Why We Drink Too Much

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2:07having to ask myself that question. Our guest today has written a book called Why We Drink Too Much. His name is Dr. Charles Knowles. Charles, you're very welcome to the podcast. Thank you for having me. Your own story is entwined in this book, but it is also a book, a scientific book, that looks at the science and that aspect of alcohol consumption. The one thing I want to say is that you're recovering alcoholic. We have to be very careful with two people who don't drink, that we don't turn this podcast into why you drink too much, why we drink too much. I think you say early on that you have no problem with people who are drinking, you have no problem being around people who are drinking in certain circumstances and I think I would have a similar viewpoint to you on that.

3:09Not until you have alcohol. Even if it didn't do me much good. You say in the book, you say, we'll get into the, there's so many aspects of this book and I love this book just for the way it just puts various different aspects of the drinker's psyche, the human psyche really together. You say, talking about yourself, you say in my own case, despite being able to exercise control in all other areas of my life and pride in myself and having something of a logical mind, I objectly failed with alcohol even after I knew what the problem was. Why do you think that was? Well, that's tied up in much of the complexity of the book, I guess, Dion. In my own instance, I became addicted to alcohol and common to addictions. The problem is that this is not a problem of logic. The executive control areas of our brains are no longer able to exercise control because

4:15the older areas of our brain and an ancient biology that's there for survival is programmed to override it. No amount of logical thinking or recourse to someone's intelligence or otherwise makes very much difference to that, it's a different set of problems. That is also set up based in how we've actually experienced alcohol from an early age and what it does to us and what it tells us about rewards and that element of the sort of alcoholic experience. Well, for everyone who drinks alcohol and chooses to do so, it's presumed that some aspect of it is rewarding and alcohol is what we call a primary reward because it actually gets to the brain and changes chemicals in the brain that produce the hedonistic feeling of drinking alcohol, the psychostimulatory and relaxant effects that are mediated at least

5:19finally by dopamine in areas of the brain. And everyone who must choose to drink must have some element of fun or an outcome which they regard is pleasurable from alcohol. The question I suppose that you're posing is why for some people that is more rewarding than it is for others and that is certainly a pertinent question to the risk of developing addiction or alcohol dependence and has been very well studied. We're opening a Pandora's box there but some simple principles of it are that people who only drink for fun, I think it's fair to say, I've never met one, very, very rarely develop dependence. It is people who drink not only for fun but also to remove something that is unpleasant that poses a greater risk and this is basic behavioral psychology of positive and negative

6:20reinforcement and both of those things can drive the desire to have a drink so if you drink to remove unhappy feelings, memories etc. or to help social integration, social fitness and to improve your self-esteem then you're at a much greater risk of having problems and if you just drink to have a good time. There will be a lot of people who would say that they do just drink for fun, like you say you've never met anyone who has developed dependence. I didn't phrase that very well. I think it's not a scientific fact but I think I've met anyone who disagrees with me that the AA and psychiatric clinics and addiction clinics are not full of people who drank for fun, they're full of people like me who had other reasons, other motivations for drinking.

7:20So would you say that you can't, if you're drinking for fun, the dependency aspect of alcohol wouldn't tip you over into that area of, I know these are all subjective terms to a certain degree but you would say that if that type of person is less likely or are very unlikely to actually develop an addiction around alcohol or what we might describe as an becoming an alcoholic. I mean most people I think who drink solely for fun are relatively neutral around alcohol and will remain so, i.e. that when they want to have fun they can drink and when they don't want to have fun, you know, they don't feel the necessity to have a drink. But this is not an exact science but it is covered in the book in the, in the framework I give of the drinking scales. The idea that the choice to have a drink is governed by the pros and cons of that and

8:21we all more or less weigh those up at least in rational thinking, you know, the pros side we've got what we've discussed, positive and negative reinforcement and on the coincide you've got all the downsides of drinking, common things like a hangover, the amount of money you spent the night before, but also much more serious things like the medical and health consequences of alcohol both acutely and chronically misx of injury, car accidents, criminality, losing your wife, you know, losing your family, et cetera and the thing that distinguishes of course addiction and the definition of dependence is that even with those harms overtly present the compulsion to drink means that someone carries on drinking and that's not a common phenomenon, two to three percent of the population to fill that criteria. And I guess for people like you and me we would be around those people, like I remember

