Explaining addiction to the professional community

What is alcoholism?

Last week as one of my duties in Public Information for Alcoholics Anonymous I started the first of three ½ days with first year medical students at one of Canada’s top schools. I started by saying that I didn’t want to talk about something that was obvious to them so I wanted to see if we had a consensus on what we are talking about.
I asked, “By a show of hands, who sees alcoholism as a disease, as an illness.” Two hands timidly went up a couple of others looked around to see to how the others responded. One of those raised their hand ½ way up and back down again.

“OK,” I said, “The American Medical Association classifies alcoholism as a disease, however controversial that is, but I see there in consensus on this theory here. How about alcoholism as a behavioral problem—an addiction that has to be corrected by reprogramming or cognitive behavioral therapy like smoking or poor eating habits?” A few of the the ten students rose their hand for that one. I said, “There is no right or wrong answers here and AA has no opinion or a position in public debate on the topic.”

“Well then, who sees alcoholism as a moral failing or a spiritual malady?” Not one student budged. “Well, that’s good, I think for us alcoholics that you don’t see addiction as a moral failing. Before Alcoholics Anonymous existed, history recalls that the medical profession saw inebriants as morally depraved and not worth the medical community’s limited time or energy. We were left to die of alcoholic complications or put in a sanatorium if we had become a nuisance to others. So I am pleased to see you don’t view us as reprobates.“

This started a discussion about how many AA’s anecdotally accept the physical allergy, coupled with a mental obsession description of alcoholism but AA wasn’t all that interested in whether the chicken or the egg came first—rather we tend to eggs as best we can. We have no experts in Alcoholics Anonymous in either alcoholism or recovery. We have experience—not expertise as our currency. We each have our experience of alcoholism that we relate to each other. The two million of us that are AA members have each found a few or many that we identify with in the stories and experience that are shared at meetings.

“Between us here today, we seem to be the seven blind people and the elephant about this beast called alcoholism.” I said to the students. “We all have our limited experience to which we have drawn some conclusions. Perhaps none of us grasp the whole picture. I hope that, through this process together, we can all leave here with a greater grasp of what this affliction called alcoholism is and how the medical and peer-to-peer community can work together to do a better job at limiting the morbidity and mortality that alcoholism brings to bear on society.

The first day followed with the history of AA, what we are and we are not, the Steps and Traditions, what an open or closed meeting would be and what might take place at each of these. CPC came in to talk about the rich history of cooperation between AA and the medical world. Our Area CPC chair and some stories about common misconceptions held by medical practitioners and how they are dispelled, in part, just by engaging in the conversation about addiction and recovery. AA members shared their stories of what it was like, what happened and what it was liked now. Often, members would speak directly to times that they evaded medical help or cases where practitioners carefully tended to symptoms such as strep-throat and depression without getting an accurate assessment of the cause, or in some cases, not even asking about how much we drank and how often. The symptoms were treated but not the cause.

We know that influenza is a virus, cancer is unregulated cell growth but what is alcoholism? And why do cancer and flu victims seek help and alcoholics evade detection? It remains a wonder to me that like the cold or cancer, the medical world has not arrested the problem of alcoholism. Certainly no one has been able to inject the addict with a desire to stop acting in a self-destructive way. We can’t present more articulate arguments, we can’t scare them and we can’t medicate addicts and alcoholics to sobriety.

Over the first two days the students got to hear three stories:

• A suburban grade A student who found smoking drugs and drinking and before she finished high school was a homeless dropout panhandling and suffering the indignities of any woman on the streets with no means of support. She got pregnant and after fantasizing about how cool it would be to raise a homeless child on the mean-streets, off the radar, she gave the child up for adoption in exchange for burden-free drinking. Realizing what she had done she went to treatment and went back to get her son. It took her two years of relapsing for recovery to take but she got sober, went back to school, got a scholarship, became a lawyer and is now running a practice, raising a boy and going to meetings.

• A teenager from a good home, school and carefree life found weed, cocaine and alcohol and was eventually confronted by an intervention and sent away to a sober treatment centre and has clean and sober since 18, active in 12-Step work, the AA young people’s movement and higher education.

• A second generation alcoholic went from growing up in the shadows to abuse and alcoholism to getting sober, getting educated and relapsing into sex and drug addiction after 22 years of sobriety, trying new drugs he never tried before. He’s sober again a couple of months and battling criminal charges and is a patient for both anxiety disorder and complications from his relapse.

This is what alcoholism (and drug addiction) is. We can’t qualify or quantify it but the best we can do to explain it to medical students is to tell them our story. And no single story can tell the whole story. But now they know, although they can’t explain it to another. Hopefully, in their practice they can identify the symptoms and confront one or two of us before it’s too late.

Maybe, just maybe, one of them will have something to teach us about addiction one day.

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