Further Reading

Can I erase my alcoholism treatment before entering med school?

Dear Stanton,

First of all, great web site! - a lot of wonderful information here.

I'm a former heavy drinker — I don't wish to wear a scarlet "A," so I don't call myself the A-word. At the height of my alcohol abuse, I was putting away about a liter of liquor per day. Of course, drinking that much, my life was totally wacko, and reflected it.

Along the way, I tried to stop drinking with AA (which did more harm than good), and finally checked into a rehab center, which turned out to be — big surprise — a front for AA. The five days at rehab did get me through the physical withdrawl, but I wasn't truly committed to the idea of really cleaning up my act, and more or less faked it through the therapy sessions. One thing I've noticed about 12-steppers — it's often quite easy to figure out what they want to hear. Fortunately, I was in the position of being able to pay for the rehab, so none of this went on insurance records.

Well, about two years ago, I stopped drinking on my own, and have been more or less dry ever since. If I had to describe my approach to quitting, I'd say I used Rational Recovery; it overlaps my approach by about 90 percent. Like you, I'm not terribly convinced of or impressed by the idea of Beast-residing-in-midbrain; but for me, the real essence of the approach is the emphasis on personal responsibilty, and upon identifying ways of thinking which work against staying sober. (By the way, I also saw your web page regarding Trimpey's "Dr. Beast" comments — wonderful!! I'm still laughing several minutes after reading that page!)

When I say "more or less," I do drink occasionally; once every couple of months or so I might have two or three drinks. For all practical purposes, I'm abstinent. And, I think I saw somewhere that most studies of alcoholism would categorize me as abstinent as well.

Now, I'm currently preparing to change careers and go to medical school. I'm not considering anything to do with substance abuse as a specialty, in case you're wondering.

Also, in order to finance med school, I'm looking at some of the military scholarship programs. The basic deal, in case you're unfamiliar with it, is, the military pays all tuition, and they own you for so many years after graduation.

Anyway, that's the background — now the questions. Even though my problem drinking days are behind me, how much bullshit can I expect from a) medical licensing boards, and b) the military? I've seen stories about people wishing to keep medical licenses being made to jump through hoops, but haven't seen anything about people wishing to get a medical license.

In particular, I have to wonder if I'm going to end up forced to undergo religious indoctrination at AA meetings. Oops — sorry, make that "spiritual" (whatever the hell that means) indoctrination. I know there have been many successful lawsuits regarding forced 12-step attendance, and I did see your explanation that licensing boards are held to the same standards as the government, and at least aren't supposed to do this kind of thing. Or, to rephrase my questions — even though the licensing boards aren't supposed to require 12-step attendance, how successful have these lawsuits been? Are things really changing, or are people still routinely forced to attend 12-step uselessness unless they sue? And what's military law like on these issues?

Thanks in advance,
Larry


Dear Larry:

Thanks for your excellent letter Larry.

You describe a typical experience — encountering a treatment experience, ultimately rejecting or going beyond it, then facing some barrier later in life where (a) your original diagnosis and treatment are used against you, (b) your reaction against the treatment and your adoption of your own (successful) approach, including especially (c) controlled-drinking, are used to bludgeon you.

Ironically, although AA and American public health agencies boast constantly about how medical and nonmoralistic is American treatment of alcoholism, being treated for alcoholism will inevitably be used against you. I must say, your paying for your own treatment was wise, to keep it off your insurance records. But, of course, you are obligated to mention all previous treatment for alcoholism. It is a sad fact that a lawyer confronted with someone who seriously want to address a substance abuse problem has to tell them there can be serious consequences down the line if they enter treatment.

These things are still prevalent, despite a few court decisions stating that state agencies cannot compel people to attend AA or a 12-step program without offering some nonreligious alternative. But most courts and government agencies (including the military) — and certainly licensing bodies and employers — still operate exactly this way. Thus, one might say that it is best never to inform anyone of any mental or substance abuse problem you have ever had. But if you are discovered concealing such information, that itself can be used to disqualify you for many licenses and positions. Every individual has to weigh these issues carefully.

Issues like these arise not only when you consider getting training leading to a license (medical, legal, nursing, et al.). They arise around many other employment situations (especially, in addition to medical and legal ones, jobs like piloting a boat or an airplane, but really any job). They arise around any legal situation in which you find yourself, such as those involving driving (and certainly drunk driving), or a family court matter.

If you have a drinking problem and treatment in your background, and your spouse is out to get you (most often around custody of children), you are facing problems. The spouse will raise the issue, usually in terms that you are still abusing a substance, and you will have to prove otherwise. A court will often order you into further treatment, perhaps relapse prevention, and it will invariably be AA and 12-step treatment.

This is the situation in the United States, and it is truly alarming, comprising what I believe is the largest unrecognized deprivation of freedom in regards to determining one's personal life. As a result, I have written a book with my colleagues Charles Bufe and Archie Brodsky, entitled, Resisting 12-Step Coercion.

Beyond reading my book, you should consider carefully any treatment you seek; and if it is too late for that, what you tell people about it (recognizing that there may be records that will surface to be used against you). Finally, when push comes to shove, you need to consult with and probably retain an attorney. Pick one who seems to understand why not everyone who has had a drinking problem needs to go to AA. And make sure he peruses Resisting, and that he or she has at least read our summary chapter.

Good luck in navigating this minefield. Care is the watchword.

Yours best,
Stanton