Wednesday, October 27, 2010

DRY by Augusten Burroughs: Case Study

DRY is Augusten Burroughs’ second memoir and the sequel to RUNNING WITH SCISSORS. Augusten’s parents divorced early in his life. His father was a professor, who abused Augusten physically when he was drunk. Augusten described an incident at nine years old in which he had to jump out of the car his father was driving because his father threatened to crash the car and kill his son. On another occasion, his father burned Augusten on the bridge of his nose with a cigarette.

When he was 12, his mother sent Augusten to live with her psychiatrist. The adopted 33-year old son and former patient of the psychiatrist raped Augusten at 13, and he was sexually abused for the next three years by this man. By the time Augusten left the psychiatrist’s house at age 17, he had little formal education, having dropped out of school after sixth grade. He instead obtained his GED. Despite this lack in education, Augusten was able to work his way up, by his mid-twenties, to a high-paying job in the advertising industry earning $200,000 as a Manhatten copywriter.

Augusten had his first drink at age 12 when he drank a bottle of red wine. Between the ages of 13 to 17, he smoked marijuana and drank alcohol once a week. At age 18, he drank nightly, always to intoxication (five drinks or more). Between ages 19 to 20, he was drinking 10 drinks per night. He also used cocaine once every six months. At age 21 to 30, he was drinking a liter of Dewar’s a night and using cocaine once a month.

When the book opens, Augusten describes being unable to limit his drinking. “I would plan to drink only until 11 or 12, but it would never actually happen. The few times that I didn't drink for a night, or alcohol wouldn't have the desired effect of numbing, I'd be overwhelmed with emotions, usually grief, and it was just really upsetting. It freaked me out because I felt like a wreck inside, like my structure was rotting and alcohol was sort of the glue holding me together. In a lot of ways, I felt like it was the only thing allowing me to function. In fact, it was the opposite. I was able to function despite it.” Augusten drinks even though he actually has an allergy to alcohol, necessitating his taking several Benadryl tablets before imbibing.

Augusten’s apartment is filled with hundreds of empty Dewar’s bottles because he is embarrassed to be seen (or heard – the clanking bottles) disposing of them. Because of the bottles, he never invites anybody to his apartment. Augusten’s support network comprises his best friend Pighead, an investment banker dying of AIDS; his drinking buddy Jim, a coffin salesman; and Greer, his tightly-wound colleague. His mother had a stroke 10 years prior, which left her paralyzed on one side and wheelchair-bound. Augusten doesn’t visit, although e-mails daily. Although he feels pressure from her to take care of her, he believes, after her giving him away to be abused, she does not deserve more than this.

His alcoholism begins to interfere with his performance at work. He starts missing meetings, shows up late, and smells like alcohol. Eventually, his co-workers stage an intervention. His boss and his partner at work, Greer, propose that he go to rehab or risk getting fired. He agrees to go to a gay rehab clinic in Minnesota, the Proud Institute, for 30 days. There, he is given Librium while he is detoxing to prevent him from physical shock from the alcohol withdrawal.

After 30 days at Proud, Burroughs returns to New York and takes his recovery seriously, throwing himself into his work with renewed vigor, and attending Alcoholics Anonymous meetings and outpatient therapy. He is clean for awhile, but Pighead's illness and a relationship with a man Augusten meets at A.A. who is addicted to crack cocaine cause him to relapse. He not only drinks but now starts using crack cocaine and puts himself at risk by going to a “crack house” one night. Despite hallucinating spiders, he retains his employment, although it takes him two years to return to A.A., where he recovers once more.


  1. 4. The following are strengths based assessment techniques.

    Exception Finding helps the client focus on the resources they have used that have been helpful.

    After you attended Proud you were able to refrain from the substance abuse. What did you learn or do in Proud that made staying away from the substance abuse a little easier?

    What did you find most helpful/least helpful about going to Proud? What did the therapist do that was helpful/not helpful for you? In what way does this make a difference to you?

    What qualities about yourself do you feel were most helpful/least helpful for you to refrain from the substance abuse?

    What is different about the times you are able to/not able to refrain from the substance abuse and the times you are able to overcome/not overcome it?

    Developing a future without the problem helps the client begin to see themselves without the problem in the future and think of what that will be like.

    When you emerge out of this problem and the withdrawal has passed, visualize what this will look like to you. What will you do and say? Who else will be there? What will they do and say? How did you succeed in moving past this? How did you make this happen?

    Envision what maintaining recovery will feel like to you? What does it bring you? How will you benefit and grow?

    Building Motivation reduces defensiveness and ambivalence to change.

    Think about the substance abuse. How did the substance abuse work for you? In what ways did the substance abuse not work for you?

  2. Prior to his admission to rehab.

    Axis 1: 303.90 Alcohol Dependence with physiological dependence

    The author demonstrates high tolerance (1 liter a day of whiskey), long duration of use (begins with intention to drink until midnight but keeps going until bottle is finished), spends to much time on use (drinking to excess every night), reduced work, social or leisure activities (he drinks with his friend every night and his colleagues tell him to go to rehab or lose his job).

    Axis 2: deferred.

    Based on reading the author's other books, he may have a personality disorder. A study of his other works may show him to be manipulative, cruel, seeking admiration, self-destructive.

    Axis 3: Allergy to alcohol

    Axis 4: Economic problems: loss of job may lead to financial problems. Problems with Primary support group: sexual abuse, poor relations with parents, enabling drinking friends, Occupational problems: is ent ot rehab by his employers for smelling of alcohol at work, Social Enviroment: living alone, friend with terminal illness.

    Axis 5: 41. The author is in serious jeopardy of losing his job and of dying as a result of prolonged serious alcohol use.

  3. I'd also add under Axis 3 that the author developed heart and neurological problems as a result of his drinking.

  4. It looks like Will posted the same time as me. I would agree that there is an allergy to alcohol for Axis III, which I neglected to include in my original diagnosis.

  5. Onset Risk Factors:

    Biological - Father was an alcoholic

    Psychological - Physical and sexual abuse as a child

    Social - Little formal education, Problems with primary support

    Onset Protective factors:

    Social - Obtained a job despite lack of education. High SES

    Course Risk Factors:

    Social - partner engages in substance use, strained relationship with mother

    Course Protective Factors:

    Social - access to support network (AA), has friends, has support form people at work for recovery.

  6. DSM Critique:

    One criticism I have regarding the DSM criteria for substance abuse involves the current guidelines that constitute the diagnosis. I think that just because someone does not meet one of the 4 criteria outlined in the DSM, this does not necessarily mean the individual is not abusing a substance.

    For example, if someone is smoking marijuana once per week, but does not technically have any problems outlined in the DSM,there are still consequences to using a substance such as marijuana frequently. Namely, there are long term health affects, such as memory loss and an increased risk for certain cancers.

    Additionally, it can be difficult to distinguish between dependence and abuse, especially when it becomes complicated to prove withdrawal or physiological dependence. One would have to discontinue the substance for a period of time to show withdrawal symptoms.