# Alcoholism



## PPCLI MCpl (4 Jul 2005)

A little background:

I have recently been involved in assisting two members of my sub-unit with their drinking problems.   After these brave young lads voluntarily came forward to ask for help, I encountered a confusing process dealing with the CoC, MP's, the MO, the Padre, Bn Duty staff and a few nosey Med A's.   While all these pers meant well, I came to realize that we didn't have a standardized set of procedures to deal with such cases.   On both occasions, these soldiers' frustrated immediate supervisors ended up driving them to a civilian addictions foundation.   Both soldiers then got the help they needed and have since returned and are doing well.   I understand that different cases require different solutions, and that the situation will always dictate, but I believe that there should be some guidelines in place.

These are my questions:
   
1) What is the correct procedure for dealing with troops who come forward voluntarily and ask for help with their addictions?   

2) Who should, and should not, be getting involved in the problem? and

3) Does a soldier have the right to check themselves in to a civilian addictions program?


Any input would be most appreciated.


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## Michael OLeary (4 Jul 2005)

While such cases used to be dealt with principally by the chain of command in cooperation with the medical system, changes to the relationship between the two makes the medical system the lead agency in any cases where treatment is clearly warranted (unless there are clear disciplinary factors which must be settled, during which medical treatment may well continue under the MO's direction). First point of contact should be the MO, who can prescribe a rehabilitation program, or direct other courses of treatment.


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## old medic (4 Jul 2005)

Here are your references:

The Medical Service Instruction (MSI) probably contains most of your answers.

A-AD-D24-001/AG-001, Alcohol Misuse -A Guide for Supervisors in the Canadian Forces

CFAO 19-31 -- MISUSE OF ALCOHOL
http://www.admfincs.forces.gc.ca/admfincs/subjects/cfao/019-31_e.asp



> PROCEDURE
> 
> 6. Members who become concerned about their personal drinking habits are encouraged to seek assistance voluntarily. A member who initially seeks assistance from the CO, chaplain, social work officer, the base alcoholism counsellor (BAC), or other such person should be referred to the unit MO.
> TREATMENT NOT REQUIRED
> ...



MSI CF 1200-101
http://www.forces.gc.ca/health/policies/medServiceInstructions/engraph/msi_cf_1200-101_e.asp


> The CFMS will provide:
> 
> * the chain of command with advice and assistance relating to the management of chemical dependencies and other addictions; and
> * treatment for members with alcoholism, other chemical dependencies, pathological gambling and other addictions.
> ...


Related:

CANFORGEN 092/02.
Medical Directive 4/92
CFMO 08-02
CFMO 29-21
CANFORGEN 026/00

Members should be dealing with the Unit/Base MO and BAC regarding any program. 

<Edit: Just to clarify for those who won't read the links, BAC is Base Addictions Counselor>


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## Chimo (29 Oct 2005)

Congrats to the "immediate supervisors" that took action. I am surprised that they didn't know that the MO should have been the first POC. I am only making a comment not making an attack, I don't know the individuals or rank/experience levels. Well done on doing the right thing. 

It sounds like a good point to bring up at your next unit's NCO PD training.


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## geo (29 Oct 2005)

Hmm... something to add to the Troop leader's aide memoire.


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## rosco (29 Apr 2010)

I need an Administrative guru.

I am the AO for a member with Administrative Action pending for ‘Misuse of Alcohol.’  I have done a lot of research and I have found that this member’s C&P was not properly administered as per CFAO 19-31 (Misuse of Alcohol) and, CANFORGEN 092/02 (Clarification of CFAO 19-31).

In short, the mandatory Medical Referral (as required by the above references) was not conducted for the C&P.  The member is now looking at a ‘Recommendation for Release’ based on a violation of C&P.  The required Medical Referals were conducted for the IC, RW and Recomendation for Release but not the C&P.

My questions is; was the C&P valid and if it is not what is the consequences for the Release?

