Repost: "Do you think Uncle Joe has a drinking problem?"

December 31, 2011

Repost from a few years ago:


As we reach the pinnacle of the drinking season (Thanksgiving through New Years) many people not in the business are thinking about addiction. It may be a concerned reflection on our own behavior over the past* coming month or so. It may arise from unusual levels of contact with our distant relations or family friends. Even though drinking, even to excess, is socially approved sometimes one starts to ….wonder.


This is not a post about how to find help or how to diagnose an addiction or substance dependence problem. Information is out there from many Internet sources, although I will say that self-diagnosis or amateur diagnosis has some severe limits. Best to involve the professionals.
And this is really the lead in. The substance abuse professionals have very low exposure to the target population of people who need evaluation. Consider the basic medical checkup / screening for all variety of ailments. Metrics for potential diabetes problems, breast cancer, colon cancer, various latent infections, cardiac problems, hypertension….the list goes on. The medical profession goes through all the established steps depending on your stage of life and various risk categories. Anything slightly suspicious turns up and, bam, right on to further diagnostics to find out what is UP with your health.
Oh, don’t worry, they screen for substance abuse problems too. But here’s the difference. Substance abusers lie like rugs. You think that a woman who has a suspicious lump is going to untruthfully say “Oh, c’mon now doc, I’ve had that thing for years”? Hell no. Substance abusers are much more likely to actively put healthcare professionals off the track by underreporting their use.
As PalMD recently explored in a post, invasive confirmatory tests on blood or hair samples for evidence of a substance abuse problem are not considered pedestrian procedures.
There are many, many other problems standing in the way of the substance abuse profession coming to bear on the population that needs their help. Some of it is captured in health insurance parity issues in which insurance may not cover addictive disorders. There is the deeply entrenched problem of addiction denial. No, not the individual saying they can stop anytime they want. I mean the covert or overt supposition from the family member to the medical care profession to the legislative process that addiction is not a medical problem. That the addicted individual merely suffers from a lack of moral fiber and should just stop it already. Despite the fact that the best available science tells us that this notion is false it persists.
It is a very, very tangled public health issue.
I come back to the substance user who makes a New Year’s Resolution to cut back. One of the things I’m resolving to do on the blog this coming year is to figure out ways to talk about parity and stigma and the neurobiological basis of addiction productively. I’m still amazed and indeed outraged when people who should know better (scientists and medical doctors) express scientifically under informed views on the topic of substance abuse and dependence. And I have a tendency to beat them up a bit when I do discuss these topics.
I am pondering turning my blogging attention to the basics and to try to figure out ways to talk about these issues that overcome off putting technical jargon. Perhaps to dial back the use of addiction science topics to discuss the science-denial part and think about what best needs to be communicated to more toward less stigma, more parity and better understanding from the concerned family member all the way up to the medical professional and the CongressCritter.
UPDATE: The NIAAA site “Rethinking Drinking” is a good place to start with some practical evaluation of alcohol drinking. It covers the questions of whether your drinking pattern is risky, how to cut down and how to get help, among other topics.
__
*I wrote this draft at the end of December last year. I never finished it up and published it but I don’t remember why. I don’t know that I lived up to my resolution but I did take some incremental steps toward this goal. For my newer readers, and even some older ones, in case it is not obvious I’m never really sure what I’m doing with all this blogging nonsense. It is a constant evolution.

Advertisements

No Responses Yet to “Repost: "Do you think Uncle Joe has a drinking problem?"”

  1. drugmonkey Says:

    I still have not taken up my resolved cause…boo me.

    Like

  2. Scicurious Says:

    It’s a great cause though. I’d love to see more public conversation about science denial and how various levels (family, individual, healthcare, etc) add up to problems with addiction reporting and treatment. Make it so, dude.

    Like

  3. anon Says:

    Nice post. I am not a drinker, not even in social occasions. But I like the thought and commitment in helping ourselves and others.

    Like

  4. AnyEdge Says:

    I’m always dismayed by how little can be done, medically. As a scientist working in health care (though not in substance abuse), and as an alcoholic in recovery, I can tell you that there is a massive, perhaps unbreachable, gulf between how the medical community understands and treats substance abuse, and how people in recovery think about and understand their disease.

    Part of the problem is the difference between statistical and clinical significance. Some interventions are statistically significant in prolonging time to relapse, for example. But that’s still useless. The difference between 30 days and 90 days of sobriety is absolutely, totally, insignificant.

    Medicine has done wonderful things in the ‘detox’ process. Alcoholics with access to health care almost never die in the first three days of sobriety any more. But what medicine cannot do, what can only happen through the long slow process of agony associated with alcoholic depair, is make a user want to quit.

    I can almost assure you that other than oxygen or water, no normal person has ever wanted anything like I’ve wanted vodka. It is a peeling, keening of the soul that obliterates all sensation, all other need. Luckily, I no longer have those feelings.

    But the willingness to pass through that fire, that addiction, and emerge from the other side, cannot come from anything external. No physician, no medicine, can make a person fight to break through that. It can only come from utter, internal desperation.

    Like

  5. drugmonkey Says:

    Are you so confident we cannot target the craving? This is definitely an interest of much current investigation.

