A sunny afternoon in Florida. I’m on holiday with my wife, Annie, and our two young children, visiting friends. The weather is warm and I am sitting outside my friend’s house.
I am alone. Or to be precise, I’ve been left alone. After a booze-soaked spree – the crescendo of a week of heavy drinking starting before I’d even reached the airport – I have been left to recover from the hangover of the night before.
But I am not recovering. I have on the table a half-empty bottle of Bacardi and a handgun. I consider taking my own life; it is not the first time.
On the face of it, my life was then – and still is – successful. I’m a respected practising surgeon specialising in bowel disease. As a professor of surgery at Queen Mary University of London, I’ve published hundreds of peer-reviewed scientific papers. I am now also chief academic officer at the Cleveland Clinic in London.
In short, my working life flourished, even while I drank.
Dr Charles Knowles, author of Why We Drink, is a surgeon specialising in bowel disease and professor at Queen Mary University of London
At my peak, I could drink a lot. All added up, there were times when I was consuming about ten times the recommended weekly limit: the equivalent, for those of you who are wondering what this means, of around 60 pints of medium-strength beer or 60 medium glasses of wine.
I concealed my addiction well. Even my wife for a long time had no idea anything was wrong – until she got a call from an emergency psychiatrist after I almost jumped off a bridge and took my own life, some eight years before the incident in Florida.
Each of us has an idea of what an alcoholic looks like, but I am guessing a professor of surgery is not a common stereotype.
But according to experts, functioning alcoholics are often high achievers with stressful jobs, while also suffering low self-esteem and mental health problems such as depression (indeed, when I first saw a psychiatrist 18 years ago, I was diagnosed with depression as well as alcoholism).
Researchers have singled out surgeons as a classic category for functioning alcoholism – a 2012 survey in the journal Archives of Surgery showed a whopping 14 per cent of male surgeons and 25 per cent of female surgeons in the US suffered from some degree of alcohol use disorder (AUD), the preferred clinical term for a spectrum of problematic alcohol use that affects around 8.6 per cent of the adult population.
Alcoholism, also known as ‘alcohol dependency’, represents the severe end of the AUD spectrum and affects around 2 to 3 per cent.
The reasons cited for surgeons being especially prone to alcohol misuse are perhaps unsurprising, including long hours and stressful working conditions, and the perpetual threat of error, complaint and litigation.
That day as I sat suicidal in Florida, almost a decade ago, my 30-year relationship with alcohol finally ended. A combination of thinking of my family and cowardice led me not to pull the trigger.
After one more drinking spree – during which I almost lost my wedding ring; a sign, I realised, that I was about to sacrifice much more than my own sanity – I woke, sweating and shaking, and kneeled on the floor, praying for deliverance to any god that would listen. That rock-bottom moment led me not only to quit drink for good, but to probe why I drank.
At my peak, I could drink a lot. All added up, there were times when I was consuming about ten times the recommended weekly limit, says the surgeon
Why did I become such an enthusiastic and proficient drinker that by my 20s, even after consuming 30 units of alcohol – roughly 15 pints of average- strength beer – I could always walk, find my home and never lose my memory?
How was it I could contemplate trips to the playground with my children based on the pubs that were near – placing alcohol above everything else in my life? That is, bar my work.
While I never drank at, or before, work – the obvious potential implications were a red line – telling my story still requires a level of honesty some may find troubling for a practising surgeon.
This is deliberate on my part: despite so much progress in destigmatising other areas of mental health, people addicted to alcohol have to remain anonymous.
And if the very people tasked with providing healthcare can’t lead in coming clean about their own problems, what hope do others have?
Investigating the causes of my drinking led me to write a book on the subject.
While I am no addiction specialist, in it I used the same scientific rigour I apply to my own field. I obviously also have much personal experience.
So why do people like me become dependent on alcohol?
For me, aside from the pressures of my profession, having ADHD is a significant factor. I was diagnosed three years ago, aged 54.
Diagnosis came eventually from my GP, who could ‘barely remember seeing a high-functioning professional with serious alcohol problems who didn’t turn out to have ADHD’. In fact, about half of adults aged 20 to 39 with ADHD will have a substance-use disorder in their lifetime.
