Shouldice Hospital: The Success Rate Essay Sample For College

Introduction and case history

The hospital is extremely successful which can be seen from the fact that, while initially, the total number of available beds was just eighty-nine, during 1982, the hospital was capable of carrying out nearly “6850 operations”. (Hooksett, 1983, p.2). This speaks volumes for the growth of this hospital over the years in terms of professional health care services provided to the community, in and outside Canada.

Having established itself way back in the 1940’s it is indeed a creditable performance for Shouldice Hospital to have traversed a long way, with a lot of accolades and performance, based solely on meeting the patient’s needs and health concerns and according to the highest priority to patient care and management.

The success rate of Shouldice Hospital could also be measured from the fact that the management is seriously thinking in terms of expanding its present infrastructure. The management is contemplating on the proposed benefits of adding to bed capacity, going in for “Saturday operations” or increasing the “number of beds by 50%, and schedule the operating rooms more heavily.“ (Hooksett, 1983, p.11).

The success rate of operations carried out is also extremely high with just 0.8% incidence of recurrences, as compared to the industry average of 10%.

It is also seen that the hospital has a dedicated number of health care professionals, nursing faculty, and support team who are committed to setting and maintaining the highest standards of patient care at all times, especially for critically ill patients who need extra care and attention. Most people are of the misconception that a hernia operation is a comparatively minor surgical process, but it is quite possible that, through lack of proper care and medical attention, this could easily develop into complexity with attendant risks, that could even be fatal for patients.


The administrative system of the hospital works in an extremely efficient and systematic manner, paying a great deal of personal attention to the needs and medical care of the patients, right from the time they are sent in for admission till the time they have been certified fit for discharge from the hospital premises.

In this hospital there are no hidden costs recovered from patients, and all charges borne by patients/their carers are towards actual services rendered with no loaded inputs, often collected as service charges by other medical institutions. Because of this, the hospital has earned a very good reputation, not due to advertisement and publicity campaigns, but only through opinions passed from one satisfied customer to others urging them to use only Shouldice’s medical services.

Moreover, it is seen that, besides having unique operating techniques not normally used by other health care institutions, the food served for the patients is from the same catering unit used by medical staff and health care professionals. Food costs are also subsidized and made economical for the patients.

Patient experiences

The excellent rapport that patients instill in each other and the nursing facility is not normally found in other health care settings. Moreover, the pre-operative and post operative care of the patient is carried out in a very systematic and customary manner, leaving very little margin for error. Although it is felt that hernia operations which this health care unit specializes in, is wrongly considered to be a simple interventionist procedure, there are possibilities that serious complications may arise, for which, attending surgeons needs to be fully prepared from the very start of operation and not leave any aspect of the surgery, however small as unplanned, or unscheduled.

Nurses’ experiences

A patient care, palliative medical interventions and procedures are considered to be hallmarks of this unit, and every effort is made to ensure that the patient’s stay is as comfortable and convenient as (s) he would like it to be. Moreover, the days spent in the hospital are least, and on most occasions, a patient need not have to stay for more than 4 days including post-operative care, whereas in the case of other medical units, this could be as much as 14 days, especially in case of critical Illness/ complicated surgery. Moreover, it is seen that the total costs incurred for surgery are also nominal, and not a strain on the financial resources of patients, sometimes being just 1/3 of what is normally charged by medical institutions, for a similar kind of surgery.

It is indeed to the credit of Shouldice hospital, that, being a non-profit making organization, the management does not believe in any kind of publicity or advertisement for marketing its services but relies just on verbal testimonies of its past patients. The hospital takes pride in having a past patients’ reunion meet during 1983 in which nearly “1400 former patients” attended (Hooksett, 1983, p.10).

The success of this hospital could also be measured from the fact that many other clinics try to imitate the operation techniques followed by this hospital, sometimes without success. This is one of the primary reasons that, as a policy, no outside medical practitioner is allowed to be trained in operation techniques followed by this hospital, since there is every likelihood that it may be misused and thus bring this institution into disrepute.

