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Alcoholics are just like you and me, only they have discovered alcohol Next

Source: Saturday Night, June 1978

By Philip Marchand

There is no health in us, according to the Book of Common Prayer. That
reference is, of course, to the spiritual corruption of fallen humanity,
but it might as well be to North American society in the late twentieth
century, a society overwhelmingly addicted to drugs of various
descriptions. A curious situation, certainly. In this society, few
members have any reason to fear the traditional scourges of humanity -
famine, plague, the devastation of war, even backbreaking physical
labor. The citizens do not live under any blatant tyranny or terror.
There is no obvious reason why most of them should feel deeply unhappy.
But it is true nonetheless, that the people in this society who feel
vigorous and free, who do not flee regularly from the grim business of
life into some opiate - drugs or television or gluttonous consumption of
food - are a minority. One of the most common of these opiates, and
socially, the most dangerous of them all, is alcohol. Nothing indicates
the depths of unhappiness in the society more than the fact that the
alcoholism within it is becoming more widespread every year.

In 1963 there were about 237,000 total alcoholics in Canada. Ten years
later, there were about 525,000. That means that in 1963 for every
100,000 Canadians over the age of twenty there were 2,190 alcoholics; in
1973 there were 3,850. Alcoholics, specifically male alcoholics - may be
defined as those who consume more than fifteen centiliters of absolute
alcohol every day, which means about fourteen ounces of whisky,
thirty-two ounces of wine, or nine bottles of beer. Another index, the
sale of alcoholic beverages, is equally discomforting. The total annual
volume sold in Canada increased, of course, is accounted for by our
growing number of youthful drinkers. In the United States the Director
of the National Institute on Alcohol Abuse and alcoholism has informed
us that the number of American teenagers who get drunk has doubled over
the past twenty years.

Encouraging male teenagers, at least, is the persistent macho image
around drinking. If the thought of a man's drinking heavily were
disgusting, Dean Martin would never come on as a lush. But the thought
is not disgusting. A "hard drinking" man is still a slightly romantic
figure, usually, "hard living" and "two fisted" as well. (Although,
curiously enough, belligerent drunks are usually timid and rather
submissive when sober.) Women have no such encouragements, since a
hard-drinking woman has never been a charming figure in popular
mythology - she's either sad and lonely or somebody like a rich heiress
in a Palm Beach mansion with a voice like Lauren Bacall's. (This does
not prevent women from drinking, of course, but it may inhibit them from
seeking treatment - it is only in the past year or so, for example, that
woman have been joining Alcoholics Anonymous in numbers nearly equal to
men.)

Alcoholism may be our largest drug problem, then, not only because it is
the most readily available drug in our society, but because our culture
seems to have an ambivalent attitude towards alcoholism. Drunkards are
disgusting, but on the other hand boys will be boys - if you're an
Irishmen and a poet, for example, it's almost obligatory to be a
boisterous and winning drunk. In some special grows I like the Canadian
Armed Forces, or teenagers in northern mining towns, heavy drinking is
so much a part of expected behaviour that an abstemious drinker, not to
mention a teetotaler, runs the risk of being an outcast.

Even when drinking is not openly encouraged, it is still fatally easy,
in all social groups, for a man or woman to become an alcoholic without
ever becoming noticed as a person with a problem. The alcoholic, unlike
the junkie or the speed freak, can indulge his vice in the best social
situations and still fit in like the priest at the Communion breakfast.
These people are often the "functioning alcoholics" - Men and women
whose daily consumption of alcohol is well above those fifteen
centiliters, but who still have their families, their high-salaried
jobs, their position in society. They don't fall into alcoholic stupors,
they never even become involved in loud alcoholic scenes. They're not
drunkards - most people, including themselves, would never think of them
even for a moment as alcoholics.

Sooner or later, however, they run into problems. A successful thirtyish
lawyer, say, wakes up in the middle of the night in a state of
approaching panic. He goes downstairs, notes the car parked in the
garage, the children sleeping in their rooms, the lights off in the
kitchen and the living room. Only one thing keeps troubling him; he
cannot remember going to bed. He remembers the party he attended, but he
doesn't remember driving home in his car, coming into the house, taking
off his clothes, and climbing into bed. He has suffered a "black-out", a
mild case of amnesia.

