The Facts About Alcoholism exclusive interview with Dr. Selden D. Bacon, Foremost Authority on Alcoholism

How extensive? What cures? What teachings to youth? How shall employers deal with problem?

The center of Alcohol Studies at Yale are engaged in teaching or in industrial University has just completed several surveys personnel work. on the problem of alcoholism–as it affects More than 1,600 have graduated from industry, education, highway safety, government the school and a large proportion is making use as well as family life: of this training in State and local, voluntary and What makes an alcoholic? Is it drinking governmental agencies dealing with problems of to excess or is it something else? What are the alcohol and alcoholism. At least 75 have symptoms–and how can anyone tell whether he become executive directors of such groups. or she is in danger of becoming an alcoholic? With the co-operation of the Connecticut What are the States and cities doing about the Prison Association, an outpatient clinic just for problem, especially as it affects traffic accidents? alcoholics was begun in 1944, and a year later How is industry, troubled sometimes by heavy the first State Commission on Alcoholism was absenteeism, handling the alcoholic? established by Connecticut and Dr. Bacon has To get the answers to these and other been its chairman ever since. In 1940 the related questions, the editors of U.S. News & Quarterly Journal of Studies on Alcohol was World Report interviewed in their conference started. The Center also published a series of room for two hours Dr. Selden D. Bacon, 15-page pamphlets that have been in unusual Director of the Center of Alcohol Studies, Yale demand for such technical material. University. The Yale Center now has six major As far back as 1930, interest in the study divisions and is primarily interested in popular of alcohol began at Yale in the Laboratory of education on the subject of alcohol and research Applied Physiology with the issuance of in certain areas of social and health problems, scientific papers and the collection of information such as drunken driving, the problem drinker in amassed in previous years. Biochemists, industry and related subjects. researchers in sociology, economists and psychologists began to make surveys and to The interview with Dr. Bacon follows: seek scientific answers to the many questions people were asking about the use and effects of Q: Is yours the only center of scientific alcohol. studies on alcohol in this country, Dr. Bacon? In 1943 the pressure of public interest A: It is the only one. We think it would be led to the establishment of a summer school of a healthier thing if there were two in the country. studies at Yale which has been operating ever We had hoped that one would start down in since. It is usually attended by representatives of Texas. Dr. Jellineck left us to go there and start the distilling and brewing industries, five or six such a center, but it finally broke up. He has professional temperance people, a dozen since become the head of the World Health physicians, and about the same number of Organization Committee on Alcoholism. nurses, 25 to 30 ministers, 30 to 40 social Q: What is the alcohol problem? workers and probation officers, 30 to 40 who A: There are several types of problems. are engaged in education, a few judges, and a There are scientific problems, there are group few members of “Alcoholics Anonymous” who problems, and there are individual problems. But

