Mornings were always the worst for Joey. In the stark sunlight filtering through the thin curtains of his barred hospital window, he had to fight the pain of his ordeal and come to grips with a terrible reality.
As he lay strapped to a bed in the psychiatric ward of a Montgomery County hospital, Joey faced the realization that at age 14 he was an alcoholic.
At a hospital in the District, doctors were making a similar diagnosis for another teen-ager, 16-year-old Mike. On the surface, Mike seemed to be the All-American boy, but to his doctors, he showed all the symptoms of alcoholism.
Mike's alcoholism was discovered after he went to his doctors to get help for his occasional blackouts. After a series of routine tests, doctors found traces of alcohol in blood and urine samples. More importantly, they recognized other symptoms that pointed to alcoholism: frequent traffic accidents in the past few months, a drop in school performance and increasing requests for sedatives to help get a good night's sleep.
The treatment prescribed for Mike was far different from Joey's, and it reflected recent shifts in the attitudes toward teen-age alcoholism. Mike was treated as a teen-ager with a disease no more reprehensible than diabetes.
While Joey was drying out in a hospital ward, Mike was at home, making frequent trips to Georgetown University Hospital for treatment sessions for teen-age alcoholics.
The two approaches to the problem illustrate a struggle in the medical world to come to grips with teen-age alcoholism.
Mike is from McLean and Joey is from Silver Spring. The youths' full names have been withheld at the request of their doctors.
Joey has left the psychiatric ward and, along with Mike, is a patient in the Adolescent Alcoholism Treatment Program established seven years ago by Georgetown and Arlington hospitals. Within the past year, the cooperative program has switched to new methods that are on the cutting edge of efforts to humanize treatment for adolescent alcoholics. The two hospitals provide several types of care and treat teen-agers on an out-patient basis as long as possible before resorting to hospitalization.
Each year, nearly 500 teen-agers and young adults from the metropolitan area are treated at the Georgetown-Arlington program. These numbers are likely to increase by about 25 percent, according to local health officials, who said the problem of teen-age alcoholism grows each year.
The officials base their prediction on the increasing number of traffic accidents involving teen-age drinkers and on the growing number of adolescents seeking treatment.
Increasingly, hospitals and doctors are recognizing the special problems, such as peer pressures, faced by alcoholics age 12 to 18. But alcoholism, especially among the young, is a social and medical problem that still eludes solution.
"Physicians as a group do not know how to handle alcoholism as a disease, and a large part of that problem is the need to take moral judgment out of doctors' evaluation of alcoholism, particularly when talking about teen-agers," said Dr. Richard Jones, a pediatrician specializing in adolescent medicine at Georgetown Hospital. "Doctors just have not been trained in the problems with teen-age alcoholism.
"Medical schools already have enough to teach students, and so often there is a fear about treating teen-age alcoholics because they tend to bring up all kinds of social questions that doctors and hospitals really can't deal with," Jones added.
There are problems with families, with schools and often with courts, not to mention the teen-agers themselves. And there seems to be a reluctance among hospitals to accept teen-agers for therapy because they require much more supervision when patients in a "de-toxing" program. Compared with adult alcoholics, teen-agers are frequently more hostile, violent and difficult to control, Jones said.
Instead of working to develop programs tailored for teen-age alcoholics, hospitals and doctors generally place adolescents in mental institutions or under psychiatric care, as happened in Joey's case.
"There is a particular problem with institutionalizing teen-age alcoholics because how is a young person supposed to deal with the underlying psychological reasons that led them to drink when they are still feeling the terrible physical effects of alcoholism?" asked Dr. Robert P. Jardin, director of a counseling program in the Montgomery County Health Department for juvenile drinkers.
"And then putting these kids, who really have a disease, in with the severely emotionally disturbed often just compounds the problem. The kids get depressed, they don't understand why they are where they are and they never recognize their alcoholism."
The Georgetown-Arlington program is staffed by a psychiatrist specializing in adolescents, an internist specializing in chemical dependencies and Jones. All but the most severe alcoholics are kept at home so the teen-agers can work out their problems with the support of their families and at the same time continue to feel a part of their communities.
This practice "benefits the family because it is cheaper and it benefits the teen-ager because he is more willing to respond to treatment as long as someone who cares is right there keeping an eye on him," said Jones. "It also helps to keep the kid in society so he can show to himself he can be a success."
The teen-age outpatients are given Antabus, a drug that causes nausea if a user drinks alcohol within 24 hours. Once a patient has used Antabus for a few months, the next step is group therapy with other adolescent alcoholics. A method is established for parents to monitor the progress of their children by giving rewards when teen-agers follow the rules of their therapy and stay off alcohol.
Teen-agers who must be hospitalized are sent to Arlington Hospital. There they are treated for alcoholism as a disease, rather than as a mental disorder.
"Our program with Georgetown University Hospital is certainly not the first of its kind, but it is unique in the way teen-agers are referred among the doctors best suited for each individual's need," said Pat Powers, director of the program at Arlington Hospital.
"It, along with a growing awareness at other Washington hospitals and treatment centers, should contribute significantly to dispelling the myth that drunkenness in teen-agers is just a part of growing up."
Mike and Joey tell similar stories of sneaking alcohol from their parents' homes and taking it to a nearby school playground or parking lot where friends met to mix alcohol with marijuana and sometimes downers, such as Quaaludes or Valium.
Both said they began smuggling booze to school; soon, they said, they couldn't wake up in the morning without reaching for a quick "starter" drink. But it is there that their stories take different courses.
Joey said the restraining straps and psychotherapy in the psychiatric ward did not end his problem. When his friends visited, they brought a concealed hip flask of his favorite drink, Yukon Jack whiskey. He also remembers how frightened he was when he first heard a mental patient screaming like a wild animal in a room down the hall.
Only after he became an outpatient in the Georgetown-Arlington program and was made to stick to the program did he begin to conquer his alcoholism, he said.
"I guess it's been about seven or eight months now since I had a drink," Joey said, "and I really don't know why that has been, except that maybe I feel better about myself now. I'm not always depressed anymore. I guess it just seems like somebody is going to care now.
Mike said the newer treatment techniques of medicine and group therapy have made his transition to sobriety easier and quicker. He said he still feels an occasional need for a drink, but he hasn't touched alcohol in about three or four months.
"If only," he said looking at Joey, "good programs like mine could be made available to everybody . . . it would save so many teen-age alcoholics so much pain."