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ALCOHOLISM: New Victims, New Treatments
Next

From the day man first sipped the liquid collecting around honey or
fruit left too long in a warm place, alcohol has played an important
role in his life. Early in history, wine became--and still is--an
integral part of religious ceremonies. The Bible acknowledged that "wine
that maketh glad the heart of man" (Psalms 104:15), and Pasteur called
it "the most healthful and hygienic of beverages." In the hectic modern
world, hundreds of millions of people drink liquor, beer or wine for
enjoyment, solace and tranquility. Yet today, as it has throughout
history, alcohol is also troubling mankind. For in almost every society,
there are those who cannot enjoy alcohol without becoming its slave.

In the U.S., the age-old problem of excessive drinking is taking a
disturbing new turn and affecting new kinds of victims. On a New York
subway train, a school-bound 15-year-old holds his books in one hand, a
brown paper bag containing a beer bottle in the other. He takes a swig,
then passes bag and bottle to a classmate. In a San Francisco suburb,
several high school freshmen show up for class drunk every morning,
while others sneak off for a nip or two of whisky during the lunch
recess. On the campuses the beer bash is fashionable once again, and
lowered drinking ages have made liquor the high without the hassle.

In one sense, it is good news: across the U.S., the young are turning
away from hard drugs. In another sense, it could not have been worse
news: 'The switch is on," says Dr. Morris Chafe, director of the
Department of Health, Education and Welfare's National Institute of
Alcohol Abuse and Alcoholism (NIAAA). "Youths are moving from a wide
range of other drugs to the most devastating drug--the one most widely
misused of all--alcohol."

The upsurge of problem drinking among the young is only part of a more
disturbing nationwide and even world-wide problem. In the past few year
alcoholism--among youths and adults alike--has at last been recognized
as a plague. From 1960 to 1970, per capita consumption of alcohol in the
U.S. increased 26%--to the equivalent of 2.6 gal. of straight alcohol
per adult per year. It is now at an alltime high, probably surpassing
the levels during such notoriously wet eras as the pre-Civil War and
pre-Prohibition years. Moreover, according to the NIAAA, about one in
ten of the 95 million Americans who drink is now either a full-fledged
alcoholic or at least a *problem drinker (defined by NIAAA as one who
drinks enough to cause trouble for himself and society). Uncounted
thousands of the problem drinkers are under 21 and, in fact, the
approximately 9 million excessive drinkers are representatives of--and
affect--the whole spectrum of American society.

The facts gathered by NIAAA about alcohol abuse are as depressing as
they are impressive:

After heart disease and cancer, alcoholism is the country's biggest
health problem. Most deaths attributed to alcoholism are caused by
cirrhosis of the liver (13,000 per year). An alcoholic's life span is
shortened by ten to twelve years. Recently, medical researchers have
found evidence suggesting that excessive use of alcohol may also quietly
contribute to certain kinds of heart disease, and that it 'eventually
damages the brain (see [sidebar: The Effect of Alcohol]).

In half of all murders in the U.S., either the killer or the victim--or
both--have been drinking. A fourth of all suicides are found to have
significant amounts of alcohol in their bloodstreams. People who abuse
alcohol are seven times more likely to be separated or divorced than the
general population.

The dollar cost of alcoholism may be as much as $15 billion a year, much
of it from lost work time in business, industry and the Government.

At least half of each year's 55,500 automobile deaths and half of the 1
million major injuries suffered in auto accidents can be traced directly
to a driver or pedestrian "under the influence." (In virtually all
states, that influence is legally set at a blood concentration of .l% or
more alcohol. A 150-lb. man can reach this level if he takes three
one-jigger- 11/2 oz. per jigger--drinks within an hour.)

Many of the deaths and injuries are caused, by the under-21 age group,
and arrests of young people for drunken driving have skyrocketed since
states began lowering the drinking age from 21. In the year following
its lowering of the drinking age, for example, Michigan reported a 41%
increase in such arrests.

But parents seem relatively unconcerned about their children's drinking.
In fact, children who drink are often simply following the example set
by their fathers and mothers. Teen-agers know that their parents make
scenes if they catch them smoking marijuana. But if the youngsters come
home drunk, most of them are merely sent quietly to bed. "Often when we
report to a parent that his kid isn't acting the way he should and
smells of liquor," says Don Samuels, a Miami drug-education coordinator,
" the reaction is: Thank God! I thought he was on drugs."' Actually many
teenagers use both marijuana and alcohol.

