HAMS: Harm Reduction for Alcohol

Should You Tell Your Doctor About An Alcohol Problem?

No one can answer this question for you. Only you can answer this question for yourself. On this page we shall just discuss some of the pros and cons of telling a medical professional about an alcohol problem to help you to decide for yourself. The big problem that always comes with getting any sort of medical help for an alcohol problems is that your doctor will be forced to put a diagnosis of an Alcohol Use Disorder on your medical records which will follow you for the rest of your life.


Medical detox:

If you find that you are having a difficult time doing a home detox as described in our web page How To Taper Off Alcohol then you may choose to do a medical detox instead. A medical detox is safer than a home detox and since there is a nurse administering the medications you might find it easier as well. Some medical detoxes will not allow you to smoke nor will they supply nicotine replacement therapy. Entry to a medical detox automatically puts a diagnosis of an Alcohol Use Disorder on your medical records as does any other form of medical treatment listed on this page.

Alcohol medications:

Some medications such as naltrexone, campral, topiramate, and antabuse can help make it easier for you to abstain from alcohol or to moderate your drinking. It is always preferable to get your prescriptions from a doctor and fill them at a drug store than to use some less reliable method like buying them off the internet.

Medication interactions:

A doctor can tell you the interactions that medications which you take may have with alcohol. However, you doctor should do this whether you confess to a drinking problem or not.

Alcohol treatment:

A doctor can refer you to alcohol treatment. If you are fortunate enough to have a harm reduction therapist in your area you may be able to work with this person on a goal of your choice, which could be harm reduction or moderation or abstinence. A harm reduction therapist will also work on you with both alcohol issues and other issues at the same time. However the vast majority of alcohol treatment programs in the US will insist on abstinence as the only acceptable goal and will refuse to work on any other issues such as mental health issues until you have a period of abstinence first. Moreover, more than 90% of alcohol treatment programs in the US insist that you participate in a 12 step program which may be offensive to your religious beliefs. Secularly based treatment centers are rare and hard to find in the US. Alcohol treatment comes in both inpatient/residential and outpatient varieties.

Inpatient/residential treatment:

If you find that you absolutely cannot accomplish an abstinence period on your own then a month of inpatient treatment where you are locked up away from alcohol may be the thing that you need. There is actually very little to recommend the option of inpatient treatment except for the fact that alcohol is inaccessible. Success rates of inpatient treatment differ very little from outpatient treatment. Inpatient treatment is very expensive. It is intended to put a lot of AA programming into your head which you may actually find to be damaging to you. Inpatient treatment is also the first time that people who drink or smoke marijuana are exposed to hard drugs and a number of people learn how to score and do hard drugs from their time in inpatient treatment. Inpatient and residential treatments are essentially the same except for the setting. Inpatient treatments are conducted at hospitals and generally cost more. Outpatient treatments are conducted at treatment centers and usually cost less. In most cases the content is the same.

Outpatient treatment:

If your goal is alcohol abstinence then you may opt to become involved in an outpatient treatment program. However, there is not much that you can get from an outpatient alcohol program that is not available fro free from a SMART Recovery or an AA meeting or some other self help group. Unless you are fulfilling the conditions of a court order or an employer there is not a great deal of value to be obtaind from Alcohol Dependency treatment. You are not likely to find underlying issues such as depression or anxiety addressed in a chemical dependency program--you will need a mental health professional for these.


Refusal of medical treatment:

Some clinics or doctors who are misinformed about alcohol misuse issues have been known to refuse essential medical treatments to patients who admit to having an alcohol problem unless the patient first agrees to attend AA meetings or undergo 12 step treatment. For example, one of our members was seeking treatment for a situational depression at a mental health clinic. This person reported to the clinic that he was currently drinking moderately according to NIAAA guidelines but had 6 years previous to this had undergone 12 step treatment for alcohol use. Even though this person reported that the 12 step treatment had been harmful and had increased his drinking the clinic refused this person any form of mental health treatment unless this person agreed to enter 12 step treatment and abstain for six months first.

Insurance loss/refusal:

Insurance companies have access to your medical records. They can and do refuse insurance to people with a diagnosis of Alcohol Dependence or Alcohol Abuse on their records.

Lifelong stigmatization:

According to the DSM-IV-TR1 Alcohol Use Disorders (Alcohol Abuse and Alcohol Dependence) are INCURABLE and once they are diagnosed they can never be undiagnosed. The best that you can have is full or partial remission. This is actually an improvement over earlier versions of the DSM which only recognized total abstinence as remission.

Job loss/refusal:

It is supposed to be illegal for an employer to ask a prospective employee if they have ever been in treatment for drug or alcohol use--but it still happens. It is also supposed to be illegal for employers to have access to your medical records, however your employer might still find out that you have been in drug or alcohol treatment. If you choose to take a month off from work to go into a residential/inpatient treatment program then your employer is surely likely to know about this. Although it is illegal for an employer to coerce an employee to take part in a religious group your employer might still illegally demand proof of AA attendance out of ignorance of the religious nature of AA. The employer night also find some pretext to fire you or refuse to hire you even though the real reason is that the employer hates drunks. Having no medical record of an alcohol problem is far, far better for your employment status all around.

1 The DSM-IV-TR is the official legal handbook of psychological and substance use disorders. This is the book which insurance companies must refer to before making payments and which courts must refer to when making legal judgments.

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