The Committee on Alcoholism and Drug Dependence of the American Medical Association defines alcoholism as "an illness in which there is preoccupation with alcohol and loss of control over its consumption, as a type of drug dependence that can harm a person's health and interface with his ability to work and get along with other people."*
How A.A. views alcoholismAlcoholism, in A.A.'s opinion, is a progressive illness-spiritual and emotional (or mental), as well as physical. The alcoholics we know seem to have lost the power to control drinking.
The medical profession has long been an ally and resource of Alcoholics Anonymous. A.A. shares with physicians a concern for the health and well-being of those who still suffer from the disease of alcoholism.
The rate of growth in A.A. shows that an increasing number of alcoholics are recovering from this disease. There are over 73,000 A.A. groups, in 114 countries. Women today constitute one-third of the Fellowship, and young people (30 years and under) about 20% of A.A. members sober more than a year have a very high likelihood of continuing their successful process of recovery.
The Alcoholic's resistance to help can be frustrating
Since denial of the problem is symptomatic of alcoholism, alcoholic patients rend to be evasive when questioned about their drinking; and some physicians may not recognize that alcoholism may be contributing to their symptoms. Patients may resist any suggestion that alcoholism is involved and may be equally resistant to the suggestion of Alcoholics Anonymous as a last recourse.
Few doctors have had the experience of having their diagnosis rejected. Few have been told, "I certainly am not a diabetic." Yet when the doctor makes a diagnosis of alcoholism, an alcoholic will often respond, "I don't drink that much," or will offer excuses for his or her drinking. Physicians can expect and anticipate this.
Rationalization and denial are part of the alcoholic's illness. Initial rejection of A.A. is part of the denial mechanism.
A.A. members, having broken through their denial and faced the harm in their drinking, are particularly suited to helping others break through their denial.
What some members of the medical profession have learned; how they apply that knowledge.
Many doctors have found effective ways to refer their patients to A.A.
In the words of Stanley Gitlow, M.D., a clinical professor of medicine, Mt. Sinai School of Medicine in New York, and chairperson of the Committee on Alcoholism of the Medical Society of the State of New York:
"No one of your patients suffers more than the alcoholic. When you once touch the life of an alcoholic and help him or her to recover, when you observe this incredible change from a suffering, helpless, sick (and dying) person to one who is alive, vital, functioning, and happy, you will be part of a rich, rewarding, and profound experience. A.A. is the most effective means of teaching an alcoholic how to stop drinking that I know of."
In an address to the Third Annual Department of Defense Alcohol and Drug Abuse Conference, William E. Mayer, M.D., director of the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), referred to the "explosive growth " of A.A. in the last decade and said:
"A.A. by and large works better than anything we have been able to devise with all our science and all our money and all our efforts.
"If you are ignoring the utilization of A.A. groups-interaction with them, referral to them-then you are ignoring a critical, crucial part of the important kinds of care people with this disorder deserve and must have.
" A.A. has shown the way and presented us with a model of long term care that is really not care. It is participatory self-management. It is an assertion of the autonomy of the individual. Instead of his thinking of himself as a victim, a helpless person,
. . . A.A. gives a person the kind of sense of self-worth and along with it the kind of humility and reality-testing that are absolutely essential in the management of alcohol problems."
Ann Geller, M.D., director of Smithers Alcoholism Treatment and Training Center, St. Luke's-Roosevelt Hospital in New York, suggests obtaining a number of copies of A.A. meeting lists from the local intergroup or central office of A.A. (listed in your local telephone directory ) to give to patients.
Dr. Geller also thinks physicians should attend open A.A. meetings, as it is extremely difficult to feel confident in referring a patient to an organization about which the doctor has little information. Dr. Geller, like many physicians, finds it helpful to have a list of A.A. contacts available to take people to their first meeting. She suggests specific inquiries as to which meetings have been attended, how frequently, and whether the patient has obtained an A.A. sponsor.
Whether the alcoholic patient is suffering from a diseased liver or an emotional depression, getting him or her sober is the first step toward recovery, according to Dr. Geller. She adds that wherever the patient lives, there is sure to be an A.A. meeting nearby for help in maintaining sobriety.
As Dr. Geller's comments indicate, A.A. is listed in most telephone directories, and a phone call is all that is needed for help. Some doctors dial the local A.A. number while the patient is still in the office, and then present the patient with the immediate opportunity to reach out for help. Some simply write a prescription to attend Alcoholics Anonymous meetings.
