Dr. Garcia's Foreword
Excerpted from the foreword of "My Way Out: One Woman's Remarkable Journey in Overcoming Her Drinking Problem and How Her Innovative Program Can Help You or Someone You Love" 

By Linda Garcia, MD

My mother consumed alcohol most of her life. She had terrible asthma and would recount to me stories about how, on the days she had the most difficulty breathing, the family physician would instruct her to make a lemon toddy. This was a special concoction made up of lemon juice and strong tea, and she would lace it with a small amount of brandy. This was before the days of Albuterol or even Primatene® Mist, and therapeutically, it made sense. The strong tea was certainly a bronchodilator; the lemon and the sugar was a good demulcent; and the brandy was a sedative.

So, mom had this history of believing alcohol was good medicine because it was introduced to her at an early age. And it indeed gave some relief to her. She was a good mother and always very supportive of me. She'd had a number of miscarriages in her attempts to have a child, so I knew I was wanted and clearly I was loved. But she drank, and as she got older, particularly by the time she reached menopause, she began to lose control over her drinking.

She had a difficult relationship with my father, who oversaw a rather oppressive household, even though he was not present most of the time. She stayed home; she did not drive, and she fulfilled her role as a stereotypical wife and mother of the 1950s. Dad felt he needed to work two jobs to support his family in a proper manner, and he spent more than three hours a day simply commuting between our suburban home and his Chicago offices.

Although my mother tried very hard to stop drinking, she could not, and the situation became increasingly intolerable. Many of my childhood memories include my father coming home late at night to find my mother passed out drunk. The doctor tried to intervene after my father brought her in to treat her leg ulcers, which had begun to appear repeatedly. Now, of course, I understand they were classic symptoms and manifestations of vitamin deficiency and tissue fragility common with early alcoholic cirrhosis. But at the time we didn't know why she would get these recurring non–healing sores. Our family physician was very kind and competent and he told my father that drinking too much wine caused the sores. The doctor convened a family conference and urged us to admit her to the hospital where she could enter a sobriety program. My father and I implored her to do so; to get some help, have a sober life, and choose not to drink.

But she chose not to go. She announced that as far as she was concerned, alcohol was more important to her than either my dad or me. I thought that was horrible. To this day, it is a very painful memory, even though I understand the statement was made by someone in the clutches of a serious addiction. But we asked the doctor "Isn't there something you can do?" Doctors are supposed to have the answers, after all. He said he simply didn't have anything else to offer her; that he could not force her to enter a sobriety program against her will.

Her disease continued to progress after I went off to college. I'd already been interested and involved in health care, starting as a Candy Striper— an unlicensed nurse helper and volunteer—at Great Lakes Naval Station. It was the early 1960s and I remember seeing men who'd been injured in the conflicts leading up our full blown involvement in the Viet Nam war. I remember feeling somewhat functionless as a 16–year–old Candy Striper and always wanted to do more—to make a contribution. I admired individuals who worked in medicine and I wanted to help others as they did.

So I became a nursing assistant, went on to nursing school, and earned my license. I was a registered nurse for 18 years, seven of which I spent as a fire department emergency paramedic once I obtained additional training. I also spent time as an intensive care and flight nurse at a university hospital.

I decided to pursue a medical degree, and afterwards underwent an additional three years of training and specialization to become an internist. This is an area that emphasizes the diagnosis, management, and treatment of chronic medical issues. As internists, our job is to help patients achieve a better lifestyle through therapeutic intervention. The diseases we often treat include diabetes, hypertension, coronary artery diseases, and addictions, such as drug and alcohol abuse.

I was acutely aware of the consequences of substance abuse from both my family situation and my many years as a nurse and paramedic. Both made significant impressions on me. I have vivid recollections of what our EMT crews found waiting for us on those New Mexico highways as we raced in the dark, siren screaming, toward the State Trooper's bright glowing strobes.

We would discover drivers and passengers in distress, some dead, some alive and simply stunned, some terribly maimed and moaning in agony. Bodies were trapped in vehicles or thrown into the sagebrush and ditches. The crashed vehicles often were littered with opened containers of alcohol, strewn among the living and deceased. Those who'd been killed had already begun to turn cold and blue. The combined odor of blood, alcohol and motor oil, mixed with the stench of regurgitated stomach contents, purged upon impact, was pervasive. It was a sensory assault on a girl from the suburbs, and I will never, never forget it.

My experiences as a paramedic in which alcohol was a causative factor extended far beyond the highway horrors. Many homicides involved people who had been drinking, as well. So did the majority of suicides.

It wasn't until after I finished my medical education and I was a practicing physician that I realized just how much, given my earlier experiences, I wanted to find ways to help individuals overcome this disease of alcoholism. I had seen such graphic examples of the ravages it caused. I wanted to find a way to help patients achieve an improved lifestyle and have empowerment over their chronic health issues. I wanted to give them choices.

There's a tremendous emotional stigma that accompanies an addictive behavior. Most individuals who are diabetic or who have hypertension don't seem to be burdened with the same sort of shame or rejection issues. But those who suffer from alcohol and drug abuse are often viewed as lacking self–control. The same is true for the clinically obese, another group who suffers a chronic disease, but is often unfairly characterized as undisciplined or gluttonous.

And when an alcoholic goes out and binges, they're considered to be evil, out of control or simply unworthy of our care, even though medical therapeutic interventions have been slow to help them with their problem. That is not necessarily true for, say, a patient with congestive heart failure. That person is not considered to be evil or a failure because he binged on a bag of potato chips and suffered a heart failure episode due to an overload of salt.

