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October 1957

To The Grapevine:

A Physician Looks at Alcoholism

"We should be friendly to our friends--the physicians," wrote Bill W. in the August Grapevine. That particular one of the "Friendly" series was written several weeks before publication, or we feel sure Bill would have enjoyed and perhaps incorporated into his text the accompanying object lesson, "lifted" from the July issue of "The Eye Opener," published by AA members in the Ohio Slate Penitentiary.

ALCOHOLISM IS A DISEASE of three facets. There is physical disease, mental or emotional aberration (some prefer to designate it as personality defect or disorder), and most important of all, there is spiritual conflict or need. All three elements of major distress must be recognized, appreciated and understood by the physician if any progress is to be made in search for solution.

The American Medical Association has acknowledged alcoholism as a treatable illness, and some practitioners of our day are beginning to accept it as such. Through the admirable achievements of Alcoholics Anonymous we have seen that alcoholics can and do achieve sobriety. And rarely, apparently, through our own individual effort, is influence carried to the patient which helps him to regain some essence of control over his drinking. We see, too, the results of spiritual approach through personal evangelism that can often have far-reaching effect. These and other signs of our times place an added responsibility upon physicians that they undertake without hesitation the care of those alcoholics who come to them for medical help.

There seem to be two significant barriers to adequate treatment of the acute or the chronic alcoholic. The greatest barrier is the unwillingness of the practitioner, or the internist, or the psychiatrist to accept such a patient freely, genuinely; and to provide service commensurate with present medical facilities. The other significant barrier, almost of equal importance, is the woeful unpreparedness of the physician to treat the patient. This is not to say that the average physician does not have an adequate knowledge of the means of therapy. His unpreparedness to deal with an alcoholic patient lies in his own ambivalent nature, the feeling that the alcoholic is a moral delinquent rather than a sick man. Most of us from childhood were taught that the behavior problem of the "town drunk" arose from faulty inheritance, ingrown cussedness or shameful lack of personal integrity. And we find today it is easier to pass the buck, to refuse treatment outright, rather than acknowledge our own inadequacy or imperfection which stands in our way when it comes to making the effort to comply with the alcoholic's need.

All the alcoholic asks is that he be treated as a human being without criticism, and without judgment. We as physicians have the means to initiate and to further adequate treatment on a high and gratifying plane if we could but become objective and selfless in our response. Our greatest qualification to serve under such circumstances is the acceptance of the fact that the alcoholic is a bona fide patient and merits the best that we have to offer.

Such publications as "The Grapevine" (national AA magazine), the splendid state-published (North Carolina) magazine "Inventory" and books like "Twelve Steps and Twelve Traditions," "Alcoholics Anonymous" and a host of others can contribute much to our understanding of the alcoholic. They can serve also the growth of our own professional integrity, and bring rewards of a more adequate and satisfying response to this major need that has so long harassed the church, the state, and our profession. It is the writer's feeling that the alcoholic must be treated first of all with the heart--and only in minor degree with the head and Its know-how. The patient will remember the attitude of his doctor far longer than his prescription, and although the alcoholic may have impaired sensibilities, his sensitivity is made keener by his suffering. This can easily be measured by the chip he so often has on his shoulder. He feels hostility towards a professional world that has so patently denied its responsibility by inaction, while giving lip-service to an abstraction that the alcoholic is sick.

The problem of today, then, is more the conversion of the physicians to their responsibility for treatment, than for need of more training in therapy. The general practitioner with a world of patience, a kindly and receptive attitude, constant availability, wholesome understanding and encouragement--and a bare modicum of sedation, fluids and vitamins--can do more in less time than a well-equipped hospital with a hostile staff, and with far better results. It follows, then, that a receptive staff in the well-equipped hospital can work real wonders of recuperation, with unrivalled opportunity to encourage additional aid through local AA groups and the ministry.

Ed. note--We had decided to reprint Dr. Jones's article--in fact it was "in the works"--when our subscription department received the following letter from him. The third question Dr. Jones raises is one of such interest and importance to AAs, in the opinion of the staff, that we would welcome letters from any readers who have had experience with this phase of "the honesty part of the program." It is a subject that is often debated, and, as with all such questions, these are many sides to be considered. What do you think?

To The Grapevine:

First--please accept the enclosed check for $7.00 (seven dollars) for two issues, not two years. I have difficulty enough reading the copy that comes before it leaves my waiting room, and would appreciate a second one that I might carry home.

Second--It has been a privilege to serve many alcoholic patients through the years. They have taught me much that has applied with equal effectiveness to problems that non-alcoholic patients have. Anxiety and escape--how terrifyingly applicable those words are to so many problems of personality and the adaption difficulties that numb so many.

Third--one question I would like to see "debated"--or commented upon, at any rate: Should the alcoholic tell his difficulty when seeking work? Specifically, I should like this discussed not from his viewpoint, but from the viewpoint of those of us who may be (and usually are) asked to recommend. If we say nothing, our future as a source of recommendation may be damned; If we tell, the alcoholic may damn us--or, may say, "What right had you to reveal a medical confidence?" My policy has been to tell the alcoholic that I will not recommend unless I can be honest all the way.

Then, I can also commend his effort towards rehabilitation to the prospective employer, who usually has more respect for the alcoholic than he would if the difficulty came to light in some sudden, sodden and devastating way.

Thanks for everything,

Tom Jones

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