by Gretta Palmer
Alcoholism 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.
The 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 realistically.
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 drinkers.
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.
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.
That 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.
Take 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 of self-consciousness.
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:
“Of 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.”
So 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.”
Bill 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.
(Eventually Bill found out and admitted to himself that liquor had him bested; this was the beginning of his recovery, but that’s another story.)
Bill 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.
She 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.
Like 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 bouts.
So 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 alcoholic ward.
Jake-like 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.
Now, 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.
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.
Alcohol, 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?
Doctor 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?
By 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 has been.
To 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.
What 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?
1. 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.
2. 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.
3. 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 sugar.
4. 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.
1. 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 did it.
2. 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 himself “dry.”
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.
“Atheists 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 religion.
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 A.A. parlance.
But there are some men and women who entirely reject the religious approach. To them, two other routes are open.
3. 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 a mirage.
The 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.”
4. 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.
Arriving 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 is admitted.
This 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.
Three 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 their ways.
Ignorance 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.”
Since 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 or reproach.
Of 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.”
What 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.
Families 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.
When 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.”
No 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.
For the Drinker Who Needs Help
ALCOHOLICS 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.
NATIONAL 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.
YALE 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.
RESEARCH 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.
(Source: Ladies’ Home Journal, August 1946)