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Thursday, July 28, 2011

Cunning Baffling Powerful. . .

That's what Bill W. called alcoholism "cunning, baffling, power on earth can remove this viscious preditor....."  That was in 1936.  The major killers of people in the civilized world were pneumonia, heart failure, tubercolosis, and cancer.  Syphilis was incurable. Gonorrhea caused female sterility.  Malnutrition was endemic during the Great Depression.  And, no one expected any of these dread diseases to ever be conquored. The recommended treatments for "depression" were either five to seven years of psychoanalytic treatment, one hour per day, five days per week, or lengthy "rest" cures that often involved long stays in sanatoria, lengthy ocean cruises, or chronic hospitalization often for life when the episodes became severely disabling. Schizophrenia was treated with "hydrotherapy" tubs where patients would be restrained for hours every day in swirling warm water.  The mechanisms of disease were basically understood: bad humor explanations had given way to bacteriology and the rudiments of public health.  But there were no "cures" for any dread disease except for "tincture of time."  The greatest physician of the time, Sir William Osler, recognized the terrible toll that alcoholism took on every body system. He set aside 25% of his teaching beds at The Johns Hopkins Hospital reserved for the treatment of male alcoholics - principally from delerium tremens, liver failure, kidney disease and Korsakoff psychosis - the end stage of mental deterioration from chronic relapse. 

Given this context, Bill W.'s observations were realistic and conservative. Since time immoemorial, physicians had known that mobilizing "spiritual" strength was extremely helpfrul to combat fatal illness.  Furthermore, the very idea that people could or should demand  a "cure" for any of these conditions was unthinkable. 

Today, people still die of the same conditions, but the rule has shifted - toward survival, even from cancer.  People demand "cures" for life threatening illness, and in the case of HIV, those demands stimulated an entire industry to create effective treatments that do not involved living in sanatoria, spending 5 hours per week laying on an anaylst's couch, of sitting in a hot tub for hours every day. Why do we still describe alcoholism the same way we did in 1936?  Before we delve into a techincal discussion, it is worth while to speciulate about this  bizarre anachronis,: is alcoholism the disease that dare not ask to be cured?  Why aren't alcoholics thronging their health care providers demanding a "cure" just like HIV victims did so effectively. Even tubercular patients rioted at the Bayer GMBH laps inGermany demanding a cure for tuberculisis - which they got eventually, from INH and streptomuycin. 

Is alcoholism really so different fron other major killers of mankind that were thought to be uncurable 80 years ago?  Or not?  Post your cumments......  

Tuesday, July 19, 2011

Is there a generally accepted physical mechanism that explains alcohol addiction?

In May and June 2011, I participated in a number of LinkedIn discussions with self-proclaimed addiction specialists - dealing with a number of topics that had to do with alcohol addiction and treatment.  As a group, everyone who participated was very experienced treating alcoholics, and had hands-on experience with implementing treatments based on at least one of three loosely aligned models of the disease process.

To get this blog rolling, I want to post my own interpretation of the three dominant viewpoints that seemed to dominate the LinkedIn discussions:
1) LEARNING MODEL: Motivational learning model - based on the assumption that alcoholism represented learned behavior that can, therefore, be unlearned or reconfigured using cognitive behavioral methods.
2) SELF-HELP MODEL: All of the LinkedIn discussants were very familiar with the Program of Alcoholics Anonymous.  While AA does recognize physical and emotional components of alcoholism, the differentiating focus is on the recognition and correction of the alcoholics impaired value system - the spiritual submission that leads toward profound character change and away from environmental triggers.
3) MEDICAL MODEL:  This was the least talked about and most universally maligned view point that takes the position that alcoholism is an error of metabolism that has less to do with learning and values than with defective bio regulatory systems.


As we gather information about these separate approaches, we must bear in mind that all of them are probably significant and contributory to some important aspect of alcoholism.  The question we will ultimately try to confront is to identify pivotal defect(s) that materially causes the addict to crave alcohol and have irrational relapses into uncontrollable drinking.  To talk of a "cure" is to talk about a critical phase of the illness, that, if modified, would  reduce the risk of morbidity and mortality for every patient, prevent further outbreakes to such an extent that remission could be sustained with minimal intervention and without any appreciagble risk of endangerment either to the former alcoholic or to his ecology.     

Sunday, July 3, 2011

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