Staying Alive

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I used to be a smoker. Not an occasional, just at parties kind of smoker but a serious, pack-a-day addict. I enjoyed the way it made me feel. I also enjoyed the way it gave me a legitimate break from work and the opportunity to meet people from all over the organisation I worked for. There was a kind of ‘smokers network’ that knew more about what was happening in the organisation than anyone else.

I stopped close to a decade ago. In my own time. When I was ready. Up until then I sang various versions of the dedicated smoker song:

“I need it to relax. It helps me to calm down.”

“Everyone needs a vice and this is mine.”

“I could give up if I wanted to but I don’t want to.”

“I could get in a car today and die in a car accident. Everything has risks attached to it.”

“Oh statistics! You can use them to prove anything.”

“I’m going to die of something. It may as well be cancer.”

Addiction has fascinated me for a long time. You see a lot of the consequences of addiction when you’re a police officer; young people almost dead from heroin that wake up angry when they’re given the antidote, diabetics with a food addiction that die young as a consequence of chronic obesity, gamblers that steal from the people that love them in order to support their habit. It seems to me that a propensity for addiction is part  of being human.

It’s also similar to the kind of thinking you see behind a lot of criminal activity. People know the dangers and the risks but do something anyway.

Interesting that when you ask people to define addiction they often use the word ‘compulsion’, or some other description that defines the behaviour as being beyond control. I’m never sure about this. I suspect we like to think of our addictions as beyond our control because it gives us an excuse not to deal with them. For me, a big part of giving up smoking involved recognising an obvious truth; I cannot smoke unless I put a cigarette in my mouth and light it. I may feel a very strong urge to do so but ultimately I must make a decision. To smoke or not to smoke.

Eventually I confronted the horrible truth. Smoking was bad for me. It carried with it a serious risk of developing any of a number of cancers as well as a bucket of other illnesses. If I really did need it to relax then I probably needed to take a long, hard look at why my life was so stressful and what I was going to do, other than smoking, to deal with that stress.

It was true that I might die in a car accident but there was a flaw with this analogy. A car provides all kinds of real benefits. At the time it allowed me to travel to work and earn a living as well as giving me the convenience to shop, travel and enjoy the company of my friends. The risks of an accident were minimal and when weighed against the benefits of car travel I was prepared to accept those risks. The same was not true of cigarettes.

The statistics argument didn’t take long to destroy. It’s true that statistics can be misleading. If you only have a one in a million chance of getting lung cancer and smoking doubles your risk then that’s still only two chances in a million. Had the odds been that long I might have kept smoking. Of course the evidence against smoking is far more damning for so many types of cancer. It’s considered a group one carcinogen. That means it’s been proven to significantly increase your risk of cancers. No question. And as to choosing a way to die, I think just about anything would be better than dying from cancer.

When I stopped smoking I also made a number of other changes. I improved my diet, increased the amount of exercise I was getting and learnt meditation to relax my mind. I read several books on the psychology of happiness and practiced some of the methods they recommended. Life was good. I was fit and healthy and taking better care of myself than most people. Then I got cancer.

I read this recently in a book written to help women with early breast cancer: “..the general medical opinion is that there is no known cause of breast cancer. It’s not one of the ‘lifestyle cancers’ like those that result from smoking of sun exposure…” (One Piece of Advice, Yvonne Hughes)

Wait a minute. What? Not a lifestyle cancer?

I’m pretty sure that there’s no cancer on earth that isn’t influenced, to some extent, by lifestyle. When I asked my oncologist why there was so much breast cancer around these days she didn’t hesitate. “Alcohol. Certainly here, around the north shore. The Central Coast also has issues with obesity, but mostly it’s alcohol related.”

Wait a minute. Alcohol increases the risk of cancer? Since when? That can’t be right. Surely there would be warnings on the bottles just like there are warnings on cigarette packets.

I spent several hours researching alcohol and cancer. It turns out that alcohol IS a group one carcinogen, just like cigarettes. If you google ‘alcohol and cancer’ and ‘alcohol and breast cancer’ you’ll find all of the evidence you need. Here’s a few choice samples:

“The International Agency for Research on Cancer (Centre International de Recherche sur le Cancer) of the World Health Organization has classified alcohol as a Group 1 carcinogen. Its evaluation states, “There is sufficient evidence for the carcinogenicity of alcoholic beverages in humans. …Alcoholic beverages are carcinogenic to humans (Group 1).”[14]

There’s no ‘may be’ here. This stuff is toxic. Alcohol causes cancer. Then there’s this:

“A woman drinking an average of two units of alcohol per day has 8% higher of developing breast cancer than a woman who drinks an average of one unit of alcohol per day. A study of more than 1,280,000 middle-aged British women concluded that for every additional drink regularly consumed per day, the incidence of breast cancer increases by 1.1%. Approximately 6% (between 3.2% and 8.8%) of breast cancers reported in the UK each year could be prevented if drinking was reduced to a very low level (i.e. less than 1 unit/week).

Among women, breast cancer comprises 60% of alcohol-attributable cancers.

Okay, two units of alcohol a day is about what most people call one home-poured glass of wine. Some genius in the wine industry managed to get a standard drink classified as 100mls. I don’t know anyone that pours themselves a 100ml serve of wine. 8% might not seem like much of an increase unless you figure in the general risks of getting breast cancer. That’s currently around one chance in ten. Ouch.

