Erudite, elderly, and introspective, one of my patients articulates clearly some of today's dilemmas facing both alcoholic patients and their physicians. When he came to see me, he smiled at me benevolently, admitted freely that he had drunk a lot of alcohol throughout much of his life, and was "CAGE positive."1 But Alcoholics Anonymous, psychotherapy, and interventions with medications are not for him, and he has continued to drink too much despite my earnest endeavors. We engage in what has become ongoing debate: "You find me something to replace the pleasure lost by robbing me of alcohol, and I'll behave." And, more recently, "While you're at it, tell me how to handle the latest news extolling the virtues of alcohol in moderation."
See also pp 761 and 797 and the March 1996 issue of Archives of General Psychiatry.
Four years ago, I speculated in these pages about the reasons
Delbanco TL. Patients Who Drink AlcoholPain, Pleasure, and Paradox. JAMA. 1996;275(10):803-804. doi:10.1001/jama.1996.03530340067033