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Cover Story: Out in the Open
by
Edward W. Desmond
Changing
attitudes and new research give fresh hope to alcoholics
Just
before the Betty Ford Center opened in the affluent desert
town of Rancho Mirage, Calif., in 1982, neighbors ventured
out across their well-manicured lawns to ask to staff a
few questions. “Will there be bars on the windows?”
they wanted to know. “Will they get out and go drinking
in the neighborhood?” The answer in each case was
of course no, but the questions reveal a familiar attitude
toward alcoholics: many people thought of them as hardly
better than criminals or at the very least disturbed and
bothersome people. But at the same time the fact that a
sanatorium for alcoholics has been started by a former First
Lady who openly admitted to a drinking problem signaled
that a hopeful change was in the air. Since then, a stream
of recovering alcoholics, among them such celebrities as
Elizabeth Taylor, Jason Robards and Liza Minnelli, have
stepped forward to tell their stories with bracing candor--of
being caught in the vortex of alcoholism, of taking the
strenuous route to sobriety offered in therapy and of regaining
their health and self-respect. The long process of recovering
from alcohol abuse, which experts insist never ends, suddenly
began to get favorable notices.
Today,
in treatment centers nation-wide, patients are getting a
message of openness and hope. In his therapy sessions, John
Wallace, director of treatment at Edgehill Newport, a center
in Newport, R.I., explains that alcoholism is a disease
with a genetic basis, and nothing to be ashamed of. “I
ask how many had a close alcoholic relative,” he says,
“and 95% raise their hands. That astonishes them.”
He describes the latest theories about neurochemical imbalances
that make an alcoholic incapable of drinking normally. “They
are really fascinated,” he says. “It takes away
a lot of their guilt and makes them less defensive.”
In
ways unimagined ten years ago, the shadow that has obscured
the truth about alcohol has begun to lift. There is encouraging
news, and it is substantial. “Silence is each day
giving way to courage,” Otis Bowen, Secretary of Health
and Human Services, said recently, “and shame to strength.”
Evident all around is a busy sense of awakening. Children
are learning about the perils of alcohol in school through
slogans like “Get Smart, Don’t Start--Just Say
No.” The accumulated scientific findings of the past
decade are having a major impact on the public. Recently
a Gallup poll found that a great majority of American adults
are convinced that alcoholism is indeed an illness rather
than a sign of moral backsliding. In that, they have the
support of the American Medical Association, which 21 years
ago formally declared alcoholism a disease. At that time,
only a handful of programs, such as Hazelden in Minnesota,
offered treatment for alcoholics. Since then medical centers
and treatment programs have proliferated across the country.
There are more than 7,000 treatment programs, a 65% increase
in the past six years alone. Partly because of the new spotlight
on the dangers of alcohol, Americans are beginning to moderate
their drinking habits: consumption of alcohol peaked in
1981 and has since declined by 5%. In many social circles
today, the big drinker stands out like W. C. Fields at a
temperance meeting.
The
most exciting developments in the battle against alcoholism
are taking place in the nation’s laboratories, where
scientists and medical researchers are probing its neurochemical
roots and hunting for genes that may influence its development.
Next month researchers from six national laboratories will
meet in New York City to coordinate their search through
human DNA for the genes that may underlie alcoholism. If
they are successful, doctors may one day be able to test
young people for certain genetic markers, the chromosomal
quirks that predispose some individuals to alcoholism, and
warn those who are at risk of developing the disease. Says
Henri Begleiter, professor of psychiatry at the State University
of New York Health Science Center and president of the Research
Society on Alcoholism: “Never in the history of alcoholism
have we made as much progress as we have in recent years.”
For
the 18 million Americans with serious drinking problems,
life is a runaway roller coaster that, left untended, inevitably
leads to disaster. “It ruins everything that matters
to you,” says New York Times reporter Nan Robertson,
a recovered alcoholic. “In the end, the bottle is
your only friend. Alcoholics would rather do anything than
stop drinking.” For the vast majority of Americans,
the occasional social drink is a harmless affair. For the
afflicted, however, the most innocent gathering of family
or friends--a wedding at a suburban country club, a casual
gathering on an urban sidewalk--can turn into a nightmare
of temptation, indulgence and worse. Recalls a youthful
recovering alcoholic: “My biggest fear was getting
through life without a drink. Today it is that I might pick
up that one sucker drink.“
The
stakes are high. Alcoholism claims tens of thousands
of lives each year, ruins untold numbers of families and
costs $117 billion a year in everything from medical bills
to lost workdays. The magnitude of the problem has been
overshadowed in recent years by the national preoccupation
with the new threat of AIDS and the widespread use of drugs
such as heroin, cocaine, marijuana and crack. “Take
the deaths from every other abused drug,” says Loran
Archer, deputy director of the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) in Washington. “Add them
together, and they still don’t equal the deaths or
the cost to society of alcohol alone.”