Among adults being treated for alcohol and substance misuse, the rate of ADHD is a whopping 25 per cent. Alcoholism and other addictions are commonly the first signs of the condition.
A common symptom of ADHD is what some experts call domestic anxiety – a constant barrage of distracting thoughts. Many discover this can be suppressed by consuming alcohol. I had seen educational psychologists in my teenage years for my inattention but nothing came of it. Having been joked about for much of my adult life, it was only given more serious consideration when my son was diagnosed with autism.
It then transpired that my father had been given sedatives at school for hyperactivity, and similar problems went even further back in the male lineage of the family. ADHD is about 85 per cent heritable.
While we have known from research in the 1970s that alcoholism is 50 per cent heritable, in terms of finding individual genes we are still only scratching the surface.
What we do know is most of the genes for alcoholism discovered so far overlap with other major mental health conditions, such as schizophrenia and bipolar disorder, and neurodevelopmental problems such as ADHD.
My first drink came aged about 13. On a school trip in Munich, Germany, a few of us were dragged by older students to visit one of the famous beerhouses: I quickly drank a one-litre stein of German lager and was halfway through a second before being extricated by teachers.
My regular drinking started around 17. Unpopular and socially awkward at my large private boarding school, around 50 miles away from my home in Boston, Lincolnshire, I was bullied badly.
While I never drank at, or before, work – the obvious potential implications were a red line – telling my story still requires a level of honesty some may find troubling for a practising surgeon
I had always been highly sensitive. For example, just hearing about Elvis’s death when I was eight, wracked me with fear – this was the end, my family would surely be next, we would all imminently expire from heart attacks.
This projection to future imaginary catastrophes extended beyond the untimely death of rock stars. I was someone who reacted to stressful or unstable situations with fear and emotional breakdown.
This didn’t help at boarding school, where fear purveyed the dormitories. One favourite horror was the sock and soap treatment, where an unsuspecting victim would be woken from sleep, held down and pommelled with soap bar-laden socks.
I did what had to be done – I learned the art of emotional suppression. I cried in secret, told my parents everything was great and never reported the bullying.
For me, boarding school instilled a habit of internally berating myself for my perceived inadequacies. This is very hard to change in adulthood.
Alcohol, though, was a seemingly instantaneous ‘cure’ for my psychological ailments.
From being a nervy teen, I moved to the centre of the party: I started dating and became the guitarist for the school band. By the time I left school, I could down a bottle of red wine in ten seconds.
In 1986, I went to Cambridge to study medical sciences and made the most of the various drinking societies.
When, in 1994, I took the primary fellowship exams of the Royal College of Surgeons of England – which has a first-time pass rate of less than 25 per cent – I don’t remember learning I had passed, as I was already drunk.
But I remember the next morning, telling my parents as I vomited into the loo. I was back on the beer by six that evening. A daily drinker, binges were now commonplace, yet I knew my limits. I never extended testing alcohol as a performance enhancer for surgery. Unfortunately, in this era, others did.
In 1996, having passed more exams necessary to become a surgeon, I embarked on a PhD. Free of regular clinical work, my drinking got worse.
This was especially problematic at medical conferences, where my drinking usually started at the airport. Whether it was participating in a brawl in New Orleans (as I did once), or giving lectures visibly drunk in Bologna or Chicago, I never learned my lesson.
My craving to drink was overwhelming as I seemed to be riddled with anxiety and fear until I had extinguished these feelings with another drinking session. In 2000, I returned to full clinical duties, then met and married Annie and our daughter was born.
This changed my habits, not all for the better.
In attempting to go home without stopping at the pub, I discovered the sauvignon blanc in the fridge every night saying ‘drink me’.
Worse, I had a fixed drinking speed calibrated to beer. I might as well have tipped the wine into a pint glass for the speed I consumed it (later I would). I would have one bottle of wine, and then start another.
Because of work, I began restricting my drinking excesses to weekends. I also conceded to changing my favourite drinking establishments to those near a playground.
Yet being left alone with my young daughter induced such anxiety I could not be relied on to look after her and would instead hit the wine.
On one occasion, Annie returned to find me comatose on the sofa with all the lights off and our daughter, then five, standing in the dark, asking when she was going to be fed.
