Your Neighbor Is An Alcoholic

alcoholism

Photo: peteSwede

My patient smiled a toothless grin and told me, “I feel fine, doc.”  But he was far from it.  His liver enzymes had risen into the thousands, his skin was a pasty yellow I didn’t need the benefit of sunlight to see, and his albumin (a protein whose level indicates the liver’s functional capacity as well as a patient’s degree of malnutrition) had fallen far too low.  Further, he’d been admitted to the hospital with a chief complaint of vomiting blood, which turned out to have been caused by esophageal varices, a potentially life-threatening condition seen in end-stage alcoholics.

“How often would you say you drink alcohol?” I asked him.

“Oh, once in a while.  You know…”

“Every day?”

After a pause, he admitted, “Yeah, I’d say that’s about right.”

“What do you like to drink most?  Beer?  Wine?  Whiskey?”

“Yeah,” was his only reply, which I took to mean he liked all three.

“How many drinks do you usually have a day?  Ten?  Twenty?”

“No!  Not twenty!”  He laughed as if we were on the inside of the same joke.  “Not twenty, no sir!”

“Ten?”

Another pause.  “Maybe ten…”

By the time we’d finished our conversation, I’d learned he drank beer (about a 6-pack), whiskey (2-3 shots), and vodka in some combination every day and had been doing so for about 20 years.  He used cocaine sometimes, too.

He was easy going and friendly, always ready with the same smile every time my team and I entered his room.  But then on hospital day #4 he started vomiting up blood again, soaking his hospital gown and sheets, so we had to transfer him to the intensive care unit.  Unfortunately, once there his bleeding accelerated, so the team placed a Sengstaken-Blakemore tube down his esophagus and inflated it against his varices (analogous to the way you’d hold pressure against a cut finger).  Despite their best efforts, however, he died the next day, literally choking on his own blood.

THE RECOVERED ALCOHOLIC

Alcoholism is broadly defined as a chronic illness characterized by continued drinking in the face of adverse consequences.  It’s progressive and often fatal.  You can generally identify an alcoholic by their preoccupation with alcohol, their inability to control their drinking, and their denial that they have a problem with alcohol at all.  However, one of the most important things to know about alcoholics—or addicts of any kind, actually—is this:  they lie.  Nothing is more important to them than their addiction and they will do anything to maintain it.  Though many exceptions exist, most commonly an alcoholic’s life self-destructs in roughly the following sequence:  interpersonal, legal, financial, medical, and finally occupational.  Though no definitive proof exists yet that alcoholism has a genetic component, circumstantial evidence abounds.  For example:

  1. The children of alcoholics are statistically more likely to be alcoholics themselves.
  2. A greater concordance of alcoholism exists for identical twins than for fraternal twins (who have as different a genetic make-up as non-twins) .
  3. Many alcoholics report the more alcohol they drink the more it has a stimulant effect (rather than the sedative effect that drinking increasing amounts typically has on non-alcoholics), suggesting at least some alcoholics process alcohol differently than non-alcoholics physiologically.

There is no known cure for alcoholism, but there is a guaranteed way to avoid all of its adverse consequences:  abstinence.  Some might argue that truly addicted substance abusers have little or no free will with which to resist their addiction, but if we believe that we’re left without a way to explain how so many alcoholics do actually succeed in achieving life-long abstinence.

Because so many of them do.  These alcoholics are considered “recovered” or “recovering” (depending on your preference for referring to their decision to stop drinking once and for all or to the ongoing process they use to maintain abstinence), and they look just like you and me.  If your neighbor isn’t one of them, your neighbor’s neighbor probably is.  The prevalence of alcoholism varies by country but in the U.S. it’s estimated to be between 5-10%.  That means one out of every ten or twenty people you know is an alcoholic, whether you (or they) know it or not.  My patient was among the worst of the worst I’ve seen and represents the image most people—and even most doctors—have of alcoholics in general.  But this image is a mirage, representing only one segment of alcoholics in our society.  Some recovered alcoholics go on to become incredibly successful.  In fact, recovered alcoholics may even be more successful than non-alcoholics as a group.  Though I know of no data that proves this, there are several reasons to think it might be true:  recovered alcoholics in general have learned to make good use of fear and are perhaps more comfortable taking risks and therefore more entrepreneurial as a result.  Or perhaps it’s because they have a faith in a “higher power” they find truly sustaining during difficult times.  Whatever the reason, recovered alcoholics can be found running everything from large companies to large countries (though how well is certainly a matter of contention).

