Your Neighbor Is An Alcoholic, Redux


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!”


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.


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).


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: How To Ensure You’re (Almost) Always Right

22 comments to Your Neighbor Is An Alcoholic, Redux

  • Lynn Hansen

    Very powerful. Thank you.

  • David Hicks

    Thank you, Alex, for a very profound & touching piece of writing—again.

    I work “on the phones” at a drug & alcohol telephone counseling service in Melbourne called Turning Point. I will share your words with my fellow workers. Even after years of reading about addiction my hunch is we will all gain some wisdom & experience renewed compassion from your blog.

  • Sheridan

    This is so true, I struggle not to compare, compete with everyone I meet. I know it’s not right and I just need to be the best me but it is my struggle. I am aware of this low level habit and self correct multiple times a day. Thanks for the insightful message.

  • Jean

    Thank you for this sad and profound story.

    For me, one of the most helpful aspects of continued attendance at 12-step meetings is the reminder that I am not alone. I’ve been clean and sober for some time, but without contact within the fellowship, I can easily forget my accomplishments and sink into self-pity and isolation—which seems to be a default setting for many addicts. Listening to the quotidian problems of others and working with newcomers are great ways to remind myself that I am not unique in my struggles and that I have much to be grateful for.

    You, through your writing, show up on my gratitude list all the time.


  • John LR

    Good insight…we all need to be more aware of ourselves!

  • Tony LaPorta

    When I quit drinking a few 24 hours ago, I thought I would never have fun ever again. Little did I know the fun did not start until I quit drinking. Cheers, Alex.

  • Your Neighbor Is An Alcoholic, Redux by Alex Lickerman - Brad Larsen, PsyD, LLC

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  • Christine

    Thanks, Alex, for your insightful post. My mother was an alcoholic but died from her smoking addiction. I could never understand why everyone in our family was in denial except for me.

    Clearly I saw no chance for her to recover unless it was okay for her to seek help and not pretend that everything was going to be okay tomorrow. I have challenges that I have not been successful with yet, but I hope other people will read this story of yours and realize there are people who can and want to help if they will not deny their suffering. I try to re-read parts of your book almost every day. It is very uplifting.

  • Seana Smith

    Ah, that’s a sad story. He sounds like a pleasant man, but it’s amazing how people with drinking problems can push away the people who love them. My father died still drinking (a fall downstairs, not his first but his final) and a cousin of mine is in a terrible state with drink. Neither a bad person, both doing or did bad things through alcohol.

    It’s very sad, and at 49 I’ve just stopped drinking as it was just creeping up and creeping up… it really is very genetic I am sure.

    So very good to aim never to judge… to stop oneself when doing so… even when being self-judgmental too.

  • Melissa

    Thank you, Alex. This is an important topic.

    As a daughter, granddaughter, sister, cousin, niece and friend of alcoholics, and as one who has struggled with (and eradicated) alcohol use myself, I think the one in 10 statistic may be on the low side. Or it could be that in alcoholic families, some of us get more than our share of exposure to alcoholics. This is a side note. My main point of responding to your post is that I see my brother in the alcoholic who came to you and eventually died, except my brother is still alive, still drinking, still denying that alcohol rules his life, and still lying. If he’s awake, he’s lying. If I allowed him to visit me, he’d drink all the alcohol in the house, and take the money from our wallets, leaving a path of drunken mess behind him. There would be no apology afterward. There would be no afterward, because in all likelihood he wouldn’t remember it.

    This is a benign example of his abuse and fallout. He has passed out drunk while the sole caretaker of his infant daughter on several occasions (fortunately, she is not longer in his custody). He has been involved in auto accidents that cost one friend his life. He has cost my parents at the very least the equivalent of a full college tuition in legal fees, destroyed property, unpaid debts, travel expenses and room and board. The emotional costs can’t be measured.

