I vs We

Why does Alcohol Services place such a premium on recovery groups? This question is especially relevant in an era where focus is on finding the right addiction medicine, teaching ways to change one's thinking about drinking, recognizing drinking cues and individual empowerment. While these are important they pale in comparison to developing and belonging to a recovery community. There is something special when one alcoholic breaks through the isolation of another. "Sharing your story" helps not only the speaker but the listener. Ernie Kurtz once described AA as based on the "shared honesty of mutual vulnerability freely acknowledged". That's what we try to create for our patients.

Group therapy is not to provide education or one on one counselling in front of an audience. We try to create an environment where members attempt to stay sober and enter recovery together. Members who have been sober for a while help newcomers. They reach out and show how they were able to stop drinking and begin a program of recovery.

Here are the magic phrases: "Yes, me too." "You're telling my story." "How did you know?" "If you can do it maybe I can too."

In essence we try to create a structure where a community can develop and create an environment where recovery can happen.

Thoughts From Brother Francis

Frank Crotty, Brother Francis, was a Christian Brother who knew more about recovery from alcoholism than anybody I ever met.  I went to the last retreat he gave in Syracuse and for once was organized enough to take notes.  Of course they're not in any particular order but these are some of the ones that resonate with me.  The best way to get the most out of them is to slowly read two or three a day and see where they take you.

The disease I have never rests and does not want me to recover. 

Abstinence is only the beginning of recovery.

The Big Book of Alcoholics Anonymous reminds us to "abandon yourself to God".

Make sure your recovery is not a "handyman special"; that is one that looks good on the outside but does not have a firmly constructed foundation.

A person can stop drinking and still not be sane.

Recovery occurs when we realize we are all alike.  I am always in need of recovery.

Accepting your alcoholism is a gift.

The key to recovery is attitude and action.

We can't live alone with our conflicts.  My pain is from thinking my troubles are unique and I have to handle them alone.

We have a disease that wants to remain hidden.

One of our internal struggles is the fear of not being wanted and the fear of being ignored.  Despit appearances, alcoholics have to deal with fear and low self image on a daily basis.

We are not looking for loopholes.  It's the little things that count towards recovery.

In recovery, all they ever told me to do, I did.  That saved my life.

The fact we are not drinking is a miracle.  Faith always preceeds understanding.  The desire to drink was taken away.  I don't know how.

Never underestimate lonliness.  It's very difficult to ask for help.  Do you see yourself as repairable?

In the bar everybody is the hero of their own stories.  Given enough time I can rationalize anything.

A grateful heart is always sober.  Do small things with great love and strive for little acts of kindness.



Is Alcoholics Anonymous For Everyone?

Recently there was an Op-Ed piece in the Washington Post entitled How AA Fails To Support Young Addicts.  The story was written by a young woman who had a negative experience when she introduced herself as a drug addict at an AA meeting.  Here is a link to the article: http://www.washingtonpost.com/opinions/how-aa-fails-to-support-young-addicts/2012/07/06/gJQAthdGSW_print.html

The article, despite its misperceptions about AA, raises some interesting topics for discussion.

Perhaps it's a testament to its success but many view Alcoholics Anonymous as a treatment provider or social service agency.  An organization so successful has to have funding, strategic planning to expand it's mission and a Board of Directors that runs the organization.  This isn't the case with Alcoholics Anonymous.

According to the AA Preamble:  "Alcoholics Anonymous is a fellowship of men and woman who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism".  It goes on to say its primary purpose is to help its members "stay sober and help other alcoholics achieve sobriety".  The essence of the program is one alcoholic sharing with another his/her "experience, strength and hope" in order to make a connection.   This is not done through evidence based medicine, best clinical practices or the application of therapeutic techniques.  Ernie Kurtz puts it nicely when he says AA is based on "the shared honesty of mutual vulnerability freely acknowledged". 

A powerful notion of Alcoholics Anonymous is that one alcoholic can identify and connect with another in a unique way.  The idea of telling one's story as a way to connect with another alcoholic who is wondering if he/she is all alone in struggling with drinking and hopeless is powerful.  "This person drank the way I do and she's been sober for a year" is a beacon of hope.  It is easy to lose sight of this principle in an age of "An addiction is an addiction is an addiction"?

Let's not even think about the problems caused by different types of alcoholism and focus on more obvious problems.  Are addiction to methamphetamine, IV heroin, gambling, sex, nicotine and now even the internet  the same as alcoholism?  Are the stories interchangeable?  Can a sex addict "tell his story to an alcoholic who's still drinking and create a connection?  Are the goals for all "a spiritual awakening as the result of practicing the twelve steps in all our affairs?  I'm not sure but I think not.

AA is a fellowship of people who joined together to stop drinking one day at a time based on spiritual growth and helping others stop drinking.  It has the humility to have limits and not claim to be a cure all for every "addiction".  Perhaps the writer should look for another young addict to help then together find a third and then build their own small fellowship and help it grow.  Her mistake is the perspective that AA is an organization that should provide her service.  Perhaps a better perspective would be for her to be grateful she's not using and show that gratitude by being of service to another young addict who wants to stop using but can't. 


Addiction Medicine?

