Excerpt: 'The End of My Addiction'

This was not a new feeling to me. Throughout my life I had been plagued by anxious feelings of inadequacy, of being an impostor on the brink of being unmasked. I had been seeing therapists for a long time before I started drinking. To be honest, they never were much help with my anxiety. Nor was the Xanax they prescribed me.

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The one Scotch at Jeff 's made me aware of how thirsty I was. I went to a Chinese restaurant, intending to have a meal as well, but wound up eating nothing and drinking one double vodka after another. And then ... I found myself bleeding in the taxicab.

It wasn't my first blackout drinking. But the blackouts were getting more common, whole stretches of evenings expunged from my memory. And this was the first time I'd come out of a blackout with a physical injury. Until then blackouts had only been sources of intense mortification as I wondered what embarrassing things I might have said or done.

The next morning I thought briefly about amusing tales I could concoct to explain the bandages on my forehead. Deciding that I was too hungover to go to work, I had my office assistant reschedule the day's patients. As my drinking had increased, I had scrupulously honored my first duty as a doctor—to do no harm. I stopped driving. And I never set foot in my office or the hospital when I was not completely sober.

Still, I resisted seeing myself as a problem drinker. All I really needed, I thought, was to learn to drink better. This delusion was encouraged by a well-meaning friend and an equally well-meaning but I think even more misguided therapist, both of whom undertook to show me how to be a moderate wine drinker rather than a binger on Scotch or vodka. I even began AA with the thought that it might give me tips on managing my drinking better rather than stopping completely.

Not everyone thought I was a candidate for moderation. The two friends who escorted me to my first meeting didn't think so. One was a longtime AA member, a poet and a writer and a very beautiful woman who looked a bit like Katharine Hepburn. She used to say, "I want you to see me before I lose my looks." She still has those looks today. When we met, she had been sober for many years, yet she told me, "I am an alcoholic." That struck me as very strange, and I was embarrassed to hear her say it. People with diabetes or hypertension didn't identify themselves by their illnesses. Why should people with alcoholism?

Of course, I thought that because I did not want to admit— to myself or anyone else—that I might be alcohol-dependent. And so I was terrified to go to a meeting. But my friends each took me by an arm, and escorted me from my apartment on East 63rd Street to the major AA meeting place in the neighborhood— the 79th Street Workshop, in the basement of St. Monica's Catholic Church, on 79th Street between York and First Avenues. It was my first step, taken reluctantly, toward facing my illness. But it was a vital one.

It is hard for everyone who attends AA to get past the potential embarrassment of being seen as an alcoholic. Shortly before I went to AA for the first time, my shrink began encouraging me to go. I said, "What about anonymity? My office and my apartment are right in the same neighborhood. What if a patient or somebody else I know sees me?"

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He said, "Don't worry. Anyone inside will be an alcoholic and won't say anything."

"But what if a colleague sees me entering or leaving the place?"

"It won't happen."

It did happen. But after I started going to AA, I 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.