As time goes on, he notices he suffers more and more of these blackouts.
He knows that it is a warning sign that he is drinking too much, that he
may, in fact, be an "alcoholic." But he can always brush this thought
aside. An alcoholic is a woman who spends all day in bed with a bottle,
who has spare mickeys of gin hidden in the breadbox. Alcoholics are men
like the character Jimmy Cagney played in some movie from the 1940's,
sweating and writhing on the floor from a bad case of delirium tremens.
Alcoholics are not like him, a responsible person who plays bridge, goes
to the Caribbean on skin diving holidays, and never gets drunk.

Of course he would have to admit that by the time eleven A.M. rolls
around he becomes a little restless in his office, waiting for lunchtime
and a few officially sanctioned martinis. And in mid-afternoon he
usually rewards himself for a hard day - or consoles himself for a
rotten one -with a few drinks from the built-in bar in his office, and
then goes home and has a drink or two before dinner, and then, while
he's getting dressed for a party, he has another one, and of course at
the party knocks back a few, and coming home afterwards treats himself
to a stiff nightcap. If he counted up all those centiliters of absolute
alcohol on his pocket calculator, starting at lunchtime, he might indeed
come up with an alarming figure, but who bothers to count? The important
thing, really, is that he's steady on his toes -he'll start to worry
about his drinking when he slobbers on the hostess and walks around with
a lampshade on his head at parties.

The warning signs are by now well known, but they are easily ignored by
people like this lawyer. He usually has powerful rationalizations on
hand to quiet the doubts. If he gets really jittery he can go on the
wagon for a couple of weeks and absolutely, definitely, prove to himself
that he has no problem with liquor. (Ignoring the fact that during these
two or three weeks he is always mindful of the reward in store for him
when he hops off the wagon - ignoring, too, the tranquilizers he turns
to now and then to help him over the dry spell.) Usually such people
continue for years before they start descending the long alcoholic slide
into more serious drinking -when their work definitely does suffer and
their family starts to fall apart from the general unhappiness
solidifying into outright misery. It's a melodrama too familiar, by now,
to recount in detail.

But it is still a North American melodrama that increasing numbers of
people regularly play out. The cost to society is staggering. (A billion
dollars a year to the Canadian people, according to the LeDain
Commission of Inquiry into the Non-Medical Use of Drugs.) Nobody is sure
how to ease this cost. And the suspicion keeps arising in people who
have to deal with the problem that the epidemic of alcoholism,
frightening though it is, may be just the most noticeable and dangerous
form of addiction in a society of many widespread addictions. In the
end, all addictions - whatever their source - may be alike.

This point will become more important in future considerations of
alcoholism. If it generally accepted, the social view of alcoholism will
doubtless be revised - revised a second time. The first great revision
occurred sometime in the 1930's with the establishment of Alcoholics
Anonymous. A.A. was heavily responsible for spreading the notion that
alcoholism was an illness, and that drunkards were not primarily moral
failures who succumbed to the bottle through lack of willpower but
sufferers from a mysterious but very real disease, perhaps an "allergy"
to booze or a metabolic imbalance or a chemical deficiency of some kind
in the body. This was an entirely commendable achievement on A.A.'s
part. In effect, it immediately raised the status of alcoholics, at
least in respectable circles. But the A.A. view also raised a few
questions. There is still no way you can predict whether a child will
have trouble with alcohol from a biochemical examination of his or her
body. And, practically speaking, A.A. itself treats alcoholism more as a
spiritual dilemma than a disease. (The key notion of A.A. is that the
first step towards recovery for any alcoholic lies in his admitting that
he is powerless over alcohol, and that only a reliance on a Higher Power
- sometimes referred to as a Power greater than ourselves - can restore
sanity to his life.)

There were certain consequences of this view. One of the consequences
was that alcohol itself became kind of personification of evil for the
alcoholic - a force in itself that has taken hold of the sufferer's life
like a plague bacillus and will not let go. As a writer in the Big Book,
a kind of operating manual for A.A. says; "Remember that we deal with
alcohol -cunning, baffling, powerful." Other consequences are an
insistence that an alcoholic can never take another drink as long as he
lives (the fatal-glass-of-beer syndrome) and the general feeling that
many alcoholics cannot free themselves from this disease - this
enticing, relentless disease until they hit "rock bottom."