Another salient aspect about the hospital is that it is non-profit making and hence, patient care is accorded the highest priority, without other considerations. The rate of an operation here is only around 1/3 of what it would cost in other hospitals or private practices.

Doctor’s experiences

The main reason for its performance has been in terms of the reasonable rates charged by this doctor of this hospital. For example, operation costs for a standard operation with four days of hospital stay works out to less than $1000 as against the astronomical sum of “$2,000 to $4,000 for operations performed elsewhere.” (Hooksett, 1983, p.10). Again the fact that the congenial atmosphere and warmth generated in the hospital precincts, the highest degree of personal care and devotion shown by the attending faculty, is unsurpassable by any of its rivals or competitors, Typically a standard procedure would last 45 minutes. Even in the case of the unique operating method followed exclusively by Shouldice in which each layer of flesh is separated and excellent suturing done to repair the ruptures, as such the dressing could be removed within 48 hours. This alleviates the post–operative soreness and discomfort felt by patients and allows them to return to normal work within a minimum time frame.

“Other methods might not separate muscle layers, often involved fewer rows of sutures, and sometimes involved the insertion of screens or meshes under the skin.” (Hooksett, 1983, p.03).

Comparative cost study of Shouldice with other hospitals



Total cost to patients Shouldice Hospital Other hospital
1. Cost of a typical operation

(average for others taken $ 3000)

$ 1054 $3000
2. Transportation to and from hospital (Average taken) $400 only local


3. Time lost from work while at


4 days 5-8 days
4. Time lost for work while


7 days 14 days
5. Value of time lost to employer

($50-500 per day) average taken – $275 day

$1925 $3850
6. Total before allowing for recurrence $ 3379 $ 6850
7. Probability of recurrence 0.8% 18%
8. Weighted cost of recurrence $27 $1233
9. Total cost to patient, employer and insurer $3406 $ 8083

Costs statements of Shouldice Hospital

Of the total 6,850 operations conducted during 1982, 82% were primaries and rest 18% were recurrences from other hospitals. Shouldice Hospital rate of recurrences was just 0.8 %

Therefore, the weighted average of recurrence for both Shouldice and others would be as follows:



Total cost to patients Shouldice Hospital Other hospital
1. Total costs of each Operation $3379 $6850
2. Proportionate weighted costs

55/6850 X 3379 = $ 27

1223/6795 X 6850 = $1233

$27 $1233




Particulars Shouldice Hospital





Revenues : 4 X$111X 6850

Costs (actual ) $1454 X 6850



Revenues : ( $510X 6850) +

($75X 6850 X 20%) =

3,493,500 + 513,750 + 102,750 =

Costs (including surgeon fees, bonuses and anesthetists fees )









( 4,038,650)

Clinic costs

Yearly Charges for a typical operation = 1029 X 6850 = $7,048,650

(Including anesthetists fees)

Surgeon’s fees $ 50,000 X 12 = 600,000

Bonus – 500,000

Total – 8,148,650

Even Swap Methodology

Particulars Addition of another floor to the hospital Initiation of Sat. operating Schedule Opening of another


Doing nothing

Let things remain the same

Marketing Will improve No change Expected to improve Will not come down
Services delivery systems More beds can be availed Expected to improve Will depend upon location, demand, etc Constant
Patient care Will improve provide patient: provider ratio is increased May improve if doctors available Will offer better specialized services Should not reduce
Fooding and conveniences Will improve No change Circumstantial Food quality and care not to lower
Investment outlay Light investments No investments Heavy investments No change
Control functions Manageable May not be manageable Need more management personnel No change
Profitability May increase No change since costs would also increase May increase depending upon patient preferences May increase due to marketing efforts

Judicious changes in the existing processes

The best changes at the present juncture would be in terms of adding one more floor to the existing hospital complex, resulting in shorter hospital stay in terms of post operative care and recuperation, etc. both optimum usage of resources and augmenting patient care and better health promotion services. This would involve additional investments of around $2million along with requisite permission from the local government. (Hooksett, 1983, p.11).

