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Alcoholism...the problem brought up to date

One of the most difficult problems that any family may be called upon to
face is alcoholism. The nature of this illness is such that the
alcoholic is unable to overcome his problem alone, yet he often finds it
difficult to accept the help he needs from his physician, or Alcoholics
Anonymous, or other private or community facilities.

That his family, too, may be slow to seek the necessary outside help is
not particularly surprising. Only in recent decades has alcoholism come
to be recognized as an illness instead of a moral problem, and it still
has not fully ceased being either a source of ridicule or socially
unmentionable. Moreover, the members of an alcoholics family are very
likely to be fighting pangs of guilt, either conscious or unconscious,
arising from a nagging worry over, "what did I do to drive him to
drink?"

Today it seems plain that an alcoholic is a sick person whose illness
has its basis in psychological or emotional factors, the precise nature
of which are as yet undefined. The alcoholic turns to alcohol to ease
psychic pain or distress. We know that present methods of treatment for
alcoholism do not "cure" the condition, in the sense that the alcoholic
can continue "controlled" drinking. The patient must shut off the use of
alcohol completely and permanently. Ail the evidence points to that
course of action as the only basis on which the disease can be arrested
and the alcoholic returned to a constructive, useful life.

Where to draw the line?

An estimated 75,000,000 persons in the United States consume alcoholic
beverages in one form or another. Over 5,000,000 of them can be
designated as "problem drinkers" - that is, as alcoholics.

Even defining the clinical features of alcoholism as a disease is not
simple. The physical signs of alcoholism, such as cirrhosis of the
liver, occur only very late in the disease - after years or decades of
uncontrolled drinking. Before this stage is reached, there may be few or
no signs of physical deterioration. The World Health Organization in
attempting a description simply says that alcoholics are "those
excessive drinkers whose dependence upon alcohol has attained such a
degree that it shows a notable mental disturbance or an interference
with their bodily and mental health, their interpersonal relations and
their smooth social and economic functioning; or show the prodromal
[premonitory] signs of such development." While attempts have been made
to arrive at a more exact, measurable definition, this seems to describe
the condition adequately.

Medical authorities are well aware of what an alcoholic does, even if
they don't know the fundamental cause of his disease. His conduct and
actions are almost predictable. The individual whose life is becoming
unmanageable because of alcohol will need a morning drink, or drinks, to
get going; he may sneak drinks, using all sorts of subterfuges and
devices to cover up his secret. He may fail to return to work after
lunch. He will begin to come in late for work, and then will build up a
record of absences with flimsy excuses. He will slip out on one pretext
or another for a quick one, carry a bottle on his person, or keep one in
his desk or locker. He will be very sensitive to criticism, both of his
drinking and of his work. He is very likely to have blackouts (complete
loss of memory); and such blackouts may cover extensive periods. An
alcoholic may even wake up in a strange city and be unable to account
for his presence there. His relations with his family, friends, and
fellow workers will show signs of disruption. His eating habits probably
will change, and late in the disease he may go for long periods without
eating anything at all.

Such signs are a clear indication that it is time to discontinue the use
of alcohol completely and forever. It is a fact that a few incipient
alcoholics are able to do just that of their own accord. But, more
typically, such a person will insist that he has no problem and reject
all offers of help. For him the need for liquor eventually will become
compulsive. One drink of anything containing alcohol and a chain
reaction follows over which the alcoholic has absolutely no control. He
finds it impossible to stop drinking.

At that point, his moral standards just about disappear. His promises
mean nothing. He becomes extremely artful and develops the most
plausible excuses and explanations to avoid coming to grips with the
reality of his situation.

This pattern stays with the drinking alcoholic all his drinking life.
Furthermore, long periods of abstinence seem to have no effect
whatsoever on his inability to regain control of his drinking. A week, a
month, a year, even 10 years after he has "gone on the wagon," the first
drink will activate the devastating compulsion, and he returns to his
old pattern, usually in an aggravated form.

Why outside help?

A person who has reached the stage of alcoholic sickness must not be
judged by the usual conventions. His actions should be regarded as
symptomatic, and accepted as part of a disease process. And that's not
easy. It is very difficult for the non- alcoholic to grasp the depth and
complexity of the emotional factors involved in compulsive drinking; to
appreciate that the socio-economic, intellectual, or professional
background of the victim does not help him to resist the progression,
once the compulsive phase of the malady has asserted itself. Help in
such cases requires patience, skill, and a depth of understanding that
can be developed only by long experience with the problem. That is why
an alcoholic's family - or the alcoholic, himself, if he can bring
himself to do so - must look to assistance from the outside.