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it is pretty impossible to separate them. Take, for ounce in two or three hours. For 100-proof example, the particular problem of alcoholism: If whisky, which is 50 per cent alcohol, that means anybody wants to say it is a mental problem, I’d that 8 ounces of whisky would be all gone from day they are absolutely correct; if anybody the system in less than 12 hours, most of it wants to say it’s a legal problem, they are breathed away, some lost through sweat or absolutely correct–or an economic problem or a urine. This proportion would vary with an medical problem or a social problem. individual’s weight and also with the amount of food he had in ‘his stomach. Then the alcohol is Q: Most people are not alcoholic, are gone. Even in the most pronounced binges, you they? lose it all in 48 hours. Chemical tests show that. A: We would say that there are approximately 60 to 70 million drinkers out of a Q: What does it do to the body? Why population of 110 million people of 15 years of cirrhosis of the liver and so on? age and over. We would suggest that there are A: The actual answer to cirrhosis is not just short of 4 million out of that 60 to 70 million known, but I think the most prevalent theory is who are patently losing, or have lost, their this: The liver under certain circumstances will control, and their lives are beginning to show, or tend to develop what is called “fatty tissue.” In have already shown, damage in one or more other words, you get fat mounting up there, aspects. which cuts down the function of the liver. Now there is an agent–probably this is over Q: Then the difference between the simplified–that counteracts this tendency, so heavy drinker and the alcoholic is that the that the fatty tissue doesn’t last and finally take alcoholic has lost control? over the whole organ. A: Yes, but there is no real line between Some of us have stronger counteragents them, no clear-cut example. and some of us have weaker counteragents. Those who have weaker counteragents are very Q: But only 1 person out of 16 who likely to develop cirrhosis of the liver–and they drinks is an alcoholic, is that right? may never have had a drop of alcohol in their A: Yes. lives! Or they could be persons who take a drink once or twice a year, at wedding ceremonies or Q: Is that proportion rising? something, and they get cirrhosis. A: The best-known estimate is that Some have very strong counteragents developed by Dr. Jellineck which shows that and they can drink the alleged fantastic amounts between 1940 and 1948 there seemed to be a that they say they do–a quart and a half every rather regular increase, and that in ‘49 and ’50 it day of their lives, and so on. reached, so to speak, a plateau, and may show Anyway, when you take a person who some indication of going down. However, may be just below average in his counteragent remember this, that it takes from 6 or 7 to 20 effect, alcohol does–this is one theory–so years for alcoholism to develop, so if you are reduce the effect of this weaker counterpart that trying to think of a rise between 1940 and 1947 this fatty tissue begins to form a little more and a don’t think of what happened between 1940 and little more, especially in the case of people who 1947 alone, although what happened then might drink a great deal and continuously. have speeded it up. It may take 10 years before it begins to show up. Then you begin to get hobnail liver and Q: It could go back to the depression the like so that just by palpation (touching the years? body from the outside) you can feel these hard A: Yes. spots where this fatty tissue has developed. Q: Does your research show that alcohol Q: What do you mean by “a great deal”? is injurious to the human body? A: You have to consider the person’s A: Alcohol oxidizes when it gets into the weight and so on, but let’s say he is drinking human system. It oxidizes at the rate of an pretty regularly a pint of whisky every day. It will

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vary with the liver, of course. Even with the weakest liver in the world, you are not going to Q: Doesn’t it cause an immediate get cirrhosis automatically. palpitation of the heart? Doesn’t a drink cause the heart to beat faster? Q: What about the heart? A: I can’t answer that question. By the A: I am no expert on that, but I will leave way, you can see almost any bad reaction you some suggestions on it. Your question is out of want to see after the injection of alcohol my field and this answer certainly should not be following certain situations, but whether that is regarded as authoritative from a medical caused by alcohol or not— viewpoint. But there is an action on the arteries from alcohol which will make it easier for blood Where Textbooks Mislead to flow. So that if you begin to get a condition similar to, let’s say, arteriosclerosis a certain Q: Physiology books in school used to amount of alcohol–and I don’t recommend warn against the use of alcohol, and one of the alcohol as the best way of doing this–may grant ways they did it was to tell you that it caused one a certain amount of relief from the immediate stimulus and as soon as the stimulus hardening-artery situation, and there will be a had worn off you would have a certain fatigue little less effort on the part of the heart to pump and a certain reaction. Therefore, alcohol, in and keep the blood going. stimulating the heart, was harmful. That was in the textbooks in the old days. Is the modern Diseases of Alcoholism theory any different? A: We made a survey in 1940 of all the Q: Is that why patients with a heart textbooks being used. I think what was done condition are given alcohol? was to pick out 10 common fallacies–such as A: I don’t think so. I don’t think many alcohol is a stimulant, alcohol causes certain physicians know much about alcohol as such, diseases, alcohol does something to the brain anyway. Why should they? They don’t get any tissue, drinking causes shortening of life, and so training on it. It isn’t mentioned in medical forth–all beliefs that have been disproved by schools, except for the alcoholic diseases which objective and empiric evidence that could be are found in probably less than 25 per cent of repeated in any laboratory–and checked the the alcoholics in some countries and I think a tests against these fallacies. smaller proportion in this country. Delirium tremens, alcoholic hallucinosis, Q: This was a survey you conducted on chronic avitaminosis, chronic gastritis, other those fallacies? things–and these are recognizable conditions, A: Well, first, we know the fallacies. We illnesses that would be discovered and labeled had worked on them in our own laboratory. Then by any competent physician–which follow upon we went out and, as far as we could, -studied years of excessive drinking–are called the every text that was used in a school system, diseases of alcoholism. If you find delirium whether parochial or State, all the manuals put tremens in 18, 19 or 20-year-olds, I think you out by the State bureaus on alcoholic education, have good grounds for suspecting a psychotic all the temperance stuff and checked to see how condition set off or merely aggravated by widespread these fallacies were. And about 98 alcohol. per cent of the books had these fallacies.

