 |
 |
|
 | ||
                      |
|
 |
|
A Drunkard's Life
"Can I have a cracker?" he asks, and we give him a handful. He's polite, washing them down with sips of the golden liquid in his Dixie cup. I assume it's beer, but the second whiff reminds me of my grandma's bathroom. A closer look at the cup confirms my suspicion. The drunk is drinking Listerine. "Hey man, you're drinking mouthwash," I say. "It's okay. It's still morning," the man replies. "Won't drinking Listerine make you... um, dead?" I asked. "Fuck it," he says. "Stuff's 80 proof." As he stumbles away, shoppers part to each side to avoid contact. I'm reminded of a reaction so many sober alcoholics tell me they have upon seeing drunks in the street: "There but for the grace of God go I." For certain, too many days on 80 proof mouthwash will kill a man just like terminal cancer. But does the drunkard have a disease? No doubt, says the conventional wisdom in the United States (outside New Orleans, at least). For years, hospitals have admitted and treated alcoholics often paid for by insurance, Medicaid or charity as if they had lymphoma, kidney disease or advanced diabetes. Recently, however, some in the medical community have openly questioned the concept of alcoholism as disease. The popular TV news magazine 20/20 devoted an entire show in June to call into question the disease concept, interviewing doctors, scientists and former alcoholics who characterized alcoholism as a bad habit, or a behavior disorder, but not a disease. The show told about new medical breakthroughs including a pill and therapy alternatives to Alcoholics Anonymous. Although new views of alcoholism only recently reached living rooms, a minority view has long questioned the disease concept. In 1988, Herbert Fingarett wrote a book called Heavy Drinking: The Myth of Alcoholism as a Disease. "No leading research authorities accept the classic disease concept," Fingarette told Boulder Weekly. "One researcher puts it quite baldly: 'There is no adequate substantiation for the basic tenets of the classic disease concept of alcoholism.' Another expert, whose views are more conservative, dismisses the classic disease concept of alcoholism as 'old and biased,' a model whose propositions are 'invalid.'" Fingarette a fellow at the Institute of Psychiatry in London and a retired University of California professor of philosophy insists alcoholism is a behavior that can be ended or modified by the patient. One might expect such views to elicit venom from zealous recovery junkies, but they don't. Few in traditional recovery seem to care much about new views that call into question their status as "diseased." Most laugh at the concept of moderate drinking for alcoholics. "The jury is still out on whether it's a disease," says Jann Scott, an alcoholic/addict in recovery for 22 years, who volunteers to help other alcoholics and once hosted the Boulder-based Addiction Free Radio show. "I guess it depends on what your definition of 'disease' is. I like to think of a disease as something organic, either viral or bacterial. Since alcoholism is neither viral or bacterial, I think of it as an 'illness,' but not necessarily a 'disease.' Using that term 'disease' has pissed off a lot of the medical community." Divisions between abstinence-only and moderation-based treatment philosophies are turning some treatment facilities into battlefields. Recently, the director of the Smithers Addiction Treatment and Research Center of St. Luke's-Roosevelt Hospital in New York resigned after a feud erupted over whether to include Moderation Management theories into its program. Dr. Alex DeLuca's decision to include the approach of controlled drinking caused a firestorm of protest from the directors of the clinic, who had always been strong proponents of the more traditional idea that total abstinence is the only recovery for alcoholics and addicts. To some in the recovery community, the idea of moderate drinking as a path for people who have had drinking problems is dangerous at best. To others, it's a lethal heresy. "In AA that's called 'stinking thinking' the idea that as an alcoholic you might be able to start drinking in moderation," says Scott, who used to run the night shift at Boulder's Addiction Recovery Center. "Whether you call it a 'disease,' or 'illness,' or neither, an alcoholic is someone who, when he drinks, experiences the phenomenon of craving. For someone who's craving, moderation makes no sense." Scott says recent media hype about moderate drinking for alcoholics has spurred widespread discussion in local AA meetings and throughout Boulder's enormous recovery community. Some people new to recovery, he says, are tempted by idea of drinking moderately. "But nobody who's been sober for a year or more is phased by it," Scott
says. "They're saying 'What? That makes absolutely no sense at all.' I've
been in recovery for 22 years, and I have thoughts like that for about 10
