"Doc, I'm NOT an alcoholic"

About 70% of my patient population has a history of substance abuse. I’m used to it, I deal with it. Being in recovery myself helps a lot. One thing that helps me stay clean and sober day after day is the frequent raw denial I see in my patients.

For your consideration, a patient encounter:

Mr. Kztrimbel is back in prison, after serving about 6 years, and being out for nearly a year. He didn’t reoffend, he just violated his parole, so he’ll do another 18 months at least in prison. He’s seeing me to complain about not getting his oxycontin. He has back pain. He’s complained of it over a decade. While in prison before, he got quite a thorough evaluation for it; it’s run-of-the-mill musculo-skeletal non-malignant intermittent back pain like everyone gets, and he made it thru his last incarceration with some tylenol or ibuprofen, exercises, and occasional ice/heat.

Upon discharge, he found a physician who believed his story of intractable pain, and gave him his oxys.

He’s got a long history of drug and alcohol abuse. Suffice it to say that drugs and alcohol are the underlying reason he got a prison sentence in the first place. He’s had some halfway decent rehab while in prison in the past. Apparently he just went thru the motions.

I evaluate him, realize that nothing has changed with his back, and I tell him he won’t be getting narcotics for his symptoms, it’s not medically necessary and certainly not appropriate. Needless to say, he’s not happy. Mr. Kztrimbel says “I knew it, I knew it, I knew that if I came back in, you’d never give me my drugs! I NEVER should have had that beer!”

“You mean you got revoked for drinking alcohol? Complete abstinence was a condition of your parole, you knew that any alcohol consumption meant that you would get returned to prison, and you drank anyway?” I queried.

“Yup, doc. That’s right. I never should have let my friends talk me into a beer”

“Mr. Kztrimbel, are you an alcoholic?”

“No, doc. I am not.”

“Mr. Kztrimbel, you knew that if you took a drink, you’d return to prison for a year and a half, you would not be given narcotics for your back, and you took that drink anyway. Now to me, that’s something an alcoholic would do, because they can’t control their drinking. We expect that behavior from alcoholics who aren’t in recovery. It’s understandable. But for a non-alcoholic to do something like that, they’d have to be either crazy or an idiot.”

“Doc, I’m NOT an alcoholic.”

“I see. Welcome back to prison, Mr. Kztrimbel. Let’s review your back exercises, and I’ll order some ibuprofen for your pain.”

Denial: it’s faaaaaaaaaaaaantastic!

No Doc. I’m not in denial.

Many years ago, I did a 6-week intership at the work release jail here. A guy comes back Sunday night from a week-end at home, and blows a number on the breathalyzer. Monday morning, he has a hearing that I sit in on. He says he had beer in his car. One of the POs I work with leans over and asks me to go out and check his car. I come back, and request to ask a question:

[paraphrase] Yo, homeboy, you parked your car within 100’ of the work-release jail, you’ve got two cases of beer in plain sight in the back seat, and you knew you had been drinking before you returned. Did you want to get caught? [/paraphrase]
He knew he was going to go back to the county jail (and lose his job) if he broke the rules of the work-release center. And he did, seemingly willfully. As a genetics prof once pointed out, most of us have commited a felony. The ones that get caught are generally not as smart as the ones that don’t, and my corellary is that the ones that don’t get caught know when to stop.

I also think that there’s a fine line between those who can control certain aspects of their personality and those who cannot. I realize that this is a touchy subject, complicated by the biochemically addictive nature of oxycontin, cocaine, heroine, etc, but I sometimes find it hard to muster any amount of a flying F for people who refuse to do anything, let alone acknowledge that they can never completely control themselves. What pisses me off the most are the people who want to suck me into their game and then get upset when I don’t play along. At that point, whatever empathy I had went out the window, because it is that empathy that they want to seize and use for their own gains. To hell with me.


Um, I’m pretty sure I haven’t. I find that statement somewhat hard to believe.

Doc, I’m NOT a felon!

I agree with Excalibre. I find this statement unreasonable, although obviously it depends on one’s definition of felony. And why would a professor of genetics be making it?

Wow. I guess it’s true that you can’t fix stupid. maybe he missed the discipline of prison? :confused:

I have very little empathy for addicted people (I don’t mean that I want them punished, I just don’t see the need for a big to do when they finally get sober/straight etc–you’re supposed to be able to go thru life not addicted. Like Chris Rock says, “you’re not supposed to go to jail[so not going is not a celebratory thing]”.
Frankly, the pain that the person is supposedly in does not equal the pain transmitted to those around him or her-so I withhold my sympathy/pity/empathy as well.*

Lucky I don’t work in addiction, eh? But I see the effects of addiction every day at work. Sad.

