, many frontline doctors feel too rushed or ill-equipped to screen for alcohol.
On the drunk-driving front, random breath testing is the future. Says Andrew Murie, CEO of Mothers Against Drunk Driving Canada: “It’s largely a male crime—females make the mistake of agreeing to be passengers. They could be a major influencer on male behavior.” In 2009, 38 percent of all Canadian road deaths were alcohol-related. In Sweden—which has random breath testing, and where the legal blood alcohol limit is .02 percent—the percentage of road deaths due to impairment sits in the low 20s. Says Murie, “Canada and the United States need to catch up with the world.” Practiced in Australia, New Zealand, and many European countries, random breath testing—or compulsory breath testing—means that drivers are required to take a preliminary breath test, even if there is no suspicion of an offense. “It’s now been more than five years since Ireland adopted random breath testing,” says Murie. “And the amazing thing is: deaths due to impaired driving are down fifty percent since it came into law in 2006. People have got the message, and changed behavior. That’s an incredible story: it saved lives—as well as valuable judicial resources and money in the health-care system. Australia has had random breath testing for thirty-plus years, and they have maintained those savings. They just shake their heads at us.”
Finally, we need to invest in sex-specific, gendered research. We’re just beginning to understand how differently women respond to alcohol. Historically, women have consumed less alcohol than men, and for that reason, we have considered them less at risk. Alcohol affects women’s bodies differently. We need to use sex-specific criteria for calculating its effect. We need to reframe the research agenda on this subject. Says Rehm, “We do seem to have losers and winners in the trends, and women seem to be the losers in alcohol-related harms.”
We know that alcohol affects women’s brains differently than men’s. We must continue to pursue sex-specific biological research. Says Nancy Poole, director of research and knowledge translation at the British Columbia Centre of Excellence for Women’s Health, “One of the things we need to understand is the coexistence of depression and drinking in women: how drinking and depression fit together—we know they are linked. How do tobacco and benzodiazepines fit with drinking? What is the integrated conversation we should be having with health providers? My key concern is: how do we understand what is facing women at higher risk—aboriginal women with high rates of poverty, violence, many of them young mothers? We need more community-based research.”
At the same time, we need research to focus on the high rates of risky drinking for underage girls. “We need to understand what supports are needed to delay their uptake of alcohol use,” says Poole. “Some international research shows interventions that may be helpful: ones that address such protective factors as computer-based interventions, all-girl groups, and programming that helps girls critically analyze media messages.” Needless to say, there is a role for advertising and social media sending a different message. Take, for instance, a memorable Australian ad you can find on YouTube, called “Becky’s Not Drinking Tonight”: a young girl texts “Naah, not drinking tonight”—and it goes viral around the world—to the United Nations, to space stations, and more. Brilliant.
One of the major questions emerging globally is this: with alcohol companies now targeting female drinkers in the developing world, will better-educated women in those countries follow the path of those in the developed world? Women in developing countries are undergoing rapid social and gender-role change. Sharon Wilsnack, who oversees the forty-one-country GENACIS project, has strong views on this subject: “When I get up on my soapbox, I would like to do an experiment in those countries on the cusp. I would like to find ways of using social marketing, to help women understand that if they choose to use alcohol, they should use it in a much less risky way—and demonstrate gender superiority. Of course, excessive drinking has come to represent gender equality, and we need to turn it around. The highest risk is for the higher-educated women in lower-resourced countries. We need to design targeted intervention and tie it into empowerment.”
This is a huge challenge, one the developed world shows no signs of embracing. But if women
in developing countries end up enjoying alcohol in a healthier, low-risk manner, they will have pulled off something quite remarkable: a standard to which many women in many countries could aspire.
Let’s dream for a minute, and suppose that both men and women adopted a less risky manner of drinking. If this were to happen, the alcohol industry would stand to lose close to half its market. Which is exactly why the alcohol industry lobbies for the status quo. Deep pockets can purchase plenty of political silence—silence that is proving all too costly on the public health front. It’s time for change.
16.
Wrestling with the God Thing
SPIRITUALITY AND SOBRIETY
The spiritual life is not a theory. We have to live it. . . .