seconds, maybe once every two weeks. Then it's gone." Inveterate drunkards Alcohol abuse has afflicted societies around the globe since antiquity. Man's quest for altered consciousness probably began shortly after consciousness itself was understood. Fermented drinks date back thousands of years. Although the exact discovery of fermented drink remains open to speculation, it seems likely that it predates agriculture. Both the Hebrew Bible and the Talmud make ample reference to the virtues of strong drink: "It gives courage and enables the poor and unhappy to forget their trials." Psalms 104:15 and Proverbs 31:6-7. As the uses of alcohol are many, so are its abuses as documented in scriptures of antiquity. In Proverbs 23:29-35, we find a description of an inveterate drunkard with his short temper, bloodshot eyes, strange visions and hallucinations. In Ancient China, where rice was one of many cereals used to make alcoholic drinks, a common saying was: "First the man takes a glass. Finally the glass takes the man." Swedish physician Magnus Huss first coined the term "Alcoholism" in the
19th century. While the negative effects of alcohol had been documented
for centuries, Huss was the first to classify systematically the damages
attributable to alcohol abuse. During this time, the fate of alcoholics
was grim. Alcoholics were thought to have no chance of recovery, and most
either drank themselves to death or wound up in sanitariums, an equally
unpleasant existence. As recently as the mid-20th century, the medical
community regarded alcoholism as an untreatable condition. While there was
little hard evidence on the physical causes of alcoholism, the experiences
of most members of the medical community led them to the conclusion that
the fate of the alcoholic was almost always institutionalization, an early
grave, or both. Bill & Bob In 1935, a man named Bill W. found himself in a hotel lobby in Cleveland on a business trip. Bill's own battle with booze had been an all consuming factor in his life for decades. His was a classic story of liquor-inspired riches to rags. Once a successful stockbroker and businessman, Bill was brought to the brink of destruction time and again by his inability to remain sober, despite the hideous consequences of his drinking. Bill sought relief from his condition through chemistry, psychiatry, religion and will power. None brought more than temporary respite. Somehow, Bill had managed to dry himself out long enough to get a job, and this job was the reason he found himself in the lobby of a strange hotel. He had been dry only a few months, and the events of the day had taxed his nervous system to an uncomfortable level. He found himself staring across the lobby toward the inviting glow of the hotel bar. Despite the damage that alcohol had done to his life, Bill felt himself drawn inexplicably towards the bar, the bottle and oblivion. But something happened to Bill in that lobby, something that many have since chalked up to divine intervention. Bill did not take that first drink, and instead chose to call a local clergyman and ask where he might find another alcoholic in town. He was given the address of Bob, a formerly respected doctor whose own battle with booze had left him a bedridden shut-in. Those who knew him did not expect him to live out the decade. This seemingly insignificant meeting of two drunks would go down in history as the first meeting of Alcoholics Anonymous which today spans the globe and boasts a membership of countless millions. The organization's recovery program is based on 12 suggested steps the alcoholics take to bring about a spiritual transformation that allows them to lead alcohol-free lives. While these 12 steps have since been copied and used by other programs of recovery, they have remained unchanged. One basic tenet of AA is that of the unparalleled power of one alcoholic helping another. Many who have never been to an AA meeting picture a church basement filled with old men swilling coffee, air thick with cigarette smoke. This is a far cry from the reality of AA in the year 2000, especially in Boulder where smoking in public is verboten. Describing a "typical" AA member is futile. AA members come in all
colors, ages, social backgrounds and political leanings. Often they are
people who would normally have little common ground in the outside world,
and probably wouldn't have been drinking pals. In the meetings, however,
