Up the Tiger Bloodline

Charlie Sheen’s father made an interesting comment, which I thought that I would post here because it furthers the dialog from yesterday’s post and comments:

“So if he had cancer, how would we deal with him? Well, he has another disease and it’s equally as dangerous as cancer. “

I think Martin Sheen, who is a card-carrying AA member, should answer his own rhetorical question. How would he treat his own cancer, should he ever be diagnosed? How would he recommend that his family be treated? Would it be with faith healing, slogans, letters of apology to anyone he ever wronged? How would he react if the cancer spread, and the doctors told him it was because he was not working the program properly? Would he ignore any potential underlying cause of the cancer, and presuppose that he got it because of moral failing and spiritual deficiency? Of course, we know the answers to questions. He wouldn’t treat his or Charlie’s cancer like he does their addictions, because it is a ridiculous way to approach a disease.

I have commented here that I believe that alcohol addiction is a disease, but I understand the logic of holding the view that it is a choice. What I really believe, is that the question of whether alcohol addiction is a choice or a disease, is a false dichotomy. A more accurate way to describe my belief is that alcoholism is a disease that manifests itself physiologically, and it results in a specific behavior. It’s like scratching, which is a behavior that can be controlled, but the itch itself is a physiological response to an underlying condition. Scratching may not be a disease, but hypothyroidism (which causes itching) most definitely is. Alcohol intake floods brain receptors with dopamine, providing a relief to someone whose brain is not firing on all cylinders. Drinking scratches that itch. The reason people self-medicate is, it works — at least temporarily.

None of us were born with a drink our hands. Each of us made the conscious decision to take every drink we have ever taken, even in the deepest throes of the addiction. That choice compromised our physiology, affecting a multitude of things. A brain that cannot properly uptake and transmit serotonin and endorphins, is diseased. We have had the choice in getting to that stage, and we have a choice in going back toward a closer to a normal state, by simply quitting drinking. Fortunately for me (someone who has drank enough in his lifetime to float a battleship), I was able to get to a point to where I have no desire to drink. I haven’t drank a drop of booze for a few years now. On rare occasions, I get the slight craving at the site of my wife drinking a beer at a ballgame, or on our deck in the summertime, after I’ve spent a day working on the lawn. It’s not unlike – and is no more cunning, baffling or powerful – than the cravings I get for a doughnut (mmmmmmmmm doughnuts!), or a plate of hot wings. The urge passes, I don’t die of it, and there is no doughnut devil doing push-ups in the parking lot whenever I stop by Tim Horton’s to grab a cup of coffee.

My choice to quit drinking, and it was a choice, was made easier with time. I assume that my brain chemistry, like my liver enzymes, have adjusted closer to normal levels. I’ve got zero desire to drink today, but if I chose to get liquored up tonight (as I may do sometime in the future…who knows), I won’t flip out and start counting the clock at zero (I don’t count days, anyway; but you get my point). Adjusting my brain chemistry to what it was, which I believe was a diseased state, takes time –although it seems to be less time than the original addiction took to take hold, and quitting from each subsequent addiction becomes more difficult (read: Kindling Effect).

Most people are like me, in that they are able to eventually quit on their own; or, at the very least, reduce their drinking consumption down to normal social levels. Some do it completely by themselves. Others may get a self-help book, find Jesus, exercise, work the steps, yodel, do SMART recovery, try touch therapy, acupuncture, or any number of other placebos. I used an online support group, myself. Whatever route a person takes, they made that choice to quit when they joined their group. It was part of the act of quitting. As time passes, their brain synapses slowly start firing properly. Their serotonin uptake becomes closer to normal. Self-esteem rises, weight loss ensues, wallets get bigger, sleep deepens and becomes regular, and cravings for drinking are diminished. AA packages these things up and sells them off as their promises™. It’s not spiritual healing from Bill Wilson’s magical voodoo formula that did the trick. It’s a healing body chemistry created by alcohol abstinence that is responsible. Getting the body to heal, is a choice.

I believe that for some people, and I know a few of them, the choice to quit is more difficult than it is for most. Not because they are “real alcoholics™,” but because their bodies are not as pliable, and once compromised, their body chemistry will not go back to its normal state. When nothing stops the cravings, obsession, physical withdrawals and overwhelming desire to drink; the choice becomes different. It becomes one of the lesser of two evils. It’s a choice of either the pain of abstinence, or the consequences of relief with alcohol. I believe dismissing them as having a choice, or that they are simply exhibiting a behavior – as though it were willpower alone, or simple behavior modification that they need to address, is wrong. I’ve intuitively felt there is something different working within their physiology, and the science is suggesting that this is likely the case. Not all addictions were created equal.

I have a friend who has remained abstinent for the better part of two years, the first in AA – which he lived and breathed, and which he left after a binge and good dose of the standard AA tough love and degradation. The second year he as done it alone (while still using the 12-steps and the ‘Big Book’), and from the first day he joined AA until today, he has these same cravings. Nothing, and I mean nothing, has helped him in this time, with the exception of Naltrexone and the Sinclair Method, which he tried shortly after leaving AA. It worked for him, but he was forced to withdraw from the program (administered by NC State University) due to problems with his pancreas, created from years of heavy drinking.