Today most theorists of alcoholism don't even bother to debate the
question of whether alcoholism is a disease; when not even medical
doctors seem able to come up with an acceptable definition of "disease."
It hardly seems a fruitful topic for debate. That some of the
implications that have been widespread because of the general selling of
alcoholism as a disease are now being challenged-the implications,
chiefly, that a return to controlled drinking is always impossible for a
true "alcoholic," and that a man cannot free himself from the "disease"
of alcoholism until the abyss beckons and he realizes that spiritual
means are the only means left to fight it. Perhaps the most important
implication being challenged is that there is something in the nature of
alcohol itself - the "subtle ease." as A.A. writers call it - that
causes addiction. If this idea is false, reasons those who question it,
the possibility arises that alcoholism may have the same roots as the
behavior of a person who deals with life by "TVing it," getting glued to
his set for forty hours a week -or, for that matter, a person who goes
on eating binges.

The people who are leading the attack on these very beliefs, and thereby
intending to revise accepted notions of alcoholism, are those Trojans of
the rat labyrinths, the behavioral psychologists. In a way it is
inevitable that they would stake out pieces of turf traditionally
associated with groups like A.A. The Alcoholics Anonymous approach -
heartfelt, exhortatory, spiritual-was bound, sooner or later, to clash
with the clinical, empirical human-engineering approach of the
psychologists. Nobody denies that A.A. has been the most effective group
by far in dealing with alcoholics, and its unlikely that any government
or private program in the foreseeable future will help alcoholics give
up their dependence on alcohol to the extent that A.A. has done. But
ours may be a time when the most significant contributions to
understanding alcoholism will come from other than A.A.

To the clinical psychologists alcoholism is not a medical problem but a
learned behavior. "The way most psychologists would view excessive
alcohol consumption," says Howard Capell, a psychologist at the
Addiction Research Foundation of Ontario, "is that, for whatever reason,
it's something that's learned, just the way a lot of other things are
learned, and that in some sense it's an adaptive response. A lot of
people thing that what it's adaptive to is conditions of stress, and
that what alcoholics are really doing is medicating themselves for
anxiety." This in spite of the fact that it has been clinically
demonstrated that large quantities of alcohol actually make a person
less able to handle tension, stress or anxiety. (But of course, the
first few drinks always do seem to lighten a man's load - the only
problem being that a man who depends heavily on alcohol for this purpose
never knows when to stop.)

In this view, alcohol is a kind of problem solving technique that is too
easily and too accessible - despite its disastrous conseq- uences - for
the person to give up, once he has learned to depend on it. Dr. Martha
Sanchez-Craig, who formerly directed a residence for alcoholics in
Toronto for the Addiction Research Foundation speaks passionately for
this view and its efficacy in treating alcoholics. It is a view that
does, in its own way, invest the alcoholic with a certain amount of
dignity. "Look," she points out, to say "you have a problems is very
different from saying You are sick." To say, "everybody has problems,
but you, unfortunately, have discovered alcohol." "You would feel more
comfortable in knowing that you and I are not different. You have
problems, I have problems, everybody has problems. But you have
discovered alcohol."

Dr. Sanchez-Craig tried a simple experiment to shed some further light
on the uses of this problem solving technique. "I sat with numerous
people and asked them to describe in very specific terms the last time
they drank in excess. This had to be in specific terms -I held them to
that. Second, I asked them how they felt about the event. How did they
interpret it? How did they come to a decision to drink? How did they
rationalize it? How did they feel the alcohol was going to function?
Ninety-five per cent of the respondents, according to Dr, Sanchez-Craig,
were reacting to what she termed, using the odour-free language of the
social sciences, an "aversive" social situation - where the boss picked
on them, or their lover walked out them. "They were feeling depressed,
lonely, anxious - the negative feelings. The thinking was rigid and
catastrophic. They would think. This woman has rejected me. Therefore no
one will ever love me. I will be alone for the rest of my life."

