in New York City struggling with addiction. Augusten had a difficult childhood.
His parents divorced when he was young resulting in him living with his
mentally disturbed mother's psychiatrist. While his father was a drunk who
was physically abusive, the psychiatrist's home was no safe haven either.
psychiatrist's older, male patients, Neil Bookman, who was also adopted by
this family. What's more disturbing is that after the initial encounters,
there was little supervision and much dysfunction in the family system,
Augusten was able to drink and smoke marijuana on a regular basis by high
school.
At 17, Augusten left his adopted family. He only had earned his GED.
He traveled to New York City and somehow managed to obtain a good job as
spin out of control with alcohol; many times waking up still drunk and late for
work. His co-worker Greer, who often covers for him, gets fed up finally when
Dewar's. His tactics of brushing his teeth then spraying his tongue with
This final meeting that was missed was the last straw. His Boss and co-
fired or checking into an inpatient rehab. Considering his options, he opts for
rehab in order to maintain his career. They allow him to attend the facility of
Minnesota called the Proud Institute. Augusten is thinking that a gay rehab
center will be like having a luxurious spa experience and starts fantasizing
about what is to come. Much to his surprise, the Proud Institute is very bare
doing everything he was told to do but his best friend "Pighead", who has
resuming his alcohol abuse and adding the use of crack. He wallows in this
for quite some time before he receives a strange gift; a gold pighead from
Pighead. This gift from the grave awakens Augusten and he is back on the
sobriety wagon.
b. Personal reactions
I'm familiar with Augusten's memoir Running With Scissors (prequel to
150 pages a week. That would mean it would have taken me two weeks to
read the entire book, then a few weeks to work on the write up. Silly me. I
was taken captive by this book and finished it in three sittings; most of which
were late at night and I fell asleep with the book on my chest because I could
What I liked and disliked the most about Augusten turned out to be the
same trait. In the beginning of the book he was aloof but in a cool way and
spoke of his fashion, which I'm very interested in as well. As the book
become shockingly clear. The way he spoke of Foster's physique and his
treatment of Pighead at times are just a couple examples that turned me off.
Other than the fact Augusten had to take mass quantities of Benydryl
immersed in the story that I wept. In this moment, the book had really done
its job. I think art is to evoke emotion. At least, good art will do that. I loved
that last gift from Pighead as well. It was perfection. I'm extremely glad I got
to experience this book, as I found I'm an Augusten myself. The ending was
written great. I was left wanting for more. I was left wondering about his long
term recovery though. The story was left with the sun shining but often times
in recovery, it doesn't stay shining forever. In reality, I'm not sure a gift from
has roots in a person's biology, DNA, and also some environmental factors
Psychoactive Drugs:
disease states and not desired conditions. (Roy & Miller 2010)
Dry & the Disease Model of Addiction 6
Disease Concept of Alcoholism. This stated alcoholism was not a disease but
"like a disease" (Davis & van Wormer, p. 89). Jellinek categorized 5 types of
diseases (Davis & van Wormer, p.88). The two considered were called
consider Augusten.
look back to the overview of Dry, Augusten's father had a very serious issue
with alcohol himself. Augusten recounts an episode when he was a child and
had to jump out of the car because he was driving drunk and threatening to
crash the car. When noticing a scar on his nose, Augusten tells of his
Augusten also has no control over his drinking. In the beginning of his
memoir he writes about going out to Cedar Tavern with his drinking buddy
Jim the night before a 9 a.m. business meeting. He had planned on being
home at 12:30 a.m.but instead got taken over and went bar hopping until
4:30 a.m. rolled around. This is the incidence out of a few we read of
showed this when after recovery he began drinking again and also became
Dry & the Disease Model of Addiction 7
development, and with habitual use, his brain became progressively more
chemically dependent. His brain chemistry had changed such that he was
b. Treatment goal
The treatment goal of the disease model of addiction is abstinence.
