Maybe you are an alcoholic and you don't know it

Dossier You can be an alcoholic and not know it 2 articles

• Maybe you are an alcoholic and you don't know it
• "Alcohol is the only EU product that does not carry a composition label"

BarcelonaEva Tenorio Álvarez, 47, says that she only drank with friends, at social events, when she went out to party… She didn't do it every day and she didn't have alcohol at home either. In fact, her acquaintances didn't consider her to be an alcoholic, but rather a drunkard.

Laia Bautista Servat, 26, only drank on Friday and Saturday nights. She did the typical drinking sessions that so many young people do. She didn't think that this was harmful either. However, both she and Eva had a problem, and a very big one.

The actor Eduard Fernández confessed days ago in an interview with Jordi Évole who for many years has been an alcoholic. He showed that great films can be made like The 47, winning a Goya for best actor and having a problem with alcohol. It is what professionals call "functional alcoholism": people who at first glance have a normal life, work and have a family. They have not hit rock bottom, nor do they wander around the streets, but they have an alcohol dependency.

Also a few weeks ago the film was released Dismantling an elephant, which tells the story of a renowned architect's addiction to alcohol and raises two crucial issues: that this is not about social class, it is a problem that can affect anyone, and that it is an elephant in the room that we do not want to see. Alcohol consumption is normalised in our society. In fact, it is the only drug that is offered to us openly in any restaurant: "Would you like a splash?" However, paradoxically, falling into addiction is a taboo. Those who are alcoholics hide it, it is very difficult for them to say it publicly. Others minimise the problem and many are not even aware that they have it.

This is what happened to Eva Tenorio Álvarez: she spent years going from doctor to doctor without knowing what was wrong with her. She suffered from depression and was aware that when she started drinking she was unable to stop. She had one drink, another and another, until she ended up very drunk. But the doctors didn't give it any importance, because she didn't drink every day. Until a psychiatrist told her the opposite: that alcohol was precisely her problem.

"Later I realized that depression was actually withdrawal syndrome," explains Eva, who defines herself as an "alcoholic," although she admits that it is a word she doesn't like. "I do it to break the stigma. Alcoholism is a disease. It's like telling a person who has cancer that they are a carcinogen. People think that we drink because we want to, but we can't help it." In fact, the correct way to call this pathology is alcohol dependence syndrome or alcohol use disorder.

Eva was in treatment for a long time, but she never entered a recovery center, nor did she leave her administrative job. However, she has not drunk a drop of alcohol for six and a half years. She no longer suffers from depression, stomach problems, does not need sleeping pills, and does not lack vitamin A, which the tests always indicated. And she is one of the very few people who have allowed themselves to be photographed out of the more than a dozen people with alcohol dependence interviewed by ARA for this report. Her goal now is to help other people: in 2022 she founded the association Project Life, the first in Andorra for the treatment of addictions.

In fact, Laia Bautista Servat, who is also Andorran, thought that perhaps she too had a problem with alcohol when she heard about Eva's case. She only drank on Fridays and Saturdays, but she could easily drink one or two bottles of vodka or gin in one night. And she says she was not the only one: some of her friends did the same. "Each of us would put in five euros and buy several bottles." To let go of inhibitions, have a good time, feel cool. That's what they were aiming for. But later she realised that what she was really looking for by getting drunk was to escape from the problems she had at home. "It was my method of escape."

Laia is also one of the few who has agreed to give her testimony openly. "I'm not ashamed, because thanks to my past I am who I am. There is an alcohol culture that we are not aware of and that we have normalized. Nobody teaches us that there are other ways to have fun or ask for help when we have problems."

But how can we know if we have alcohol dependence syndrome? According to the World Health Organization, risky consumption is drinking four standard drink units a day (SDU) in the case of men and two in the case of women. Or drinking six or more SDUs in one go in the case of men and four or more in the case of women. The female body metabolizes alcohol worse, so the parameters are different. A SDU is equivalent to a glass of wine or cava, or a beer, or a shot of coffee or a thimble.

