Why is Alcoholism Different from Cancer?

Yesterday on twitter I had a brief conversation with @Dirk57 and @drugmonkeyblog about treatment of alcoholism. It started with @Dirk57 (who is also in recovery) tweeting a question about why we don’t do more to treat addiction with compassion rather than condemnation. I responded that it is not cruel to say: “I can not participate in your illness.” I then went on to say that I believe in “Compassion with boundaries, and honest appraisal. Pussyfooting around doesn’t help.” And @Dirk57 agreed that otherwise, compassion can simply be enabling.

At this point, that agent provocateur (and highly regarded addiction researcher) @drugmonkeyblog chimed in: “Do that for cancer, depression and you are an ass – why different?”

It’s a really good question. Now, I’m not going to address the depression aspect (and I said that in the twitter conversation too). I’ve been diagnosed with Major Depression more than once in my life. I have found that treating my alcoholism has treated my depression for the most part. When I have gotten situationally depressed in sobriety, I have sought medical attention from a psychiatrist, and have taken short runs of SSRI-based antidepressants. My depression has resolved completely and quickly. Now, I treat it with exercise. It works for me. I do not claim to have any insight on the treatment of depression.

I do claim to have some insight on the treatment of alcoholism. It’s opinion, of course, but it’s opinion based on more than five continuous years of diligently working a program of abstinence and emotional, mental, physical, and spiritual maintenance. I have seen treatment succeed, and I have seen treatment fail. I read a lot of the current literature in the epidemiology of addiction and the various predictors of success. I have deep concerns that the medical community at large remains incapable of understanding how addiction is treated successfully. In part because the way that science measures success remains largely irrelevant to successful recovery.

However, strides are being made. And the fact that addiction researchers like @drugmonkeyblog are interested in engaging with us, the hoi polloi of the recovery community, in order to understand our philosophy of recovery is very encouraging. Unlike some recovered alcoholics, I do not dismiss the efforts of science to improve our odds at better lives, free from addiction. But I think that there may need to be wholesale changes in the reductionistic means of examining addiction in order to do so. The fact that preeminent scientists are willing to engage is very encouraging to me.

So how do I answer @drugmonkeyblog’s question? First, I said that refusal to enable is part of an addict’s treatment. Getting a job, paying our own bills, making our own food, these are things that help us recover. When people relieve us of these requirements, they give us what our addiction wants: lack of responsibility, more shame, more isolation. When we break down the false ego of feeling like we’re above work, and above responsibility, we can start to build the real ego-structure of useful adults. We talk a lot in recovery about breaking down the ego. But really, what we mean is basing our ego on real things, rather than inflated senses of entitlement.

To this, he responded that cancer patients make horrible treatment decisions too, and that there’s room to judge there. And that may be true. I’m fortunate enough never to have been involved in the treatment profile of a cancer patient. Especially not one making decisions that I think are against their best interests. So I responded: “We all have the right to say, ‘I will not help you make yourself sicker.'” And @drugmonkeyblog agreed.

For me, alcoholism and cancer share many basic aspects: serious diseases that often kill, that need to be understood and treated aggressively, and from which sustained remission is often a perfectly reasonable goal and outcome. But alcoholism has a behavioral element that makes the way people legitimately respond to the sufferer a factor. We don’t yet know what makes an alcoholic choose to attempt to recover. But we do know that those who enable alcoholics do themselves and their alcoholic loved ones no favors. We alcoholics in recovery say that we turned to recover when the pain from our addiction became to great to bear.

No one I’ve heard of says: “Look, I just want a little bit of cancer now and then. I can handle it.” And then refuses treatment because they like the way cancer makes them feel. But addicts do that all the time, and our loved ones help us. We all have the right not to help people make themselves sicker. And for the recovery of the addict, I personally believe it is imperative.