Tuesday, May 25, 2010


Following my post of the Jung and Bill W. correspondence, I’d like to make some comments on addiction.

Probably the granddaddy of all addictions is alcoholism. After millennia of personal, family and cultural destruction, Alcoholics Anonymous evolved around 1935. Some would say, that despite the probably billions of dollars that has been thrown at alcoholism (and other addictions – some prefer to lump them together and refer to the “isms”) by the government and private industry, and to the chagrin of high-powered medical science, that AA is and remains the only consistent and most effective treatment for this equal opportunity malady. (I know, there are always new therapies touted as the "silver bullet" but most are a flash in the pan.) In the following comments, I will make repeated reference to alcoholISM. I want the reader to understand that like those who use the word, “ism”, I mean to suggest that all behaviors that closely match alcoholism to be nearly synonymous.

  • [Disclaimer #1] I am not an alcoholic or drug addict though I have had the usual youthful dalliances. I am not a member of AA or any other 12-Step program, because of that, I am on VERY THIN ICE when I make any comments about 12-Step programs. While it is true that there are no rules, per se, in 12-Step groups one of the 12 Principles is that these groups have no spokesman – so anything I say should be understood to be my limited understanding of 12-Step concepts.
  • [Disclaimer #2] I think AA is a miraculous phenomenon. That’s my belief and while I have my reasons for believing it, I have no hesitation in saying it is not everyone’s cup of tea. Perhaps at any given time, I may have 150 active patients. If all of them practiced the 12 Steps of Alcoholics Anonymous, I imagine that 80% - 85% would have no need of my service. Years ago, when I was clinical director of an out-patient treatment program, I pushed AA attendance hard & heavy. It was required in our program and it is required in most treatment programs today. There’s a reason for that. I will agree that there is more than one way to skin a cat (PETA, forgive the reference). Many people stop drinking without AA. Perhaps they were not alcoholic, but if one is alcoholic, in order to pursue “recovery”, one needs to practice the concepts embodied in AA’s twelve steps. When one practices the Steps of AA, they develop a profound change in their reaction to life. They develop a more realistic sense of how much power/control they have in this life. One develops a more vibrant spiritual life when practicing the Steps. Relationships with others and one’s self are mended. Practicing the Steps is an excellent treatment for those suffering from bloated Egos.

Imagine an oncologist is discussing cancer treatment with a patient and says the patient will have to drive long distances to receive treatment and endure painful side-effects. I’d wager the patient would be willing to do whatever it takes. They would adjust their work schedules and be willing to incur great debt. But when I speak with an untreated alcoholic who states they want to be free of the disease (A disease which left untreated is nearly always fatal and devastates themselves, their family and careers.)… I’m frequently told that they’ll think about pursuing treatment… they say they’ll get back to me… most don’t.

The American Medical Association has long acknowledged alcoholism as a disease, but there are no diseases I am aware of that are characterized as cunning, baffling and powerful – and that’s exactly what alcoholism is. While many other diseases are powerful and may be baffling, I know of none described as cunning. When I hear the word "cunning" I think of skill in deception and guile. In part, this is why alcoholism is described in part as a spiritual disease.

Before going further it’s very important that we make a distinction between alcoholISM and alcohol abuse.

Alcoholism (and all the other isms) is characterized by:
  • The repeated use of alcohol leading to progressively severe repercussions. (lost friends, lost job, lost family lost house, lost freedom, lost front teeth, lost physical and/or mental health to name just the most common).
  • An escalating isolation.
  • Dishonesty – in one’s relationship with others as well as with one’s own self.
  • Sincere delusion. This is when one seems to truly believe preposterous rationalizations for one’s ongoing use.
  • Escalating quantities or frequency of use. (Because one’s liver is sometimes damaged, it’s also possible that decreasing quantities will result in inebriation.)
  • Withdrawal symptoms characterized by obsessive thinking about a drink, shaking, drinking in the morning or waking up at night to drink.
  • Escalating shame characterized by hiding behaviors.

Abuse on the other hand is drinking too much and while it may lead to an argument, it lacks most of the above characteristics. I suppose one can abuse watching basketball on TV.

Dorland’s Medical Dictionary defines disease this way: “A disease is an abnormal medical condition of an organism that impairs bodily functions, associated with specific symptoms and signs it has a predictable natural course. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions. It’s cause may or may not be known. A cure may or may not be known."

Alcoholism can and does mimic the symptoms of physical and mental disorders. Alcohol is a central nervous system depressant. The cost of alcoholism is staggering. In 2002 the health-care costs were 176 B-B-B-Billion! (I hope this is part of the health-care solution that we are promised.) Consider the following conservative estimates of alcohol-related mortality. This year, there will be 12,000 deaths from cirrhosis, 5,00 from withdrawal symptoms, 7,000 from heart-disease, 10,000 from cancer, 5,000 from pneumonia, 17,000 in car accidents, 11,000 suicides, 12,000 murders and 16,000 “unclassified” deaths. On top of this the majority of domestic violence, child abuse, sexual abuse, (together, about 3 million cases annually) and emergency room visits are alcohol related. Alcohol-related problems are involved in 1/3 of the couples seen in a therapist’s office. If you do not have addiction problems you are probably effected by another’s alcohol problems. If alcohol (a liquid drug) were ever presented to the FDA as a medication, it would never be released due to it’s side-effects

Without doubt, alcoholism is a contender for the bane of our culture. So, if you accept, try to solve what may seem to be a paradox. Why is it that those members of AA who practice the 12 steps, frequently refer to themselves as “grateful alcoholics?”

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