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Survey, A.pril 194S1

Hope for the Alcoholic

New attitudes, community programs, government action and scientific research promise a more effective attack on alcoholism, a maior public health problem.

By Kathryn Close

THE SCENE IS A MUNICIPAL brought forward by their relatives, and only then COURTROOM. The setting could be any of will community leaders take an active interest in thousands of localities throughout the United seeing that the proper facilities are available to States. The judge looks wearily down from his them. bench at a long line of bleary-eyed, disheveled, Happily some dramatic developments haggard men. Several of them are as familiar to within the past fifteen years indicate that the him as old friends. Time after time their faces negative attitudes which have long blacked out have appeared in the morning line-up hope for the alcoholic may gradually be downcast, hopeless, ashamed. eliminated. Happily, too, these developments Not a man among them Puts uP a augur well for a shift in interest from an defense. Each pleads guilty to a charge of emotional controversy over liquor control to a “drunk and disorderly.” With the exception of concern for the alcoholic as a suffering human one or two “new faces” let off with an being. admonition, each is led back to jail to serve a Down through the centuries people have sentence of ten, thirty, or perhaps ninety days. taken sides for or against drinking with a frenzy But they will be back in court soon. The judge equaled only by their reactions to politics or knows it; the prisoners know it. For when they religion. But the alcoholic was lost in the turmoil. are free they will drink again, become drunk and Those against drinking saw the tragedies of disorderly, be hauled into jail in a stupor, or alcoholism and wanted to abolish alcohol. lt was wildly belligerent, or just plain sick, and they will a though persons with a knowledge of the be thrown into a cell until they are sober enough discomforts of diabetes were to start a to appear in court for a new sentence. And the movement to abolish sugar. Those who believed circle will go round and round until they are in the freedom to drink fought hard for their dead. freedom and looked down on the man without For these men are victims of alcoholism, “self-control.” And in “wet” periods or “dry” one of the most vicious diseases known to periods the alcoholic drank and suffered. mankind. And neither they nor anyone with Shortly following repeal of the Prohibition whom they come in contact have any hope for Amendment, the air began to clear. A them. Coming from almost any walk of life, they recognition dawned that alcoholism or addictive have “hit bottom” as a result of a progressive drinking, is not synonymous with drinking or disease from which some 4,000,000 Americans even drunkenness; that only a fraction of those are currently suffering. who drink become alcoholics; but that this Alcoholism is one of those major fraction is large enough to represent one of the diseases that have been nourished by major public health problems in the United ignorance, misunderstanding and stigma – long States; and that something must be done about the protectors of venereal disease, cancer, and it. For the first time attention began to be tuberculosis. lf it is to be effectively attacked in diverted from alcohol to the alcoholic. Today the communities where alcoholics undergo their voluntary groups, states and municipalities rounds of binges, terror, and agonized throughout the country are working out awakening, the stigma and misunderstanding programs to help the alcoholic get out of his surrounding it must be lifted. Only then will the vicious circle of drunkenness, aching sobriety, “hidden alcoholics” – family skeletons in the and drunkenness, into satisfactory, useful living. closet – come fonryard and ask for help or be

