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ALCOHOLISM
by Donald G. Cooley
How
can you tell if you are an alcoholic or in danger of becoming
one? What can you do about compulsive drinking? Here are
some
common sense facts on the subject
You
think you know a drunk when you see one. He weaves and wobbles,
talks thick and woolly, and you can chin yourself on his
breath. “There goes an alcoholic,” you may remark-but
smile when you say that! Intoxication is not proof of alcoholism.
Plenty of grandmothers used to get potted on “female
remedies,” but they weren’t compulsive drinkers.
They wore their white ribbons in utter honesty.
On the other hand, a true alcoholic may never seem to be
drunk at all. Bob, a young sales agency executive, was like
that. He always had an edge on, but you had to know him
very well to suspect it. A different kind of alcoholic was
a 35-year- old architect whom we’ll call Fred. For
months at a time he would be on the wagon, doing good and
brilliant work. Then he would disappear, to be eventually
discovered helplessly drunk in the wreckage of his bottle
–strewn apartment. Periodically, Fred lands a new
job which always seems to pay a little less that the one
he drank himself out of.
Clearly there are drinkers and drinkers; and the vast majority
of person who take a nip do not arrive at the problem stage.
But there are an estimated 800,000 compulsive drinkers in
the country – a staggering public health problem,
not helped by the fact that the realistic voices of scientists
have an almost hopeless time making themselves heard. Indeed,
is basing this article solely upon the analytical findings
of specialists who know alcoholism best, the risk is being
run that violence almost certainly will be done to the popular
fables, misconceptions, and irrelevant concepts of “morality”
that have muddied a problem which is, essentially, one of
human illness.
Not even that superb movie, The Lost Weekend, conveys an
entirely accurate picture, in the opinions of researchers
in alcoholism. The reasons why the Don Birnam of that enthralling
production became an alcoholic are glossed over. Not all
alcoholics are like him. More important, the spectator may
draw the conclusion that alcoholics cannot be cured and
that doctors and specialists are tough hearted hombres with
little to offer the chronic drunk. The truth is that thousands
of ex-alcoholics have been restored to positions of trust,
responsibility and esteem in their communities. Strictly
speaking, alcoholism cannot be “cured.” Neither
can tuberculosis. But doctors can arrest the disease’s
progress. And when the arrest endures for a lifetime, the
practical results are the same as cure.
A
popular attitude is that the alcoholic enjoys drinking and
should be punished for overindulging his pleasure. No alcoholic
ever drinks for fun. He drinks because he has to in order
to feel normal. Neither the teetotaler nor the social drinker
can understand the sometimes terrifying psychic pain that
drives the alcoholic to bottled anesthesia. He is a sick
man. If alcoholism is not a disease in itself, it is at
least a symptom of a disease.
There
are alcoholics who drink to ease pain. There are others,
usually of low intelligence, without family or business
responsibilities-bums-who have time on their hands, little
to occupy them and no particular reason to stay sober. But
the typical problem drinker is one whose personality is
so maladjusted, so un-grownup, that there is continual agonizing
friction between himself and the world of reality. The compulsive
drinker, like everybody else, is a man with problems. The
difference is that he uses alcohol to “solve”
his problems. He tries to build up a 100-proof insulating
wall between himself and the world of responsibilities.
No one has ever identified the drink that is “one
too many,” that pushes a man over the hazy borderline
of controlled drinking into the danger zone of alcoholism.
But there are warning signs aplenty. Dr. Robert V. Seliger,
assistant visiting psychiatrist of Johns Hopkins Hospital
and an authority on problem drinking, has listed thirty-five
red flags. Many other workers are agreed upon symptoms that
ought to paralyze the elbows of potential chronic alcoholics.
Here are some of the most important:
When
you need a drink to quiet the “shakes.”
When
you become a morning drinker.
When
you need “a hair of the dog that bit you.” One
specialist warns that “only a confirmed or potential
alcoholic can tolerate the morning after, without nausea.”
When
you become a solitary drinker.
When
despite loss of reputation, loss of working efficiency,
loss of standing with family and friends, you can’t
give up or reduce drinking.
When
nothing but a drink can make up feel at ease with the world.