This could also lead to a quantitative increase in number of beds by another 50% which could help the hospital take up more operations in future. This will also accelerate the process of patient care and operations since more facilities, resources and personnel would be available to provide excellent health care services to patients.

Additional investments necessary for constructing one more level, would required to become self generative, instead of depending upon outside loans or credit arrangements. Again, the option to set up a new venture outside Canada (preferably US destination) may be stalled until government clearances are approved and necessary climate for US investments become more conducive.

Saturday operations would be a heavy toll on surgeons, and with the availability of more surgeons, this could be made possible.

Although Shouldice is a non-profit making establishment, the management is aware of the extreme competitive health care market in which it operates. The reasonable fees along with unique and excellent patient care facilities have ensured a remarkable degree of success during the past. However, for the future, it is necessary to embark on more ambitious expansion plans to stay ahead of competition and services offered by potential rivals, even in terms of undercutting health services delivery costs in order to woo potential patients to their units.


It is seen that Shouldice needs to expand its facility with better and more productive use of existing technology and personnel. The health care markets are extremely competive and most of them justify the exorbitant fees that are charged in terms of professional health services and post operative facilities, sometimes spanning two weeks or more. Routine cases are disposed off overnight using the Canadian methods.

Shortage of trained and experiences nursing and medical staff is also a major constraint and it thus becomes necessary to maintain the patient: provider ratio consistently.

The medico-legal aspects are also areas of concern since such instances could lead to lowered goodwill and higher litigation costs. Ethical and moral considerations towards patients/carers, their consent and keeping their best interests in mind, even in conflicting situations, are challenging areas for Shouldice, and this medical care institution needs to invest time and efforts in this direction in right earnest.

Medical research is a major area in which Shouldice needs to invest, considering the various types of diseases which may not be controlled or cured with conventional treatment and interventions. Thus, there is need to diversify at other locations into other specialties offering similar opportunities such as eye surgery, varicose veins, or hemorrhoids.


From the deliberations made above it is clear that the highest standards of patient care and commitment has underpinned the success of this Hospital. Moreover, aspects like reasonable operation costs, low post operative stay and high success rate of surgery have all contributed, in no small measure, to the continued success story of this hospital. It is believed that in the coming years, with more infra structure at its command and disposal, the hospital would take greater strides in patient care and alleviation of their pain and sufferings.

It needs to make better operational facilities, including making examination, admission and operation of outstation and long distance patients available in a single day. It could also reducing incidence of recurrences and relapses of conditions, through the use of careful and appropriate need based operations and interventions available.

Finally, as is the pre-requisite of all good health professionals- the criteria of good health and well being of the patient are paramount considerations and should not be compromised, or lowered, at any cost. The hospital needs to understand that its future success and growth would, to a very large extent, depend upon the degree of excellent care and benefits it provides its client base, and seek new and modern methods of reducing costs and increasing efficiencies in its various departments, all intended with the best intentions of safeguarding and protecting the health and well being of patients at all times.


  1. Hooksett, James. (1983). Harvard Business School 1983 Shouldice hospital Limited: History. p.02. (Provided by the customer).
  2. Hooksett, James. (1983). Harvard Business School 1983 Shouldice hospital Limited: History. p.03. (Provided by the customer).
  3. Hooksett, James. (1983). Harvard Business School 1983 Shouldice hospital Limited: History. p.10. (Provided by the customer).
  4. Hooksett, James. (1983). Harvard Business School 1983 Shouldice hospital Limited: History. p.11. (Provided by the customer).

“Son Of The Revolution” Memoir By Liang Heng


The Chinese Cultural Revolution of the 1950s, when the Communist Party of China came into force to build the socialist country based on fear, absence of freedom of speech, and the need to strictly follow all the guidelines of the Party is one of the brightest examples of usurping of power by a political force that managed to control the thoughts and minds of the whole nation. This was namely the time when Liang Heng, the author of Son of Revolution, and at the same time its protagonist was born and brought up.

