Chapter 1. Test1

Introduction

Written by Elaine Cassel, J. D., M. A.

Lord Fairfax Community College

(c) 2013 Worth Publishers (Photo Credit: John Knill / Getty Images)

1.1 Presenting Complaint

Fifty-five-year-old Jerry was sitting in the reception area of the J.J. Hopkins Treatment Center for Alcoholism and Drug Addiction. He could not believe that it had come to this. After all, he didn't have a drinking or a drug problem. His sons just couldn't seem to get into their heads that he was a social drinker, and had been as long as he could remember. But he sure wasn't a problem drinker, an alcoholic, or a drunk—names they had used at one time or another to try to convince him that he needed help.

Jerry only agreed to come because his youngest son Scott, aged 23 years old, was so distraught about Jerry's health. Scott was very close to Jerry, and it was with Scott that Jerry had the best relationship after he and his wife divorced 10 years ago. Jerry, a commercial airline pilot, had lost his FAA license six months ago because he had had a heart attack. Scott, who was in pilot training with the U.S. Navy, idolized Jerry and wanted to follow in his footsteps. In order to regain his FAA license, the doctors told Jerry that he had to lower his cholesterol level, lose weight, and stop smoking and drinking. Smoking was no problem—Jerry gave that up cold. And, he had been taking medication for the cholesterol problem and going to the gym. But he had not lost weight. When Jerry asked the doctor why he was not losing weight, the doctor asked Jerry about his diet. Jerry told the truth—he ate mostly salads and fish (Jerry was a good cook). But of course, Jerry had lied about the amount of alcohol he drank a day. Jerry was consuming about 1500 calories a day in alcohol. While he didn't tell his doctors this fact, Scott knew.

Two weeks before Jerry arrived at the treatment center, Scott had spent a week with his father. Scott watched as Jerry started to drink wine in the middle of the afternoon. By early evening, before dinner, Jerry had finished one bottle of wine and was working on another. Scott liked to drink, too, but couldn’t hold his liquor as well as Jerry could. Jerry drank and drank and never appeared to be intoxicated. After dinner, Jerry would open up the Jack Daniels and start drinking whiskey over ice. Scott watched him night after night as Jerry drank at least three tumblers of whiskey before falling asleep on the couch. Scott got pretty drunk himself and felt lousy in the morning. But Scott was amazed that Jerry never seemed to have a hangover.

Although Jerry had no physical signs of a hangover, he couldn't remember much about the previous evenings. He often asked Scott what they had for dinner and what movie they watched. When Scott told him, Jerry appeared agitated, wondering if he had “early onset Alzheimer's or something.”

One night after Jerry fell asleep, Scott was sitting at Jerry's desk playing solitaire on the computer. His eyes fell on what turned out to be Jerry's FAA medical files. Scott opened the file and started to read. He came to the notes of Jerry’s last FAA physical, two weeks prior. He read the doctor's scrawled note that referenced a question the doctor had asked about Jerry’s drinking. The note said, "Patient says he limits alcohol intake to two drinks a night." There was a reference to Jerry complaining about memory loss and the doctor had written "Alcohol related?"

At the end of Scott's visit, he told his dad he wanted to talk to him. Scott broke down as he faced his father with what he perceived to be a serious drinking problem. "Dad," he said, "I lost you once when you and Mom divorced" (Scott had stayed with his mother and brothers while he finished high school). I don't want to lose you again."

"What in the world are you talking about?" Jerry asked.

"It’s your heart problem—and…you drink an awful lot."

Jerry got defensive and angry, as Scott imagined he would. But Scott persisted. "I want you to get your FAA license back and I want us to be able to fly cross-country together. Drinking as much as you do can't be good for you. You say you can't lose weight, and you don't eat much. Why don't you quit drinking and see if that doesn't help you lose weight?"

"O.K.," Jerry said, “I'll quit for awhile."

That was too easy, Scott thought. When he left, he knew he had gotten nowhere.

A week after Scott returned to the Naval base, he got a call from his mother. Jerry had called her and told her that he had apparently passed out, hit his head on a glass table, and lost consciousness. When he came to, he couldn't remember how he got on the floor. He called an ambulance and was taken to the local hospital. They told him he had passed out from drinking. The ER doctor tried to get more information about Jerry's drinking habits. Did he drink every night? Had he ever had a substance abuse evaluation? Did he think he had a drinking problem? Jerry answered no to all questions.

He had not had a drink for six days after Scott left. Then the night of the accident, he was feeling down. There was nothing to watch on television. He started with the wine, finishing a bottle. He thought he might have drunk some of another bottle, too. Well, he knew he didn't have a drinking problem, but he wasn't getting any closer to getting his license back. His regular doctors, the ER doctor, and his son kept asking him about his drinking. To appease them, and to prove that he didn't have a problem, he was going to check himself into the Hopkins Center. Fred, a golfing buddy, had gone there and told Jerry that it was a piece of cake if you told them what they wanted to hear. It was a nice place, sort of like the Betty Ford Clinic. It ought to be—it cost $10,000 a week.

Jerry signed up for seven days—though they wanted him to commit to 14. He figured seven days would be enough to convince the staff and Scott that he didn't belong there. Once signed up, Jerry called his ex-wife, Lisa. He told her to tell Scott that he was going to get checked out about the drinking, just to show him that he didn't have anything to worry about.

So here Jerry sat. In the reception area of this fancy clinic, that looked more like an upscale hotel, he waited for the clinical director so that he could sign himself in and get this seven-day treatment over with. In fact, Jerry thought, maybe it won't even take the full seven days. He wondered if he could get a refund if they told him he didn't need to be there.