That people will turn to booze when they feel hit hard by life, or when
they succumb to what the A.A. folks term "stinking thinking" -the low,
sweet descent into despair and self-pity - is hardly news and yet if
alcoholic behavior can be traced back, as Dr. Sanchez-Craig and other
psychologists feel it can, to this kind of habitual response, gradually
imprinting itself on the nervous system of an alcoholic -the response of
seeking relief from painful situations in the soothing touch of alcohol
- then it may be possible to imprint new responses, new awareness of
different choices, on that same nervous system. Alcohol itself is not
the problem. It could just as well be Valium the alcoholic loved, if
that alcoholic had grown up in a culture where there were two or three
Valium bars on every city block. Alcoholics, or "problem drinkers," once
they are taught new responses to the painful stimuli that drove them to
drink, could conceivably even learn to drink moderately again.

This suggestion infuriates many workers in the field of alcoholism who
feel that one of the greatest enemies of the recovering alcoholic is the
delusion he often cherishes that one day he will be able to drink again
- drink again and handle liquor like a gentleman. For alcoholics one
drink will always be too many and a million not enough. But sometimes
the issue of just who is, and who is not, an alcoholic becomes almost
metaphysical in its elusiveness and remoteness from specific, concrete
touchstones. A.A. for example, insists that any "alcoholic" who
subsequently learns to drink moderately and never goes on a binge for
the test of his life was not a true alcoholic in the first place - a
formulation that obviously begs the whole question.

Part of the problem is that most alcoholics do not seek any form of
treatment until they are in their forties, in which case they've usually
had about twenty hard-drinking years behind them. If you have been
drinking heavily for that long, your brainstem is pretty-well
shell-shocked anyway, and obviously not capable of resisting the lure of
those first few drops of Alcohol. The critical question revolves around
young people in their twenties who are clearly on the road to
alcoholism. Dr. Gordon Bell, president of the Donwood Institute in
Toronto, a hospital that treats mostly alcoholic patients, concedes that
" many of the patients we've had, had they been fortunate enough to come
to us much earlier, would have had another alternative besides total
abstinence. "If a program of teaching controlled drinking were ever
launched successfully, it would have a great deal more impact on this
group of budding young alcoholics than programs that had total
abstinence as their only aim.

Dr. Sanchez-Craig, who is very much interested in such a program of
controlled drinking, insists that people who enrolled in it would have
to meet very definite criteria - they would have to be young,
intelligent, in good health, strongly motivated to overcome these
drinking problems, and strongly attached to things like jobs or families
they knew they stood to lose from chronic heavy drinking. No one who has
been abstinent for any length of time, even somebody who was under
thirty, would be submitted into the program.

The concept of controlled drinking for "problem drinkers" is one fruit
of the approach to alcoholism that treats it as a learned response
rather than a disease. Another fruit is the concept of "constructive
coercion" wherein alcoholics are confronted by their employers or their
spouses or someone else, who threatens them with severe consequences if
they don't enter treatment for their alcoholism. According to this
concept, you don't have to wait for the alcoholic to recognize one
morning, through the mist of his pain, the awful unmistakable image of
his utter helplessness. This coercion implies, in a way, that alcoholism
is no big deal. It is based on the premise that people, unless their
nervous systems are completely warped, will respond the way you want
them to when you make it absolutely clear to them what they have to do
and what will happen to them if they don't do it. Clinical psychologists
tend to feel that if you could just apply constructive coercion to the
alcoholic on a daily basis you would have the means once and for all to
reduce or eliminate his drinking problems. Arrange it so that the spouse
has to spend fifteen minutes in an isolation booth before he can take a
drink, things like that; a few "behavioral interventions" imposed upon
him. Enough behavioral intervention and you've probably got the problem
licked, supposing the subject is not too far gone at the start of the
project.

Of course this means that you've got to have many allies, agents so to
speak, in your struggle to tinker with the environment of the individual
alcoholic. Dr. Capell sums up the perspective of the behavioral
therapist in this way; "When you start to talk about effective
individual interventions you're probably going to end up having to think
of ways to intervene that involve more than just interaction between a
patient and a therapist. Rather we'll have to recruit the environment.
It's probably the case, as with most things, that effective treatment
will involve more than one approach to the same individual but my basis
is that behavioral interventions of the type that experimentally
oriented psychologists advocate look like the way to go. They look like
it to me because people have actually been able to demonstrate their
effectiveness, at least in the laboratory. The argument against that is,
well, the laboratory isn't the real world. My counter argument to that
is, do you have something better? I mean, at least, they've been able,
in some cases, to show that if you're clever enough to figure out for an
individual how you can actually work on a person's environment to help
them cope with their drinking, it can have an effect.

 

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