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Can Alcoholics Recover?
by Gretta Palmer
has been called our No.4 public health problem by a medical
director of the U.S. Public Health Service-and the postwar
years, in which drinking always increases, have scarcely
begun. In the U.S. there are 750,000 known alcoholics, or
one and one half times the number of victims of tuberculosis.
In addition to these, there are 3,000,000 “excessive
drinkers,” many of them approaching the stage of true
alcoholism, in which they will require expert help.
Yet alcoholism-which touches almost every family in the
country-is not recognized as a disease at all by millions
of Americans! Even many wives of alcoholics confuse the
malady with “lack of will power” of “failure
to face facts” when they discuss their husbands’
problem. The medical world itself is remiss in dealing with
the disease: only 110 institutions listed by the American
Medical Association accept alcoholic patients, and most
of these are content to restore the patient to sobriety
and "dry him out," with no fundamental attack
on alcoholism itself. The public is indifferent; there are
no widespread, publicly supported drives to raise funds
for an attack on this disease. In our large cities there
is almost never a clinic to which the alcoholic can go for
such impersonal, scientific help as would be extended if
he were suffering from polio or cancer.
Yet the inebriate is as little capable of recovery, without
help, as the victim of any other disease. With help, the
alcoholic who wishes to get well can be restore to normal
living in about six cases out of ten.
Why are we so lax in dealing with the alcoholic?
There are several reasons, according to doctors, psychiatrists
and recovered alcoholics who are trying to bring about a
change. One reason why the alcoholic is neglected is that
he was, until very recently, considered incurable; doctors
rejected such patients because they did not know how to
help them. Of the four methods of therapy now in wide use,
three have been developed in the past fifteen or twenty
years. Before them, recoveries were rare and not thoroughly
understood even by the practitioners who brought them about.
fact that the alcoholic can be saved in six cases out of
ten is news, and important news, to millions of Americans.
But in order to understand the hopeful, recent advances
in the field they must first digest the fact, familiar to
several generations of physicians, that the alcoholic is
a sick man or woman. Knowing this, they can attack the problem
He is sick. But with a malady whose seat is even now unknown
to science. Alcoholism is a complex disease, which may have
both physical and psychological aspects. The methods of
treatment which are successful are all timed at changing
the patient’s way of looking at life and liquor; they
are, primarily, psychological forms of treatment. But no
matter how successful the treatments may be, the recovered
alcoholic can never again, with safety, take a single drink.
(alcoholics have tried, after five years or fifteen years
of strict sobriety, and have found themselves as badly off
as ever in a few month’s time.) Some students of alcoholism
therefore believe that there is a bodily idiosyncrasy present
among all alcoholics; what it is they still do not know.
There are about 50,000,000 Americans who “take a drink.”
Of every 1000 of these, 45 are “excessive drinkers,”
whose health suffers from their habits; 30 of them seem
still able to stop drinking. The true alcoholic is not one
of these; he is one of the 15 drinkers out of every 1000
to whom alcohol has indeed become a drug, a psychological
necessity so precious that he will cling to it in spite
of every appeal to reason and self-interest and his “better
self.” He has an uncontrollable urge to drink, never
experienced at any time by nine out of 10 of our 50,000,000
Over twenty million of the Americans who drink are women:
a recent Gallop pole showed that 59 per cent of all our
women take a drink at least occasionally, although the percentage
is much lower among women older than fifty years. Women’s
increased drinking may explain why our national consumption
of liquor, which was going down before the war, has now
increased, so that the 1943 consumption of alcohol in this
country was 30 per cent higher than it was in 1940. Americans
now drink 1.17 gallons of alcohol a year, on the average,
compared with the 4.6 of France, the .93 of Great Britain,
Norway’s .55 and Holland’s .4. Within our own
country, the state that consumes the smallest amount is
North Carolina (.32 gallon a year per capita); the hardest
drinking areas are the District of Columbia (4.09), followed
by Nevada and Connecticut. Three of our states-Kansas, Oklahoma
and Mississippi are dry by state law, and one third of the
whole country is dry by local option.
confirmed alcoholic lives in a private world. Alcoholism,
doctors say, is a deadly disease, not a moral issue. Can
we find happy endings for the 750,000 alcoholics of both
sexes we have in America?