Times are finally changing. Medication is now available for those who live with alcohol addiction. As outlined in this book, they can be administered in a less emotional manner and in conjunction with supplemental therapies to create a highly effective program. Many people will benefit from this approach.

I've prescribed the older generation medications, such as Antabuse®, which produces an aversion to alcohol if it is consumed. However, many patients simply don't want to take it because they know they will become sick if they drink. Another group of patients has learned how to modify administration of Antabuse® so the effects are not so harsh, and for this reason, it is not very effective. Naltrexone is another drug used for this purpose, but it can become ineffective relatively quickly.

The approach described in this book employs a new type of medication to help individuals gain control over a drinking problem without having to become completely abstinent. Many people do not want to say good–bye to alcohol. But they desperately want to learn how to control it and to become safe, social drinkers. Alcohol use is pervasive in our culture, and many people take great pleasure in moderate drinking.

Other individuals chose to be abstinent, and this program can also help them achieve that goal, as well.

Most of the patients I've followed simply want to have control. They want to enjoy a glass of wine with dinner, but they don't want to get sucked into that mode where they can't stop at one glass. They don't want to find themselves in a position where after the first drink their entire evening is spent in a tailspin of consuming more and more alcohol because a certain part of their brain just won't let them stop.

Utilizing the integrative therapies outlined in this program, and under the care and counseling of a physician, one can now choose between gaining control over alcohol or abstaining completely. So it's really a two–in–one program: control or abstinence, whichever is most appropriate and desirable.

It also seems to fit within most individual's lifestyles much better than other therapies. In the past, I encouraged many patients to attend fellowship–based programs, whether they be religious counseling, Alcoholics Anonymous or other local support groups, most of which are modeled after AA.

But there are a significant number of people who do not wish to reveal in an open discussion setting they have an alcohol or drug problem. Or they feel they don't have the time in their busy schedules to attend group meetings on a regular basis. There are many reasons they are not comfortable in that therapeutic milieu, yet they wish to seek an opportunity to treat their problem and to gain control over their health issue. I've found that providing a secure, private environment, as this program does, has been very appealing to the patients I've offered it to.

We finally have an opportunity to provide effective tools to patients who suffer chronic addiction. As physicians, we can develop individualized therapeutic programs for them based on the important work conducted by researchers at the University of Texas START Center and later published in The Lancet, a highly respected journal of medical research. The START Center researchers demonstrated that a medication called topiramate can significantly curb cravings for alcohol. Combined with the other critical offerings in this book: hypnosis; herbal, nutritional and homeopathic supplements; exercise; and proper diet, we finally have a new avenue to treat patients who live with this disease.

Looking back at my mother's situation, I realize just how important gaining access to these tools has become to me and to my patients. Our family's doctor was a wonderful and compassionate physician. When he met with us and urged us to get her to the hospital for treatment, he took a great deal of time with a middle class family obviously in distress. He attempted to find a solution to a very bad situation. But he had neither the tools nor the solution. He had only himself, his best intentions to help us, and his input regarding a program available at the time that involved withdrawal and abstinence. And she rejected it.

After I left for college, I missed many of my mother's subsequent episodes, but of course when I would return home, I would note the disease had progressed. By then, my father was completely helpless to control her. As her drinking increased, she became more secretive and clever about procuring alcohol. She would take a taxi to the market to buy her elixir, or have a cabby deliver it to her door. This would infuriate my father who, in an effort to control her drinking, had forbidden her to leave the house.

When he retired, my dad was able to more carefully supervise my mother's activities, although he was never completely capable of blocking alcohol from the home. He revealed to me that when they would go shopping—which they did twice a week—she would sometimes go to the alcohol section in the supermarket, grab a bottle, open it quickly, and take a swig. They were then required to purchase it. He was beside himself in his inability to control this type of behavior. But he also was mortified by the potential embarrassment at their local suburban supermarket, so ironically, he eventually began to buy the alcohol for her.

He could not comprehend any of this. He didn't drink himself. He disliked the taste and smell of liquor and couldn't understand why my mother could not stop herself from drinking it. And of course, he hated the disruption, embarrassment, and disorder it created in his family.

The situation with my mother and her disease got progressively worse, and although she had developed increased symptoms of cirrhosis, it was ultimately an alcoholic seizure coupled with a stroke that stopped her from drinking. She spent about six weeks in the hospital, but when she returned home, she resumed drinking. A few months later, she fell and broke her hip, which put her into a nursing home for approximately one year.

She finally returned home, but because of the stroke, paralysis on one side of her body, and fractured hip, she was no longer able to access alcohol. And my father would not provide it for her anymore. One of my most significant memories is of talking with her around that time—and by then she could no longer recognize who I was, and instead would refer to me as "that girl"—and would repeatedly ask me for just a little drink.

So my mother's memory of me as her daughter had passed with a series of seizures and a hypertensive stroke. She was unable to remember who I was, but was very much able to remember that she wanted that little drink.

My mother's health continued to decline, and she eventually succumbed to pneumonia at the age of 81. My father passed away exactly six months later, at the age of 85. They lived long, but their longevity was always overshadowed by alcoholism, and the contentment they could have had in those long years together was vastly compromised by my mother's drinking.

The same suffering still exists. A person becomes addicted to alcohol and it's followed by family disruption, myriad health problems, lost work productivity and many other issues. Overwhelming data from the National Institute of Health and other reputable organizations documents the pain and the price to problem drinkers, alcoholics, and their families.

But now we have an opportunity to reach out to those individuals and to offer them tools to achieve a desired level of drinking, or abstinence, and to help them be successful in the process.

My mother didn't have access to those tools, but my patients do. And with this book, so do you.
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