Mind over Matter

Dear Dr Ash,

This year, like the past four or five, I made a New Year’s resolution to undertake a Dry January. But I barely made it through the first week and by week two I’d totally crumpled. Why do I have so little resolve and what can I do about it? I’m now looking down the gun barrel of Lent, but that’s an even longer period of time and I can’t seem to manage seven days. I’m not a huge boozer, but I do enjoy a glass of wine most days around 6pm and at the weekend one glass can easily become a bottle. I’m almost 50 and feel I should be able to muster the resolve to quit for a while, but in practice I give in. I’m aware I’m setting my children a bad example and as I hit middle age it’s doing my waistline no favours.

Alcohol-dependent mother,
Leicestershire

Dear Alcohol-dependent,

In the failing light of a grey January morning, I cast my gaze out the window beyond bare trees and over soggy fields towards what I imagine would be a beautiful long view if it weren’t utterly obscured by low cloud and mist. I am in awe of anyone who would choose this particular month to embark on a mission of self-improvement. 

The same milky skies must have drowned the horizon in January 2013, when Alcohol Change UK ran its first Dry January campaign. There are, in fact, good reasons they chose to target this otherwise inauspicious month. Compared to a typical December of boozy holiday parties (or, if you prefer, “work events”), sobriety in January requires less sacrifice. Moreover, research into the neuroscience of habits demonstrates that changes are easier to implement immediately after a starting line like New Year’s Day, a birthday, or an anniversary. Katy Milkman and her colleagues at the University of Pennsylvania call this the “fresh start” effect. Dry January also meets what behaviour change experts call the SMART criteria: it is Specific, Measurable, Attainable, Realistic and Timely. The fact it is a nationwide campaign leverages supportive group effects, which research shows are predictive of successful habit change. Dry January is, in short, an excellent idea backed up by strong science with an established track record of success.

And yet… and yet. 

A New Year’s resolution will, by definition, be something significant that you’ve wanted, but failed to achieve in the preceding year. In that sense you’re stacking the deck against yourself; you’re choosing to test your willpower on a problem that’s already proven intractable, then berating yourself for failing to solve in two weeks what you know you weren’t able to solve in the preceding fifty-two. Sticking to the resolution may require figuring out what has prevented you from achieving your goal already.

Which brings us to the pointed end of the stick: why do you drink? Is it to counterbalance a rich, heavy meal? Is it to unwind after a stressful day? Is it a coping mechanism for a more uncomfortable truth? If you want to change this habit you’ll need to understand what drives you to drink in the first place. Paradoxically, while you’re drinking it can be harder to figure out why you drink. You may need help with this.

It is worth stating clearly that you are addicted to alcohol. I think you know this. You have expressed a desire to drink less and an understanding of at least some of the negative effects drinking has on your life, but you still find yourself struggling to cut back. My advice is that, in the short term, you visit Alcohol Change UK’s website, sign up for their newsletters and follow their practical advice. You might consider discussing this with your GP, who can connect you to a variety of resources that will help. Alcohol is a powerfully addictive substance, and the difficulty you’re encountering in cutting back is not uncommon. Dry January is a good start but there may be a longer journey ahead.

Best wishes,
Dr Ash

Dear Dr Ash,

I’m a 42-year-old married man and here’s my guilty confession: I’m just not that interested in sex. In fact, I never have been. On the scale of my enthusiasms, I’d put it somewhere below reading a good book and above going shopping. I do it twice a month for my wife’s sake but I’m sure she can tell my heart’s not in it – though I deny that when she asks. I’m glad the whole business has given me two lovely children, but I think it’s a bit overrated otherwise. I’m aware I’m supposed to display enthusiasm for at least another decade, but not sure I can. What should I do?

Guilty lawyer,
London

Dear Guilty,

As a data scientist myself I appreciate the linear elegance of your scale of enthusiasms, but as you know real life comes in more than one dimension. Sexuality involves so much more than sex. It can involve physical and emotional intimacy, vulnerability, play, connection, love, anger: the entire range of human emotions. I suspect that somewhere within that many-dimensional space are feelings and experiences that could interest you very much.

Locating yourself in that space will require you to accept one of the great paradoxes of neurobiology, which is that although human beings clearly differ by gender, race, size and a myriad of other ways, our brains are largely indistinguishable at group level. Even computer algorithms operating on large data sets cannot reliably distinguish a male brain from a female one. (Incidentally, the same is true of other organs like the heart, lungs, liver and kidneys. No one has ever been told they have a girly pancreas.)

It can be tempting to assume that this biological uniformity means our basic drives, like sex, hunger and sleep, are equally shared. But this would be like assuming that all television screens only show one programme because they are all wired the same. It’s the information that counts, and information flow in the brain is heavily shaped by life experience.

So although you and your wife may appear to be like everyone else, each of you is sexually unique. There is no reason to feel guilty about your sex drive, and you certainly shouldn’t be having sex because you feel you ought to. In any case, no one’s sexual attitudes and preferences stay the same over decades. 

It sounds like it’s time for a loving and open conversation with your wife about what is working and what isn’t. Since that could be an awkward or fraught conversation, you might seek help from a relationship counsellor or a sex therapist. Your lack of interest in sex may be due to an emotional issue from your past. Or you may find that this is simply who you are. Either way, traditional sexual arrangements don’t work for everyone and it may be time to get creative about the parameters of your marriage. You and your wife both deserve the chance to find fulfilment.

Best wishes,
Dr Ash

Dr Ash Ranpura is a neuroscientist and clinical neurologist. He qualified in medicine and general neurology at Yale University and the Yale-New Haven Hospital, and trained in cognitive neuroscience at Queen Square, London