Alcoholism’s
toll is frightening. Cirrhosis of the liver kills at least
14,000 alcoholics a year.
Drunk
drivers were responsible for approximately half the 46,000
driving fatalities in the U.S. in 1986. Alcohol was implicated
in up to 70% of the 4,000 drowning deaths last year and
in about 30% of the nearly 30,000 suicides. A Department
of Justice survey estimates that nearly a third of the nation’s
523,000 state-prison inmates drank heavily before committing
rapes, burglaries and assaults. As many as 45% of the country’s
more than 250,000 homeless are alcoholics.
Despite
all the advances in knowledge and attitudes, plus the deluge
of books, movies and television programs on alcoholism,
the cartoon image of the cross-eyed drunk slumped in the
gutter or staggering through the front door still lingers
in the minds of some Americans. Not long ago many believed,
as two researchers put it in the 1950s, that “alcoholism
is no more a disease than thieving or lynching.” Such
attitudes are fading fast, to be sure, but not without leaving
a residue of ambivalence. Says LeClair Bissell, 59, a recovered
alcoholic and physician: “At the same time we say
through our lips that alcoholism is a chronic disease, many
of us feel in our guts that it’s a moral or self-inflicted
problem.”
Yet
it is a disease, and it can be a ruinously expensive one.
A four-week drying-out regimen can cost anywhere from $4,000
to $20,000 for in-patient care; today medical insurance
covers the tab for 70% of American workers in companies
with more than 100 employees. In the early 1970s, the Kemper
Group of Long Grove, Ill., was the first national insurance
company to include coverage for alcoholism in all its group
policies. The firm’s hunch: the bill for helping an
alcoholic quit today would be cheaper than nursing him through
afflictions like cirrhosis of the liver and strokes later
in life. The logic of acting sooner rather than later has
spread throughout corporate America. Some 10,000 firms and
public agencies, including 70% of the Fortune 500 companies,
now have employee-assistance programs to help alcohol and
drug abusers pull their lives together and get back to work.
“Before this,” says William Durkin, employee
assistant manager at ARCO, “the normal handling was
to tolerate the alcoholic employee until he became intolerable
and then to fire him.”
Progress
in the actual treatment of alcoholism is disappointing.
Most facilities still rely on basic therapies worked out
in the 1940s. Though some centers advertise grossly exaggerated
success rates of 70% after four years, the best estimates
are that only 12% to 25% of patients manage to stay on the
wagon for three years. Alcoholics Anonymous, the tremendously
popular association of an estimated 1 million recovering
alcoholics, remains the single biggest source of support
for chronic drinkers. But its record is hard to assess because
of members’ anonymity. Even so, only 15% to 20% of
alcoholics get any treatment at all. Says Enoch Gordis,
director of the NIAAA: “Something very important is
still missing here.”
Simultaneously,
another shadowy fact of life about alcoholics has been dragged
into the light: the severe emotional scars they leave on
their spouses and especially on their children. “Years
ago the focus fell solely on the alcoholic,” says
Carol, a mother of four and wife of an alcoholic. “Nobody
identified the needs of the family.” Indeed, alcohol
abuse accounts for more family troubles than any other single
factor. A Gallup poll this year found that one in four families
reported a problem with liquor at home, the highest reported
rate since 1950 and twice the 1974 rate. According to Health
Secretary Bowen, alcohol is the culprit in 40% of family-court
cases and accounts for between 25% and 50% of violence between
spouses and a third of child-molestation incidents.
Though
awareness of alcoholism’s destructiveness is growing,
the sheer number of alcoholics
shows no sign of abating. Young people are especially vulnerable.
Bowen states that nearly 5 million adolescents, or three
in every ten, have drinking problems. Several studies show
that children are beginning to drink earlier than ever before,
and a Weekly Reader study earlier this year reported that
36% of fourth-graders were pressured by peers to drink.
