To understand the weird way we treat alcoholics lets imagine how diabetics would be treated if they got the same care as alcoholics.
First of all, diabetics would get no help until they were ready to accept abstinence. They would need to agree to eat no carbs at all. Their diet would be limited to meat, eggs, vegetables, and yogurt. If they refused to accept the MEVY diet we would say they are in denial. They would need to hit bottom: perhaps a diabetic coma or losing a toe will convince them to avoid all carbs. There would be no help early on. Pre-diabetic symptoms would be ignored, and the diabetic would be on their own until they were ready to accept the carb abstinence diet.
It sounds ridiculous doesn’t it? Who would expect a diabetic to never eat another carbohydrate? Yet that is how the disease of alcoholism is treated. We have a “one size fits all” approach to the treatment of alcoholism. We don’t help alcoholics unless they are willing to quit. According to the Center for Disease control, as reported in the CASA study Addiction Medicine: Closing the Gap Between Science and Practice, 73.2% of diabetics receive treatment for their disease, while only 10.2% of alcoholics ever receive treatment.
There were approximately 88,000 alcohol-related deaths in 2016. I wonder if there were more options available, over-drinkers might seek help earlier. As a former over-drinker, I could have used some early education about alcohol. Here are two things I wish I had known.
1. Females do not process alcohol as well as males.
If a woman and a man of the same body weight drink the same number of drinks per hour, she will become more intoxicated. Women who over-drink are more likely to become pregnant, and to pick up sexually transmitted diseases.
2. I would have liked to have been taught the basics of moderate drinking.
Like many, I tried for years to control my drinking — without the basic knowledge of how to do that successfully. I did not know how to track my blood alcohol level, or how to measure and track my drinks. I will never know if I could have successfully moderated my alcohol intake. If I’d had that information when I drank, I could have figured out in a few months if I was capable of it. To me this is an important point, that most over-drinkers do try to manage and control their drinking, but without some basic education they often flounder for years on end. With education, a problem drinker can give moderation a try and see if they are capable of controlling the amount they drink. If they succeed, great! If they learn that they cannot, most will opt for abstinence. A minority will choose to continue heavy and harmful drinking and for them some education about reducing harm would be useful.
There are other reasons why over-drinkers don’t seek or get help sooner. One reason is that the medical field ignores the problem. According to the CASA study, 2/3's of over-drinkers are in contact with a primary or emergency care about twice a year, yet physicians neither notice nor respond to the identifiable and treatable signs of addiction. This means that the person with the disease of alcoholism has to advance to late stages before the problem is noticed or addressed by the medical system.
Alcoholism is more likely to be noticed by the penal system. 44% of referrals to publicly funded treatment come through the court system. Employers make less than 1% of referrals to publicly funded treatment, while private insurance covers only 20% of the total costs of treatment for addiction.
Getting help for alcoholism is a challenge for most. Early help is practically non-existent. 90% of the treatment centers are abstinence-based and 12-step oriented. Even if a person is willing to go, the cost of private pay treatment is prohibitive for most. For publicly funded treatment there are often long waiting lists, lack of childcare, and numerous rules and regulations to be followed. And if treatment is available, practitioners with little or no medical training provide it.
If we treated diabetics like this it would be considered unethical. They would have to wait until their symptoms are dire to be noticed. They would have to break a law to get help. They would have to agree to eat no carbs in order to get in or stay in a treatment program. As the CASA study concludes,
“There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards.”
I hope someday there is earlier and better care for alcoholics. I hope there is education that will help over-drinkers determine earlier whether they can control their drinking. I hope that someday the medical system, not the penal system, will notice, provide, or refer over-drinkers to better sources of care. I hope that moderation and harm reduction education will be commonly available for those who are not ready for abstinence. Mostly I hope that the weird way we treat alcoholics will end.