The alcoholic tide has been pushed higher by the fast-selling,
inexpensive pop wines, which disguise their alcoholic content with sweet
fruit flavors. "Kids seem to look on the stuff as a zippy, sophisticated
soft drink," says Houston's Bruner Lee, education director for the Texas
Council on Alcoholism. "But this 'kiddie stuff,' this pop wine, contains
9% alcohol--about twice as much as beer." After the pop wine phase is
over, the kids often go on to much stronger drink.

Vanilla Extract. Most school officials are too embarrassed by the
alcohol problem to do much more than reluctantly admit that it exists.
One system that has faced up to it and conducted reliable surveys is in
the suburban county of San Mateo, south of San Francisco. There, in
1970, school officials found, 11% of the ninth grade boys (13-and
16year-olds) said that they had drunk some kind of alcoholic beverage 50
or more times in the past year; in 1973 the figure had jumped to 23%.
Among senior class boys (17-and-18-year-olds) the percentage of such
relatively frequent drinkers rose during the same time span from 27% to
40%. Senior class girls drank less, but they are catching up fast: 29%
said that they drank 50 or more times in 1973, compared with only 14% in
1970. Notes Paul Richards, an adviser at a San Mateo high school: "This
school represents a socioeconomic background from welfare to upper
middle class, and the drinkers come from all categories."

The under-21s are not the only ones who are drinking more. Reversing
past patterns, which showed middle-aged men the most prone to
alcoholism, there has recently been a marked increase in alcoholism
among people in their 20s and 30s and among women. In the '5Os, by
National Institute of Mental Health estimates, on of every five or six
alcoholics was a woman; the ratio is now one woman for every four men.

These figures may in fact be under-stating he problem for women, because
a nonworking woman, who does not have to punch a time clock or stand
scrutiny in the office, finds it easier than her husband might to hide
her habit. One alcoholic housewife in Miami admitted stashing Clorets in
every jacket pocket and downstairs drawer to disguise her liquor breath
from unexpected callers. Others try to hide their alcoholic breath by
sipping Listerine, Scope or vanilla extract.

In some places the ratio between men and women problem drinkers is
already equal. For example, in Florida's Dade County (pop. 1,385,000),
authorities estimate that there are 78,000 alcoholics--and almost half
are women. At the Women's Alcohol Education Center in South West Miami,
patients can relax in a pool or on a patio and their kids can play in a
garage full of toys and live animals. The center is open from 9 a.m. to
11 p.m., and has a daily average of 18 women visitors.

Who is an alcoholic, and who is "merely" a problem drinker? The
definition depends on the definer. Thus Mrs. Fred Tooze, head of the
National Woman's Christian Temperance Union, maintains that an alcoholic
is "anyone who drinks alcohol. As soon as they start to drink they're on
that road downward." By that definition many of the researchers in
alcoholism would be practicing alcoholics themselves.

Quantity consumed is only one criterion--and not necessarily the
decisive one. "We see little old ladies who drink less than a pint a day
who are dying," says Harold Swift, of the Hazelden Foundation's model
treatment facility in Minnesota. "Yet we see men who go through better
than a fifth a day and still function well."

An alcoholic does not necessarily know that he is an alcoholic. The
stereotype of the stumbling, mumbling Bowery bum applies to no more than
about 5% of the alcoholics in the U.S. Most alcoholics hold jobs, raise
families, and manage to hide their addiction from everyone, often even
from themselves. An alcoholic may go on for years, imbibing three
martinis at lunch, two more on the way home and three when he gets
there. One day, however, he may wind up in a hospital with a broken leg
and, deprived of his daily quota, may suddenly find himself in the
middle of the DTs (delirium tremens), which are characterized by extreme
agitation, confusion and frightening hallucinations.

Social Custom. The National Council on Alcoholism, a voluntary health
organization, has drawn up a checklist of 26 questions for drinkers. In
its view, a yes answer to any one of them warns of possible alcoholism.
Some of the council's questions: Do you drink heavily after a
disappointment or a quarrel? Did you ever wake up on the morning after
and discover you could not remember part of the evening before, even
though you did not pass out? Do you try to have a few extra drinks when
others will not know it? Are you secretly irritated when your family or
friends discuss your drinking? Have you often failed to keep the
promises you have made to yourself about controlling or cutting down on
your drinking?

The Rutgers University Center of Alcohol Studies offers a more concise
definition: "An alcoholic is one who is unable consistently to choose
whether he shall drink or not, and who, if he drinks, is unable
consistently to choose whether he shall stop or not." Yet the more
researchers study alcoholism, the more complex they realize it is. There
are, in fact, almost as many "alcoholisms" as there are alcoholics.
Behavioral Scientist Don Cahalan of the University of California at
Berkeley objects to even attempting a strict definition. Drinking, he
says, is a continuum, and no one can draw an exact line between an
alcoholic and a severely troubled drinker. "The issue," he states, "is
why some people apparently waste their lives on alcohol while others
don't. What's the 'glue' that binds some people to their alcohol
problems?" Adds Marty Mann, the woman who founded the National Council
on Alcoholism: "No one has ever found the way to turn a non-alcoholic
into an alcoholic. There is a basic difference in people."