Some of these symptoms indicate that the habit is pretty
well advanced. Can a man tell before reaching that stage
whether he is the kind in whom drinking is likely to become
uncontrollable? In a general way, racial studies indicate
that Mediterranean peoples are less likely to use liquor
to excess than persons of northern European background.
Too, your occupation has some bearing on your susceptibility.
Salesmen, especially the high-pressure type, are at the
top of the list. Jobs which require you to hoist one with
prospects pretty frequently, and which involve considerable
tension and nervous drive, seem to fertilize the soil in
which alcoholism flourishes. Advertising men, brokers, and
similar professionals bottle themselves up in comparatively
high numbers.
But compulsive drinking is, above everything, an individual
problem. Let us examine some of the personality factors
commonly found in connection with it.
The typical alcoholic, according to statistics compiled
by Dr. Merrill Moore, begins drinking in the last two years
of high school or the first two years of college. At first
it is ordinary social drinking. After a couple of years
he advances to the occasional spree stage, which lasts for
about a decade. There is a gradual trend towards solitary
drinking. Finally, after some twenty years of imbibing,
he arrives at the point where he must have medical care-on
the average, at age 40.
Yet the roots of his trouble are in his childhood. Typically,
the alcoholic has parent trouble, though neither he nor
his parents may realize it. His father may be stern and
exacting, or so upright and successful that the son feels
it is hopeless to try to compete with him. Sometimes there
is undue pampering; more often, rigid standards of unquestioning
obedience. In either case, normal relations between him
and his father or other men are handicapped. He may not
be able to hold his own with his group in school, in athletics,
in social life.
Altogether, he grows up with a terrible feeling of insecurity.
In an emotional sense, in fact, he doesn’t grow up.
He shrinks from the give-and-take tests of the world, is
so dreadfully fearful of failure that he won’t try
to succeed, and seeks desperately for some means of escape.
Alcohol – anesthetizing, consoling, socially approved
and convenient – becomes his way out.
An alcoholic is not necessarily a man with a hollow leg.
The relation of constitution to temperament has been illuminated
by Dr. W.H. Sheldon of Harvard University. In brief, he
finds that the stoutish, heavy-set man of pleasant digestion
and phlegmatic temperament relaxes and enjoys other people
under alcohol. The more athletic fellow, bold, muscular,
and adventurous, reacts assertively and aggressively to
alcohol. The man for whom alcohol is practically poisonous
is likely to be spare, lean, inhibited, crowd-hating, solitary,
and mentally overintense.
Alcohol is always a depressant, never a stimulant. And it
works from the top down. That is, it depresses higher functions-inhibition,
speech, fine motor co-ordination-in descending order. From
this, one can derive a rough yard-stick of drunkenness.
The earliest stage (often thought of as stimulation, but
really a depression of inhibitions) is the pleasurable,
relaxed unself-consciousness that is also the last stage
for normal drinkers to whom alcohol is a controlled social
accessory. But as the depression descends to lower levels,
triggers are released that give the shrewd observer considerable
insight into the alcoholic personality.
For instance, the solitary drunk ordinarily is punishing
his worst enemy, the one he fears most-himself. The drunk
who beats his wife is giving vent to contempt, hatred, and
yen to punish womanhood, perhaps to get even for a domineering
mother. The weepy drunk is the regressing infant. The drunk
who wants to fight has a frustrated, unconscious rage against
the whole world of men outside himself. And the drunk who
gets amorous has complex difficulties in the sexual sphere.
Typically, the alcoholic’s alleged love affairs rank
high in quality. To hear him tell it, he is irresistible
to women. Actually, he only rates about 10 proof, for underneath
his manly protestations is a basic fear of women. Often
what he craves is not a wife but a substitute mother. His
marriage adjustments are notoriously poor.
The problem “to drink or not to drink” is so
complex for any individual that no ready-made blanket therapy
can be guaranteed. Families of compulsive drinkers are much
more optimistic about “easy” cures than are
specialists who know the problem. In considering possible
treatments for alcoholism, it is advisable first to dispose
of some popular “treatments” that have no value
at all.