9:25I spent a lot of time around people who I felt were drinking like I was and yet I could see they didn't sort of something about them, they didn't have that same sense of escaping something, that same sense also I always felt that there was a sort of a self-containment within people who didn't seem to be developing the drinking problem that I had. I think you're absolutely right, there's a sort of self-confidence about people who don't seem to need it, whereas from the first time I started drinking alcohol was a revelation for me because it seemingly solved all of my problems, particularly when I started regularly drinking at about the age of 17 at school, I was a pretty unhappy character then bullied at school, nerdy, you know, academic but not terribly popular and socially

10:34awkward and alcohol solved all those problems for me and you know it's no great surprise that if alcohol solves those problems it's much more reinforcing than if you don't need that. I can ask Charles when you were, you know, you're a surgeon, you're a scientist and like as you said, like the intellectual side of your brain couldn't help you with this but how long were you wrestling with this as a kind of an issue and a problem in terms of trying to figure out who you were and where you kind of what your drinking was doing to what you felt you needed to do about it? Yeah, and in my drinking history can be summed up as sort of ten years of fun, ten years of fun with consequences and then about ten years of consequences without very much fun at all. So from the age of 33 when I got married is when I first remember thinking I had a

11:35significant problem with alcohol and I didn't stop drinking for the first time until the age of 40 and I didn't and my last drink was about ten years ago at the age of 48. And in that period again there was sort of negotiating whether it's like trying to manage it in different ways that kind of that sort of pattern. 33 to 40 was sort of mostly self negotiation and modification of my lifestyle particularly around work. And then from the age of 40 onwards it was back and forth from alcoholics, anonymous and a variety of other interventions more often on. And what was Charles, what was the professional side of your brain and your education and your knowledge telling you about yourself? Like what would you, were you

12:35ever looking at yourself saying what would I say to me if I was looking at this, if this person was coming to me as a patient? Yeah, I think the logical side of my brain knew that I had to do something about my drinking. Mostly my brain was giving me thoughts of negative self worth. And I mean I have a tendency to sort of neurotic personality trait. My brain is the sort of brain that will whizz around until it finds something to punish me with, you know, some sort of thought or memory. And if I put that out of my mind it finds another one. And so that was much, much worse if I was drinking. And really for me it was the consequences to my own mental health that were the main driver of knowing I had a problem with it. I mean it wasn't like I had my wife or other people telling me that I had a problem with it because I wasn't hitting my wife or abusing anyone or crashing motor vehicles or I was paying the rent and putting food on the table

13:41for the kids. But it was my own mental health that was the main problem. And so it was really an internal battle with that. I mean I was telling myself I needed to stop. Yeah. And let's talk about certain chapters in the book because like it is so fascinating as I said, but you start off with chapter two, you talk about learning to drink. And that's just an interesting concept in the context of this book. Can you explain why that is important in terms of the sort of formation and the patterns that we get used to as drinkers? Yeah. Now it comes back to the point we earlier discussed that we learned to drink in the same way that any new behavior is learned. The our choice to exact a behavior is based around the outcome of that behavior and that's basic psychology. If the outcome of a behavior is good

14:45or more likely to repeat it, if it's not good, we're more likely to avoid it in the future. And based on that experience, we learn anything really and drinking is no exception to that. You know, when we first have a drink, we have no idea what it's like. We might have seen it in our parents and things, but we have no personal experience of it. Maybe we don't like the taste, maybe like most people when they first drink, you know, the sickness or drunkenness involved. And with time, we calibrate what we decide what drinks we like, what we don't like, we calibrate how much we can drink when we drink, who we drink with, etc. And that is based on learning. One of the, of course, one of the things that runs through the book from that is like learning anything, you can't unlearn it, which is an important fact. Once it's memorized, you can't unlearn to drink any more than you can unlearn to ride a bike, you know, once it's learned,

