Can Alcoholics Recover?
WE MUST DESTROY THE LEGEND OF THE ROMANCE OF ALCOHOL
With all our efforts, we shall be unsuccessful if we do not destroy the
legend of the "romance of alcohol." This legend, so diligently propagated
by our liquor advertisements, and so innocently indoctrinated by our
novels and photoplays, portrays alcohol as an inevitable concomitant of
"gracious" living and an absolute necessity if one is to be considered a
sophisticated or up-to-date member of society. Drinking and having a good
time, drinking and smart living, drinking and style, drinking as a sign
of conspicuous spending, drinking as a sign of good fellowship, are all
being drummed into the American mind by radio, press, magazine and
billboard. Addressed to emotionally mature adults, such advertising would
be comparatively harmless; addressed to immature youth, boys and girls
still in their teens, it produces a yearning for the romance of alcohol.
Youth hears the repeated shibboleths concerning alcohol: liquor increases
sexual potency, liquor is just the thing to pep you up, liquor is
absolutely necessary to have a good time. The inevitable result is
wholesale drinking among boys and girls too immature to withstand its
allure, and the early development of a tragic addiction to alcohol.*
Practically speaking, young people should be discouraged from drinking
before the age of twenty-one, and moderation should be held up as an
ideal in this as in other forms of self-indulgence. Drinking during
adolescence, and the association of drinking prowess with sexual
conquest, have catastrophic effects in the establishment of fundamental
interpersonal relationships.
A girl should never drink for relief of pain associated with menses.
Drinking to assuage psychic or physical discomfort is always dangerous.
The social drinker, too, has no guaranty against his slipping over into a
state of dependence upon alcohol. A little fear of alcohol and a
realization of dangers involved is advisable even in the strongest and
least susceptible.**
With all our efforts, we shall be unsuccessful if we do not destroy the
legend of the "romance of alcohol."
* From an article on alcoholism by Robert V. Seliger, M.D., John Hopkins
Hospital, which appeared in ALCOHOL HYGIENE, an educational project of
The National Committee on Alcohol Hygiene, Inc. (practical practicing
medical workers in the field of alcoholism). Baltimore, Maryland.
** By James H. Wall, M.D., Assistant Director, The New York Hospital,
Westchester Division, White Plains, New York-an article entitled The
Prevention of Alcoholism. Published in Alcohol Hygiene.
BY GRETTA PALMER
Alcoholism has been called out No.4 public health problem by a medical
director of the U.S. Public Health Service-and the postwar years, in
which drinking always increases, have scarcely begun. In the U.S. there
are 750,000 known alcoholics, or one and one half times the number of
victims of tuberculosis. In addition to these, there are 3,000,000
"excessive drinkers," many of them approaching the stage of true
alcoholism, in which they will require expert help.
Yet alcoholism-which touches almost every family in the country-is not
recognized as a disease at all by millions of Americans! Even many wives
of alcoholics confuse the malady with "lack of will power" of "failure to
face facts" when they discuss their husbands' problem. The medical world
itself is remiss in dealing with the disease: only 110 institutions
listed by the American Medical Association accept alcoholic patients, and
most of these are content to restore the patient to sobriety and "dry him
out," with no fundamental attack on alcoholism itself. The public is
indifferent; there are no widespread, publicly supported drives to raise
funds for an attack on this disease. In our large cities there is almost
never a clinic to which the alcoholic can go for such impersonal,
scientific help as would be extended if he were suffering from polio or
cancer.
Yet the inebriate is as little capable of recovery, without help, as the
victim of any other disease. With help, the alcoholic who wishes to get
well can be restore to normal living in about six cases out of ten.
Why are we so lax in dealing with the alcoholic?
There are several reasons, according to doctors, psychiatrists and
recovered alcoholics who are trying to bring about a change. One reason
why the alcoholic is neglected is that he was, until very recently,
considered incurable; doctors rejected such patients because they did not
know how to help them. Of the four methods of therapy now in wide use,
three have been developed in the past fifteen or twenty years. Before
them, recoveries were rare and not thoroughly understood even by the
practitioners who brought them about.
The fact that the alcoholic can be saved in six cases out of ten is news,
and important news, to millions of Americans. But in order to understand
the hopeful, recent advances in the field they must first digest the
fact, familiar to several generations of physicians, that the alcoholic
is a sick man or woman. Knowing this, they can attack the problem
realistically.
He is sick. But with a malady whose seat is even now unknown to science.
Alcoholism is a complex disease, which may have both physical and
psychological aspects. The methods of treatment which are successful are
all timed at changing the patient's way of looking at life and liquor;
they are, primarily, psychological forms of treatment. But no matter how
successful the treatments may be, the recovered alcoholic can never
again, with safety, take a single drink. (alcoholics have tried, after
five years or fifteen years of strict sobriety, and have found themselves
as badly off as ever in a few month's time.) Some students of alcoholism
therefore believe that there is a bodily idiosyncrasy present among all
alcoholics; what it is they still do not know.