“Kids are making decisions about alcohol and drugs
when they are 12 to 14, whereas in the preceding generation
they made those decisions at ages 16 to 18,” says
Lee Dogoloff, executive director of the American Council
for Drug Education. “The younger a person starts drinking,
the more likely he is to develop problems later in life.”
Who,
exactly, is an alcoholic? The question is a tricky
one: symptoms are not always clear cut, and even doctors
do not agree on a definition of the disease. The extreme
cases are obvious. A person in the grip of alcoholism blacks
out from drinking too much, suffers memory loss, and wakes
up trembling with craving for another drink. But most cases
show fewer dramatic symptoms. Also, the behavior of alcoholics
fluctuates wildly. Some drink heavily every day, while others
can stop for brief periods, only to go off on binges. This
past year the American Psychiatric Association settled on
three basic criteria to define and diagnose alcoholism:
physiological symptoms, such as hand tremors and blackouts;
psychological difficulties, which include an obsessive desire
to drink; and behavioral problems that disrupt social or
work life.
The search for alcoholism’s general underpinnings
began in earnest in the early 1970s with a simple question:
Why does the disease seem to run in families? Dr. Donald
Goodwin, chairman of the psychiatry department at the University
of Kansas School of Medicine, set about seeking an answer
by studying 133 Danish men who were all adopted as small
children and raised by nonalcoholics. Goodwin divided his
subjects into two categories: those with nonalcoholic biological
parents and those with at least one alcoholic parent. Then
he interviewed each of the adopted men in depth and examined
health records to see which of them developed alcoholism
in adulthood. If the disease had a genetic basis, Goodwin
reasoned, then the children who had an alcoholic biological
parent would wind up with drinking problems more often than
the others.
His
findings were startling. The sons of alcoholics turned up
with drinking problems four times as often as the sons of
nonalcoholics. That result helped put to rest the popular
assumption that alcoholics took up drinking simply because
they learned it at home or turned to it because of abuse
suffered at the hands of an alcoholic parent. The study,
however, did not rule out environmental factors. Indeed,
scientists now estimate that fully 30% of alcoholics have
no family history of the disease. But Goodwin showed that
some inherited attribute was involved. “What we learned
from the adoption studies,” says Dr. C. Robert Cloninger,
a professor of psychiatry at Washington University in St.
Louis, “is not that nature was important or nurture
was important but that both are important.”
But
it was still far from clear how hereditary and environmental
factors combine to create an alcoholic. In the early 1980s,
Cloninger joined a team of Swedish investigators led by
Michael Bohman, a psychiatrist at the University of Umea,
to study an even larger group of adoptees. Since Sweden’s
extensive welfare system keeps thorough records on each
citizen, Bohman was able to compile detailed sketches of
1,775 adopted men and women, more than a third of whom has
an alcoholic biological parent. As Cloninger studied the
health, insurance, work and police records of his subjects,
two distinct categories seemed to emerge--and with them
new evidence that alcoholism may have more than one form.
Cloninger’s
first group of alcoholics, about 25% of the total, tended
to drink heavily before the age of 25, had bad work and
police records and met with little success in treatment
programs. Drinking was a habit they seemed to pick up on
their own, with little encouragement from friends or other
influences. When Cloninger checked how often alcoholism
appeared in the sons of men who fit this description, he
found it surfaced nine times as often as in the general
population. This variation of the disease, Cloninger concludes,
is heavily influenced by heredity. Because it appears primarily
in men, he calls this form “male limited” alcoholism.
The
second type included both men and women and made up about
75% of the study’s alcoholics. They started chronic
drinking usually well after the age of 25, rarely had trouble
with the law, and often successfully kicked the habit. Their
children were only twice as likely to have trouble with
alcohol compared with the general population. Cloninger
labeled this category of alcoholism “milieu limited,”
indicating a genetic predisposition to the disease that
is triggered by extended heavy drinking.
Cloninger’s
work added key pieces to the puzzle
of alcoholism by suggesting traits that certain types of
alcoholics have in common. For example, Cloninger found
that his male-limited alcoholics tended to be aggressive,
even violent types. He hypothesizes that the nervous system
underlying such behavior may react to alcohol in a way that
quickly leads to dependence. “It’s not proved,”
says Cloninger. “It’s testable.” Says
Boris Tabakoff of the NIAAA: “For those of us looking
for biological markers, Dr. Cloninger’s work gives
us a road map we can follow to link genetic traits to behavior.”
