From the NY Times of October 19, 1894:
“Alcoholism in the Army.
WASHINGTON, Oct. 19., 1894.
Alcoholism is on the increase in the army, according to Dr. R. Smith, Surgeon at Governors Island" who reports that several thousand days' labor was lost on this account by troops in the Department of the East this year. Alcoholism comprises a large percentage of the disabilities of the soldier. Fort Porter, N.Y, and Newport Barracks. Ky., give the greatest proportion of disability from effects of alcohol, a trifle more than 100 cases per thousand of mean strength. The Surgeon makes a suggestion which may be taken up by the War Department.
He says: "It ...certainly would be naught but justice were there a difference between the pay and allowance of those suffering from the effects of alcohol during the time they are unable to perform their duty in consequence of such causes and the pay of the soldier who has lost no time from disease or who has lost time only for causes tor which he is not responsible through his own self-indulgence and misconduct.”
This commentary from 123 years ago emphasizes the enduring difficulty of segregating personal responsibility from compulsion. It may never be resolved, for the reason that there is an element of accountability in both the progress of addiction as well as in recovery from it. While it is consoling to our patients to understand that not all of the consequences of addiction, of specifically alcoholism in this example, are the result of misconduct, a diagnosis of addiction is not exculpatory of all accountability. With examples such as malaria and famine-associated nutritional deficits apart, the most prevalent illnesses, whether obesity devolving into diabetes, heart disease, or skin cancer tend to begin with neglect or a bad decision. There is little defense in behaving otherwise. In fact, it may be paradoxically empowering to understand one's own role in illness propagation. Those ill may come to understand that they preserve some elements of authority, most notably in seeking help once aware of the illness.
Editor-in-Chief: William Haning, MD, DFAPA, DFASAM