Elsa Karlsson

If your sister is going through a bottle of wine a night, every night, and she's not in AA, she's not in rehab, she's not "an alcoholic" in the way her GP would tick a box — but she is awake at 3am hating herself, and she's started cancelling things she used to love, and her teenage daughter doesn't sit at the breakfast table with her anymore — it isn't because she lacks willpower. It isn't because she "just needs to try Dry January again." It isn't because she needs another book. You're going to be furious by the end of this. I was. Three things are true and nobody is telling middle-aged women any of them. ONE. The 5pm voice in their head is not weakness. It is documented receptor depletion in the part of the brain that produces calm signals. TWO. Every supplement they've ever tried — kudzu, milk thistle, B-complex, magnesium — has been quietly destroyed by their own liver before it ever reached their bloodstream. THREE. There is a medication called naltrexone that has been licensed in this country since 1994, with thirty-one years of clinical evidence behind it, and almost no GP will mention it until the woman calls herself "an alcoholic" first. And she won't, so they won't. My sister Hannah is forty-seven and she has been on a bottle of Pinot Grigio a night for the last six years. She is a primary school deputy head. She is married. She has a fourteen-year-old daughter. She is funny and she is kind and she is the best aunt my children have, and she has been falling apart slowly for half a decade and nobody — least of all her GP — has been able to help her. It started during the pandemic. Stayed after the pandemic. Got worse during perimenopause. The empties piled up in the recycling and she started buying her wine at three different supermarkets so no single cashier saw the volume. She told me about this one Sunday afternoon and I didn't sleep that night. She tried everything. Dry January in 2022. Dry January in 2023. The Try Dry app, which she deleted because seeing the numbers made her feel worse. Annie Grace's book. Two different brands of kudzu capsules — Planetary Herbals and a Swanson one — taken religiously for two months at a time. Milk thistle. B-complex. Six sessions of private CBT at eighty pounds a go. Alcohol-free Pinot. Mocktails on a Tuesday. She went to her GP. The GP asked how many units. Hannah underreported. The GP said try to have two dry nights a week. The whole conversation was six minutes long. Hannah walked out and bought wine on the way home. "Try Dry January again." "Have more dry nights." "Cut down by about 25%." "Maybe see a therapist." "Drink water in between." That last one nearly made me put my phone through the wall. DRINK WATER IN BETWEEN. As if my sister, deputy head of a primary school, with a master's degree in education, hadn't thought of drinking water in between. Why hasn't anyone in the medical system actually explained what is happening to her at a receptor level? Why hasn't anyone explained what's happening to her liver? Why hasn't anyone in our country's medical system said the word "naltrexone" out loud to her in eight years of drinking? Nobody tells us this. After several years of nightly wine, the brain's GABA-A receptors — the calm receptors — go quiet. They've outsourced the job. Your nervous system runs glutamate-dominant by 5pm. The 5pm voice isn't a moral failing. It is documented receptor downregulation. At the same time, your liver gets so busy clearing the alcohol every morning that every supplement you swallow to help — kudzu, milk thistle, B-complex — gets broken down on the way in. The very organ that needs support is destroying the support. This made my blood boil. The reason your GP won't mention naltrexone is partly because the addiction treatment system in this country is built around twelve-step abstinence and not around women like my sister. The reason oral supplements don't work for her is because nobody at her supplement counter is being trained to explain first-pass metabolism. The industry that's grown up around "wellness drinking" doesn't profit if women like Hannah quietly get better. My friend from book club is married to a clinical research nurse — nineteen years in nutritional medicine, works alongside hepatologists in a clinic outside London. She told me about a patch. A transdermal patch. The same delivery principle NASA used in 1979 to dose astronauts on Spacelab missions. Bypasses the gut. Bypasses the liver. Twenty-four-hour release. Kudzu — the plant Tang Dynasty doctors used to settle heavy drinking from around 600 AD — plus magnesium glycinate, B-complex, and milk thistle silymarin. The kudzu mechanism was confirmed at a leading university in [country] in the early 1990s. I sent the name to Hannah on a Wednesday morning. Frimod. Day three she texted me and said she'd slept eight hours. Day seven she rang me and said her daughter had looked up at her at breakfast — actually looked up, not at the phone — and said "Mum, you look different. Better." Hannah cried on the phone telling me. Day fourteen she went a whole evening without opening the cupboard. Day twenty-one she came to my house for Sunday lunch and had one glass and walked away from the second. I noticed she hadn't yawned once all afternoon. Today she sleeps. Today her face isn't puffy. Today her daughter sits at the breakfast table. 👉 If you're reading this for your sister, your wife, your daughter, your mother — don't wait until she's ready next month. Send her the article right now. Today. Sarah Mitchell tells her own version of this in the article on the next page. Twenty-five years of it. The morning her daughter looked up at her in the kitchen. Reading her story was the first time my sister felt understood instead of judged. Read it. Send it to her. https://www.zynvista.com/UK/gray-area-drinking