If
researchers could develop medical tests that identify biochemical
signposts indicating a predisposition to alcoholism, they
could warn potential alcoholics before trouble started.
SUNY’s Begleiter found just such a potential marker
in the brain. By using an electroencephalograph to measure
the brain waves of nondrinking sons of alcoholic fathers,
Begleiter discovered that a particular brain wave called
the P3 showed a dampened response. In each instance the
sons’ brain waves closely duplicated those of their
fathers, while other subjects with no family history of
alcoholism showed strong P3 waves. In addition, Dr. Marc
Schuckit, a researcher at the San Diego Veterans Administration,
has found that after several drinks some men whose fathers
are alcoholics show fewer changes in the levels of two hormones,
prolactin and cortisol, than men whose fathers are nonalcoholics.
Eventually, such findings may provide important clues in
the search for the genes involved in alcoholism.
Scientists
acknowledge that work on the effects of alcohol on individual
brain cells is still in its infancy. Part of the problem
is that ethanol, the active ingredient in alcoholic drinks,
easily penetrates the membranes of all cells and disrupts
their normal function. Unlike other psychoactive drugs,
ethanol does not target specific parts of nerve cells, or
neurons, but seems to enter cell membranes and sabotage
the nervous system indiscriminately.
Steven
Paul, chief of the clinical neuroscience branch at the National
Institute of Mental Health, is studying how ethanol affects
certain cells in the brain to induce sedative effects. He
is looking at a group of receptors, sites on the membranes
of brain cells, that link with a molecule called gamma-aminobutyric
acid (GABA), a neurotransmitter that moves across the synapses
between neurons. GABA homes in on a complex known as the
GABA-benzodiazepine receptor. If there are a sufficient
number of GABA molecules present in certain areas of the
brain, anxiety diminishes. Tranquilizers such as Valium
and Librium work by attaching themselves to the receptor
and increasing GABA’s effectiveness.
Paul
believes ethanol also reduces anxiety by acting on those
GABA-sensitive neurons. Altering the amount of GABA in the
brain could theoretically neutralize the effects of intoxication.
To that end, Paul is currently experimenting with a drug,
Ro15-4513, that blocks ethanol’s ability to activate
the GABA receptor, thus sharply reducing alcohol’s
sedative effects in rats. Although the drug is toxic to
-humans, variants could one day be useful in treatment.
Other scientists are studying a new class of drugs that
seem to block the alcoholic’s craving for a drink.
These compounds boost the amount of another neurotransmitter,
serotonin, in the brain, thus encouraging a sense of well-being-and
bolstering abstinence.
Ethanol
has a harmful effect on nearly every organ in the body.
Chronic heavy drinking increases the risk of myocardial
-disease and high blood pressure. Alcohol eats away at the
stomach and intestines, causing bleeding in some drinkers.
Alcoholic males may experience shrunken testes, reduced
testosterone levels, and even impotence. Sustained drinking
sometimes disrupts women’s menstrual cycles and can
render them infertile. Among expectant mothers, drinking,
can produce birth defects and is a major cause of mental
retardation in American children. Even the immune system’s
efficiency is reduced by alcohol. Studies are under way
to determine whether heavy drinking might cause AIDS to
surface more quickly in infected carriers.
But
alcohol takes the worst toll on the liver, where most of
the ethanol in the bloodstream is broken down. Because alcohol
is so high in calories (there are 110 calories per jigger
of 90-proof liquor), the liver metabolizes it instead of
important nutrients, a phenomenon that can lead to sever
malnutrition. The high caloric content of ethanol also causes
fat to build up in the liver, one of the earliest stages
of alcoholic liver disease. This is frequently followed
by scarring of the liver tissue, which interferes with the
organ’s task of filtering toxins from the blood. The
slow poisoning leads to other complications, including cirrhosis,
an often fatal degeneration of the liver that affects at
least 10% of all alcoholics and is especially hard on women.
‘They die of cirrhosis earlier than men, even though
they consume less alcohol,” says Judith Gavaler, an
epidemiologist at the University of Pittsburgh Medical School.