WHILE fHE MAJORITY of our the same year. That year, a red letter one for 4,000,000 alcoholics still swim in a sea of alcoholics, was 1935. hopelessness, more and more ropes are being One seed was planted in Akron, Ohio by thrown them by groups with a conscientious two habitual drunks. One was a doctor, the other awareness of their responsibility to help. Among a broker, both of some distinction before alcohol these are self-help groups of former alcoholics; addiction began to ruin their careers and community committees which are setting up threaten to break up their homes. lntelligent information centers, clinics and hospital facilities men, they fought hard, but without much for alcoholics; research scientists doubling their success, until they managed to get together in a efforts to learn more about this disease; and sober interval. Then they decided that one drunk enlightened government agencies which are might help another. Out of this idea grew the beginning to recognize its public health aspects. now famous Alcoholics Anonymous. ln a year’s The question of whether or not time these two former inebriates had not only alcoholism is a disease is till in dispute among achieved continuous sobriety for themselves, some of the groups doing most to combat it, but but had helped others to the same goal. Today the dispute boils down to one of semantics, for the organization they started has some 85,000 a all are agreed on single concept: that members in 2,400 chapters throughout the alcoholism – chronic excessive drinking, country. characterized by distinctive behavior patterns – The entire membership is composed of is not caused by alcohol alone, but by more or alcoholics fighting desperately to help each less mysterious psychological disturbances other stay away from the substance that is incompatible with the presence of alcohol. The poison to them. Many of the members have not end result is an intolerance toward alcohol as touched a drop since they became A.A.’ s permanent and incurable as the diabetic’s Others have slipped from time to time, but have intolerance toward sugar. Just as the diabetic returned to the organization to keep up the fight. must abjure sweets, the alcohol must abstain Some former members have sunk back into the from alcohol. One drink will lead him to a mire of perpetual drunkenness. But Alcoholics disaster. Anonymous, which maintains that 75 percent of The basic cause is unknown. There may its members have achieved sobriety, is generally be one or many, and scientists are searching conceded to present the most widely successful vigorously for clues. Their researches have attempt at alcoholic rehabilitation in this brought forth the fact that there are many types country’s history. Statistics on “success” are of alcoholics, variously amenable to treatment. unreliable, for a man who is sober today may be The most reliable statistics indicate that of drunk tomorrow – even though his sobriety has 65,000,000 drinkers in the United States, lasted over a number of years. Nevertheless, 4,000,000 are chronic excessive drinkers doctors, scientists, social workers, clergymen, borderline or actual alcoholics. These have been public health experts, suffering relatives, and broken down into problem drinkers, compulsive others who have had to deal with alcoholics, drinkers of primary and secondary types, social have watched the A.A.’s achievements with misfits and psychotic drinkers. Of these amazement. 4,000,000 inebriates, 750,000 are chronic The other seed was planted in New alcoholics or persons whose drinking has Haven, Connecticut, by two scientists, Dr. resulted in diagnosable physical or psychol- Howard Haggard and Dr. Leon A. Greenberg. ogical deterioration. Director and associate respectively, of the Yale University Laboratory of Applied Physiology, THE MOVEMENT TO EXTEND they were carrying on research in the effects of PRACTICAL help to alcoholics sprouts from alcohol on the human body. This led them into several seeds, all planted at about the same an awareness of alcoholism as a phenomenon time. The two with the most dramatic growth distinct from normal drinking or occasional were sown independently in different places in drunkenness. As they continued their studies they realized that alcoholism could not be

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studied in a test tube, that too many factors the Southwest. Each has a reach far beyond the involving disciplines other than physiology were academic setting where the Plan originated. concerned. Accordingly they raised the money The Research Division conducts studies to enlarge their staff to include sociologists, on the effects of alcohol on humans – moderate psychiatrists, psychologists, economists, and drinkers as well as inebriates. Currently it is medical men. Today the laboratory’s section on attempting to find the physiological disturbances alcohol is larger than all the rest of its sections that scientists feel must accompany the combined and heads up the program of psychological factors in alcoholism – a theory research, education, and treatment that has based on the observation that though the come to be known the country over as the Yale alcoholic can be converted to a total abstainer, Plan on Alcoholism. he can never hope to be a moderate drinker no From these two seeds have emerged matter how well adjusted he becomes through the present sturdy sprouts of public and psychiatric treatment or other means. Such community concern. The A.A. experience has knowledge, if attained, might not only bring created a growing awareness of the fact that about a revolution in treatment methods, but alcoholics are not “weak-willed” or “immoral,” but also a hope of prevention by making it possible people who need and can respond to the proper to spot a potential alcoholic before he has ever kind of help. ln a twelve-point program chiefly taken a drink. emphasizing insight, fellowship, work for others, The Publications Division brings together and spiritual faith, A.A. has wrought miracles the findings of scientific research on alcoholism that no amount of pleading, threats, shame, and of medical psychiatric, social, and legal cajolery or punishment has ever been able to experience with alcoholics. Chief among its effect. Simultaneously, the Yale Plan has publication is Ihe Quarterly Journal of Studies in brought to light scientific facts about a problem Alcohol, the bible of the field. formerly regarded only with emotion, ln the realization that knowledge in an indifference, or disgust. Largely because the ivory tower can be of little help to the sinking scientists at Yale have insisted upon putting alcoholic, his harried wife, or terrified children, their knowledge to use, communities and the instigators of the Yale Plan determined to government agencies throughout the country are spread what they learned as quickly as possible beginning to stir from their lethargic indifference to persons who could put the facts to most to do something realistic about their alcoholics. effective use. Accordingly in 1943 they Already thirteen states have initiated inaugurated the Yale Summer School of Alcohol programs concerned with alcoholism, while in Studies, a four week course for persons fifty cities throughout the country voluntary professionally concerned with alcoholics or committees are surveying the local problem and education on alcoholism – doctors, ministers, taking action to meet it. ln addition, a number of social workers, police chiefs, judges, teachers. municipalities, notably, New York, Washington, The curriculum, which covers almost everything, D.C., and Oakland, California, are beginning to that is known about alcohol and alcoholism, recognize the fact that the jails are no answer to focuses on alcoholism as a disease and the a public health problem and are experimenting alcoholic as a sick person who should be treated with more effective types of treatment programs’ with kindness, sympathy, and firmness and without resentment or moral judgment. The role IN ITS FOURTEEN YEARS OF of education in prevention is equally stressed, existence the Yale Plan has gradually enlarged with the emphasis on supplanting “folklore” with its original test tube focus to embrace six main true facts – for example the common belief that divisions: Research; Publications; the Yale alcohol is a stimulant with the fact that alcohol is Summer School on Alcoholic Studies; the Yale a depressant, or the not unpopular assumption Plan Clinic; the National Committee for that drinking inevitably leads to alcoholism, with Education on Alcoholism; and the recently a clear definition between the moderate drinker inaugurated Yale lnstitute of Alcoholic Studies in and the addict.