For those who are susceptible, U.S. society offers powerful temptations.
Observes NIAAA 's Morris Chafetz: "There are houses where they don't
even say anything to you when you come in the door before they ask,
'What will you have to drink?"' He also notes that "in our crazy-quilt
value system, masculinity means that if you can hold a lot of alcohol
and seemingly not show its effect, that's somehow a sign of strength."
Chafetz points out that in some other countries--Italy and Israel, for
example--drinking is an accepted social custom, but there is little
alcoholism. Why? The reason, he thinks, is that alcohol in those
countries is a companion to a happy occasion, not the occasion itself.

Many other countries, however, have a much worse problem with alcohol
that the U.S. France, for instance, has the highest rate of alcoholism
in the world (an estimated 10% to 12% of the population, including some
children), and the Soviet Union may not be far behind. Soviet newspapers
now blame 60% of their country's murders, holdups and burglaries on that
old demon vodka. Soviet Party Chief Leonid Brezhnev gave tacit
recognition to the problem when U.S. Secretary of State Henry Kissinger
visited him recently. Discussing with Kissinger plans for a U.S.-built
soft drink factory in the Soviet Union, Brezhnev mused: "Maybe we can
teach our people to drink less vodka and more Pepsi-Cola."

Bad Reflection. Some experts believe that alcoholism may be encouraged
by the destruction of traditional values. Buttressing this notion is the
experience of the American Indians and Eskimos, whose cultures have been
disrupted more than those of any other ethnic groups on the continent.
" The major problem is one of social disintegration," says Dr. Charles
Hudson, chief of psychiatric services at the U.S. Public Health
Service's Alaska Native Medical Center. 'The original social structure
in many places in rural Alaska has been blown apart, much as it has been
in central cities, the ghettos

and Appalachia. The things that were important to people have been taken
away, and when there's nothing to do, they'll take their last buck to
get a bottle and stay drunk all the time."

Blacks and Chicanos are also particularly prone to alcoholism, possibly
for similar reasons. Among whites, the Irish Americans probably rank
highest on the alcoholic scale. No one can explain precisely why,
although Irish American social life has often centered around the pub or
bar, and heavy drinking has been a culturally accepted means for
temporarily getting away from problems. Jews, by contrast, have a
relatively low incidence of alcoholism, though it is rising among them
too. Jews have always frowned on public drunkenness as being a bad
reflection on their entire culture, and drinking has not been the
accepted way to relieve problems ("Jews eat when they have problems,"
quips one Jewish psychiatrist in Manhattan).

Although alcoholism, when it occurs, often follows ten years or so of
problem drinking, there are also alcoholics who apparently skipped even
the social-drinker phase. They passed from total abstinence directly
into chronic alcoholism. This may be due in some cases to a biochemical
imbalance of some sort. "There have been people I call 'instant
alcoholics' who are in trouble the minute they drink," says Marty Mann.

There may be some yet unknown hereditary factor that fosters alcoholism.
Dr. Donald Goodwin, a psychiatrist at Washington University in St.
Louis, studied the case histories of 133 Scandinavian men who had been
separated from their natural parents and raised by foster parents. The
sons of alcoholic fathers were four times as likely as the sons of
non-alcoholics to be alcoholics themselves. Similar studies by Goodwin
of twins raised by different families seem to offer even stronger
support for some genetic explanation. Most researchers are reluctant to
accept such biological determinism as the sole cause, but many agree
with Goodwin that there may very well be some errant gene that makes at
least some alcoholics more vulnerable than the rest of humankind to the
bottle. "There is no one overall answer," concludes Don Cahalan. "We are
trying to exorcise a devil, but there is no one devil. There is a host
of demons."

There is also a host of treatment centers - 7,500 by latest count - and
treatments.

Until recently, alcoholics were thought to be all incurable, afflicted
with a kind of psychic leprosy. Doctors would scarcely touch them (many
still refuse to treat them), and the law looked upon them as human
vermin who had to be swept off the streets and thrown into drunk tanks.
Old attitudes still persist, but within the past five years there has
been a remarkable change in prognosis. No miracle cure, no equivalent of
the Salk vaccine is in sight for the alcoholic, and none is ever likely
to be found; but for every one of the many alcoholisms there is at least
one treatment or combination of treatments that offers a good chance of
cure.