There are about 50,000,000 Americans who "take a drink." Of every 1000 of
these, 45 are "excessive drinkers," whose health suffers from their
habits; 30 of them seem still able to stop drinking. The true alcoholic
is not one of these; he is one of the 15 drinkers out of every 1000 to
whom alcohol has indeed become a drug, a psychological necessity so
precious that he will cling to it in spite of every appeal to reason and
self-interest and his "better self." He has an uncontrollable urge to
drink, never experienced at any time by nine out of 10 of our 50,000,000
drinkers.
Over twenty million of the Americans who drink are women: a recent Gallop
pole showed that 59 per cent of all our women take a drink at least
occasionally, although the percentage is much lower among women older
than fifty years. Women's increased drinking may explain why our national
consumption of liquor, which was going down before the war, has now
increased, so that the 1943 consumption of alcohol in this country was 30
per cent higher than it was in 1940. Americans now drink 1.17 gallons of
alcohol a year, on the average, compared with the 4.6 of France, the .93
of Great Britain, Norway's .55 and Holland's .4. Within our own country,
the state that consumes the smallest amount is North Carolina (.32 gallon
a year per capita); the hardest drinking areas are the District of
Columbia (4.09), followed by Nevada and Connecticut. Three of our
states-Kansas, Oklahoma and Mississippi are dry by state law, and one
third of the whole country is dry by local option.
Much of the dry propaganda has centered around the problems raised by the
alcoholic; prohibitionists would attempt to prevent alcoholism by making
liquor impossible to obtain except by breaking a law. The political wets,
on the other hand, say that such a law is unfair to the 90 per cent of
all drinkers who are in no danger of becoming alcoholics and that it is,
in any case, an experiment that has already failed. Sixty-six million
American voters are neither wet nor dry; they are the "on-the-fence"
spectators, who have an open mind on the problem and who wish to help the
alcoholic by whatever method the experts find to be the best.
Women are playing a large part in organizing the new attack on alcoholism
as a health problem-as women volunteers have been the spearhead of drives
on cancer, tuberculosis and infantile paralysis. The new National
Committee for education on Alcoholism has a woman organizer, Marty Mann.
She believes women have a special interest in alcoholism; wives and
mothers of alcoholics suffer from the social stigma which now attaches to
the disease and which would be avoided if it were as matter-of-factly
viewed as deafness or rheumatism in the family. And besides that, a large
and growing proportion of alcoholics today are women. Before the war the
Yale School of Alcohol Studies estimated that one of every six alcoholics
was a woman; many students of the subject now believe the figure has
changed to one out of four. In Chicago's Municipal Court arrests for
drunkenness used to be six men to one woman; the ratio is now one woman
out of three. FBI reports on arrests for drunken driving show that women
are offenders five times as often today as in 1932. So woman's interest
in alcoholism is no longer limited to the puzzled and unhappy curiosity
of the alcoholic's family; women nowadays may share the life-and-death
interest in alcoholism of the victim himself.
That victim of alcoholism; who is he? How did he get that way? Why is he
incapable of drinking like a gentleman? Why do his good resolutions, his
promises of moderation inevitably fail? Why is he-reasonable enough in
other matters-incapable of seeing the clear fact that his drinking brings
him much more misery than happiness, and of sensibly stopping it?
The answer to some of these questions is still a mystery, locked in the
dark recesses of the alcoholic's hidden personality. But some facts are
known.
The alcoholic does not have a basic personality which varies
significantly from that of the average man. Detailed studies of normal
drinkers, alcoholics and recovered alcoholics were recently carried out
by the Research Council on Problems of Alcohol, of New York. No important
differences in fundamental attitudes were found.
But after some years of drinking the alcoholic is set apart from other
men; he is especially apt to avoid the responsibilities of married life.
A study made by Dr. Selden Bacon, of Yale, on arrested inebriates showed
that less than half of them had ever married-although four fifths of the
men of their age and geographical groups were married. Only 23 per cent
of the alcoholics were living with wives, compared with 73 per cent of
the population as a whole. Of those who had married, 25 per cent were
separated and 16 per cent were divorced. Other differences appeared which
must make living with the inebriate a trial for any wife: alcoholics hold
their jobs for shorter periods and are more poorly paid than other men of
similar background; they amuse themselves either alone or with casual
acquaintances, instead of belonging to any group; they do their drinking
alone or with members of the same sex, instead of indulging in normal,
social drinking.
Such reports give valuable clues to those who would help the alcoholic.
But our best guidance comes from the life stories of the alcoholics
themselves.
Take the case of Bill, representative of the very large group on
"introverted" drunks. Bill was a shy and studious boy, sheltered by a
devoted mother. At high-school dances he was often too bashful to ask the
prettiest girls to dance; in "bull sessions" he rarely had the confidence
to speak out and express his views. Between him and the others in his
group their loomed an invisible wall of self-consciousness.