1.2 Social/Family History

Jerry was raised by his mother and stepfather. His biological father left his mother before Jerry was born. During the summer between high school graduation and his first year of college, Jerry went on a search for his father. He found him living in a tiny town in Texas, with a pretty wife, much younger than his dad. His dad, Martin, had never amounted to anything—just as Jerry’s mother assured him would be the case. Martin and his wife, Linda, were happy to have Jerry visit, though to Martin, Jerry wasn't like a son. He was a nice enough kid and they all got to know each other with long talks at night over dinner and wine. Jerry stayed three weeks with them, and though he had never really had much of a taste for alcohol (his mother and step-father were Seventh Day Adventists and did not drink or allow liquor in the house), he found that he like the taste of wine, and even the "hard stuff." He liked the way it loosened him up and made him feel less awkward about barging in on Martin and his wife. All three of them had a good time, drinking, smoking cigarettes, and swapping stories about their lives.

When Jerry left, he kept up with his dad (though he never saw him again) by writing him from college. Jerry entered a state university, pledged a fraternity, and made the junior varsity football team. At his fraternity house, he learned that drinking was as much a part of everyday life as was sleeping, eating, and studying. Jerry could drink a lot, and gained quite a reputation as a guy who could stand down anyone when it came to drinking. On weekend binges, he would be the one who would still be upright and fairly lucid, while the rest would be vomiting, passed out, or hung over.

After graduation from college, Jerry tried out for the Air Force Officer Candidate School, was accepted, did well, and was admitted into pilot training. He had wanted to be a pilot and here was his chance. He didn't want to be just any kind of pilot—he wanted to be a fighter pilot. Though there was no war going on, the men who became fighter pilots were an elite corps. It was at pilot training in the California desert where Jerry made life-long friends. By then Jerry was married, but his wife, Lisa, and the wives of other pilots, were back at home. Pilot training consisted of rigorous classroom settings and demanding flights by day, but at the end of each day the group gathered at the base's Officer's Club bar. They started drinking by 5 pm, and drank into the night, mostly whiskey or gin. For dinner, they usually had sandwiches at the bar—flirting with the women who came in to pick up young officers. They closed down the bar at 10 pm (closing time on weeknights) with nightcaps of cognac and black coffee. Jerry was admired for his stamina. Again, he was without peer in his ability to drink without seeming to be intoxicated.

After serving eight years in the Navy, Jerry landed the job he still had with a major airline. Since he only flew 10 or 12 days a month, he had plenty of time to relax at home. Too much time, in fact. He and Lisa fought all the time. She complained that he did nothing but drink. He told her that she was delusional—all he had was a couple of drinks a night, to keep her from getting on his nerves. Though they stayed married for 15 years, it was an unhappy home. The boys frequently heard them fight; their youngest child Scott was particularly affected by the arguments . Though he was sad when his dad moved out, it was a relief not to hear them fighting at night.

When Jerry moved out of the family home, he bought himself a nice condo nearby. He was well-liked by fellow airline pilots, and he had a series of relationships with flight attendants. But he never had another serious romantic relationship. One astute pilot friend said that Jerry didn't need a girlfriend. He had the best friend a man could have—Jack Daniels whiskey. Freed from Lisa's nagging and the obligation to keep his drinking under control for the sake of the boys, Jerry could cut loose now. He started the pattern, when he wasn't flying, of beginning to drink in early afternoon and drinking the night away. This lifestyle caught up to him when he had his heart attack.

Jerry's first meeting with Marsha, the clinical director, went better than he had expected. She obtained the background of his medical and work history and asked Jerry why he was there. She didn't press Jerry when he minimized his drinking problem. She did surprise Jerry by informing him that a week's stay was hardly worth the bother and if Jerry did not decide to stay beyond a week he would be wasting his money. She left the decision up to him, and he could let her know later.

Marsha gave Jerry the rules of the Hopkins Center. Jerry was shocked to find out that: (1) he had a roommate; (2) he and his roommate had to clean their room daily; (3) he had to help in cooking or serving one meal a day; (4) there was no radio, television, or newspapers allowed and no books except those provided by the center; (5) he would participate in individual and group therapy every day as well as other educational activities dealing with substance abuse; and (6) he could not use the phone or have visitors for the first seven days. She explained that the Hopkins Center used an eclectic treatment approach, but that its foundation was the 12-step model of Alcoholic Anonymous.

This is absurd, Jerry thought. I didn't pay all of this money to be treated like a cross between a child and a prisoner. And what's this about not reading or watching television? He was a news junkie—he had to have his daily paper and cable news. But Jerry reluctantly signed the paper with the rules that Marsha shoved in front of him. If he bailed out now, Scott would never forgive him. And, after all, he was not in a bunker in some war zone. The place was comfortable, even plush.

Marsha told Jerry that he would meet everyone before dinner and after dinner he would attend his first group meeting. "You mean we have to sit around and talk about what drunks we are? Well, I won't have anything to say, since I am not a drunk," Jerry grumbled to Marsha.

Marsha made a note on Jerry's file and smiled, "That's what they all say, Jerry. But most—those who want to stop killing themselves with booze—change their tune." She stood up, signaling to Jerry that their meeting was at an end, told him to follow her and said she would show him to his room.

Jerry had a sinking feeling as he followed Marsha down the spartan hall. What have I gotten myself into, he mused?

1.3 Multiple-Choice Questions