"Having a risky consumption does not mean being an alcoholic, but it is the gateway to addiction," says Dr. Gabriel Rubio, a psychiatrist specializing in the treatment of alcohol dependence and author of the book The Crystal Maze: How to spot the signs and take action if you live with an alcohol addict. "Alcohol addiction is not measured by the amount of alcohol consumed, but by the relationship you have with the drink," he adds. That is why it is such a swampy and difficult area to identify. Even more so considering that one of the symptoms of alcoholism is precisely the denial of the problem, according to experts.

"You deceive yourself because, if you recognize that you have a problem, you must remedy it and what you want is to continue drinking," explains Àlex Florensa, a recovered addict and director of the Tools Addiction Center in Sant Cugat del Vallès. According to him, drinking a bottle of wine and not being affected is already cause for alarm. "That means that your body has created a tolerance." Or that someone in your environment warns you that perhaps you drink too much: "If they suggest that you have a problem, it is because you possibly do."

Dr. Rubio gives more clues: "You have a problem with alcohol if you need it to feel good emotionally or to be able to do a certain thing." "Or if you say you're going to drink two beers and you drink five. Or if you prioritize alcohol over more important things in your life. For example, if you have to go home because your wife is waiting for you and you go have three beers at the bar," adds Dr. Antoni Gual, who was previously head of addictions at the Hospital. Every month they see fifty new visits, and more than half are linked to alcohol.

Depression, anxiety, stress

"Many people come with depression, anxiety, stress, but what is really behind it is a problem with alcohol," explains Dr. Gual, who assures that people with functional alcoholism rarely turn to public health. "Out of shame, out of fear," he argues.

In fact, private addiction treatment centres continue to grow, according to Pau López Ferrer, a psychologist at Addiclia, a private company based in Valencia that knows the market well because it is dedicated to guiding patients about the offer of existing centres. "The average price of an admission centre is 3,000 to 5,000 euros per month. In contrast, an outpatient centre can cost from 200 to 1,000 euros per month," he explains.

It's ten in the morning and three friends are having breakfast at the Foxos bar-restaurant in the Sant Martí district of Barcelona. They have a bottle of wine on the table and they're already halfway through it. One of them, Antonio, aged 67, admits that he used to drink a lot: "In the morning I had breakfast with wine, a shot of coffee and a glass of wine. And I also drank wine for lunch and dinner." He was a firefighter and never stopped working, but all that alcohol took its toll on him. In 2012 he suffered from cancer. "You realise [that alcohol is harmful] when it's too late," he laments. Now he only drinks on exceptional occasions.

The bar waiter, who has been working in the hospitality industry for 26 years, says that "a little beer or wine is the normal thing to have for breakfast." "From those who work in construction to those who work in an office," he sums up in a few words. In other words, those who don't drink are in the minority.

Logically, with this panorama, being abstinent is a challenge. "If you stop smoking, everyone congratulates you. But if you don't drink, they ask you what's wrong, if you're sick," says Dr. Gual. "Going happy little thing It is normalized. As a society, we have a lot to learn and review," says Rocío Barrero, therapist coordinator of the Projecte Home outpatient program.

Consum en Catalunya

According to theSurvey on alcohol and other drugs in Spain (EDADAS) 2024In Catalonia, 70.5% of men and 58% of women between 15 and 64 years old drank alcohol at least once in the last month, and 12.6% got drunk. The average age for starting consumption is 16 years old. Alcohol is also the cause of more than 50% of drug-related hospital emergencies, and the main reason for starting specialized addiction treatment in the public health system in Catalonia. Specifically, 6,555 people (44.3% of the total treated) received treatment in 2023 for this cause. Behind them are those who use cocaine (23.6%).

