I have a friend who started to binge drink when he was in his teens. It was a problem that stayed with him throughout his university years and it led him into all sorts of drunken scrapes. He didn’t care too much about the chaos his drinking caused and when he reached his twenties he decided to settle down and get married. But, despite having a steady relationship and a good job as a journalist, he continued to binge drink.
Even though he drank most days, in his mind things were okay because on the whole he enjoyed booze and he only tended to get really drunk at weekends or on special occasions. The trouble was that his definition of a ‘special occasion’ got broader and broader, until eventually, even going for a ‘quiet’ drink after work with a friend would result in him getting completely hammered.
When his wife first suggested to him that he might be an alcoholic he was horrified. But, deep down, he knew something was probably not right and he agreed to go and see his family doctor. For any alcoholic, seeking help for the first time is a huge step, because no drinker likes to admit that they have a problem.
‘I’m a bit worried about how much I drink,’ my friend told his GP. ‘I don’t do it all the time, but occasionally I go over the top and get very drunk.’
The doctor listened patiently for a few moments before asking my friend exactly how many drinks he’d have. ‘Normally only two or three pints of beer,’ he replied (which was a bit of an understatement to say the least), ‘but every now and then I drink more and end up with such a terrible hangover that I can’t function.’
‘How much have you had to drink when you get these hangovers?’ asked the doctor.
‘About eight pints of beer… but it could be as many as 12 or 13. I lose count,’ was the reply.
Now, if a patient had confided in me in the same way during a therapy session, by this stage the alarm bells would be ringing loud and clear. But then I’m not a doctor – I’m an addiction therapist.
The GP asked my friend a few more questions about his general health. He felt fine, he replied (after all, he was still only in his mid twenties, so the booze hadn’t yet taken its full toll on his body). After a while the GP had heard enough.
‘My advice to you is to cut out the 12- or 13-pint sessions, because they don’t do anybody any good,’ he said. ‘The other thing you might like to do is switch to drinking red wine. You’ll drink it more slowly, and you might find you don’t finish the bottle.’
And that was it! No advice about seeking specialized help. No detailed investigation into what it was that was making my friend drink. No real understanding that the young man sitting in front of him was already in the early stages of a violent addiction that would stay with him for life. All that my friend received was a well-intentioned plea to cut down, along with some perverse advice about switching to a different form of alcohol.
The reason I mention this case is that I’ve heard so many similar tales over the years about the lack of understanding that many doctors demonstrate when it comes to addiction. In my friend’s case, he was displaying no obvious symptoms of ill health as a result of his drinking, so in the doctor’s mind the problem wasn’t serious. My friend drank heavily for another 15 years before ending up in the Priory. His problem progressed to the point where it nearly cost him his job, his marriage and his mental health.
My own experience with doctors was little better. One medical practitioner told my wife that he thought there was little hope for me. When I finally went into recovery, I told him that I’d started to attend a 12-Step fellowship and that it seemed to be helping me. ‘They’re a little bit evangelical aren’t they?’ he sniffed, referring to the group that I’d joined. It was obvious to me that my problem was so far beyond his comprehension that I was wasting my time talking to him (in fact, I felt like landing a punch on him!)
So why do doctors get it so wrong? In a nutshell, it’s because they tend to be fixated on treating the symptoms of addiction rather than the causes of the condition. Another factor is that the training they receive for dealing with addiction is often woefully inadequate. A friend of mine is a qualified doctor in his fifties who now runs a successful addiction centre. One day, he confided to me that when he was training to be a junior doctor he spent just one hour studying the causes of addiction.
Of course, the situation may have improved slightly today, and I’m not trying to suggest that every doctor is ignorant (in fact, there are some excellent physicians out there). What I can say, however, is that I’ve met hundreds of addicts with similar stories about how they’ve been misunderstood, misdiagnosed or simply ignored by their doctors.
This is because doctors almost always look at symptoms and confuse them with causes. For example, if you drink heavily you might be red-faced, sweaty and anxious. Your doctor sees this and thinks, I know what it is – this patient has been drinking heavily. That may be true, but what the doctor doesn’t understand is that the heavy drinking itself is also just a symptom. The primary cause of the patient’s discomfort is the thing that’s making him or her drink heavily.
It’s our inability to cope with our extreme sensitivity to emotional distress that causes us to drink or to take drugs, or to overindulge in things like food or sex. This is the condition that doctors fail to treat.
If an alcoholic goes to a doctor, the chances are that they will offer advice and medication that’s designed to help a patient cut down on their alcohol intake. This is all well and good, but when you take away the alcohol, the patient is still left with the underlying issue.
This is why so many addicts relapse when nothing is done to tackle the emotional and spiritual causes of their illness.
Fortunately, things are slowly changing for the better. In the UK, the NHS website now lists Alcoholics Anonymous as a potential source of help and advice for alcoholics. In the USA, physicians are also becoming more open-minded, and in some quarters there’s now wide acceptance that addiction is a primary illness that results in many different forms of behaviour.
The implications of this are profound. Ultimately, it means that in addition to managing various symptoms that differ from person to person, we need to regard alcoholics, drug addicts, sex addicts, overeaters and people displaying various other forms of compulsive behaviour as all belonging to the same group.
This is something that’s already widely understood in the private practices in which I’ve worked. In the Priory, and at the One40 Group, it’s common for people suffering from many different forms of addiction (including anorexics and self-harmers, where appropriate) to join the same group therapy sessions.
The more we understand about addiction, the more we realize that very few people display only a single addictive trait. Instead, their addictive nature will often present itself in multiple ways.