Q: From the ordinary use of alcohol, Q: What does alcohol supply? What is it what would you say is the effect on the heart? Is that people seek? it helpful or harmful? A: There is one very good answer: A: I wouldn’t say that it was particularly Alcohol–and I don’t care in what form you get it one or the other until you get into conditions as long as it’s ethyl alcohol–is what is called a relating to certain ages, as, say, 50 beyond, in “sedative.” I am merely repeating their which it may serve a useful function. statements of the pharmacologists, the

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physiologists and the biochemists. Under the the point. If you were tested on this learning you sedatives they would subclassify it as a might get a score of 95. After one or two small “depressant.” This means that it tends to drinks, however, you would only score perhaps produce sleep finally. But it does so in a very 85. If geography or the study of flowers had special way–namely, that you can take just a always been painful or difficult for you, your little bit and it will have a slight depressant sober score might be 88, but after one or two action. No matter how little you take, it will hit small drinks it might drop to 65. certain central nervous functions. But for human beings, this sort of Incidentally, the outward behavior of the learning is not too important. person may seem just the opposite of being Learning that is important for us in the “depressed”; what happens is that certain sense that it affects our daily lives and carries controls are reduced; it is more like releasing a heavy emotional impact would concern such brake; it is not a stimulant, not stepping on an things as, perhaps, one’s perception of one’s accelerator. self. “Am I a pretty reasonable sort of guy? Do Then you drink a little more and it hits the most people think I’m a stinker? Am I weak? Am central nervous structure more; a little more, it I stupid? Am I sexually rather impotent, so that hits still more; and finally you will go to sleep. If no woman would ever be interested in me?” –or, somebody should then inject more while your if a woman–“Would any man ever look at me,” are asleep finally the heart would “forget,” if you and “I can never be a mother.” This sort of like, and you would drop dead. You already will learning is very painful. It may take over 15 to 20 have been dropped, however, before that takes years to learn, and it is horrible to live with. Or place. there is the matter of not being able to assert It’s lucky, shall we say, that it is very one’s self, to stand up in competition with others. difficult to drink yourself to death. You could do We know of people who are frightened in these it, but it takes quite a few minutes for the alcohol ways. They may have the capacity, the ability, to get into operation. Drinking at any ordinary and so forth, to live adequately and happily–but speed would result in one’s passing out before a they can’t exercise it. fatal amount was consumed. But if you drank a quart or a quart and a half just as fast as you Q: So they take to alcohol to forget all could, possibly injecting it into your system, you this? might kill yourself. A: Well, this is what happens–this is the sort of learning that is first realized: Here’s a Q: Alcohol is a poison? fellow who is very shy in a group. He has a A: On the basis that any substance you couple of drinks and loses some of that very take can kill you, yes. But this is also true of painful learning (shyness or exhibitionism are mashed potatoes. learned modes of behavior) temporarily, so that now he can talk a little more freely. He suddenly Why People Drink forgets that he is incompetent or frightened.

Q: Well, why do people drink? If it is a Q: His inhibitions are gone? sedative, why would people go through all this A: They are not gone–they are just to go to sleep? temporarily reduced. A: In the early stages, alcohol has this reaction: You relax, you operate more slowly, or Q: Would you consider, then, to that you operate with less efficiency and exactitude extent that alcohol can serve a useful purpose? and discrimination. This takes place first in those A: Well, you selected the word “useful.” I areas in which “learning” is recent or difficult or didn’t. Let’s take an example: This man on my painful. Now as to this learning, if we had an left may be my boss. I think he is an awful experiment here and sat here and went around stuffed shirt and I want to punch his face in and learning the names of the States or 15 varieties tell him he’s an old jackass. However, I have of flowers, that might be interesting and prove learned to control such impulses. But now I have