In Catalonia we are lucky to have had the Beve Menys programme in primary care for 24 years: health professionals ask patients a questionnaire to detect possible excessive alcohol consumption, and give them advice on how to reduce it. We also have a network of specialised care with 63 addiction care and monitoring centres (known as CAS) and a dozen hospital detoxification units, as well as places in day centres, therapeutic communities and integration flats.

"The network is exemplary, but the problem is that it is very saturated," laments Maite Tudela, vice-president of the Catalan Federation of Drug Addiction. For example, she says, the average waiting time for a first visit to a CAS is 30 days, and two or three months to enter a therapeutic community. In addition, inexplicably, the CAS depend on the Department of Health, while the day centres, therapeutic communities and integration flats depend on the Department of Social Rights.

"It is a subject under permanent study, which we are working to solve," answers the deputy director general of Addictions of the Department of Health, Dr. Joan Colom, in reference to this contradiction. Regarding the waiting lists, he declares: "In all areas of health we would like to have more resources, but we have difficulty in hiring."

The president of the Catalan Society of Psychiatry and Mental Health, Dr. Gemma Parramon Puig, goes even further and states that "many people do not want to go to the CAS because it links them to drug addicts." These centres treat alcoholism but also other types of addictions. "The basis of recovery from an addiction is identification with the other in a group. If you put a functional alcoholic with one who has lost everything, the functional one will tell you that he is not an alcoholic and will not submit to the therapeutic process," says Oihan Iturbide, clinical biologist, editor at Yonki Book.

In fact, according to Dr. Gabriel Rubio, in Spain only a third or half of dysfunctional alcoholics ask for help, and it takes them an average of ten years from the time they begin to have the problem. Functional alcoholics, however, rarely come to the consultation. "We are only attending to the tip of the iceberg," he warns. And at this point, the worst off are women, according to Monica Jimenez, a psychologist specializing in addictions and gender perspective and director of the GenA therapeutic center. "There is a double social penalty for being an addict and a woman. If a man undergoes treatment, everyone will congratulate him. On the other hand, a woman will be told that she is a bad mother," she gives as an example. Women always go alone on the first visit, she adds. However, men are always accompanied by someone, usually a woman.

"Hi, my name is Núria and I'm an alcoholic." "Hi Núria," they all answer in unison. The meetingsAlcoholics Anonymous They are, at first glance, just like they appear in the movies. But what is surprising is that many of those who participate would never say that they have a problem with alcohol. You can find everything from a well-groomed woman who would not look out of place at an executive meeting, to a man who carries a stuffed animal in his backpack because he has just dropped his son off at school, or an adorable old lady. "Before coming here, I also thought that there would only be ordinary drunks," says one of the attendees.

Alcoholics Anonymous has about eighty mutual aid groups in Catalonia, made up of an average of between ten and fifteen people each. In the case of Barcelona, ​​there are groups every day of the year, including weekends and holidays. Those who attend do not have to register or pay anything, beyond making a small donation if they wish. In fact, this is how this group is financed, which usually meets in parishes and civic centers.

Entity to help relatives

Apart from Alcoholics Anonymous, there is another sister organization dedicated to the families of people with alcohol dependence. It is called Al-Anon and in Catalonia there are 35 mutual aid groups. "We talk about how our relative's illness affects us, but also about the changes in attitude that we can make so that they realise that they have a problem," explains M. Carmen, the director.

In fact, alcohol is the drug that causes the most harm to third parties, according to the deputy director general of addictions of the Department of Health. Not only to their relatives, but also through "traffic accidents and violence." He also claims to cause up to "200 illnesses." So why did the Department of Climate Action of the Generalitat make a campaign to promote Catalan wine in 2023? After a pause, Dr. Colom answers: "We live in a society of constant contradictions. I can only respond with regard to the Department of Health."

Dossier You can be an alcoholic and not know it 2 articles

• Maybe you are an alcoholic and you don't know it
• "Alcohol is the only EU product that does not carry a composition label"