No secret potion dropped into Frank’s coffee will
cure him of drink. No alcoholic has ever been cured on the
sly, without his knowledge. “Let’s have his
father or the doctor or his boss or the minister give him
a good talking-to” is not very helpful unless such
advisers are well-trained. The patient may brace up for
a while; he may take the pledge, and mean from the bottom
of his heart his promise never to touch another drop. He
may think he knows why he drinks, but he never does-not
until someone gives him insight. Sending him off to a farm
or into confinement where he can’t get alcohol will
keep him sober as long as he stays there-but no longer,
if confinement was his only treatment.
Fear is a goad, not a cure. The alcoholic whose world is
tumbling about his ears knows fear all too well. It is brutally
inhuman to expose him to pictures of cirrhotic livers and
the like. It is doubly pointless because what impresses
people in horror exhibits from the platform may have slight
if any basis in scientific fact. Most doctors now believe
that cirrhosis of the liver is nutritional rather than alcoholic
in origin. Plenty of teetotalers have “alcoholic”
livers.
Any general practitioner can help a patient recover from
an attack of acute alcoholism with the use of sedative drugs,
rest, forced nutrition and other well-understood methods.
But this is an entirely different matter from curing him
of compulsive drinking. The difference is important because
many a doctor, after periodically assisting lushes over
the hump, becomes convinced that his patients are incurable,
whereas the specialist takes a much more hopeful view. He
knows that the patient’s basic problem is not alcohol-that
alcoholism doesn’t come out of a bottle but out of
the man. To focus treatment on removal or proscription of
whisky is comparable to “curing” a brain tumor
by prescribing aspirin. It is the compulsive drinker’s
psychological trouble that must be remedied.
It is fundamental to any successful treatment that the problem
drinker must sincerely want to get well. Invariably he will
say he wants to. And he may sincerely mean it, especially
after recovering from a binge that may have cost him his
job or his wife or his reputation. But since he does not
know why he drinks, and since alcohol, at whatever cost,
serves for him an inner purpose, he usually needs to be
helped to self-insight that will make his desire for cure
psychologically genuine.
Another
basic if brutal truth is that for him there are only two
choices: he can remain an alcoholic, or he can become a
teetotaler. There is no middle road. Never again can he
be a controlled social drinker-if he ever was one. Many
a problem drinker, after apparent cure, has figured he could
handle mild liquors-beer or wine-only to find out that a
drink of ale was the first step to an epic spree that lost
him all the ground he gained. When the boys order another
round of the same, he is going to have to order plain ginger
ale and like it. For him there is no such thing as a little
alcohol.
How, then, are problem drinkers cured? The first step is
to settle the practical question: “Is he really an
alcoholic? And if so, what kind is he?”
A simple method of determining whether or not the patient
is an addict is suggested by Dr. H.W. Haggard. He advises
doctors to limit the patient’s drinking, for an extended
but reasonable time, to two drinks a day. If the patient
stays within those limits, he is hardly a true alcoholic.
The genuine addict may be able to cut out liquor completely,
but he cannot be moderate.
Next, if the man fails that test, is he an alcoholic because
of exposure, association, careless habit or other outside
factors, or because of deep psychic maladjustments? If the
latter is the case (and in Dr. Haggard’s opinion the
majority of alcoholics are reasonably normal), understanding,
tolerance, and sympathetic treatment by a physician should
be effective. The more deeply disturbed drinker, however,
requires more intensive treatment. So does the rarer type
whose troubles are symptomatic of underlying mental disorder-a
psychosis.
It is the specialized, individual skill of the psychiatrist,
plus sanitarium care, that seems best for the toughest cases.
The job is to uproot the complexes that have unconsciously
been driving the man to drink, and since these long-repressed
triggers are different in every case, it is quite an assignment
to locate the specific ones that explode the alcohol cartridge.
It may take months, perhaps a year, but the patient is finally
brought to genuine insight as to why he has been using alcohol
as a false answer to his troubles, he’s a good bet
for release to the outside world.
All this is not so easy as it sounds. Relapses are always
possible. But a fair guess is that about 35 per cent of
addicts are cured, by any of several types of treatment.
A deep, sincere desire to be cured undoubtedly plays a part.