Then Bill discovered beer; he found that if he took three or four glasses
of it, he was able to join in the fun. His shyness disappeared. His sense
of well-being increased. He began to see himself as a very witty,
admirable fellow. The process has been described by Prof. William
McDougall:
"Of all the intellectual functions, that of self-criticism is the highest
and latest developed, for in it are combined the functions of critical
judgment and of self-consciousness. It is the blunting of this critical
side of self-awareness by alcohol and the consequent setting free of the
emotions and their instinctive impulses from its habitual control, that
give to the convivial drinker the aspect and the reality of a general
excitement.
Many shy men have discovered, in alcohol, the same welcome release that
Bill found, and have still been able to keep its attraction under
control. Bill, however, could not do this. Perhaps his longing to be
accepted as one of the group was deeper than that of other boys; his
sense of his own gawkishness may have been abnormally acute. Perhaps for
most of his years on earth Bill had been ill-at-ease, so that his only
memories of complete well-being were associated with pre-kindergarten
days. Such a boy - if his physical constitution allows him to drink a
great deal without becoming sick at his stomach-may use alcohol to put to
sleep all his mature, self-critical faculties. He may return, through the
various stages of drunkenness, to the state of the young child-the last
state in which he found happiness."
So it was with Bill: he drank enough, every time, to make him as helpless
as a child. Alcohol, even to a normal drinker, offers a release from
grown-up responsibilities. The authors of Alcohol: One Man's Meat-Dr.
Edward A. Strecker and Francis T. Chambers, Jr.-say "To view the panorama
of the various states of intoxication is to witness a progressive
psychological descent or repression..Most individuals seen satisfied to
regress to some phase of the teen age, which was probably an enjoyable
and carefree time, deeply imprinted on the unconscious. Others seem
satisfied with a very slight descent, and still others are never
satisfied until they have reached an infantile level in intoxication." Of
these is Bill.
Bill's case was typical enough of the average alcoholic; looking back to
his college years, long afterward, he decided that there had never been a
time when he drank "normally." Like many alcoholics-perhaps most-he used
his very first drinking bout as an escape, rather than a means of
sharpening experience. When Bill had once discovered that drink was a
drug, which would make him forget his shyness, it was not long before he
used it to help him escape other worries too. Within a few years he had
worked his way into the typically alcoholic pattern of behavior: whenever
life became painful, he took enough drinks to be carried back to the
state of mind and body appropriate to a carefree four-year-old child. He
was now a serious "problem drinker."
Bill passed through the usual steps: expulsion from college with the
promise that he could return if he would "brace up"; a job, precariously
held for a few years; marriage to a charming girl who believed that he
would stop drinking as soon as he had "responsibilities to straighten him
up." There were periods when her beliefs seemed justified; Bill obtained
jobs and did well, for a time. But sooner or later there came a day when
some discouragement made him long for the carefree days when he was a
little boy. A few steps to the nearest saloon, a dozen "quick snorts" and
Bill was off on another bender.
Now, the vicious and difficult thing about Bill's drinking was this: he
did not know that he had a disease. Neither did his wife or his employers
or his friends. They thought that will power was what he needed; they
imagined that "a good talking to" would help. When Bill promised, in all
sincerity, that he would never get drunk again, they believed it. Why
not? He believed it himself. Bill was as puzzled as anyone else over why
he got drunk; he thought, every hang-over morning, that from now on he
would be content to take one or two drinks, as other men did. Even a
visit to a sanitarium failed to prove to Bill that he was incapable of
moderate drinking, that he was a sick man.
(Eventually Bill found out and admitted to himself that liquor had him
bested; this was the beginning of his recovery, but that's another story.)
Bill had started drinking to get rid of his self-consciousness. But Mary,
who never had a self-conscious minute in her beau-filled days, also
arrived in an alcoholic ward in a big city hospital. Mary belonged to the
flapper age. She was a "prom-trotter," in the company of young men who
carried hip flasks inside their coonskin coasts and who believe that a
speak-easy card was a proof of great sophistication. Mary had a lovely
time her debutante year: she was the girl with the "hollow leg," the good
scout who was always able to drive a car home from a party when the owner
was tight. Mary may have been a normal drinker at this period; no one can
be quite sure of whether alcoholism, in its very early stages, has subtle
symptoms which some future scientists will be able to detect. But it
isn't essential for us to know: for after eight years of apparently
normal hard drinking Mary showed symptoms of alcoholism which nobody
could doubt.
She became the girl who always managed to have lunch with someone who
liked a cocktail first. She was the woman who would say, "why don't we
have a second? That one was so small?" She was the girl who found that
straight whisky "cured" insomnia and headaches and "braced her up" for
any disagreeable chore-from arguing with the butcher over his bill to
making a boring visit to her in-laws. For quite a while, Mary's daytime
drinking went undetected by her family (she was a great girl for cloves
and mouthwash). But every month she increased the size of the nips a
little more, until evening found her half intoxicated on several days a
week.