of the dry propaganda has centered around the problems raised
by the alcoholic; prohibitionists would attempt to prevent
alcoholism by making liquor impossible to obtain except
by breaking a law. The political wets, on the other hand,
say that such a law is unfair to the 90 per cent of all
drinkers who are in no danger of becoming alcoholics and
that it is, in any case, an experiment that has already
failed. Sixty-six million American voters are neither wet
nor dry; they are the “on-the-fence” spectators,
who have an open mind on the problem and who wish to help
the alcoholic by whatever method the experts find to be
Women are playing a large part in organizing the new attack
on alcoholism as a health problem-as women volunteers have
been the spearhead of drives on cancer, tuberculosis and
infantile paralysis. The new National Committee for education
on Alcoholism has a woman organizer, Marty Mann. She believes
women have a special interest in alcoholism; wives and mothers
of alcoholics suffer from the social stigma which now attaches
to the disease and which would be avoided if it were as
matter-of-factly viewed as deafness or rheumatism in the
family. And besides that, a large and growing proportion
of alcoholics today are women. Before the war the Yale School
of Alcohol Studies estimated that one of every six alcoholics
was a woman; many students of the subject now believe the
figure has changed to one out of four. In Chicago’s
Municipal Court arrests for drunkenness used to be six men
to one woman; the ratio is now one woman out of three. FBI
reports on arrests for drunken driving show that women are
offenders five times as often today as in 1932. So woman’s
interest in alcoholism is no longer limited to the puzzled
and unhappy curiosity of the alcoholic’s family; women
nowadays may share the life-and-death interest in alcoholism
of the victim himself.
victim of alcoholism; who is he? How did he get that way?
Why is he incapable of drinking like a gentleman? Why do
his good resolutions, his promises of moderation inevitably
fail? Why is he-reasonable enough in other matters-incapable
of seeing the clear fact that his drinking brings him much
more misery than happiness, and of sensibly stopping it?
The answer to some of these questions is still a mystery,
locked in the dark recesses of the alcoholic’s hidden
personality. But some facts are known.
The alcoholic does not have a basic personality which varies
significantly from that of the average man. Detailed studies
of normal drinkers, alcoholics and recovered alcoholics
were recently carried out by the Research Council on Problems
of Alcohol, of New York. No important differences in fundamental
attitudes were found.
But after some years of drinking the alcoholic is set apart
from other men; he is especially apt to avoid the responsibilities
of married life.
A study made by Dr. Selden Bacon, of Yale, on arrested inebriates
showed that less than half of them had ever married-although
four fifths of the men of their age and geographical groups
were married. Only 23 per cent of the alcoholics were living
with wives, compared with 73 per cent of the population
as a whole. Of those who had married, 25 per cent were separated
and 16 per cent were divorced. Other differences appeared
which must make living with the inebriate a trial for any
wife: alcoholics hold their jobs for shorter periods and
are more poorly paid than other men of similar background;
they amuse themselves either alone or with casual acquaintances,
instead of belonging to any group; they do their drinking
alone or with members of the same sex, instead of indulging
in normal, social drinking.
Such reports give valuable clues to those who would help
the alcoholic. But our best guidance comes from the life
stories of the alcoholics themselves.
the case of Bill, representative of the very large group
on “introverted” drunks. Bill was a shy and
studious boy, sheltered by a devoted mother. At high-school
dances he was often too bashful to ask the prettiest girls
to dance; in “bull sessions” he rarely had the
confidence to speak out and express his views. Between him
and the others in his group their loomed an invisible wall
Then Bill discovered beer; he found that if he took three
or four glasses of it, he was able to join in the fun. His
shyness disappeared. His sense of well-being increased.
He began to see himself as a very witty, admirable fellow.
The process has been described by Prof. William McDougall:
all the intellectual functions, that of self-criticism is
the highest and latest developed, for in it are combined
the functions of critical judgment and of self-consciousness.
It is the blunting of this critical side of self-awareness
by alcohol and the consequent setting free of the emotions
and their instinctive impulses from its habitual control,
that give to the convivial drinker the aspect and the reality
of a general excitement.
Many shy men have discovered, in alcohol, the same welcome
release that Bill found, and have still been able to keep
its attraction under control. Bill, however, could not do
this. Perhaps his longing to be accepted as one of the group
was deeper than that of other boys; his sense of his own
gawkishness may have been abnormally acute. Perhaps for
most of his years on earth Bill had been ill-at-ease, so
that his only memories of complete well-being were associated
with pre-kindergarten days. Such a boy – if his physical
constitution allows him to drink a great deal without becoming
sick at his stomach-may use alcohol to put to sleep all
his mature, self-critical faculties. He may return, through
the various stages of drunkenness, to the state of the young
child-the last state in which he found happiness.”
it was with Bill: he drank enough, every time, to make him
as helpless as a child. Alcohol, even to a normal drinker,
offers a release from grown-up responsibilities. The authors
of Alcohol: One Man’s Meat-Dr. Edward A. Strecker
and Francis T. Chambers, Jr.-say “To view the panorama
of the various states of intoxication is to witness a progressive
psychological descent or repression….Most individuals
seen satisfied to regress to some phase of the teen age,
which was probably an enjoyable and carefree time, deeply
imprinted on the unconscious. Others seem satisfied with
a very slight descent, and still others are never satisfied
until they have reached an infantile level in intoxication.”
