YOU CAN HIDE ALCOHOL BUT NOT FOREVER
Just how much alcohol can a man hide? Plenty. There are men out there in suits and ties, holding down professional jobs, who have daily blood-alcohol levels that would almost kill the average person. These habituated drinkers appear to function successfully. They’re impressive in their jobs, and the casual observer wouldn’t be aware that there was a problem. In fact, many doctors wouldn’t be aware either.
‘Apparent sobriety’ is a common feature in hospital emergency departments. Men frequently come in with complaints seemingly unrelated to alcohol and are treated without their drinking problem being exposed. According to medical textbooks, an average man would be dead if he had a blood-alcohol level of 0.4, yet many men at this level or higher seem completely sober.
One US study of 204 emergency patients, all over 0.4, reported that 80 per cent were so fully orientated (knew who and where they were etc.) that experienced emergency doctors had difficulty determining if they were intoxicated.
Seasoned drinkers can hide their intoxication. When an 80-kg man drinks two bottles of wine over lunch, he will return to the office with a blood-alcohol level of 0.2. While he may appear socially normal, he’ll be having difficulty with mental organisation. Ask him, for example, to count backwards from 100 subtracting seven each time. After the second subtraction, he’s likely to lose it. An average organised adult could go all the way back.
His reflexes will also be slower, and while he may look like he can operate a car efficiently, he will definitely be a hazard on the roads.
Drinking problems visible in the workplace are only the tip of the iceberg. The majority of regular heavy drinkers remain hidden.
But how long can they hide? For decades. For 20 or even 30 years they can seem to be going along flat ground, travelling quite easily, until they realise they are approaching a cliff. Suddenly they begin showing signs of physical damage they cannot ignore or reverse. That’s the way it goes. When the alcohol starts catching up, it keeps catching up.
For all those years they probably hadn’t thought of themselves as having real problems because they were working and supporting a family. Also there is a tendency to think that only men on park benches have drinking problems. But during these years of denial they’ve been damaging their brains. Alcohol starts by knocking off the highest of brain functions – the frontal lobes – the very things that differentiate men from animals or computers and enable them to form concepts, encode information, plan and organise.
Typically, a heavy-drinking lawyer will run his practice smoothly for a couple of decades as long as the job remains fairly routine and familiar. If things are suddenly reorganised and he has to learn a new skill, such as how to use a computer, or his secretary who has been acting as his frontal lobes for years resigns, he can’t cope.
If his wife suddenly leaves or dies, and in his grief he continues to drink but doesn’t eat, he’s at high risk of another kind of brain damage. If he didn’t eat for a month he could develop Korsakoff’s syndrome, which would wipe out his short-term memory and simultaneously wipe him out as a working adult.
It is strange that while Australians find it unacceptable to drink and drive, they find it quite acceptable to drink and do brain work. If a judge came onto the bench after lunch and was over the legal driving limit, no-one would know, and the judge wouldn’t think this was an immoral thing to do. But his judgement would be impaired. Comfortable professionals have an easier time with their drinking than others. Social support cushions heavy drinkers and keeps them functioning longer.
Just look at the 30-year Yale University study that compared inner-city Boston boys with boys at ivy-league schools who later went on to Harvard. The Harvard boys became professionals and captains of industry and drank the same as, if not more than, the inner-city boys, who became blue-collar workers.
While the Harvard graduates managed their alcohol far better, had more support, kept down good jobs and maintained themselves, the inner-city boys experienced more psychosocial problems related to drinking.
But this cushioning is double-edged, because while it keeps the problem hidden for longer, it allows more damage to occur. While many men draw comfort from the belief that their habits are not known, an experienced observer can easily identify a habituated drinker. Many have coarsened features, muddy conjunctiva, dilated vessels on the face, particularly around the nose, enlarged parotid glands (in front of the ears) and general puffiness. Their faces give them away.
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