Wednesday, November 09, 2005

Stay on the scene like a fax machine, huh...

Apologies to James Brown, but the last hour of my job was spend photocopying and so on. Get on up, and so on.

Well, today was spent at the DAC, which either stands for the Dependence Assessment Clinic, or the Desperate Alcoholics Clinic, depending on whom you ask.

DAC is the least loved part of my new job with what I will call the South Mordor Area Council to Help Eradicate Addictive Drugs (SMAC-HEAD) - at least until I can think up a less boring acronym. Around here, the drink driving limit is a blood alcohol of 0.05. One offence means loss of licence, two is loss of licence for a longer period of time plus come to see us, and so on. Soon after that there are lifetime disqualifications, increasing prison terms and so on.

What happens is once you get, say, your second sizeable drunk driving offence you get sent to us to determine if you are dependent on alcohol. The doctor sits you down, asks you thirty or forty standard questions, does a physical exam, takes some blood for blood tests and then two weeks later you get a letter saying whether you are dependent on alcohol or not.

It's weird medicine. Even more than psych, it's "helping" people in ways that they bitterly resent, and asking them to sit idly by while I make some decision that is going to have a significant impact on their life (and on how they see themselves). It's confrontational, and it's also very tightly regulated (I have to ask everyone the same forty questions), there's limited room for rapport or chatting about the footy, and everyone hates doing it.

One thing I find deeply weird at DAC is the sheer amount of lying that goes on. The patient lies to me, and I lie back by nodding and arranging my face as if to say "That seems reasonable", rather than throwing myself on the floor and flailing my arms and legs in the air as I cry with derisive laughter. Then we both mouth our respective untruths about wishing each other well and thanking each other for their time, and then we close the door and smirk about how we sure fooled that guy.

But God, it's difficult to restrain myself. "So all you had was three light beers and a lemon, lime and bitters? and then when they pulled you over you blew five times the legal driving limit? And that's pretty much what's happened the last fifteen times you've been done? including last month where you were done for the illegal use of a traffic cone, and driving a combine harvester without due care inside a church, and your blood alcohol concentration would have killed a Tequila worm? No wonder you seem pissed off."

And that is all true. People who lie about their drinking, I was told, tend to paint unrealistically sober pictures. There are questions in the test that are pretty much designed to identify when people are lying: "have you ever caused embarrassment to yourself or someone else while drinking?", "have you ever had a headache or felt nauseous the morning after drinking?" and so on. While I am sure there are people who have never ever done this, they are not the same people who blow 0.30 on the breathalyser three times in a row.

The weird thing is, I remember in my irresponsible youth drinking much more than I do today, causing embarrassment to myself or someone else while drinking, and having a headache and feeling nauseous the morning after drinking. And to my shame I remember driving home drunk, taking two and a half hours to cover the eighty kilometres of straight, flat highway, a hot December night in country Western Australia, some time in the eighties.

I suppose I could say "who am I to tell these people not to drive drunk?", but I don't reckon there's a problem combining a fallible character with good medicine. I do reckon that's helped me in psychiatry. And I note that it's often the slim, young doctors who tell the middle aged fat men that all they have to do is lose that thirty kilos.

Anyway, off to read everyone else's blog. Thanks to those who've been reading. Hopefully today Sarah can put some links on my blog beside the one she did "so I'd know how".

See you all soon.

Thanks for reading,


Blogger Foilwoman said...

Oh, and there I was, feeling unique and special. Now that feeling's going to end!

12:51 PM  
Blogger Benedict 16th said...

Well BJ, I would have to say the DAC is probably why I'm not working at SMACHEAD. I almost enjoyed the challenge of witty fencing with the armed opponent, it was the poor witless guys who try to help you feel sorriest for. It was definitely confrontational and I felt horribly guilty using the "respect of the doctor" to get answers out of people. Sometimes you could hear their thoughts when the stories change slightly - : "My God he is a Doctor and can tell I am lying, faking it..." or "I shouldn't have worn this shirt it's a dead give-away"*. What bothered me most it is the closest I have ever been to being physically assulted - and this bloke** was verbally intimidating and I'm a big guy, in control, stethoscope in hand, and ask BJ, not easily verbally intimidated.*** Now, with a bit more experience if I were to come across something like that again, I think I would just walk out. And of course when I talked to my superiors about this and whether I should/could have walked out - [irony mode = on] they were just so supportive [irony mode = off].