"The more things change the more things remain the same."  In typical Western medicine fashion the race is on for a pill to cure addiction.  The latest is Suboxone to "cure" opiate addiction.  Though lip-service is given that physicians incorporate counseling/treatment with pill dispensing it's a suggestion that more often is observed in its breach.   Methadone, Campral and Naltrexone are additional drugs that allow physicians to provide "office based" treatment.  Why has Addiction Medicine become the province of the pharmaceutical industry?  What is "office based" treatment?    Wouldn't it have been better for them to take what the addiction field has learned ( the need for mental, emotional and spiritual growth; the value of recovering in a community of others with the same illness and deflation of ego in depth) and apply it to other illnesses? Diabetes has a poor prognosis in terms of treatment compliance as does asthma.  Why doesn't addiction medicine attempt to change the medical norms in terms of the treatment of those illnesses?  Is medicine simply matching the right drug to the right patient?  How many physicians are paralyzed dealing with obese patients.  Traditional medicine doesn't have an answer.  Is addiction medicine's task to find a better drug or work with their colleagues to develop a new view of patient care and the role of a physician?  Wouldn't it be great if "addictionologists" worked with their physician colleagues to develop communities of patients in an individual practice working together to recover from a specific illness?  It would change medicine.  I'm afraid Addiction Medicine has passed on the opportunity to do something innovative and has settled for riding their prescription pads into the sunset.



Loving a Drinking Alcoholic Hurts

"Alcoholism is a family illness" is a phrase that's bandied about so frequently that we assume we know what it means.  It's implications are so profound we've developed the practice of saying the sentence while ignoring its meaning.  It's easy to get angry at schools ignoring the needs of children of alcoholics (which make up around 25% of kids in a classroom) or at treatment providers not offering family members the care they need and deserve.  It's easy to get angry with institutions and practicioners.  It's more difficult to deal with the sadness that comes from working with spouses, children and parents of alcoholics.  Few come here looking for help for themselves.  The majority come looking for a way to fix their alcoholic/addicted loved one.  They are desperately looking for a technique, strategy or well crafted phrase that would result in their loved one entering into treatment.  Their suffering is palpable yet their focus is on the other.  "If only he/she would stop drinking everything would be fine."

Truth is that the best first step a family member or loved one can do to help an alcoholic is to immerse themselves in their own program of recovery.  It indicates a seriousness about change and results in an internal transformation for the family member.  In one sense nothing has changed but in a deeper sense everything has.  Alcohol Services can help a family member(s) develop and implement a strategy to regain control of their home, detach with love from the alcoholic's behavior, create a strategy where the alcoholic suffers the consequences of alcoholic behavior and make entering treatment an attractive option for the alcoholic.  The problem is unless the loved one is engaged in a program of recovery of their own they either will be unable to take the necessary steps or if they do it will tear their heart to pieces. 

Facing this issue a family gets a glimpse how difficult recovery is for the alcoholic/addict.  Their resistance to attending four Al Anon or Families Anonymous meetings per week mirrors the alcoholics resistance to AA meetings.  "Why do I have to do all this stuff?  She's the one with the problem!"  If they don't take care of themselves, odds are even if the alcoholic/addict recovers the family will be stuck in the anger, sadness and fear of the past.  The key is to get the entire family involved in recovery.  The shift is defining themselves as a "family in recovery"  rather than simply viewing the alcoholic/addict as the "designated screw up".

The pain of family members will not be healed by the action of the alcoholic/addict.  They need and deserve care for the unique "illness" that comes from loving an active alcoholic/addict.  Alcohol Services is very good at helping them address the situation but Al Anon and Families Anonymous are essential for attaining healing.




Mickey Mantle's Legacy

I'm reading Jane Leavy's biography of Mickey Mantle titled The Last Boy.  It reminded me of his honesty and courage at the end of his life.  It also reminded me of the disservice that was done to him by the medical field ignoring his alcoholism for so long. Once Mantle got sober after treatment for his alcoholism he frequently spoke of missed opportunities.  Despite the accomplishment of Mantle and his family in increasing organ donations, the end of his life and his death provided one last lost opportunity. 

The events of his final days are still vivid.  His last news conference, announcing the organ donor program, the gathering of his teammates and Bob Costa's eulogy were poignant and hopeful.  They connected the past to the present and gave a vision of progress for in the future.  However touching, they were incomplete. 

The time was right, the ingredients present, yet the catalyst was missing.  The missing catalyst was the willingness of the medical team to directly acknowledge alcoholism and use that teachable moment to galvanize the medical field into awareness and action.

My most enduring moment of sadness was the news conference held by the head of the Baylor University Hospital surgical team.  In a quote that belongs in the Health Care Hall of Shame, he said there is no doubt that Mantle's "lifestyle choices" contributed to his illness and death.

It was not "lifestyle choices" that brought Mantle to the surgeon's table.  It was alcoholism; a chronic, progressive, terminal disease recognized as such by the American Medical Association in 1955.  The same disease that is the cause of 25 percent of the admissions to general hospital beds nationwide.  The same illness that costs New York State 1.3 million days of inpatient care and 720,000emergency room visits each year. 

Cloaking alcoholism under the guise of "lifestyle choices" deprived Mantle of one last opportunity; to use his honesty about his alcoholism to change the way the medical field views and addresses alcoholism.   Just like a fantasy baseball camp, I had my own fantasy news conference.  In this fantasy the doctor said:

"Alcoholism played a major role in Mickey Mantle's death.  In talking with Mickey we realized that of all the doctors he saw over all the years few, if any, screened for alcoholism.  If any did, they did not know how to get him into appropriate care.  In his memory and in memory of all the alcoholics we have treated for everything but their primary illness we ask the following: We call all physicians to invite their patients to talk about their drinking and to screen each patient they see for alcoholism.  We are hoping this tragic early death of an American icon will inspire our felow physicians and medical institutions to overcome their discomfort and denial and provide these people with the care they need and deserve."

It need not be a fantasy.