The common element in most of the cures is group support. Explains Jim
Bryan, director of therapy at Chit Chat Farms, a highly successful
alcoholic treatment center west of Reading, P.: "We tell the patients it
can be done and you don't have to do it alone. The patients help each
other get well." Half the staff-including Bryan himself-are recovered
alcoholics, providing even more credence to the support they give to
patients during Chit Chat's 28-day, $840 treatment. "We do not look into
the whys of their drinking," says Bryan, "but how can they stop."

No In-Depth Therapy. At Lutheran General Hospital northwest of Chicago,
where the treatment runs 21 days and costs $1,827, there is also an
emphasis on interaction between patients and staff and among the
patients themselves. For most patients, there is no in-depth therapy.
" We're off this kick of using psychotherapy," says Medical Director Dr.
Nelson Bradley, a psychiatrist, echoing the general opinion of experts
that classical psychoanalysis is of limited help for most alcoholics.

The patient at Lutheran General is treated for withdrawal symptoms-which
can range from the shakes and hallucinations to convulsions and full
blown DTs-and given a medical assessment during his first five days. On
the sixth day he is assigned to one of three 25-patient teams. They meet
three times a week-in many cases with wives, husbands, children and even
employers-in sessions designed to bring the alcoholic back into society
through lectures, educational films and discussions about drinking
problems. Lutheran General follows up its patients for about two or
three months, some of them with psychotherapy, and it estimates its
success at about 50% after three years. "Beyond 50%," says Bradley,
" you've got to have the involvement of the family and the employers.
Then the success rate can go as high as 80%."

A variant of the Lutheran General and Chit Chat models is the treatment
center that combines group therapy and hypnotic suggestion with a
behavioristic kind of aversion treatment: electric shocks or drugs to
make the very odor of liquor abhorrent. At Seattle's Schick's Shade1
Hospital, which offers an eleven-day, $1,500 program, each patient is
taken to "Duffy's Tavern," a small room decorated with enough bottles of
whisky to lubricate a regiment. The patient is given a nausea-inducing
shot and then handed a glass of his favorite brand. He sniffs the aroma,
takes a sip and swirls it around in his mouth. Then, sickened, he spits
it out into a handy container.

Fatal Illness. The patient goes through a similar process four more
times during his stay at Schick's Shadel, at the end of which he will
presumably associate nausea with liquor-and have a long-term aversion to
the stuff. "Aversion conditioning is not fun at all," Schick's Shadel's
Director Dr. James W. Smith tells incoming patients, "but you are
dealing with a fatal illness. In other fatal illnesses, such as cancer,
surgery is often called for if it gives the patient the best fighting
chance for survival. At the moment this is the best we know of-the
method that will do the best job in the shortest time."

Aversion therapy has been widely criticized. Says one social scientist:
" I think doctors who emphasize aversion conditioning are misguided. They
claim that they are curing alcoholics by giving them a shot in the
behind, which makes them sick. But how long does that really last?" A
program that draws even more fire is one in which doctors study
alcoholism by *offering drinks to alcoholics. Indeed, Dr. Edward
Gottheil, who oversees such a research project at the Coatesville
Veterans Administration Hospital in Pennsylvania, admits that his work
is "extremely controversial." Still, he argues, traditional centers
either study alcoholics without their alcohol or alcohol without the
alcoholics-but not drinking itself. 'The idea that complete abstinence
is the only treatment interferes with research," he says.

At Coatesville, patients are not only given individual psychotherapy,
group therapy, music therapy and antidrinking seminars but are also
allowed one or two ounces of pure alcohol (ethanol) once an hour on the
hour, from 9 a.m. to 9 p.m., simply by asking for it. If he drinks the
allowable maximum every hour, a patient can achieve a considerable buzz
by 9 p.m. More important, 13 times every day he must make a conscious
decision: to drink or not to drink. In a follow-up study of their first
group, Gottheil and his associates claim that, after six months,
approximately half of the group members were either dry or drinking less
than twice a week.

Almost everyone else who works with alcoholics regards this study as
heresy against the almost universally accepted belief that a recovered
alcoholic can never drink again. "Out of 3,000 alcoholics treated at
this hospital and another 12,000 consulted, I have never seen one return
safely to social drinking," says Richard Weedman, head of an alcoholic
treatment center at Chicago's Grant Hospital. "One drink won't push him
off the wagon, but if he takes another three weeks later, bang! He's
gone."