I have looked into the CFAOs, DAODs and QR&O.  As well as the ‘Grievance Board Decisions’ but I can find no precedent.  Does someone with more TI than me have any experience to share?

I would appreciate restraint regarding comments on this individual’s behaviours.  This is strictly an administrative query.


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## Pusser (29 Apr 2010)

You need to talk to your Command G1/N1/A1 organization.  There should be an officer there who is specifically responsible for this sort of thing.  It may have to be elevated to DGMC(?).  I've seen a number of cases where files were reviewed and "do-overs" were granted because of anomalies in the IC/RW/C&P process.  The bottom line is that the system cannot deviate from the Misuse of Alcohol flowchart.  If someone misses a step, you can't just blunder ahead.  You have to turn around, go back and then follow the right line.  If you don't do this, them member simply goes to the Human Rights Tribunal and gets reinstated with backpay.  If you don't want this to bite you later, you have to correct the previous mistakes and do it right.  

I was involved in a case years ago where a member was on his way out the door when I discovered a few errors in how his case had been handled.  I managed to convince the CO that we had to fix what had gone wrong.  The end result was that the member was allowed to stay in, he sobered up, his marriage came back from the brink of collapse and he went on to become a senior NCO and productive member of the CF.  I don't take credit for all of this because it was the member who had the biggest challenge ahead of him, but it does show that rehabilitation is possible, IF the system follows the correct steps.


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## Occam (29 Apr 2010)

Have you tried the people at DMCARM 5 (aka "Sex, Drugs & Rock 'n roll"), as the last para of the CANFORGEN suggests?

Additionally, this DWAN link will bring you to several documents related to Misuse of Alcohol.  The link for the aide-memoire contains the following:

_In order to facilitate the administrative review process, unit must take the following actions:
- Take admin action every time there is a Misuse of alcohol (MoA).
- *Send member for medical assessment after every incident related to alcohol and document that you have done so*.
- Examine member’s Pers File for all applicable information concerning MoA.
- Assemble copies of all applicable info.
- Summarize all information and make a recommendation for either Release or Retention. Documented substantiation supporting the CO’s recommendation is required by DMCARM.
- Send all info to DMCARM 5-4_


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## rosco (29 Apr 2010)

Pusser - Thanks for the reply.  That is what I thought.  The file is at DGMC and I put the ‘Administrative Error’ forefront in the member’s representation.  I am hoping this will buy one more chance for this individual to turn things around.

Occam – Thanks for the link.  I did find that aide-memoire and used it as a reference in the representation.  I appreciate the help. DMCARM was not too helpful.  They told me that the matter was a part of the Administrative Review and that I had to wait for that decision.  Fair enough I suppose.

My biggest question is, due to the error, what are the chances this member will be retained?  I am trying to anticipate the next bound which would involve a Redress of Grievance based on the ‘Administrative Error.’


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## Pusser (29 Apr 2010)

Frankly, retention is a bit of a crap shoot.  Much of it depends on Chain of Command support.  DMCARM will take the CO's recommendations very seriously.  Another thing to keep in mind is his overall performance.  A solid performer who gets in trouble when he drinks too much will be lookded at differently than an all round waste of rations who drinks too much.  Other factors include how much he/she embarrasses the organization or if whether their actions while drunk were over ther top.  

I know of another case where a junior officer (who was drunk) punched out a subordinate.  he was tried, found guilty, fined and then promoted!  Everyone swore up and down that the previous incident was out of character and that it would never happen again.  The next time it did hapen (when he was then a senior officer), you could feel the wind of the paper moving to administratively release him.


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## Eye In The Sky (29 Apr 2010)

Aside from the issue of if the C & P was administered properly, another thought comes to mind.

If the mb you are talking about wants to stay in the CF...and obviously has trouble with alcohol, I'd say one of the best things he/she can do at this point is get in contact with the Addictions folks at the mbr's CFHS location.  Seriously.

