Dear RDH,
I have been a faithful reader of RDH since its inception and have always enjoyed the articles and features presented. However, the article titled, "Help Patients Before They Hit Rock Bottom" (August 1995), prompted me to take issue with several points made in this article. It made me realize again how little information most health-care practitioners have concerning the disease of alcoholism.
First, alcoholism is a truly progressive disease with a myriad of clinically evident and mental manifestations. To categorize it as merely a "political and social idea" is, in my opinion, professionally irresponsible and dangerous. Cancer, diabetes, and heart disease are all progressive diseases with equally negative outcomes and consequences as alcoholism. Yet no one would be foolish enough to dismiss them as social problems to be treated with counseling and anti-depressants. Additionally, the behavior and problems of a habitual drinker significantly affect the well-being and psychological health of those closest to him or her - the spouse, children, parents, friends, and co-workers.
Using the terms "functional alcoholic" and "non-functional alcoholic" to define relative levels of alcoholism is an oxymoron. An alcoholic who "functions well" is a matter of definition. Does this mean he or she holds a job? Many alcoholics are successfully employed in white-collar, professional positions and, by all outwards appearances, have the trappings of a "normal" situation. But "drinking to excess during the evening, on weekends or bingeing occasionally" is not normal behavior and its results are most often felt by those who live with the alcoholic. A person who appears to "function well" on the outside usually, in fact, has many problems on the inside - financial problems, marital problems, problems with children, self-esteem problems, etc. Additionally, the alcoholic may display extreme mood wings, uncontrollable rages which may lead to verbal and physical abuse, lying and dishonesty, which contribute to his/her feelings of guilt, remorse, and self-hatred. These feelings then lead to more drinking which makes the alcoholic feel mentally, emotionally, and physically worse. Despite having a job and having the outward signs of "success" this is not functioning normally.
Because drug and alcohol abuse are predominate contributing factors to physical and verbal abuse, I thought it was quite interesting that an article on child abuse was followed by an article on alcohol abuse. Perhaps dental hygienists should become more aware of the signs and symptoms of alcohol abuse so they can more effectively detect abuse of the alcoholic`s spouse and children.
Lastly, in order to believe that they have a problem with alcohol, most alcoholics do have to hit a "bottom." It may be a physical, mental, or spiritual bottom, and it may take the alcoholic many years of crises, resulting in several failed marriages, career setbacks, DWIs, financial disasters, or family estrangement. People hit their "bottom" at different times and in different ways before they realize that "functional, social drinking" is no longer possible.
I urge all dental professionals to attend an open AA meeting and to listen to the stories and experiences of previously "functional" alcoholics to hear the facts about the disease of alcoholism and its effects on the individual`s life and family. Only survivors of a disease are capable of describing to others how that disease impacted their lives.
Name withheld at author`s request