THE RECOVERED ALCOHOLIC AND YOU

Even if your neighbor isn’t literally an alcoholic, he or she is undoubtedly a metaphorical one:  like a recovered alcoholic, your neighbor has problems you don’t get to see.  Most people we encounter in the course of our day seem on the surface to be living relatively calm, functional—even happy—lives.  And some certainly are.  But many are not.  Not that most people intentionally work to create such a facade.  Rather, most people simply work to carry out their responsibilities as best they can.  Which isn’t to imply everyone is a fragile reed at risk for breaking when the mildest of winds blows either.  Just that people often appear more composed and together than they actually are, unintentionally fooling the rest of us into believing their polished surfaces reflect equally polished inner lives—polished inner lives we know ourselves to be lacking.

But don’t be fooled into thinking your neighbors have a secret power you don’t.  If you stopped everyone you met in the course of a single day and asked them to tell you about their most pressing worry, you’d find yourself astounded not just by the sheer intensity of the suffering people live with silently every day but by their ability to live in spite of it.  In this sense, we’re all like alcoholics (not to minimize the incredible and unique difficulty of overcoming a literal addiction to alcohol)—all struggling with problems we don’t routinely broadcast to the world.  My problems may not be yours, and your problems may or may not include a problem with alcohol, but no one’s problems make them something more or less than anyone else.

I was reminded of how often we forget this when I watched my team interacting with my patient before he died.  They all cared a great deal about what happened to him, wanted him to live, and worked hard to save him.  But they all seemed to presume a great distance separated his life from theirs, as if there were some fundamental difference between the problems he faced and their own.

But whether a recovered alcoholic or not, a doctor or a patient, you or your neighbor—no real difference exists.  It’s a surprisingly difficult truth to believe.  I still struggle to remember it myself when I get mad at someone and feel the urge to slander them or look down on them, the way people still do alcoholics, or for that matter anyone who struggles with problems they’re not struggling with themselves.  At those times I try to remind myself that everyone has a point of view, that everyone has dreams they carry in their heart and situations they fear yet struggle against.  Maybe if everyone were a little more interested in understanding one another rather than in comparing themselves to one another someone might have appeared in my patient’s life in time to provide the support he needed to overcome his addiction.  Though such support certainly wouldn’t have been by itself sufficient, I think it would have made success more likely.  I’m reasonably confident no such support ever came his way, though.  After he died, no one ever came in to claim him.

NEXT WEEK: What Compassion Is

24 comments to Your Neighbor Is An Alcoholic

  • The NIAAA, NIDA, WHO and others concur that abstinence based treatments can be successful—in 10 to 15 percent of addicted drinkers. Which means that failure rates are in the order of 85 percent. Up until now abstinence was the only thing we really had to offer to alcoholics. Medications like disulfiram did not work. But now research emanating from the National Public Health Institute in Helsinki, Finland changes the entire field. A treatment known as pharmacological extinction or the Sinclair Method is 100 percent effective in getting alcoholic rats to stop drinking and—get this—in over seventy clinical trials, many of them double blind, success rates are over 75 percent in humans—that is the patients reduce their drinking to safe levels or abstain altogether. The treatment is described in The Cure For Alcoholism, BenBella Books, Texas. Now we can stop treating problem drinkers and alcoholics like lepers because we have a cost-effective medical solution for a medical condition.

  • Tony LaPorta

    For a person like myself, it was not the 10th drink that got me drunk. It was the 1st drink, because the 1st drink always led to the 10th. For a person like myself, alcohol is there to do one thing and one thing only. Kill me.

    My sobritety date is Novemeber 15, 2003. I am an alcoholic in recovery. Unless I go back out there, I will always be an alcoholic in recovery.