Most of the methods owe a large debt to Alcoholics Anonymous, the
oldest, the biggest (650,000 to 750,000 members) and still the most
successful organization by far for helping alcoholics. "Until the
researcher is able to demonstrate some better practical techniques, the
A.A. approach continues to merit our admiration and endorsement," says
Gottheil. And, write Sociologists Harrison Trite and Paul Roman:
" Despite lay leadership, A.A. has apparently achieved a success rate
that surpasses those of professional therapies."

An A.A. member is anyone who considers himself a member. There are no
required dues, and lest riches corrupt the fellowship, no one is allowed
to contribute more than $300 per year. Instead of using professional
therapists, the members help each other; one alcoholic is always on call
to come to the aid of another. The treatment is nothing more
sophisticated than the gathering together of a dozen or more other
alcoholics who share their drinking histories and admit to themselves
and each other that they are powerless to control their drinking.
Members attend meetings as often as they feel the need. "My name is
John," a member will intone at each meeting, "and I am an alcoholic"
Says an Atlanta executive who has been a member for 25 years: "I am
deeply convinced that AA. is the only way. Doctors cannot cure
alcoholism because it is not simply a sickness of the body.
Psychiatrists cannot do it because it is not simply a sickness of the
mind, and ministers cannot do it because it is not a sickness of the
spirit alone. You must treat all three areas, and that is what AA.
does." (If a member's physical problems are acute, A.A. gets him
admitted to a hospital.)

Easy Cop-Out. Even A.A. requires the alcoholic's commitment to change.
Many workers in the field are now trying to downplay the idea--espoused
by Marty Mann 30 years ago--that alcoholism is a disease. The label may
make problem drinking worse by absolving the drinker of responsibility.
An over-emphasis on the psychological causes of alcoholism can have a
similar effect. "A search for the roots of the personal problems that
cause a person to become addicted can become an easy cop-out," says
Psychiatrist Robert Moore. 'The classic therapy game becomes a technique
of protecting his alcoholism."

What about the alcoholic who does not want to change--or does not even
recognize his problem? For many there is still no answer, no lifeline
that can be thrown to them. For many others, however, there is new hope
in an old and hitherto unacceptable technique-arm twisting by the boss.
Recognizing that alcoholic employees are costing them countless billions
a year, many companies are investing money and effort in affirmative
action. Since the late '40s, when the first industrial programs started,
some 200 firms, including General Motors, Hughes Aircraft and even Hiram
Walker, the distiller, have jumped on the bandwagon, the majority of
them in the past five years. Many of the firms have written the plans
into their union contracts. Although the programs are costly, they
actually save money in the long run because they can salvage valuable
careers.

An alcoholic employee is absent 2 l/2 times as often as a non-alcoholic.
Indeed, he is partially absent even when he is working, often without
drinking. The industry could no doubt change its pitch--use older models
and show people drinking only at parties--without cutting sales or
profits.

Public Awareness. What else can be done? For a starter, the Nixon
Administration should give Chafetz's agency the entire $137,947,000 it
has requested for the coming fiscal year, instead of attempting to cut
it to $99,800,000. The money would be well spent on research, training,
community health services and public education. Second, the 30-odd
states that have not yet removed drunkenness from the criminal statutes
should do so, adding treatment centers and halfway houses on the
Minnesota model. Third, more companies should start alcoholic
rehabilitation programs, looking upon money spent combating alcoholism
as almost an efficiency measure, which it certainly is.

How is the battle against alcoholism going? Again, there is good news
and bad news-with an emphasis on the latter. Senator Hughes, who, more
than anyone else, was responsible for the turnabout in the Government's
attitude, is as good a judge as any. He is happy that tax dollars are
joining the fight against alcoholism, and that the public is finally
becoming aware that alcoholism is a treatable condition from which, with
dedicated help, two-thirds or more of its victims can recover. But he
sees even that as only limited comfort. "I'm not optimistic that we're
gaining on the problem," he reckons, "Instead, it's gaining on us."

 

SIDEBAR: The Effects of Alcohol

 

Almost immediately after it hits the stomach, alcohol is coursing
through the bloodstream to the central nervous system, where it starts
to slow down, or anaesthetize, brain activity. Though it is a
depressant, the initial subjective feeling that it creates is just the
opposite, as the barriers of self-control and restraint are lifted and
the drinker does or says things that his well-trained, sober self
usually forbids. Only later, after a number of drinks, are the motor
centers of the brain overtly affected, causing uncertain steps and hand
movements.