Like many alcoholics, Mary scorned the term. "I can stop any time I
want," she insisted. And, "Drinking is a part of normal gracious living
to my generation. We may overdo it once in a while, but what of it? An
occasional bender lets off steam.
This stage of bravura didn't last long; after Mary had been arrested
twice for driving while intoxicated, and had waked up with her third
black eye, she began to wonder whether she shouldn't "cut down." But it
was only after several more years of painful experimentation that she
became convinced, in all humility, that liquor was something she could
never handle again. Her recovery dated from that admission to herself.
Jake was a self-made man, who had come up the hard way from a childhood
in the slums. Self-educated, he had attained success as a trial lawyer
with no backing, no encouragement but his own determination to get to the
top. His will power was his strongest quality; his ability to win out
over every discouragement had been proved through the years. Jake, after
several of his greatest triumphs, went on long, expensive benders that
ended up in a bleak hotel room filled with empty bottles, in a town he
couldn't name. Jake never drank when there were hard problems to be
faced: it was only success that sent him off on these strange, frantic
bouts.
So Jake stopped drinking; just like that. He did not say to himself. "I
am incapable of handling liquor." He said, "I'll stop drinking until I
make a million dollars." After ten years, the million dollars was safe in
a brokerage account, and Jake reached for the bottle. Inside of a month
he was drunk; inside of a year he had lost all his money and was a
patient in a hospital alcoholic ward.
Jake-like Bill, like Mary, like the public at large-did not know that
alcoholism is a disease and that he had it during all his "dry" years.
The man who grits his teeth and fights the desire for drink, as Jake did,
has not recovered from the craving (which is the malady). He still looks
on liquor, and the escape it offers as a reward which he can someday win.
To Jake, success brought with it the fear of losing it of sliding back
into the poverty and misery of his-childhood; liquor helped him to run
away from this fear-to run all the way back to the state of helpless
infancy, before his baby mind had discovered that such things as failure
and success existed. Jake drank to escape from ambition. Until he had
learned to view alcohol as a drug (so far as he was concerned) and until
he had learned to live without the prospect of ever drugging himself,
there was no hope of recovery for him.
Now, doctors and psychiatrists knew many things about the life stories of
such alcoholics twenty years ago. But their knowledge did not help them
to effect many cures. Psychiatrists helped some alcoholic patients to
recover then, as they do today; but psychiatry nowadays has the benefit
of the past fifteen years of intensive study of alcoholism on the part of
scientists. It has also learned much from Alcoholics Anonymous, the group
of men and women who, disgusted with the failure of the known medical and
religious approaches, made a daring experiment of pulling themselves up
by their own boot-straps- and were successful. It is because of the
collaboration of realistic, laboratory-minded scientists with the
patients themselves that alcoholism is today a disease from which almost
any alcoholic who wants recovery can attain it.
It was in the early '30's that Dr. Howard Haggard, head of the Laboratory
of Applied Physiology, began an intensified program of research on
alcoholism at Yale University. His experiments verified the fact that
this disease has no apparent physical cause, and that almost no lasting
effect of alcoholism can be blamed on drinking alone. Vitamin deficiency
occurs among 50 per cent of chronic alcoholics, but only because liquor
has crowded out of their diet other food essential to health; 8 per cent
of all alcoholics have cirrhosis of the liver, compared with less than 1
per cent of the population at large-but cirrhosis of the liver does
appear in teetotalers. Delirium tremens afflicts about 4 per cent of
heavy drinkers, but it is only a temporary effect.
Alcohol, of course, has its temporary effects on the nervous system, as
its percent: age mounts in the blood stream. Even such small amounts of
alcohol as are contained in two cocktails affect the drinker's ability to
distinguish pitch and color, to memorize poetry to react to light
signals. But these effects are shared by the alcoholic and the normal
drinker as well. Physiology alone can give no answer to the question: Why
do 15 drinkers out of 1000 become the victims of alcoholism?
Doctor Haggard began casting around among the sister sciences, to see
what enlightenment their studies might give. He and his colleagues
founded a scholarly publication- the Quarterly Journal of Studies on
Alcohol-and assembled on the Yale campus a number of scientists to work
in various fields. Here, in the Yale Section on Alcohol Studies,
neurologists, psychiatrists, statisticians, sociologists,
anthropologists, lawyers under Dr. E. M. Jellinek tried to crack the
age-old questions: What makes an alcoholic? How can he be helped?