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Some 200 persons have registered at Diagnosis was from the first a major the summer school each year since its opening. concern of the Yale Plan Clinic, but experience ln addition, so many others have indicated soon demonstrated that if diagnosis was to have interest in the course that this year a similar any meaning it would have to followed by summer school will be held at Trinity University, therapy and guidance in cases needing San Antonio, Texas, under the auspices of a treatment not provided by other community newly organized Yale lnstitute of Alcoholic services. Since its opening the clinic has Studies in the Southwest jointly sponsored by received 1,100 alcoholics, 60 per cent of whom Yale and Texas Christian University. The new have achieved either complete sobriety or project includes plans for research, a summer markedly lengthened spacing between their school and clinical facilities similar to the parent drinking bouts. Referrals between the clinic and program at New Haven. lt is under the direction Alcoholics Anonymous are a commonplace, the of Dr. E.M. Jellinek, biometrician with the Yale clinic getting patients from A.A. and in turn PIan since the first expansion from its recommending A.A. to persons who seem able physiological beginning. to benefit from the fellowship program. Many persons are clinic patients and active A.A. SCIENTIFIC FINDINGS ARE OF little members at the same time. use to the sick unless translated into treatment. The Yale Plan Clinic was developed as a The Yale Plan Clinic, with a staff of two model for other communities as well as for psychiatrists, a physician, a psychologist, and experimental purposes. But neither Yale nor two psychiatric caseworkers, opened in 1944 as Alcoholics Anonymous pretended to be able to a demonstration of an integrated approach to tackle the whole cast problem of alcoholism the rehabilitation of alcoholics. Far from an alone. No real dent is ever made in a public attempt to compete with New Haven’s flourishing health problem until widespread understanding A.A. chapter, the clinic is an effective of its true nature develops. complement to the group. For four years the National Committee ln spite of the relative success of for education on Alcoholism, an affiliate of the Alcoholics Anonymous a group fellowship Yale Plan, has been trying to break down program does not answer the needs of all community ignorance and indifference, through alcoholics – nor even of all who want to be field trips, consultation services, the provision of cured. ln many persons alcoholism is merely a literature, and the promotion of institutes. The symptom of some deep disturbance of either a fifty communities which have setup local psychological or physical nature. Thus a brain committees for education on alcoholism provide tumor may have its first manifestations in a measure of its success. excessive drinking; a psychotic of the manic These committees are usually composed depressive type may go on bouts in his of persons of some influence in the community depressed periods; a person with deep neurotic because of their social or professional standing, conflicts may find in alcohol his only release; or as well as of persons whose work brings them in an “uncomplicated alcoholic” may cringe from close contact with alcoholics or their families the testimonial or religious facets of the A.A. social workers, doctors, clergymen, judges, program. teachers, and members of Alcoholics All these persons need diagnosis and Anonymous. As a rule, they begin shooting at individualized treatment. Only an operation will three main goals: general public education on help the man with the brain tumor. The psychotic the problem and nature of alcoholism; the will need care in a mental hospital; the neurotic, establishment of an information center where deep psychotherapy; while the uncomplicated alcoholics, their relatives, and other interested alcoholic may need less intensive psychiatric persons can find out more about the disease help in gaining insight into the nature of his and where to go for effective treatment; affliction, along with some counseling and promotion or establishment of specialized guidance in regard to employment, domestic clinics, hospital beds, and convalescent homes troubles, or social interests. for alcoholics.