Of these is Bill.
Bill’s case was typical enough of the average alcoholic;
looking back to his college years, long afterward, he decided
that there had never been a time when he drank “normally.”
Like many alcoholics-perhaps most-he used his very first
drinking bout as an escape, rather than a means of sharpening
experience. When Bill had once discovered that drink was
a drug, which would make him forget his shyness, it was
not long before he used it to help him escape other worries
too. Within a few years he had worked his way into the typically
alcoholic pattern of behavior: whenever life became painful,
he took enough drinks to be carried back to the state of
mind and body appropriate to a carefree four-year-old child.
He was now a serious “problem drinker.”
passed through the usual steps: expulsion from college with
the promise that he could return if he would “brace
up”; a job, precariously held for a few years; marriage
to a charming girl who believed that he would stop drinking
as soon as he had “responsibilities to straighten
him up.” There were periods when her beliefs seemed
justified; Bill obtained jobs and did well, for a time.
But sooner or later there came a day when some discouragement
made him long for the carefree days when he was a little
boy. A few steps to the nearest saloon, a dozen “quick
snorts” and Bill was off on another bender.
Now, the vicious and difficult thing about Bill’s
drinking was this: he did not know that he had a disease.
Neither did his wife or his employers or his friends. They
thought that will power was what he needed; they imagined
that “a good talking to” would help. When Bill
promised, in all sincerity, that he would never get drunk
again, they believed it. Why not? He believed it himself.
Bill was as puzzled as anyone else over why he got drunk;
he thought, every hang-over morning, that from now on he
would be content to take one or two drinks, as other men
did. Even a visit to a sanitarium failed to prove to Bill
that he was incapable of moderate drinking, that he was
a sick man.
Bill found out and admitted to himself that liquor had him
bested; this was the beginning of his recovery, but that’s
had started drinking to get rid of his self-consciousness.
But Mary, who never had a self-conscious minute in her beau-filled
days, also arrived in an alcoholic ward in a big city hospital.
Mary belonged to the flapper age. She was a “prom-trotter,”
in the company of young men who carried hip flasks inside
their coonskin coasts and who believe that a speak-easy
card was a proof of great sophistication. Mary had a lovely
time her debutante year: she was the girl with the “hollow
leg,” the good scout who was always able to drive
a car home from a party when the owner was tight. Mary may
have been a normal drinker at this period; no one can be
quite sure of whether alcoholism, in its very early stages,
has subtle symptoms which some future scientists will be
able to detect. But it isn’t essential for us to know:
for after eight years of apparently normal hard drinking
Mary showed symptoms of alcoholism which nobody could doubt.
became the girl who always managed to have lunch with someone
who liked a cocktail first. She was the woman who would
say, “why don’t we have a second? That one was
so small?” She was the girl who found that straight
whisky “cured” insomnia and headaches and “braced
her up” for any disagreeable chore-from arguing with
the butcher over his bill to making a boring visit to her
in-laws. For quite a while, Mary’s daytime drinking
went undetected by her family (she was a great girl for
cloves and mouthwash). But every month she increased the
size of the nips a little more, until evening found her
half intoxicated on several days a week.
many alcoholics, Mary scorned the term. “I can stop
any time I want,” she insisted. And, “Drinking
is a part of normal gracious living to my generation. We
may overdo it once in a while, but what of it? An occasional
bender lets off steam.
This stage of bravura didn’t last long; after Mary
had been arrested twice for driving while intoxicated, and
had waked up with her third black eye, she began to wonder
whether she shouldn’t “cut down.” But
it was only after several more years of painful experimentation
that she became convinced, in all humility, that liquor
was something she could never handle again. Her recovery
dated from that admission to herself.
Jake was a self-made man, who had come up the hard way from
a childhood in the slums. Self-educated, he had attained
success as a trial lawyer with no backing, no encouragement
but his own determination to get to the top. His will power
was his strongest quality; his ability to win out over every
discouragement had been proved through the years. Jake,
after several of his greatest triumphs, went on long, expensive
benders that ended up in a bleak hotel room filled with
empty bottles, in a town he couldn’t name. Jake never
drank when there were hard problems to be faced: it was
only success that sent him off on these strange, frantic
Jake stopped drinking; just like that. He did not say to
himself. “I am incapable of handling liquor.”
