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When One Drink Is Too Many

VERY SATURDAY MORNING in a conference room at Scripps Memorial Hospital, John Seaman meets with the families of alcoholics or other drug addicts who won’t stop their drinking or using. The loved ones are desperate for help. The use of booze or drugs (or both) is ruining the addict’s life—and the lives of those closest to the abuser. The addict denies there’s even a problem in the first place. What can a family do to help someone who doesn’t want help?

“Please don’t buy into that old saying that you have to wait till a person hits bottom or wants help before they’ll get help,” Seaman tells the group. “It doesn’t make sense. Bottom could be too late.”

Seaman then begins to educate the group about the process of intervention, where the significant people in an abuser’s life join with a facilitator, at the same time and place, to confront the alcoholic or addict in what Seaman calls “a loving and acceptable way” about specific selfdestructive behavior.

Seaman is perhaps the best-known interventionist in Southern California. A recovering alcoholic who’s been sober for 22 years, he teaches about chemical dependency at UCSD and coordinates a program for “impaired physicians,” doctors who are recovering from alcoholism and drugs. (“Addiction is an equal-opportunity disease,” he reminds the group.) He also is the chief interventionist for the Scripps McDonald Center at the La Jolla hospital, a highly respected medical treatment center for alcoholism and drug addiction.

“Intervention is the best way I know to help break through the delusional thinking of the addict or alcoholic and help him or her gain insight into the problem and become willing to accept help,” Seaman says. “The delusional thinking is ‘protected’ by a rigid defense system, which, of course, leads to denial.” thinking is ‘protected’ by a rigid defense system, which, of course, leads to denial.”

What’s delusional thinking? “The addict fails to make the connection between the consequences he experiences and the substance he’s using,” Seaman says. “You need to understand the cunning, baffling aspects of this illness. A person loses control, and the drug takes over.”

The goal of an intervention is to get the alcoholic or drug addict to agree to enter a treatment program immediately, as soon as the intervention is completed. Seaman, who has conducted more than 1,300 interventions, says this goal is met about 75 percent of the time. He says a fair percentage of the remainder eventually will seek help.

ABSTINENCE IS THE ONLY “CURE” for alcoholism and drug addiction. Some quit drinking or using on their own, and some obtain and maintain abstinence through the 12-step recovery program of Alcoholics Anonymous or Narcotics Anonymous. For others, a hospital-based treatment program may be the best option.

Since its opening in 1979, the Scripps McDonald Center estimates it has treated about 22,000 alcoholics and addicts. There is no typical patient, says Dr. Fred Berger, an addiction psychiatrist who has been medical director of the center since 1998. The majority of patients entering the center are addicted to alcohol only, others to alcohol and/or illegal stimulants (like cocaine) or opiates (heroin). Some are addicted to prescription drugs, such as painkillers.

Patients at the Scripps McDonald Center must be at least 18. One patient Berger knows was 90. Some come following an intervention, while others check themselves in, having hit what Berger calls “a relative bottom. They feel they’ve lost enough, and they don’t want to lose any more,” he says.

It is typical, he adds, that an alcoholic or addict won’t voluntarily seek help until experiencing a major problem with the legal system, an employer or family, or there’s a serious health problem related to the abuse, such as liver damage or pancreatitis. “Most people have tried to quit many times on their own, but they can’t do it,” Berger says. “They’ll come to us when they recognize they can’t do it by themselves.”

Once at the center, an assessment team determines what sort of program the alcoholic or addict should undergo. A medically supervised three- to five-day detoxification may be required, because immediate withdrawal from alcohol or drugs can lead to a seizure or a stroke. About a third of patients undergoing detox will then admit themselves to the center’s highly structured, 28-day residential recovery program. When an enlargement of the center is completed this month, the facility will house 50 residents, nearly twice as many as were previously accommodated.

Sharp Healthcare operates a well-respected in-patient treatment facility for chemical dependency, the 16-bed Vista Pacifica Hospital in the Kearny Mesa area. Its programs and services are similar to those offered at Scripps McDonald Center.)

“In the 28-day program, we give residents the tools to stop drinking or using, and to stay stopped,” Scripps’ Berger says. “We hold up the mirror to show them the life-destroying consequences of their behavior. We break through the minimization and denial of the disease.”

A resident is assigned to a counselor and is immersed in the 12-step program of Alcoholics Anonymous, regarded by addiction experts as the most effective of recovery programs.

The basic elements of the AA 12-step program, which has been adopted by numerous other recovery groups, include the alcoholic admitting he or she is powerless over alcohol, appealing to a higher power, developing a personal relationship with another AA member who serves as a sponsor, sharing personal stories and a willingness to help other alcoholics.