I know others who have tried Naltrexone, both using the Sinclair protocol, or using it simply as a tool for complete abstinence. Others I know have used Campral and other drugs with varying degrees of success. Not that the anecdotal experiences of my acquaintances mean anything, any more than the testimony of an AA who says they have, “seen it work too many times.” What does mean something, however, is the research and studies done with various drugs. Treating alcohol addiction with drugs like Naltrexone is treating addiction like it is a disease, and the Sinclair Method is the only method of treatment proven through controlled, double-blind studies; to work at getting people to quit at any significant rate.

I don’t believe that Naltrexone is the final answer. I’m not even advocating it. It’s just put here as an illustration. There are a number of problems and side-effects to the drug, including some potentially dangerous ones (it can negate the effect of morphine, for example, which is problematic in an emergency situation). It isn’t a appropriate for someone suffering liver damage, and there is not much information on long-term use of the drug as a tool for moderation management. What Naltrexone is, is the next best thing. It’s a step. So is Campral and Baclofen, and hopefully new forms of non-drug treatment. Real science builds on itself, subjects itself to peer review, takes our current understanding and advances it from there. My hope is that Naltrexone will become obsolete, and some other drug or psychological therapy with greater efficacy will take its place.

When the solution is not religion, as AA is, it isn’t a threat to find the next thing and move on. I personally don’t care if the solution comes from a drug, or psychotherapy, or jello shots, or astrology. As long as it’s subjected to the scientific method, and our understanding and treatment of it is advanced like any other disease or compulsion or behavior, or whatever you choose to call it. The debate on what we refer to it as, is a straw man, anyway. What matters is how we treat it.

– MA

  • Innocent Abroad

    The idea that the reason that some people recover from the consequences of their alcohol abuse more quickly than others because their body chemistry does so makes intuitive sense, although I would be interested to know if there have been any properly designed scientific case studies of the hypothesis.

    I read the Sheen interview too, and felt that the cancer analogy was less than helpful, since cancer is only a physical illness: although I did know someone who cured herself of cervical cancer by spiritual means – the materialist line would presumably be that it would have gone into full remission anyway, and her behaviour was irrelevant. You pays your money and you takes your choice…

  • lucy

    A doctor friend once told me about a patient who was a single mother and an epileptic. She said that the patient once went into a gran mal seizure in front of her two year old, and, when she came out of it, found a cookie on her head. The doctor said that people who watch people in pain often assume that what makes them feel better, makes the person in pain feel better, and why wouldn’t a 3 year old try to comfort her mother with a cookie?

    Mr. Sheen loves his son, and far be it from me to question how he wants to help him.

    I have been in his place, and I know you do anything and everything to try to stop it, even when you know it’s a lost cause.

    • chris walton

      I agree here too. Maybe then people can let Mr. Sheen be aware of all his options besides what doesn’t work.

  • Disclosure

    I have a disease that tells me thats an ugly picture…

  • chris

    I have a disease that talks to other people about me. It`s a conspiracy!

  • chris

    Because he wont talk to me himself, he doesn`t like me either. Evidently my disease is very out of shape also and has to do push-ups everyday.

  • MikeAugustine

    @lucy, that brought a tear to my eye.

  • pogue mahone

    Oh yeah?
    I’m in a religion that tells me I’m not in a religion…so there!

  • in the BB it says we have a spiritual malady! How do you like those “1936” words to help you today in 2011.
    A bit like bloodletting…..

    • chris walton

      I agree. There have been so many medical advances since then!

  • Matt

    This is the most coherent, intelligent, and funny review of addiction treatment I have read. And I have read a lot!

    I like my own car accident analagy for AA and god. No one would tell a person to pray away the damage. It takes medicine to heal, and some drugs may ultimately be needed for life. However, a higher power addresses why the car was crashed to begin with. A life needs meaning. If you believe there is no purpose to life you will just crash the car again because you have no idea where to stear it….

  • SoberPJ

    Thanks Matt, stick around and chime in whenever ya want … There was a dishonest pro-stepper here a while back ( ok, several) and I doubt very strongly that he would have considered what is happening here was coherent, intelligent and funny. They just don’t seem to get it like you do 🙂

  • chris walton

    My x-husband has been with these 12 step programs for 13 years now.(NA-AA) He is like a puppet and mimics slogans to me. He is so guilt ridden beyond the point of resonably necessary. He divorced me because I refused to jump aboard and get back with the program after quitting the family and friends groups.(Naranon-Alanon) Imagine having a marriage that consisted of me, him, and his sponsor. This is total nonsense!

  • atheisticallyyours

    Would someone please tell me how a “disease” can be VOTED INTO EXISTENCE as such? WHEN did medical SCIENCE become subject to a majority vote at an AMA convention (in the 1960’s no less!)?