Alcohol and Hepatitis C - Moderation vs. Abstinence

 

You can look up every obscure website on Hepatitis C, and will be able to garner support for either position. I found plenty of websites and books that suggested moderation in alcohol consumption as an appropriate choice for someone with Hep C. The fact that I went to such lengths to get confirmation for this stance implies that my struggle with the alcohol question was complicated. I didn’t want to quit drinking, and I wanted that to be okay.

As you can probably guess from the tone of the previous paragraph, eventually I had to accept that I needed to be abstinent from alcohol. This realization came about only after four years of veering between the two positions – abstinent for three months, six months, nine months and then a phase of “moderate” drinking. The difficulty was that there is no universal definition of the word moderate, and, well, in my world, it meant many things not intended by the medical professionals who endorsed it.

I was formed by my culture, and in the late seventies and early eighties when I lived my adolescence, drugs and alcohol defined youth sub-culture. As an American teen, it went beyond experimentation. I used no more or less than my circle of friends, but we “partied hard” and made this a central part of our identities. As I grew to adulthood, I let go of the more serious of my drug interests and built a more focused life. Nonetheless, at thirty-five, at the point I was diagnosed with Hepatitis C, I drank beer regularly.

I live in the Pacific Northwest. In our rainy and dynamic city, fine craft-brewed beers are as ubiquitous as the cafes that crowd every corner. As a musician, I spent a lot of time in local bars, playing music and receiving drink tickets in exchange. I went to shows and drank beer, played cards at home with friends on rainy weeknights and drank beer, sat outside in bar patios during the rare, sunny summer months and drank beer. I didn’t drink hard alcohol, or drink to vomiting, or stagger home with strangers. We all drank our finely brewed beer in a healthy way – with interesting and intelligent people, thoughtfully holding back if we were the designated drivers, moderate.

Yet, I knew, sitting with my golden brew in hand, that this was not what the websites meant – that choosing organic beer over whiskey did not make me a moderate drinker.

So, I started self-regulating. Beer or wine only was a no-brainer, but I clearly couldn’t drink with friends three, four, five times a week. One or two an evening was moderate, but, hey, how did this third pint get in my hand? Well, I’ve been here for five hours, played a show, that’s a long span. Suddenly it was a complex list of rules, and I found myself cheating. I had only myself to answer to, and I am a clever manipulator of my own truths.

So I tightened the boundaries. I decided that “moderate” meant you only drank on special occasions. I had met people who only drank at celebrations, who barely drank at all; they were surely the moderate drinkers I could emulate.

A holiday would approach. For weeks I would anticipate, plan – on Christmas I am allowed a glass of red wine. My interpretations of moderate were the ravings of an addict mind, full of the making of rules, the codicils to those rules, the clauses that allowed their breakage. Surely a glass of red wine on Christmas is moderate, and how does one drink a single glass of wine anyway? I’m not wasting the bottle, and here we are, my love and I, sitting on the front porch in the cold darkness, laughing and drinking wine, and I am warm, and we are close, and laughing is easy and there’s another bottle in the cabinet, and it is Christmas. Tomorrow is Boxing Day. Saturday is the weekend that goes with Christmas. A beer on your birthday, that’s moderate, if it is organic, well, if it’s organic, two is okay. This is also my birthday party, although my birthday is one month past, but these people weren’t able to come to that party, and look they’ve brought me presents, so this is definitely my birthday.

And so it went. For years. Rules and their breaking. Guilt and its making. Shame and fear, and wanting to break out of my solitude and then wrapping myself up in it again to keep myself safe. Through it all, my friends and loved ones believing the things I said: “don’t worry, it’s okay, the liver biopsy shows that I’m a survivor” or “livers regenerate and this seven months of abstinence mean I’m starting with a basically fresh liver.” They believed me because they wanted to believe me, because those times on the porch, or in the bar playing pool, or toasting each other in the fine restaurant were happy and important for them too. Because no one who loved me wanted to admit I might be dying.

Finally I realized that in trying to maintain this position, I was straddling two worlds and that as the gap between them grew, I was about to lose my balance and fall into the yawning chasm in the middle. I was afraid of who I would be if I chose abstinence. I was afraid that if I killed that pirate part of me, that reckless and wild aspect of myself that was released when I drank with friends, I would no longer be myself. I was afraid that the alternative to that being was a controlled, boring, ultra-serious loner.

I don’t want to be that.

Yet, I also want to live long and be healthy. I want to watch my children become adults and to travel through India and to canoe the Yukon. I need to be doing everything in my power to combat this virus. This disease feeds on alcohol, greedily, and grows larger with every drop consumed. I was growing the disease, and, simultaneously, shrinking the part of me that needed to be strong to combat it. 

I don’t want to be lying in the hospital, waiting for a liver transplant, and recognize that I could have chosen to stop drinking, but instead opted for my own brand of moderation. If I go down, it won’t be with the taste of guilt in my mouth. 

I finally chose abstinence, and have not looked back. I have struggled, and grown through those struggles; I have lived moments in which I was uncomfortable and resentful and isolated in this choice. Still, every morning when I wake up, no matter what else I am looking toward in my day, I am sure, absolutely sure, that I’ve made the right decision. The argument inside myself ended, and a peaceful stillness took its place.

An honorable doctor will tell you “the single most impactful thing you can do in living with Hep C is to quit drinking alcohol.” They say this as though it were simple. Such things are never simple. Some humans smoke cigarettes through the hole in their throat, or puff their cigar between inhalations of oxygen from their tank. Yet there is a quiet and profound satisfaction in actively committing to heal your body, and this feeling intensifies and gives you more power as you approach the next change, and the next. The hardest things are often those most worth doing.

Comments

[George D. Henderson]

Thankyou. I have no tolerance at all for people who think that moderate drinking with HepC is OK. First of all, regular drinking is never moderate in my experience - noone using this excuse stops at one standard drink. Second, if it's OK, then why are they still telling me their symptoms? Thirdly, there are better drugs. Even without hep C or cirrhosis, alcohol is so destructive it should be illegal. Alcohol raises levels of malondialdehyde (MDA), as does HCV. MDA is a marker of oxidative damage, of lipid peroxidation in HCV. So, Hep C and alcohol produce the same toxic chemical. If you combine the two, in my opinion, especially every day, you are just asking for it. like you, I had to learn the hard way. But I look at the swollen bellies of my friends who still drink, and I could never start again. Drink and you give the virus a helping hand. That said, drinking a couple of glasses of red wine less than once a week (and avoiding alcohol the rest of the time) is what one person who cleared the virus naturally did. I don't think it helped, but it didn't hurt, and, as they were anorexic, it may even have helped them to eat.