Anda di halaman 1dari 12

Dry & the Disease Model of Addiction 1

Dry & the Disease Model of Addiction


Holly Gerard
University of Maine at Augusta
PSY229
Professor John O'Brien
June 2013
Dry & the Disease Model of Addiction 2

I. Part One: Overview


a. Introduction
Dry by Augusten Burroughs is the memoir of a homosexual male living

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.

Augusten describes accounts of being sexual abused by one of the

psychiatrist's older, male patients, Neil Bookman, who was also adopted by

this family. What's more disturbing is that after the initial encounters,

Augusten begins to take some comfort in this unhealthy relationship. Since

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

a copywriter for an advertising agency. During this time, Augusten's

addiction to alcohol and casual use of cocaine is progressing. He begins to

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

he misses an important client meeting and shows up smelling of his favorite

Dewar's. His tactics of brushing his teeth then spraying his tongue with

expensive cologne were in vain.


Dry & the Disease Model of Addiction 3

This final meeting that was missed was the last straw. His Boss and co-

workers decide to have an intervention. He is given an ultimatum of being

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

his choosing. He remembers someone had told him of a gay rehab in

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

bones. He partakes in his treatment with much reluctance.

When Augusten returns to home, he immerses himself in work and

outpatient treatment. He also attends A.A. meetings on the regular. He is

doing everything he was told to do but his best friend "Pighead", who has

AIDS, becomes very ill and dies. Meanwhile, Augusten is involved in an

unhealthy relationship with a crack-addicted man from his group therapy

treatment. These events lead to Augusten spiraling out of control and

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

Dry), which recounts his turbulent childhood with his mentally-disturbed,

bohemian mother and unethical psychiatrist, so I knew I'd be in for an


Dry & the Disease Model of Addiction 4

interesting read. I had actually originally planned on pacing my reading 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

not put it down.

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

progressed, This trait which I didn't identify as shallow at first started to

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.

I was satisfied to see him redeem himself in the end.

Other than the fact Augusten had to take mass quantities of Benydryl

to drink alcohol, my strongest reaction was to Pighead's death. I was so

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

Pighead would've been enough to shake Augusten's deep-seated addictions.


Dry & the Disease Model of Addiction 5

I think he would've had to have another intervention along with

psychotherapy to teach new coping mechanisms. For storyline purposes, the

gift reaction felt right.

II. Part Two: Model of Addiction


a. Etiology
I chose the disease model of addiction to apply to Augusten's case. The

disease model of addiction refers to addiction as a chronic disease that that

has roots in a person's biology, DNA, and also some environmental factors

such as excessive consumption. According to the American Heritage

Dictionary on page 517 in 2000, a disease can be defined as "a condition or

tendency, as of society, regarded as abnormal or harmful" (Davis & van

Wormer, p.14); "alcoholism certainly qualifies, along with diabetes and

certain heart conditions, for consideration as a disease" (Davis & van

Wormer, p. 14). Another clear description comes from the Journal of

Psychoactive Drugs:

[the] recognition that addiction is a medical condition, a disease of

the brain. William Silkworth, a New York City psychiatrist, had

presented the medical perspective in the 1939 book, Alcoholics

Anonymous, describing alcoholism as a medical condition in which the

individual had intrinsic deficits in self-management of drinking. The

AMA followed its declaration of alcoholism as a disease with its

declaration in 1987 of drug addiction as a disease. These concepts are

reflected in the sequence of legislative recognitions that addiction are

disease states and not desired conditions. (Roy & Miller 2010)
Dry & the Disease Model of Addiction 6

In earlier descriptions of the medicalization of addiction was Jellinek's

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

disease related alcoholics but only considered two to be addictions and/or

diseases (Davis & van Wormer, p.88). The two considered were called

Gamma and Delta alcoholics. Gamma, which is Jellinek characterized as

having increased tolerance, withdrawal symptoms, loss of control with

progression and highly impaired interpersonal relations, is what I would

consider Augusten.

Augusten depicts the disease model of addiction in various ways. If we

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

alcoholic father burning him with a cigarette.

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

Augusten showing up drunkenly late to work.

The addicted brain is also prone to relapse (McLellan 2000). Augusten

showed this when after recovery he began drinking again and also became
Dry & the Disease Model of Addiction 7

addicted to crack. Environmentally, Augusten was exposed to alcohol at a

young age, an age where he would be more susceptible to abuse

development, and with habitual use, his brain became progressively more

chemically dependent. His brain chemistry had changed such that he was

engaging in compulsive behavior.

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

progression of the disease. It is decided there is no cure. Once a safe detox

process is complete, total abstinence from all drugs and alcohol is expected.