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a few drinks and say, “You’re an old jackass.” Q: What is your answer to the question Well, that probably didn’t turn out very useful. as to what makes an alcoholic? Most people don’t know what the word means. Most people Q: But couldn’t it be the opposite? don’t understand why, since they can take a Couldn’t it relax the fellow who is too shy to drink every day in their homes and never get stand up and address a group and help him to drunk, all of a sudden somebody comes along forget about his shyness? and takes one drink and he’s under the table. A: Well, here is a classic example: There Why is that? was the man in Germany in 1888 or so who A: I can’t accept the example of one moved to a new town. He was quite a shot, and drink and under the table. An alcoholic might they have a rifle club there and they go out to pass out after taking one drink while you see Herr von What’s-his-name and ask him if he watched him. He would have had 20 drinks can shoot. He says, “Sure,” and goes boom, previously without your knowledge. Sometimes boom, boom, and gets 20 bull’s eyes out of 20 people who are utterly inexperienced will act, shots. So they ask him if he would like to join the following a drink, in ways they think to be “tight” team when they go over and play Von or “high.” Adolescents experimenting with Sedlitzville. All right. So they make him anchor alcohol may show behavioral responses utterly man down there, but old Boom-boom-boom gets inexplicable from the action of the small 12 on the bull’s eye, 6 on the outside, and so amounts they have consumed. However, it’s forth. “Oh, well. He was upset, he was new.” So hard to believe that even they would fall under a they try him again, and again he’s a failure. But table with one drink. in the interim he is out on the range practicing and hitting 20 out of 20. One day somebody by Q: What about the difference between mistake or something happened upon this: “Just the person who takes a drink every day and is before the meet we will give him a couple of not an alcoholic and the person who drinks a drinks.” He goes up and, instead of hitting only little now and then and is an alcoholic? 12 out of 20, he gets 17. A: We would say that there are probably two important criteria to distinguish the alcoholic How Score Can Rise, But Ability Fall from what might be termed the “heavy drinker.” One of them is this: the lack of control exhibited Now what has happened is this: The by the individual over, first, when or if he will alcohol has reduced his acuity, his reaction time, drink. That is, “Will I drink this afternoon, or not?” his discrimination, so that he could not get 20 Of course, he is going to drink sometime. out of 20, but it has also reduced his inhibition, Second is the loss of control over the extent to his fear, or whatever it was that was bothering which he will drink. That is, sometimes he has him in competitive situations, so that he doesn’t decided he will sit down for two and suddenly drop way down to 12. Alcohol actually seems to finds he is having his sixth drink. And when I improve his ability, but it has also actually say, “decided,” I mean that this can even be brought his abilities down. Is it useful? announced. It is not only internal, which can be The problem here is not the answer. It is discovered by an objectively trained observer, the question. Americans always want black-and- but he may even say, “I’ve got this meeting white, or yes-and-no, answers to questions coming up,” or “My kid’s having a birthday party concerning good and bad, or true and false. and I’m not going to take a drink.” Then to his Most questions, unfortunately, cannot own amazement, shock and horror, he finds realistically be answered in such simplicity. himself having drinks. Alcohol is not either useful or nonuseful. It is The other is that he plans to have three clearly both, depending on the person, situation, drinks but–not every time, but with increasing amount and many other variables. frequency–he takes 30 or 40 and is drinking to oblivion. He’s out of control. That is one aspect. What Makes An Alcoholic The other we would say–and this must happen eventually–is that this excessive

