August 1970

group. It was, and is, the source of Ps ychiatrg and alcoholism medicine’s practical working approach to alcoholism. I ask my patients simply to share my per- to offer, life becomes meaningless Doctor, Why Can’t I sonal learning experience from AA -to go to six different meetipgs to him, too. There is nothing more rewarding than the look in an alcowithin six weeks, not to join, not Stop Drinking? even to stay sober, but just to learn holic’s eyes when he really begins to believe that he is understood and by G. E. Deering, MD the basic information that is avail- accepted by a man he has been able to everyone. With this Easy ducking for years. Of course, this Does It approach, I’ve doubled the same thing happens in AA,, but my For guilt and remorse, substitute a worthwhile number of my patients who really patients usually come to me before experience, suggests this doctor friend of AA make it in AA. And, incidentally, they know about AA, before they I have lost a lot of good patients can believe that anyone in the world an idea that being sober wouldn’t who found that I, too, was only a will accept them when they feel as VER AND over in my office, I 0 hear alcoholics say, “Now that I understand I have a problem, I’ll hurt as much as staying drunk, but he needs help in beginning to subsubstitute and one they didn’t need forever. Nothing makes a doctor feel better than to offer a patient worthless as they do. The doctor’s role is very different from AA’s role. It, too, is a substop drinking. But 1’11 do it my stitute safely. The essential steps in treatment that works! way.” I see them come back after treatment are care for physical and stitute for drinking, often the first . Along with the AA experience, I substitute; but, unlike AA, it should the next bender wondering why mental illness, a new way of life, and trust in someone. Now, as a do my best to .offer “professional be only a beginning, never a way of their way didn’t work – and some- friendship,” the real heart and soul times willing to listen to me when doctor’s “first step,” I offer two life. It’s the psychiatrist’s job to things: AA thinking and the idea of psychiatric treatment -as a sub- make a good life available to his I say, “You can’t stop drinking, but stitute, until the alcoholic finds it you can substitute totally for drink- that treatment will mean substitut- patient. Like AA twelfth-steppers, possible to believe the world will we can offer a meaningful way to ing, so that you’ll never have to ing a worthwhile experience for offer other kinds of friendship. live, but the patient must do his own drink again.” guilt and discomfort. Both must be No one is more lonely, more No one really ever stops doing made as simple and acceptable as work to make it real. Once the idea helpless, or more friendless than a of sobriety has been substituted for anything that has been an important possible in order not to frighten sick alcoholic. Family and others sick people into running away again. the first drink, the psychiatrist and and time-consuming part of his life. Still, we do change our thoughts, Many have been refusing to join close to him seem to act like en- his patient must decide what other . emies, distant, cold, and hostile. parts of the alcoholic’s life need our attitudes, and our way of living. AA for months or years. Others The psychiatrist who enjoys work- And we change by substituting. We have never heard of it and are sure substitutes. Often, he has a mamage ing with patients with drinking (and dissolving in alcohol, a family on cannot stop eating, but we can sub- they don’t want to get involved in drug-abuse) problems really likes stitute meat for ice cream. We can- anything that will spoil their drink- the rocks, a job lost or nearly lost, I his patients, even when they’re physical health in bad repair, men- I not stop drinking all liquids, but we ing. drunk and have grown sick and can substitute soft drinks for beer. AA was the first source of useful, tal illness, and, perhaps most impractical help for the drinking tired of being sick and tired. In a portant of all, a need to find a We cannot stop having friends, but way, this feeling of the doctor’s is we can substitute sober friends for problem to stand up under the test Higher Power. of time, and the first to be success- as “selfish” as the AA program. If What AA is doing for my patient, drinking and barroom friends. he does not see his patients as sick The sick alcoholic just off a fully passed on without the require- I try to leave to AA. No one person, people in real need of what he has psychiatrist or anybody else, can bender may have the glimmering of ment of a great leader in each

promise to be available without fail any alcoholic when I was able to his own until he is working sincerely thing special of their own to add in *” in a crisis. But the Fellowship of say honestly that he was really on his other problems. Most active helping alcoholics to handle prob- AA is ready now and will be for the making a sincere try. alcoholics I know are without belief lems that come before and after the rest of his life. The alcoholic will want to sub- in themselves or any other power, First Step is taken. More doctors are It seems to me that those who stitute the best possible physical and most recovered alcoholics have becoming aware of the truths conmake it in the program first sub- health for the merely comparative found their own concepts of a tained in the Big Book and the need stitute AA for marriage and family, improvement that comes after the Higher Power. How do you find a to keep their help flexible. Just as then find health and a Higher last drink, and this substitution can Higher Power? For my patients, AA AA has made many changes and Power. But not everyone makes it be accomplished best with profes- begins the job. You can’t make it much progress since Doctor Bob, all the way or all at once. When I sional help. The family doctor o r alone. When others are with you, the co-founder, decided AA itself sit down with husband, wife, and the specialist in internal medicine you have your fingers on the mean- was a possible substitute for alcohol, children and teach them to sub- (internist) should follow up on any ing of Higher Power. When you so the rest of us doctors are making stitute hearing and seeing each health problems. There are still close your fingers and grab fast, progress, too. Many doctors and other for the old feelings of guilt, physicians who don’t understand you have a religion. If you are like many hospitals no longer autodisgust, and hatred, I am sure the alcoholism (and have even been most of my patients, you eventually matically say “no” to alcoholic paresult will be worth all the time known to prescribe “a few drinks” find that religion is not an empty tients. They are willing to offer and effort, many times over. Not for alcoholics), but more and more word. their services as a first substitute everyone can have a perfect mar- do understand. The sober alcoholic The successful treatment of alco- for alcohol. With a little more time , riage with perfect children, but it should keep looking till he finds the holism starts with AA. But now and work, more of us are going to is the rare family that can’t make right one. doctors are beginning to have some- get to like and trust each other. enough good substitutions to make a Mental-health treatment nowlife together possible. adays frequently requires the use of I There are still a few employers drugs, and “the horrors” (delirium ‘ who will fire a man outright for a tremens or dt’s) always do. Only a drinking problem, but there are very few alcoholics are “insane” once few who won’t listen to a doctor or they stop drinking. If they are a social worker when we care mentally ill, they can be treated with enough to pick up the phone or effective but nonaddictive medicawrite a letter saying that we know tion. I feel it is always best to re- John (or Mary) well and that we strict drug use to patients with believe he is making a sincere tnd mental illness. Substitution of drugs successful effort to control, not only for alcohol is not treatment for alhis drinking, but his life. One of the coholism. When drugs are necessary biggest companies in our city has for good psychiatric care, nonadcalculated that it costs over $8,000 dictive ones are nearly always to fire a semiskilled worker with available. three years’ experience on the job. I’ve left the Higher Power till That company has never yet fired last, since I rarely see anyone find