Suzi Godson

Your friend is not a nymphomaniac; she is a girl who has issues with alcohol, issues with sex and, as you so rightly point out, issues with herself. Is there a cure? Getting her to avoid alcohol would help, but her motivation for drinking is probably complex.

Female self-esteem is a fragile thing and for some young girls alcohol provides a short-lived escape from insecurity. No matter how functional or dysfunctional a girl is, attention from the opposite sex is taken as a form of validation, and because it is easier to have meaningless sex when you are drunk, the two things often go hand in hand. But when drunken one-night stands become a pattern,the high of “feeling wanted” is balanced by a crashing low the following morning.

Your friend frequently feels ashamed and humiliated, which then creates a spiral of self-loathing and carelessness that she tries to alleviate by drinking to abandon. She then gives herself away because she feels worthless. Besides the damage that she is doing to her liver and the risk she runs of contracting a sexually transmitted infection, the longer your friend's behaviour goes unchecked, the more it is likely to escalate.

The number of women drinking heavily has risen to such an extent in recent years that hospitals are dealing with women in their twenties and thirties who are suffering from liver damage. The alcohol industry realises that to create a lifetime heavy drinker, the best way is to start them early.

Although you and your friends don't realise it, your attitudes to alcohol have been heavily influenced by advertising from a young age. A 2002 study by the Center on Alcohol Marketing and Youth at Georgetown University, in Washington, that looked at the advertising content and readership ages of popular magazines such as Vogue, Cosmopolitan, Maxim and Sports Illustrated, found that while under-age boys saw 29 per cent more advertising for alcohol than legal-age men, under-age girls saw 68 per cent more such advertising than legal-age women.

So what can you do to help? You may be able to persuade her to see her GP and get a referral for therapy, but if she refuses to admit that she has a problem, you can still try to get her to channel her energy into more constructive activities. Instead of going drinking, go to the movies or have a night in with girlfriends a couple of times a week. Or get into exercise. It generates a natural, as opposed to an alcohol-induced, high and the stronger your friend gets, the better she will feel about herself. If you can, make sure that she eats properly. A report from the National Center on Addiction and Substance Abuse, at Columbia University in New York, suggests that alcohol abuse is far more common among those with eating disorders. Lower body weights and different metabolisms mean that one drink for a teenage girl has roughly the same impact as two drinks for a teenage boy, but if a girl is living on non-fat yoghurt she has no ballast to counter the impact of alcohol.

The key to hauling your friend back from the abyss is to offer her help, not judgment, because she probably feels bad enough about herself already. It can be difficult to sustain a friendship with someone who reels from crisis to crisis and who seeks your advice but then refuses to take it, but hang in there. We get what we give in this life, and one day you might need a good friend too.

Suzi Godson is the author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)

Dr Thomas Stuttaford

Whether discussing behaviour in bed or at the bar it is essential to avoid labelling people. It is too easy and often inaccurate to describe somebody as an alcoholic or nymphomaniac even though the diagnosis in both cases must have been subjective rather than objective.

Immense damage can be done to the cause of encouraging sensible drinking by official campaigns, and those run by anti-alcohol groups, labelling people as having an alcohol problem. Some of the criteria laid down by opponents of alcohol are so restrictive that they would, for example, consider that a woman who had more than one home-poured gin and tonic a night to be a problem drinker.

Similarly, the pejorative term promiscuous was one that was not allowed by my clinic's chief when I started in genitourinary medicine. He always maintained that promiscuity was not a matter of numbers, but of the underlying motivation of the multipartnered person. Is your friend so indifferent to her partners that she has no interest whatsoever in them other than as human dildos? Does her regard for them ever extend above their belts?

Conversely, it could be, and in my experience often is, that a woman or man was genuinely committed to, and even loved, two or three people and their sex life together was a manifestation of the depth of feeling in their relationship and not of a preoccupation with sexual satisfaction. Even so, it's a safe bet that most of the person's friends would have described him or her as promiscuous without knowing any of the details. This contrasts to society's opinion of those who have relatively few contacts, but those that they have had have always run in series rather than in parallel. Even though this latter group might not give a damn about any of their sexual partners, and conducted the affairs without any emotional involvement, their neighbours would probably judge them as worthy citizens.

If your account of your friend's lifestyle is accurate, it would seem that her nightly escapades were to achieve only transitory physical pleasure and escapism. The sex was probably more akin to mutual masturbation than consensual sexual intercourse.

Both heavy drinking and hyperphilia - a preoccupation with or over-indulgence in the pursuit of sexual arousal and gratification - may be a symptom of a wide variety of problems. A worthwhile opinion on this case would have to be based on a detailed knowledge of the person's background, age, physique and other symptoms.

Most men are at their most hot-blooded in late adolescence, the equivalent surge usually hits women about ten years later. The standard suggestion would be that your friend may well have had a poor or emotionally distant relationship with one or both parents in early childhood. A lack of rapport is thought to be more damaging if it is related to the mother rather than father. There is also the premise that hyperphilia is often the result of a lack of self-esteem and confidence. As a result, the person needs the constant reassurance of sexual conquest and satisfaction to boost self-worth. There may be a familial pattern to alcoholism, but as with hyperphilia, the trigger can be a lack of confidence.

A surfeit of alcohol or lovers can boost or disguise social vulnerability. Both hyperphilia and irresponsible drinking can be signs of several personality disorders. These are difficult to treat.

Dr Thomas Stuttaford, The Times doctor, spent many years working in a genitourinary clinic

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