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It’s very easy to reach for the alcohol when you receive bad news, but as Steve found out it can end up becoming a crutch that causes more problems than it solves…

Beer, Pint, Drink, AlcoholWell, the date has come and gone: after over forty years of heavy drinking, I’ve just completed my first year since I was oh, thirteen or fourteen without a single alcoholic drink. The decision to stop only came after I was told that I had cirrhosis. Not advanced enough to be a threat to life (after all I made it through all of last year, as Mr Sondheim said), but sufficient that if I didn’t knock it on the head liver disease was around the corner. My partner’s death was basically caused by liver failure induced by the drugs he was taking as immune modulators, and it isn’t a very pretty way to go. The idea of lying in bed waiting for nurses to come and clean my diarrhoea up wasn’t appealing – when John was dying I didn’t have the strength or skill to turn him to clean him up without causing him a lot of pain.

Despite drinking heavily all those years, there were only two occasions when I hit what I call silly drinking: when John was first ill (he got HIV through an accident at work and dammit! I was supposed to die first), I went to AA for three months. Then someone said in a meeting “what they don’t realise is that we’re the only people who can help” and my mind shrieked “CULT!”: I never went back. It obviously wasn’t for me, even if it does work for others.

When I was in hospital in 2012 my consultant wrote me up for librium “to help me through the DTs”. I told him that that wouldn’t be necessary, and I was right. At the time, despite what my liver enzymes said, I was just as capable of having a can or two of an evening as I was of seeing off the best part of a bottle of gin. And I didn’t need the librium. After I’d been on the ward for a couple of weeks he was doing his rounds and I had a can of some energy drink next to my laptop. The can was designed to look like a fancy European lager; he took one look and in a tone of rising anger asked “is that beer?” I deadpanned “Yes, it is. Well done. You now have twenty seconds to find the gin…” He didn’t take well to my brand of sarcasm and I’ve moved to another hospital for other reasons.

One day early last year I woke up and had about ten to fifteen centilitres of Southern Comfort for brunch, finishing the bottle, and thought about the liver scan I was due to be having later in the week. Almost on a whim I decided that things had gone too far and that it was probably time to give the booze a bit of a rest. I got some cheap cider to see me through the rest of the day. The following morning, nothing: despite the fact that I’d been silly drinking for long enough to react to it not being there, frankly, I had a worse time when I stopped smoking. (Note: I do not recommend doing what I did as sudden withdrawal from alcohol can cause a number of problems with the central nervous system.)

Cirrhosis is monitored by fibroscan
Cirrhosis is monitored by fibroscan

I had the scan and my expectations were realised: my liver shows enough cirrhotic scarring for alcohol to be top of the list of bad ideas. I’ve realised since that alcohol was part of my support system for dealing with HIV, and especially for dealing with being a long term survivor of HIV. I never thought I’d need my liver as long as it turns out that I need it: as I remarked to a doctor who nagged me about smoking (which went in 2003) “you tell me I’ve got AIDS and expect me to worry about lung cancer? Dream on!” Part of my bargain with myself last year was that I could still have a glass of wine or whatever “occasionally”.

A couple of months later I had a friend-with-benefits staying. I got in a bottle of vodka for him and a couple of four packs of Newcastle Brown for me. I watched him get through the vodka and coke while the Brown ended up being tips for the guys who deliver my internet groceries some months later. Soon after that friend-with-benefits visited again and I didn’t even bother getting in any beer for me. I’d bought him Absolut vodka because they were using the rainbow wrapper: I thought it was clever marketing and the first time I’d seen a mainstream product ally itself so closely and obviously with the gay movement. I’ve kept the bottle, because in its own way it’s a reminder of how far we’ve come since I came out in the mid-seventies. A couple of months ago I realised there was still a trickle of vodka in the bottle. Despite the evaporation problem I used to have with bottles of spirits, that trickle is still there.

So I’ve knackered my liver, what’s that got to do with HIV? Well, the liver is the major organ involved in processing many ARVS. Indeed the booster drugs cobicistat and ritonavir pre-empt an enzyme in the liver yelling “me first” so that other drugs are in your system longer. The other connection is that it’s all too easy to do what I did and use alcohol as part of your mechanism for dealing with HIV; after all, how many times have you or someone you know had a shock and the first reaction (yours or someone else’s) has been to open the whiskey? And let’s face it, like many other drugs, alcohol makes you feel good, making you want more…

Another connection is that cirrhosis, like HIV, diabetes and lung cancer, is seen as a self-inflicted disease. I score three out of the four and am familiar with things like “well, I hope you’ve stopped drinking now”, “but how easy is it to put a condom on?”, “you’ve obviously worked hard to get rid of the weight” respectively – nothing about lung cancer because, to the best of my knowledge I don’t have it. There’s something about all four diseases that people think gives them carte blanche to come out with moralistic nonsense like this: I’ve even heard two of those statements more than once from people with HIV. Don’t we love to judge others?

You can follow Steve on twitter as @RottieSteve

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3 COMMENTS

  1. Hi Steve – I am 42 years old but started turning to alcohol when I was 21 due to a stressful job & I’ve never really got out of the habit. No doubt my HIV infection at age 28 hasn’t helped either.

    I tend to drink half a bottle of wine each evening but worry about progressive liver damage, especially when taking ARV’s & other medications. Is this a small amount compared to what you were drinking?

  2. Hi Mark, First let me stress that I’m not a doctor, nor do I have any medical qualification. The article above and what I say here are (possibly informed) lay opinions. End of disclaimer.

    It’s certainly less than I was drinking: at my “silly drinking” points when I could be getting through twenty or more units in a day. Your half bottle an evening, assuming it’s 12% alcohol (wine can range from 9% to 16%) comes to four and a half units, so over the week that’s just over 30 units, over the government’s guidelines of 21 units (recently reduced from 28).

    Remember that when it was silly drinking I was drinking to my limit: I’m a short-arse at only 5’6″ and expect to be around 70kg. Body mass is a factor in how much alcohol is safe for a given person…

    As I understand it, there’s a case for having a couple of alcohol-free days a week (which would also get you down to the new lower weekly limit for men).

    Best suggestion I can make is that if you’re concerned about your drinking, talk to your doctor (and if you feel you can’t actually say the words, write them down and have your doctor read them) or an alcohol advice service . If your liver is stressed by the amount you’re drinking, it will show on your liver function test.

    Take care…

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