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The local committees are in various than not refuse to have anything to do with the stages of development. Though the oldest was alcoholic patient except in extreme created in Boston early in 1945, many of them emergencies. only came into being in recent months, and are Because the lack of hospital facilities has still in the organizational stage. Nineteen, long handicapped their work, many A.A. groups however, are far enough along to be operating have exerted special efforts to persuade general information centers as well as community hospitals to provide beds for such patients, but education programs; and a few are offering without much success. A notable exception is in direct rehabilitation services. New York City where the Knickerbocker Hospital One of the more highly developed is the has given over an entire wing to alcoholics and Western Pennsylvania Committee for education put admission into the hands of the A.A.’s. Every on Alcoholism, in Pittsburgh. Organized in 1945, person admitted to Knickerbocker’s wing for this committee carries on a continuous alcoholics is assigned an A.A. sponsor, who educational program through a speaker’s visits the patient every day during his five-day bureau, institutes, and the dissemination of stay and is the only visitor allowed. Doctors, literature, emphasizing the three points stressed nurses, and the A.A. visitors urge the patient to by the national committee; alcoholism is a a realization that hospital treatment is only the disease; the alcoholic can be helped; alcoholism beginning of rehabilitation and must be followed is a public health problem. ln addition, the through by the patient’s own efforts if real committee operated an information center and recovery is to be achieved. diagnostic clinic, staffed by a psychiatrically Generally frustrated in their attempts to oriented physician and the executive secretary, secure hospital beds, A.A. chapters are who is a trained social worker. The center welcoming such efforts on the part of local cooperates closely not only with the A.A.’s, but committees for education on alcoholism, in the with other community agencies serving hopes that these representative community alcoholics, particularly Morals Court. The groups may be able to achieve through prestige committee has fortunately been spared a what the A.A. ‘s with no pressure group value, problem which looms heavily in other areas, the have found extremely difficult. A number of local securing of hospital facilities for alcoholics, for committees already have experienced some Pittsburgh is one of the few communities where success in this direction. Only one, however, the hospital beds are available to alcoholic patients. Youngstown (Ohio) Committee for Education on How to get a person suffering from acute Alcoholism, has managed to secure an entire alcoholism into hospitals is an urgent problem in hospital for alcoholics, which it owns and most communities. Acute alcoholism is often an operates itself. As in the case of the A.A. extremely dangerous state which can be fatal if association with New York’s Knickerbocker emergency medical treatment is not provided. Hospital, this system makes it possible to screen The number of alcoholics found dead in their patients carefully at the point of admission so cells after being callously tossed into jail to that the beds are made available to those most “sleep it off’ probably never will be tabulated, but in need of them. lt also makes it possible to offer anyone who has been around jails knows that rehabilitative service at the time of this occurrence is not uncommon. Good hospital convalescence when the patient is more apt to care in the sobering up period may also be be in a receptive mood. crucial to rehabilitative efforts, since the mental and physical pain of the hangover is what ALCOHOLISM IS CALLED THE frequently drives the alcoholic back to drink. FOURTH public health problem in the United Few communities, however, have States. As such it warrants attention from the sufficient, if any, hospital beds available for public authorities as well as from voluntary alcoholics, a situation mainly due to the general groups. Recent actions of thirteen state hospital’s disinterest in the alcoholic as a patient’ Iegislatures in authorizing programs on While some municipally owned hospitals operate alcoholism indicate that such attention may at alcoholic wards, general hospitals more often last be forthcoming.

