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Moment that mattered: Amy Winehouse dies

File photo dated 23/07/2011 of floral tributes left outside the home of singer Amy Winehouse, at Camden Square in north London, where the singer was found dead as a foundation set up in Amy Winehouse's name by her father is to be run from her home, it was reported.

Sadly I can’t say I was particularly surprised when I heard the news that Amy Winehouse had died. Certain people live on a high wire and some of those people fall off. The fact that we seem to lose so many [musicians] at the age of 27 – Janis Joplin, Jim Morrison, Jimi Hendrix and now Amy, isn’t just a sad coincidence. In the world I work in you learn that it’s in your late 20s when you can get yourself into real trouble. A lot of heavy users I come across started in their teens. If you’re going to wreck yourself it takes about ten years, so if you start abusing drugs or alcohol at 16 it’s at 26 or 27 that it’s going to hit home.

There’s this idea that when you’re 27 and successful that you’re immune to it all, but neither money nor position can protect you. In fact the lifestyle means it’s all stacked against you even if you want to extricate yourself. If you’re well-known, people buy you a drink and nobody’s going to reprimand you for turning up to “work” drunk. It’s difficult to combat that level of exposure. People I have worked with leave with the best intentions, but every night they’re surrounded by temptation.

The chemical link between alcohol and cocaine is one a lot of people don’t understand. One fires an interest in the other. There’s a substance called cocaethylene that’s formed by the combination of cocaine and alcohol and is more toxic to the heart than either drug alone. There’s evidence to suggest that it actually encourages the user – its maker – to create more of itself. When you mix the two drugs you find you can drink more without getting drunk and you can use more cocaine without feeling so depressed the next day. Understanding this is vital to breaking certain cycles – particularly the cycles of those whose social environments and livelihoods render them unlikely to try to save themselves.

People forget that alcohol is a poison. The good news for those who enjoy a drink is that the body can process one unit of alcohol an hour, but that’s all it can do. The liver is like an airport; it will only let one unit land at a time. Therefore, if you were to drink ten units over one hour (say a bottle of wine), nine units continue to circulate around your body waiting for permission to come into the liver, essentially pickling you as they go. If somebody keeps on drinking as Amy apparently did, then these units keep on arriving at the liver and the levels never return to zero. For every two units she’d lose via detoxification she might take in five more. Before you know it you’re into toxic levels that can kill. If you have a tendency to not be revolted by the effects of the alcohol or if you’re generating cocaethylene you will keep going. For some people the combination of physical and environmental pressures, their genetic make-up and their personality can predispose them to disastrous consequences.

We had a huge increase in calls to our helpline and applications through the website in the weeks after Amy’s death. When somebody you know or somebody in the public eye gets themselves into trouble then people are forced to examine their own drinking – but usually the interest wanes soon after. There’s this need to debunk the fact that some people need help. The natural instinct of a peer group is to play down a friend’s problem and say everything’s alright – especially if they’re drinking more than the person thinking of getting help. After a case like Amy’s, there’s this period of shocked reflection and then someone says “what the hell” and continues behaving much as before.

However, I still believe that some good can come out of these high profile tragedies. If you look back at the tragic story of Leah Betts, what her parents did by allowing her picture to be published and by talking openly about the fact their daughter had died as a result of drugs – that really made a difference. People did start to question the decisions they made on a night out. Working in the field, anything that encourages people to examine their behaviour can help.

Dr William Shanahan is Medical Director of the Capio Nightingale Hospital

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