In addition to receiving counseling, residents at Scripps McDonald Center attend alcohol/drug education classes, participate in group therapy, spend time writing in personal journals, go to outside AA meetings and learn specific methods to prevent relapse. To keep patients focused on recovery, cell phones and other electronics aren’t allowed, nor is reading material that isn’t specific to the recovery program. Family may visit only once a week, and short phone calls are restricted to certain hours.

NO DOUBT ABOUT IT. It’s an extremely intense program,” says Jeff R., a 57-yearold recovering alcoholic who got sober at Scripps McDonald Center a few years ago. “If you’re not there to cooperate, you’re gone. There’s a lot of control to it, and I didn’t like that, but I could understand why they have to have it, because when you go in there, you’re basically out of control.

“It’s a very good program,” he says. “I learned a lot and met a lot of good people. The best part was hearing people share their stories and seeing them get better. I realized I wasn’t alone in the problems I had, and if they could get better, I could get better, too.”

“In the residential program, we also teach people to have fun,” says Seaman. “We insist [patients] have fun, because they need to learn to laugh again and need to know that it can happen without alcohol or drugs.”

Because alcoholism or drug use always carries a heavy toll on families, an integral part of the Scripps McDonald program is a mandatory four-day “family week” that occurs for residents during the third week of their stay. Here, the addict’s family members and significant others receive education and counseling designed to heal the anger, guilt and hopelessness they’ve experienced because of addiction. They also are encouraged to become involved with Al-Anon or Alateen, 12-step programs for families and friends of alcoholics.

At the completion of the residential stay, the newly clean and sober have several options. Some resume their daily lives, ideally incorporating the knowledge they’ve gained to not drink or use drugs, and maintaining a schedule of AA meetings. The Scripps McDonald Center may recommend a patient continue with its seven-week outpatient program, attending evening sessions three nights a week.

For those who would benefit from remaining in a structured regimen, referrals may be made to medical programs that are not affiliated with hospitals (such as Rancho L’abri near Dulzura and Pemarro in Ramona) or to what’s known as social-model residential recovery programs, where participants may stay for several months. These are non-medical programs strongly rooted in the 12-step philosophy, with staff members who are in long-term recovery themselves. Two of San Diego’s oldest non-medical recovery programs are Pathfinders of San Diego for men and Crossroads Foundation for women.

The cost of a medically managed recovery treatment program isn’t cheap, but it may not be as expensive as is often believed. While the Betty Ford Center in Rancho Mirage—perhaps the country’s best-known substance-abuse treatment facility—charges about $21,000 for a 28-day residential program, the in-patient program at Scripps McDonald Center costs $8,400. A 30-day residential program at Sharp Healthcare’s Vista Pacifica Hospital is $9,000. Insurance may cover some of these services.

The success of a medical treatment program —or any substance-abuse recovery program—depends on your definition, experts say.

“One part of me says success is total abstinence,” says Berger of the Scripps McDonald Center. “But people do relapse and need further help. If you view success or failure as relapse or not, you have a very tiny definition. The important thing is to not relapse and stay drinking or using. If you take the broader view that we give people the skills to have longer and longer periods of staying clean, minimizing any relapse time, then we’re very successful.”

Adds Dan Valentine, director of Sharp Vista Pacifica Hospital: “Relapse can be a valuable learning experience—as long as you immediately get your butt back into treatment.”

Some, of course, don’t succeed by any standard. They quit the program early or immediately start drinking or using again after they check out. “You have to be ready to hear the message and internalize it,” says Berger. “Some people may need to lose some more. They may need to fail.

To learn more about the treatment and recovery services mentioned in this article:

Scripps McDonald Center, 800-382-4357, mcdonald-center.scripps.org. Free weekly seminars on the intervention process are offered by the center at its La Jolla location and biweekly at locations in Chula Vista, Encinitas, El Cajon and Hillcrest. The center also operates a schoolbased prevention and early-intervention program for students ages 12 to 18 on the campus of Carlsbad Village Academy.

Sharp Vista Pacifica Hospital, 800-734-3477; sharp.com/hospital. Pathfinders of San Diego (men’s social-model recovery home), 619-239-7370; pathfindersrecovery.org.

Crossroads Foundation (women’s social-model recovery home), 619-296-1151; crossroads4recovery.org.

Pemarro (co-ed medical residential treatment), 760-789-8070; pemarro.com.

Rancho L’Abri (co-ed medical residential treatment), 619-468-9333; rancholabri.com.

Alcoholics Anonymous, San Diego Central Office, 619-265-8762; aasandiego.org.

Al-Anon and Alateen, 619-296-2666; alanonsandiego.org.

Narcotics Anonymous, 619-584-1007; sandiegona.org.

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