The End of My Addiction

there is this common truth: to shun is to shame. This fact should long ago have altered how the majority of physicians treat patients with addiction. It hasn’t.
    We live in a world that assumes everything is fixable—by experts or money, or a combination of both. And if the “experts” can’t solve a problem, well, then either the problem doesn’t really exist or it falls to the sufferer to fix it alone. We like to see ourselves as strong creatures, up to meeting all life’s challenges. We flatter ourselves that willpower can overcome all obstacles.
    That was the heart of Rational Recovery’s appeal for me. The fantasy that I could think and will myself into freedom from addiction was enormously attractive. Reflecting on my past as I recuperated, I could see that I had exerted significant willpower in my life: taking the baccalauréat early; auditioning for Artur Rubinstein; becoming a good cardiologist.
    But at the same time, based on what I had seen in AA meetings, there was no shortage of willpower among alcoholics, some of whom functioned at a high level in demanding professions and other circumstances. (Not to mention the willpower that all addicts show in obtaining whatever addictive substance it is that makes them feel better.) What AA and Narcotics Anonymous assert is that willpower, no matter how strong, is inadequate against severe addiction. That too made sense to me. I was finding much wisdom in the first of AA’s original twelve steps: “We admitted that we were powerless over alcohol—that our lives had become unmanageable.”
    There was one thing the alcoholics I met in AA seemed to have in common: they all said they drank to relieve lifelong emotional pain, usually connected with an anxiety, mood, or personality disorder. I found this remarkable.
    The fact that every alcoholic seemed to have a preaddiction morbidity like my own encouraged me to think that alcoholism must fundamentally be a biological disease. And because it was a biological disease, it couldn’t just be addressed by willpower or positive thinking: it had to be addressed medically.
    In the last days of my hospital stay, I began to hope that the worst was behind me. Taken out of my daily routine, with its triggers for anxiety and drinking, and inspired by my talks with John Schaefer and Liz Khuri and their confidence that I could achieve a full recovery, I felt a deep inner quietness and clarity of mind. In his books Bill W., the cofounder of AA, described these sensations as heralding the spiritual awakening that ushered him into lifelong sobriety. I had heard similar accounts in AA meetings.
    The next time Liz Khuri came to see me, I told her about my experiences and said, “I have always considered myself an agnostic, but I think I’m feeling a spiritual awakening. It makes me feel that I will never drink again.”
    Liz said, “The sensations you’re describing fit the model of all that we know about spiritual awakenings in people with addiction. It could be some kind of miracle, and after what you’ve been through, you deserve it. Remember what I keep telling you; you’re a child of the universe, and maybe the universe is looking out for you now.”
    With cautious optimism verging on outright confidence, Liz and I prepared for my discharge from the hospital after a thirteen-day stay. I would continue to consult her on an out-patient basis at her Cornell office, and I would also see John Schaefer again in a month for routine follow-up.
    Before I left the hospital, I told John that I would be happy to give a talk at medical grand rounds at Cornell to share my experience with other doctors and encourage those with a dependency to seek help.
    “It’s a noble offer, my boy,” he said, “but you should only do that after you’ve been sober for five years and you know you’re out of the woods. Plenty of doctors still think alcoholism is a weakness, not a disease, and some of them will try to use whatever you say against you. It’s best to keep a low profile until you know you’re well.”
     
    John Schaefer’s warning aside, the next week was a joyful one. My spirits rose day by day, as I looked forward to resuming my normal life, and before long my cardiology practice, without the burden of alcohol cravings. I delighted in playing the piano and in Joan’s company, and we spent a wonderful weekend at a Victorian resort hotel on a lake in upstate New York.
    And then, without knowing why, I drank.
    In retrospect,