  • rdp

    Such an important point you make in your last paragraph—I wonder how many readers will focus on that part of the essay, rather than on the notion of drinking as a uniquely “sick” mechanism for coping with problems that are beyond an alcoholic’s power to solve or endure. I believe that the culture we live in privileges certain types of coping (eg. extreme competitiveness, greed, need for self-display), and casts stones at others, without regard for underlying spiritual health. People whose mechanisms lead to success in spite of underlying issues, often develop defenses that, as you say, “presume a great distance [separates their lives from the lives of the unsuccessful].” Often they are only possessed of a less sensitive nature or a capacity to limit their vision to the immediate and the concrete.

    Perhaps because of the problems my parents had, it’s easy for me to see us all as “broken” to some degree or other (certainly, myself!) And I hope and try to interact with others with compassion for their unique variant of brokenness. What I have found, however, is that many people’s “addiction” is to a state of denial that they are broken at all. This addiction is no less vicious than alcoholism, and, like alcoholism, is rarely willingly abandoned.

    I will be interested to read your take on compassion next week. How does one demonstrate compassion when the other person is “more successful” and disregards his/her own brokenness? How, for instance, might you demonstrate compassion for the person who knew the alcoholic and treated him like a leper?

    rdp: I’m really glad you take the time to write such thoughtful, well-articulated comments here. Your ideas always make me think and help to make my posts better. I completely agree that many are “addicted” to denying that there’s anything about themselves in need of repair. As you noted, the point I was trying to make here is that because everyone is in need of repair in some way (imperfection being a part of the human condition), to use the specific way in which each of us malfunctions as a means to assess our individual value is itself a kind of malfunction (perhaps called arrogance?). Compassion is a much harder topic, so this week’s post was my attempt at a warm up. ;)
    Alex

  • JED

    More than likely, someone in your extended family is an alcoholic. Because alcohol is legal, used by many non-addicted people on a regular basis, and offered at nearly every celebration in our culture, sometimes as a marker for a ritual, this heartbreaking addiction is the most difficult to sort out and beat. Alcohol is a drug.

    Most people consider alcohol and other drug addictions the result of bad behavior, poor choices and weakness, or all three. Thus, the lack of support for insured treatment in a disease model—or compassion.

    My daughter has 90 days sober from an agonizing year-long heroin addiction brought on by a legal Oxycontin prescription. Heroin is much cheaper and easier to obtain. Three rounds of detox with very little inpatient time, a mental health evaluation, or any aftercare didn’t offer much help. People are simply dumped out of treatment.

    I worked for 2 1/2 years with people in recovery from all sorts of addictions. I’d llke to hear more about the Sinclair Method. Relapse rates confirm that most of what we can offer isn’t very effective. Stigma is humiliating.

    Great site, thanks.

  • Jules

    So interesting, the question you ask at the end of your essay. Another might be, how many people were able to separate themselves from this alcoholic and therefore save their own lives, solve their own problem and/or their children’s before this alcoholic took them all down? In recovery myself, and most familiar with the lying aspect of the disease, I must have compassion for those who make the excruciating decision to cut someone this sick out of their lives because they are ill-equiped to help them. This group could include physicians. I think of all the alcoholics I’ve known who tried to agressively yet unsuccessfully treat their symptoms with anti-depressents and counseling, which in my view prolonged the lie. I would guess it is so much easier for a medical team to treat such an individual with compassion as the lies he/she may tell do not affect them on a personal, financial, or legal levels. When they leave for the day, their lives outside of the “office” have not been adversely affected by trying to help the addict. I don’t know why I was gifted with the moment of truth that brought on my recovery. I don’t know why my best friend was not. I, unfortunately, had to make the difficult decision to say goodbye so I could concentrate on my own issues. For those who did not, she continues to do what she does, at times harming them over and over.

    Jules: So heartbreakingly true, what you say. I think (and will touch on in my next post) that detaching from an addict who for whatever reason isn’t yet able to stop using their substance of choice and who continues to damage the lives entwined with theirs is a horrendously difficult but nevertheless compassionate act—towards yourself. Thanks for such a great insight.