15:47it's always there. And that's a really important thing to consider when trying to modify our relationship with alcohol. Because, especially because of the reward element of it as well, because the learning, because you point out in the book as well, nobody likes the taste of alcohol. Like that, you know, I can remember as a kid tasting alcohol for the first time, and you know, just it's been revolting, you know, it's actually, and yet somehow you come to persuade yourself that you like, you know, you like the taste of wine or you like the taste of whatever it is, but that's, that's linked to that sense of reward that it's giving us. Yeah, I think it's almost completely linked to the sense of reward in the same way as it is with smoking or snorting cocaine or things, which is similarly aversive. You know, when you first try them, the, I mean, there is a complex relationship to an alcohol and taste because taste itself is wired in the brain in some instances to be a reward. And that's the background to all the

16:52problems of processed food that I talked about and studied at the moment. So, but yes, the general heuristic here is that we don't much like the taste, but we come to think we like the taste, because of the fundamentally rewarding properties of the alcohol that the drink contains. And how much of dependency and addiction are shaped by the world around us? Because I know when when I was drinking, people used to say to me, well, you're a journalist, you're a journalist drink, you're in the culture where people are drinking, you don't have, you pour you kind of thing, you know, you can't have, it's not very easy for you. And I saw it was exceptionally, I know, it's very tough, but I never drank when I need journalists. Hi, this is Pablo Torei from Pablo Torei finds out and today I want to talk to you about boost mobile, because we spent a lot of time analyzing inefficiencies in sports, overvalued contracts,

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20:05Just beautiful. Millions of fines, each with a story. eBay, things, people, love. With its two juicy beef patties, three slices of melted cheese and tangy big-art sauce, the big arch is what happens when you start making a McDonald's burger and never stop. The big arch. The most McDonald's McDonald's burger yet for a limited time. So it was like, I tried to get everyone else, but I didn't really. I tried to keep my work separate from it, I would occasionally, but it had no bearing on it, but yet we like to think that the external, these external forces are things, but you would argue that actually a lot of it is coming from internal. I think really you can separate people here. They're not all the same. I mean, in the general population, there are undoubtedly a lot of people where our first recourse to alcohol is based on peer pressure or cultural norms. And for many people, that will

21:06be a significant motivation for drinking to socialize with other people who are doing the same thing. However, I think if we're in the realm of talking about problematic drinking in plurality, i.e. people have developed some degree of reliance or has it a so harmful and drinking, then I think it's the internal motivations that are important. And I mean, here there's some very simple facts. I mean, it's a sort of cheap shot and maybe a convenient and fashionable narrative to blame the alcohol industry for advertising or media or, you know, the government for failing to act on minimum pricing, et cetera. And I think there's some truth in all of that, but actually when it comes to the problem side of drinking, we're not greatly influenced by advocates. I mean, humans have been drinking alcohol for 15,000 years, have been deliberately manufacturing it and logibed and invented the television, you know, in 1928. And I don't think

22:10my drinking was any more motivated by advertisements than, for instance, my Labrador's are motivated by advertisements for sausages when it comes to, and I mean, Labrador's a great model of addiction because, of course, it has a genetic deletion that makes it permanently addicted to food, which is being well-studied. But again, like, yeah, that's funny because I sort of say, like, like a dog, I have no off switch, you know, it's the same thing. And it's the same now if you put a packet of sweets in front of me, they're gone. Yeah, to sort of all or nothing, response. And I mean, there is one aspect of advertising that I think I bring up in the book that I think is novel to the book and not discussed by others. And that is this idea that in drinking, we are in a sense converting our real self into one that we might see as a more ideal version

23:14of ourselves. So for people like me at school, I had the version of self that I was unhappy with, and through drinking, I very rapidly learned that I could create a different version of me that was much more popular and happy. And of course, that carried on for 30 years with various versions of me created by alcohol over that period of time. And in advertising, if you look at the thematics of advertising and the paper's written on this subject, they're not really about the alcohol. They are about the consequences of being a drinker of that alcohol in terms of being successful, chivalrous, manly, brave, successful. And you know, James Bond, when he drinks a vulcan martini, conveys to the audience all the things, it's, you know, it's not the vulcan martini, you know, but could you make yourself more like James Bond if you were

