Mornings were always the worst for Joey. In the stark sunlight filtering through the 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 fact that at age 14 he was an alcoholic.
It was an extremely hot and muggy late spring night when David was brought into a District hospital after a traffic accident. David had been out with some friends, driving around, drinking beers out of crumpled paper bags so the police couldn't see the cans. Going out and drinking on nights like this was part of the rites of spring for David and his friends, but on this night everything went dark.
They had been driving near Logan Circle, going pretty fast and laughing up a storm. David, who was driving, reached back to ask a friend for another beer. By the time he looked up the headlights of an oncoming car blinded him. The wreck left everyone in David's car seriously injured.
Emergency room doctors noticed strong traces of alcohol in David's blood and urine samples. Looking at his record, they also noted he had been involved in several other traffic accidents in the past few months. Putting the indicators together the doctors realized David was a teen-age alcoholic.
But the treatment prescribed for David was far different from Joey's, and it reflected recent shifts in attitudes toward teen-age alcoholism. David was treated as a teen-ager with a disease no more reprehensible than diabetes. He stayed at home while attending frequent treatment sessions at Georgetown University Hospital in the District.
The different ways Joey, of Silver Spring, and David, of the District, were treated illustrate a struggle in the medical world to come to grips with teen-age alcoholism. The youths' full names have been withheld at the request of their doctors.
Joey has left the psychiatric ward and, along with David, 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 adolescent alcoholism treatment. The two hospitals provide several types of care and treat teen-agers on an outpatient basis as long as possible before resorting to the traditional, in-hospital, drying-out method by which Joey was treated.
Each year, nearly 500 teen-agers and young adults from throughout the Washington area are treated in Georgetown and Arlington. These numbers are likely to increase by about 25 percent, according to Montgomery County health officials, who said the problem of teen-age alcoholism grows each year.
The officials base their prediction, which applies to the entire metropolitan area, on the increasing number of traffic accidents involving teen-age drinkers and on the growing number of adolescents seeking treatment. They said the increase might have been higher had not Maryland raised the state's legal drinking age from 18 to 21 on July 1.
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."
There are problems with parents, with families, with schools and often with courts, not to mention the teen-ager himself. And there seems to be a reluctance among hospitals to accept teen-agers for therapy because they require much more supervision when "de-toxing." Compared to 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," said Dr. Robert P. Jardin, director of a counseling program for juvenile drinkers in the Montgomery County Health Department.
"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 that 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," Jones said. "It also helps to keep the kid in society so he can show himself he can be a success."
The teen-age outpatients are given Antabus, a drug that causes nausea if a user drinks alcohol within the next 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 teen-age alcoholism program at Arlington.
"It, along with a growing awareness at other Washington hospitals and treatment centers, should significantly contribute to dispelling the myth that drunkenness in teen-agers is just a part of growing up," Powers said.
Joey and David tell similar stories of first 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 tranquilizers, such as Quaaludes or Valium.
Both said they soon began smuggling booze to school and soon after that got so 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 remembers how scared he was when he first heard a mental patient screaming like a wild animal in a room down the hall.
Only after he was taken out of the hospital, treated on an outpatient basis in the Georgetown-Arlington program and made to stick to the program did treatment really work, 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."
For David, the newer treatment techniques of medicine and group therapy made his transition to sobriety easier and quicker. Because he was closely monitored at home by his parents, David said, he has been able to get past the old peer pressures and cravings for alcohol that haunted him in his drinking years. He said he had not touched alcohol in almost two months and was beginning to see an end to his disease.
For that he thanks the teen-age alcoholism program at Arlingon and Georgetown. "I'd hate to think what might have happened if I had not been made to accept I was an alcoholic," he said. "I never thought I could be. . . . I mean, only old bums are alcoholics, and I was just going out having fun. Some people said I could have died."