A sobering letter that can prevent a lifetime of misery

VANDERBILT UNIVERSITY
MEDICAL CENTER
NASHVILLE, TENNESSEE, 37232
Primary Care Center
Division of General Internal Medicine

PERSONAL AND CONFIDENTIAL

John Doe
Vanderbilt University
Nashville, Tennessee

Dear John:

At the request of your grandfather, Jack Doe, I am writing you as his physician and a close personal friend. All of the grandchildren of college age in your family will be receiving this letter, and I would appreciate hearing your thoughts on this matter.

As you know, your grandfather is recovering from alcoholism. He is doing extremely well, and we are all grateful that he has received treatment and is maintaining an active role in Alcoholics Anonymous.

You may well be asking, "What does this have to do with me?" I want to alert you to the fact that heredity plays a strong role in the development of alcoholism. It is thought that the majority of our nation's 18 million alcoholics come from families with an inherited tendency, and recent medical research has supplied compelling evidence for this claim. In one patient sub-group study, sons of alcoholic fathers adopted at birth had a 9 to 1 chance of developing an addiction over children adopted at birth from nonalcoholic fathers. The transmission from mother to daughter stood at 3 to 1. These extraordinary statistics are supported by the personal experience of alcoholism counselors, and at any meeting of Alcoholics Anonymous, it is likely that between 60 to 80 percent of those present have relatives (fathers, mothers, brothers, sisters, aunts, uncles, grandparents) who are alcoholics.

The evidence in your own family is equally striking. Joseph Doe, born in 1861 and the brother of your great grandfather, was an alcoholic. Philip Doe, your uncle, is also an alcoholic. And of course your grandfather is now recovering from the same disorder.

Perhaps you are wondering what we mean by "alcoholic."

Here it is important to distinguish between alcohol abuse and alcohol addiction. The alcohol abuser frequently drinks to intoxication and may suffer painful consequences from his excessive consumption. However, he can still choose when he drinks, how much he drinks, and if he drinks. The alcohol addict on the other hand is no longer in control of his own will, and he can not predict when or how much he will drink. He continues to drink even after alcohol is causing him serious problems with family, health, jobs, and finances, and he begins to organize his entire life around his need for a drink. Some of the symptoms of alcohol addiction include guilt and shame about drinking, increased anxiety, marriage problems, blackouts (periods of time when the drinker functions normally but later does not remember what he did), increasing consumption, preoccupation with drinking, and extreme mood swings.

I am writing this letter to inform you that, like your brothers, sisters, and cousins, you may have an inherited tendency towards addiction. Drinking alcoholic beverages is likely to be hazardous to your health, and repeated heavy drinking may lead you unawares into alcoholism. I trust that you will take this warning seriously, and that you will make an appropriate decision regarding your own drinking habits. If you have any questions or would like further information, please feel free to write or call.

We love you very much and desire for you happy, productive lives. You come from a distinguished family, and I am certain that you will make a unique contribution with your life. Please consider this letter a part of your education, and I look forward to meeting you one day.

Sincerely,

Anderson Spickard, Jr., M.D.
Professor of Medicine
Medical Director
Vanderbilt Institute for Treatment of Alcoholism