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“I’m tired of feeling like a criminal.”

During my first week as a 4th year medical student rotating through Ria Health, I heard powerful confessions and testimonials about alcohol consumption. I could hear the guilty intonation in their voices, and the even stronger voice of addiction consuming their lives. In my own clinical education, I watched as all addicts were categorized as lost causes and deferred to social workers. Try as they may, most recommendations to “just stop” or to join support groups were futile. It seemed to me that no one knew how to treat this problem, including myself. I decided I wanted to change this and learn how to better manage the most common, legal drug of them all: alcohol.

“I didn’t drink because I enjoyed it anymore, I drank because my body needed it.”

What I found most interesting in those coming to Ria Health was the patient population. The media consistently portrays alcoholics as unemployed with an absent support system, those requiring public interventions to reverse their habits. I was under the impression that it was only a problem when they became frequent flyers to the hospital for variceal bleeds and massive ascites. But what I came to realize was that this was a minority – most heavy alcohol users are just like you and I, flying under the radar with declarations that “I don’t have a drinking problem,” until one day it becomes one. Most heavy drinkers have jobs, relatively stable relationships, and homes. They could be sipping wine throughout the day, or they could be drinking two pints of liquor in one sitting. Whether it be by habit or by cravings, these drinkers have lost control of their decision-making capacity – and are fully aware of it.

“I asked my primary doctor for help, but he refused to prescribe me the medication I needed.”

A major barrier to the growing problem of Alcohol Use Disorder (AUD) is the social stigma that alcoholism is merely a result of poor self-control. I believe that by treating it as a psychological and social problem, the medical community and greater society fail to recognize the chemical and physical dependence these people also struggle with. With the current social construct, only 1 out of 10 people with AUD seek help. Alcoholics Anonymous and other rehab centers, both of which have a financial burden and time constraint, are the only options patients are aware of existing. This is an immense problem because this also means that physicians do not have enough exposure with how to medically manage AUD. The first-line drug for AUD and the initial drug for Ria Health is naltrexone, a drug that was proven over two decades ago to decrease the craving for alcohol. Over a period of months, the body slowly disassociates alcohol with the reward system to the point where individuals can control the amount that they drink and not physically depend on alcohol. With the only “serious” side effect of nausea that resolves within a few weeks, this relatively harmless drug has been under-prescribed to those that need it. It is a clear disservice to our patients and I urge this to change.

“I came here because I was desperate.”

Here at Ria Health, I have a sense that we are treating AUD like any other human disease – a quantifiable and treatable condition. There is no longer a need to feel ashamed or helpless. Time and again, I heard tremendous feelings of relief and self-empowerment from individuals that have just joined to those that have been part of the program for months. I hope to learn enough this month to continue this movement towards dignifying those with AUD, and to understand how to treat my future patients with all the resources that are available.

Daisy Young

Touro University California

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