By the summer of 1943 the scientists thought they knew enough about the
second problem to share their findings with the public. They had studied
many alcoholics who had learned how not to drink; they believed that
knowledge of this sort should be shared with leaders of the community,
who might use the information to attack the social evil that alcoholism
has always been. For from 25 to 28 per cent of all crime is associated
with alcohol; the costs to society of merely confining and punishing the
alcoholic run to a billion dollars a year (and none of that money is used
to treat the alcoholic). Our prisons and hospitals and mental asylums
would be relieved of a heavy load if alcoholism could be wiped out, as
smallpox has been.
To help bring this about, the Summer School of Alcohol Studies was held
at Yale in 1943 and every summer since. Men and women representing
twenty-five professions have attended in a single season; there were a
college dean and a "reformed drunk," a judge and several ministers, a
distiller and an officer of the Women's Christian Temperance Union. The
course of lectures covers the significant findings of the scientists at
the laboratory; they also bring in data from the two Yale Plan Clinics
set up to help alcoholics who are sent in by the courts or who come,
voluntarily, to seek treatment there.
What are the facts spread before the students at a summer session by this
group-which has learned more about alcoholism than any other in the
history of the world?
1. Why one man becomes an alcoholic and another doesn't is still a
mystery. We know that alcoholism is not hereditary: only 35 per cent of
alcoholics come from alcoholic homes, and the children of excessive
drinkers, brought up in another environment, have no significant drinking
difficulties. Nor can environment be blamed: the men who started to drink
with the alcoholic are usually moderate drinkers twenty years later. A
longing to escape from reality, and a desire to return to the security of
an earlier period of life, is common to alcoholics; but the same desire
is shared by thousands of other men and women. Some of these misfits
become psycho neurotics or invalids, but never feel attracted to drink;
others, for an unknown reason, turn to alcohol.
2. Against these negative results of fifteen years of study, the Yale
group can say that there are now four recognized methods of treatment
available to the alcoholic who wishes to get well and that, if he is
sincere, he has a slightly better than 60 per cent chance of recovery.
His alcoholism will not, however, be cured-it can only be arrested.
Nothing now known will make it possible for the alcoholic to drink
moderately, on any terms, in any foreseeable future. He must be willing
to abandon all forms of liquor, as long as he lives.
3. But the alcoholic can be taught to live happily without drinking;
recovered alcoholics rarely feel deprived or resentful of their inability
to take a drink. They look upon their disability much as a diabetic
resigns himself to doing without sugar.
4. The greatest problem facing those interested in alcoholism now is to
reach the alcoholic and his family with the news that help is available -
provided that they will look upon alcoholism as a disease. If the public
at large once recognized this fact, alcoholism could be almost wiped out
in a few years, and at very small expense. The Yale Plan Clinics, for
instance, have reclaimed a high percentage of their patients, at a cost
of only $100 per recovery. All the known alcoholics in the country could
be given such help for $75,000,000, or one thirteenth of what we now pay
merely to lock up such patients, and punish them, every year.
Now, how did all this progress come about? Was it through the research
scientists, the diligent doctors that the problem of helping the
alcoholic was primarily solved? No, it was not. The scientists have done
much toward re-educating the alcoholic into the ways of happiness and
health; but of the four forms of treatment, which have proved successful
only one-psychiatry-can help a patient without the help of other
alcoholics.
1. Psychiatrists pointed the way- their painstaking, heartbreaking
efforts to reclaim alcoholics broke the trail. They discovered the
compulsive element in alcoholism and taught us to expect that the man who
says, "I only want three drinks," at noon may be reaching for his
twentieth at cocktail time. Psychiatrists uncovered the reluctance to
grow up which lurks in the breast of every alcoholic. But psychiatry,
working alone, had only a very limited success-2 per cent, according to
some estimates.
(Psychoanalysis, one form of psychiatric cure, has been carried out on
very few alcoholics. The Institute of Psychoanalysis in Chicago, of 1593
patients interviewed, had only 36 classified as alcoholics or drug
addicts; only 4 of these were analyzed).
Psychiatrists who have the highest percentage of success with alcoholics
today draw heavily on the experience of the three other forms of
treatment. By combining their own valuable, specialized approach with one
of the other therapies, they have had great success in recent years. In
co-operating with the three other forms of treatment, they are accepting
the help of recovered alcoholics themselves, who have given tremendous
help to the scientists studying the disease in recent years. It was only
when the desperate inebriates started pulling themselves up by their
bootstraps that things began to hum.
Take a look at the alcoholic, this medical pioneer: he is no "man in
white," no winner of Nobel prizes. He is just the village drunk; the
stumblebum on the Bowery; the man who broke his mother's heart; the
figure of comedy; the improvident father; the helpless recipient of more
useless good advice than any other man in history. Take a look at him. It
was he who helped the Drys to clinch their argument and legislate
50,000,000 indignant normal drinkers into national Prohibition. It was he
whom many sanitariums and private hospitals will still not receive for
treatment. This s the alcoholic, half crazed with the shakes, eaten with
remorse, up to his ears in debts and disgraceful episodes, the prey of
quacks who give him "cures" for just the amount of his family's bank
account, and leave him worse than ever-the man weeping wives and
ministers and judges brand as "worthless." This was the man who decided
something had to be done about himself-and did it.
