The difference between a medicine and a poison, the difference between the life of the party and a drunk

Tell me, what do you think,

About having the occasional drink?

If it’s one, sometimes two

It’s a great thing to do,

Any more and you’re needing a shrink.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week

I took premedical classes as the University of Colorado at Denver.  My biology lab partner and I stayed friends.  In the fall of my first year of med school, she wrote me that she had multiple sclerosis (MS).  In 1975, very little could be done to change the course of the disease, which usually progressed relentlessly shutting down various parts of the nervous system.  Three years later, she mentioned going to AA, and I expressed my surprise.  When pressed, she said, “Well, you’ve got your high bottom drunks and your low bottom drunks.  And thank my Higher Power I’m a high bottom drunk.”

By that she meant she had hit bottom before a lot of things had gone bad in her life.  Later clinical experience showed me that MS and alcoholism frequently, though not always, go hand in hand.

The alcoholic who hits bottom early in the course of the disease does a lot better than the ones who hit bottom late. 

Not surprisingly, alcoholics get sick more often than non alcoholics; and smokers tend to drink and drinkers tend to smoke.  Thus I see the spectrum of alcoholism from those who learn early to those who learn too late, from those who function well despite their drinking to those who don’t, from those who drink daily to those who drink once or twice a year but go all out when they do.

I’ve watched alcoholics destroyed their families, finances, bodies, and careers without figuring things out.  On the other hand I have known alcoholic professionals who did something crazy on a dance floor, heard about it the next day, and never had another drop.  They never went to meetings, but a lot of them embraced their religion.

In between I can tell you stories of hundreds who quit just before their liver or their heart or their brain gave out for good, those folks who came back from the edge of the pit and lived to tell the tale though they lived the rest of their lives with significant disabilities.

Most people know about alcohol’s tendency to damage the liver, and we all know about liquor’s brain toxicity.   Yet most alcoholics who keep drinking and don’t die of trauma tend to die from heart attacks and strokes brought on by intemperance; booze raises blood pressure, brings hardening to the arteries, and directly weakens heart muscle.

But wait, you say, isn’t a glass of wine a day good for you?

Sure, just like labetalol 100 mg twice a day is good for some people, but if you save 3 months worth for the day of the Superbowl, it’ll kill you.  Thus a medication differs from a poison by nothing other than the dose.

And women who drink a glass of wine a day double their risk of breast cancer.

In my experience, a typical alcoholic is witty, fun to be around, unique, and intellectually stimulating when sober. And when drunk he or she is just another drunk.


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