The belief is that is one cannot control their intake of the misused substance,
they must not have interaction with it at all. Users must abstain to stop the
process is complete, total abstinence from all drugs and alcohol is expected.
feelings, share personal experiences, and help get them used to asking for
Augusten's experience with treatment was based off the disease model
prevent shock from withdrawal. He had a short period of detox then was
required to be clean the rest of his stay in the rehab facility. Sobriety was
carry the bottle into the bathroom. I hold it up to the light. See the pretty
bottle? Isn't it beautiful? Yes, it's beautiful. I unscrew the cap and pour it into
the toilet. I flush twice. And then I think, why did I flush twice? The answer, is
Dry & the Disease Model of Addiction 8
drink from the toilet, like a dog. (p.98) Repetition is constant in the facility.
handle the emotional stress and went back to the only thing he knew could
control his feelings; Alcohol and a new friend, Crack. After two years of rock
"It's just so fucking uncomfortable."I nod. "I know, I get like that. I get
where I feel like I'm gonna drink anyway, eventually. So I might as well
do it now. It's awful. Sometimes I feel like I have hives in my brain that
I can't scratch." "What do you do" Jim asks, very hungry for the
you hate them or if you feel stupid or you just don't want to go. The
thing is, if you go to a meeting, you won't drink that day." (p.293)
c. Treatment strategy
According to Davis and van Wormer, before the founding of Alcoholics
Anonymous,
treatment for alcoholics was not well developed, they were "hospitalized,
were usually locked
Dry & the Disease Model of Addiction 9
Bill W. and Dr. Bob adopted the principles of the movement and,
course, Bill W. codified the central principles into Twelve Steps. The
and/or addict. The primary focus is on the chemical dependency and not so
and some kind of therapy, whether group or individual. AA has its members
admit to being powerless over their disease and promotes peer support
consequences of using.
his experiences with his addiction. At first Augusten was incredibly resistant
Dry & the Disease Model of Addiction 10
to treatment. He did not want to open up to his peers and felt that treatment
was juvenile. I sit there and think how it isn't fair that I can't drink at all,
into a decade of hard-core drinking and that is why. I blew my wad. (p. 223)
Thoughts like these and being appalled by rituals like "Monkey Wonkey time"
Augusten seemed to give into the process when he was asked to get
up in front of group and write down his using history. As he stepped back and
order to abuse alcohol, he saw himself in a new light. "'I guess I drink a lot.' I
feel ashamed, like I wear the same pair of under for days at a time."(p.57)
His guards seemed to come down and he began actively participating in his
sees the kind of consequences that have come from being a user, i.e. his
d. Advantages
There are many advantages to the disease model of addiction. Before
weakness. When this model started to gain some acceptance it removed that
stigma. It also removed guilt and shame related to having "moral weakness"
since it was being legitimized as a disease. The treatment goal is clear and
communication is key.
provided that for him. Although he was resistant at first, he gave in to the
abstain from any use. AA also provided peer support for him. He seemed
knew where active users (until Jim was sober in the end). This was a place
where he could go and relate to other people and not be judged. Augusten
wrote of AA meetings:
strangers getting together in rooms at all hours and saying things that
right away, with everyone. It's like some sort of love affair, stripped of
e. Disadvantages
There are some disadvantages to the disease model. It is thought that
this model removes personal responsibility for their addiction, and thus may
nothing approach is simple but can scare off individuals potentially seeking
help. Abstinence may not be something the individual can maintain; since it
to the task. The individual may not want to think that they are plagued
catapulted into sobriety and the idea of being chronically diseased. Many
References
McLellan AT, Lewis DC, OBrien CP, and Kleber HD. Drug dependence, a
chronic medical illness: Implications for treatment, insurance, and
outcomes evaluation. JAMA 284(13):1689-1695, 2000.
Roy, K., & Miller, M. (2010). Parity and the medicalization of addiction
treatmentdagger]. Journal of Psychoactive Drugs, 42(2), 115-20.
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