I'd say the CO will take note of that.  It might be "too little, too late"...it might not.  Either way, this person needs treatment and that is the place to go.


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## McG (29 Apr 2010)

Occam said:
			
		

> DMCARM





			
				rossco said:
			
		

> DMCARM


There is no DMCARM.  DMCA it is.



			
				rossco said:
			
		

> My biggest question is, due to the error, what are the chances this member will be retained?


There are a lot of factors at play, and an administrative oversight is only one.  Without getting into the details of your case (and we should not get into those details here), you will only get vague speculation here.


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## Occam (29 Apr 2010)

MCG said:
			
		

> There is no DMCARM.  DMCA it is.



Well, I'll be damned.  Just when you thought you had the organization nailed down after 20-odd years...

http://www.forces.gc.ca/site/commun/ml-fe/article-eng.asp?id=4347

I wonder how many person/years of work that renaming process took?


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## George Wallace (29 Apr 2010)

It all comes with the broken links and "Common Look".


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## PMedMoe (30 Apr 2010)

George Wallace said:
			
		

> It all comes with the *broken links*



Those broken links drive me batty!!


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## gunnars (25 May 2010)

I am interested that a social worker was not involved. In my opinion, a social worker would be the best professional to advocate for the best method of treatment based on individual needs and desires. Addictions is an area of such fine tuned expertise that outside resources may be the best possible option to assist is successful outcomes. What led me to applying to the military was literally stumbling into addictions counseling in my profession that led me to be linked to the CF. I provided many a crash course on the variouus methods of treatment for the addiction at hand and I encouraged critical thinking on the behalf of the client and the superiors to determine which treatment would be best for the client and the circumstances. Like with opiate addictions, methadone treatment is controversial in the CF because methadone keeps the individual fuctionally high, is this the person you want to be holding a gun beside you? But methadone treatment is very successful in the civillian population. 

Basically, I do not think that a set standard of practice can be established but it should be encouraged in the health professions to stay up to date on standards of best practice and basic screening methods (screening takes 5 minutes.... it simply determines if there could be a cause for concern)

Finally, congrats to the member to be proactive in their health!


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## captloadie (26 May 2010)

If the error was that he was not referred "this time" to the MO, you might need to investigate the results of previous referrals. If he has been through the program before, and was not successful for all three phases, it will be as previously stated, a crap shoot with DMCA. It is sad to say though that in this day and age, a CO (or his adjutant who is doing the paperwork), does know the process for issuing a C&P, especially for alcohol related issues. In the several cases I have been involved with, we always do a thorough review of a member's files before issuing C&P to ensure the member can be briefed on the specific consequences to him/her, and not just the standard "if you screw up on C&P your out on your a**".


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## clericalchronicals (3 Feb 2011)

I'm kind of surprised to not see anything here about the new DAOD on Misuse of Alcohol.  Any thoughts?


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## reccecrewman (15 Aug 2014)

Just curious as I have zero knowledge on the subject of alcohol misuse from my career - if a member voluntarily comes forward and says "I have a bad drinking problem, can I get help?" Is that individual going to be on the receiving end of disciplinary action? Let's suppose his drinking has never interfered with his work performance, he just finds he spends his evenings after work whetting his whistle and wants to get treatment to stop the drinking BEFORE it turns into an issue at work. Or would this be a supervisory call? (ie - His immediate C o C likes or dislikes him, and this becomes an easy way to nail him to the wall)


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## Eye In The Sky (15 Aug 2014)

The CofC doesn't have to be involved at all.  Tell the mbr to go to the Base Hospital, and talk to a MO.  The correct bouncing of the ball should start from there.

Seriously.  This is a medical issue at this point.  The mbr could only expect the treatment he/she needs (and at the appropriate *level*) IF...IF...they are honest with the CF Health Svcs staff they speak to about the amount of/frequency of drinking they actually do.  As the mbr is looking to self-refer, I assume they are going in with the right mindset.  Honesty is the key.


