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

Repost from a few years ago:

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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.
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*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.