He said, “I’ll stop drinking until I make a
million dollars.” After ten years, the million dollars
was safe in a brokerage account, and Jake reached for the
bottle. Inside of a month he was drunk; inside of a year
he had lost all his money and was a patient in a hospital
Bill, like Mary, like the public at large-did not know that
alcoholism is a disease and that he had it during all his
“dry” years. The man who grits his teeth and
fights the desire for drink, as Jake did, has not recovered
from the craving (which is the malady). He still looks on
liquor, and the escape it offers as a reward which he can
someday win. To Jake, success brought with it the fear of
losing it of sliding back into the poverty and misery of
his-childhood; liquor helped him to run away from this fear-to
run all the way back to the state of helpless infancy, before
his baby mind had discovered that such things as failure
and success existed. Jake drank to escape from ambition.
Until he had learned to view alcohol as a drug (so far as
he was concerned) and until he had learned to live without
the prospect of ever drugging himself, there was no hope
of recovery for him.
doctors and psychiatrists knew many things about the life
stories of such alcoholics twenty years ago. But their knowledge
did not help them to effect many cures. Psychiatrists helped
some alcoholic patients to recover then, as they do today;
but psychiatry nowadays has the benefit of the past fifteen
years of intensive study of alcoholism on the part of scientists.
It has also learned much from Alcoholics Anonymous, the
group of men and women who, disgusted with the failure of
the known medical and religious approaches, made a daring
experiment of pulling themselves up by their own boot-straps-
and were successful. It is because of the collaboration
of realistic, laboratory-minded scientists with the patients
themselves that alcoholism is today a disease from which
almost any alcoholic who wants re-covery can attain it.
was in the early ‘30’s that Dr. Howard Haggard,
head of the Laboratory of Applied Physiology, began an intensified
program of research on alcoholism at Yale University. His
experiments verified the fact that this disease has no apparent
physical cause, and that almost no lasting effect of alcoholism
can be blamed on drinking alone. Vitamin deficiency occurs
among 50 per cent of chronic alcoholics, but only because
liquor has crowded out of their diet other food essential
to health; 8 per cent of all alcoholics have cirrhosis of
the liver, compared with less than 1 per cent of the population
at large-but cirrhosis of the liver does appear in teetotalers.
Delirium tremens afflicts about 4 per cent of heavy drinkers,
but it is only a temporary effect.
of course, has its temporary effects on the nervous system,
as its percent: age mounts in the blood stream. Even such
small amounts of alcohol as are contained in two cocktails
affect the drinker’s ability to distinguish pitch
and color, to memorize poetry to react to light signals.
But these effects are shared by the alcoholic and the normal
drinker as well. Physiology alone can give no answer to
the question: Why do 15 drinkers out of 1000 become the
victims of alcoholism?
Haggard began casting around among the sister sciences,
to see what enlightenment their studies might give. He and
his colleagues founded a scholarly publication- the Quarterly
Journal of Studies on Alcohol-and assembled on the Yale
campus a number of scientists to work in various fields.
Here, in the Yale Section on Alcohol Studies, neurologists,
psychiatrists, statisticians, sociologists, anthropologists,
lawyers under Dr. E. M. Jellinek tried to crack the age-old
questions: What makes an alcoholic? How can he be helped?
the summer of 1943 the scientists thought they knew enough
about the second problem to share their findings with the
public. They had studied many alcoholics who had learned
how not to drink; they believed that knowledge of this sort
should be shared with leaders of the community, who might
use the information to attack the social evil that alcoholism
has always been. For from 25 to 28 per cent of all crime
is associated with alcohol; the costs to society of merely
confining and punishing the alcoholic run to a billion dollars
a year (and none of that money is used to treat the alcoholic).
Our prisons and hospitals and mental asylums would be relieved
of a heavy load if alcoholism could be wiped out, as smallpox
help bring this about, the Summer School of Alcohol Studies
was held at Yale in 1943 and every summer since. Men and
women representing twenty-five professions have attended
in a single season; there were a college dean and a “reformed
drunk,” a judge and several ministers, a distiller
and an officer of the Women’s Christian Temperance
Union. The course of lectures covers the significant findings
of the scientists at the laboratory; they also bring in
data from the two Yale Plan Clinics set up to help alcoholics
who are sent in by the courts or who come, voluntarily,
to seek treatment there.
are the facts spread before the students at a summer session
by this group-which has learned more about alcoholism than
any other in the history of the world?
Why one man becomes an alcoholic and another doesn’t
is still a mystery. We know that alcoholism is not hereditary:
only 35 per cent of alcoholics come from alcoholic homes,
and the children of excessive drinkers, brought up in another
environment, have no significant drinking difficulties.