2. The most popular of the four therapies for alcoholism did not exist
when Doctor Haggard began his experiments. It was in 1935 that the
founding fathers of Alcoholics Anonymous got together and began to cure
themselves. They were extreme cases; even today 80% of A.A.'s have been
locked up for drunkenness. These men were desperate in their weariness of
being told the wrong things by outsiders who didn't understand. In
despair, and fumblingly, they worked out their own form of self-help-a
kind of composite of what religion and science could give the drunk that
would keep him from wanting to drink. This treatment- the patient's own
personal creation-is Alcoholics Anonymous. And it works.
A.A. has spread, with the speed of a chain letter, among the "hopeless"
alcoholics of the country. In 1935 there were three members; in 1959,
when the book, Alcoholics Anonymous, was published, there were 100, most
of them in Akron and New York. Today there are 752 A.A. branches, 24,000
members. Some of the chapters have clubrooms, open most days and
evenings, where the members can play games, drink soft drinks and
exchange experiences-they provide the sociability of the barroom to men
still a little unsteady about trusting themselves in the old
surroundings. Best of all, they have meetings where recovered alcoholics
tell their stories to encourage new members.
Each man or woman begins the talk with the humbling words, "I'm an
alcoholic." He tells the funny things he did when he was drunk, as well
as the dangerous and cruel things-for he knows that he was the victim of
a sickness, and he feels no shame over its manifestations. He tells of
the difficulties in making the first, painful surrender of self to some
"greater force," and the whole reorientation of values that that
entailed-for there is a strong reliance on God in the A.A. program. If
the speaker had an early relapse-as some A.A. do-he admits that this came
from careless or self-centered thinking. A.A.'s tell the audience that
the place to lick the temptation to drink is in the mind, as soon as the
self-excusing mechanism begins to work. It is at this moment that the
A.A. pleads "Give me the name of an alcoholic who needs help." For it is
by showing the way out to other men, in more desperate need than himself,
that an A.A. keeps himself "dry."
There is always an alcoholic, somewhere, to be helped; with 750,000 in
the country, the supply is never low. A.A.'s in strange cities, when they
feel themselves slipping, call hospitals and ask, "Have you a drunk I can
come up and talk to?" Others appeal to ministers whose names they pluck
from the telephone directory. The first chapter, that of Akron, Ohio,
sprang from just such a need on the part of the original A.A., who had to
find another alcoholic whom he could help, to save himself from drinking.
The A.A. way is brought to the alcoholic by a former sufferer, and at the
right moment-when he is still filled with self-reproach and misery and
has a hang-over to humble him. In this period of self-abasement, the
drunk is willing enough to take the first step: to admit-as a mere
possibility, mind you-that there may be some force in the universe bigger
than himself. That admission-combined with a sincere desire to stop
drinking-is enough for the A.A. to build on.
"Atheists and agnostics, who stumble over using the word 'God', are still
able to admit that the universe contains laws and forces broader than
themselves," say the A.A.'s One half of their members, indeed, used to
scoff at all religion.
Doctors now take the A.A. technique seriously. Philadelphia General
Hospital, among others, allows A.A.'s the privileges of staff members, so
that they may work with fellow alcoholics outside of visiting hours. Some
psychiatrists urge their patients to combine A.A. membership with
psychiatric treatment; Dr. H.M. Tiebout, of Blythewood Sanitarium in
Connecticut, was one of the first of these.
Of the alcoholics who are contacted by Alcoholics Anonymous, about one
half immediately catch on and remain dry. Another 25 per cent are flat
failures-they either do not want to stop drinking or are so confused and
psychopathic that they cannot be reached. The last 25 per cent go off,
after a meeting or two, and try drinking; but they usually return. One of
the early founders had no apparent converts at all among the first 75 men
with whom he worked; ten years later he found that three had died but
that 67 of the rest were members of different A.A. groups throughout the
country. When he first talked to them, they were not yet ready to stop.
They only "wanted to want to quit," in A.A. parlance.
But there are some men and women who entirely reject the religious
approach. To them, two other routes are open.
3. There is the very successful record of the "lay therapists"; these are
men who used to be alcoholics themselves, but who have reconditioned
their minds, by psychological methods, so that the desire for the first
drink can be dealt with before it becomes a real temptation. There are
only a few lay therapists in the country. Most of them are graduates of
Richard R. Peabody, of Boston, who wrote The Common Sense of Drinking and
who taught other men the technique by which he had cured himself of
alcoholism. The lay therapists work closely with hospitals and doctors,
who help them screen their patients and choose only those for whom this
method seems a promising one. Office consultations, once or twice a week
for a year, are supplemented by daily psychological exercises. Francis T.
