About Why We Drink Too Much by Charles Knowles

Explaining such differences in our human relationship with alcohol is not straightforward. It requires the synthesis of information from many scientific disciplines, including medicine, neuroscience, psychology, genetics, epidemiology, sociology, and even anthropology. Moreover, any explanation must satisfy an acid test—does it fit with the lived experience of someone who is either coming to worry about their drinking and their ability to control it, or someone who is dependent? Ultimately, many problems with alcohol derive from an erosion of choice caused by changes in our brain. These changes result from the way we process reward and how we remember such experiences. For some of us, the effect of alcohol on our psyche is just not the same as for other people—we feel more reward from it, and we more deeply memorise the experience. Such variation stems partly from genetics but greatly from what the world throws at us, especially during our childhoods.

 I am a senior academic at a major UK university who has published over three hundred peer-reviewed scientific papers and several other books. While many of these papers concern aspects of neuroscience which align with my interest in bowel disease, I am not a trained expert in any health discipline pertaining to alcohol. However, my lack of formal qualification has enabled me to cast a fresh pair of eyes on a very challenging subject without being professionally siloed. In so doing, I have applied the scientific rigour I would apply to any subject in my own field, but also the personal experience gained only by seeing the problem first hand in myself and many others.

 I started writing this book to answer the “why me?” question for myself, one that seems to be almost uniformly swerved by other books. I also realised that there was a need to close the gap between the content of abundantly available memoirs, quit-lit, self-help books, and the detailed information found in several medical textbooks. The result, I hope, is a book that avoids excessive medical jargon but does contain a lot of scientific information, especially in regard to the troublesome complexity of the brain. Where possible, I have used examples, analogies, and some of my own experiences to illustrate certain themes. My wife, Annie, has also added some further perspective on my story.

 I have tried at all times to carefully separate my opinion from what we know with a level of certainty. The text is scientifically referenced for the interested reader with selected citations taken, where possible, from top scientific journals such as the Lancet and Nature. It also covers the relevant historical scientific discoveries that underpin the study of any complex disease.

 Although I never drank at or before work, in telling my own story I have applied a level of honesty that some people may find troubling for a practicing surgeon. This is deliberate on my part. A great deal of the societal problems with alcohol stem from ongoing prejudice. When I eventually got sober, I asked the question that if the very people tasked with providing healthcare couldn’t lead in coming clean about their own problems, what hope did everyone else have? In this I am in good company. One of the two original founders of Alcoholics Anonymous, “Dr. Bob,” also was a proctologist. After so much progress in destigmatising other areas of mental health, why do people addicted to alcohol have to remain anonymous?