If we are painstaking about this phase of our development, we will be amazed before we are half way through. We are going to know a new freedom and a new happiness. We will not regret the past nor wish to shut the door on it. We will comprehend the word serenity and we will know peace. No matter how far down the scale we have gone, we will see how our experience can benefit others. That feeling of uselessness and self-pity will disappear. We will lose interest in selfish things and gain interest in our fellows. Self-seeking will slip away. Our whole attitude and outlook upon life will change. Fear of people and of economic insecurity will leave us. We will intuitively know how to handle situations which used to baffle us. We will suddenly realize that God is doing for us what we could not do for ourselves.
Are these extravagant promises? We think not. They are being fulfilled among us—sometimes quickly, sometimes slowly.
They will always materialize if we work for them.
—“THE PROMISES” OF ALCOHOLICS ANONYMOUS
Shelburne Falls, Spring of 1994
A ten-day silent Vipassana retreat in rural Massachusetts—my “hair-shirt holiday.” Rising at four thirty every morning, meditating for more than nine hours each day. Not only is talking forbidden; we are encouraged not to meet the eyes of others. Gillian has come with me: she is a veteran, understands what we are taking on. I do not. On the first day, I pray to God: I want a sign that I will find the courage to go forward. I need to deal with the deep depression that dogs me, and the loneliness, too.
Here, it is unspeakably difficult, and deeply rewarding. Day Four: a breakthrough. Day Six: another.
Day Ten: my last day, the day we break the silence. I take a walk at dawn to say good-bye to the property, wandering into the small field. I look up in the sky: two jet trails have crossed, making the wide horizontal X of St. George. At home, I have been reading the story of St. George and the dragon to Nicholas. On his flag, the wide horizontal X cross. As I walk into breakfast, I notice that my steps across the field—marked in the dew—have created the same image: the wide X of courage.
I take it as a sign: what is in the sky can be brought to earth. My spirits lift considerably.
Dublin, Spring of 1995
Alone at the Point, a Van Morrison concert. The crowd is on its feet, dancing. “Did you get healed?” he asks, onstage, a dozen musicians backing him up. Maybe. I can feel the tectonic plates shifting: something is changing in my being. I am opening up.
Toronto, Winter of 1996
I have been to a meeting of Alcoholics Anonymous, but I haven’t begun to wrestle with the God thing. Not even close. I am beginning to be concerned about my problematic drinking, but I am not going to beg God for help. The way I see it: just because I want it gone doesn’t mean it’s God’s garbage day.
Besides, I’m not sure I even qualify as an alcoholic. Two seasoned members, Bob and Linda, have taken me for coffee before the meeting. They ask me: am I comfortable declaring myself an alcoholic? I tell them I’m still unsure—the word is so loaded. I see them exchange a glance before one of them says: “This is normal.”
Am I an alcoholic? I think of Mum’s behavior. Mine is nothing like hers: raging, anesthetized. Alcoholic: the word makes me squirm.
Still, there are times when I drink way too much. Not often. But there has been an incident. Onstage at Maclean’s magazine’s ninetieth-birthday party, June Callwood said she didn’t have a chance of being named editor decades earlier because she had “the wrong genitalia.” I had too much to drink, and repeated the line to someone I work for. Bad move. True, but still not smart.
Bob and Linda have taken me to a “closed” meeting, for alcoholics only. They prepped me: “When they go around the circle, saying ‘My name is X, and I am an alcoholic,’ just say ‘pass.’”
Down some dark stairs, into a brightly lit church basement, where we sit like kindergarten children, in a circle. My heart pounds. “Pass,” I say. The whole room stares. My head is swimming. I want to run.
At the break, an older man confronts me: “You didn’t identify as an alcoholic.” I freeze. “This is a closed meeting for alcoholics only. Do you belong here, or don’t you?” I vow never to return.
Toronto, Winter of 2002
Carol Shields is dying of cancer. I am writing a short profile of her, and we sit together in the sunlight. She looks unspeakably tiny and frail, her head wrapped in a scarf. Over lunch, I ask her if she believes in God. “No. Human goodness is the only thing I believe in. To me, it seems astonishing that people are as good as they are: that’s the surprising thing. I do feel this sense of goodness is part of our human conversation—the biggest part of it.”