    I tell you this, because my sober siblings, I, and others have tried to help my brother for decades in every conceivable way. The simple fact is, he will not stop drinking. He can’t be counted on to maintain his life and behavior for any length of time. He regularly causes harm to himself and would harm the lives of our children if we let them have exposure to him. He’s simply toxic, and all we can do is detach with love. My mother is in denial herself, is an enabler and feels, as your post suggests, that we have abandoned him. She’s fine with leaving my young nieces alone in his care. This dynamic has caused a great rift in all our lives, is a source of continual pain. People can’t exist with toxicity at this level. For my own sanity, I’ve had to distance myself from my brother and my mother. My sober siblings have as well for the sake of their lives and the lives of their children.

    The story of your patient is indeed a sad one. Some people can’t be helped. Understand that it probably wasn’t for lack of trying.

  • Michelle

    The pithy version of this, useful to me for self correction, is “Be kinder than necessary because everyone you meet is fighting some kind of battle.” (Variously attributed to Plato, James Barrie (author of Peter Pan), T. H. Thompson, John Watson, and others.) As I’ve explained to my teenaged daughter, even the rich, beautiful captain of the cheerleader squad may be tortured by feeling that no one loves her for her true self.

  • Jude

    Alex, I’m a “recovering” alcoholic. Twelve years sober. I’m not so sure alcoholism is genetic so much as the underlying symptoms, mainly depression. Depression can be genetic and generations of families self medicate with alcohol and drugs. That’s the case in my family. People are still judgmental towards alcoholics. The old bums-under-a-bridge stigma. I was a housewife who drank in my kitchen, but when I was drunk, I was just as drunk as the bum under the bridge. Alcohol is the common denominator. I will always be conscientious about my alcoholism, but alcohol will not define my life. Good article.

  • Great post. I have found a lot of wisdom in the writing of addicts. Even though I have healthy instincts for dealing with drugs and alcohol, the addict’s understanding of humility and patience is inspiring to me.

  • OK, so thinking about others and caring how they really are is good.

    Yes. (No “but” included.)

    What about those of us who tip over into wanting/needing to care about others? It can make US wounded, unable to stop worrying about how someone else is doing. Personal responsibility is just that—it’s personal—and there are degrees of being able to offer and being able to accept advice/information/direction.

    I now try to have a positive/uplifting/realistic outlook.

    My most favorite phrase is “this too shall pass” and “tomorrow is another day.” I find it works for me and others seems to accept it as possible. Tomorrow IS another day, and yes, most things do pass/change/resolve for either better or sadly for worse.

    Caregiver burnout is intense. The balance of giving/caring and protecting myself is one of the most difficult things I have ever done in my life. I believe that with technology we are less connected to one another. Texting & e-mailing instead of looking into another person’s eyes, walking side-by-side, chatting or putting a hand over their hand to offer comfort is so detached and remote.

    I am unsure our ability to connect and communicate will ever recover.

  • Elle

    What a moving, sad story. What strikes me most deeply, even more than the gruesomeness of the clinical picture, is the aloneness he must have experienced. It’s easy to imagine or assume that all the loved ones in his life were driven away by his addiction. After having given up on him, no one even cared that he had died. Yet I also wonder if aloneness or isolation might not have been a factor that compelled his drinking as well—like a vicious cycle. Someone said “strength is to be found in solitude.” I don’t know; maybe there’s strength to be found in not being so alone, too.

  • Elle

    Although I must add that being accompanied by people who help stop the addiction rather those who cannot is the key.

  • Ana

    Oh, my. Addiction. Isn’t it silly that we Westerners ascribe “negative” behaviors (only?) to addiction; from, “addiction” is: “the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma.” Nothing in this definition suggests lifestyles of delight and joy. We writers are addicted to writing—both via hand and keyboarding—which causes severe trauma to our wrists (carpal tunnel syndrome notwithstanding)…as well as to other parts of our upper bodies, yet, indeed, we are likewise psychologically “enslaved” to our passion for words, and sentences, and paragraphs, and…well, you know. I’m an addict. I experience all sorts of pain, but I think it’s no more—or less—than the pain that my loved one’s alcoholism brings. (Really.) Isn’t this point Alex’s point? That we are all…one? We’re all addicts. (We all breathe—>we oxygen fanatics Ha.) (Hey, if the universal shoe fits, baby…). Thanks for listening. 🙂 ~Ana

  • Excellent, Alex. NO man is an island.

