An open, anonymous letter to your doctor about drinking too much
If I thrash around in bed for many nights, work up the courage to speak to you, if I stop lying to your face, and I FINALLY tell you that I’m worried about how much I drink, then you should take note.
You’re supposed to double the quantity when a patient answers the question: “How much are you drinking?” By the same logic — please — if I actually blurt out that I’m drinking too much, then you can be sure that it is. Too much.
And maybe it’s not too much for you, or maybe it’s not too much according to some mythical guideline based on standard units of blah blah. To be fair, you tend to be so busy dealing with “low bottom” booze problems, that your definition of over-drinker probably doesn’t include nice, well-employed people like me, especially as that might hit too close to home (1).
If Alison arrives in your office, and she’s brave enough — because it is a shockingly courageous thing to do — to say that she’s worried about how much she’s drinking, then don’t suggest that she just needs to try to cut back.
If we are asking you for help, then we have tried moderation.
We don’t speak to the doctor first. We speak to the doctor last. If we ask you for a prescription for something, then it’s because we think it will help. You could offer something like Antabuse, with a couple of days of Valium or Ativan so that the first week is a little easier to bear.
You can take the gist of what I’m saying and rinse it through your years of experience and education. And while I am not a doctor, I am an over-drinker. Or I was. Until I quit. And I quit from a place that you would have considered to not be a problem. You would have said: “You look so healthy, you have a perfect physical.” And that would be my excuse to keep on drinking (2) maybe for years.
You don’t want to read this from me and I don’t blame you. I’m some smart-mouthed online sober coach who knows jack-shit (admittedly). But when I get crying emails from my sober penpals who tell me that their doctor says — after they’ve worked up the courage to finally say something — that they don’t actually have a drinking problem, then I’m worried for all of us.
Because if Alison is saying it’s a problem, then it is.
And if you double what she says she’s drinking, then it is. And if she’s drinking less than you consider a problem, or less than you drink yourself, then you put all that aside and assist her with tools and ideas that might help her to be sober.
You can look her in the eyes and say: “Nobody needs to drink. You don’t have to figure out how to cut down, all that work on moderation is too exhausting. Maybe instead you can take a break, don’t drink at all for a while. Do a sober experiment. See how you feel. I’ve got some resources here that might help you. In-person meetings, but also there are many online resources. Books to read, sober podcasts to listen to, sober coaches to email.”
When we’re in your office, we are looking for permission to stop drinking. You can give us that. It’s an easy thing to recommend. Because nobody NEEDS to drink.
It’s so vulnerable to expose ourselves.
Please Doctor, no judgement, no inserting of what you would do, and especially no dismissing. Because we might only try this once (3).
When I sent out a preview copy of this article to some of my subscribers, I got a boatload of suggestions, attaboys, and additions. So Dear Doctor, this letter isn’t just from me. It’s from all of us.
(1) Dr. S (sober on day 36): “What the doctor can say to Alison is ‘if you are worried, then you should quit. I can help you by….’ And then, wise physician, fill in that blank. Please.” To be fair to my fellow docs, they tend to be so busy dealing with “low bottom” substance abuse that their definition of “alcoholic” just doesn’t include “nice people” or anyone who isn’t drinking all day every day. Even setting the bar very low leaves huge numbers of people who need help that we are stretched too thin to properly give. Nor does their definition of “problem drinker” include nice well-employed people especially as that latter might hit too close to home for many of us. Dunno how it is in EU or UK or anywhere else (or even here in US since the 1990s), but my only medical school training in addiction medicine was a one-week unit during my outpatient psychiatry rotation.”
(2) Runner Girl (day 130): “Every year I get a physical. Each year I would mention that I think I may drink too much. It was dismissed each time saying ‘you look so healthy, you have a perfect physical.’ Well, that was my excuse to get right back on the drinking path. I think every doctor should know that telling them is really the last thing we want to admit.”
(3) AM (day 804): Basically whether you’re a doctor or not, you need to take your judging hat off and truly listen, with compassion not comparisons. It’s so vulnerable to expose yourself. Please doctor, no judgement, no inserting of what you would do and especially no dismissing. Because we might only try this once.”
Phoenix (day 221): “My doctor, bless her, went down the moderation idea = WOW, hadn’t thought of that! (insert sarcasm). I guess she didn’t think I looked like someone with a problem. When I presented again about a year later, her ONLY suggestion was AA … so I just went home and opened a bottle of wine and another year went by.”
Sober Sparkles (day 102): “I would say that I don’t think the doctors have a clue how to help, and what they do know is still, like most people, influenced by the AA model that we see on TV… since just under 10% of deaths in the US are contributed to alcohol consumption and so many people are having problems with it, it is about time they took this more seriously instead of waiting until someone comes in with liver trouble or cancer.”