Winnipeg, Winter of 2008
At dinner, I tell Jake that I want to go to rehab—maybe I should wait for a sign? If I see a rabbit in the backyard tonight, I’ll take it as God’s will. He likes this idea. For the two of us, rabbits are totemic creatures. He calls me “Rabbit.” He’s the jackrabbit.
I wash the dishes, and turn off the kitchen lights. I take a look out the back window. No rabbit.
Jake lights the fire, I light the candles. Let me take one last peek, I say, before I sit down. I peer out, and there, on the moonlit snow, it sits: my rabbit. Call me primitive: for me, it’s a sign. That, and Jake’s hand holding mine. These are the reasons I know I’ll go.
The Bahamas, Spring of 2008
Fresh out of rehab, a trip to Kamalame Cay, where Jake proposed two years ago. Walking to the great house for breakfast, we come across a small egg: a baby killdeer, just emerging. My bird. Here is my small bird of recovery. I pick up the fragile shell: I will keep this by my bed as a reminder.
That night, I offer to get Jake a drink at the self-serve bar at the beachside villa where we’re staying. I pour him a gin and tonic. Then, with considerable restraint, I pour myself a cranberry and soda. At the last minute, defiantly, I add a generous shot or two of vodka. How bad can it be?
All of a sudden, a man is at my elbow. “Hi, my name is Bill.”
“I’m Ann.”
“Can you pass me the cranberry juice?”
“Sure. Anything else?”
“No, I don’t drink.”
I look at him: tall, healthy, in his sixties. “Nor do I,” I say.
“Really? I could have sworn I just saw you pour vodka in that glass.”
I put down the drink. “I think I need to talk to you. I just got out of rehab.”
Bill and I spend the next half hour discussing sobriety. He has been a member of AA for many years. So has his wife. A close call.
Two days later, lunchtime, eating alone. Jake has gone fishing for the day. I bring the New Yorker for company. At the next table, an enthusiastic crowd of women, sipping margaritas and white wine, laughing. They order a second round. Damn it, I think, I’m having a glass of wine. I start to rise, heading to the self-serve bar. “Hi, darlin’! I just thought I’d circle by to see how you’re doing.” It’s Bill. “Can I sit down?”
I’m beginning to think there’s something larger than myself. Is this possible?
Toronto, November 3, 2008
I cannot stop drinking: two weeks, three weeks, and then I relapse. I don’t drink much—a glass or two—but it calls out to me. I cannot stay stopped.
I am broken: mentally, spiritually. Down on my knees before breakfast, in tears. In my journal, Carol Kushner’s words: “Our awareness of God begins where our self-sufficiency ends.”
At a crowded noon meeting, I am at the back of the room, quietly weeping. A woman approaches me. “Do you need to talk to someone?”
She picks me up for the evening meeting, and delivers me home. Opening the door, I hear the phone ring. “Hi, darlin’. It’s Bill. Just found your number in a knapsack from the Bahamas, and thought I’d give you a call to make sure you’re doing all right.”
Seven months later, and he calls on the day I got on my knees. What are the chances? And I am down on my knees again, with prayers of thanks. Am I just hedging my bets? Who knows. It’s too early to tell.
Try to get sober and sooner or later, you’re going to be confronting the big kahuna of sobriety—namely, Alcoholics Anonymous. Sooner or later, the issue of God is going to be part of the conversation, and you’ll be wrestling with your notion of spirituality.
Is spirituality the antidote to alcoholism? Spiritus con spiritum: was Carl Jung correct? I know, in my bones, he was.
I love the story of Jung corresponding with Bill Wilson, the co-founder of AA. The year was 1961. Wilson wrote to commend Jung on his guidance to a fellow named Roland H., someone who had suffered as an alcoholic. Jung had counseled Roland H. on recovery, saying that the only hope was his becoming the “subject of a spiritual or religious conversion.” Wilson closed his letter by telling Jung: “Please be certain that your place in the affection, and in the history, of our Fellowship is like no other.”
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