24:16moturing him from Camartini? And actually, this is a very strong concept because it comes back to the older areas of our brain that are measuring our self-worth in comparison with other people of the society, and extremely strong drivers of addiction because of their position in the brain, and only recently being studied with modern neuroimaging. But you can easily see someone with low self-esteem, which is really our own measure of our own self-worth, who can treat that with alcohol could easily see that this generation could easily be influenced by adverts that make you believe that you could be a more ideal version of the person you are by drinking. When you talk about that idea of, you know, that the alcohol has been around for so many thousands of years of, you know, the idea of advertising, what is that element? Because I remember being told, again, just after I stopped drinking, that no, no cult should ever touch alcohol. That

25:22was, that was the thing I was told, you know, and obviously Irish people get, you know, like, it's a stereotype, it gets put out there, although we kind of embrace it at times ourselves, but we don't like it when other people bring it up. But is there anything in this sense of a kind of, you know, a sort of a genetic inheritance at a kind of, at a national level? Not really. So the genetics of alcohol use disorder or alcoholism have been well studied, are complicated. So first off, we know that it's heritable. Yeah. So, um, so in countries where more people have problems of alcohol dependence, then their offspring will have more problems of alcohol dependence. There's a four to eleven times risk, particularly for men if you have an alcoholic father, for instance. And that's been very well studied since the 1960s, starting in Scandinavia, and replicated in really all studies.

26:25So is it consistent finding 50% heritability? That means 50% of the variance we see in a population is conveyed by the inherited genome. Somewhere in our genetic makeup, the risk is in there. And doesn't, of course, mean that a person has 50%. An individual is 50% genetic and 50% environmental, you know, you could be anywhere from zero to a hundred and across a population. That is the, um, when studied, that's what you find. The difficulty is that then, of course, it will be very nice to say, well, can we identify what those genes are? And there, it may be, then we could have sort of a personalized approach to this where an individual would know their risk based on the genes. And there, we're in a needle in a haystack situation. And in fact, it's worse than a needle in a haystack because this is a complex disease or trait. That means on the genetic side, we're looking for thousands of needles in a haystack, all of which look pretty much

27:28like hay, i.e. they're not very different from the normal genes. And most of them aren't in the genes at all. So they're in non-coding regions of DNA that are incredibly difficult to study. So we do know some genes that pose a small increase in risk. They're mainly genes that relate to neurotransmitters. It's the chemical signals between our nerve cells in the brain, in parts of the brain like the reward pathway. And in other areas of functioning, including taste, or recently, some genes have come up that are common to obesity and alcohol use disorder. But it's not an easy subject. And I think as a general remark, what much better established is the effects of the environment and the effects of our psyche on the risk of developing alcohol-related problems than the risk of genetics? Well, that's what would have struck me as well, like when you hear about an icon from a long line

28:34of a long family tradition of drinking too much. But it's you wonder too like that. What the environmental pressure draws in that sense? Because I've heard stories about my grandfather and my father that you kind of think, well, he's handing a man hands on misery to man as Philip Larkin. And that being a bigger driver of, and also mimicking the sense that it's a genetic or a heritable trait because the anxiety, the stress, the stuff you talked about in your own life, that's there, and that's more likely to be there if you're growing up in an alcoholic household. I mean, the studies that look at heritability of control for the alcoholic household, for the effect of the environment. So I think that's a real finding. It's just more easy to study the other effects. And certainly as a general rule, the earlier something happens to you in terms

29:36of abuse and neglect in your life, the more effect that has later on in terms of the psychological consequences, including the risk of developing substance misuse and alcohol use disorder. What is, you go through, like you talk about units and various things like that, and I suppose it's very helpful for people who are trying to figure out if they have an issue or not. But I know from my own story, and it's only one story, but I remember being out with people when they go do the checklists in newspapers around Christmas time. And I remember being out for dinner one night with eight people, and everyone answered yes to all the questions. Yeah. And again, I was delighted because I was like, well, I'm getting, I'm not scoring any higher.