This
year studies at the Harvard Medical School and the National
Cancer Institute reported than even women who drink moderately
may have a 30% to 50% greater chance than nondrinkers of
developing breast cancer. Heavy drinking among men and women
alike has been linked to cancer of the liver, lung, pancreas,
colon and rectum. In October a team led by Dr. Charles Lieber,
a leading alcoholism researcher at the Bronx Veterans Administration
Medical Center in New York City, reported that it had isolated
a possible link between alcohol and cancer in humans. The
culprit appears to be a member of the family of enzymes
called cytochrome P-450s. In the presence of alcohol, the
cytochrome can turn certain chemicals in the body into carcinogens.
Despite
the medical recognition of alcoholism as a disease 21 years
ago, there is still uncertainty over its legal status as
an illness.
Michael
Deaver, the former aide to President Reagan who is on trial
for lying to a grand jury about his lobbying activities,
is arguing that he was not responsible because he is an
alcoholic and his drinking at the time impaired his memory
of events and facts. In the past the so-called alcoholism
defense generally has not been very successful, but it has
worked on occasion in perjury cases.
Next
month the Supreme Court will hear a case that is likely
to hinge on the Justices’ decision as to whether alcoholism
is a disease. Two former soldiers, now recovered alcoholics,
are seeking to overturn a 56-year-old Veterans Administration
policy that classifies alcoholism as “willful misconduct”
rather than a sickness. The VA’s definition prevents
alcoholics from receiving benefit extensions awarded to
veterans with illnesses. In seeking to make their case,
the plaintiffs’ lawyers are expected to bring up the
new evidence that alcoholism may have a genetic basis. Says
Kirk Johnson, general counsel for the A.M.A., which filed
an amicus brief in the case: “We want a medical judgement,
not a ruling based on fear, misunderstanding and prejudice.”
For
alcoholics, the only way to stop the havoc alcohol causes
is, of course, to quit drinking. That is easier said than
done. The main barrier to ending the torment is the alcoholic’s
characteristic, and usually adamant, denial that any problem
exists. Mary, 61, who has not taken a drink for 14 years,
remembers blacking out and waking up with her hands trembling
so badly that she could not hold a cup of
coffee. “I had reasons for all those things happening
to me,” she says, “and none of them had
to do with my drinking.”
How,
then, to break the psychological impasse? One way is to
follow a strategy called intervention, which was pioneered
in the early 1960s by Vernon Johnson, an Episcopal priest
in a Minneapolis suburb. In intervention, family members,
friends and co-workers directly confront the alcoholic to
shatter his carefully nurtured self-delusions. Beforehand
they meet with a specially trained counselor (the fee: $500
to $750) to rehearse. In the actual confrontation, the alcoholic
is presented with a tough but sympathetic portrayal of the
mess he is in and is urged to accept prearranged admission
to a treatment center, often the same day. Says Carol Remboldt,
publications director at Johnson’s institute in Minnesota:
“Intervention allows a tiny aperture to be poked in
the wall of an alcoholic.”
The
process can be painful. A 31-year-old daughter
read her alcoholic parents a letter in which she described
how she had seen her mother change “from the best
friend I ever had” to an unhappy and unreliable woman.
“The good parts of your character,” she said,
“are being stolen away by alcohol. Don’t let
that bottle overtake your life.” Indeed, children
often provide the most persuasive statements. One alcoholic’s
resistance crumbled when his son said, “Daddy, when
you read me the funnies on Sunday morning, you smell.”
Peggi, a former schoolteacher and recovered alcoholic, remembers
the day seven years ago when she was faced down by her husband,
sister and three sons. “It was awful”’
she recalls. “But it was crucial for me to see how
my drinking affected their lives.”
As
Poet Robert Bly, the son of an alcoholic, puts it in a book
called Family Secrets, edited by Rachel V. (Harper &
Row, 1987): “Every child of an alcoholic receives
the knowledge that the bottle is more important to the parent
than he or she is.” To mend the damage from those
year-in, year-out traumas, hundreds of thousands of Americans
have turned to Al-Anon and other family-therapy organizations.
An offshoot of A.A. that was formed in 1951 for relatives
and friends of alcoholics, Al-Anon has more than doubled
in size since 1975 and now boasts some 26,000 regional groups.