If you didn’t like that you’re going to hate this:

“A study of 17,647 nurses found that high drinking levels more than doubled risk of breast cancer with 2% increase risk for each additional drink per week consumed. Binge drinking of 4–5 drinks increases the risk by 55%.

Wait…..binge drinking is four to five drinks? That’s not even a whole bottle of wine. (A bottle is generally seven and a half standard drinks by the way. Most people think it’s about four.)

But haven’t they proven that red wine is actually good for you? Well, sadly no. In fact the research that’s used to promote red wine involved one compound extracted from the skin of red grapes that was tested in vitro. They didn’t even use wine. Just something from a grape skin. And in vitro proves nothing. It just provides a good starting point for other research. And even if this research pans out it will prove the benefits of red grapes, not red wine. Eat all the grapes you want.

The short version; there is no safe level of alcohol consumption. If you doubt me, do your own research.

Let’s get back to addiction. I think the definition that works for me, when getting my head around addiction, is this one:

Addiction is the continued repetition of a behavior despite adverse consequences. Classic hallmarks of addiction include impaired control over substances or behavior, preoccupation with substance or behavior, continued use despite consequences, and denial.  Habits and patterns associated with addiction are typically characterized by immediate gratification (short-term reward), coupled with delayed deleterious effects (long-term costs).

So here’s my problem. Given what I know about alcohol I feel I cannot continue to drink. It’s a group one carcinogen.

Even if I hadn’t already had cancer, this information should be enough to make we want to stop drinking. It was enough to make me stop smoking.

The popular advice is that it’s fine to have a couple of drinks a few times a week but here’s my acid test; if instead of breast cancer I’d had lung cancer would you be okay with me having a couple of cigarettes a few times a week? Or would you consider that to be stupid, self destructive behaviour?

What’s fascinating is the resistance I get when I talk about alcohol and cancer. Guess what people say:

“I need it to relax. It helps me to calm down.”

“Everyone needs a vice and this is mine.”

“I could give up if I wanted to but I don’t want to.”

“I could get in a car today and die in a car accident. Everything has risks attached to it.”

“Oh statistics! You can use them to prove anything.”

“I’m going to die of something. It may as well be cancer.”

In some cases, the people making these statements are the doctors and health professionals that are treating me. They all have their own excuses for why they still drink. It reminds me of the data around health professionals and smoking back when they first tried to ban it in public hospitals.

What interesting animals we are. Knowledge on its own will not change our behaviour, even when that knowledge warns us that something is very dangerous. We have an extraordinary capacity for denial, for redefining our own circumstances as ‘special’ or exceptional or just pretending not to know better. If knowledge were sufficient to change behaviour then nobody would smoke.

And nobody would drink alcohol.

But I’m guessing that if you are already a drinker then nothing I can write here will make you stop. It’s okay. I’m not on a campaign. I’m really just fascinated by how this relates to my recovery and my survival chances.

I gave up drinking a week ago. Unlike smoking, this wasn’t very difficult. I’ve previously given up alcohol when I was pregnant and breast feeding for 18 months. I also gave it up for three years when I was in a relationship with an alcoholic (although his therapist warned me that this was codependent behaviour). I’ve always enjoyed drinking and used to have a reputation for being able to drink fellow police officers under the table. Not my finest achievement.

Having concluded my research on alcohol I showed my husband a page of information that summarised the cancer risks. It’s not just a risk for breast cancer but for several different cancers, including cancers of the mouth, liver, stomach, colon, rectum and lung. It’s not just large quantities of alcohol that increase your risk, but low to moderate amounts. The only reason various cancer organisations have issued drinking guidelines is because they accept that most people will continue to drink, but read their actual position statements and it’s pretty clear that there is no safe level of consumption. When Graham had finished reading the summary I asked him this:

“Do you think I should give up drinking.”

His answer was “Having read this, I don’t think anyone should drink. You should stop. I should stop.”

I didn’t ask Graham to stop drinking. (I understand codependence now)

Still, he’s decided to only drink very occasionally. He’ll probably still have the odd glass with friends over a meal. Or he might just stop. Certainly he hasn’t had anything to drink for the last week.

For me, a big part of the decision was influenced by how I will feel if the cancer comes back. If I haven’t done everything I can reasonably do to prevent recurrence then how will I feel? Surely there will be a part of me wondering if avoiding alcohol could have prevented another bout. It’s not a situation I want to be in.

My first thought when I read about the dangers of alcohol was, “I could stop drinking any time.” My second thought was, “What’s wrong with right now?” It’s possible my drinking has already cause permanent damage to my body. That’s not a reason to compound the problem. Even a couple of drinks a week can increase my cancer risk and I don’t NEED to drink.

I also find it hard to dance around the addiction issue; if I continue with a behaviour that I know to have adverse consequences then, by definition, I am an addict. That’s just the cold, hard truth of it.

Now observe your own reaction to that statement for a minute.

Or just pour yourself a nice glass of red and ignore me. 

May as well have a cigarette while you’re at it.

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2 thoughts on “Staying Alive

  1. I also gave up smoking 10 years ago this year and I too was a serious smoker but commonsense won – as far as alcohol I have not had any since the end of May 2013 the week before I began chemo, I decided that I have already lost enough to breast cancer (both breasts) and am not prepared to lose anything else – I do not miss it and feel mentally and physically better for it – agree Meg staying alive is the most important thing from here on !

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