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drinking, through drunken behavior, begins to manifestations don’t strike you or the man on the create problems of itself–remorse, anger toward street or the cop on the corner, except in rare others, guilt, feelings of inferiority, helplessness, instances. and so forth, within the individual, and manifest But he gets drunk 30, 40, 50 times a signs appear of trouble in his relations with his year, and the “drunkenness” behavior is social environment, that is with friends, family, noticeable. This, if you like, is a facade, the on the job and the like. appearance of the condition. He may well be This man is having his “status quo” as an called a “damned drunk” or “inebriate,” or individual regularly damaged because of this whatever the term happens to be. He is haled drinking. Now, it is those two things—chronic into court, the social worker will see him, the and increasing damage directly related to minister will see him, his wife will scream, his drinking, and the lack of control over drinking– boss will fire him, and so forth, and he will be which mark the alcoholic from the “heavy called an alcoholic. And maybe he is developing drinker.” alcoholism, but his major problem is something else. We find this with certain types of Q: Do you think that a person who is a psychotics. chronic drinker inevitably becomes an alcoholic? A: No, that isn’t so. There are millions of Q: Are there quite a few of that type? regular drinkers who aren’t and won’t become A: I would say that, although our figures alcoholics. are not too good, there are quite a few. I would say that a number of epileptics can be found Q: Well, then, what is it that encourages here, because alcohol apparently reduces the the chronic drinker into the alcoholic stage? strength of the trigger mechanism that sets off A: But the alcoholic doesn’t have to be a the epileptic seizure. chronic drinker. Of course, if I could give you the People who have brief epileptic seizures answer just like ABC, we wouldn’t have to be like that–3-second attacks, so that all you notice here, because it would be something we would is that sometimes the person doesn’t seem to be know how to fix. We have some ideas about it, paying attention to you–may gain some relief however. from using alcohol. The man may not Let’s say that we have a number of understand it, but he drinks and he feels better. people who meet these two criteria–they are out And he had better look out. Because the day of control, which has gone on over some period one starts using alcohol as a medicine for a of time, and some socially or emotionally chronic condition, he is using a sedative forsignificant aspect of their lives has been privately defined purposes. damaged thereby. I think we will find that there are quite a few different types. Q: Then aren’t you finding that mentalhygiene problems are closely related to Major Problem for Some is Psychotic alcoholism? A: Very. One type I would call “adjunctive” alcoholism. That is not a technical term; I just Q: So that some people who have use it. Here is a man who from the point of view mental or emotional aberrations of one kind or of the depth of his condition, the difficulty of another become alcoholics? treating it, and its impact on his whole life is A: Yes, they might try to find relief in this more importantly affected by something other way. However, I would say that the larger than his drinking problem. He is what the number of people who are neurotic–and I mean psychiatrists call psychotic or protopsychotic, if here psychiatrically determined neurosis-there is such a term. And he has found, or thinks although they have the opportunity to drink, do he has found, that getting drunk relieves the not become alcoholic. While excessive drinking horrible feelings of psychosis. His psychotic may have relieved some emotional pain, it was symptoms are not extreme, so the not acceptable to them for a variety of reasons.

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Maybe their own neurotic pattern was functional Take the Catholic priest who is a enough for them to meet their troubles. Maybe recovered alcoholic. At Mass, as I understand it, they were brought up to believe that getting nobody gets any wine at all except the priest; drunk is a horrible evil, far worse than their sometimes he may have to take quite a little neurotic pain. because it all has to be used. I have heard, and I Let me say that the likelihood of a would believe that in the case of certain priests woman who is neurotic becoming regularly and who were recovered alcoholics, that this often rather drunk, perhaps even developing into ingestion of alcohol–because chemically that is an alcoholic, is much less likely than in the case what it is–did not cause the man to revert to of a man, because the social pressures on alcoholism. Certainly a sincere priest wold not drunkenness are much heavier against a woman interpret this act as “drinking.” However, it would than a man in our society. As a result, it is a less seem a great risk to run. likely sort of adjustment to problems for women in our society. Alcoholism in Feeble-Minded

Mental Problems Q: Well, do you think that if we make progress with mental hygiene in America we will Q: Let’s take it in reverse. Aren’t the tend to reduce alcoholism? people who are trying to cure alcoholism aware A: We will reduce that proportion that I today of the fact that they have to cure the was speaking of. I started off with the worst, the mental problems as well? psychotics and pronounced neurotics. A: This calls for a lot of comment. First, Let me say none of us accepts the word “cure.” Q: What are some of the others? That is one of these words I would like to A: There is a certain proportion that are eliminate because we say that no alcoholic is feeble-minded. We would say that the proportion ever cured–it is merely an arrested condition. of alcoholism in the feeble-minded is much higher than it is in the general population. But, Q: Does that mean that alcoholism is a altogether, it’s a small number. The feebledisease? minded, the psychotic and the epileptic are three A: Only to this point–that to our categories in what I termed adjunctive knowledge it cannot be helped to the extent that alcoholics. The person who begins to act like an the person can relearn how to become a social, alcoholic at 17, 18 or 19 presents at least a temperate, moderate drinker. strong suspicion of a major neurotic or approaching psychotic situation, perhaps Q: He must give it up completely? schizophrenia. A: Absolutely, forever, in any form, in any Ordinarily alcoholism will take anywhere amount. We have cases of people who had from 7 to 15 years to develop from the early stopped for 15 years and who thought it was symptoms to the final full-blown appearance But safe, or some naive doctor told them a beer isn’t with major neurotic conditions the development really drinking, and so they go on again— may take less than a year.