Growing up in a broken family, the boy experienced all the advantages and drawbacks of the socialist country; he saw the horror of communism with his own eyes and came up to tell about it in a literary work. Thus, Son of Revolution is a masterpiece of the world literature which manages to combine the universal and the personal ideas in it in order to present the comprehensive picture of the life of people in the Communist China in the era of Mao and Deng.

Liang’s Parents

The very family of Liang predetermined the future he had to witness. He was born in the family of the influential Communist Party journalist and a secretary responsible for validating the arrest warrants for their whole city, Changsha. Being the committed Communist Party supporters, Liang’s parents saw their whole future connected with it:

My parents were deeply involved in all the excitement of working to transform China into a great socialist country, eager to sacrifice themselves for others. They dreamed passionately of the day when they would be deemed pure and devoted enough to be accepted into the Party. It was only natural that the family come second; Father’s duties at the newspaper often kept him away for several months at a time, and my mother came home only on Sundays, if at all, for she had a room in her own unit and stayed there to attend evening meetings (Heng and Shapiro, 1984, p. 3).

Driven by this commitment to the sacrifice, Liang’s parents sent him to the child care center in order to focus more on the work, but their marriage was soon destroyed. As a firm Communist, Liang’s mother participated in the right-wing meetings of Party workers where everyone was encouraged to speak the truth of anything they did not like about the Party. Having spoken herself, Liang’s mother however, was labeled the rightist for her incorrect words. His father knew that since his mother was a rightist, he and his sisters would not be able to get education, good jobs and marry. He, therefore, decided to divorce his wife. At the court, his father was given custody over Liang and his siblings.

Society of Communist China

Needless to say, such a situation was typical of the Chinese society during the Great Cultural Revolution of 1950s. The social stratification of the country was destroyed from the former monarchial way of living and the social classes of people started being mixed up and made equal. Therefore, lots of intellectuals and the representatives of the most educated layers of the Chinese population were sent to the rural areas where the Communist Party of China saw their task in educating the peasantry and helping the latter to reach the level of overall literacy and access to the information (Heng and Shapiro, 1984).

The book by Heng and Shapiro (1984) presents the examples of this, as Liang’s mother and father were sent to the rural areas where Liang could first see the real life that the Chinese peasantry lived, and it turned out to be much harder than the life that intellectual families in the urban parts of China had. Instead of reading books and following the politics, peasants had to think every day of feeding themselves and their families. Therefore, it was a planned step by the Communist Party and the Cultural Revolution Leaders to inform the peasants of their activities to get their support in the future struggle (Heng and Shapiro, 1984). However, that was nothing about actual help to the lower classes as the intended social structure of the communist China included the Party leaders and the poor only.

Communist Party and Personal Life

On the whole, the major ideological platform that Communist Party of China stood on during the early Cultural Revolution was the idea of the overall subordination of the activities, thoughts, and plans of every single citizen should be monitored and controlled in order to ensure the success of revolution. When a mass of people are involved in an activity, there is a great possibility of the fact that some of those people can fail in the tasks which would result in the complete failure of the activity (Heng and Shapiro, 1984). Therefore, Mao Zedong and other Communist leaders of China wanted their power over the citizens to be overwhelming and comprehensive. The book under consideration exemplifies this truth with several occurrences from Liang’s life.

For instance, the boy was excluded from the reactionist group of youth as soon as its leaders came to know that his father was an intellectual. Liang was mocked to be “a stinking intellectual’s son” (Heng and Shapiro, 1984) and sometimes even tortured by his peers. His mother was sent to the exile because of her courageous speeches criticizing her boss, Liang’s education was full of pro-communist and Mao-adoring ideas, and on the whole the life of China at that time was built around the cult of Mao’s personality.