30:37They might have got eight out of ten, I got ten out of ten, but it was, you know, it was marginal. And again, anything that creates this sense that it's for, you know, everybody has a problem. It tends to somehow tell people that they don't have a problem. When you go through the units of what categorizes a binge drinker to Irish and British sensibility, they would be like, everybody, everybody, yeah, certainly everybody for young age. And it is nearly everybody who's a regular drinker. I mean, it's the most costly and common form of drinking, binge drinking. I mean, of course, one thing in this is that we do tend to select for other people, socially, who do the same things. I mean, maybe if you'd been out with a group of nuns regularly, it would have had a different result. But the, so the, but the, yes, counting units. I mean, it's only really part of the story. I mean, there are problems, of course, with counting

31:39units in that no one can agree worldwide what a unit is and it differs from country to country. And of course, government safe limits vary country to country. So this doesn't make it easy. I think in terms of one's personal contentment with the relationship we have with alcohol, it's not just about consumption, or if it's really even about consumption. It's much more about consequences and an assessment of whether control has been lost is, you know, the worrying thing. And I talk in the book about the three C's, consumption consequences control. And if we want to get a rounded view of how we're getting on with alcohol, I think we need to look at all three of those. And in the consequences, one of the big things is, of course, it might be seemingly obvious once harm has started to happen. I mean, once you've got a DUI and you've locked up in the police cells, that's pretty obvious

32:41for everyone. But what the World Health Organization calls hazardous alcohol use is probably far more important. And that is the concept of the yet, that in our heart of heart, when we're picking up that drink, we know there are a number of things that haven't happened yet. We're overweight, but we haven't had a heart attack yet, or diabetes yet. We drink drive, but we haven't crashed the car yet, or been arrested yet. We haven't lost the wife or the family yet, we haven't lost our job yet, or been pulled up at work. And this sense of the yet is embodied in this idea of hazardous alcohol use, things where there is a risk of harm, but those harms are yet to occur. And that is, you know, underpins what's now called grey area drinking, which is a very popular term to sit between the whites of neutrality and the black of dependence, a group of people who find

33:41it difficult giving up because it's become a habit, but wouldn't meet the medical criteria of dependence, like me, but have this sense that their behaviour no longer aligns with their own values or the context of society they're in, and is likely to relate in heart in harm if they carry on. In that grey area now, we also have the kind of sober, curious people. We've seen our huge rise in non-alcoholic drinks, non-alcoholic beers, that kind of thing. A friend of mine says that non-alcoholic beers are for non-alcoholics. I think that he's onto something there, but people aren't drinking, given all the health consequences of drinking, not even the long-term health consequences, you talk about it in the book, the statistics about

34:42casualty A and E every weekend are staggering. But how is that changing? That rise in a different view of alcohol? Is that going to change things over time, Charles? Because you know, when you talk about it is embedded culturally in countries like Britain and Ireland for so long, like we're talking on a Friday evening, and when we finish this conversation and I go out to the shops, I know I will see people everywhere in that first flush of freedom on a Friday night. When I see it, I can still get a little bit of euphoric recall at that sense of it, but that's a deeply ingrained thing, but is it changing? Or is there only changing on the margins? No, I think it is changing, and the stats bear that out, particularly in young people. So the stats in the UK now are 25% of 16 to 24-year-olds are T-total,

35:44and I don't know what it was like when you were growing up, but certainly I didn't know anyone who didn't drink. Or if I did, it was because they were religious reason or some rare health reason. I mean, everyone drank alcohol. And so, and the alcohol drinks industry is recognising this, and they're terrified to be honest. Some was an article in the economist about this recently, is, you know, is this the fall in the drinks industry? They're very worried about it, and many of them are investing in producing non-alcoholic drinks. By that, I mean, drinks that seek to mimic an alcoholic drink, but without containing alcohol. And of course, Guinness, a prime example of that in Ireland, who've perhaps been more successful than any other in producing a drink, which is great, in my opinion. Don't advertise on your programme, but it is an Irish. But, you know, they're sponsoring their six nations now, aren't they? Things like that,