But the real comer is the children-of-alcoholics movement,
aimed at the nearly 30 million offspring of chronic drinkers
in the U.S. Made up of a variety of organizations, the movement
took off four years ago with the best-selling book Adult
Children of Alcoholics, a guide to the dilemmas C.O.A.s
face, by Janet Geringer Woititz, a human-relations counselor
in Verona, N.J.
At
a typical C.O.A. meeting, participants sit in a circle and
offer reflections on their own experiences, from a paralyzing
fear of intimacy to acute conditions like bulimia, a disorder
marked by episodes of excessive eating. At the heart of
their pain and confusion is a childhood fraught with anxiety.
“When we were kids and our parents were drunk’
it was our problem,” a 21-year-old daughter of an
alcoholic told Time’s Scott Brown. “Somehow
it seemed that we should be super people and make our family
healthy.” Reliving painful childhood experiences among
sympathetic listeners enables the C.O.A.s to feel emotions
they had suppressed. Recalls Rokelle Lemer, a pioneer in
the movement: “I had to learn to re-parent myself,
to comfort the little girl inside.”
For
both family members and chronic drinkers, the greatest frustration
is the absence of a surefire treatment for alcoholism. The
truth is that success rates often depend more on the individual
makeup of the alcoholic than on the treatment. Alcoholics
fitting Cloninger’s male-limited type are less likely
to remain sober after treatment, along with those with unstable
work and family backgrounds. ‘The best predictor of
patient outcome is the patient,” says Thomas Seessel,
executive director of the National Council on Alcoholism.
“Those who are steadily employed, married and in the
upper middle class are more likely to succeed. They have
more to lose.” In response to allegations that some
centers have exaggerated how well their patients do after
treatment, Congress has ordered the NIAAA to investigate
treatment programs.
Today
about 95% of in-patient treatment centers in the U.S. use
a 28-day drying-out -program developed in 1949 at Hazelden.
For the first few days, staff help patients through the
tremors and anxiety of withdrawal. From that point on, the
emphasis is on counseling. The aims: dispel the alcoholic’s
self-delusions about drinking, drive home an understanding
of alcohol’s destructive properties, and make it clear
that the only reasonable course is to stop, drinking--permanently.
Some centers use Antabuse, a drug that induces vomiting
and other symptoms if the patient has a drink. Schick Shadel,
a program with hospitals in California, Texas and Washington,
employs aversion therapy to condition alcoholics to recoil
at the smell, taste and even sight of a drink. Most programs,
however, rely on A.A. or other counseling programs to help
reinforce the message of abstinence.
“Everyone
knows how to get sober,” says Michael Baar,
an Albany, Calif., psychologist. “The problem is keeping
them in that state.” Relapse prevention is the latest
attempt to help reduce the number of recovering alcoholics
who fall of the wagon. Terence Gorski, president of the
Center for Applied Sciences in Hazel Crest, Ill., has studied
thousands of relapse cases and found that on their way to
recovery, alcoholics go through specific stages, each with
its dangerous temptation to return to drinking. Early on,
it may be hard to cope with withdrawal. Later, the patient
may falter in developing a normal family and social life.
Finally, there is a period of complacency, when the recovering
alcoholic no longer fears drinking as he once did. At each
point, says Gorski, “the person is out of control
before he actually starts to drink.” His solution:
counselors who meet regularly with recovering alcoholics
to help them identify and face problems before they get
out of hand. Says Gorski: “It is compatible with A.A.
and self-help groups. The only difference is that we go
beyond what AA. has to offer.”
Will
there ever be a simple cure for alcoholism? Probably not.
Even so, the next decade or so holds dramatic promise for
advances in understanding and effectively treating the disease.
Researchers hope eventually to sort out alcoholics according
to the neurochemical bases of their addiction and treat
them accordingly. “We are still trying to map out
these neurochemical systems,” says Edgehill Newport’s
Wallace. “If we succeed, then it is likely that we
will be able to design treatments.” A.A. and other
groups may always be necessary to help alcoholics assess
the psychological and emotional damage of chronic drinking,
but there is hope that medicine may make the course to sobriety
less perilous.
Medical
and scientific promise, however, should not eclipse the
importance of public policy efforts to curb heavy drinking
among adults--and stop it altogether among youngsters and
adolescents. Education is one approach. The Government’s
“Be Smart” campaign, aimed at eight-to-twelve-year-olds,
has had some success. Mothers Against Drunk Driving has
been a primary factor in the fight that has raised drinking
ages from 18 to 21 in 34 states plus the District of Columbia
since 1982. Despite strong opposition from the alcohol industry,
which lobbies vigorously against higher excise taxes for
alcohol and warning labels on beer, wine and liquor bottles,
groups like MADD and the National Council on Alcoholism
continue to push initiatives that will further discourage
consumption of alcohol.
