I met somebody recently with health issues on his mind. They were clearly troubling him and he shared his thoughts without any prompting from me. He had been told that his blood pressure readings were too high, and he had been diagnosed as pre-diabetic. He had been advised to lose weight. He explained to me that his problem was overeating.
What he had to say made me curious. I didn’t tell him that I’m an alcoholic in long-term recovery but I told him that I work with alcoholics and occasionally drug users. I said I had great sympathy for him. Those of us suffering with various forms of substance use disorder can, with help and support, reach sobriety – abstinence - but people with eating disorders cannot simply not eat.
As the conversation continued, he opened-up in more detail. He said his problem was that he always overloaded his plate and then felt compelled to eat everything on it. Then he would often seek out more. I said to him, “why don’t you simply put less on the plate or try a strategy of grazing – eating little and often to curb appetite”?
Afterwards, I went away thinking about how unhelpful my comments were. I have no expertise in eating disorders whatsoever, though my experience and study of addiction should have taught me a lot. Working with fellow sufferers should have taught me that you can’t go around generalising and offering advice without finding out a lot more about somebody’s background and pattern of behaviour.
More fundamentally, asking why somebody with an eating disorder can’t simply put less on the plate is a bit like saying to an alcoholic – “why don’t you just have one”? If somebody had said that to me in the past, then I would have put my head in my hands and walked away thinking that the other person was an idiot!
I'm sure there are many strategies for coping with eating disorders. Here are some of the equivalents of “put less on the plate” or “grazing” when applied to problem drinkers:
First, count units. Roughly speaking, one unit of alcohol is the equivalent of a half pint of average strength beer, one glass of wine, or a single shot of spirit. The medical advice is not to drink more than 14 units of alcohol per week. Nowadays, the same limit applies to both men and women.
Unfortunately, from an alcoholic’s perspective, this doesn’t even come close to a single session – so it’s a rather challenging strategy to say the least! I tried it many times, at least as a way of monitoring how much I was drinking. But I gave up when I found that I was consistently drinking more than the weekly allowance every day.
Second, make sure that every other drink is non-alcoholic. In other words, have a glass of water or a soft drink in between drinking alcohol. Well, this might help to quench thirst or to slow things down but it doesn’t negate an underlying desire to get drunk.
Third, have dry days. Indeed, many people now attempt a Dry January as a challenge and report feeling some benefit to health at the end of the month. We’ve apparently just had Sober October, although I’ve never heard of it before.
I also tried having dry days many times, as part of my strategy to ration units. It was a laudable aim but I usually stopped paying attention when I realised that I’d gone about three weeks without having a dry day. As for Dry January or Sober October, that’s all well and good for people who believe they can have a break from drinking. But it’s not much use to somebody suffering from alcohol use disorder unless it’s attempted along with other measures.
No doubt, all of these are very sensible suggestions as part of an overall strategy. One of my mentees is currently attempting a different variation on the theme. His plan is to only drink alcohol in moderation when away from home and not to have alcohol in the house. It’s working out quite well for him so far, so he says.
Unfortunately, as said, these various strategies didn’t work for me or for many others I’ve come to know over the years. Actually, if I walked into a fellowship meeting and shared some of these ideas then I suspect most people would fall off of their chairs laughing. Or they would nod sagely, thinking to themselves – “we’ve all been there and done that”.
I’m aware this might sound discouraging. I don’t mean to sound overly pessimistic about the chance of success. It probably works for some people, and it might work for you. Give it a try. More fundamentally we need to go much deeper. We need to understand the background, the history, and the pattern of behaviour. We need to devise an overall strategy to support recovery.
This is likely to incorporate a mix of medication, if needed, and therapy. The latter will encourage self-exploration aimed at discovering what factors have led to so-called “alcohol use disorder”. We need to come up with better ways of coping with whatever life throws at us. We also need to encourage how we can find meaning, purpose and contentment in what we do.
Devising a strategy will also consider how to provide ongoing motivation, discipline and support. For some this will involve a return to so-called controlled drinking – “put less on the plate”. For others it won’t