The local A.A. office can provide the physician with information about the types of A.A. meetings in the area -e.g., professional, women's, young people's, gays', blacks', Hispanic, etc. Such information may help patients to identify with their peers more readily.
Dr. Saul Cohen, a Canadian physician, emphasizes the need to focus on stopping the drinking itself in the "here and now ," and he urges A.A. attendance as a way of dealing with that problem. He further encourages the family to become involved in Al-Anon and Alateen.* This combined approach, along with the doctor's continued encouragement, increases the support that the alcoholic so desperately needs in the early days of recovery.
Dr. Cohen also points out that:
"The recognition and management of alcoholism, one of the most untreated, treatable illnesses, is when within the scope of any physician who is willing to test his diagnostic acumen on a widespread, multiple-system disease which masquerades in many disguises. Paraphrasing Osler's remark, one may say that 'to know alcoholism is to know all medicine.'
"The physician who works closely with Alcoholics Anonymous in his community is in a key position to provide leadership, education, and support in an area which will pay great dividends in the quality of care and rates of recovery of those still suffering alcoholics."
When physicians recommend A.A. to their patients, the physicians should not base their opinion of the effectiveness of A.A. on one or two meetings attended by the patient, but give A.A. a fair trial. Having a patient attend the first A.A. meeting with a member is desirable, although not a must. Most newcomers have many questions. The older member can answer these and reassure the newcomer that others have experienced the same reluctance and fear in taking a first step toward recovery. Sharing experience as peers is the unique service Alcoholics Anonymous offers. In most instances, doctors find A.A. members not only willing but eager to introduce newcomers to the A.A. program.
Your patient may object to going to A.A., saying:
"It's too religious."
In fact, A.A. is not a religious program, but a spiritual fellowship. It refers to a "Higher Power" and "God as we understand Him," but no belief in God is necessary; atheists and agnostics find plenty of company in A.A.
"I don't want to stand up and bare my soul in front of a lot of other people."
Only those who wish to do so speak at A.A. meetings.
"I don't want to meet with a lot of losers. It's too depressing."
A.A. more accurately represents across section of "winners," in the sense that they have survived the disease. A.A. rnembers are an interesting representation of society at large. If patients go to enough meetings, they are sure to find people with whom to identify.
"I can't go there. An those people are sober and I'm not. I'd be too ashamed."
The only requirement for rnembership is a desire to stop drinking. Members who are still drinking are encouraged to "keep coming back." Sober alcoholics are not going to sit in judgment on someone who cannot stop drinking, since not being able to stop drinking is what brought them to A.A.
"I don't want everyone to know about my drinking." Anonymity is and always has been the basis of the A.A. program. Traditionally, A.A.'s never disclose their association with the movement in print, on the air, or through any other public medium. And no one has the right to break the anonymity of another member anywhere.Nonalcoholics are welcome at open A.A. meetings. (Closed meetings are for alcoholics only.) We invite doctors to visit and see what A.A. offers the alcoholic.
Many doctors have found the following pamphlets helpful in introducing patients to A.A.:
This Is A.A.
44 Questions
Is A.A. for You?
Young People and A.A.
A.A. for the Woman
Too Young? (for teenagers)
A Newcomer Asks
Time to Start Living (for alcoholics over 60)
A Member's-Eye View of A.A.
Do You Think You're Different?A.A. publications and complete order forms are available from Box 459,Grand Central Station, New York, NY 10163.
American Medical Society on Alcoholism Resolution on Self-Help Groups, October 19, 1979
WHEREAS, alcoholism is a complex disease affecting the body, mind, family, occupational and social life of the person afflicted;
WHEREAS, the treatment of the disease alcoholism requires a cooperative effort involving many disciplines in addition to physicians;
WHEREAS, self-help groups, particularly Alcoholics Anonymous, have been a tremendous help in recovery to many thousands of alcoholics, their friends and families;
THEREFORE, be it resolved that the American Medical Society on Alcoholism encourages all physicians and the alcoholism treatment agencies with which they work to develop relationships of maximum cooperation with the self-help groups, such as Alcoholics Anonymous.
* From the pamphlet "The Illness called Alcoholism," published by the American Medical Association (Committee on Alcoholism and Drug Dependence, Council on Mental Health, Department of Health Education); reprinted with permission.
*The fellowship of Al-Anon Family Groups, though entirely separate from A.A., uses a similar program to help those close to alcoholics, who may be either recovering or still drinking. Alateen, for teenage children of alcoholics, is a part of Al-Anon. If the local phone book shows no AI-Anon listing, information may be obtained from: World Service Office, Box 862, Midtown station, New York, NY 10018-0862.
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