AA members unite with a common desire to live sober. The problem with AA Some recovery seekers bristle at what they consider to be the dogmatic approach of various 12-step programs. Problem drinkers who come to AA hoping to learn how to moderate their drinking are disappointed. An oft-heard saying at meetings goes something like this: "You can't change a pickle back into a cucumber." In other words, once you're an alcoholic you can't go back to social drinking. For those unwilling or unready to admit to being totally powerless over alcohol, there are other programs geared toward moderation. One such program is Moderation Management (MM). The name alone sends chills through long-time 12-step adherents, who fear it sends a message that alcoholics can moderate drinking. The program's website (www.moderation.org/), tries to set the record straight, stating: "MM is not intended for alcoholics or chronic drinkers. It is intended for problem drinkers who are not severely dependent on alcohol. The program also supports a goal of complete abstinence for those who find moderation is not appropriate for them. MM is for people who want to cut back or quit drinking." The approach of Moderation Management, however, didn't work for its
founder, Audrey Kishline. Earlier this year, Kishline was involved in a
drunk driving accident that claimed two lives. In a statement released on
their website on June 29, Moderation Management confirmed that "Audrey
Kishline had withdrawn from Moderation Management (MM) and joined AA
months before her tragic auto accident. This tragedy for the victims and
their families, for Ms. Kishline and her family should not be construed as
a 'failure' of MM, any more than it is a failure of AA, which Ms. Kishline
was attending at the time of the accident." The "God" problem Another sticking point for some to the traditional 12-step approach to recovery has to do with the spiritual nature of such programs. The word "god" is mentioned liberally throughout the texts of AA and other 12-step programs. While the literature stresses that this reference to a higher power is non-denominational, the alcoholic or addict is told that it's necessary to believe that a higher power can restore them to sanity. "A higher power can be anything that is more powerful than I am," says "Richard," a recovering alcoholic. "For me, drugs and alcohol had been that higher power for years. Now I have a god of my own understanding, a power that I ask to keep me sober on a daily basis." "Are you a Christian?" I ask. He laughs. "No, I'm a pagan," Richard says. "Lately I've been worshipping Cthulu." If accepting the tenets of a 12-step program requires a leap of faith, the target is extremely broad. Still, the dependence on spiritual beliefs is a turn off to some who want desperately to recover from alcoholism, but refuse to accept God or a "higher power." Groups such as SOS (Secular Organization for Sobriety), SMART (Self Management and Recovery Therapy) and RR (Rational Recovery) all offer non-religion based programs of recovery. While these programs differ from AA and from each other in various ways, all programs of recovery place great importance in the alcoholic's own willingness to address his problem. At Boulder's Addiction Recovery Center, Rational Recovery meetings are offered as an alternative to AA. "It's very difficult to get some people into AA because they don't like the religious aspect," says Chris Reid, attendant counselor at the center. "Rational Recovery takes God out of the picture altogether. And unlike AA, it doesn't tell alcoholics they need to attend meetings for the rest of their lives. It's a one-year program that teaches you to recognize your addictive voice to understand when you might turn to alcohol to deal with a situation." Most in the medical community still accept alcoholism as a disease. But unlike polio, alcoholism resists being studied under microscopes. While a predisposition toward alcoholism is often passed to offspring genetically, there is no medical test that can detect whether or not one person is a potential alcoholic. The best definitions of alcoholism come from those who suffer from it. Richard, a Naropa student who has been sober for three years, describes alcoholism as a tri-fold disease. "Alcoholism is a disease of the body, mind and spirit. I'm dubious of any so-called 'cure-all pill' for alcoholism. They might help to alleviate the physical cravings, but the idea that they could somehow allow me to drink safely is laughable." Naltrexone is one of the new "wonder drugs" mentioned on 20/20. Like Methadone, Naltrexone blocks the brain's opioid receptors. While the precise mechanism of action for Naltrexone's effect is unknown, reports from successfully-treated patients suggest three effects. First, Naltrexone can reduce craving, which is the urge or desire to drink. Naltrexone can also interfere with the tendency to want to drink more if a recovering patient slips and has a drink. Contrary to what some people have said, the drug is not meant as a stand-alone cure for alcoholism. And Naltrexone is by no means a "cure-all pill," but is intended to allow the alcoholic to have a few drinks free from the risk of binge drinking and insatiable cravings. "If they had a pill that would allow me to drink two beers without becoming a raving maniac, I'd wind up taking 10 pills and drinking 20 beers," says "Otis," a sober alcoholic. "I mean, what's the point of drinking two beers?"