The heartening side of the picture is that thousands of
ex-drunks, once reviled, scorned, lambasted or recriminated,
have become respected and productive citizens of their communities-their
bibulous backgrounds often quite unsuspected.
Drugs play a role in some treatments, notably in “conditioned
reflex” or aversion therapy. The patient is given
an injection of a drug which, a definite number of minutes
later, will tear him apart with violent vomiting. The doctor
opens a bottle of his favorite bourbon, pours a drink, and
with diabolical timing hands it to the patient. Down goes
the snifter-up comes the viscera, or so it feels. Associating
the drink with the hell breaking loose in his interior,
the patient develops an aversion to said drink.
Oddly
enough, it doesn’t seem to matter whether the patient
understands the trickery or not. The aversion sticks-his
stomach knows best. Aversion treatment patients have gone
to dinner parties too soon after a session with the doctor,
observed the host approaching with a tray of highballs,
and have heaped gastric insult upon hospitality. The method
appears to be most effective where the addiction is one
of simple habituation, without any deep personality factors.
Basically, the treatment of alcoholism seems essentially
to be faith healing, whether through the help of a psychiatrist
or by other means. Group therapy apparently is most effective
in this respect, as indicated by the successes of such organizations
as Alcoholics Anonymous and the Salvation Army. Their methods,
based on religious conversion in the broadest sense of the
world, produce as many cures, if not more, than other treatments.
Today there are some 17,000 members of Alcoholics Anonymous
in some 500 groups throughout the country. Each member is
a freely confessed ex-alcoholic who stands ready at any
time of day or night to wrestle purple snakes with a fellow
sufferer. Meetings are informal, soft drinks are served,
life histories frankly recounted, and reliance is placed
upon a higher power for help beyond the individual’s
ability.
Not the least value of such groups is that the alcoholic
accepts their members as his kind of people. Everybody has
been in the same boat. Nobody is going to bluenose him,
wag fingers, or moralize.
The members are good fellows and fellowship is one of the
deep needs of the problem drinker. That is one reason why
he likes bars and taverns-the company ordinarily is friendly,
uncritical, not given to harsh judgments from a level of
superiority.
Few people are so sensitive, so likely to cringe in advance
or to put up defenses against anticipated disapproval, as
the alcoholic.
Most large cities and many small ones now have one or more
Alcoholics Anonymous groups. Much of the organization work
is done by correspondence. A central office of Alcoholics
Anonymous (P.O. Box 459, Grand Central Annex, New York 17,
N.Y.) brings groups together, fosters new groups, and cheerfully
dispenses information.
Nobody claims to have a cure-all for compulsive drinking.
All serious students agree that major problems remain unanswered.
And they agree that a lot of popular “answers”
aren’t answers at all. For instance, throwing drunks
into the workhouse. In a very few communities, such as New
Haven, Connecticut, where Yale Plan Clinics operate, practice
is more enlightened. A drunk there who runs afoul of Johnny
Law is “sentenced” to the clinic, where he gets
a sympathetic, understanding, but thoroughly scientific
going over-and the records of human salvage thus established
are impressive.
Yet, as Dr. E.M. Jellinek of the clinic has pointed out,
this therapy has come in for a good deal of criticism from
people who feel that alcoholism is encouraged when “horrible
examples” of it are taken off the street and the wages
of gin shielded from public view!
Short
of competent professional treatment, there are some practical
measures that can be observed in managing alcoholics-or
even social drinkers. “Feed him well” is a good
rule. Drinkers who consume an adequate well-rounded diet
are considerably less likely to become medical problems.
For wives, Dr. Merrill Moore underlines the necessity of
never nagging or blaming the victim. “Remember that
he is a sick man, emotionally sick, or with an immature
personality, and maybe he is doing the best he can.
Keep him busy and amused because many alcoholics drink only
when bored or unoccupied. Try everything that is wholesome
and go with him and participate with him.”
And, if you have to have a drink the morning after, or incline
toward solitary drinking, or if you need a snifter to quiet
the shakes or just to feel “normal,” take heed!
Alcoholism has not necessarily arrived, but those are signposts
along the road leading to it.
(Source:
TRUE, May 1946)
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