Q: And it takes very little quantity– Q: Are these the only groups who are A: It’s the alcohol. The quantity doesn’t likely to turn from social drinking to excessive matter, no. If they are unaware that they are drinking? taking alcohol, if they don’t even know about it, A: On, no. This is just one small or in some circumstances if the ingestion is segment. I would say that we have some people interpreted in so ritualized a fashion that it has that are called “neurotic.” Now, what I mean by nothing whatsoever to do with “drinking” as that “neurotic” is approximately this: His peer group-is interpreted by the individual, then there might- we will say “his” and not “her” because we run 5 -and I emphasize the “might”–be no effect. I still l/2 males to one female–thought at the time, say wouldn’t be surprised if it did start him off again.

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during the teens, that the individual was clearly neurosis. You only discover them when they are peculiar. 40. You go back through their life histories and They are “screwballs,” or whatever the you can’t find in the school record any evidence popular word is among their group, and they are that they were peculiar–they were just like known as that by the others. They’re frightened, everybody else. they’re shy, they don’t get along well in Now everybody–and this is pertinent to interpersonal relationships, they don’t know how the mental-hygiene question–everybody has to fight, they don’t know how to date, they don’t personality difficulties. We all of us have know how to dance, they don’t know how to stronger and weaker spots in emotional and dress, and so forth. They may study excessively, social adjustment by definition. Some of us are they may be highly overcompensating athletes quite well adjusted in relationships with the who are terrified of other people, they may be opposite sex on a series of levels, whether it “mother’s boys.” And the others recognize it, and refers to actual sexual intercourse or whether it it is noticeably interfering with their day-to-day refers merely to talking to secretaries. Some of life. This person at 16, 17 or 18 may discover us are average and some of us are a little more alcohol. He may not even know that he has or a little less well adjusted. Some of us in the discovered it. He may go to his first party and matter of competition and assertion and have some drinks and simply know that, “Gee, dominance are stronger or weaker. All of us when I go to the Joneses on Saturdays I have a have certain weak spots. We are not robots. wonderful time!” Let’s say that I am weak when it comes But after several experiences he can’t to asserting myself with people in a higher status help making the correct discrimination because or with older men. Maybe it has something to do he went to Green’s house and it was Thursday with early experiences with my father or my and there were drinks and he had a wonderful older brother. Anyway, it is a common thing. It is time, and the next Saturday he went to the found in personnel problems all the time. You Joneses, had no drinks and he felt awful. This promote a good man and he collapses. Why? person, then, begins to find that with drinks he He cannot give orders on a higher level. can act more like a human being, that he his A boy is, let us say, now 23, 24, 25, and accepted by others, and there is this he has all the ambitions that most young tremendous relief–“My God, I can be a human American men have, and he feels a little more at being after all!” ease, a little more relaxed, and loses a little of The group of alcoholics with this this restraint after a few drinks. Well, he says to background, I would say, is more sizable than himself, so do a lot of other people. So what! the psychotics. But I would not say that they are Along about age 25, 26, 27, this all the alcoholics by any means. Anybody who particular problem becomes even more tries to explain alcoholism entirely in terms of significant to him. The boy is no longer in the basic or character neurosis faces an impasse. school or college situation and can’t fall into one of those nicely defined categories where this is Preventing Neurosis the faculty, these are my elders, these only lower classmen, and begins to realize that he is Q: If we should make more progress in a competitive person, too. mental hygiene will we make more progress in He, too, can get up there and can even the field of alcoholism? disagree with those people. In fact, the situation A: As mental hygiene is able to do demands that he compete. This makes him something about the prevention of psychosis, for somewhat ill at ease, but over the week end this percentage, yes. As it is able to do when he has a cocktail, some highballs, or something for the prevention of neurosis, or whatever it may be, he loses some of his fears social or emotional deviation, obviously for a and anxieties on this score, and this loss bigger percentage, yes. becomes highly important. But, then, take this even large group of There would seem to be a point, as we alcoholics who don’t give evidence of early recapture the life experience of the alcoholic,