Rehab facilities try to get patients to engage in open communication of

feelings, share personal experiences, and help get them used to asking for

help. The Disease Model treatment also strives to make addicts/alcoholics

feel worthwhile through affirmations and giving back.

Augusten's experience with treatment was based off the disease model

of treatment. Upon entering treatment, Augusten was given librium to

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

emphasized so much, Augusten writes, Freshly brainwashed from rehab, I

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

of course, because I truly do know myself. I cannot be sure I won't attempt to

drink from the toilet, like a dog. (p.98) Repetition is constant in the facility.

The affirmation of "I am somebody" is uttered often by patients in group and

is encouraged to be used for self-talk.

Augusten maintains this sobriety for a time then relapses due to

an unhealthy relationship with Foster and Pighead's death. He could not

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

bottom using, he receives Pighead's golden gift and returns to abstinence

and AA. He leaves us with a conversation with a newly sober Jim:

"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

answer, as this has probably described perfectly the way he feels at

this moment. "You're supposed to go to a meeting. I mean, as much as

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

up with the mentally ill and considered hopeless" (p.85). AA developed


"principles of

sobriety: the Twelve steps" (Davis & van Wormer, p.84).

Bill W. and Dr. Bob adopted the principles of the movement and,

when many of the AA groups began to diverge from the original

course, Bill W. codified the central principles into Twelve Steps. The

notions of powerlessness, seeking divine guidance, making confession

and restitution, and carrying the message to other persons were

among the concepts borrowed. (Davis & van Wormer, p. 85)

Although these are the principles, the only requirement of AA is the

desire to stop use. Members are urged to identify as an recovering alcoholic

and/or addict. The primary focus is on the chemical dependency and not so

much on psychological or environmental issues. The basic schedule of

treatment is a 30-day or longer inpatient program followed by AA meeting

and some kind of therapy, whether group or individual. AA has its members

admit to being powerless over their disease and promotes peer support

through that of sponsors and experience sharing. Through sharing personal

stories, addicts/alcoholics feel personally linked and can identify the

consequences of using.

Augusten entered Proud Institute for a 30-day inpatient stay. There, he

engaged in group therapy, AA meetings and, other various therapeutic

activities. He was encouraged to identify himself as an alcoholic and share

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,

even a little. I realize I have crammed an entire lifetime of moderate drinking

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"

show his abhorrence toward treatment.

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

evaluated this list, especially when he realized he was abusing Benydryl in

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

recovery. The self-awareness he gains is paramount. He becomes more

comfortable with stating, "My name is Augusten and I am an Alcoholic" and

sees the kind of consequences that have come from being a user, i.e. his

bottle-filled apartment acting as a shield.

d. Advantages
There are many advantages to the disease model of addiction. Before

alcoholism was likened to a disease, an alcoholic was thought to have moral

weakness. When this model started to gain some acceptance it removed that

stigma. It also removed guilt and shame related to having "moral weakness"

so that an individual may be more likely to seek treatment. The medicalizing


Dry & the Disease Model of Addiction 11

of addiction also helped individual to get insurance coverage for treatments

since it was being legitimized as a disease. The treatment goal is clear and

communication is key.

Augusten clearly needed a drastic intervention and change. This model

provided that for him. Although he was resistant at first, he gave in to the

process and accepted that he had a disease and needed to completely

abstain from any use. AA also provided peer support for him. He seemed

strained in his interpersonal relationships. The only addicts/alcoholics he

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:

"My feeling at the end is that AA is utterly amazing. Complete

strangers getting together in rooms at all hours and saying things that

are so personal, so incredibly intimate. This is the kind of stuff that

happens in a relationship after a few months. But people here open up

right away, with everyone. It's like some sort of love affair, stripped of

the courtship phase". (p.110)

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

over identify as addict; using it as an excuse. This model ignores important

psychological factors and overlooks possible mental disorders. The all or


Dry & the Disease Model of Addiction 12

nothing approach is simple but can scare off individuals potentially seeking

help. Abstinence may not be something the individual can maintain; since it

is over-emphasized, a relapse may make individual feel worthless and not up

to the task. The individual may not want to think that they are plagued

with a disease. A different perspective may be needed for some. It may be

easier on the individual to slowly step into recovery instead of being

catapulted into sobriety and the idea of being chronically diseased. Many

addictions have coexisting mental illness or insufficient coping skills. This

model's treatment doesn't help to resolve these.

References

Burroughs, A. (2003). Dry: A Memoir. New York: Holtzbrinck Publishers.

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.
Retrieved from http://search.proquest.com.ursus-proxy-
7.ursus.maine.edu/docview/603182023?accountid=28933.

Van, W. K. S., & Davis, D. R. (2013). Addiction treatment: A strengths


perspective. Belmont, CA: Brooks/Cole, Cengage Learning.

Anda mungkin juga menyukai