In
his speech two weeks ago, Health Secretary Bowen complained
that brewers and beer distributors spend $15 million to
$20 million a year marketing their products on college campuses,
encouraging heavy drinking and “contributing to poor
grades, excessive vandalism, many injuries, and not so infrequently,
death.” Bowen asked Education Secretary William Bennett
to encourage university presidents to restrict alcohol promotions
on campus. Spuds MacKenzie, the canine star of Anheuser-Busch’s
advertising campaign for Bud Light beer, is also in the
doghouse. This fall the National Association of State Alcohol
and Drug Abuse Directors filed complaints with several federal
agencies charging that the campaign encouraged kids to drink.
For
those who know what British Novelist Malcolm Lowry described
as the alcoholic’s “fine balance between the
shakes of too little and the abyss of too much,” sobriety
cannot come too soon. That is the challenge for medical
researchers. But just as much energy should go into the
job of preventing the disease. That means not only finding
genetic markers to warn those susceptible but also changing
attitudes in a society that still glorifies drinking. As
Bowen remarked recently, ‘To do anything less than
all this would be a disservice to ourselves, our society
and to the many future generations whose lives and livelihoods
are at stake.” For millions of American alcoholics,
there is no time to lose.
Diary
of a Drunk
What
is it like to suffer from alcoholism?
The
writer of the following article, who spent 28 days in a
treatment center in the Northeastern U.S., offers his reflections:
Dying of alcoholism normally takes years. But before a final,
prolonged bout of uncontrolled drinking caused my physical
collapse and led to treatment, there was no doubt I was
well on my way. My appearance was shocking. I was about
20 lbs. Underweight and malnourished, the result of giving
up almost all forms of food except coffee, sugar and, of
course, alcohol. I was in the early stage of delirium tremens,
the DTs. I sometimes heard faint ringing noises in my ears
and suffered unexpected waves of vertigo. I felt near constant
pressure in my lower back and sides from the punishment
my liver and kidneys were taking. My personality was also
seriously diseased. I was nervous, reclusive, by turns extravagantly
arrogant and cringingly apologetic. I tried to cover my
extremes of mood with brittle cheerfulness, even though
I was desperately afraid. If you asked me how I was feeling,
I usually lied, “Just fine.“’
I
now see “just fine” as a key phrase that encompassed
my diseased physical and mental condition. At the nadir,
my addiction to a chemical that was killing me was nearly
complete. I knew that something was very wrong with me.
I even knew I was an alcoholic, but I had long since come
to believe there was nothing I could do about it. I had
decided that it was perfectly appropriate--just fine--that
I should die. In fact, I honestly hoped that I would, sparing
further grief for many people I loved. Dying, I thought,
was the best thing I could ever do for them. The idea of
living without alcohol could not occur to me. I preferred
the idea that I was a hopeless case.
No
one finds alcoholism more mysterious than the suffering
alcoholic, and I was no exception. I had no idea why I was
an alcoholic at all, though I should have: my father was
one. But from his illness I had gained only a morbid fear
of the substance, which lasted until I reached college.
I would never touch the stuff. That prolonged abstinence
while my adolescent peers experimented with liquor only
made what happened to me more mystifying. I thought I could
take alcohol or leave it.
Why
did I ever start to drink at all? The short answer
is that initially it made me feel better. Alcohol numbed
my self-awareness, the same trick that it performs for nonalcoholic
drinkers at cocktail parties. The difference is that normal
drinkers dull their self-consciousness only slightly, the
better to socialize. I very quickly tried to send all my
thoughts and feelings about myself to oblivion. Psychologically,
I was undoubtedly depressed when I began to overcome my
well-founded but ill-understood fears about alcohol: my
father died when I was a sophomore. For whatever reasons,
I spent the better part of two decades trying to stay emotionally
and physically numb.
Even
in those early days, signs might have pointed an expert
on alcoholism toward my growing problem. One hint was my
immediate tendency to drink to unconsciousness. At parties,
I would often fall asleep in mid-hullabaloo on the couch.