    Alex

  • Lindsay

    Wow. Here I am, reading this post on my train commute home from work, weighed down by the burden of a recent breakup with an alcoholic. I love this blog and thought it might lift my spirits. My ex is 26, and I am 24. He was sober for 2 years of our 4.5 year relationship, but a recent move & new “friends” led him to return to his old ways, and I don’t want to live my life searching the house for bottles and being lied to. Thanks for the comment, Jules, and for remembering that compassion can = separation sometimes. The synchronicity of this post is such a gift to me. Thanks.

    Lindsay: Thank you for reminding me why I write this blog. The very best of luck to you.

    Alex

  • Andrea

    I’ve known three alcoholics in my life. One was sober over thirty years when he died from heart disease (unrelated to his prior alcoholism). He attended AA meetings until the week before he died and was one of the few people of wisdom I’ve known. I miss him dearly.
    One really was my neighbor. I was living in my first apartment when I met her; she was my mother’s age. An artist from a famous family, she was charming, bright, and highly manipulative. She would often knock on my door late at night asking if I had any liquor. Sometimes she’d have nasty mood swings. She had had cancer on her lip and told everyone she was getting treatments long after they stopped. It was a cover for her slurred speech. Her famous sister (her name is still a household word) wrote an advice column for a major women’s magazine and was a well known academic. I met her often and she’d sometimes call to see if her sister was all right. The alcoholism was never mentioned; she wrote about it in her column but it was the family secret. She didn’t intrude on my life and I did feel sorry for her. Sometimes things got a little nutty, like when she tried to fix me up with her drug addicted musician son because she thought he needed a “nice Jewish girl” to straighten him out. (She wasn’t Jewish.)

    Then there was my late cousin’s companion. He kept his drinking under control until my cousin (who was like a brother to me) died. A moneyed WASP, he managed to keep a successful business going by hiring good people, but his drinking got so bad he got cirrhosis. When he was at his home in Palm Springs, his close friends arranged a “first class” intervention. Only the best; someone from the Betty Ford Center helped arrange it and came. His friends offered to fly me across the country to be there; I couldn’t go. It didn’t take. This man betrayed me in the worst way; my cousin had left a trust for me that I was supposed to get after his companion died. He lied to me until the end. He’d taken the money for the trust and gave it to the hospital where he’d been treated to set up a chair for AIDS research. He did die friendless and when he collapsed in the street after leaving his yacht, the police thought he was homeless. He had no i.d. and looked like a derelict. My late cousin established this annuity for me because he was so worried about my health problems; he knew my private disability would end when I turned sixty five and was hardly generous. At the time the betrayal was so severe I could not feel compassion for him. Fortunately, I’m hanging on financially but things are scary. I don’t trust addicts: their addiction will always come first; they will lie. This man changed his will when he became an alcoholic and became a V.I.P. at the hospital he donated money to. I questioned him when I saw the newspaper clippings but he actually sent me a copy of the will before he changed it to reassure me. I always thought that he actually believed his doctor would keep him alive if he threw enough money his way (the chair was in his doc’s name; he took him and his family for fancy vacations on his yacht ). We had been very close for many, many years before the drinking got totally out of hand. Considering he betrayed my cousin’s wishes and left me in an extremely precarious state, I’m surprised I do feel compassion for him now. But I remember what he was like before the alcohol. I thought of what you wrote about your patient not getting support. I’m sure that’s what the first doctors who saw him thought too. When my psychiatrist, one of the most compassionate men I’ve ever met, found out, he said one word to me when I told him: “Betrayal.” He had no sympathy for him; of course at that point he was concerned I’d end up homeless. He also had known my cousin and how much he worried about me when he found out he was dying.

    Andrea: What a story. Unfortunately, “betrayal” is a common word connected to alcoholics who still drink.

    Alex

  • Andrea

    That makes sense. One of the steps in AA is to make amends to those you’ve hurt. He did leave me a small amount of money. I was the only one. All others in his original will were left out. His millions went to the hospital. It’s a small hospital in Connecticut with no research history. It was obvious to me if he really cared about research he would have left it to Yale/New Haven.

  • christine

    Very simply, thank you. I’ll share that last paragraph with everyone. I look forward to reading more thoughtful observations. How lucky your patients are to have your care!

  • Joe

    What a well-written article. I am a recovering alcoholic with just over one year of sobriety and I truly enjoyed the article and all of the comments. I am looking forward to reading more!

