Alcoholism – True, May 1946

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)