Nor can environment be blamed: the men who started to drink
with the alcoholic are usually moderate drinkers twenty
years later. A longing to escape from reality, and a desire
to return to the security of an earlier period of life,
is common to alcoholics; but the same desire is shared by
thousands of other men and women. Some of these misfits
become psychoneurotics or invalids, but never feel at-tracted
to drink; others, for an unknown reason, turn to alcohol.
Against these negative results of fifteen years of study,
the Yale group can say that there are now four recognized
methods of treatment available to the alcoholic who wishes
to get well and that, if he is sincere, he has a slightly
better than 60 per cent chance of recovery. His alcoholism
will not, however, be cured-it can only be arrested. Nothing
now known will make it possible for the alcoholic to drink
moderately, on any terms, in any foreseeable future. He
must be willing to abandon all forms of liquor, as long
as he lives.
But the alcoholic can be taught to live happily without
drinking; recovered alcoholics rarely feel deprived or resentful
of their inability to take a drink. They look upon their
disability much as a diabetic resigns himself to doing without
The greatest problem facing those interested in alcoholism
now is to reach the alcoholic and his family with the news
that help is available - provided that they will look upon
alcoholism as a disease. If the public at large once recognized
this fact, alcoholism could be almost wiped out in a few
years, and at very small expense. The Yale Plan Clinics,
for instance, have reclaimed a high percentage of their
patients, at a cost of only $100 per recovery. All the known
alcoholics in the country could be given such help for $75,000,000,
or one thirteenth of what we now pay merely to lock up such
patients, and punish them, every year.
Now, how did all this progress come about? Was it through
the research scientists, the diligent doctors that the problem
of helping the alcoholic was primarily solved? No, it was
not. The scientists have done much toward re-educating the
alcoholic into the ways of happiness and health; but of
the four forms of treatment, which have proved successful
only one-psychiatry-can help a patient without the help
of other alcoholics.
Psychiatrists pointed the way- their painstaking, heartbreaking
efforts to reclaim alcoholics broke the trail. They discovered
the compulsive element in alcoholism and taught us to expect
that the man who says, “I only want three drinks,”
at noon may be reaching for his twentieth at cocktail time.
Psychiatrists uncovered the reluctance to grow up which
lurks in the breast of every alcoholic. But psychiatry,
working alone, had only a very limited success-2 per cent,
according to some estimates.
(Psychoanalysis, one form of psychiatric cure, has been
carried out on very few alcoholics. The Institute of Psychoanalysis
in Chicago, of 1593 patients interviewed, had only 36 classified
as alcoholics or drug addicts; only 4 of these were analyzed).
Psychiatrists who have the highest percentage of success
with alcoholics today draw heavily on the experience of
the three other forms of treatment. By combining their own
valuable, specialized approach with one of the other therapies,
they have had great success in recent years. In co-operating
with the three other forms of treatment, they are accepting
the help of recovered alcoholics themselves, who have given
tremendous help to the scientists studying the disease in
recent years. It was only when the desperate inebriates
started pulling themselves up by their bootstraps that things
began to hum.
Take a look at the alcoholic, this medical pioneer: he is
no “man in white,” no winner of Nobel prizes.
He is just the village drunk; the stumblebum on the Bowery;
the man who broke his mother’s heart; the figure of
comedy; the improvident father; the helpless recipient of
more useless good advice than any other man in history.
Take a look at him. It was he who helped the Drys to clinch
their argument and legislate 50,000,000 indignant normal
drinkers into national Prohibition. It was he whom many
sanitariums and private hospitals will still not receive
for treatment. This s the alcoholic, half crazed with the
shakes, eaten with remorse, up to his ears in debts and
disgraceful episodes, the prey of quacks who give him “cures”
for just the amount of his family’s bank account,
and leave him worse than ever-the man weeping wives and
ministers and judges brand as “worthless.” This
was the man who decided something had to be done about himself-and
The most popular of the four therapies for alcoholism did
not exist when Doctor Haggard began his experiments. It
was in 1935 that the founding fathers of Alcoholics Anonymous
got together and began to cure themselves. They were extreme
cases; even today 80% of A.A.’s have been locked up
for drunkenness. These men were desperate in their weariness
of being told the wrong things by outsiders who didn’t
understand. In despair, and fumblingly, they worked out
their own form of self-help-a kind of composite of what
religion and science could give the drunk that would keep
him from wanting to drink. This treatment- the patient’s
own personal creation-is Alcoholics Anonymous. And it works.