* True - one guy for THC dependence instead of Alcohol, you get these occasionally but since there is zero tolerence (ie get a positive urine at any level and instant fine and licence goes bye bye) they are few and far between. Anyway this guy was wearing one of those flannellette shirts that are really good for hiding the track marks.... when he said that. My assessment was he is a reckless dickhead but not dependent. And no track marks.


** A used car salesman

*** How many lectures in Medical school didn't I speak up in? And excluding a certain wanker neurology registrar who else asked or answered stuff more? Maybe Blondie from California?

9:19 PM  
Blogger Champurrado said...


How many of those patients started binge drinking early on as is the norm these days? Barrett Seaman wrote a book about the phenomena after spending two years among the bingers. I don't recall drinking myself into unconsciousness when I was young and stupid. Certainly I would also be lying if I said I never blundered way too far over the limits of social drinking but never a binger. What changed?

1:28 AM  
Blogger Prom said...

I drank once to the point of near alcohol poisoning (induced asthma in me although I didn't know it because I was in blackout mode from it). This was highschool graduation first time I drank hard liquor. Thank God for friends who watched over me.

I didn't drink even one drink for about 5 years after that. The mere thought of it made my stomach flip over and my hair hurt.

I still don't drink to any extent. An occasional glass of wine with dinner or a hot toddy after skiing and then only one.

People simply respond differently to drugs and alcohol at a young age. Some are vaccinated by it, some infected.

What I find weird is that people have any trouble at all knowing what the "right" answers are on the 40 questions test. Are drunks just mentally unorganized enough to lie effectively?

1:45 AM  
Blogger Chade said...

Throughout University I found that my Bachelor of Tavernology often left me little knowledge of the night previous, often requiring I sit the test again and again. I think I passed with distinctions, although I'm think that the Bartenders may have marked me up for enthusiasm.

8:44 PM  
Blogger Bronze John said...

Hail Prom,
I like the vaccination idea. From what I can work out, the test questions that "fool" people are not those aimed at ascertaining how much someone drinks, it's more those aimed at determining tolerance and withdrawal: if it takes six beers until you start feeling any effect at all, for example, something's gone awry.


9:48 PM  
Blogger Bronze John said...

Hail Cham',
From what I can work out, the pattern of drinking, the social and individual use of alcohol as a tool, is as important a factor in determining alcoholism/problem drinking as the amount or frequency of alcohol consumed. Some of the folk I see seem never to drink small amounts. They binge, their dad binges, their brother binges, the whole social circle binges. Often it's a social thing - some guy gets his payment in, buys some alcohol, everyone sits around and drinks it, then a few days later some other guy gets paid.... if you drink two standard drinks a night, but with two alcohol free days a week, that's probably not an alcohol problem. But if every fortnight you drink twenty standard drinks - that's more of a problem.

I don't think anything has changed; there were bingers then and there are sippers today... but as to what makes someone become a sipper rather than a binger, that's a complex question.

9:57 PM  
Blogger Bronze John said...

Hail Bene,
Any time you feel guilty about misusing the respect people grant to doctors, do a bit of work for NUTTAR, the 'northern unit treatment, transport and response' group, my previous employers about two years back. These are the people that the government pays to keep an eye on the paranoid. We got to go out to people's houses after hours and casually check on their mental health. Beelieve me, an unexpected call from NUTTAR produced a lot of emotions - but respect wasn't one of them. Horrible job.


10:22 PM  
Blogger Bronze John said...

Hail FW,
The special feeling's not going to end any time soon, I suspect...


10:24 PM  
Anonymous said...

This cannot have effect as a matter of fact, that is what I suppose.

6:48 PM  

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