How quickly the alcohol takes effect depends on many factors. One person
may be bombed after a glass, while another stays relatively sober after
several. Because alcohol is diluted in the blood, a 200-lb. man can
usually tolerate more liquor than a 110-lb. woman. Food also retards
absorption of alcohol from the gastrointestinal tract, and a few ounces
taken with a meal are less powerful than an equal amount downed an hour
before. By the same token, some drinks with food in them--eggnogs made
with eggs, milk and cream, for example--have slightly less wallop than
straight drinks. The tomato juice in a Bloody Mary or the orange juice
in a screwdriver is not enough to make any appreciable difference.

The total quantity of alcohol in a drink and the rate of consumption
determines the alcohol level in the bloodstream. Thus a Scotch and water
would pack the same punch as Scotch on the rocks or a Scotch and soda if
all three were drunk at the same speed; drinking more slowly gives the
system a chance to eliminate some of the alcohol. The mixing of
different types--beer, wine, whisky and brandy, for instance--might make
a drinker sick, but it would not make him any more drunk than the same
alcoholic measure of just one of these drinks.

So far medicine has found no cure for the hangover, although aspirin can
alleviate the headache. Despite a plethora of folk cures (none of them
really effective), the best policy is to avoid drinking in excess the
night before. Actually, no one knows exactly what causes the hangover's
unpleasant symptoms of headache, demonstrating much less efficiently
than his non-alcoholic colleagues. If he is fired, the investment that
the company has put into-his training is lost altogether. "The company
of any size that says it does not have an alcohol problem is kidding
itself," says Ray Kelly, an Illinois state mental health official. In
any typical group of workers, 3% to 4% are likely to be disruptive
drinkers.

In the typical industrial program, a supervisor, noticing an employee's
work slipping, alerts a counselor. If the counselor's investigation
finds that alcohol is the culprit, he calls the man in and recommends a
treatment-and-rehabilitation plan that falls under the company's medical
insurance coverage. There will be no stigma attached if he enters the
plan, the counselor tells him, and if he successfully completes it, his
career will not be hurt. "If they do not want to go for treatment," says
Jack Shevlin, an alcohol counselor in Illinois Bell Telephone's
pioneering program, the answer is in effect: "Of course you do--if you
want your job."

The results have been more than encouraging, and in most programs about
90% of the alcoholic employees do elect treatment. When a company puts
its weight behind an employee's rehabilitation, the chances of success
are better than 2 in 3, say doctors at Lutheran General, which works
with 52 companies in the Chicago area.

Halfway Houses. Government at all levels has become sensitive to the
alcoholic's plight--and the enormous damage that he wreaks. Since 1970,
when Congress demonstrated Washington's changed attitude by passing an
alcohol abuse and alcoholism act, a score of states have enacted laws
that remove drunkenness (though not drunk driving) from the criminal
statutes. Thus drunks are no longer put in jail. Other places, however,
must be provided to receive them. These are called Local Alcoholism
Reception Centers (or LARC), where the alcoholics are detoxified. They
then graduate to "halfway" houses for outpatient treatment. Because LARC
makes a strenuous effort to reach alcohol abusers early, the centers can
usually help improve the physical condition, earning ability and family
situation of their patients.

Sparked by Iowa's Senator Harold Hughes, who is himself a rehabilitated
alcoholic, the Government has begun an expensive program to combat
alcoholism through research, education and funding of local programs.
Starting with $70 million in 1971, federal spending has now reached $194
million. Eighty-five percent of this amount is allotted to treatment,
rehabilitation centers and halfway houses, many of which would no doubt
still be only token efforts without substantial federal funding to the
states.

The liquor industry has awakened to the problems that excessive use of
its products causes. Some of the companies have been promoting
moderation through advertising and posters. Seagrams, for example, last
year spent $250,000 for hard-hitting magazine ads against excessive
drinking. Licensed Beverage Industries, Inc., the public representative
of the distillers, spends $150,000 a year on research projects and
allots $250,000 each year for a national advertising campaign, promoting
" responsible" drinking. (Know when to say when" is the theme of one ad.
" If you can't stop drinking, don't start driving" is the message of
another.) Last week liquor industry leaders and state beverage-control
officials met in Miami with experts from the Rutgers Center of Alcohol
Studies to consider other measures that could or should be taken. Jack
Hood, board chairman of the National Alcoholic Beverage Control
Association, told conferees of plans to use "the unmatched power of
education to convince every American, young and old, that responsible
drinking is the only kind that anyone should tolerate."

Still, for an industry that has revenues of $18.3 billion a year (after
federal, state and *local taxes), such expenditures are probably only a
fraction of what they should be. Contrasted with this are all the ads
pitched toward the young, implying that not even a weekend in the
country can be truly enjoyable nausea, depression and fatigue, which
many drinkers experience at one time or another.