A.A. has spread, with the speed of a chain letter, among
the “hopeless” alcoholics of the country. In
1935 there were three members; in 1959, when the book, Alcoholics
Anonymous, was published, there were 100, most of them in
Akron and New York. Today there are 752 A.A. branches, 24,000
members. Some of the chapters have clubrooms, open most
days and evenings, where the members can play games, drink
soft drinks and exchange experiences-they provide the sociability
of the barroom to men still a little unsteady about trusting
themselves in the old surroundings. Best of all, they have
meetings where recovered alcoholics tell their stories to
encourage new members.
Each man or woman begins the talk with the humbling words,
“I’m an alcoholic.” He tells the funny
things he did when he was drunk, as well as the dangerous
and cruel things-for he knows that he was the victim of
a sickness, and he feels no shame over its manifestations.
He tells of the difficulties in making the first, painful
surrender of self to some “greater force,” and
the whole reorientation of values that that entailed-for
there is a strong reliance on God in the A.A. program. If
the speaker had an early relapse-as some A.A. do-he admits
that this came from careless or self-centered thinking.
A.A.’s tell the audience that the place to lick the
temptation to drink is in the mind, as soon as the self-excusing
mechanism begins to work. It is at this moment that the
A.A. pleads “Give me the name of an alcoholic who
needs help.” For it is by showing the way out to other
men, in more desperate need than himself, that an A.A. keeps
There is always an alcoholic, somewhere, to be helped; with
750,000 in the country, the supply is never low. A.A.’s
in strange cities, when they feel themselves slipping, call
hospitals and ask, “Have you a drunk I can come up
and talk to?” Others appeal to ministers whose names
they pluck from the telephone directory. The first chapter,
that of Akron, Ohio, sprang from just such a need on the
part of the original A.A., who had to find another alcoholic
whom he could help, to save himself from drinking.
The A.A. way is brought to the alcoholic by a former sufferer,
and at the right moment-when he is still filled with self-reproach
and misery and has a hangover to humble him. In this period
of self-abasement, the drunk is willing enough to take the
first step: to admit-as a mere possibility, mind you-that
there may be some force in the universe bigger than himself.
That admission-combined with a sincere desire to stop drinking-is
enough for the A.A. to build on.
and agnostics, who stumble over using the word ‘God’,
are still able to admit that the universe contains laws
and forces broader than themselves,” say the A.A.’s.
One half of their members, indeed, used to scoff at all
Doctors now take the A.A. technique seriously. Philadelphia
General Hospital, among others, allows A.A.’s the
privileges of staff members, so that they may work with
fellow alcoholics outside of visiting hours. Some psychiatrists
urge their patients to combine A.A. membership with psychiatric
treatment; Dr. H.M. Tiebout, of Blythewood Sanitarium in
Connecticut, was one of the first of these.
Of the alcoholics who are contacted by Alcoholics Anonymous,
about one half immediately catch on and remain dry. Another
25 per cent are flat failures-they either do not want to
stop drinking or are so confused and psychopathic that they
cannot be reached. The last 25 per cent go off, after a
meeting or two, and try drinking; but they usually return.
One of the early founders had no apparent converts at all
among the first 75 men with whom he worked; ten years later
he found that three had died but that 67 of the rest were
members of different A.A. groups throughout the country.
When he first talked to them, they were not yet ready to
stop. They only “wanted to want to quit,” in
But there are some men and women who entirely reject the
religious approach. To them, two other routes are open.
There is the very successful record of the “lay therapists”;
these are men who used to be alcoholics themselves, but
who have reconditioned their minds, by psychological methods,
so that the desire for the first drink can be dealt with
before it becomes a real temptation. There are only a few
lay therapists in the country. Most of them are graduates
of Richard R. Peabody, of Boston, who wrote The Common Sense
of Drinking and who taught other men the technique by which
he had cured himself of alcoholism. The lay therapists work
closely with hospitals and doctors, who help them screen
their patients and choose only those for whom this method
seems a promising one. Office consultations, once or twice
a week for a year, are supplemented by daily psychological
exercises. Francis T. Chambers, Jr., of Philadelphia, Raymond
McCarthy, of the Yale Plan Clinic at New Haven; and Donaldson
Clark, of New York City, are well-known therapists.
The lay therapist accepts only the alcoholic who is honestly
willing to recover. One of them tests the sincerity of the
patient by asking him, “Do you recognize your drinking
as the central problem of you life and the one that must
be solved first?” A surprising number of alcoholics
who have been fired, divorced and jailed for excessive drinking
refuse to admit that they are alcoholics: they drank, they
will tell the doctor, only because the conditions of their
lives were insupportable. If they were given “the
breaks” they could still drink moderately. Alcoholics
in this frame of mind are not ready to be helped by the
lay therapist. Such patients, when they hint that they can
now drink moderately, are usually advised to, by all means,
try. A few months or years later the majority of them return,
finally convinced that “moderation” is only
patient who once admits that alcoholism is his largest problem,
and that he will work toward recovery, has already made
a big step forward: for the first time in his life, he has
accepted the responsibility for his misfortunes and can
set about correcting them. This is a first step out of the
old, alcoholic way of retreating from painful experiences.