For example, almost every cocaine user that I know is also a heavy drinker. They may also have issues around sex. Quite often they may seek help for cocaine addiction, but it’s the alcohol that triggers their drug use, which in turn leads to them seeking out prostitutes.
All three activities are just symptoms of the same underlying problem, the origins of which reside in their limbic system and are often characterized by oversensitivity to emotional distress and childhood trauma.
When an addict walks into a doctor’s surgery the chances are that they will be less than honest about their problem. The furtive nature of addiction often results in patients being defensive and cagey. No alcoholic likes the idea of giving up booze, so they’re likely to lie about the scale of their intake.
To be fair to GPs, this makes their task all the more difficult because they can only treat what’s presented to them. If a patient lies about the nature of their habit, most doctors in busy NHS surgeries in the UK don’t have the time to make a detailed investigation to check if they’re telling the truth.
The situation is made all the more complex by the fact that the addict himself often doesn’t have a clue what’s wrong with him. All he or she knows is that they feel like shit, and that in some way their addiction may be to blame. In fact, what’s really happening when they walk into the surgery – even though they might not know it – is that they’re making a cry for help because they cannot cope with life.
The trouble is that most doctors are not geared up to help us cope with life. What they love to do instead is treat our symptoms, because that’s what they’re trained to do.
The way that the NHS treats heroin abusers in the UK is a prime example of how conventional medicine gets it wrong when it comes to treating addiction. When somebody seeks help for heroin addiction, the immediate goal of the doctor is to persuade the patient to stop taking the drug, and the way they do this is by prescribing methadone as a substitute.
As I said earlier, this is crazy. Methadone isn’t only addictive but it also has a lower tolerance level than heroin. By making methadone widely available to addicts, doctors are condemning their patients to years of misery. In my opinion it would be far more effective to wean people off heroin by prescribing heroin itself in smaller and smaller doses, but doctors are forbidden from doing this because heroin is illegal.
The logic behind doctors prescribing methadone is perverse; it goes like this:
Problem: Patient is addicted to heroin.
Solution: Give them methadone instead.
Result: Hey Presto! No more heroin addiction.
In reality, the patient is still hopelessly addicted to a dangerous drug, and in the meantime nothing has been done to treat the emotional and spiritual problem that triggered their addiction.
I strongly believe that it’s time to decriminalize heroin so that doctors can use it in a controlled way for the treatment of addiction. In fact, I believe that in future we may need to have an open mind about decriminalizing all forms of drugs. Before I’m deafened by the inevitable howls of protest, we need to ask ourselves a very simple question: is our current policy of criminalizing drugs working? By almost any yardstick you care to mention the answer is ‘No’.
All we have done is created a sub-culture in which organized crime makes millions from the supply of illegal drugs. At the same time we’ve demonized addicts themselves by making them liable for criminal prosecution for possession.
Instead of providing effective treatment for drug addicts, society on the whole has chosen to deal with them through the criminal justice system.
Of course, I’m not suggesting for one moment that all drugs should be freely available – there’s a big difference between decriminalization (with appropriate safeguards) and full legalization. Nor am I suggesting that addicts shouldn’t be prosecuted if they commit a crime – clearly they should.
However, I would certainly be in favour of decriminalizing possession of most substances in small amounts. This is because we need to stop treating addicts as criminals simply because they suffer from a medical condition. Meanwhile, doctors who specialize in the treatment of addiction should have the freedom to prescribe whatever substance is clinically required.
Our current drugs laws are perverse to say the least. Why, for example, is marijuana generally considered to be less serious than many other drugs? I’d like to attack the idea that cannabis doesn’t kill. Of course, it might be extremely rare for it to have directly resulted in anybody’s death, but I’ve met hundreds of addicts who’ve come in for treatment for cocaine and heroin who all began by smoking cannabis.
Meanwhile, two of the most dangerous drugs of all – alcohol and nicotine – are legal. It shows that our whole approach to substance abuse is muddled and confused. Locking up addicts for abusing one substance, while letting them freely consume others, simply isn’t working.
So, what steps could the medical profession take in order to provide better care and treatment for people suffering from addiction? I believe the answer lies in providing a response that acknowledges that addictive behaviour is caused by an underlying disorder of the limbic system. We need to examine and tackle the emotional and mental causes of the condition.
In specialist private practices, we regularly see positive results from tackling these through group therapy and trauma reduction work. This is especially the case when childhood trauma is a major factor. None of this is easy – but all of it is possible to do.
What would this mean in practical terms for people like the friend I mentioned earlier who went to see his GP about his booze binges? Well, if he’d been referred to the correct specialist at the time, instead of being packed off to drink red wine, it might have led to him coming to terms with the reasons why he drank heavily far sooner.
He eventually achieved sobriety after going into private rehab at the age of 42, and later underwent a number of child trauma reduction sessions. This was all paid for by private medical insurance. He’s now teetotal and leads a more normal life. He’s still an addict by nature, but the understanding that he has of his condition brings him a degree of serenity that was previously lacking.
Providing effective treatment for addicts is expensive, but it would save society money in the long run. It would take many millions of pounds of public money, but if you consider the huge cost to society from the health problems currently caused by addiction, coupled with the social and real costs of the crime that it generates, it makes sense to tackle the problem at its root.
What we require is a fresh start that’s led by government and involves inter-agency cooperation from both the medical profession and the criminal justice system. Unfortunately, because this would need a government brave enough to invest huge resources, it may be a long time coming.
I fear that, in the meantime, our society will continue to simply muddle its way through, and that’s a crying shame. I believe that the way in which addicts are currently treated represents a fundamental abdication of government’s responsibility to protect the welfare of a huge part of the population.