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where there suddenly is an increase in the begins to get drunk. Now, when he gets drunk, intake. Let’s say that in his group they usually he has not only the remorse that any might have have, say, three cocktails two nights a week and who experience a -hang-over, but also has this on Saturday nights. This man’s intake jumps up awful remorse about the situation which he 50 percent— didn’t resolve and about what he did while drunk, plus the fact, “I’ve done it before and When Drinking Gets Serious before and before, and I can’t stop it!” He experiences a monumental psychological effect Q: Is this suddenly? from the hang-over. A: It would seem so. At least the man A vicious-circle process can now be remembers it, and so do some of his friends. seen. As the individual more and more depends Then he begins to show all sorts of symptoms, on alcohol to meet certain situations–and for a but I will skip all of them and go right into the while he is successful, for it does work–he is, possible mental-hygiene aspect of it. He begins through lack of exercise, so to speak, reducing to increase the time of drinking and may have a his basic equipment to meet other people and couple in the afternoon. He may even shift jobs particular types of situations effectively. As this so that he may get into a position where this sort happens, he needs a little more. As he begins to of thing is more possible. He may shift friends so take a little more, he begins to make that he associates frequently with those among “drunkenness” mistakes. In other words, he whom heavier drinking is socially acceptable. could be overly aggressive and doesn’t even And we will find that he is making certain know it; you can be critical of him, and he decisions and is meeting certain people doesn’t even notice. particularly at the times when he can have a few Pretty soon the liabilities of drinking drinks–not that he is going out and hanging on overtake the assets. Furthermore, occasionally to lampposts. He may tie one on now and then if he oversteps and really gets drunk and does the people in his group tie one on. But he is things that create new, major difficulties, so he regularly drinking more. Perhaps he is meeting has to get over this additional problem. To cover problems with his wife or his kids that have up this new problem created by the excessive made him very uneasy. He can’t stand the kids use of alcohol, he uses more alcohol, and so the at supper time, and he is afraid his wife expects nice little vicious circle becomes a bigger vicious him to do things he can’t do, but if he has two circle. cocktails every night he no longer notices their It may be that a definition of criticisms, their requests for his attention. He psychological addiction” would be the use of may be abrupt and even a little sarcastic with alcohol to overcome the effects of alcohol, them, and doesn’t know that he is doing it. whereas when you are merely using alcohol to This is a very slow, gradual process. We overcome situational problems or neurotic call it the “pampering effect” of alcohol. There problems, this is not the case. Then you are was a weak spot in his personality armament drinking to overcome shyness or inferiority and, instead of trying something new and feelings, which are not created by alcohol. learning through variation, no, he protects himself more and more by alcohol. The needs Q: Now, where does mental hygiene fit for the personality go on and new needs come in? up, especially in the weakest areas, and this A: We would say two things. First, let’s fellow is not learning, he is not growing, he is not note this fact. Over the past 50 years, which is at changing, but more and more is covering it up. longest the reign of modern psychiatry—and Then, if the situation develops whereby perhaps you would prefer 25 years–psychiatrists he is put under some special pressure, he may– have been peculiarly unsuccessful with and it is three o’clock in the afternoon–say, “If alcoholics. The psychiatrists know this and only I had a couple of drinks!” And he’s right– dislike the alcoholics; the alcoholics know this because he has those couple of drinks and it and dislike the psychiatrists. And so the hope of doesn’t bother him so much. Then occasionally doing anything, one with the other is, of course,