But it is only the first step.
No alcoholic, even after he has begun a course of treatment,
is really convinced that he will ever reach a stage of not
wanting to drink: only months of mental discipline and suggestion
can bring about such a radical change. “perhaps you
can make me grit my teeth and determine never to take a
drink,” the patient will say, “But I’ll
always want one.” He is wrong: when he has recovered,
his antipathy to alcohol is so great that, in the words
of one recovered alcoholic, “If doctors tomorrow discovered
a pill that would enable me to drink moderately, I’d
say, ‘That’s fine-give it to someone else. I
don’t want to drink.’” Another states
the case this way: “NO alcoholic is safe until he
can honestly say that if he had only twelve hours to live,
with nobody watching him and the certainty that nobody could
learn about it later, he still would pass his last day on
earth without a drink.”
How do lay therapists bring this transformation about? Under
their guidance the patient orders every hour of the day,
according to a schedule he himself has worked out in advance-and
he never departs from this, except in a case of real necessity.
In this way he learns to direct his own destiny. He spends
a part of every day tracking down his hidden mental reservations
about future drinking, or trying to figure out the reason
for his benders in the past. This teaches him to look at
alcoholism realistically, without shame or fear.
Most important of all: he trains his mind to associate the
first thought of a drink with the painful episodes to which
it would inevitably lead him. He learns, like the A.A.,
to deal with the temptation to take a drink when it is first
forming in the mind, and to destroy it there. During a period
of at least a year the patient has several sessions a week
with the therapist, who helps him over the rough spots and
compares experiences from his own past.
Dr. Foster Kennedy, head neurologist of Bellevue Hospital,
New York, has said, “I have no doubt that a man who
has cured himself of the lust for alcohol has a far greater
power of curing alcoholism than a doctor who has never been
afflicted with the same curse.” Dwight Anderson, director
of public relations of the Medical Society of New York,
says, “The recovered alcoholic will never give up
hope. He cannot forget the numberless times that his friends
and relatives gave up all hope for him, to say nothing of
the occasions when he had no hope for himself. But when
the time was right and he himself was ready, he became accessible."
Alcoholics themselves are very skeptical of they remember
how often they said so themselves, with no real intention
of taking the step. That is one reason why recovered alcoholics
are used as interviewers who greet all patients arriving
at the hospitals which give the “aversion treatment”-the
fourth method which claims recoveries today.
patients are warned, by recovered alcoholics on the staff,
that this treatment is painful, disagreeable and no good
to them unless they are desperate enough to welcome a future
in which the mere sight or smell of any drink will sicken
them. If they face this prospect without flinching, they
are considered for one of the hospitals specializing in
this technique; only about one man out of eight who applies
patient is taken, several times a day into the hospital
barroom, where various kinds of drinks are mixed in a setting
that has the familiar associations of his pet saloon. A
spotlight plays upon the bar; ice clinks pleasantly as the
attendant, in a white coat, mixes his favorite “poison.”
It is poison, too; for the patient has been given injections
of drugs which make him deathly ill at the exact moment
when he swallows the drink. Combined with psychotherapy,
and repeated several times in the first year, this method
has had success with 65 per cent of cases accepted. It is
used at the two Shadel Sanitariums in Seattle and Portland,
and at the University of Wisconsin Medical School.
of these approaches are new-three of them lean heavily on
the sympathetic skill of the recovered alcoholic for their
success. All of them claim a record which is twenty to thirty
times as high as that claimed by any method twenty years
ago. For in that brief period, alcoholism has become recognized
as a disease from which even the most despaired-of cases
can usually recover.
But the alcoholics and the doctors cannot do the whole job
of helping our 750,000 cases alone; they need the force
of public opinion behind them. They need, in every city,
a demand for the kinds of clinics which, at Yale, have blazed
the trail. They need public recognition of the fact that
alcoholism is not a reflection on the patient’s character,
but is a misfortune for which society is partially to blame.