Chambers, Jr., of Philadelphia, Raymond McCarthy, of the Yale Plan Clinic
at New Haven; and Donaldson Clark, of New York City, are well-known
therapists.
The lay therapist accepts only the alcoholic who is honestly willing to
recover. One of them tests the sincerity of the patient by asking him,
"Do you recognize your drinking as the central problem of you life and
the one that must be solved first?" A surprising number of alcoholics who
have been fired, divorced and jailed for excessive drinking refuse to
admit that they are alcoholics: they drank, they will tell the doctor,
only because the conditions of their lives were insupportable. If they
were given "the breaks" they could still drink moderately. Alcoholics in
this frame of mind are not ready to be helped by the lay therapist. Such
patients, when they hint that they can now drink moderately, are usually
advised to, by all means, try. A few months or years later the majority
of them return, finally convinced that "moderation" is only a mirage.
The patient who once admits that alcoholism is his largest problem, and
that he will work toward recovery, has already made a big step forward:
for the first time in his life, he has accepted the responsibility for
his misfortunes and can set about correcting them. This is a first step
out of the old, alcoholic way of retreating from painful experiences. But
it is only the first step.
No alcoholic, even after he has begun a course of treatment, is really
convinced that he will ever reach a stage of not wanting to drink: only
months of mental discipline and suggestion can bring about such a radical
change. "perhaps you can make me grit my teeth and determine never to
take a drink," the patient will say, "But I'll always want one." He is
wrong: when he has recovered, his antipathy to alcohol is so great that,
in the words of one recovered alcoholic, "If doctors tomorrow discovered
a pill that would enable me to drink moderately, I'd say, 'That's
fine-give it to someone else. I don't want to drink.'" Another states the
case this way: "NO alcoholic is safe until he can honestly say that if he
had only twelve hours to live, with nobody watching him and the certainty
that nobody could learn about it later, he still would pass his last day
on earth without a drink."
How do lay therapists bring this transformation about? Under their
guidance the patient orders every hour of the day, according to a
schedule he himself has worked out in advance-and he never departs from
this, except in a case of real necessity. In this way he learns to direct
his own destiny. He spends a part of every day tracking down his hidden
mental reservations about future drinking, or trying to figure out the
reason for his benders in the past. This teaches him to look at
alcoholism realistically, without shame or fear.
Most important of all: he trains his mind to associate the first thought
of a drink with the painful episodes to which it would inevitably lead
him. He learns, like the A.A., to deal with the temptation to take a
drink when it is first forming in the mind, and to destroy it there.
During a period of at least a year the patient has several sessions a
week with the therapist, who helps him over the rough spots and compares
experiences from his own past.
Dr. Foster Kennedy, head neurologist of Bellevue Hospital, New York, has
said, "I have no doubt that a man who has cured himself of the lust for
alcohol has a far greater power of curing alcoholism than a doctor who
has never been afflicted with the same curse." Dwight Anderson, director
of public relations of the Medical Society of New York, says, "The
recovered alcoholic will never give up hope. He cannot forget the
numberless times that his friends and relatives gave up all hope for him,
to say nothing of the occasions when he had no hope for himself. But when
the time was right and he himself was ready, he became accessible."
Arriving patients are warned, by recovered alcoholics on the staff, that
this treatment is painful, disagreeable and no good to them unless they
are desperate enough to welcome a future in which the mere sight or smell
of any drink will sicken them. If they face this prospect without
flinching, they are considered for one of the hospitals specializing in
this technique; only about one man out of eight who applies is admitted.
This patient is taken, several times a day into the hospital barroom,
where various kinds of drinks are mixed in a setting that has the
familiar associations of his pet saloon. A spotlight plays upon the bar;
ice clinks pleasantly as the attendant, in a white coat, mixes his
favorite "poison." It is poison, too; for the patient has been given
injections of drugs which make him deathly ill at the exact moment when
he swallows the drink. Combined with psychotherapy, and repeated several
times in the first year, this method has had success with 65 per cent of
cases accepted. It is used at the two Shadel Sanitariums in Seattle and
Portland, and at the University of Wisconsin Medical School.
Three of these approaches are new-three of them lean heavily on the
sympathetic skill of the recovered alcoholic for their success. All of
them claim a record which is twenty to thirty times as high as that
claimed by any method twenty years ago. For in that brief period,
alcoholism has become recognized as a disease from which even the most
despaired-of cases can usually recover.
But the alcoholics and the doctors cannot do the whole job of helping our
750,000 cases alone; they need the force of public opinion behind them.
They need, in every city, a demand for the kinds of clinics which, at
Yale, have blazed the trail. They need public recognition of the fact
that alcoholism is not a reflection on the patient's character, but is a
misfortune for which society is partially to blame. When these facts are
widely known, many alcoholics-who have no idea they can be helped-will be
restored to lives of health and usefulness. Many families, whose present
fumbling efforts are actually driving their sons to drink, will change
their ways.