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## George Wallace (15 Aug 2014)

reccecrewman said:
			
		

> Just curious as I have zero knowledge on the subject of alcohol misuse from my career - if a member voluntarily comes forward and says "I have a bad drinking problem, can I get help?" Is that individual going to be on the receiving end of disciplinary action? Let's suppose his drinking has never interfered with his work performance, he just finds he spends his evenings after work whetting his whistle and wants to get treatment to stop the drinking BEFORE it turns into an issue at work. Or would this be a supervisory call? (ie - His immediate C o C likes or dislikes him, and this becomes an easy way to nail him to the wall)



I would tend to agree with Eye In The Sky.

It only becomes a disciplinary issue if the individual is charged for inappropriate actions they took under the influence of alcohol, or any other substance abuse.


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## reccecrewman (15 Aug 2014)

Thanks Eye in the Sky & George.  I'm out now, but that's good info to know as I still have plenty of still serving friends. However, Eye in the Sky brought another question to mind that got me thinking.  If alcoholism is considered a medical issue, it makes me wonder if a diagnosed alcoholic would be able to apply to VAC for a pension for alcoholism.  Before you blow me off or laugh at me, consider this;  

Many people join the Military as 18 or 19 year old kids.  They do a full physical upon entry and SHOULD have a clean bill of health.  Now, perhaps my argument here isn't as relevant for today's still serving members as the Army has changed greatly over the years, BUT, lets use the older soldiers and Veterans as my examples.  Right up until the early 2000's, drinking alcohol in the Army was, for the most part, expected of soldiers.  Especially as one climbed the ranks.  The Snr NCO's & Officers Mess regularly has Mess functions and such that soldiers are/were expected to attend (and, drink); Beer calls after work, the Officer's are required to show up to the Mess Friday after work; Smokers after/during FTX.... these are just a few examples of how the Army (I'm using the Army here as that is were my familiarity is) took alcohol and it was etched into the Army culture.

Now, turn around and couple the Army drinking culture with the horrors soldiers endure on operations; I've seen the booze flow freely overseas despite the two beer per soldier rule, the underground railroad inevitably gets on track shortly after each rotation changes hands and the troops find ways to get their booze.  Soldiers come home and many turn to alcohol to blot out the images seared into their minds.  As years progress, some drink more and more and next thing you know, you have a full blown alcoholic on your hands.

Now, don't get me wrong, no one is holding a gun to soldiers heads saying "drink!".  We all choose to drink or not drink, but there was considerable pressure on soldiers TO drink in the years past and get into the old boys club.  Chats about subordinates, courses, postings and such have all echoed off the walls of the Snr. NCO's and Officer's Messes as the liquor flowed freely. 

I'm just throwing this out there as food for thought.  By no way would I expect a soldier/Veteran to receive a 5/5th pension from VAC for alcoholism, but 2/5 or 3/5, by my opinion, shouldn't be out of the question. (I'm no VAC adjudicator, I just used those percentages as hypothetical) An approved pension needs 1) A confirmed diagnosis - which alcoholism is by medical definition, and 2) A link to Military service, which, I think anyway, that I have illustrated that a Veteran COULD argue a valid case against VRAB if he had a diagnosis of alcoholism.  I especially think this would be important if a Veteran had no other pensions from VAC, or, if he did, he was only an A client and therefore, only entitled to VAC coverage for his pensioned condition.  If he had even a 2/5 pension, he would still have ENTITLEMENT on his file for the pensioned condition of alcoholism, and thus, guaranteed coverage after he left the service if he happened to fall off the wagon and wanted to seek rehabilitation services.

I apologize now, as I didn't mean to hijack PPCLI WO's original post.  Eye in the Sky just got my mind going.