  • I have great respect for those who have come thru the fire, so to speak and help others thru it as well. Dry drunks–not so much. But I digress.

Two whooshes in one go, impressive.

He meant that we’re all so related, most sex is incest.

Oh, and if he didn’t have a history of alcoholism, I don’t think having that one beer that will send you back to prison means you’re an alcoholic. It could just mean you were confident you wouldn’t be caught, and had a really poor ability to prioritize. Of course in this case, with his history, the guy is clearly in denial of a spectacular sort, which…wait, is my father in prison again? :rolleyes:

I couldn’t begin to estimate the number of alcholics I’ve had in the ER who drank nothing or “one beer” and have alcohol levels four times the driving limit; women who’ve used during their pregnancy; addicts who have docs who have had them on huge doses of Contin, but have negative drug screens when their supplies have been recently replenished. (Junkies may have a problem they can’t control, but the traffickers aren’t even always addicted – how low can you go?)

The part of your story that rang true, for me, was it wasn’t even the guy’s fault that he wanted a beer, or drank it. His FRIENDS MADE him drink it. Not only does he not have a problem, it isn’t even HIS problem.


Oooookey. The comment was made in the context of a discussion over what had more control over behavior: genes or environment. You don’t have much control over genes, you can only modify their effect on your behavior to some degree. You can, however, change your environment such that you yourself remove things that lead to poor choices. Genetically determined (but not always) intelligence can override environment to produce good choices in a poor environment, or succumb to a poor environment when not robust enough. Both intelligence and environment have equal roles in determining whether or not we do wrong, and if we will get caught when doing wrong.

I will admit that he may have been gone over the top when he asserted that we had all commited a felony, but his point was taken that by force of intelligence and having learned how to make good choices, we (successful college students) had avoided getting caught doing wrong.


People don’t start out intending to get addicted. And the “big to do” is about supporting them in the rough spots.


I don’t think that’s what he meant. From a legal standpoint (since “felony” is an explicitly legal term) that’s not true - statutes like that are specific in describing which familiar relations count as “incest” and which don’t. Besides, your interpretation makes no sense in context.

Most, not all. Big difference.

Agreed. The guy got out of jail and wanted a beer, his friends encouraged him (twist my arm), he knew having a beer would violate his parole. This makes him an idiot, not neccesarily an alcoholic.

QtM I’m kind of surprised by your reasoning here. Granted there is a very good chance that you are absolutely right about this guy’s addiction. The guy got caught with a beer or his urine showed that he drank. Which? The fact that he had a beer when he knew that would send him back was enough to label him an alcoholic? I’m sure his past history told you that already. How did he get busted?

I’m sure this guy’s friends are not Rhodes scholars, and if he were to hang out with any of them, his refusal of alcohol would be ignored if not taken as an insult.

The guy seems to be an addict. But, saying

allows for the guy to be either an alcoholic, crazy or an idiot. Why can’t he just be a dumbass that had a forbidden beer and then got caught?

I guess what I’m trying to say is that the beer that he got caught with (or beers) is not enough to label him an alcoholic in and of itself. His history might make that determination. Maybe this thread should have been titled “Doc, I’m NOT an addict.” I’d buy that reasoning given the same facts much more easily.

QtM, I had no idea your establishment straddled a river in Egypt! :smiley:

Qadgop didn’t label him an alcoholic. A dumbass who has a forbidden beer when aware of the tremendous consequences, gets caught, blames it on his friends is, in medical parlance, an “idiot”. Or perhaps “crazy”.

I don’t get your distinction between dumbass and idiot. Alcoholic is a more specific word than addict but addiction encompasses doing something despite knowing the tremendous negative consequences… and in this case the something was (among other things) booze.

That’s not calling him an alcoholic, but it certainly implies it.

The bulk of the thread centered on the guy’s addiction to Oxy-contin, hence my use of addiction.

There is no real distinction between dumbass and idiot, why do you ask?


Makes zero sense. Medical parlance my ass.

QtM will certainly be able to clarify this, but this sounds like the patient was looking for a source of narcotics, and gambled that by violating his parole, he might be able to get a steady source from the prison MD. When QtM said no, the patient realized he had lost his bet, and tipped his hand with the comment “I never should have had that beer.” That is an addictive type of behavior, and an idiotic decision to make. The patient was willing to give up his freedom and screw up his parole record for the chance at a long-term fix of narcotics. At the very least it was incredibly short-sighted.