That drew plenty of jokes at the time. Only much later did
I recognize that I had been passing out. Another signal
was an initial, abnormally high tolerance for alcohol, at
least until the passing-out stage. I thought I could hold
my liquor pretty well. Now I think it means that my body
was being less dutiful than most in handling overdoses of
a hazardous chemical. (Years later, when only a couple of
drinks would overload my toxified -liver, causing slurring
of words and other drunken symptoms, I finally joined the
company of those who “can’t hold a drink.“)
Exactly
when did I become addicted to alcohol? I don’t
know that either. The addiction was preceded by a delusion:
I thought I drank to socialize. Maybe I did. My alcoholism
took years to develop into a chronic affliction, and during
much of that time I went to bars after work, one of the
guys. The delusion was gradually reinforced by gravitation.
I mingled more and more with other persistent drinkers who
took longer and longer to call for their bar tabs. Most
of us were actually alcoholics in varying stages of development.
The nonalcoholics had long ago selected themselves out.
Those of us who remained agreed that we were “normal.”
Unhappy, but normal.
Alcoholic
perception is like that, in a hundred insidious and distorting
ways. All of them are aimed at protecting a drunkard’s
notion that he is possessed of free will. My drinking buddies
and I agreed that we did not have a drinking problem. Everything
in our increasingly narrow world, though, was a problem
that required drinking: the wife, the kids, the boss, the
government. In dingy watering holes from which everyone
with a healthy life to lead had gone home, we conspired
to overlook the obvious, that our bodily cells were addicted,
and our minds were along for the ride.
Inexorably,
the need for alcohol grew, while the lies wore thin. As
my alcoholism accelerated, I abandoned most drinking partners
and joined the ranks of solitary topers bellied up to countless
bars. I lost any sense at all of what would happen after
I started drinking; I became completely unpredictable. Sometimes
I would go home after a couple of drinks (there was usually
more booze there). More often, I would join the lineup of
other alcoholics at the bar telephone stalls, fumbling with
worn-out excuses about unexpected visitors and urgent business
meetings. Sometimes I would simply hole up in my office
with a bottle after everyone else had gone home. There simply
wasn’t anything else in my life. Most frightening
of all, I began to suffer alcoholic blackouts during drinking
episodes. I would swim back into consciousness with no recollection
of where I had been or what I had done. Once, I came to
late at night on a downtown city street with my suit trousers
slashed down one side by a razor.
Bizarre
incidents like that left me petrified but unable to stop
drinking. None of the growing physical pangs of alcoholism-the
retching, nervous spasms, sweaty and sleepless nights, dehydration--matched
the moments of hammering panic I felt every morning for
months on end, as I tried to remember exactly what I had
down the night before. At one point, terrified that I might
kill someone with my car, I gave up driving, but never alcohol.
Along with the fear came sudden rages--at my wife, at my
friends, at anyone who tried to stop me from drinking. My
homelife became a nightmare. Creeping paranoia set in.
No
one wanted me to stop drinking more than I did. What I could
not say was that I did not know how to do it. Every day,
the inability inspired waves of remorse and self-loathing.
But in my fearfulness, I stayed willfully ignorant of alcoholism.
I would walk out of the room if a television commercial
mentioned the subject. I was convinced that getting sober
was merely a matter of personal willpower--and that, through
some unfixable flaws of character, I lacked the power. I
never wanted to be reminded of what was, to my mind, a moral
affliction. Who would?
I
still consider the fact that I did not die a miracle, meaning
that some kind of providence intervened. For me, it took
the form of a friendly superior at work who confronted me.
I finally broke down and admitted that I needed help. That
simple admission, so long in coming, brought an enormous
release. Suddenly, alcoholism was no longer something I
had to endure in private. Somehow, in that encounter, a
powerful psychosis dissolved.
Years
later, after hundreds of Alcoholics Anonymous meetings and
many hours of intensive counseling, I am happy to acknowledge
that I have a serious, progressive ailment, with no cure.
Alcohol is no longer a terrifying, destructive force in
my life. It is just another chemical, fine for you, perhaps,
but deadly for me. I avoid it, but without a sense of panic
or fear. Friends say I am a completely different person
now. Only, sometimes, I remember the feelings of hopelessness
and shame from those terrible years, and I still have to
struggle to hold back the tears.
(Source:
Time, November 30, 1987)
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