Pulse
The Dear Abby of Addiction
A retired Mayo Clinic psychiatrist answers questions and dispels myths about alcoholism and drug dependence.
Dear Dr. Bob:
How long does drinking go on before alcoholism occurs? Since becoming unemployed one month ago, my mother has been drinking in the morning and all day. Has she been alcoholic all along?
“It is not uncommon for someone to drink ‘socially’ for a number of years before showing signs of this disease,” writes Robert Morse, M.D., who calls the question a “very good one that touches on a number of key alcoholism concepts.”
Morse, who directed Mayo Clinic’s addictive disorders services until he retired in 1999 and has chaired the National Council on Alcoholism and Drug Dependence’s (NCADD’s) medical and scientific committee, goes on to explain how alcoholism develops over time and that it’s not uncommon for someone to drink socially for years before becoming addicted.
As “Dr. Bob,” Morse has become the Dear Abby of addiction. Every month for the past six years, he has written an online column for NCADD’s Web site (www.ncadd.org/facts/askbob.html), fielding questions from the public about how to tell whether someone might have alcoholism, what alcohol does to the body and mind, and what can be done to help someone whose drinking is out of control. “In spite of the education we’ve done nationally, most people don’t understand the fact that addicts and alcoholics in particular don’t know that they have the disorder. They deny it and blame others. Families don’t know how to handle it,” the 72-year-old psychiatrist explains.
Dispelling the myths about alcoholism has become a mission for Morse, who says people continue to think of it as a personal weakness rather than a disease. “The fun part for me has been trying to educate as I go along. For example, if someone says, ‘My husband drinks a case of beer or two on the weekends but doesn’t drink during the week, could he be an alcoholic?’ it gives me an opportunity to talk about how alcoholism isn’t a matter of whether you can stop drinking from time to time but whether you can drink normally once you start. It gives me a chance to ask about other symptoms—Does he hide his drinking? Does he get defensive? Does he have blackouts?”
Morse injects what NCADD board chair David Lewis, M.D., calls a dose of “earthy, good humor.” For example, in answering a touchy question about whether sexual dysfunction could be related to alcohol consumption, Morse quotes Shakespeare—“Alcohol provokes the desire but takes away the performance”—before giving a scientific answer that’s easy to understand.
“I think it’s very difficult sometimes to present scientific or medical information relative to alcoholism that doesn’t put you to sleep,” says Ames Sweet, director of communications for the NCADD. “He has been able to find a way of blending the information with the compassion that he has and the experience that he has in the addictions field.”
‘Timing Is Everything’
Morse, who grew up in International Falls, Minnesota, near the Canadian border and still spends his summers fishing, canoeing, playing golf, and enjoying the cabin he and his wife own on Rainy Lake, never planned on a career in addiction psychiatry. In fact, he’s watched the field develop in much the same way he’s witnessed physicians’ understanding of the neurobiology of alcohol addiction take shape.
A graduate of the University of Minnesota Medical School, Morse took a job as a psychiatrist at the Mental Health Center in Rochester in 1966 after finishing his residency at Mayo Clinic. “It was around the time people started getting interested in alcoholism,” he explains. “It [addiction medicine] was an evolving subspecialty of psychiatry that started with alcoholism and branched out into other addictions.” The Mental Health Center’s administration wanted Morse to create a program for treating alcoholism. “A little against my will, I decided to try it,” he explains.
Morse developed the program with a couple of counselors who happened to be recovering alcoholics themselves. “Lo and behold, a few people got well, and I got interested in this field,” he says. Two years later, Mayo Clinic recruited him to the Department of Psychiatry and eventually he started an inpatient unit for treating patients with alcohol addiction. That led to his directing the addictive disorders service, which included the inpatient unit, an outpatient unit, and a fellowship in addiction psychiatry. “Timing is everything,” he explains, downplaying his accomplishments. “I happened to get into this on the crest of the wave.”
Through his work with the NCADD, Morse helped write one of the first definitions of alcoholism that acknowledged the role denial played in the disease. That definition was published in the Journal of the American Medical Association in 1992. “We heard from teachers in the field when our definition was published that it was very helpful in teaching professionals about the disorder,” he recalls.
Still, Morse laments the fact that the public still has a long way to go in terms of understanding the disease. “Lay people continue to misunderstand it,” he says.
No Question’s Too Hard
And that’s one reason why Morse plans to continue as Dr. Bob. Another is that he likes the fact that writing the column forces him to stay up on the latest research and allows him to explore some of the little-known consequences of alcoholism.
For example, one of the more unusual questions he’s received came from someone who wanted to know about the effects of alcohol on the spinal cord. “You wonder if that came from a graduate student,” Morse says with a chuckle.
Morse found a number of references in the medical literature to spinal cord injuries caused by alcohol-related accidents and a couple of unusual conditions in which alcohol directly affects the spinal cord or the peripheral nerves. Myelopathy, for example, can be caused by liver disease or folate deficiency, both of which may be alcohol-related.
Another writer wanted to know about a compound called RU-21, which was being touted for its potential to prevent hangovers and reduce liver damage. “It turns out it was not so,” Morse says.
One other question came from a writer who was caught driving with a blood alcohol level that was over the limit and wanted to know if having a thyroid disorder could affect the way the body metabolizes alcohol. In other words, could thyroid disease have slowed the driver’s metabolism of alcohol enough to keep his blood alcohol level higher than anyone would have predicted, given his intake? “I think he had a good attorney who was maybe going to use that,” Morse says. After finding nothing in the literature on the topic, he went to one of the drug lab experts at Mayo, who also hadn’t heard that. “Eventually, we had to say there was no evidence as far as we knew that this could take place. But it’s one of those things that keeps you stimulated and interested.”
Morse says such intellectual stimulation plus the ongoing hope that education will “push people in the right direction” and help them recover are the rewards he gets from the job. But he admits one frustration: not knowing what happens to the people who write to him.
That, however, won’t deter him from continuing to answer the questions that need answering. “It’s a labor of love,” he says of the column. —Kim Kiser