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Medicine vs. Alcoholism.

29 April 2016

Michael Phelps recently made news by saying he doesn’t know if he’s an alcoholic. That’s a fine answer to give to the question “Are you an alcoholic?” Most of us don’t know, or pretend not to know, or are in denial about what we are. And please don’t think I am diagnosing Michael Phelps. I have absolutely no idea if he is or isn’t. And it’s none of my business. Frankly, I don’t much care.

But I’ve been thinking about how medicine and science define us, and how terms change and what it means. Physicians and other health care practitioners don’t really use the term “alcoholic” anymore. They prefer the terms “alcohol abuse” and “alcohol dependence” and with these redefinitions, I think they’ve killed a lot of us. Medical professionals, by and large, have no idea what alcoholism is or how to treat it, and it appears that they never will.

That’s not a bad thing. Medicine has its place in recovery, certainly. As you all know, I took benzodiazepines in early recovery to prevent myself having potentially lethal seizures. Alcohol detoxification is dangerous, and medical professionals should be involved to help ensure we are safe as we go through it. But frankly, that’s about the extent of their utility.

And this is the reason: as the reductionistic process of medical science proceeds, the biology of addiction and the experience of addiction diverge. And so far at least, understanding the biology of addiction has not made recovery better, or more attainable. In fact, I would argue from my experience that too much medical care in early recovery is often really, really bad for us.

Expecting physicians to help us abstain is dangerous for many reasons. First of all, not everyone who needs to recovery from alcoholism necessarily exhibits “abuse” or “dependence” as scientists and physicians define it. Deciding you’re an alcoholic is only peripherally related to those concepts. We need to recover when we can no longer tolerate the way our lives intertwine with alcohol, whether that matches up with a textbook definition or not. And having a doctor tell us that we don’t meet definitions often convinces people badly in need of recovery that they are not yet at the point that they have to take action.

Second, even if we and the medical providers agree on our need for recovery, having our care (after the acute phase of detoxification) managed by someone else allows us to blame them for our relapses. The doctor didn’t cure me. It’s not my fault. It’s his responsibility, not mine. The medicine didn’t work. I still had cravings. They didn’t cure me. It’s all the disease convincing us to allow it to stay in command of our lives. It will latch on to any convenient excuse to compel us to keep drinking.

More times than I can count, I’ve seen people undergoing medicalized recovery treatments fail over and over again, always blaming the treatment program and not taking responsibility for their recovery. If we can find a way to keep drinking, if we can blame someone else, we will. We don’t recover until we’re willing to own that we are our own problems, and we have to find our own solutions. Doctors can’t cure us.

If you “don’t know” if you’re an alcoholic, I’d personally still recommend you take a good hard look at your relationship with alcohol. Recovery isn’t about volume and it isn’t about frequency and it isn’t about whether we fit the medical definitions of abuse or dependence. These are tools we alcoholics use to continue drinking. Not tools we use to recover.

Recovery, alcoholism, these things are about how we feel. Who we are. What things live inside us and what we decide we have to do about them. As an alcoholic, when someone comes to talk to me about their drinking, I am utterly uninterested in whether they fit definitions of abuse and dependence. They don’t matter. What matters is: have they come to an emotional, spiritual point in their lives where they’re willing to go to any lengths to give up drinking?

And as long as a person is interested in a physician doing the heavy lifting of their recovery, they haven’t come to that point yet. No matter what they say.

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