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## Eye In The Sky (15 Aug 2014)

Alcohol can be addictive, addictions = medical issue.

I remember the days when "supporting The Mess" happened regularly and in cases, not 'optional' like it is today.  That has been both good, and bad, in different ways.

I have no valuable input WRT to you post from a medical or policy application side, however as a guy who has been in awhile and seen things change over a few decades, I can see where you are coming from and think there is some merit in what you said.  Sure, everyone makes the choice to tip the bottle or not...in reality, that is not the ONLY factor though.  Peer pressure, self medicating, etc come to mind.  Cultural expectations/norms.


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## dapaterson (15 Aug 2014)

Well, VRAB has a case where gonhorrea was pensionable, so who knows?


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## StaffGuy (20 Jul 2016)

Hope this is not considered as hijacking this thread, but here's my situation vis-à-vis alcohol....

1. July 2015 - got very drunk at a work-related social function, at the mess, where I went into blackout drive conducted myself very poorly. First such offence (or any offence, for that matter) in my 12 years in the CAF. Investigation launched, which took a ridiculous length of time (see below).

2. May 2016 - placed on RW for conduct ,backdated to Jan 2016, as it was recognized that I had been on a very short leash for 10 months already. Medical referral issued, go see the doc who in turn refers me to addictions counsellor for assessment for alcoholism.

3. Also May 2016 - finally charged with drunkenness, summary trial, admit to all particulars, guilty.

4. July 2016 - RW successfully completed on 18 Jul. On same day, I finally get in to see the addictions person. Her conclusion is that I had a binge drinking (behavioural) problem, not an alcohol dependency. I say "had", because it's been a year that I don't drink to blackout point anymore - ever. I learned a hard lesson, but a very good one. She agrees, and says not treatment required, but would like to follow up in 3 months. No problem. HOWEVER, the doc disagrees, wants to put me on a 6-month TCAT, whereby I'm must completely abstain from alcohol, with regular follow up (every 2 weeks) and regular piss tests. Addictions counsellor thinks this is draconian and not required, but her hands are tied. I am not upset about not drinking for 6 months (although it kinda sucks), but it's now like I'm being 'punished' a third time for this (yes, I get the diff between disc, admin, and medical, but you get my point...), for something that happened over a year ago and has not re-occurred. Not to mention the fact that I'm in Ottawa, so every trip to Montfort eats up half a work-day that I have to somehow make up.

MY QUESTION - does a doc have the authority to order me to piss in a cup on a regular basis as part of 'medical treatment/observation' as condition for lifting a TCAT for (presumably) alcohol dependency (which in itself contradicts the expert opinion)? May not be an answer out there, but I know there are a lot of smart/experienced people here.


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## ModlrMike (20 Jul 2016)

Stuck_in_a_Cubicle said:
			
		

> MY QUESTION - does a doc have the authority to order me to piss in a cup on a regular basis as part of 'medical treatment/observation' as condition for lifting a TCAT for (presumably) alcohol dependency (which in itself contradicts the expert opinion)? May not be an answer out there, but I know there are a lot of smart/experienced people here.



Yes. The Medical Officer has absolute discretion to award a T-Cat after taking ALL of the recommendations into account. I suggest that you read DAOD 5019-7. Part 8 answers your question. The remaining parts bear keeping in mind.


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## StaffGuy (20 Jul 2016)

ModlrMike,

Thanks for the reply. I had already read the DAOD. Not 100% sure what you mean by "Part 8", as it's not numbered (at least on the version I'm looking at on the DWAN), but I assume you mean the section entitled "Treatment and Rehabilitation".

Ack that the doc has final auth on TCAT, treatment, etc. I was really just questioning his auth to piss test someone, which would be categorized as "control testing" (compliance) which is normally associated with Administrative Action (IAW DAOD 5019-3), whereas abstention from alcohol and regular counselling sessions is prescribed medical treatment.


