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Guestwords: We All Failed My Brother

Thu, 09/07/2023 - 05:52

The most troubling aspect of the disease of addiction (often called substance use disorder, or SUD) is that the addict is often forced to participate in their own slow, painful, dehumanizing death. They desperately yearn to live, yet crave the instrument of their death. That’s how my brother, Tim, lived the last years of his life before we lost him at age 49.

The nature of how he died is rarely spoken about within the family. His story, like so many others like his, has been suppressed or whitewashed in a futile attempt to vanquish the guilt, grief, and helplessness we all felt watching him slowly die. But that censorship only helps condemn other addicts to the same fate.

Up until three years before his death he was the type of guy you might admire and certainly befriend. He was a loving husband, doting father of two girls, military veteran, reservist, successful human resources adviser, and prominent community volunteer.

Tim was not a garden-variety drunk, as one sibling once labeled him. He was an unassuming, vibrant, kind, loving soul who simply wanted to return to the life he once knew, but couldn’t find his way home in the darkness of the addiction treatment community.

He openly acknowledged his drinking problem and entered over 30 facilities for detoxification, rehabilitation, or hospital care in the last three years of his life, all of which endorsed Alcoholics Anonymous and its 12-step program.

Regardless of how many times he failed to respond to the 12 steps, each subsequent health care provider prescribed the same treatment. I cannot imagine there is another potentially fatal disease for which an alternative treatment would not have been explored, nor one in which the patient would be blamed for a treatment’s failure.

The family was frequently told that it wasn’t A.A. that failed Tim. It was Tim who failed to “work the program.” Yes, there are some who can find sobriety through sheer willpower and the support of A.A., but that doesn’t mean everyone can. And it doesn’t mean those who can’t are weak. Like any disease, SUD afflicts addicts in varying degrees. One person may have a tougher time than another.

A 2012 Columbia University study on addiction medicine found that only one in 10 drug or alcohol addicts gets medical treatment, leaving more than 20 million Americans untreated. “This is inexcusable,” the report noted, “given decades of accumulated scientific evidence attesting to the fact that addiction is a brain disease with significant behavioral components for which there are effective interventions and treatments.”

A.A. is thought by many to have a success ratio of just five to 10 percent, and its program is not rooted in science, but rather an almost century-old, faith-based approach. The third step of recovery, for instance, instructs alcoholics to turn their “will” and “lives over to the care of God” as they understand “Him.”

Lance Dodes, a psychiatrist and author of “The Sober Truth,” suggests that the belief in a “higher power” may cause the “well-documented tendency among A.A. members to aggressively defend the organization and its precepts without giving consideration to opposing ideas.”

Although A.A. certainly can help some find sobriety, it is not the be-all and end-all of addiction treatment, and it’s irresponsible and harmful to foster that belief when there are board-certified physicians in addiction medicine and effective pharmaceuticals.

For example, the Sinclair Method uses naltrexone, Food and Drug Administration-approved since 1994, to block the brain’s endorphins that give us a buzz from alcohol. It is often confused with disulfiram (Antabuse), which causes nausea whenever the patient consumes alcohol. Naltrexone has very few side effects and nausea is not one of them.

According to the Columbia study, “patients taking naltrexone report significantly fewer drinking days, fewer drinks per drinking day, reduced cravings, and reduced relapse.” It comes in pill form or as an extended-release injection.

A.A. insists that total abstinence is the only course of action, yet pharmaceuticals like naltrexone demonstrate that some alcoholics can live productive lives simply by drinking less. For those alcoholics who might never consider or achieve complete abstinence, this offers a more appealing alternative that could save their lives.

Unfortunately, most hospitals, rehabilitation and detoxification facilities, and even the courts overwhelmingly see A.A. as the sole option, yet the only credential required of virtually all A.A. members tasked with trying to save critically ill addicts is that they be recovering alcoholics themselves.

It is noteworthy that one of A.A.’s own handbooks, “The A.A. Member — Medications & Other Drugs,” cautions: “No A.A. member should ‘play doctor’; all medical advice and treatment should come from a qualified physician.”

The Columbia study explains: “This profound gap between the science of addiction and current practice related to prevention and treatment is a result of decades of marginalizing addiction as a social problem rather than treating it as a medical condition.”

I’m ashamed to admit there were times I viewed Tim as a pathetic, weak, lost cause instead of a loved one afflicted with a chronic, progressive brain disease who needed my help.

I suspect Tim died tormented by strong feelings of inadequacy and alienation. It is unconscionable that many A.A. members and other caregivers do not readily endorse scientific, evidence-based treatments when the outcome of not doing so could be the agonizing death of individuals like my brother and more than a hundred thousand others each year.

I don’t blame anyone in particular for Tim’s death. We all, family and friends alike, unwittingly played a role because of the lack of readily available information about all the treatment options and the lack of health care providers who are well informed on the subject. 

I simply want others who are dealing with the disease themselves or with loved ones to know what we learned too late in trying to save Tim.

Jeff Gewert, a retired video writer, producer, and director living in Montauk, is a frequent contributor to newspapers including USA Today, The New York Times, and those published by Hearst Media.

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