When these facts are widely known, many alcoholics-who have
no idea they can be helped-will be restored to lives of
health and usefulness. Many families, whose present fumbling
efforts are actually driving their sons to drink, will change
among members of the alcoholic’s family is very widespread,
indeed. Alcoholics anonymous found that they were spending
most of their time educating the relatives of prospects,
instead of concentrating on the problems of the alcoholic
himself. Two years ago a group of them devised a plan for
public education on the subject. Marty Mann, an A.A. secured
the backing of the Yale University group and launched the
National Committee for Education on Alcoholism to teach
the known facts to the public. The essential teaching of
the committee is three simple facts, as all their literature
states: “Alcoholism is a disease and the alcoholic
is a sick person. The alcoholic can be helped and is worth
helping. Alcoholism is a public-health problem and therefore
a public responsibility.”
the committee was formed, information centers have been
established in four cities and permanent committees formed
in nine. Clinics will eventually be set up, it is hoped,
in every large town in the country; when that is done, the
alcoholic will at last have a place where he can go to find
his problem discussed without moral indignation, sentimentality
the need for such a viewpoint, Dr. Selden Bacon recently
wrote, “Apathy, secret shame or attacks on scapegoats
can be the response of the public to a problem. During the
past 200 years the public in this country has reacted in
these unrealistic ways when faced with the problems of mental
ills, political corruption, venereal diseases. People have
reacted the same ways to alcoholism. Stimulation of the
public is essential to bring about a new adjustment.”
good can education do? Well, if the public understands that
alcoholism is a disease, it will no longer urge the alcoholic
to “Drink like a gentleman”; or “Take
two cocktails and stop, as I do”; or “Learn
your capacity”: it will be common knowledge that alcoholics
cannot do these things and that moderation is impossible
for them. When the public has learned more of this disease,
hostesses will not urge “Just a little one”
on guests who have refused a drink-they will understand
that some people cannot drink at all.
would give the alcoholic a better chance to recover early
if they realized that alcohol, to the patient, is the only
thing which makes his muddled, miserable life at all supportable.
The threat that it may be withdrawn appalls him and he will
face the horrors of a “dry” future only if he
has convinced himself that this present life is even more
unendurable. Families who protect the alcoholic from painful
experiences may be doing him a great disservice; sometimes
it is only the loss of a job or the horror of a serious
accident which jolts the alcoholic into a state of mind
in which he admits that the barren, frightening prospect
of a life without liquor may be better than going on as
he is. At that moment he has, as the alcoholics say, "hit
bottom”; he is ready to begin.
the public is better informed, employers, employers and
parents will not scold the alcoholic for behavior he cannot
yet control; as one of the committee pamphlets says, “The
alcoholic knows well enough that he is not fair to his family,
that he is losing his friends and endangering his future.
He reproaches himself more bitterly than anyone else does.”
With greater understanding of the subject, no friend will
suggest, “Just stick to wine and beer,” or “Try
drinking only over week ends.” The committee says,
“If the alcoholic could, he would do all this. He
has tried over and over again and has failed. But with expert
guidance he can learn to deal with his problems in a normal
way and without any alcohol at all.”
man or woman becomes an alcoholic through choice; all authorities
agree on that. No alcoholic deliberately and perversely
chooses a life that will bring misery on his family. No
alcoholic sets out, on purpose, to become a problem to society.
His sufferings are real and grim and he is very eager to
escape from them, if society will give him the chance.
And if society doubts whether the alcoholic deserves much
help or sympathy, it is well to remember this: this is the
first malady in history which has been licked by its own
victims, when science, without their help, had failed. If
Bill, the stumblebum, and Mary and Jake were able to perform
some thousands of miraculous changes in their own lives
and those of other sufferers, then they have perhaps earned
the right to ask society to adopt the only attitude which
can ever help the alcoholic back to sanity: to look on him
as a very sick man who-now or later-will reach the stage
where guidance can help him to recover.
the Drinker Who Needs Help
ANONYMOUS. Confidential information for the alcoholic in
need of help. Will provide address of members in his community
or, if necessary, advise him by personal letters. P.O. Box
459, Grand Central Annex, New York 17, N.Y.
COMMITTEE FOR EDUCATION ON ALCOHOLISM. Information for civic
minded men and women who wish to arrange for lectures, radio
programs and newspaper publicity campaigns in their communities.
Advice on the organization of local committees and literature
on alcoholism. Room 447, New York Academy of Medicine Bldg.,
2 East 103rd St., New York 29, N.Y.
SCHOOL OF ALCOHOL STUDIES. Information of a technical nature
for physicians, psychiatrists, sociologists, penologists,
and others interested, professionally, in alcoholic problems.
4 Hill House Ave., New Haven, Conn.
COUNCIL ON PROBLEMS OF ALCOHOL. Information on different
types of treatment and lists of recommended literature.
60 East 42nd St., New York 17, N.Y.
Ladies’ Home Journal, August 1946)