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## ModlrMike (20 Jul 2016)

Two points:

a. the command to submit to testing is not manifestly unlawful; and
b. confirming that the member is compliant with treatment falls well within the very broad scope of the MO's responsibility and authority. Mechanisms to ensure same also do.


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## Eye In The Sky (20 Jul 2016)

I'm more concerned with the amount of time it took for your CofC to direct the medical referral and the RMs in the form of your RW, which they seemed to link together.


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## StaffGuy (20 Jul 2016)

Eye in the Sky - yeah, the whole process was long and ridiculous, but that's behind me and I'm not fighting something that's already in the past. What irks me is that the alcohol-related conduct (binge drinking at a work social event with adverse behaviour) was over a year ago, was the first such incident, and has not recurred. More importantly, an addictions expert has assessed that I don't have an alcohol dependency. What more 'proof' do they need that I have this behavioural problem under control?

ModlrMike - you're right, it's not manifestly unlawful, but in the case of drug testing it is DAOD 5019-3 that outlines when and how you can do it (cause, control, blind, safety, etc), based on QR&Os, and that is what provides the specific authority to do it, and if you don't do it IAW those guidelines you have no leg to stand on. I just can't find a similar regulation, order or directive that authorizes a doc or anyone to test for alcohol consumption (note that alcohol is specifically excluded from DAOD 5019-3).


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## ModlrMike (20 Jul 2016)

Stuck_in_a_Cubicle said:
			
		

> Eye in the Sky - yeah, the whole process was long and ridiculous, but that's behind me and I'm not fighting something that's already in the past. What irks me is that the alcohol-related conduct (binge drinking at a work social event with adverse behaviour) was over a year ago, was the first such incident, and has not recurred. More importantly, an addictions expert has assessed that I don't have an alcohol dependency. What more 'proof' do they need that I have this behavioural problem under control?
> 
> ModlrMike - you're right, it's not manifestly unlawful, but in the case of drug testing it is DAOD 5019-3 that outlines when and how you can do it (cause, control, blind, safety, etc), based on QR&Os, and that is what provides the specific authority to do it, and if you don't do it IAW those guidelines you have no leg to stand on. I just can't find a similar regulation, order or directive that authorizes a doc or anyone to test for alcohol consumption (note that alcohol is specifically excluded from DAOD 5019-3).



Stop tying yourself up in knots. Take the high road - "I'm not sure how I feel about this testing, but I'll do it to show that I'm holding up my end of the bargain." To do otherwise might make people think you have something to hide.

I know that it would energize my spidy senses if you were my patient and challenged a request for testing.


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## StaffGuy (21 Jul 2016)

Tying myself up in knots? I'm simply trying to understand a process with which I am largely unfamiliar, instead of being a pinball bouncing around in the blind. Isn't the point of this forum to have intelligent and facts-based discussion?

Of course I'll take the high road and comply with whatever I'm told to do (as I always do), even if I think his decision is unjustified based on all the other facts. 

As for bargains, I was ordered (both verbally by my CoC, and via remedial measure) to refrain from drinking excessively and conducting myself poorly - I have kept that bargain for over a year, and will continue to do so. I don't understand why this guy thinks a new 'bargain' is required, but I do understand that it's his prerogative to make that conclusion - doesn't mean I have to like it.


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## StaffGuy (22 Jul 2016)

Just thought I'd close the loop on my part of this discussion. The MO ended up re-considering and is happy with me following up on my own with the addictions counsellor every few months. My mission remains to never put myself in a similar situation again. All's well that ends well.


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## PuckChaser (22 Jul 2016)

Stuck_in_a_Cubicle said:
			
		

> My mission remains to never put myself in a similar situation again. All's well that ends well.



Glad it all worked out for you in the end. We all %$@ up sometimes, but it takes a real professional to admit you did it, and take those visible and hard steps to fix it, especially with the stigma of alcoholism (albeit yours was an isolated incident).


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