In most communities, the possible sources of help for a family facing
alcoholism are varied, and it is impossible to predict which of them
will prove most useful in any one instance. But it is worth noting that
some forty states now have tax-supported programs covering help for
alcoholics, and in such a state reference to the state or local health
department usually can make this resource available.

Also, the National Council on Alcoholism, Inc. (2E. 103rd Street, New
York 29, New York) has local affiliated councils in 64 cities in the
United States, most of which provide Alcoholism Information Centers
where those who are interested can get personal consultation and
literature, and referral to other community resources, such as hospital
clinics specializing in the ambulatory or in-patient treatment of
alcoholism.

The physician's role in treatment

Often the first attempt of an alcoholic at self-help is to arrange a
visit to the family doctor for a check-up and a discussion of the
problem. So much the better if the physical examination can be given by
a physician who is experiences in treating alcoholics or is familiar
with community resources for managing alcoholism.

What about treatment? It has become increasingly clear that alcoholics
are prone to addictiveness. Barbiturates and tranquilizers, which are
still prescribed for some alcoholics because researchers once hoped they
would ease the emotional distress underlying alcoholism, hold implicit
dangers of addiction and toxic reactions and are best used in a
controlled situation. Antabuse, however, is a successful drug adjunct.
This drug makes the body react with acute distress if alcohol is taken
in any form. But Antabuse tablets have serious drawbacks. They should be
used only under the continued supervision of a physician who is
thoroughly familiar with the drug's properties. They must be taken
daily; but, if responsibility for taking Antabuse is left to the
patient, he often will skip it. More serious is the very real
possibility that the alcoholic may be tempted to rely solely on the drug
and avoid dealing realistically with whatever emotional and social
problems are associated with his trouble.

In any event, it is only when the patient has obtained medical and
psychological management that the real recovery process truly begins.
And achieving this first goal is a long-term process.

Alcoholics Anonymous

As a method of dealing with emotional and personality problems of the
alcoholic, group therapy appears to be more promising than private
therapy. On this score, many patients, as well as their physicians, lean
heavily on Alcoholics Anonymous (A.A.) to help out. Indeed, this
organization is almost universally recognized as the one type of group
therapy which has been most successful in helping alcoholics.

As most readers are undoubtedly aware, A.A. is an informal fellowship of
alcoholics who are joined together to help themselves and others to
maintain sobriety. The only requirement for joining the organization is
the serious desire to quit drinking.

At the same time, the family of the alcoholic who has not yet accepted
the fact that he must stop drinking altogether (or even of one who has
accepted that fact and is acting upon it) can get comparable help for
themselves from another organization, called Al-Anon, which is separate
from, but closely identified with, A.A. (For information, write to
Al-Anon Family Groups Council, 40 East 40 Street, New York 17, N.Y.)

The membership of one or more of his immediate family in an Al- Anon
group has been an important factor in many an alcoholic's recovery.
These groups emphasize the fact that they do not discuss the case
histories of the alcoholics in whom they are interested, but confine
themselves to the tensions and anxieties that are inherent in their own
situations. Those who are within the family circle of an alcoholic
suffer extreme anxiety, anguish, and frustration, since their attempts
to help come to nothing; they feel beaten, hopeless, and angry - with
overtones of guilt. It is only when they clearly realize that alcoholism
is a disease, and that they are not responsible for its development, and
when they understand and master their own feelings of guilt and
hostility through group discussion, that they can cope effectively with
the vagaries of the alcoholic's conduct and eventually help him get back
on his feet.

A look to the future

So far, this report has devoted itself to a program which, in effect,
locks the barn door after the horse is stolen - that is, to treatment of
the alcoholic after he is in trouble and is seeking help. Another sort
of program - aimed at detecting alcoholism early in the disease - is
being pioneered by a few industrial concerns. The companies recognize
that valuable personnel who might otherwise be lost to alcoholism can be
kept productive if help is provided soon enough. Their program begins
with a general educational program, aimed at both employees and
management. Supervisors, in particular, are trained to sense the
existence of problems in the lives of the employees under them. A
channel is set up through which workers who may be succumbing to
alcoholism can be referred, with a minimum of embarrassment, to a
qualified group of therapists. In most instances, this group is composed
of a physician, a psychiatrist, and counselors who are members of
Alcoholics Anonymous.

There is growing acceptance of such an approach within the medical
profession, and even by alcoholics themselves. The success of such
programs depends, of course, on the wisdom and patience of the
counselors in dealing with highly personal situations. They must neither
exhort nor lecture; and they must gain the confidence of the alcoholics
with whom they deal.

Today, alcoholism ranks among society's major health threats. It is
widely felt that the prevention and control of this disease will come in
the course of time, but only through the same methods and efforts which
have proved successful in combating other public-health problems: a vast
program of public education, and of intensive research and study.

Source: Consumer Reports, November 1960.

 

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