    Like

  6. AnyEdge Says:

    I don’t doubt that the craving can be targeted. Already some medicines do that, yeah? But you can’t make an alcoholic want to take them.

    Like

  7. DrugMonkey Says:

    Ok, you are right about the free will thing…but perhaps having cures that actually work would make that easier? No? If you could stop the craving in some, wouldn’t that help convince others?

    Like

  8. AnyEdge Says:

    I have never once met an alcoholic who said that the cravings were what stood between them and recovery. Not people who relapsed a lot, not people who never get sober.

    A pill that stops cravings isn’t a cure. Craving is a single symptom of the addiction. The thing that most alcoholics say stands between themselves and recovery is _honesty_. They cannot tell the truth to themselves or to others. And we prefer intoxication and inebriation to sobriety. Because inebriation allows us to avoid confrontation with truth.

    No pill (well, no pill that isn’t just as bad as alcohol) provides that. And here’s the thing: I don’t think it should. Making recovery easier just makes relapse more attractive. Recovery, in the early stages, _needs to hurt_. I’m not saying we shouldn’t alleviate certain amounts of suffering. I came down on benzoes so that I didn’t seize.

    But the only way to recover is to become willing to face everything, honestly, forthrightly, and without trying to find some “easier, softer way”. All that does is make it easy to drink again.

    Like

  9. AnyEdge Says:

    I guess I should clarify: the insanity provoking craving is indeed an obstacle _at times_, but never in the long run. A bigger obstacle is the thought process by which we alcoholics try to convince ourselves that we don’t have a problem. Or that the problem is manageable. Or that “if you had to deal with what I have to deal with, you’d drink like I do”. All of that bullshit that are excuses to drink again. That’s not a craving, exactly, although it serves the same purpose. It causes us to find a way to put alcohol in our bodies.

    And anything that serves as a crutch, even if designed to help us quit drinking, actually feeds the disease. Because the core nature of the disease is about relying on crutches. Using shortcuts to avoid feelings.

    The only way to get to long term sobriety is to suffer enough that we are willing to face what is, for us, the agonizing reality of life without crutches. And so, for all of medical science’s good intentions of trying to help, anything that shortcuts the suffering actually does us no good.

    Like


  10. I’M FUCKEN DRUNKE RIGHT NOW!!!!!!!!!!! HAPPY NE YEAR!!!!!!!!!!

    Like

  11. drugmonkey Says:

    Happy New Year, PP. Thanks for keeping me entertained for another year of Internet life.

    Like

  12. chall Says:

    “There is the deeply entrenched problem of addiction denial. No, not the individual saying they can stop anytime they want. I mean the covert or overt supposition from the family member to the medical care profession to the legislative process that addiction is not a medical problem. That the addicted individual merely suffers from a lack of moral fiber and should just stop it already. Despite the fact that the best available science tells us that this notion is false it persists. It is a very, very tangled public health issue.”

    It’s so much easier (cheaper too) to state “well, I can manage it so they should be able to do it too – if only they were moral responsible beings”. Sure, for some over consumers (at specific times in their lives) it’s “a choice to go on a bender” but those people are usually not the ‘addicts’. Imho, it’s similar to the notion that depression is like to “feeling a little blue” and that “if you only thought you are happy you’ll be fine”…

    Anyway, AnyEdge write some things that I’ve encountered through support groups;
    “…And anything that serves as a crutch, even if designed to help us quit drinking, actually feeds the disease. Because the core nature of the disease is about relying on crutches. Using shortcuts to avoid feelings. ”

    Life is scary, it hurts sometimes, it’s hard to manage etc… failure is always happening but the important thing is to get up and try again. We’re only humans…

    Like

  13. Vicki Says:

    Crutches aren’t the worst thing in the world. Unpack that metaphor. Maybe you can find a treatment that will let you walk unaided (or, outside the metaphor, live honestly without drinking). But if you can’t, would you rather be walking with crutches, using a wheelchair, or housebound and immobile?

    I’m not saying not to do the sometimes hard work of rehab, just that sometimes the perfect is the enemy of the good-enough.

    Like

  14. Sugel Says:

    Historically, doctors have always had a high rate of substance abuse. It’s generally been viewed as an occupational hazard because physicians are constantly exposed to prescription medication and have constant access to a prescription pad. This can easily lead to addictions. Some doctors have been known to write their own prescriptions for pain killers or other narcotics and have used these substances on the job, despite the side effects that can occur and affect the treatment of patients. Nurses and other medical professionals have been caught abusing prescription drugs at work. Many end up stealing medication from patients or hospital pharmacies.

    Like

  15. pramod Says:

    Thanks for writing this up!

    Do you have any pointers to blog posts or readable papers that discuss the fact that substance abuse is a medical problem and needs to be treated as such and is most definitely not a “moral” issue? I know your post touches on this, but it’d be nice to find something that has a gazillion references and summarizes all the evidence we have for believing this to be the case.

    Like


  16. Hello there! This is my first visit to your blog! We are a team of volunteers and starting a new project in a community in the same niche. Your blog provided us valuable information to work on. You have done a outstanding job!

    Like


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: