July 28

AA

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An eye-opening article on Alcoholics Anonymous in the London Review of Books by someone who is an alcoholic and does attend meetings.
You can get a taste of the writing style by this excerpt on the alcoholic’s contempt for doctors:

The belief that they are victims of an illness allows recovering alcoholics to forgive themselves for the awful things done in drink. Few, by the end of their drinking careers, have not committed offences the sober mind shudders at. But although AA subscribes to the disease theory, it despises the medical establishment whose business disease is. At meetings, scorn is routinely poured on the ‘ignorant professionals’. As a favourite joke puts it: ‘there are those who say doctors don’t know everything. And there are those who say doctors don’t know nothing.’ AA is firmly of the second party. Alcoholics have good reason to dislike doctors and psychiatrists and to jeer at their ignorance (despite the fact that doctors themselves are notoriously prone to alcoholism), for traditionally, the medical schools and teaching hospitals of America and Europe have given their students abysmally inadequate tuition on the nature of the ailment.
Many alcoholics who apply for treatment find the conventional health services too busy to mollycoddle sots like them, when there are patients with real illnesses to treat: broken bones, cancer, acne. Sitting for two hours after appointment time in the waiting room at the Maudsley (Bedlam, as it once was), with a splitting hangover, in the company of the stark staring mad, is the drunken Rake’s foretaste of hell. AA bases its good works on the shrewd analysis that drunks know better than doctors how to deal with fellow drunks. For doctors, drunks are a job of work or raw material for some career-advancing research project. AA places special stress on welcoming rituals, designed to allay the newcomer’s crippling shame and make him feel at home.

As I think back on it he’s right, at least about the lack of medical training on alcoholism. The only course dealing with the treatment of alcoholism that I got in medical school was in Behavioral Science, one of the first courses taught in the very first year. By the time the four years of med school had passed, not only the tiny segment devoted to alcoholism, but pretty much the entire course of Behavioral Science had dissolved into oblivion.
Unfortunately, the following few years brought me into contact with more than enough intoxicated people and the shootings, stabbings, car wrecks and other diverse carnage fueled by alcohol. The unpleasant hours I spent in emergency rooms sewing and splinting and casting all these folks back together while listening to their incoherent blather left me with the certainty that I didn’t want to be in the business of treating alcoholism. In fact these long hours spent in busy metropolitan emergency rooms were my “foretaste of hell,” and I decided to take my career in a different direction.
Strangely, now I find myself dealing with patients (and myself) who have another kind of addiction: food. Especially the wrong kind of food, specifically the fatty, sugary combination that in its own way causes as much physical damage as alcohol. In fact, it causes the same damage to the liver as that caused by alcohol. The only difference between the fatty, fibrotic liver from someone who has a history of obesity and carbohydrate (especially fructose) overconsumption and the fatty, fibrotic liver from someone who is a long-term alcoholic is that the latter has a history of drinking. Otherwise the two are indistinguishable. One is called alcoholic fatty liver disease; the other, non-alcoholic fatty liver disease. Both can lead to cirrhosis and probably liver cancer. Both are best avoided.
Both can be reversed and treated (assuming the disease hasn’t progressed beyond the point of irreversibility) by cessation of the habits that created them along with a low-carb diet full of a lot of low-carb, colorful fruits and vegetables. Anyone who has either of these disorders should not let a gram of high-fructose corn syrup pass their lips.


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