"Bio-psycho-social disease" In addition to its mental component, alcoholism has a profound physical component. "Wendy," a drug and alcohol counselor, classifies alcoholism as "A bio-psycho-social disease." "The medical community might find chemicals that will reduce the cravings that an alcoholic experiences, but I don't believe that there is any chemical that could reduce the damage to the body or psyche of an alcoholic who has chosen to pick up that first drink." One thread that seems to run through nearly every alcoholic is the eventual inability to live without alcohol. In describing his own story of DUIs, evictions and lost jobs, Otis said: "I could deal with the legal hassles. I could always find another job, and there were always friends' couches to sleep on. Then I realized that my court ordered daily Breathalyzer would mean I'd have to give up drinking. I couldn't deal with that. I couldn't imagine life without alcohol, and couldn't live life with it." Names in quote marks were changed to protect anonymity. It's a strange ailment that makes one hallucinate, pick up a gun and fight a war in the middle of town. Alcoholism, disease or not, did just that to Phil. He's a handsome and articulate Boulder native, with the bearing of someone you might find playing mixed doubles tennis, surfing or working as a rock climbing instructor not the sort you'd expect to go on an armed rampage. He just finished eight years probation for, as he put it, "freaking out the community." It's the story of his last drink: "I had been drinking alcoholically since I was 16," says Phil. "By alcoholically I mean drinking for conscious escape from reality. I had been drinking to blackout for years. Even so, this binge was atypical in its scope. At the time of the incident that led to my recovery, I had been drinking all night long. I was also doing cocaine. They tell me that my blood alcohol level at the time was .538. "I remember drinking a liter of vodka at a friend's house up on Baseline. The higher I got, the more I could drink. I got in my car and went to my mom's house. Something happened at that time, and I was thrown into what a toxicologist later called 'a toxic psychosis.' This was in 1992, and the Gulf War was going on. I'm not all too clear about what was going on, but I had the idea that Iraqi soldiers had invaded Boulder. "It was 8:30 in the morning. I was drunk, staggering, psychotic and armed with a .308 Winchester elk rifle. I went outside and noticed that my fellow citizens seemed to be in a state of fear and panic. I assumed that the invasion was well underway, and as I was the only one still armed, I wanted to form a resistance cell. "God must have intervened, and I realized that the people on the street weren't worried about Iraqis. It was me they were frightened of. It was at that point that I had a moment of clarity. I realized that I long ago had crossed the threshold into insanity. I disarmed the rifle, letting the clip fall to the ground. I started running, and was caught by the police moments later. I came to, handcuffed to a stretcher in Boulder hospital. I saw the supervising officer standing over me, and realized that something was not right. My first question was 'Did I shoot anybody?'" Phil was lucky as were his neighbors. Nobody was shot, and he spent only seven months in the Boulder County jail. It was this experience that led Phil into AA. "I do not wish to minimize my own responsibility for my actions. While alcoholism certainly led me to my crimes, today I have the responsibility for dealing with my disease. I can't blame my disease for my circumstances. I have the responsibility for not drinking on a daily basis, and for me, AA is the way that I do this."
Our sources Resources for this story include: A History of Alcoholism, by Jean-Charles Sournia The Big Book of Alcoholics Anonymous Beyond the Influence: Understanding and Defeating Alcoholism, by Katherine Ketcham and William F. Asburry Heavy Drinking: The Myth of Alcoholism as a Disease, by Herbert Fingarette Recovery resources Boulder County Alcoholics Anonymous: (303) 447-8201 Secular Organization for Sobriety: (310) 821-8430 Self-Management and Recovery Therapy (SMART) A scientific approach to addiction recovery, based on modern cognitive/behavior methods, particularly Rational Emotive Behavior Therapy (REBT): (216) 951-0515 Suggested Reading: SOS Sobriety, by James Christopher
|
A local drunkard lurches toward me, as I sit behind my friend's
stand at the Boulder Farmers Market. He's clutching a paper cup, and the
air around him fills with a strangely antiseptic odor I haven't smelled in
years.