On another, after a medical conference in Birmingham, I attempted to pick her up from nursery at 3.30pm, but was so drunk the school would not release her to me. Annie had to be called to the rescue from work.
Not surprisingly my drinking made her feel resentful and distant from me.
Even after the arrival of our second child, a boy, in 2005, my drinking continued.
I fulfilled basic family duties, kept work going as a senior registrar in colorectal surgery, and collected the kids from school and nursery (though walking a route home that took me, and the kids, into at least one pub).
Investigating the causes of my drinking led me to write a book on the subject. While I am no addiction specialist, in it I used the same scientific rigour I apply to my own field.
So when did the wheels really start to come off?
Perhaps the most obvious point was my son’s christening in 2005. I got so drunk I had a stand-up row with Annie’s father. Apologies the next day defused the immediate crisis, but everyone – including me – knew I’d crossed a line.
And so that week I went to my first Alcoholics Anonymous (AA) meeting. I fully conceded I was an alcoholic, but still didn’t really get how much I needed to change my life.
I felt guilty that, unlike many people who shared their stories, I seemed to be one of the few with no good reason for being there – unlike those with alcoholic parents, or victims of serious abuse or neglect. For a long while I concluded I had only myself to blame.
But as well as the ADHD being a factor, now I also see alcohol helped me dissociate from painful emotions: my life has been hampered by emotional austerity since school days – a problem that remains a barrier in my relationship with Annie today.
I seem unable to demonstrate love and affection to anything other than babies and pets.
Alcohol, though, enabled me to ‘let people in’ .
Annie decided I needed psychological counselling. But I needed a few drinks to even go in.
After about session four, I hit the spirits and woke up on the living room floor of my empty house. Annie had taken the kids and left after I’d returned, blind drunk, and threatened her. (She eventually returned.)
Not long after, I set off to the Christmas work party in Central London. I’d been off work that day and spent it drinking, so was already drunk and agitated. At some point I walked out and wandered onto a large bridge, where I was suddenly overwhelmed with the conviction I should jump off into the black ice-cold water.
With the help of friends and colleagues, I was taken to see an emergency psychiatrist and signed off work for two weeks.
The psychiatrist was plain-spoken: my diagnosis was alcoholism and if I didn’t stop it would kill me. For now, my problem was not widely known; but, he said, if I picked up another drink, he would sign me off for longer and send me to rehab (then everyone at work would know).
He also diagnosed depression, gave me antidepressants and instructed me to go back to AA, which I did.
The following years were tough. A few bumps along the way culminated with the gun in 2015.
Back home from Florida, I returned to my psychiatrist and restarted treatment for my depression. I also enrolled in the UK’s Practitioner Health Programme, established for doctors with mental health problems.
But what helped most was getting a new sponsor at AA (this mentor would guide me through the recovery process).
A moment I remember very well was walking out of my sponsor’s flat, and him saying: ‘You know, Charlie, you never have to drink again.’ I had the sudden realisation he might be right. A strange peace came over me; the uncontrollable urge to drink left and has never returned.
Today I will go to the pub with friends and drink soft drinks. If they ask why, I tell people I am a recovering alcoholic.
I’ve found this invites others to open up about their problems with alcohol, which is not uncommon among my friends and colleagues.
Annie – who had been what we call a ‘grey-area drinker’, with a keen eye for wine o’clock – gave up drinking after the pandemic. Now a sober coach, she works to support women to address the reasons they drink.
We know I will never be cured of alcoholism even if I remain sober for the rest of my life.
However, there is a ‘sober community’ out there, for people like me. For example, Annie and I recently climbed to watch the sunrise over Snowdon, a mountain in North Wales, with about 30 members of the UK’s Over The Influence group, a truly memorable experience.
All of our journeys with alcohol differed. But they, like Annie and I, can attest that a life without alcohol truly is a joyful one.
Adapted from Why We Drink Too Much, by Charles Knowles (Macmillan, £20), to be published on January 8. © Charles Knowles 2026. To order a copy for £15.17 (offer valid until January 17; UK P&P free on orders over £25) go to mailshop.co.uk/books or call 020 3176 2937.
For confidential support, call the Samaritans on 116 123 or visit samaritans.org
