The End of My Addiction

chart in the intensive care unit, he assumed I must have been in a massive car crash, because my CPKs were extraordinarily high. Rhabdomyolysis explained the urinary catheter and another of the IVs; they were to make sure I was getting enough fresh fluids to prevent renal failure.
    “You almost lost your kidneys, my boy,” John said. His characteristic jovial “my boy” cheered me up and made me feel I could talk to him about the real problem, that I had subjected my body to this trauma by excessive drinking. (Perhaps fortunately for my state of mind at the time, he only told me much later that I was admitted to the hospital in “status epilepticus,” an ongoing seizure state that put me “near death.”)
    “You are going to have to report me—” I began.
    “On the contrary,” John said. “I’d like to commend you. I know you haven’t seen patients all summer. Too many doctors continue to practice for years when they are—and know they are—alcohol-dependent.”
    “I am going to resign as associate professor and associate attending physician here.”
    John shook his head. “Are you crazy? You don’t resign because you have an illness.”
    “I know alcoholism is a disease. But in my case, that’s not what it is. I know I should be able to control my drinking, but I have not succeeded so far. I guess it’s a weakness on my part. Do you understand?”
    “No,” John said. “It is an illness. One you will have to recover from and then you will come back and work normally. To help that along, you should begin seeing an expert in these matters. With your permission I would like to call in a friend of mine, Professor Elizabeth Khuri, as a consultant. She is right next door to the hospital at Rockefeller University and also has an office here. Would that be okay with you?”
    “Can I tell her…?”
    “You can tell her anything and it will not filter to anyone here at the hospital, including me.”
    “Okay, then, I will be glad to see her. Thank you. Thank you for everything.”
    “Glad to be of service, my boy. I will check in on you in the morning. For now, just get some rest.”
    “John, given the risk of infection, don’t you think this urinary catheter could be removed now?”
    John laughed. “You must be feeling better if you’ve got the energy to resent that imposition, and you are right about the infection risk,” he said. “I’ll tell the head nurse about the catheter. Now get some rest, and you’ll be back to normal in no time.”
    I wondered if things would ever be normal again for me. One fact was clear and could no longer be denied: I had become an alcoholic.

2. A Remedy Gone Wrong
    THEY SAY that alcoholism runs in families. Not mine. Unlike most French families, we never had wine with our meals, and my parents rarely drank, at home or on vacation. Two or three times a year I might see them with a small glass of Scotch in the evening, and there was a sip of wine once a year at Passover. That was it.
    But I have come to believe that it isn’t addiction that recurs through the generations so much as it is dysphoria (the opposite of euphoria)—a chronic, underlying distress that predisposes people, to varying degrees, to addiction and other compulsive behaviors.
    In addiction medicine, it has long been recognized that people addicted to various substances and compulsive behaviors frequently experience symptoms of anxiety, depression, and/or other mood or personality disorders. (Medicine classifies anxiety, mood, and personality disorders in separate but related categories for precise diagnosis; I sometimes use mood disorders as a catchall term, in the commonsense way of speaking of anxious and depressed moods.) The concept of dual diagnosis and comorbidity—the presence of two or more diseases, or morbidities, at the same time, with one seen as “primary” and the other(s) as “secondary”—is a vital one, for both treatment and research. At the same time, though, the nomenclature of “dual” and “co-” can be misleading. It implies either that the addiction and the mood disorder originate together or (and this is what tends to be assumed by treatment protocols) that they are associated without cause and effect.
    This assumption follows from the fact that anxiety or depression, say, is far less likely to bring people to medical attention than addiction is. Thus the primary diagnosis will almost always be addiction, and the secondary diagnosis will be anxiety,