Crystal Light (day 132): “Based on my experience in the medical field, doctors have too many patients to take the time to discuss issues like this … I believe doctors really care about each patient and would do more if they had more time. It is how the United States Healthcare system has evolved. Sad.”
19Cathleen (day 625): “If I could send an anonymous letter to my doctor, I would say this: Dear Doctor, when my sister was diagnosed with breast cancer, I learned that alcohol use could be a factor in getting this disease. So, each year at my annual physical, I asked you about alcohol use. Me: Should I be concerned about alcohol, Doctor? You: Are you a moderate drinker? Me: Yes (I lied). You: Just limit your drinks to 1–2 drinks per week. Me: (Did I hear that right? 1–2 per week? I can’t even limit it to 1–2 per day). In the following years for my annual exam, I complete a questionnaire in the waiting room. Regarding the question about alcohol use, I answer “moderately.” You do not question me. I do not have the courage to tell you that I think I have a problem. So, I continue to drink “moderately” which for me is every day. I do not drink and drive — I do not get arrested — I quietly get on the elevator and continue to go down. But, one day, I search online for help and find a huge support system out there; people who really “get it” and understand. I am now sober for over 600 days — and I am telling you this to maybe open your eyes to the epidemic of drinking among women. There’s a “romancing” the drink going on and it’s all too easy to get tangle up in this affair. It’s serious stuff — as serious as smoking, sunscreen, and seat belts are to our health. Please, please pay attention to your patients. Please put your tablet down and have a heart to heart talk with your patients about alcohol. You may just save someone’s life.”
Little Lynn (day 247): “This article is spot on. Before I became sober I had my yearly physical exam. When I filled out the paperwork I honestly answered that I drank one bottle of wine per night, two on the weekends. My doctor didn’t even acknowledge that I had written anything about my alcohol consumption. It was a cry for help and she didn’t even say anything to me, not even, you have to cut back. I was having some acid reflux (big surprise) so she sent me to a gastro doc. I told this doctor the same thing about my drinking and that it was certainly contributing to the acid reflux. Not only did she not lecture me about my abusive drinking, she said she envious of my lifestyle. (In her defense, I had told her that at age 55 I was retired, had a place in the mountains, a place in town, lots of travel and entertaining with my husband, great kids, grandkids and lots of “fun” friends, who like to drink. Basically my life was just one big party.) It’s hard to believe that two very qualified doctors would let this slide … Thank God for you, Belle. I would have eventually ruined my wonderful life if I had kept drinking. No one understood what I was going through except you. Thanks for being my penal and sober coach.”
Melmel (day 27): “I once mentioned it to my doc, by saying I was having trouble sleeping at night. I added that I was probably having too much wine every night, and asked if that could be the problem (full well knowing that of course the booze was the problem) and that I didn’t want to be drinking so much. She never addressed it, and I walked out of the office with a prescription for sleeping pills! Fucking sleeping pills on top of too much wine? Yeah, that was a recipe for serious disaster. Needless to say, I never took the pills or went and saw that Doctor again! Of course, I kept drinking and it took me a long time to find you! :) That just made me tear up and send you this big virtual hug! … If I could send an anonymous letter to my doctor, I would say this: ‘Please don’t make me feel ashamed of my drinking, you are the one person that I trust right now. I would like for you to discuss my options with me as an intelligent, but scared person. Your response is critical to my future healing process. If I walk out of your office more defeated than when I walked in, I am sure to continue drinking for an unknown/extended period of time. I would like help today, as I have tired moderation and it just isn’t working for me, so please take the time to acknowledge how difficult this is for me to admit today. PS: I may eventually be one of the fortunate people who will find an anonymous sober person across the continent who totally gets me. She is not a medical doctor, but she does know her shit and she listens. She was an over-drinker, so she has expertise in this field and will offer support to anyone who asks, no insurance or co-pays required!’”
Fern (day 194): “I think that the average doctor does not know about all the sober supports that are available and so can’t really help. Also, maybe the doctor has a problem with drinking and by telling their patient that yes, you have a problem with alcohol, then they are looking in a mirror, so they suggest moderation because they are struggling too. It took me years to finally admit I had a problem to my doctor, and probably took five more years to actually quit. I had no idea that I could seek anonymous help on the internet and that there were thousands of other people out there just like me. Knowing that I am not alone and that I am not broken has been the exit off the elevator for me. Having you as a sober penpal even though we do not know each other has been my lifesaver.”
Thanks for reading. Can you click on the little ‘clap’ picture? 👏🏼 Helps people find the stuff I write. Merci.
Belle Robertson, sober 6+ years, blogs and writes and records free sober audios. She has been sober penpals with 2,940 people. She works as a text designer, a baker & caterer, and as a sober coach. She thinks all coffee is good coffee, especially when it’s at 6 a.m. And that lemon meringue pie isn’t served often enough outside of diners. This blurb updated March 2019.