I was asked to consult on a 43-year old female with abnormal liver blood test results.  It took but a few minutes to determine that she was an alcoholic, which was the likely explanation for her abnormal blood results.  She drank several beers daily over several years.

My diagnosis was alcoholism, but did the patient concur?

“Do you feel that you are drinking excessively or do you have it under control?” I asked.

She replied, “I’ve got it under control.”

That sad reply indicated that the probability of helping her to help herself was zero.  Ultimately, the addict must forge a pathway to healing.  Sure, we can help, coach and support the effort, and we should.  But, no addict ever reached the promised land by force or persuasion.

Sure, we’ll get this patient out of the hospital, back into the cauldron of inexorable self-destruction.  Did we help her?  I don’t think so.  This is not like treating a urinary tract infection where healing requires no effort from the individual.  The addict, in contrast, can never be healed from without.

I have witnessed family members of alcoholics agonize in their frustration and disappointment that they cannot coax their loved one onto a path leading toward sobriety.  If I were in their place, I might behave similarly.

I have many patients who have conquered addictions.  I admire them for vanquishing demons that prey upon so many of us.  Some struggled ferociously and prevailed while others curiously threw off the yoke with seemingly little effort.  Life isn’t fair.  Without exception, these folks broke free because they decided to pursue a different direction.   No yelling, screaming, threatening, begging or bribing can bring an afflicted addict across the finish line.

When loved ones reach the point where they realize that they can’t be the solution, they experience a sense of resignation and peace, even though the pain remains.

The serenity prayer offers wisdom to us all.

God, grant me the serenity to accept the things I cannot change.
The courage to change the things I can.
And the wisdom to know the difference.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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