Liang in the Red Guard

Nevertheless, one of the greatest dreams that Liang used to have in the childhood was to become a member of the Red Guard of China. Liang wanted to be enrolled into the Red Guards because he had a bad childhood at a daycare. He was also brainwashed by Mao’s belief that the revolution would prevent China from taking the revisionist road to capitalist restoration. Being a Red Guard was an honor to many young Chinese. The Cultural Revolution took the entire generation of the young students or slightly older “educated youth” and gave them an unintended education into how the Chinese political system worked.

Being a Red Guard Liang learnt that the new authorities were a hundred times harsher than the old ones, that the arrival of feudalism was the much more real danger in China than the rebirth of capitalism. Liang was one of the youngsters who were used by Mao to rampage the cities and homes with the aim of destroying the old ideas, culture and customs (Heng and Shapiro, 1984). The leaders of the Cultural Revolution argued that the first 17 years had been basically wasted until they discovered the correct revolutionary way. Red Guards allowed the Chinese youngsters to travel the country and exchange experiences, and Liang was one of the youngest members of the organization to be involved in the struggle for Mao’s ideas (Heng and Shapiro, 1984).

Socialism and Liang’s Life

In the early 1970s, the life of Liang develops in the direction that he never even expected it to. The young man finds a job at the local factory and starts seeing how his living conditions improve. Needless to say, by earning money Liang becomes able to say that socialism really brings good results. But he keeps thinking so until the moment when he becomes eager to enter a college or marry the girl he likes. What Liang faces in this situation can be called the brightest examples of corruption and bribery that dominated the socialist political structure of China (Heng and Shapiro, 1984).

For example, Liang’s relations with girls are broken when their parents come to know about Liang’s family background and his own Red Guards past. To apply to a college, Liang has to bribe the bosses of his factory as only they can guarantee a place in the educational establishment to Liang (Heng and Shapiro, 1984). Being unable to explain this, Liang realizes that the communist slogans he studied while at schools are empty words, and that is when Liang becomes disappointed in socialism (Heng and Shapiro, 1984).

Deng for China and Liang

With the death of leader of the Cultural Revolution, Mao Zedong, Liang and the whole China hoped for the better in their lives. Indeed, Deng did much to develop the Chinese economy and modernize the country’s enterprises. Although some people claim that Deng brought little improvement to the life of ordinary people in China, the example of Liang states the opposite. Studying in the college, Liang falls in love and later married his English teacher, Mrs. Shapiro who came from the USA.

Apart from being the love story, this marriage symbolizes the improving relations between China and the rest of the world; it is used by Heng and Shapiro (1984) as a picture of the greater openness that China was characterized by when Deng took the power after Mao. That is why the first thing that Deng did to improve the lives of people is that he gave the Chinese freedom of speech, conducting business, and thinking.

Personal Reflection

Thus, Son of Revolution by Heng and Shapiro (1984) is a skillful story about the life of a Chinese man who lived through the Cultural Revolution to see how the ideals proclaimed by Mao were transformed and later completely rejected by Deng who changed the China and the country’s economy to give people freedom and hope. The authors of this book manage to personify the history of China in the middle of the 20th century in the memory of the person who was like millions of other Chinese at that time. Liang was a fierce supporter of Mao but than was disappointed to the extent that he started perceiving the fanatic slogans of the Chinese Communist Party with irony (Heng and Shapiro, 1984).

For me personally, the book gave the much deeper insight of the Chinese history and the life of ordinary people during one of its dramatic periods. Moreover, this book rose China in my perception now as I see clearly that the freedom of speech is possible although at the first sight it seems absent in China. Finally, I think this book is a valuable source of information on history and the peculiarities of human relations; that is why I assess this memoir as highly skillful and informative.

Works Cited

Heng, Liang and Judith Shapiro. Son of the Revolution. Vintage, 1984.

Alcoholism And Its Effects: Beyond The Influence


In the age-old debate regarding the relative merits of alcohol, one of the most difficult issues has been the determination of what exactly causes some people to drink to such excess that they lose their reputations, their careers, their families and even their lives in their devotion to the substance. A number of theories have been brought forward over the years, many of which tend to place the blame for alcoholism on the weak will of the individual.