36:45the international rugby, where you would previously have seen alcohol containing your sponsoring. So, that's interesting. You see it as a kind of, because that is going to result in a change in that reward, that learned behaviour, that reward system, I see the dog with no off, which is making an appearance. But, you know, that system of reward, and as you say, if that changes, that's a fundamental thing that's changing in society then. Yeah, I mean, I don't have a problem without all three drinks, although I would say... Hi, this is Pablo Torei from Pablo Torei finds out, and today I want to talk to you about Boost Mobile, because we spent a lot of time analysing inefficiencies in sports, over value contracts, money tied up in the wrong places, and so on. But those inefficiencies

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38:55Be sure you get the care you actually need from menopause expert doctors wherever you are, no waiting rooms, no pharmacy lines, just real menopause solutions delivered straight to you. 95% of women feel better in just two weeks. Visit myalloy.com. That's nyalloy.com and don't forget to use code forever 35. That's forever 35 for $20 off your first order. Alloys here to help you feel like yourself again. I spent many years not touching them. I will have them now, but it took me a good number of years in sobriety before I risk touching any of those. There's a good reason scientifically for that. It comes back to taste and other aspects of the drink. If it serves as a reward cue, that is something that reavokes a memory, and the reward system is attuned to spot things like that, the smell of the bar, the noise of the bar, and all any addict knows that,

40:01you know, a heroin addict going back to an alleyway with a familiar smell, can re-invoke the the strong desire to relapse. I don't have a problem with it, but I would say that if anyone, you shouldn't drink them if it makes you want the real thing, and you're trying to stop the, I mean, I spent several years trying to suck the 0.1% of alcohol out of 10 bottles of the USA. So during periods of trying to stop, I know the problem. Yeah, I think you're right. I think it's not something that queues and those tastes and what that does, because that can create its own mimic, a drunk sensation anyway. It gives you a little giddy, even just the process, because, you know, and I think this is true of not just alcohol,

41:03but lots of other drugs. That sense, like, the process, the practice, becomes part of the ritual. It does. And actually, the reason that they removed posters of drug paraphernalia in anti-drugs campaign was that it was causing relapse in people. So the, and I mean, in that we're like an insect, you know, they spot the brightly colored petals of the flower. They are the reward cube. The insect isn't interested in the petals, but it uses them to find the statement of the flower where the pollen is, because its life depends on finding that pollen. And it's exactly that primitive mechanism that's going off in our brains, you know, even in humans. We're designed for that to override other considerations. So the smell, sights, sounds, all capable of inducing that desire. Can I ask you, Charles, about, you know, again, what you write about your own recovery,

42:08and you talk about going to AA, and it is extraordinary to me in a book that is so full of science and, you know, heavily leans on the science involved in this, that alcoholics anonymous started in the, you know, 1930s. So much of what has been done there remains like such a phenomenal way of helping people get sober and say sober. And, you know, I've used this line on the podcast before, but Kurt Vonnegut said it was America's greatest contribution to the 20th century. And the way the way America is going into 21st century, I don't think they're going to do anything in this one, but it is extraordinary that it has, like so many of the principles actually correspond

43:10to what you should be doing in according to science in the 21st century. And that's one of the things I dissect out in the book. It's remarkable. I mean, I mean, actually, the last number of major scientific discoveries, particularly in medicine, have been serendipitous. I mean, Fleming and penicillin, and, you know, there are many examples of things. And I think Bill Wilson and Dr. Bob, who was a proctologist like me, the first two AA's stumbled upon something that, of course, they have no scientific knowledge of that just happened to be right. I mean, they got lucky. And today we can now look at the mechanisms by which AA may operate to help people in recovery and separate those out. And they're pretty much are the main mechanisms that we understand are important for the treatment of addiction. They are, you know, a change in cognition, a change in thinking, a change in social support and networks, and addressing the psychological drivers

