https://www.asam.org/resources/publications/asam-weekly/asam-weekly-editorial-comment

William Haning, MD

A link below honors the singer Eminem for a sobriety accomplishment, 10 years of abstinence.  It will be for some a mixed message. Of two, the former and probably more important one is the value assigned to recovery by those in prominently public roles. But exactly because this then puts the celebrity in a position of representing, specifically, Alcoholics Anonymous, it runs afoul of a central premise of that program: anonymity. Many may feel troubled less by the appeal for recognition than by the risk pool that this puts him in. The literature of AA contains many cautions regarding what such a public claim can produce, most concerningly the risk to the individual. For clinicians, this represents the horns of a dilemma: we would like the recovering community to assert the values of hard work and of adherence to well-vetted principles as a component of overcoming a chronic, relapsing illness. The opposing horn is of course that it is generally undesirable to place any one person in such an ego-sensitive posture. If they then slip, it would seem, the fall is from a much greater height. Those practicing in the field have sufficient challenge dealing with the Abstinence Violation Effect, and the difficulty that it creates for those who have had a relapse and would then want to reenter the community of recovering people.

The discussion surrounding this point goes as far back as the founding of Alcoholics Anonymous; there are arguments on both sides, for and against self-revelation in a public setting. One of the strongest counterarguments has been that no one person may take credit for his or her own recovery in the context of Alcoholics Anonymous. It is certainly possible to do so on the basis of relationship with a physician or other therapeutic agent, but a major presumption of membership in AA is that the individual cannot accomplish recovery alone; and thus has no business asserting personal responsibility for success.  It is among those advisory principles generally thought of as “spiritual”.

Improvement in medical care requires attention to Systems-Based Practices, one of the six core competencies* of any residency training program, and of which this is one example – involvement of the subject patient population in the design of treatment approaches.  Including the link provides a reminder, which may not be needed, that unlike management of rheumatoid arthritis or diabetes mellitus there is an element of both shame and guilt that distorts both the individual and the public views of this illness, and which commonly prevents those who have sustained the illness from participating in any public policy discussions or solicitation programs. Note that even without such a proscription, the March of Dimes is extremely circumspect in its use of pictures of children in recovery from their crippling illnesses.  It has already been said here and elsewhere, that there deserve to be participatory advocacy organizations independent of programs of recovery such as AA or NA, enabling the person with addiction to have a louder voice.

*[ACGME Core Competencies: Practice-Based Learning and Improvement, Patient Care and Procedural Skills, Systems-Based Practice, Medical Knowledge, Interpersonal and Communication Skills, and Professionalism].

Comment;

Well said.  I congratulate him for the milestone, while cautioning as Dr. Haning does.  Anonymity is the cornerstone of AA/NA for a good reason!

Dr. Raymond Oenbrink
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