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 over intense.
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 unselfconsciousness 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
Contact:
The Legacy Group of Alcoholics Anonymous © 2005