Alcoholics are widely accepted, even among the alcoholics themselves, as having some deep form of psychological issue that they are not able to deal with. As a result, they seek to drown these issues in an alcoholic fog. However, more recent science has suggested there is another, deeper cause to alcoholism that can only be found in the genes. In the book Beyond the Influence by Katherine Ketchum and William Asbury, the authors present their proof that the disease of alcoholism is a physiological disease rather than a psychological disorder.

The psychological disorders typically associated with the disease, they contend, are the effects of alcoholism on the brain rather than the other way around. The authors use scientific data to prove that alcohol affects different people differently based upon their unique genetic make-up by illustrating how it affects the alcoholic as opposed to how it affects the non-alcoholic.

Rather than attempting to provide the alcoholic with an excuse for his or her behavior, though, the focus of the book is on understanding the process of the illness and the various ways in which it might manifest itself in different individuals. In presenting this material, they enable individuals such as myself who have had some difficulties with alcoholism understand why it has the strong effect it does and provides some help in learning more about how to return to a more normal life pattern.

Main Body

The book begins by attempting to debunk some of the more common myths associated with alcohol. In relating the story of Terry McGovern, they seem to be attempting to point out They point out that each human body responds to different substances differently and alcohol is no exception to the rule. They call it a “selectively addictive drug” and insist that alcoholics have “basically the same psychological problems as non-alcoholics before they start drinking, but these problems are aggravated (and new disturbances are created) by addiction to alcohol” (5).

Because of the unique effect alcohol has on the brains of those who are genetically susceptible to it, people who are otherwise very strong-willed and responsible can easily fall into its trap and, once the susceptibility has been discovered, can never return to drinking again without restarting their brain’s addiction to it. Though this brief introduction into their material doesn’t seem to provide much proof for such strong refutation of long-standing myth, the rest of the book goes into an exhaustive study of just how the chemical alcohol affects the body, both in the non-susceptible individual and in the susceptible one.

There are, of course, a number of factors that determine how alcohol will affect the individual regardless of genetic susceptibility. These factors include a person’s weight and percentage of body fat. Weight has a strong effect upon a person’s ability to handle alcohol because higher blood volume helps to dilute the alcoholic content. However, it seems body fat has more to do with it as fat does not absorb alcohol as quickly. “Fat … is nonpolar, and alcohol has a difficult time getting into fatty tissues; … As a result, the greater the amount of body fat you have, the higher your BAC will be” (16). This has a number of effects.

First, body fat leaves alcohol alone, allowing it to collect in the bloodstream rather than processing it through the rest of the body. Women tend to have more body fat by proportion than men and are also affected by their menstrual cycles making it difficult to assess her capacity for alcohol at different times of the month. Older people gain more body fat and other body defenses grow less capable, affecting their ability to handle alcohol. Other important factors that contribute to a person’s ability to handle alcohol include their nutritional status, the health of their stomach and intestines, their emotional state, the drink strength, any mixers or food taken with the drink and the presence of carbonation.

The authors provide a long and often complicated explanation of how alcohol affects the body system on a chemical level, although one gets the sense that they’ve simplified the explanation tremendously. This discussion includes information about chemicals such as ADH and NAD+ that help the body to break down alcohol in the liver and the steps that are taken in this process. It also includes information about something called the microsomal enzyme oxidizing system, which is described as a backup system, “somewhat like an emergency generator that can be used when the normal circuits are overloaded” (24).

The basic message of this segment of the book is that it takes a number of different enzymes to process alcohol through the body and these enzymes are different in each individual body. Thus, everyone experiences alcohol differently. Because it is something experienced differently by different bodies, there are a number of effects that can be felt depending on the body, how much of what kind of drink is consumed over how long of a period of time and whether or not food was consumed with it. Alcohol can act as a stimulant and as a sedative, but it is not an effective tranquilizer, anesthetic or health boost. It is at this point in the book that I began to finally link the content to my own experience.