    The writer Charles Bukowski often wrote perceptively on his alcoholism, often crudely, but it offers a good insight from one who was able to use language in the service of explication (though he was wily, like all alcoholics, and that is obvious, too.)


    First a disclaimer: I am an adult child of alcoholic parents. So my take is obviously influenced by my own history.

    The rawest part of this article is two simple words: “They lie.”

    My mother denies she’s an alcoholic but meets the criteria. My father knew he was an alcoholic but manipulated and deceived his way through most of his adult life, and in doing so was a human wrecking ball. I remember him sober once, when I was about 13 years old. He didn’t drink for a whole summer. And then he started drinking again. I’d wish he had never even stopped for that short time because it gave me a glimpse into a normal family that was never to be. I was heartbroken by that.

    Honestly, when I think about how most people have hidden problems and put up a façade, I don’t see them as a metaphorical recovered alcoholic. To me, they seem more like metaphorical children of alcoholics: scared, dysfunctional, trying to just navigate through the world, wanting to be loved and taken care of. I have been walking this planet for over 4 decades wearing a smile on my face. But I’m so damaged. Not damaged enough to not squeeze out a good life. I have a husband, a home, friends, family, a good job, etc. You’d look at me and think, wow she’s so fun and so together. And I am, except there is a place within me where there is still so much pain. And so that allows me to really SEE people sometimes. When you suffer pain, you know your own kind.

    My dad died at the age of 67. That’s a long time to live so pickled, so delusional. After getting loaded from a bottle of vodka he poured into his feeding tube, he fell and hit his head. Despite his emotional and physical abuse and failure to care for us, forcing us into poverty as children, he didn’t die alone. My three brothers gathered at his bed side and they ultimately had to make the choice to remove him from life support. Even in death, my dad put a terrible burden on my siblings. That’s some power.

  • Lee

    For those not theistically inclined there are a number of secular organizations dealing with recovery.

    To locate them, a quick web search should do the trick.

  • jessica

    This post has been on my mind all week. Progression scares me. But I’m clean and sober today, for that I am so grateful, and I do the work to stay that way.

    Thank you, Alex, for your continued inspiration.

  • Cecilia

    Alex: To quote you: “Maybe if everyone were a little more interested in understanding one another rather than in comparing themselves to one another…” Well how do you stop comparing yourself to another? It’s a horrible demeaning thing to do. Something that will bring you nothing but dissatisfaction and eventually self hatred… But—at least I—can’t find a way to stop comparing myself to friends and idols… You’ve said it yourself: We all sort of deal with the same problems. Yet the outcome is always so different: Some suffer to keep putting one foot in front of the other, and others get to “play life on easy mode.” So who’s to say that he or she or I might get a better or worse outcome than him or her?

    … I’m having a hard time finding the right words… How could I put this? I’ll try to explain as best I can, but I’m sure you have also experienced having your thoughts so nice and neat inside your own head, but all jumbled up once you try to get them outside…

    You see, to me, no problem is bigger than another, because I think our mind tricks us into thinking that even the most trivial of problems are as big as much more concerning problems. Therefore spilling ink all over your paper that’s due tomorrow might just feel as horrible as discovering your parents have been eaten by carnivorous toads. This is what I think leads to exaggerations, and situations spiraling out of control. […] But I’ve gone off topic. That one’s for another day.

    In conclusion: I am frustrated that though we all suffer the same amount (because our problems are sort of the same) some people still get a easier life than others. And it is very difficult to control the envy, or desire to obtain the life these lucky people have. And because of this envy and/or desire, I frequently find myself comparing my person to said lucky people.

    Now that I have explained my question, I will once again ask it: How do you stop comparing yourself to others?

    Cecilia: I very well understand your question. At the risk of sounding self-serving, I’d point you to my book, The Undefeated Mind. I talk about social comparison in Chapter 3. In it, I make the same point that you do above, namely that most of us can’t help comparing ourselves in some way to others. The goal, in my view, then, isn’t to get ourselves to stop, but rather to get ourselves to do it in a way that serves us rather than discourages us. My views on how to do that can be found there.


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