Slow Progression


It can be argued that, before AIDS, the greatest problems facing the gay community were alcoholism and drug abuse, not the discrimination or our status as criminal outlaws. Obviously the latter set the stage for the former, and each served to fan the flames of the epidemic. In any case the central role of the bar in the gay underground came with a heavy cost.

That's the window through which I have viewed alcoholism, until the last decade or so, when I stepped away from being an AIDS activist, and began trying to re-establish relationships with my straight friends and family. Only to discover that excessive drinking is just as much a problem on the not so wild side.

I'm a great admirer of blogger Dean Esmay, of Dean's World, even though we met online, as I often seem to, by way of an argument: a late night, early morning debate over Canadian vs US crime statistics.

Dean has posted an essay and comment thread on the nature of alcoholism, the general progression of the disease and his own experience of it.

One of the most insidious things about the disease of alcoholism–and it is a disease, despite the best efforts of thundering moralists to deny the science and the plain medical and biochemical facts–is that it plays on your character defects (which all people have) and, worse, it progresses slowly.

He's critical of AA (often pity parties, he says) but believes 12 step programs work for a lot of alcoholics, including him. He also believes abstinence isn't always the only solution, and that some early stage alcoholics can learn to successfully moderate their drinking. Some. In his case he says it's too late.

OK, but I just said it may be possible to do something before you get to advanced stages to prevent advanced stages. Some will thunderingly declare that this is impossible. That’s particularly true in AA circles (as I say, I endorse the program, but I grant that its critics are often right on certain things, and "closed-mindedness" is one valid criticism).

There are two books I recommend reading, *with caution.* One is Stanton Peele’s Truth About Addiction And Recovery.

Peele is a professional substance abuse counselor. What he’ll tell you is that some people with problems can find ways to control and manage their problem and still drink with moderation. That is scandalous heresy in AA circles and among some substance abuse counselors. But the most important thing to understand from what he says (and he’s got plenty of clinical experience as well as scientific studies to back him up) is that this is true for *some*. He is quite open that for some people, this will just not be possible, and they’re going to have to accept that drinking is just not an option for them. Not because they have character defects, but because their brain chemistry is just not going to allow for it. But as you might suspect, if it’s a brain chemistry issue, then some people are going to have brain chemistry that does allow for it.

This is why it’s important to understand that alcoholism is not a character defect. Character defects may lead you to alcoholism, especially because all people have character defects and alcohol is an easy way to experience pleasure and stress relief. Your character defects can lead you to alcoholism, but the alcoholism itself is not the defect in your character, it’s a defect in your brain chemistry. (Let’s leave aside questions about whether all character issues are brain chemistry issues, which will make us wander off into philosophical weeds that we’ll never get out of.) Just like character defects (which we all have) might lead you to get syphilis, but the syphilis itself is not a character defect, it’s a disease that needs treatment.


Dean warns that occasional periods of moderation or abstinence can serve to hide the ongoing progression.

What’s also well-documented about the disease, even symptomatic, is that the alcoholic will occasionally undergo “dry spells” where they “prove” to themselves and others that they’ve got the problem “under control” by just not drinking, or by moderating their intake. I myself had such a dry spell 3-4 years ago, where I went about 100 days without drinking, trying a few meetings and then giving up on them because I hated them...

You have instances where you do indeed don’t-drink, or succeed in your goal to drink less. But you don’t notice that the times you fail are increasingly more frequent than the times you succeed. You see the success (”See! last night I said I’d have only two, and I had only two!”) but the failures are just things you kick yourself for in the morning, with much self-abuse, and then move on.


He recommends that someone trying to permanently moderate their drinking should use a structured approach, such as the one suggested in Responsible Drinking: A Moderation Management Approach for Problem Drinkers.

It did not work for me, partly because I was lazy and did not actually keep the log, I thought I could do it in my head. Now it’s too late for me. But I know it works for others because I’ve talked to people for whom it did. The goal is to get yourself to where you take no more than 14 drinks in any week, and no more than 4 at any one sitting. Why? Because that’s what scientific research says is not just safe, but may actually be beneficial to your health; moderate alcohol consumption at that level is arguably good for you, extending lifespan and reducing risk of certain diseases, particularly heart disease.

(That’s another scandalous heresy in some circles. Alcohol good for you?!? Yes, it can be. That, too, is one of the reasons why the disease of alcoholism is progressive and insidious.)


Posted: Thu - June 26, 2008 at 11:30 AM          


©