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Post Info TOPIC: A Medical Opinion re: Alcoholism Denial


MIP Old Timer

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A Medical Opinion re: Alcoholism Denial
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Dealing with Denial in Alcoholism

by Mark S. Gold, MD
October 4, 2006

Denial is a characteristic distortion in thinking experienced by people with alcoholism. For decades, people who treat alcoholics, and recovering alcoholics themselves, have puzzled over why alcoholics continue to drink when the link between alcohol and the losses they suffer is so clear. Denial is an integral part of the disease of alcoholism and a major obstacle to recovery. Although the term denial is not specifically used in the wording of the diagnostic criteria, it underlies the primary symptom described as drinking despite adverse consequences.

Treatment professionals are beginning to recognize that not all individuals with alcoholism have the same level of denial. In fact, people have various levels of awareness of their alcohol use problems, which means they are in different stages of readiness to change their behavior. Professionals have taken advantage of this insight about alcoholism to develop treatment approaches that are matched to a persons readiness to change and that motivate people to enter the change process even when they are frightened of whats in store. However, despite these advances in treatment, many individuals with alcoholism persist in denying their problem, and typically, the more severe the addiction, the stronger the denial.

The power of the alcoholics denial may be so strong that it carries over to the alcoholics family and important people in his or her life, convincing them that the alcoholics problem is something other than it isweak health, bad luck, accident proneness, depression, a tendency to be preoccupied and worried, a mean temper and countless other possible problems.

Many adults young and old have experienced a shock of recognition when they look back over their childhood and realize that their mother or father, a beloved grandfather or a family friend was an alcoholic. No one talked about it; everyone covered it up. The stigma of alcoholism and the many myths that have merged to form a distorted portrait of people with alcoholism have strongly contributed to denial both on an individual and a societal level. The hope of health professionals and others who have worked to educate the public that alcoholism is a disease and not a defect of willpower or a moral failure is that, now and in the future, fewer people will have to experience this shock of recognition when it is too late to do anything about it, and that people will get the treatment they need when they need it mostbefore alcoholism has led to irreversible consequences.

When people close to an alcoholic are affected by their own and the alcoholics denial, they often act in ways that protect the alcoholic from experiencing the full consequences of his or her behaviors. This type of protective behavior, although often motivated by love and concern, is referred to as enabling, because it permits the individual to continue drinking and allows the disease to progress, the symptoms to intensify and the consequences to become worse for all concerned. Like denial, enabling is another one of the symptoms of alcoholisma symptom displayed by others, not by the alcoholicthat is not specifically mentioned in the diagnostic criteria, but that is a well-recognized aspect of the disease. Special groups, like Al-Anon and Alateen, have been established to help people concerned about the alcoholics in their lives to understand them and to help them, largely by gaining the strength to stop enabling. Overcoming denial and enabling is often the first step into treatment for the alcoholic.



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From AA 12 and 12......The First Step.

"We admitted we were powerless over alcohol--that our lives had become unmanageable."


