The first time I accompanied my adult son to the emergency room while he was drunk became an intensive lesson in addiction care. Despite his drinking history that included seizures, the hospital simply sent us away after a few routine checks, stating that they did not handle detox. However, on the drive home, withdrawal symptoms tightened their grip on him, even though hours had passed since his last drink. Quitting alcohol can be dangerous for heavy drinkers, as it can trigger heart attacks, seizures, and strokes. He mentioned that the lesser symptoms of withdrawal made him wish he had died.
In a sudden panic, he flung open the car door and jumped out while we were on the highway. My husband swiftly hit the brakes and swerved to the shoulder, and I watched Ben disappear up an offramp. Filled with fear, I started running, terrified of the loud night traffic and the possibility that I might fail to catch up to him. Eventually, I found him at a gas station buying beer, which he desperately consumed like a person deprived of water in a desert, letting it cascade down his face.
If the hospital refused to treat his withdrawal symptoms, he would seek his own means of finding relief. After years of heavy drinking, every attempt to quit resulted in chaos and disruption in his brain. He could not hold a job or find stable housing, so he returned to live with us in California at the age of 30. His friends on the East Coast sent me frantic messages, pleading for me to retrieve him before it was too late.
He had been talking about suicide all morning and was already intoxicated. I had planned to call the police when I left the office, but now he locked himself in his room and refused to respond to my knocks. This was not the first time this had occurred – he had already been to the hospital four times within the past ten days. I was filled with fear and worry for his well-being.
Frantically, I connected him with Alcoholics Anonymous, hoping that social support would be enough to help him overcome his addiction. However, it quickly became clear that this was not sufficient for him. He had been addicted to alcohol since his high school years.
Ben believed that this confession would bring about a positive change. He thought that doors would open, and the medical community would rush in to provide the help he needed. Unfortunately, this surrender did not lead to any immediate treatment or support, despite our ongoing nightmare unfolding in the midst of California’s efforts to improve addiction and mental health services for low-income individuals, who tend to rely heavily on emergency rooms for care. The Advancing and Innovating Medi-Cal initiative aims to create a more cohesive system, ensuring timely and appropriate care. However, these changes did not aid Ben in his search for treatment.
Instead, Ben found alcohol everywhere he turned – at gas stations, convenience stores, and grocery aisles. When he ran out of money, he resorted to drinking mouthwash or hand sanitizer. There were no waitlists, uncomfortable questions, or barriers to obtaining these substances, as they were available 24/7.
As he navigated from one crisis to another, the emergency room became the default option in our county in northern California. One nurse even commented that there were “too many alcoholics” to treat them all. Alcohol abuse is a leading cause of preventable death in the U.S., with 1 in 4 deaths of people aged 20 to 34 being attributed to alcohol-related causes. The odds were even worse for Ben, given his severe alcohol use disorder, major depression, and anxiety. It is common for addiction and mental health issues to coincide, so treatment should address both aspects and be tailored to the severity of each. Ben required detox, therapy, and addiction counseling in a seamless and comprehensive manner. However, this seemed like an unattainable goal.
The first crucial step, detox, was not readily available. Given the severity of Ben’s alcohol use, he required medical detoxification, which typically involves the presence of doctors and nurses. Unfortunately, this option was largely confined to the emergency room for low-income patients. While our local hospitals claimed to have a policy against providing detox services, a hospital worker in Southern California informed me that they would only offer it if the patient had another concurrent medical issue. In essence, they would address a heart problem but neglect the deadly addiction that contributed to it. Other private rehabilitation centers marketed their ability to provide medical detox, but recent incidents of deaths within such facilities led to stricter regulations in California. Several other states allow doctors to oversee detox in residential facilities, but this was unknown to me at the time Ben arrived. I assumed that detox in rehabilitation centers would be supervised by doctors, and I believed that ERs would readily provide this service. Initially, one ER did admit him on occasion, as he had experienced seizures in the past. This provided a few weeks of sobriety, but detoxification is only the first step, and without a comprehensive plan that included therapy and support, relapse was inevitable.
The other ER barely did anything beyond checking his vital signs. When I informed a nurse that he would need to drink immediately, she nonchalantly replied, “That’s why we’ll be referring to alcoholism as a disease in 2022!” Another staff member claimed that admission was unnecessary because addiction was a “social problem.” Both hospitals soon began pushing him away, stating that he was using up resources meant for truly sick individuals. Ben overheard derogatory terms used to describe him, such as “boozer.” A doctor even warned him, “This is the last time I’m saving your life!”
The lack of support and treatment options left us with no alternatives for medical detoxification. His insurance company informed me that the key to receiving treatment in the ER was experiencing acute withdrawal, which was the worst stage characterized by delusions, hallucinations, and intense fear. Convincing him to go to the hospital during this stage was a monumental challenge, akin to pulling someone out of a deep hole. It could take hours to persuade him to leave, hours to prepare, and seconds for him to abandon the plan altogether.
Upon arrival at the ER, he would often produce a hidden bottle of vodka, attempting to survive the waiting room and risking acute withdrawal symptoms. On one occasion, when he was on the verge of bolting, his fellow patients engaged him in conversation, providing a temporary distraction. During the conversation, he falsely identified himself as a veteran, which prompted even greater efforts from those around him to calm him down. One man even sought me out in the hallway to express gratitude to my son for his service. Another individual shared their story of losing a son to a heroin overdose.
Attempting to handle these situations at home by waiting for the peak of his pain would lead to 911 calls and encounters with law enforcement. Our minds were spinning with confusion and frustration. We felt inclined to blame him, as the medical system implied that his addiction was a problem only he could resolve. However, hospitals do not refuse to treat diabetes or any other chronic disease simply because the individual made poor lifestyle choices or failed at weight loss programs.
His copy of the AA Big Book was well-worn, and his mentors were equally exhausted from his repeated relapses. He often expressed his intense dislike for drinking.
It turned out that Ben experienced not only acute withdrawal but also the prolonged version that seemed to linger indefinitely. With each relapse, the ER would fervently urge him to “seek help.” One social worker even suggested that I consider kicking him out of our home, failing to recognize that someone struggling with severe addiction and depression would unlikely benefit from being forced onto the streets.
In our attempts to seek help, we once turned to county mental health services, only to receive a list of other places to try instead of counseling. Each attempt to find appropriate support proved futile. On one occasion, when he needed someone to talk to, I dialed a county mental health hotline. The conversation went as follows: a woman asked him if he was suicidal, he answered no, and she promptly referred him to a rehab facility.
During one of his visits to the ER, his agitation resulted in his arrest and subsequent ban from seeking treatment at that particular hospital. His memory of the incident was hazy, but he recalled not receiving sufficient medication and the vow to never return to the ER. In a previous visit, I called the hospital to inquire about his status, only to discover that he had left hours earlier. He had no cell phone and no money, yet he managed to wander on foot for miles, still heavily medicated, wearing hospital slippers. It felt as though everything was spiraling out of control.
So what next?
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