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Most of the state programs are headed ineffectualjail terms, welcome the opportunity to by legislatively created commissions with break the vicious cycle. Usually, however, they varying degrees of responsibility. Some refer only those alcoholics who would seem commissions are charged only with providing amenable to treatment – newcomers to their educational programs. Others, responsible also courts or persons in whom the repeating pattern for surveying the problem and establishing has not been long established. The 69-year-old facilities to meet needs, are hamstrung by woman who had 124 jail sentences in New inadequate appropriations. However, a few have Jersey would probably not be considered a good drawn up comprehensive plans for education, treatment prospect. rehabilitation, and prevention. ln Oakland, California, a court-devised Among the most ambitious state plan for breaking the circle of spree-jail-spree programs is that of the Connecticut Commission leans heavily on the authority of the court. lts on Alcoholism, set up by the state legislature in instigators were two probation officers – one a 1945. With an income of about $200,000 a year, “graduate” of the Yale Summer School of representing 9 percent of the state’s revenues Alcoholic Studies – who persuaded the county from liquor licenses, the commission plans to judge to let them take a try at rehabilitating operate a network of out-patient clinics modeled police court alcoholics. Accordingly, the judge, on the Yale Plan Clinic, as well as hospitals and who used to sentence the day’s line-up of 60 to possibly convalescent hones for alcoholics. 100 drunks en masse, views each inebriate as Already three of the clinics are in operation, and an individual person and fits the “punishment” plans for opening a fifty-bed hospital in Hartford not to the crime, but to the man’s or woman’s are nearly completed. The commission benefits potentialities for rehabilitation. Those he regards considerably from consultation with the Yale as capable of straightening out without benefit of Plan staff and has its chairman, Selden D, institutional care he puts on probation, leaving to Bacon, staff sociologist at the Yale Laboratory of the probation officer the job of painstaking Applied Physiology. A joint undertaking with the guidance or referral to other services. Others Yale Plan Clinic involves special services and who obviously need the protection of an research among women alcoholics at the State institutional setting he sends to the county farm. Reformatory for Women. The question of the comPulsorY Oregon is unique in having developed a treatment of alcoholics is still under debate, but rehabilitation program under the auspices of an opinion seems to be growing that the protection advisory committee to the State Liquor Control of society as well as of the victims of also holism Commission. Here, too, the funds come from demands a move in this direction. ln New York liquor licenses, and bring $115,000 biennially to State a bill drawn up by the State Bar the state’s outpatient alcoholic clinic located in Association, and already introduced in the Portland. Plans for expanding the clinic’s legislature, would authorize a proposed Bureau services to other areas in the state are currently for Alcoholics to establish state farms for under consideration. alcoholics to which persons needing long term Washington, D.C., has two clinics institutional treatment could be committed by the operating under the Bureau of Mental Hygiene courts, either after arrest or at their own relatives of the District’s Health Department, and a third in request. The bill would not only provide needed the offing. The latter, authorized by a special act treatment facilities, far superior to jails, but of congress in 1947, and to be financed by liquor would make commitment long enough for license revenues, will cooperate closely with the rehabilitation to get a good start. District Courts. Under the proposed plan the courts will send men and women to the clinic on ONE OF THE MOST VIGOROUS probation. opponents of compulsory treatment is a man Most clinics for alcoholics have a who through his own experience has devised a voluntary arrangement with the courts in their unique method of rehabilitation which he tried communities. Apparently the judges, weary of out on others with considerable success. sentencing endless lines of familiar drunks to Edward J. McGoldrick, Jr., director of New York

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City’s Bureau of Alcoholic Therapy, established success, using Mr. McGoldrick’s measurement within the Department of Welfare in 1943, is an of one year of complete sobriety, is 66 percent individualist among alcoholic therapists for he a good record but one not affecting some also holds out against the theory that alcoholism 200,000 alcoholics in New York City who do not is a disease. The method which he uses at reach Bridge House, nor any of the city’s Bridge House, the bureau’s convalescent home alcoholic women. lt is, however, a project being for selected male alcoholics, is based on watched throughout the country. theories of will and thought control. Agreeing lndustry as well as the public has a real with the scientists that alcoholism has a stake in combating alcoholism, for alcoholic “psychic” basis, Mr. McGoldrick has developed a workers cause a tremendous waste. lt has been system of personal interviews and group estimated that the 1,370,000 alcoholic males lectures intended to convert the alcoholic from a employed in heavy industry lose an average of sense of defeat to a sense of power over 22 days each year from the acute effects of himself. alcohol. Moreover, the alcoholic has an accident All therapists at Bridge House are former rate twice as high as the non-alcoholic. On the alcoholics who have been rehabilitated through basis of such statistics, the Yale Plan Clinic is the McGoldrick method. Though the method offering industrial plants a service to help take differs from procedures of Alcoholics up the fight against this menace. This involves a Anonymous, the director goes along with them survey of the extent of the plant’s problem, help in the theory that persons who have “hit bottom” in developing constructive personnel policies as alcoholics themselves can more easily help affecting the alcoholic, the introduction of an other alcoholics. educational program and an information service Mr. McGoldrick objects to calling for workers, and help in establishing alcoholism a disease on the grounds that it adds rehabilitation facilities. to the alcoholic’s sense of weakness and All the efforts so far initiated to help the helplessness, thus giving him an excuse to go alcoholic seem infinitesimal when viewed on drinking. He opposes compulsory treatment against the size of the problem. But it is as useless, for it ignores the ingredient of encouraging to remember that fifteen years ago positive willingness which he feels is necessary practically nothing at all effective was being to reform. done in this direction. The developments which Bridge House, with onlY twentY beds, have come in that short time mark an auspicious serves about 350 alcoholics a year, both on a awakening to a long neglected responsibility. resident and a non-resident basis. lts record of

Source: SURYEY, April 1949.

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