Monday, January 9, 2012

I have noticed a stunning irony when it comes to the treatment of alcoholism.

In my work I regularly encounter individuals suffering the ravages of alcoholism. 

Whether it is late or early stage alcoholism, I explain that alcoholism is a disease for which there is no “cure” but with proper treatment, the progression of the disease can be arrested. I explain that if left untreated, alcoholism is more lethal than cancer, particularly when one considers the societal costs. 

  • Roughly 25% of hospital beds are filled by alcohol related conditions 
  • 50% of emergency room visits are alcohol related
  • over half of domestic violence is alcohol related 
  • over half of child abuse/neglect is alcohol related and almost 50% of traffic fatalities are alcohol related 
  • Lost wages resulting from hangovers in the U.S. alone was $148 BILLION in 2005.

The implications are staggering.

If most patients I see were diagnosed with cancer, and were told that a near certain cure was possible but the patient would have to travel a thousand miles, be financially ruined, undergo perilous surgery and followed by chemotherapy with it attendant side effects, they would gladly endure the gauntlet. If those same patients were told there was a slim chance that eating a macrobiotic diet has been reported to help but there was no evidence to support it; they’d probably pass (though, in Santa Barbara, I’m unsure).

But, if my patients are diagnosed with alcoholism (more lethal than cancer) and told that the disease is treatable with good success – and the treatment is essentially free and the treatment is local, with few side effects … and the treatment is AA… probably half my patients will find reasons to avoid treatment for this deadly disease which will effect generations.

I think if I were told I had cancer which had a good cure rate if I converted to Judaism – I would convert in a heart beat. If they told me I could be successfully treated by converting to Roman Catholicism, I'd be saying my Hail Marys now.

I do not understand the aversion people have to AA. 

Some say that AA is religious (it’s not) or is a cult (it is) – I’d be the first to sign up for the religious cult if it would treat my condition. If I converted to Catholicism, it might take a while to learn the theology – I probably wouldn’t agree with every belief – but if it treated my condition, I'd eat fish on Friday, go to Mass twice weekly, go to confession and say the rosary.

(By the way – a cult – the root word for culture – is ANY group with a shared set of ideas, that use language that is characteristic to the group, that have rituals that help people feel like members of the cult. This would include therapists, physicians, chefs, or AAers.)

Really; I wish someone would tell me, what’s the big resistance… particularly when one considers the alternative?

I tell my patients, “If a person is drowning they ought not to be picky about the color of the lifeboat.” If they’re picky, it means to me that (a) they don’t really believe they’re drowning or (b) they are REALLY confident a different colored lifeboat is close behind.

I’ve been singing the praises of AA for years. 

Believe me, I think I’ve heard every criticism of AA; that it’s religious, that it’s founded on Christian thinking, that’s paternalistic, that it’s a cult ad nauseum. Some of it MAY be true – but if it will successfully treat a lethal condition, sign me up.

If all of my patients (whether they have a substance abuse problem or not) practiced the 12-Steps of AA, I believe I’d have 80% fewer patients – but I guess that would make them feel like they’re just “garden variety” humans.

I quote the below from AA’s “Big Book” – it’s in the back of the book; many think it should be in the front.

Appendex I I

The terms “spiritual experience” and “spiritual awakening” are used many times in this book which, upon careful reading, shows that the personality change sufficient to bring about recovery from alcoholism has manifested itself among us in many different forms.

Yet it is true that our first printing gave many readers the impression that these personality changes, or religious experiences, must be in the nature of sudden and spectacular upheavals. Happily for everyone, this conclusion is erroneous.

In the first few chapters a number of sudden revolutionary changes are described. Though it was not our intention to create such an impression, many alcoholics have nevertheless concluded that in order to recover they must acquire an immediate and overwhelming “God-consciousness” followed at once by a vast change in feeling and outlook.

Among our rapidly growing membership of thousands of alcoholics such transformations, though frequent, are by no means the rule. Most of our experiences are what the psychologist William James calls the “educational variety” because they develop slowly over a period of time. Quite often friends of the newcomer are aware of the difference long before he is himself. He finally realizes that he has undergone a profound alteration in his reaction to life; that such a change could hardly have been brought about by himself alone. What often takes place in a few months could seldom have been accomplished by years of self-discipline. With few exceptions our members find that they have tapped an unsuspected inner resource which they presently identify with their own conception of a Power greater than themselves.

Most of us think this awareness of a Power greater than ourselves is the essence of spiritual experience. Our more religious members call it “God-consciousness.”

Most emphatically we wish to say that any alcoholic capable of honestly facing his problems in the light of our experience can recover, provided he does not close his mind to all spiritual concepts. He can only be defeated by an attitude of intolerance or belligerent denial.

We find that no one need have difficulty with the spirituality of the program. Willingness, honesty and open mindedness are the essentials of recovery. But these are indispensable.

“There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance—that principle is contempt prior to investigation.”
—Herbert Spencer