* * Anonymous Doc

Thursday, March 11, 2010

We had a workshop this afternoon about dealing with alcoholism-- identifying patients who may be alcoholics, guiding them toward treatment, etc. A recovering alcoholic spoke to the group, told us the lies he would tell his doctor, told us some signs to watch out for...

It's interesting to think about where the line is between what a doctor is expected to do and what he isn't, and a lot of it depends on the context. During my inpatient rotations, I've seen a lot of alcoholics come into the hospital, with all sorts of problems-- and never once did I see anyone talk to them about treatment. We treated the immediate medical issue, released the patient, and, as often as not, I'd see the same patient back again, after another drunken fall or other consequence of the alcohol. In the inpatient setting, the focus is on fixing and releasing.

But in the outpatient clinic, we do talk about treatment, we talk about addiction, and therapy, and I've heard people mention AA. The difference, I think, speaks a little bit to why I'm drawn to outpatient care more than inpatient. I don't just want to deal with the acute problems, I want to help the patients have better lives. I want to fix the big picture as much as the small. Not that the things they're coming to the ER with are small. But I don't know how to better articulate the difference.

Also, I think one of my friends is an alcoholic.


  1. You probably already know, but there is a lot of controversy over the effectiveness of AA. You should look into it before you start telling people to do it.

  2. While a Cochrane report found no difference between AA and other treatment programs, one should remember that AA is free while other options (inpatient, psychotherapy, CBT, etc) are not.

  3. I've always thought getting a bunch of alcoholics together for a meeting seemed to be self defeating. Since AA is anonymous, how does anyone really know if it is effective long term? Every alcoholic I know has had "dry" periods of time, sometimes extending many years but they all seem to go back to it at some point. Your patients probably have many people telling them to stop drinking, but sometimes a doctor or someone else not emotionally involved can say something that resonates with the person and gives them a different view. It could be exactly what other people have said to them for years, but those people aren't "heard," for whatever reason.

  4. I would NOT recommend AA or any other 12-Step program, as it IS religious in nature, and IS a cult.