Glasgow author James McInally says problem drinking can remain hidden behind careers, families, and otherwise ordinary lives. People do not have to call themselves “alcoholic” or reach rock bottom before deciding to change, whether that means cutting down or stopping completely.
The reality of high risk drinking
Around 1 in 5 adults in England drinks at increasing or higher-risk levels, according to the latest Health Survey for England. In Scotland, 1 in 5 adults drinks at hazardous or harmful levels. Among Scots aged 55–64, that figure rises to 28%, the highest proportion of any age group surveyed.
Yet problem drinking does not always fit the stereotype of severe dependence, lost jobs, or public crises. It can remain hidden behind everyday routines, with people quietly storing alcohol at the back of a cupboard, pouring wine before a partner arrives home, disposing of empty bottles separately to conceal how much they have consumed, or understating their intake when asked.
It can also appear in less obvious patterns, such as drinking most evenings despite repeatedly deciding not to, topping up a glass almost automatically, worrying about how much was consumed the night before, or waking determined that tonight will be different. Many people who otherwise lead normal lives but drink too much remain reluctant to seek help from doctors or other professionals because of social stigma.
From the outside, life can look completely normal. Inside, a more uncomfortable question may be developing: Why am I drinking more than I actually want to?
Challenging the traditional recovery model
That question is at the heart of Alcohol: Cut Down. Stop. Stay Stopped., a new book by Glasgow author and alcohol recovery professional McInally.
McInally believes conversations about alcohol too often focus on extremes: either someone’s drinking is regarded as relatively normal, or alcohol problems are associated with severe dependence, “alcoholism”, rehab, and rock bottom. But alcohol problems do not suddenly begin when someone’s life falls apart.
“Some people can be functioning extremely well in almost every area of their life while becoming increasingly worried about their drinking,” says McInally.
“They may have a career, a family, a home, and an active social life. Nobody looking at them would necessarily think alcohol was a problem. Sometimes even the people closest to them don’t know how much they’re actually drinking.”
“But they know. They know because they’ve started making rules about alcohol and breaking them. They know because they’re hiding quantities, thinking about drinking more often, or waking up regretting it and promising themselves they’ll do things differently.”
McInally argues that people do not need to adopt a particular label before taking concerns about their drinking seriously. “You don’t have to call yourself an alcoholic to acknowledge that alcohol is taking up more space in your life than you want it to.”
“And you certainly don’t have to wait until you’ve lost something important before you’re allowed to change.”
Neuroscience, habits and relief
Rather than treating excessive drinking simply as a failure of willpower, the book explores what can happen when alcohol becomes repeatedly associated with reward, relaxation, relief, and routine. It examines dopamine and reward learning, GABA and glutamate, cravings, anxiety, sleep, stress, habits, cognitive distortions, and the learned associations that can make drinking increasingly automatic.
It also explores the shift that can occur when drinking becomes less about pleasure and increasingly about relief. For some people, alcohol gradually becomes a way of switching off after work, quietening anxiety, falling asleep, escaping uncomfortable thoughts, or changing how they feel.
Understanding those mechanisms, McInally argues, can help explain one of the most frustrating experiences for people trying to change their drinking. “Someone can genuinely mean it when they wake up and say they aren’t going to drink that evening, and then find themselves pouring a drink at six o’clock.”
“Understanding why that happens doesn’t remove personal responsibility. It gives us something much more useful: an opportunity to understand what’s driving the behaviour and change it.”
Multiple paths to recovery
A central argument of the book is that there is no single approach to changing our relationship with alcohol that will work for everyone. Across more than 300 pages, McInally brings together medical treatments, psychology, neuroscience, practical behavioural change, and other established recovery methods.
The book discusses both reducing alcohol consumption and abstinence, as well as medications, supplements, and therapies including CBT, DBT, motivational interviewing, mindfulness, Alcoholics Anonymous, and SMART Recovery. It also covers relapse prevention, cravings, trauma, and the impact of drinking on families and loved ones.
“I don’t believe we help people by pretending there is one correct route,” McInally says.
“For one person, the answer may be complete abstinence and mutual aid. Another may benefit from medication and behavioural change. Someone else may begin simply because they’ve realised they’re drinking more than they want to.”
“Often the answer is a combination of approaches. The important thing is helping people understand what’s happening and what their options are.”
Women and midlife drinking
The book devotes specific attention to women and alcohol, including the relationship between drinking, anxiety, sleep disruption, and the physical and psychological changes that can accompany perimenopause and menopause.
It also examines how drinking can become part of an evening routine, particularly when alcohol is used to relax, sleep, or cope with uncomfortable emotions. Because much of this drinking happens behind closed doors, the extent of it may not always be obvious to friends, colleagues, or family members.
Lived experience driving support
McInally writes from both lived and professional experience. He has personal experience of alcohol use disorder and long-term recovery, has spent years working with people seeking help, and is the founder of Detox Today, a UK alcohol information and support service.
“I’ve experienced alcohol problems personally, and I’ve spent years seeing how differently they can present in different people.”
“The person who has lost everything is real. But so is the person sitting in a perfectly ordinary house tonight, opening another bottle and wondering why they’re doing it again.”
“I’d like that person to know they don’t have to wait for their life to collapse before they take that question seriously.”
Cut Down. Stop. Stay Stopped. by J.S. McInally is available in paperback and Kindle on Amazon, as well as on Apple Books and other retailers.