Monday, January 24, 2005
Response to AA questions
One of you asked a question regarding my reference to substance abuse and dependent people to use AA and wondered if I thought there was other approaches. One concern was with the religious aspect of AA.
Yes there are other approaches. I am not a radical fan of AA.
First, let me define abuse. Abuse of a substance is continued use despite bad outcomes. For example, you get drunk and get a DUI. Oops. You screwed up. Poor judgment. I would not from that alone diagnose abuse. But get two or three and you have a problem with alcohol. Or you and your partner fight over your drinking or get nasty when drunk. You have medical problems or medications that are contraindicated and drink. And so on.
Now all use is not abuse. You get drunk one night. In lay terms you abused alcohol and you body, but medically this is not a disorder. Sometimes the line is blurry... But an otherwise healthy person who smokes pot once a week at home is probably not suffering from drug abuse.
Dependence is another issue. This means mainly that you have to use to prevent withdrawal symptoms. In a minor form that headache when you miss your daily coffee. You smoke pot daily and run out. And in a few days you get cranky. More serious, you are a wreck without that nicotine. Worse you are crawling the walls without you heroin. Most dangerous you get seizures when you miss that morning glass of Vodka (32oz tumbler).
Often both exist. You drink to prevent early withdrawal symptoms. A morning eye-opener. And drinking has impacted your life, yet you continue. Your doctor has asked you to cut down or quit for your health. Family or friends have confronted or avoided you. You lose your job. You cannot sleep well. You cannot perform sexually. You get in accidents. You do foolish things sexually, verbally or aggressively.
So what to do? Some people say enough and stop or cut way back. And that is that. But for many it is not that simple. And that is where AA can be useful.
First, it gives a cognitive structure to work with. An explanation. A program to follow step-by-step. You know it has helped millions. Just follow it. No need to think it out or read book after book. Just do it. It may sound passive and juvenile to some, but at the early stages that can be useful. A healthy regression. Besides addictions are infantile for the most part. A bottle is a bottle. Suck a nipple or suck a smoke.
Second there is a clear behavior plan. You can't drink. Ever again. It sound harsh and has been questioned. I don't think it applies in every case myself. But a period of extended sobriety lets the body and brain recover and breaks the addictive habits. But if using again leads back to the same place, quitting forever makes sense.
Third there is a support network. People in various stages themselves. They all have their stories. You are not alone. When you need help, there is someone to call.
Fourth it offers a social group. Recovery can be lonely. A whole life is built up around the drug. Happy hour, friends, even family. Activities are drinking activities: Boating, fishing, golf, parties, ballgames,... One may have to search AA groups for one to their liking. In a big city there are athletic groups, outdoor groups, religious groups, singles,...
Finally, it is independent of other entities. It is not a church. It is open to all and no fees charged. It is free of doctors and therapists. Last comment meaning?
So are there other ways to treat addictions? Doctors have three things to offer. First we can question and examine you and identify problems. We can get you to think about it as an issue and at times confront you. Feeling that enlarged liver. That blood alcohol level in the ER. Labs consistent with drinking in your blood counts and chemistries.
Second we can detox you, usually in the hospital. Some addictions can be life-threatening in detox. Others just miserable. We can take the edge off.
Third we have a limited number of treatments to reduce cravings and block the highs.
And I should add, we can avoid giving you more addictive drugs. I'd like to slap some of my profession for handing out Xanax and Klonopin like candy to alcoholics.
As for my negative attitude towards treatment programs, perhaps I am too harsh. But I do not see much good done. Plenty of money and time is spent and the same people come back again and again. This is an industry and as such fights for its existence. It looks like something is being done.
For many patients, it is a scam. Ideally they get benefits (VA, Social Security Disability, Medicaid, Food Stamps, ...) and buy whatever drug or drugs they like with your tax dollars. Then when the money runs out they show up for treatment. They get "three hots and a cot," drugs to chill the down-side, more drugs if they can con the doctor and maybe some entertainment. Go along with the program until the next check comes in.
OK I am harsh here, but I've seen it folks. From multiple angles.
