Alcohol: truth and fantasy

It seems to me this is bunk,

The uncomplicated life of a drunk

With a true loving wife

And a well-ordered life

And insight that comes by the chunk.

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 read over the information about the male patient, age 42.  The main reason given for the visit came down to concern with alcohol use.

He drinks 6 Jack and Cokes a night, 4 nights out of 7, more on the weekend.  Doesn’t smoke.  Married.  Employed.  Wife concerned he’s drinking more than he used to, and he confirms that over the last 4 years his alcohol use has accelerated.  He doesn’t have problems at work.

He maintains a normal blood pressure and pulse.  His blood work came back as normal with the exception of the liver functions, which, unsurprisingly, run high though not dramatic.  I asked for and received an acute hepatitis profile which came back normal, and I couldn’t order an ultrasound.

He has tried to cut down, he gets complaints from his wife about his drinking, those complaints annoy him.  But he has never had to have an eye opener, a drink to get going first thing in the morning.

I find no family history of alcoholism; he has no symptoms of depression, no tremor, no headache, and absolutely no sleep disturbance.  Sure that he is not an alcoholic, he notes that most of his friends drink more than he does and that most of his socializing has to do with alcohol.

And so the motivational interviewing starts.  No judgmental statements, just questions, like What is important to you?  How does your drinking fit in with that?  Visit after visit, he makes more and more progress whittling away at his tippling and then he starts going months without any alcohol at all. He changes friends, and he gets closer with his patient and loving wife.

The patient didn’t give me permission to write these details because the patient does not exist.  The information came to me in a case scenario, a clinical simulation, during my preparation for Family Practice recertification, in the module called Health Behavior.

The case presentation doesn’t match with the reality of my alcoholic patients.  As a group, none sleep well, all have family histories of alcoholism, all live in a continuous state of household chaos, going from one crisis to another, sabotaging success and intimacy.  A few have normal bowel habits, fewer live without headaches.   Most of my alcoholic patients have scintillating, quirky personalities and great senses of humor; yet prone to fits of unreasoning anger, occasional rages, and unrealistic demands on the people around them.  Despite tremendous generosity, they betray friends, lovers, spouses and children.  Embarrassing others in public leads to progressive isolation.  All but the homeless drunks have an enabler, who will sabotage progress towards sobriety.  They rarely stay dry without a 12 step program.

Even when sober, they generate chaos, though if they get religion (AA is a religion) they generate less chaos as time goes by.

With all their problems, they’re still fun and exciting to be around. Unlike patient case scenarios.



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One Response to “Alcohol: truth and fantasy”

  1. eddiered Says:

    Thanks for your words. I got help getting clean and sober when I was 17 from a place called New Life House. I am now sober 8 years and I love the life that I lead. Check out their site if you are looking for help. New Life House – A Structured Sober Living

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