Some recent research indicates that even social drinking can have both
immediate and possibly long-range deleterious effects on the body.
According to Dr. Peter Strokes, a psychobiologist at Cornell University
Medical College, the liver becomes fatty and therefore less efficient
after only a few weeks of downing three or four drinks a night. But in
the early stages, at least' the condition can be reversed by abstinence.
More moderate imbibing-two drinks a night with meals, say--almost
certainly does no harm to most people. New studies link drinking to
heart-muscle damage and deterioration of the brain. Research by Dr.
Ernest Noble of the University of California at Irvine shows that
alcohol inhibits the ability of the brain cells to manufacture proteins
and ribonucleic acid (RNA), which some researchers believe play a role
in learning and memory storage. After 20 or 30 years, says Dr. Noble,
two or three drinks a night on an empty stomach may impair a person's
learning ability. Both Stokes and Noble cite studies showing premature
and irreversible destruction of brain cells after years of heavy
drinking.

Some frightening studies of the results of drinking have not yet been
accepted throughout the medical profession, but the physical effects on
an alcoholic of very heavy drinking are beyond dispute. A pint of whisky
a day, enough to make eight or ten ordinary highballs, provides about
1,200 calories--roughly half the ordinary energy requirement--without
any food value. As a result, an alcoholic usually has a weak appetite
and often suffers from malnutrition and vitamin deficiency. The slack
cannot be taken up by popping vitamin pills; heavy alcohol consumption
impairs the body's utilization of vitamins. At the same time, excessive
intake of alcohol also affects the production and activity of certain
disease-fighting white blood cells, giving the alcoholic a particularly
low resistance to bacteria.

Inevitably, the alcoholic develops a fatty liver, and his chances of
developing cirrhosis, a condition of the liver in which liver cells have
been replaced by fibrous scar tissue, are at least one in ten. A
severely damaged liver cannot adequately manufacture bile, which is
necessary for the digestion of fats; as a consequence, the alcoholic
often feels weak and suffers from chronic indigestion. This may be made
worse by gastritis, which is caused by alcohol irritation of the
sensitive linings of the stomach and small intestine. The troubles of a
heavy drinker do not end there, and through damage to the central
nervous system and hormonal imbalance, alcohol may even cause impotence.

The Price of Alcoholism:

Five Case Histories

No one is a typical alcoholic, and the only thing all alcoholics have in
common is their

addiction. That fact was reemphasized by the reports of Time
correspondents who interviewed many of them across the U.S. and Canada,
including the following:

JOE, 52, an Atlanta stockbroker, began his career as an alcoholic at 15
when he went camping with his brothers. One of the boys opened a bottle
of wine, and Joe instantly discovered his weakness. "That night was it
for me," he says. "I went looking for a drink in the morning, and I
drank all the way through high school. I was in the grip of an
insidious, progressive disease." Joe continued to drink through Harvard
and the service, but when he went home again his parents sent him to a
hospital for "aversion therapy." "I stayed sober two or three months,"
he remembers. But for him, the aversion was only temporary.

Drinking, borrowing money, being arrested repeatedly, at 27 he was so
far gone that he was not able to write his name. In December 1948 he
went to Alcoholics Anonymous but fell of the wagon after only two
months. In March he was back in A.A., and has been going to meetings
ever since.

"People there welcomed me," he says. "My goal was to live. Survival,
that's all. They told me that if I helped other people, I, would receive
and be helped myself. A funny thing happened. I got better. In two or
three months I was in better shape than I had been in for five years. I
needed a miracle and got it. But it's not over yet. It won't be over
until I die."

ELIZABETH, 44, a Manhattan advertiz- ing woman, was a fierce teetotaler
because both her parents were problem drinkers. At 35, facing the
prospect of a mastectomy, Elizabeth went to her psychoanalyst. The
doctor proposed that she try a drink to calm her fears. "I'll never
forget the feeling," Elizabeth says. "It hit me instantly. This was
something I'd been waiting for without knowing it, and I never wanted to
be without it again. I felt so warm and calm and safe."

It turned out that she did not have cancer, but she went on drinking
anyway, "right around the clock." Although she sipped almost a fifth of
Scotch a day, it did not seem to affect her work. "I never got really
drunk' never had a hangover." One night while waiting for a date she
took an extra slug of Scotch "to be bright and special." Instead she
stumbled and cut her forehead on the mantel. Her date found her bloodied
and bleary and walked out. This shocked her so much that she went to AA.

