| Off the Couch |

Time to Admit

“The doctor is aware that everyone thinks I’m a drunk, yes, sweetie”


Dr. Berger was referred to me by his wife and our mutual colleague, Dr. Berg, for an evaluation of his drinking problem. It was clear that he wasn’t as concerned about his alcohol consumption as the people who were encouraging him to get help. PART II

The idea of reaching out for help was pretty much anathema to Dr. Berger, although he admitted that he “needed a drink to relax sometimes” because of the stress he was enduring after a difficult aliyah and getting his family practice going.

The first step in treating anyone suffering from substance abuse is to get them to the place where they admit they need the substance in order to survive or at least make it through the day or the next few hours. And that need is more fierce and desperate than any amount of willpower a person thinks he can muster.

“Dr. Berger,” I asked gently, “do you need alcohol to function?”

He thought for a moment before answering, “No, that’s ridiculous. I just ‘need’ it to relax after a tough day.”

“Meaning you can’t relax without alcohol?”

“Of course I can,” he cried defensively.

“When was the last time you successfully relaxed after a tough day without alcohol?”

“Last week I didn’t drink for one day, and I was fine.”

“And you didn’t experience any withdrawal symptoms?”

“Totally not,” he said definitively. “You think I’m some kind of alcoholic or something?”

“That’s great to hear, Dr. Berger. So then it wouldn’t be a problem for you to swear off alcohol for the next 30 days — you know, maybe just to get your wife and your friend off your back.”

“Off course not. Why should it be?”

“Well, someone with an alcoholism issue probably wouldn’t be able to just give up drinking like that,” I said, snapping my fingers. “They’d struggle mightily and could easily end up caving in after a day or two.”

“Good thing I don’t have an alcoholism issue, then,” he said smugly.

“Baruch Hashem. Let’s call your wife and let her know then?”

“Hey, why do we have to drag her into this?”

“To keep you honest.”

“You don’t trust me?”

“I’m not going to be at home with you to see if you got rid of your alcohol.”

“What?! Now I need to throw out my entire whiskey collection?”

“Well, we can negotiate on that one. You can have someone remove it and lock it up. But either way, isn’t it better to be over bal tashchis with your whiskey than with your liver, your marriage, and your professional practice?”

“Dr. Freedman, are you threatening my professional career? I thought all of this was confidential.”

“I’m not threatening anything,” I replied with what I hoped was a comforting smile. “I want to make sure that alcohol isn’t threatening your body and your career like it’s threatening your marriage.”

That one apparently hit home.

“Fine,” he said. “I’ll call my wife now and put her on speaker.”

He dialed his wife and put the phone on the ottoman between us.

“Hi sweetie,” he said in as kind a tone as he was able to force upon himself. “Listen, I’m here with Dr. Freedman and I’ve told him all about how you and Dr. Berg are convinced that I’m an alcoholic. Anyway, I’m about to prove you all wrong by giving up drinking for 30 days and showing you that I’m not a drunk.”

“Wow, I mean, that’s fantastic,” his wife said over the phone. “But does Dr. Freedman know that you drink sometimes in the afternoon even before you walk in the door? And the drunk driving charge a few years ago before we made aliyah? And the—”

He blushed and then grinded his teeth before cutting her off, “The doctor is aware that everyone thinks I’m a drunk, yes, sweetie.”

This was important information, but I kept quiet.

“Anyway, that won’t be happening anymore because I’m going to do 30 days without a drink and prove to you that this is just a biiiiiiiiiiiit excessive — and then you can all leave me alone!”

Mrs. Berger broke the ensuing silence. “I hope that you’ll be willing to work with the doctor to address the issues.”

“Yep, sure. Happy to do so, that’s why I’ve wasted my afternoon here today. I came, beseder, we’re fine. Thanks, sweetie,” he said, as he hung up, practically seething.

I’d been doing this for a long time, and although I never say never, I didn’t believe Dr. Berger, with his level of frustration and lack of self-awareness, would be successful.

“So, Dr. Berger, we’ll meet again in 30 days, and you’ll report back on your success… And if not, you’ll see me sooner, and we’ll come up with a plan to make sure you’re successful the next time.”

“Can’t wait.”

He left my office in the kind of quiet fury that made me feel we’d be seeing each other sooner than he’d like. I was unfortunately correct.

Mrs. Berger, meanwhile, booked her own appointment, with Dr. Berger’s grudging permission. Deep down, it seemed, he also wanted to fix things.

Mrs. Berger was clearly loyal to her husband, and it wasn’t easy for her to disclose information she felt was talking behind his back. I assured her that it was included in her husband’s permission for us to meet.

And so, she went on to tell me about a problem far more extensive than he was willing to admit to.

“This goes all the way back to medical school,” Mrs. Berger shared. “His drinking problem was so bad that they put him on probation and made him go to counseling. But he desperately wanted to be a doctor and was dedicated to being sober at the time. He was willing to do the work.”

Mandatory therapy combined with medication treatment to help ease him through the process of sobriety was a successful combination. And it was during those months of sobriety that he met his future wife who was in nursing school at the teaching hospital at the time. They were married shortly after and began a life together, where drinking wasn’t a part of the picture.

Both of them became stronger in their religious commitments during that time. Dr. Berger pushed through the end of med school and residency, they had kids, saved money for a house, and opened a successful private practice in Five Towns — all the while maintaining his sobriety. And then something snapped.

“I don’t know exactly what happened then,” Mrs. Berger continued. “Maybe it was the pressure of supporting the 12 employees we had, maybe it was the schools asking for donations on top of tuition, maybe it was the stress of having the kids getting older, but one day he came home with a bottle of whiskey and had a shot before he went to bed.

“It started with a drink after the kids were asleep and then morphed into a drink as soon as he walked in the door. And then there was the drink he took on the way home that got him into trouble after he ran a red light and failed a breathalyzer test.

“He won’t make 30 days, Dr. Freedman. I doubt if he’ll make it half of that.”

We were up to 13 days before Dr. Berger showed up in my office with his wife at his side.

“Are you happy to see I’ve failed!?” he growled angrily while glaring at his wife.

To be continued…


Identifying details have been changed to protect the privacy of patients, their families, and all other parties.


Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills outside of Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 874)

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