AN UNUSUAL TOPIC

AN UNUSUAL TOPIC

It wasn't the typical subject to come up at an AA meeting  but then this wasn't an ordinary gathering.  The questioner was asking himself  "am I being too self centered when I have a patient who is an old time alcoholic that I am admitting for severe decompensation resulting from chronic alcoholism if I ask him if he has tried AA? And when he answers yes  but denies its efficacy and I ask him further if  he has read the big book  is it ok for me to then try to pin him down  if he says "Yes I have read it five times and it doesn't do any good!".  Am I being too into my own program when I am skeptical and say can you then tell me what the first step says? To which he replies warily "you sure know a bit about AA" as if he is getting the third degree?"

This question came from a concerned physician early in his own recovery worried about several things. One he was wondering whether he was being so forward just to primp his own conscience against this failed alcoholic and feel superior to him. And then by delivering the coup de grace, finally prove how superior his program was.   Or was he correctly using his new found knowledge of AA in a constructive manner to help this individual?

This could be a gut wrenching dilemma but it needn't be. First, we as physicians in recovery are well aware that if we are probing in our questions about drinking, it may seem out of the ordinary experience of the professional alcoholic  to receive this unaccustomed and often unwanted attention.  But that does not mean that because we are privy to greater understanding that we should eschew our responsibility in order to protect our anonymity in the fear that our knowledge in and of itself will naturally reveal our true natures and histories.

We still have medical oaths to fulfill not to mention the 12 step work that we undertake as practicing members of AA. And we do not need to divulge our anonymity by revealing  that our special knowledge is the result of our being a practicing alcoholic or a member of AA.  Additionally, we can parry those questions by stating that we as physicians for many personal and professional reasons have found it helpful and prudent to become well versed, in fact much more well versed in addiction medicine than most of our medical colleagues.  We do not owe our patients any other explanation than that except that when we see that they need our help in that area we find we must apply that knowledge to their benefit.

And in a case where an individual who is a chronic alcoholic with many hospital admissions and lots of secondary organ damage as a result of many years of drinking presents and gives a history of having tried AA in order to stop drinking but has failed we then wonder why.  And when asked and told that he has read the instruction book over and over but cannot then name the first tenant of the program we then owe it to the patient to state that he really hasn't tried the program at all so what is it that is getting in the way of admitting that the person has a problem with alcohol and why can't he see that his life is going to hell in a hand basket? Is he denying his alcoholism or is he denying that his life is unmanageable as a result of his alcoholism or both? Does he want to live or does he want to die?

The point here is that this person has had physicians who when receiving that answer have let it slide with an "if that's the way he wants to do it  attitude so I will leave him alone" . He has never had a physician who is confident about calling him out on his self delusionary behavior  because he does not have the insight nor the tools to feel confident about doing so.  But the physician in the program does have the tools.  He can say that this attitude does not make sense. It does not sound like he has tried to work the program at all. And then you can offer any number of ways in which he can work the program successfully. Such as, going to meetings every day, for no doubt this has not been done.  Often the excuse will be that he cannot find a meeting that he likes. Of course the answer is to find one or more that he does like. If queried, the answer will be that this was not even sought.

 Not drinking one day at a time sounds pithy and pie in the sky but it is the only "magic" that every AA uses to succeed in the program.  It works and it is a segment of time that anyone can get his head around. Getting a sponsor. Having a real adult to help you with staying sober while you are acting as a child, really helps.  Using the telephone, calling several alcoholics each day and especially when you feel like taking a drink. Call Before  taking a drink not after.  Changing friends, people places and things that he was used to doing while drinking.

These are life saving suggestions that we can offer our patients.  Of course, he can get all of this information for free at an AA meeting and you can tell your patient that too.  You can tell your patient that what you have just told him is referred to in psychiatric circles as Cognitive psychotherapy.  In AA it is labelled as hard won experience and found in the "Living Sober" book.

The point here is to let the drunk know that he cannot manipulate you so he should not even try.  He doesn't have to listen to you but he should be forewarned that your sympathy is not up for grabs. He cannot pull on your heart strings. You will be giving him tough love. Tough choices. He will be having to make a  life and death decision, not an easy choice. And you will be helping him to get in contact with those people who will get into a group that will help him to stay sober.

Or he can reject the help understanding nonetheless that you've got his number.  But in any case, you will have fulfilled your role as a physician and your twelfth step pledge to help another alcoholic in need.

© 12/10/11