    Joe: I’m glad you liked it. And congratulations on over one year of sobriety!

    Alex

  • Kismet

    Thanks for this article. I would go a bit further and say that the points you make apply to ANY addiction not just to alcoholism—the biggest difference being that alcoholism is the largest addiction in the US—dwarfing heroin and crack addiction. It is an addiction fueled by the availability of legal alcohol—and in my opinion makes it so difficult for alcoholics to seek help and why they are so often totally beat down by the time they quit (if they ever do).

    Kismet: Of course, you’re right about similarities among addictions of all kinds. Thanks for making this excellent point.

    Alex

  • Great post. That’s all I can really say. But it’s enough, right? ;)

    Josh: Exactly enough. Thanks.

    Alex

  • Elise

    I stumbled across here from TPP’s blog on the nytimes, and have spent the last hour engrossed. This post made me think about a movie I recently saw, Sin Nombre, about migrants who suffer through the most abject conditions to reach a better life in America, and about gang life in southern Mexico and the kind of living it engenders. Sitting in a theater in Bethesda, MD, we feel incredibly removed from this experience, but it reminds me that this is one way that humans survive on this Earth, and it is a part of all our shared humanity. Just like people who murder and rape, and people who do incredible things and effect real change in the world—we have a part of them (however small or large) in each of us through our common humanity.

  • LLD

    25 years ago I had a neighbor (2 doors away in the suburbs) who was an alcoholic. The mother of 3 children, she volunteered and drove and did everything that I did—while barely sober—from morning through her kids bedtime. From then until midnight, she was famously drunk. Her home was a mess. There was shouting every day that could be heard from quite a distance.

    On Friday night, I spoke to her about 9 pm. Our husbands and sons were away on a scout trip. She asked her youngest to refill her glass with vodka while speaking with me. She was also smoking and sitting on her bed.

    At 2 am I was awakened from a sound sleep by the sound of fire engines. In a panic I rushed from my bed and threw open the window, leaning out in the direction of her house. Fortunately, her house was not ablaze. The next morning I called our pediatrician (who lived in our town and treated her kids as well). I told him of the incident and asked him how I could help—what we could do to address her drinking and her children’s safety? His reply: “It’s a disaster waiting to happen—there’s nothing you or I can do.” He clearly did not want to get involved and I had little else I could do.

    Today, she is divorced and alienated from her oldest daughter. She lost everything and lives in a small apartment. I know her other children were impacted by their mother’s problem. No one ever intervened. It makes me sad even today.

  • Enjoyed your lovely writing. I can picture this man as I have taken care of many like him. They are truly viewed as “others”: broken, failed, and, most importantly, different from “us.” A fascinating and heartbreaking phenomenon.

  • Nick

    I found your article very insightful and it corresponds with a point I try to make to my kids when they get down on themselves in comparing themselves to others. Those people who seem to have the perfect life? They have their issues, too. You just don’t know what they are. Believe it or not, this may be another part of the genius of the movie Mean Girls (one of my and my kids’ favorites), which shows that it’s not necessarily all fun and games to be one of the “popular” kids.

    I might quibble with your theory that your patient never had anyone to support him and might not have been where he was if he had. I think it’s much more likely that the people who tried to support him eventually had to give up. I’ve had to give up on more than one such person myself. Finally, after nothing you do makes any difference, you realize you have to “sacrifice” the one person for the good of the many—all his/her family members, friends, etc.

    Nick: Others here have made the same point as your last, and I find myself agreeing.

    Alex

  • Cat

    I found your web site today and really like it.

    Not only is alcohol served at all kinds of festivities, it can affect your job.

    I am a recovered alcoholic—been sober 18 years this October. I was a child alcoholic (started at 9 quit at 20) so most people I know would never in a million years know it. But I am very open about it because you never know when something you say or do will mean something significant to somebody else. Plus for a long time I considered it a dirty little secret and it held a huge power over me even after years of sobriety.

