The first time I took my adult son to the emergency room drunk was a crash course in addiction care. After a few routine checks, they sent us on our way, ignoring a drinking history that included seizures. “We don’t do detox,” I was told.
On the drive home, hours since Ben’s last drink, withdrawal tightened its grip. Alcohol poisoning can be fatal, but for heavy drinkers, so can quitting, with its potential to trigger heart attacks, seizures, and stroke. Its lesser symptoms make you wish you’d died, he said.
In a panic, he threw open the door. The highway rushed in. As my husband hit the brakes and swerved to the shoulder, he jumped. Behind us, I watched Ben vanish up an offramp. Then I was running, terrified of the roaring night traffic and that I might not catch up. I found him at a gas station buying beer, which he tipped like a flask of water in the desert, letting it pour down his face.
If the hospital wouldn’t treat his withdrawal, he would.
After years of drinking, any time he stopped, hell broke loose – a chemical arcade in the brain. Unable to hold a job or housing, he returned to California at 30 to live with us. His friends on the East Coast had shot me screaming messages to come get him – or he would die!
He’s been talking about suicide all morning and crying, already drunk. I was going to call the police when I left the office but now he’s in his room and won’t answer the door.
This is not the first time – he’s been to the hospital 4 times in 10 days.
I’m just really scared for him.
Frantic, I connected him with Alcoholics Anonymous, but social support wasn’t enough. He’d been hooked since high school.
Ben clearly thought this confession would change everything. Arms would open (Yep!) and the medical community would rush in to help (Nope).
His surrender failed to magically open doors to treatment, even as our nightmare unfolded amid California’s overhaul of addiction and mental health services for the low-income, who are known “super-users” of costly emergency rooms. The Advancing and Innovating Medi-Cal initiative aims to connect the dots in a fractured system so people won’t have to turn to the ER. “The goal is to ensure access to the right care, in the right place, at the right time,” the program’s website reads.
Instead, Ben found liquor in every corner: at gas stations, food marts, grocery aisles. When he ran out of money, he’d chug mouthwash or hand sanitizer. Open 24/7. No waitlists, awkward questions or health care gatekeepers.
As he lurched from crisis to crisis, the ER was the default option in our northern California county where one nurse told me there are “too many alcoholics” to treat them all.
Alcohol is a leading cause of preventable death in the U.S. and is responsible for 1 in 4 deaths of people age 20 to 34 – and for Ben, the odds were worse. Alcohol use disorder is diagnosed as mild, moderate or severe. Ben was a Category 5 with a twister thrown in: major depression and anxiety. Addiction and mental health issues commonly go together, so treatment needs to cover both aspects and match the severity of each. He needed detox, therapy and addiction counseling in seamless succession. But alas …
“Ben found liquor in every corner: at gas stations, food marts, grocery aisles. When he ran out of money, he’d chug mouthwash or hand sanitizer.”
First, detox – the mother of all steps – wasn’t available. At Ben’s severe stage of drinking, he needed medical detox, with doctors and nurses on hand, which for most low-income patients is found only in the ER.
Our hospitals claimed to have a policy of not doing detox, while a hospital worker in Southern California told me theirs will do it only if a patient is simultaneously experiencing another medical issue: We will treat your heart problem but not the deadly addiction that drove it (unless both are killing you at the same time).
Expensive private rehabs crow about medical detox, but after numerous deaths in facilities that failed to actually provide medical supervision, California tightened the requirements of rehabs that want to offer it. At least nine other large states allow medical care in residential detox or treatment, and several require that doctors oversee detox. I knew none of this when Ben arrived. I assumed detox in rehabs was overseen by doctors, and that ERs willingly provide it. Early on, one ER did sometimes admit him, which is recommended for those who’ve had a seizure before. It kept him safely sober for a few weeks, but detox is only the start, and he would come home without a plan besides medication, so the next step was always relapse.
The other ER did little more than check his vitals. When I told a nurse he would immediately have to drink, she replied, “that’s why in 2022 we’re calling alcoholism a disease!” A different staff member claimed admission wasn’t needed because addiction “is a social problem.”
Soon both ERs were pushing him away.
“You’re using up resources needed for sick people!” Ben was told.
“This is what we call a boozer,” he overheard.
A doctor told him, “This is the last time I’m going to save your life!”
The stonewalling left us with no other options for medical detox. His insurer told me the key to ER treatment was acute withdrawal. When Ben was anywhere near that worst stage, which brought delusions, hallucinations and terror, just getting him in the car was like pulling someone out of a manhole. It could take hours to convince him to go, hours to get ready, and seconds for him to call it all off.
Upon arrival, he might pull a bottle of vodka out of a hat, a plan to survive the waiting room that risked leaving him outside the window of acute withdrawal. Once, on the verge of bolting, he was corralled into conversation by kind fellow hospitalgoers, to whom he falsely confessed to being a veteran, eliciting redoubled efforts to calm him. One man tracked me down in the hallway to thank my son for his service. Another said his son died of a heroin overdose.
At home, if I waited for peak pain, a 911 call would bring cops and Tasers to worry about.
Our heads were spinning. We blamed him because the medical system was saying he had a problem only he could fix. But do hospitals refuse to treat diabetes or any debilitating chronic disease because the sufferer chose a poor diet or failed at Weight Watchers?
His AA Big Book was dog-eared. His mentors were even more worn out. “I hate drinking,” he’d say.
It turns out acute withdrawal isn’t the only kind. He also experienced the long version that hangs on indefinitely. The more he lapsed, the more the ER nagged him to “get help.”
“Have you thought about kicking him out?” a social worker asked. I couldn’t imagine how someone with severe addiction and depression would benefit from being forced onto the streets.
Even as they were declining to treat his addiction because “we don’t do detox,” they refused to admit him to their psychiatric ward because “they don’t treat substance use disorders.” But his problems were entwined: a dual diagnosis.
We once tried county mental health services where instead of counseling, he received a list of other places to try. Off we drove, fruitlessly, in all directions. Another time when he needed to talk, I dialed a county mental health hotline. It went like this: A woman asked him if he was suicidal, he said no, and she referred him to rehab.
“At home, if I waited for peak pain, a 911 call would bring cops and tasers to worry about.”
During one ER visit, his agitation landed him in jail, where he was told he was permanently banned from the ER. All he recalled is that he wasn’t given enough medication – and never wanted to go to the ER again. The visit before, I called to find he’d left hours earlier. No cell phone, no money. Heavily medicated. I raced down the highway. Halfway there I saw him, blond hair askew, taped-together black glasses. He was shuffling miles along a skinny shoulder in hospital slippers.
Everything felt like a system humming in sync – to not help us.
What choice did we have, I’d asked a social worker…