The End of My Addiction

told him, “AA is a great place. Have you been to a meeting?”
    “No.”
    “You refer people. Maybe you should know what it’s like. Will you come with me to an open meeting?”
    “No.”
    “Why not?”
    “Because somebody might see me.”
     
    There is a moral stigma to addiction, and it is prospective shame that drives people to resist admitting they have a problem. It leads physicians to miss or delay a diagnosis of addiction, too. Only a couple of months earlier, I had brought up AA in a session with my shrink. “Oh, you’re not an alcoholic,” he said dismissively, “but you could become one.” Then he changed the subject away from alcohol and drinking.
    Later on in my alcoholism, when I knew more about the course of the illness, I wondered how he could have missed the signs of its onset in me, and could even have turned a deaf ear to my first outright call for help. The responses of my physician colleagues at New York Hospital–Cornell puzzled me, too. When I would discreetly ask around about how to help “someone” with a drinking problem, they’d ask, “Is the person close to you?”
    If I said no, they’d say, “You don’t want to get involved. It’s a minefield.”
    If yes, “Well, I really don’t know what to say. It’s very complex…”
    Recent studies have shown that, at least among physicians who are not specialists in the field, a missed or delayed diagnosis is the rule, rather than the exception, in cases of addiction. One study videotaped doctors and patients and found that when patients mention addiction issues, doctors tend to change the subject as quickly as possible. 1
    I didn’t know what to make of this phenomenon when I first encountered it. But it has dawned on me that doctors are uncomfortable with the subject because they don’t have a reliable treatment to deliver or recommend.
    The lack of reliable treatment also explains the moral assumptions attached to addiction. Whenever medicine has lacked a means to cure an illness, it has blamed the patient’s lack of moral virtue, positive thinking, and willpower. In the nineteenth century, tuberculosis was associated in novels and operas with characters of dubious morality or sanity, at least insofar as the establishment was concerned. Think of Fantine, the unwed mother turned prostitute in Victor Hugo’s Les Misérables ; the deranged revolutionary Kirillov in Dostoevsky’s The Possessed ; or the courtesan Violetta in Verdi’s La Traviata . Susan Sontag memorably exposed a similar dynamic at work in relation to cancer and AIDS, respectively, in Illness as Metaphor and AIDS and Its Metaphors .
    I very much feared moral judgments about my drinking, and no one was judging me more harshly than me. “I am supposed to be an intelligent person with willpower. I should be able to control my urge to drink. When people find out about my drinking, they will finally see what a fake I am,” I told myself.
    What further complicates the picture is the fact that some people are able to halt their compulsive behavior with the help of twelve-step programs like AA and commonly prescribed medications like Revia, Campral, and Antabuse. But for the vast majority of people with addiction, these are not enough. They weren’t for me. Which is not to say that AA didn’t help me. It did. It was a critical resource without which I might not have survived until I found an effective medication in baclofen. It taught me a great deal about accepting my illness and about my fellow sufferers and myself, but it couldn’t stop my cravings or the uncontrollable anxiety that led me to drink.
    I was terrified of living without alcohol. Without it, I would be an anxious wreck. Admitting my problem drinking to most of my friends and my colleagues terrified me, too. I feared being ostracized, and since I felt that drinking should be under my control I felt ostracism would be justified. (Naively, I assumed that very few physicians had a drinking problem. I didn’t yet know that about 10 percent of physicians, like roughly 10 percent of the general population, will become dependent on alcohol at some point in their lives, that many more in each group are problem drinkers, and that according to the British Medical Association, physicians are three times more likely than the general population to have liver cirrhosis from alcohol abuse.) 2
    Through the next two months after my appearance in the ER, I clung to abstinence. I called my new AA sponsor