    I used to work as a consultant and it was the company atmosphere to work hard and play harder. When I wouldn’t drink or stay out most of the night socializing with these people (who showed all kinds of alcoholic behavior) they would talk to me about not being a team player blah blah blah. I finally just told them that I had to quit drinking because I had a problem and being around them drinking was uncomfortable to me. Well their drinking buddies all got promotions and better assignments then those of us who didn’t go out.

    I no longer work there but met a girl at a consultant company the other day that is in that same situation of work hard and play harder. She’s trying to quit drinking but is having trouble doing it.

    My heart goes out to others in that situation.

    I have another question…

    Can you blog about coming to terms with hidden anger?

    Growing up in the south it was frowned upon for girls to display anger…I realized one day that I hardly ever express anger—I turn it inwards and it becomes sadness and depression.

    Thanks,
    Cat

    Cat: That’s an excellent suggestion for a blog post. Let me chew on it.

    Alex

  • Anita

    I have had this framed quote of Yasutani Roshion my bookcase for many years:

    “The fundamental delusion of humanity is to suppose that I am here and you are out there.”

    As different as we all are, we’re all the same in many ways.

  • [...] do.  And people, of course, are flawed (a fact I dissected in minute detail in a previous post, Your Neighbor Is An Alcoholic).  I’d fallen prey to the mistaken assumption that people always try to do the right thing, [...]

  • Monica

    Addiction….oh yes. I know it all: the shame, the lost reputation, the lost love, the lost respect. The sickness that follows. And yet. What if the only moments of peace and happiness happen only while drinking? I quit drinking. Today I am lonely and tired. I do not love life, is something I need to put up with—not for my sake, but only not to hurt people who care for me. I do not take any pleasure in living. This was why I was drinking. What is left for me? This is ironic and hopeless. I am tranquil and silent and I know there is no answer, no reason and my only purpose anymore is to avoid hurting anybody.

    Monica: If you are recently sober, the feelings you describe are entirely normal and to be expected. With time, you will rediscover joy in life. The process of recovery from an addiction doesn’t end when you stop the addiction. It begins. Have hope.

    Alex

  • [...] Compassion, then, may represent the ultimate cure for shyness.  It may seem odd to imagine upon entering a room full of strangers whom we not only don’t know but have no reason to guess are even suffering, that they’re in need not only of compassion in general but of ours specifically (being, as we are, a stranger to them).  But to this I’d respond:  who isn’t struggling with something?  It may not be an enormous or cataclysmic something, but everyone hides, to some degree, a secret inner life in which they struggle on a daily basis (as I wrote about in a previous post, Your Neighbor Is An Alcoholic). [...]

  • Malissa

    What you wrote here really struck home for me. My husband and I are both alcoholics and stopped drinking last November due to a physical fight that ended up with him being arrested. He hasn’t drunk since then, but I have on a few special occasions like our wedding…I like to tell myself that I am not addicted anymore, but I probably am. I use to feel it was a stimulant rather than a sedative, but now I feel it is a sedative when have anything to drink. I feel I can handle myself and do not need to drink by any means, but do it anyway on holidays and such. I am wondering if anyone else has been in any kind of situation like this and been okay. I am new to your blog and will continue reading it. You are a great writer. I plan to major in psy :)

    Malissa: I know of many alcoholics who’ve reported that alcohol acts as a stimulant rather than a depressant, which has led me to believe that some alcoholics metabolize alcohol differently than non-alcoholics. Alcoholics do not ever get better from their disease. When they abstain for a while and then return to drinking, things often seem to go well for a while, but invariably the downward spiral begins again. The only successful way to approach alcoholism is total abstinence. If you suspect you are an alcoholic, I’d strongly suggest you be screened by a physician and that if he or she concludes you likely are (there’s no blood test for alcoholism—just a survey instrument that strongly predicts the presence—or absence—of the disease), that you make a determination to abstain from drinking completely. Best of luck to you.

    Alex

  • How to Feel Better – Part 2: Expect the Best Out of People | Eva Jio

    [...] One nice article to read – Your Neighbor Is An Alcoholic. Filed Under: Productivity, Random Thoughts, Work [...]

  • Hilly

    My Dad said something to me one day that still rings true to now (my 10-month sobriety):

    “One is too many,
    one is not enough.”

    I hope this helps anyone else as much as it helps me.

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