THE EXPERT WITNESS: The truth is indeed sobering (part V): Sell 'improved' to MADD

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By Michael G. Brock

Lavitt asks why Dodes holds AA to the standard of abstinence while accepting improved status in his own patients. Dodes says that he doesn’t, but that many studies don’t define what they mean by improvement.  He suggests that one study measured success by “percentage of days abstinent.”  He says, “Complete abstinence is lovely if you can have it, but the important thing is to be better.”

Anyone who does substance abuse treatment has seen many examples of people who go from a pattern of daily drinking to one of binge drinking in an effort to have their drinking do less damage to their lives.  These people would show improvement in their percentage of days abstinent.  However, the CDC reports that binge drinking is some of the most destructive to physical health, accounting for half of all alcohol related deaths.[i]  If a person has a 50-50 chance of dying from binge drinking or more frequent drinking, what kind of choice is that?  And keep in mind that the CDC considers “binge” drinking to be 4 drinks per setting for a woman and 5 drinks for a man.

This is not very much by alcoholic standards, and it is another reason why it is so hard to conduct a study that has any real validity.  Just about any measure of improvement (or abstinence) would have holes in it.  It’s also not very realistic, as Dodes admits, to rely on anyone’s self-report about their past and current drinking behavior, but how are you going to get this information other than by self-report?  There is denial inherent in all addictive behaviors.  How often have your heard from smokers, “I’m cutting down?”  Or from the overweight, “I really don’t eat that much (it’s my metabolism)?”  Does the smoker ever cut down to nothing?  One or two a day?  Get real.

As for food, I really didn’t know how many calories I was consuming with a cookie here or an ice cream there until I went on a modified Weight Watcher plan.  The plan was/is to eat two meals a day and a yogurt parfait (with fruit and granola).  No desert except fruit, and no junk food.  When I quit drinking anything with sugar I lost 20 lbs. before even starting the eating plan.  And once I started keeping track of what I ate, I suddenly became aware of all of all the times I would have extra calories and not think about it.  Knowing I have to get on the scale the next morning, I do think about it.  It’s not about metabolism or exercise, it’s about calories.  And being honest with yourself.

The principle of not taking the first drink could also apply to eating.  How?  Ice cream is my favorite way to consume calories.  Quality ice cream, with a high fat content.  If I’m under my weight I’ll have one.  But if I have one today, I’ll want one tomorrow.  And some key lime pie when I go out to eat.  Anything worth eating is worth overeating.  Disciplined behavior takes time and effort to establish, but bad habits are easy to establish and hard to break.  A lot of therapists don’t treat alcoholism, but most of my colleagues tell me that if a drinker wanted therapy for a mental health condition they would make abstinence a condition of treatment.

And I noticed when I did a general practice that it was truly impossible to treat clients for other conditions if they were abusing substances.  They would undo whatever progress they were making with their drinking.  And when I was doing child custody evaluations there were certain problems that would typically come up in what I liked to call an “alcoholic milieu.”  Infidelity and domestic violence were not unheard of with teetotalers, but they were more common among drinkers and drug abusers.

Their kids were also more likely to have problems too, especially ADD or ADHD.  And when I saw kids who were addicted in their late teens or early twenties, they always had at least one alcoholic parent.  If there was ever one who didn’t have an addicted parent, he was the exception that proved the rule.  But the most common complaint that kids had about a parent who drinks was not that he was abusive, it was that, “he’s not there much, and even when he’s there he’s not there.”  Alcohol affects the family before it affects anything else, but how would you measure that?  Would Dodes think of these people as making progress?  I guess so.

There are some truly social drinkers.  Folks who have a glass of wine with dinner and maybe don’t finish it.  Recovered alcoholics laugh about these “earth people.”  Many people who drink to excess are not alcoholic, but it detracts from their quality of life and the quality of life of those around them.  That’s bad enough.  If you’ve reached the point where your drinking is truly problematic for others (your spouse, your boss or the courts), you should be thinking about making amends and repairing the damage you’ve already done, not asking someone to help you do the same behavior and get a different result.  Einstein said that was the definition of insanity.  He may not have been a mental health professional, but he knew crazy when he saw it.
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[i]  Binge Drinking Intensity and Health-Related Quality of Life Among U.S. Adult Binge Drinkers; Xiao-Jun Wen, MD; Dafna Kanny, PhD; William W. Thompson, PhD; Catherine A. Okoro, MS; Machell Town, MS; Lina S. Balluz, ScD, MPH (CDC 2012); http://www.cdc.gov/pcd/issues/2012/11_0204.htm.
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Michael G. Brock, MA, LLP, LMSW, is a forensic mental health professional in private practice at Counseling and Evaluation Services in Wyandotte, Michigan. He has worked in the mental health field since 1974, and has been in full-time private practice since 1985. The majority of his practice in recent years relates to driver license restoration and substance abuse evaluation. He may be contacted at Michael G. Brock, Counseling and Evaluation Services, 2514 Biddle, Wyandotte, 48192; 313-802-0863, fax/phone 734-692-1082; e-mail, michaelgbrock@ comcast.net; website, michaelgbrock.com.