Elizabeth dried out for a while and then had a relapse, drinking more
heavily than before. Finally she returned to the A.A. program, which she
has followed successfully for five years. "Mine was one hell of a
binge," she says, "and I consider my sobriety precious. I wouldn't do
anything to jeopardize it."

JAY, 45, a Montreal journalist, says that he began drinking heavily "out
of a sense of fatalism"; his father, mother and brother are all
alcoholics.

"I turned into a chronic liar and charlatan, trying to cover up my
affliction. I made raucous scenes and picked fights for no reason. I
often wet my pants and vomited all over myself in public. I went to
doctors and got tranquilizers, which I proceeded to combine with liquor,
which made me even worse. I went to private clinics, public hospitals
and even ended up in a mental home. I went to a priest and then to
Alcoholics Anonymous. They were well-meaning people, but their piety
seemed too facile to me, and I usually had to rush to the nearest bar
every time I came out of a meeting. I was thrown into jail, mugged, and
slept in the gutter. I stank' my gums bled, and my hands were too shaky
to shave without a couple of drinks."

The turning point for Jay came when he awoke in a seedy hotel with the
DTs. "My eyes were bulging from their sockets. My arms and legs flailed
about like windmills. Then those black dots started spreading across the
walls and ceilings, and I had to choke back a scream.

This was the point at which I finally decided I wanted to live, not die,
and forced myself to go get cured."

The cure came at Toronto's Donwood Institute, where he went into group
therapy and was put on a daily dose of Antabuse, a drug that causes
nausea, palpitations and anxiety at the first whiff of liquor. To ensure
his long-term sobriety, a six-month supply was implanted under the skin
of his abdomen. "I finally walked out--cured, tingling with life and
vigor and almost hypersensitively aware. But as I saw a bar, the craving
hit me so hard that I bent double. Was this the way it was going to be
all my life? The answer apparently is yes. The desire would fade, but
somewhere--in the clink of glasses or the sight of good red wine--is the
trigger. It is a trigger that I dare not pull."

BARBARA, 26, a Miami divorcee with two young children, started drinking
when she was 13. "My mother was a heavy drinker," she says, "and we
always had lots of liquor around the house." Married soon after high
school, she became pregnant and--at doctor's orders--began downing a
shot of brandy to help her sleep. "I didn't like the taste, but before
my baby was born I was drinking half a bottle a night."

She and her husband eventually separated, and Barbara started to vary
her drinking habits. "The kids were one and three, and I sipped wine
while I prepared their lunch. Within six months, I went from a small
bottle a day to a gallon, then on to martinis and Scotch. It could be
blowing a blizzard, and I'd trek through anything to get my bottles."

"People are so drink-oriented," she adds. "It's the acceptable thing to
do. You never go to a party or dinner without drinks." Guidelines
morning or before driving--were discarded, and arrests for drunkenness
began to pile up. Sent to a detoxification center after one eight-day
binge, she sneaked out to a bar, then, at 5 a.m., accepted a ride back
from one of the male patrons. He invited her to stop at his apartment
for a drink. She had to fend off a rape attempt, suffering a broken jaw
and scarring cuts on her face. "I thought I'd hit bottom before," she
says through the wires that still hold her teeth together, "but now I
realized that this was it."

After attending a Dade County alcohol rehabilitation center for the past
three months, Barbara is sober and plans to remain that way. She fears,
however, that her drinking may have permanently hurt her children. "They
remember my wine-drinking days when I'd throw up in their wastebasket.
Now if they see me drinking a Coke, my older girl will come over and
taste it and then reassure the younger one: "It's OK."

BOB, 18, a New York City carpenter, started off on a bottle of Canadian
whisky from the family liquor cabinet when he was twelve, and from that
moment would drink whatever and whenever he could. "If it was beer, I
laughed a lot. If it was wine, I would get very mellow. If it was
whisky, I was sure to go wild and get into a fight."

Kicked out of school for fighting a guidance counselor in what he calls
a "temper blackout," Bob was sent to Bellevue Hospital for a psychiatric
examination. "At the nut house they told me I wasn't an alcoholic
because of my age. I was told that if I handled my emotional problems, I
would be able to drink normally." Bob nonetheless tried AA., not once
but three times between binges. "I just hadn't decided that I wouldn't
drink any more."

Finally the A.A. "cure" took when Bob was at the ripe age of 15.
Sobriety has not been easy. A well-meaning social worker pressured Bob
to take tranquilizers to relieve his tension. He refused. "If I did
that," he asks, "then why not drink? I was tired of being told that (1)
I'm alcoholic, and (2) I need to take tranquilizers to -survive. If I
had taken drugs, I would have been in the nut house again in a matter of
months."

Source: Time, April 22, 1974

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