Ignorance among members of the alcoholic's family is very widespread,
indeed. Alcoholics anonymous found that they were spending most of their
time educating the relatives of prospects, instead of concentrating on
the problems of the alcoholic himself. Two years ago a group of them
devised a plan for public education on the subject. Marty Mann, an A.A.
secured the backing of the Yale University group and launched the
National Committee for Education on Alcoholism to teach the known facts
to the public. The essential teaching of the committee is three simple
facts, as all their literature states: "Alcoholism is a disease and the
alcoholic is a sick person. The alcoholic can be helped and is worth
helping. Alcoholism is a public-health problem and therefore a public
responsibility."
Since the committee was formed, information centers have been established
in four cities and permanent committees formed in nine. Clinics will
eventually be set up, it is hoped, in every large town in the country;
when that is done, the alcoholic will at last have a place where he can
go to find his problem discussed without moral indignation,
sentimentality or reproach.
Of the need for such a viewpoint, Dr. Selden Bacon recently wrote,
"Apathy, secret shame or attacks on scapegoats can be the response of the
public to a problem. During the past 200 years the public in this country
has reacted in these unrealistic ways when faced with the problems of
mental ills, political corruption, venereal diseases. People have reacted
the same ways to alcoholism. Stimulation of the public is essential to
bring about a new adjustment."
What good can education do? Well, if the public understands that
alcoholism is a disease, it will no longer urge the alcoholic to "Drink
like a gentleman"; or "Take two cocktails and stop, as I do"; or "Learn
your capacity": it will be common knowledge that alcoholics cannot do
these things and that moderation is impossible for them. When the public
has learned more of this disease, hostesses will not urge "Just a little
one" on guests who have refused a drink-they will understand that some
people cannot drink at all.
Families would give the alcoholic a better chance to recover early if
they realized that alcohol, to the patient, is the only thing which makes
his muddled, miserable life at all supportable. The threat that it may be
withdrawn appalls him and he will face the horrors of a "dry" future only
if he has convinced himself that this present life is even more
unendurable. Families who protect the alcoholic from painful experiences
may be doing him a great disservice; sometimes it is only the loss of a
job or the horror of a serious accident which jolts the alcoholic into a
state of mind in which he admits that the barren, frightening prospect of
a life without liquor may be better than going on as he is. At that
moment he has, as the alcoholics say, "hit bottom"; he is ready to begin.
When the public is better informed, employers, employers and parents will
not scold the alcoholic for behavior he cannot yet control; as one of the
committee pamphlets says, "The alcoholic knows well enough that he is not
fair to his family, that he is losing his friends and endangering his
future. He reproaches himself more bitterly than anyone else does." With
greater understanding of the subject, no friend will suggest, "Just stick
to wine and beer," or "Try drinking only over week ends." The committee
says, "If the alcoholic could, he would do all this. He has tried over
and over again and has failed. But with expert guidance he can learn to
deal with his problems in a normal way and without any alcohol at all."
No man or woman becomes an alcoholic through choice; all authorities
agree on that. No alcoholic deliberately and perversely chooses a life
that will bring misery on his family. No alcoholic sets out, on purpose,
to become a problem to society. His sufferings are real and grim and he
is very eager to escape from them, if society will give him the chance.
And if society doubts whether the alcoholic deserves much help or
sympathy, it is well to remember this: this is the first malady in
history which has been licked by its own victims, when science, without
their help, had failed. If Bill, the stumblebum, and Mary and Jake were
able to perform some thousands of miraculous changes in their own lives
and those of other sufferers, then they have perhaps earned the right to
ask society to adopt the only attitude which can ever help the alcoholic
back to sanity: to look on him as a very sick man who-now or later-will
reach the stage where guidance can help him to recover.
For the Drinker Who Needs Help
ALCOHOLICS ANONYMOUS. Confidential information for the alcoholic in need
of help. Will provide address of members in his community or, if
necessary, advise him by personal letters. P.O. Box 459, Grand Central
Annex, New York 17, N.Y.
NATIONAL COMMITTEE FOR EDUCATION ON ALCOHOLISM. Information for civic
minded men and women who wish to arrange for lectures, radio programs and
newspaper publicity campaigns in their communities. Advice on the
organization of local committees and literature on alcoholism. Room 447,
New York Academy of Medicine Bldg., 2 East 103rd St., New York 29, N.Y.
YALE SCHOOL OF ALCOHOL STUDIES. Information of a technical nature for
physicians, psychiatrists, sociologists, penologists, and others
interested, professionally, in alcoholic problems. 4 Hill House Ave., New
Haven, Conn.
RESEARCH COUNCIL ON PROBLEMS OF ALCOHOL. Information on different types
of treatment and lists of recommended literature. 60 East 42nd St., New
York 17, N.Y.
Source: Ladies' Home Journal, August 1946
Contact:
The Legacy Group of Alcoholics Anonymous © 2005