Referring patients to Al-Anon.
From then on, if anyone answered "yes" to that question, I would refer them to Al-Anon. Some patients agreed right away to go to a meeting. Others said they didn't see why they should go, because they didn't think it would help them. I persisted, and if they still said no, I said, "Well, you don't have to try it, but if you don't, every time you come into office I'm going to ask you about it, because it's on the problem list."
Many did try Al-Anon. Soon, their visits to my practice decreased. One woman used to come in almost every month with something, and after she started going to Al-Anon, she stopped coming except for her annual checkup. People also seemed happier.
But there was another amazing result. Five people came back and told me that the nonjudgmental nature of Al-Anon gave them the courage to address their own addiction. Four went to Alcoholics Anonymous (AA); one went to Narcotics Anonymous.
Denial can show itself in many ways. I do rotations at a sexually transmitted disease (STD) clinic. Many patients I see there drink excessively, but don't think they have a problem. They think they're just like everyone else. That's probably true: They drink just like their family and friends do. To them, even a six-pack a day seems normal. So I say to them, "I'm concerned because you caught this STD through sexual activity while intoxicated. I think your drinking is impacting your health, and it could have been AIDS." But if they don't think they have a problem, they're not going.
Instead of pushing them, I ask if there is a problem drinker in their family. (There always is.) Then I refer them to Al-Anon. Most have never heard of it, or think it's Alcoholics Anonymous. But some take a referral to Al-Anon. I give them a handout with a listing of self-help groups and remind them that they can sit in back and just listen, they don't have to say anything, and it's free.
I also suggest that they try four or five different meetings, because each one is different--some are small and some are large. They might want to try same-sex meetings if there's one around, and if they're gay I suggest that they try a gay meeting.
I think every doctor would find it helpful to their patients to make referrals to Al-Anon. And all providers would find it helpful to attend at least one or two Al-Anon meetings themselves, because we all deal with alcoholics. An open AA meeting is another good idea, because it will be easier to make AA referrals once you are familiar with how the organization works.
DR. EPSTEIN is medical director for the South Bay Area of the Los Angeles County Department of Health Services Division of Public Health. For a listing of Al-Anon meetings, visit www.al-anon.alateen.org.
BY MARSHA EPSTEIN, M.D.
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|Title Annotation:||Alcoholics Anonymous|
|Publication:||Internal Medicine News|
|Date:||Aug 1, 2005|
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