I have always known alcohol as a stimulant. It is what I rely on to help me loosen up for an evening on the town because it helps me to relax all those important social restrictions that I have to follow during my day. I always seem to have more fun when I’m out drinking and a night on the town seems to be missing something if we haven’t thrown back a few first. One of the things that make this particularly attractive to me is that I am able to drink much more than many of my friends even though I am not the biggest of the bunch.

Everyone expects me to be a lightweight, but I’m often the last one standing. Like many of the people mentioned in the book, I have always considered this element of my makeup a matter of pride, but the information presented in the book has made me reconsider this position. As the book got deeper into defining the characteristics of alcoholism, I found myself reassessing my drinking experiences and attitudes, wondering if perhaps this is something I need to watch out for.

The authors define alcoholism as “a progressive neurological disease strongly influenced by genetic vulnerability. Inherited or acquired abnormalities in brain chemistry create an altered response to alcohol which is turn causes a wide array of physical, psychological, and behavioral problems” (46). In providing this definition, they make a strong statement regarding the nature of the disease as something that progresses from a stage or stages that are almost never recognized to a much more serious stage at which it is finally recognized by the common definition.

I never would have considered myself as a possible alcoholic when just considering the normal definition because I don’t need to drink to feel happy, I haven’t lost any social status because of my drinking and I am still in control of whether I drink or not. The authors then go on to describe the stages of alcoholism that they recognize and it is this information that began to cause real concern for me.

The first stage of alcoholism described by the authors seems very harmless, but some of the things they describe can be applied to my situation. They indicate four main characteristics to this stage. These are “intense pleasure associated with drinking; lower-intensity reaction; acquired tolerance; and preoccupation with alcohol” (54). Assessing my own reactions to alcohol, I don’t really believe that I experience more pleasure than my friends seem to, but how would I know for sure? I know I have a really good time when I’m drinking and so do my friends, but is it the same? I just can’t answer that and that bothers me.

In terms of the lower intensity reaction, I’ve already noticed that I can consume a lot more alcohol and still function compared to my friends. “If your metabolism is speeded up, you get rid of alcohol faster, which means that alcohol does not build up in your bloodstream as quickly, which in turn means you will not feel as intoxicated as someone with a slower metabolic capability” (56). It is perhaps because I don’t really feel the effects of it so much anymore that I thought I was okay to drive the night I got my DUI. Everyone had been drinking that night and there really wasn’t anyone scheduled to be a designated driver.

We needed some more beer and I was just sure I was okay. I’d felt drunker before. I wasn’t sure how much I’d already had to drink. Honestly, I’d lost count, but I was just sure I could function fine. Obviously, I was wrong, but why didn’t I know better? The final characteristic identifying the early stage of alcoholism is a preoccupation with alcohol. My immediate response seeing this was relief since this, at least, was something that didn’t match my drinking habits.

Upon further reflection, though, I realize that there are some ways in which this is true. For instance, when I go out on the weekends, I am always concerned about how much beer we have on hand, whether this will be enough and spend a good deal of my evening trying to make sure there will be enough for me. Although this is only a concern to me when I’m going out instead of an all-the-time thing, the argument could be made that this constitutes a preoccupation.


To be honest, discovering that I identified so closely with these early stages of alcoholism disturbed me enough that I mostly skimmed through much of what the authors had to say about the middle and late stages to find out what the solutions might be. I did take note of the symptoms of these stages to make sure I wasn’t there yet, but I have never experienced a blackout and I have not noticed any personality disintegration, signs of withdrawal or denial.

Having recognized me at least a little bit in the early stage was sufficient for me to begin looking for a way to stop this process. Even after going through all the material provided in the book, I am unable to determine unquestionably whether I am or am not in the early stages of alcoholism. However, I am now much more aware of the dangers facing me if I continue to drink and have determined to find out whether or not I can really have a good time without drinking. I have also decided to learn more about alcoholism, work through this book a little more and begin to develop a healthier form of entertainment.

Works Cited

Ketcham, Katherine & William F. Asbury. Beyond the Influence. New York: Bantam Books, 2000.

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