The real question is do you want to stop? Then its grow up and take responsibility. Get help if you need it, but you are the one ultimately responsible. Nobody said it was easy, but that is life for most of us.
Yes there are other approaches. I am not a radical fan of AA.
First, let me define abuse. Abuse of a substance is continued use despite bad outcomes. For example, you get drunk and get a DUI. Oops. You screwed up. Poor judgment. I would not from that alone diagnose abuse. But get two or three and you have a problem with alcohol. Or you and your partner fight over your drinking or get nasty when drunk. You have medical problems or medications that are contraindicated and drink. And so on.
Now all use is not abuse. You get drunk one night. In lay terms you abused alcohol and you body, but medically this is not a disorder. Sometimes the line is blurry... But an otherwise healthy person who smokes pot once a week at home is probably not suffering from drug abuse.
Dependence is another issue. This means mainly that you have to use to prevent withdrawal symptoms. In a minor form that headache when you miss your daily coffee. You smoke pot daily and run out. And in a few days you get cranky. More serious, you are a wreck without that nicotine. Worse you are crawling the walls without you heroin. Most dangerous you get seizures when you miss that morning glass of Vodka (32oz tumbler).
Often both exist. You drink to prevent early withdrawal symptoms. A morning eye-opener. And drinking has impacted your life, yet you continue. Your doctor has asked you to cut down or quit for your health. Family or friends have confronted or avoided you. You lose your job. You cannot sleep well. You cannot perform sexually. You get in accidents. You do foolish things sexually, verbally or aggressively.
So what to do? Some people say enough and stop or cut way back. And that is that. But for many it is not that simple. And that is where AA can be useful.
First, it gives a cognitive structure to work with. An explanation. A program to follow step-by-step. You know it has helped millions. Just follow it. No need to think it out or read book after book. Just do it. It may sound passive and juvenile to some, but at the early stages that can be useful. A healthy regression. Besides addictions are infantile for the most part. A bottle is a bottle. Suck a nipple or suck a smoke.
Second there is a clear behavior plan. You can't drink. Ever again. It sound harsh and has been questioned. I don't think it applies in every case myself. But a period of extended sobriety lets the body and brain recover and breaks the addictive habits. But if using again leads back to the same place, quitting forever makes sense.
Third there is a support network. People in various stages themselves. They all have their stories. You are not alone. When you need help, there is someone to call.
Fourth it offers a social group. Recovery can be lonely. A whole life is built up around the drug. Happy hour, friends, even family. Activities are drinking activities: Boating, fishing, golf, parties, ballgames,... One may have to search AA groups for one to their liking. In a big city there are athletic groups, outdoor groups, religious groups, singles,...
Finally, it is independent of other entities. It is not a church. It is open to all and no fees charged. It is free of doctors and therapists. Last comment meaning?
So are there other ways to treat addictions? Doctors have three things to offer. First we can question and examine you and identify problems. We can get you to think about it as an issue and at times confront you. Feeling that enlarged liver. That blood alcohol level in the ER. Labs consistent with drinking in your blood counts and chemistries.
Second we can detox you, usually in the hospital. Some addictions can be life-threatening in detox. Others just miserable. We can take the edge off.
Third we have a limited number of treatments to reduce cravings and block the highs.
And I should add, we can avoid giving you more addictive drugs. I'd like to slap some of my profession for handing out Xanax and Klonopin like candy to alcoholics.
As for my negative attitude towards treatment programs, perhaps I am too harsh. But I do not see much good done. Plenty of money and time is spent and the same people come back again and again. This is an industry and as such fights for its existence. It looks like something is being done.
For many patients, it is a scam. Ideally they get benefits (VA, Social Security Disability, Medicaid, Food Stamps, ...) and buy whatever drug or drugs they like with your tax dollars. Then when the money runs out they show up for treatment. They get "three hots and a cot," drugs to chill the down-side, more drugs if they can con the doctor and maybe some entertainment. Go along with the program until the next check comes in.
OK I am harsh here, but I've seen it folks. From multiple angles.
The real question is do you want to stop? Then its grow up and take responsibility. Get help if you need it, but you are the one ultimately responsible. Nobody said it was easy, but that is life for most of us.