Who cares to admit complete defeat? Practically no one, of course. Every natural instinct cries out against the idea of personal powerlessness. It is truly awful to admit that, glass in hand, we have warped our minds into such an obsession for destructive drinking that only an act of Providence can remove it from us. No other kind of bankruptcy is like this one. Alcohol, now become the rapacious creditor, bleeds us of all self-sufficiency and all will to resist its demands. Once this stark fact is accepted, our bankruptcy as going human concerns is complete. But upon entering A.A. we soon take quite another view of this absolute humiliation. We perceive that only through utter defeat are we able to take our first steps toward liberation and strength. Our admissions of personal powerlessness finally turn out to be firm bedrock upon which happy and purposeful lives may be built. We know that little good can come to any alcoholic who joins A.A. unless he has first accepted his devastating weakness and all its consequences. Until he so humbles himself, his sobriety--if any--will be precarious. Of real happiness he will find none at all. Proved beyond doubt by an immense experience, this is one of the facts of A.A. life. The principle that we shall find no enduring strength until we first admit complete defeat is the main taproot from which our whole Society has sprung and flowered. When first challenged to admit defeat, most of us revolted. We had approached A.A. expecting to be taught self-confidence. Then we had been told that so far as alcohol is concerned, self-confidence was no good whatever; in fact, it was a total liability. Our sponsors declared that we were the victims of a mental obsession so subtly powerful that no amount of human willpower could break it. There was, they said, no such thing as the personal conquest of this compulsion by the unaided will. Relentlessly deepening our dilemma, our sponsors pointed out our increasing sensitivity to alcohol--an allergy, they called it. The tyrant alcohol wielded a double-edged sword over us: first we were smitten by an insane urge that condemned us to go on drinking, and then by an allergy of the body that insured we would ultimately destroy ourselves in the process. Few indeed were those who, so assailed, had ever won through in single-handed combat. It was a statistical fact that alcoholics almost never recovered on their own resources. And this had been true, apparently, ever since man had first crushed grapes. In A.A.'s pioneering time, none but the most desperate cases could swallow and digest this unpalatable truth. Even these "last-gaspers" often had difficulty in realizing how hopeless they actually were. But a few did, and when these laid hold of A.A. principles with all the fervor with which the drowning seize life preservers, they almost invariably got well. That is why the first edition of the book "Alcoholics Anonymous," published when our membership was small, dealt with low-bottom cases only. Many less desperate alcoholics tried A.A., but did not succeed because they could not make the admission of hopelessness. It is a tremendous satisfaction to record that in the following years this changed. Alcoholics who still had their health, their families, their jobs, and even two cars in the garage, began to recognize their alcoholism. As this trend grew, they were joined by young people who were scarcely more than potential alcoholics. They were spared that last ten or fifteen years of literal hell the rest of us had gone through. Since Step One requires an admission that our lives have become unmanageable, how could people such as these take this Step? It was obviously necessary to raise the bottom the rest of us had hit to the point where it would hit them. By going back in our own drinking histories, we could show that years
before we realized it we were out of control, that our drinking even then was no mere habit, that it was indeed the beginning of a fatal progression. To the doubters we could say, "Perhaps you're not an alcoholic after all. Why don't you try some more controlled drinking, bearing in mind meanwhile what we have told you about alcoholism?" This attitude brought immediate and practical results. It was then discovered that when one alcoholic had planted in the mind of another the true nature of his malady, that person could never be the same again. Following every spree, he would say to himself, "Maybe those A.A.'s were right..." After a few such experiences, often years before the onset of extreme difficulties, he would return to us convinced. He had hit bottom as truly as any of us. John Barleycorn himself had become our best advocate. Why all this insistence that every A.A. must hit bottom first? The answer is that few people will sincerely try to practice the A.A. program unless they have hit bottom. For practicing A.A.'s remaining eleven Steps means the adoption of attitudes and actions that almost no alcoholic who is still drinking can dream of taking. Who wishes to be rigorously honest and tolerant? Who wants to confess his faults to another and make restitution for harm done? Who cares anything about a Higher Power, let alone meditation and prayer? Who wants to sacrifice time and energy in trying to carry A.A.'s message to the next sufferer? No, the average alcoholic, self-centered in the extreme, doesn't care for this prospect--unless he has to do these things in order to stay alive himself. Under the lash of alcoholism, we are driven to A.A., and there we discover the fatal nature of our situation. Then, and only then, do we become as open-minded to conviction and as willing to listen as the dying can be. We stand ready to do anything which will lift the merciless obsession from us.



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"LOVE" devoid of self-gratification, is in essence, the will, to the greatest good...of another.


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As well chronicled in the Big Book, the medical profession has long been stymied by the alcoholics' denial and dishonesty.  Even the most experienced psychiatrist seeing a patient only 50 minutes a week has little choice but to take their statements at face value.  The people who live and work with the alcoholic (as well as his neighbors and most of the police department) may be totally aware of the problem, while the psychiatrist is not.

Most of us would not dream of going to a doctor with a serious illness and then lying about the symptoms. 

I agree about the degrees of denial.  I guess I had enough education in the disease as a child that I pretty much knew what I was doing the day I first picked up a drink.  Where I missed the boat was in that I loved alcohol so much, that I thought I needed to control my drinking to avoid becoming an alcoholic, yet when that type of thinking began - which was immediate, IMO I already was one.

I think most of us who call ourselves sober alcoholics can relate to the denial on every level, even if we have not experienced it.  I've had people outside the program tell me I was "smart" to quit drinking.  I've always thought of myself as fairly intelligent, but if my brain had worked at even half power I would have never started drinking in the first place.  Some of the smartest people I know are still out there killing themselves.  I know a woman who is too smart for AA, every time she shows up she questions every facet of the program and analyzes everything wanting to understand it before she does it.  I should also mention that this intellectual doesn't have enough education or ability to hold a job as anything other than a bartender or stripper.  Invariably after a period of sobriety, she goes back to "work", and it leads rapidly to relapse.  I have no doubt she is very intelligent... could probably whup me at an IQ test.  She can't possibly learn anything from someone like me who is not her intellectual equal.

But denial isn't confined to the intellectual... intellectuals are just much better at articulating their denial and complicating it... LOL.  The chapter "Doctor, Alcoholic, Addict" in the Big Book is my favorite example of intellectual denial.  The good doctor was unquestionably a very smart man, yet he thought himself into a mire of addiction that even the dumbest person on earth could have seen was waaaay out of control.  And as he gradually came to his senses in recovery, he saw the humor in his own thought process and wrote it down for us to read.  He opened up his lead one time with "I didn't come to AA because I was an alcoholic.  I came to AA because it was the only way I could get a pass out of the psych ward at the hospital I was on the staff of".

There doesn't be any particular sequence of events, education, incarceration, consequences, love, hate, conflict, or treatment that can force the alcoholic out of denial.  And we who have lived that denial to any degree know the answer deep down: we got honest with ourselves when we were good and ready, not a minute before.  I really don't think there is any other answer.

Barisax


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