44:22of alcohol use that were there in, you know, pushed the problem in the first place. AA does all of those things within something that is almost free to society. And if you attend a meeting, it's, you know, up to you, whether you put a dollar in the, in the pot or not. I mean, John Kelly, who's the professor of addiction medicine at Harvard, if I know and have met on an interview on several occasions, says it's the most cost effective treatment in the whole of medicine ever. And, and, and I think it'd be hard pressed to say that was wrong. It really is the most cost effective. And of course, there are randomized trials that show the effectiveness of it. Many people say that, you know, this is all Hocus Pocus. It's a cult. It's, you know, trying to shame alcoholics. And, and, and there's no validity to in terms of its effectiveness. It's completely untrue. And, but I'm not here to advertise AA, you know, as you will know, one of the traditions

45:26of AA is that it doesn't advertise. No, I'm tracking, yeah. Attraction, yeah. So, but I, I, I think, and of course, the final piece of this, and in the final chapter of my book, I unravel the spiritual aspect of this. And one of the things, of course, that AA is slated with, by many people, is that it's a religious organization because the word god is used in the book, ex number of times. AA is categorically not a religious organization and never has been, but it is a spiritual organization. And the spiritual aspects of the program are completely optional to people. Some people adopt them. Some people don't. But there is now good evidence that spiritual operators, like mindfulness and meditation, make changes to areas of the brain that are affected by addiction. And that can be shown on MRI scans. And I think it won't be long before we really see that there is actually a mechanism for that that can be proved biologically.

46:32I think the other aspect, and it's linked to that, is, and, you know, we are seeing more and more studies about this as well. And you quote the letter from, from Carl Jung to Bill Wilson, and that line, which captures so much about AA, but also what's important in many areas of life, that protective wall of human community. And that is the thing. And that's linked to this, that is, you know, some people might even see it as the spiritual element of AA. That sense that, and you touched upon it earlier when you talked about your brain, trying to always find problems for yourself, and you mentioned it in the book, what you do is you take action, you walk into a room, you do something, you open your mouth, and it is counterintuitive to that sense of figuring things out on your own. For actions are important, because you can't think you way out of a thinking problem, you know, and as I proven, you know, personally,

47:32so actions are some means of changing thinking are very important. But I think the protective wall of community can be looked at at several levels. I mean, at its simplest level, if someone who is, you know, an alcoholic or has any, you know, level of alcohol dependence will often be left with a die hard group of friends, you know, at the bar, or being completely isolated, only going out to see the person in the off-licens, you know, and I know people like that. And in that instance, having a new community of people is simply an absolute requisite, you know, of any form of recovery, because otherwise you're just defined by what you're not, you're a non-drinking person. I'm now a non-drinker hanging out with drinkers. I mean, you haven't got a hope in that situation. But at a greater, you know, at a deeper level, actually caring for other people and human contact are essential for our well-being. And the, and our rewarding of themselves.

48:40So this idea that, you know, the, that you can replace alcohol with another rewarding activity is absolutely, you know, key to the whole social aspects, which Carl, you're spotted and well studied. I mean, now in the, of course, you have in the, in Ireland, the Hilda study, for example, which is this longitudinal cohort, and people, and it's like the Harvard study, it's been running for 18, eight years. And what are the biggest determinants of mental health and longevity? Their social, human contact. Yeah, it's, it's at the heart of everything, it's a heart, and the lack of it is at the heart of lots of problems in the world today as well. And Charles, the book is brilliant. I read it in, in one sitting, and I think it's, it's fascinating reading for anyone who has thought about this subject on lots of people think about it, and it's important to engage it at whatever, wherever you, you land on the, on the drinking spectrum, whether you're like

49:45us or like my wife who can drink one glass of wine, half a glass of wine, and I have to sometimes tell her to drink a bit more. She's letting the side down. One of us has to drink. Yeah. But, but it's, no, it's a brilliant book. It's called Why We, Why We Drink Too Much by Dr. Charles Nose, and Charles has been great talking to you today. Thank you, Dale. Thank you for having me on the show. Shipping, building, admin, payroll, marketing, you're managing all the things,

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