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very low. Psychiatrists are not alone in that, however–it covers everybody else, too. Q: So you do have your original problem in personality and mental hygiene? Slips In Psychiatry A: Yes–and perhaps you can tie this original to poor neighborhoods, unresolved Q: But why have the psychiatrists, if this Oedipus complexes, lack of affection, and so is a mental-hygiene problem, not done better? forth, yes. But, unless there is also A: One answer to that would be that the understanding of the impact of excessive and psychiatrist, quite correctly, sees that this person chronic alcohol ingestion and what it can do to has personality difficulties and in some an emerging, growing personality, therapy won’t instances they see a long-lasting character get very far. neurosis, one that’s been in the developmental In the first place, you will have a lot of stages for years, perhaps since the age of 4 or alcoholics who won’t have what you would call a 5. So the psychiatrist says that, unless we get neurosis, and yet they are just as bad as the rid of this thing at the bottom, we are just playing other fellows in the end. When you get the one games with the thing at the top. who has this real neurotic problem you probably So the alcoholic comes into the office can’t reach him by the usual psychiatric and the psychiatrist starts needling back into technique because, as the psychiatrist would put this, perhaps, adolescent problem, and then it, he is an objectionable, un-co-operative back to the 7 or 3-year-old period. The alcoholic person–and that is right. looks at the psychiatrist and wonders, “Which one of us is screwy?” Here he is; his wife is Heredity going to toss him out on his ear, he can’t hold food on his stomach, his glasses are smashed, Q: Is there any inherent tendency to he has lost his papers, he is going to lose his become an alcoholic? You hear of people job. He has this horrible feeling of fear, of referred to as a natural for alcoholism— additional worry about this alcohol business, and A: Let’s put it this way: Acquired here this weird character is asking him what characteristics are not inherited–that is, you dreams he had about his great-grandmother cannot inherit a taste for alcohol. You do not when he was 4 years old. inherit drinking. Alcoholism? There is an inherited structure which is closely related to Q: That’s an exaggeration, of course– one’s potentiality to develop an effective A: Yes it is, but it is significant of a very personality. So, since weaker personalities are important thing: The psychiatrist, very correctly, prone to maladjustments of all sorts, including proceeds on the premise that there were alcoholism, yes. underlying difficulties much more significant than We say that alcoholism is found to a the actual effect of the alcohol. And so they higher degree among the feeble-minded than begin to talk about alcohol as a symptom, but I the rest of the population. Certain of the feeblewould suggest to you that, as the alcoholic ‘has minded probably have a structured, organic gone through alcoholic experiences for many deficiency which can be inherited. However, years, he is no longer merely a neurotic type B they inherit feeble-mindedness, not alcoholism. or a neurotic type C. He may once have fitted such a label, but now he has added alcohol- Q: I want to clear up this heredity dependency and has fused the two into question a little bit. Do I understand you to say something new. He has problems, demanding that, while there is no acquired taste, if a parent problems, problems that have gone so deeply has a personality defect, and that defect is into his insides that this alcohol will trigger him reproduced in the child-off even 15 to 20 years later, even if he never A: It couldn’t be personality–it would takes a drink in the interim. The alcohol have to be an organic defect. dependence is terribly important in itself. It is a new thing. It is what we call “alcoholism.” Q: Well, does that cause the child to take

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to drink? One noticeable thing is the difference A: The organic defect does not cause the between the sexes. In this country the ratio is individual to drink. The organic defect has an about 5 l/2 or 6 to 1; in England for many years, effect on their ability to intellectually or in 1890 to 1940, it was running about 2 men to 1 reaction time or in emotional spasms or in woman; in Scandinavia at the same time it was certain diseases, say, tuberculosis. about 27 men to 1 woman. But it is interesting to note that, after three generations in this country, Q: If that is reproduced in the child, then the Scandinavian rate began to descend to the child will be susceptible to the same thing? about 11 or 12 to 1, the English to come up to A: It will be susceptible to personality disorders, about 4 to 1. Those Jews who have more and sometimes alcoholism, sometimes delinquency more become secularized, gotten away not only or neuroses. Now, I should add one more thing– from the Orthodox but also from the that alcoholism runs in families. Conservative or the Reformed—especially if their parents have also–their rate has begun to Q: What is the reason that it runs in go up. families? In other words, the Americanization A: Because the father or the mother who process is gradually working in this sphere as is an alcoholic finds it almost impossible to give well as others. love and affection and attention and responsibility to anybody, especially to a child, Symptoms who may well make him feel guilty and the like. This is, of course, particularly true of the mother. Q: What are the prealcoholic symptoms? The situation in which the alcoholic’s children A: Well, there’s an increase in intake–we live, the way they are brought up, just have the man who is drinking just like the other everything, tends to make them upset people. people in his group. The quantity doesn’t matter- Sometimes they will become extreme, wild -it may be six sherries a week, or two highballs a “drys,” ascetics; sometimes they will become night. This man starts increasing his intake, and extreme drunks. Sometimes they may be he begins to show some of these behaviors–and moderate drinkers. But they experience remember it is the repetition of these behaviors hardships of an emotional nature during infancy, and their patterning with the others, not just their childhood and adolescence if the parent is an occasional appearance. alcoholic. The first thing it suggests is an increase I might add something else here. in gross, drunken behavior–that is, when he has Alcoholism cuts across all social groups, all a little too much, instead of acting the way he educational groups, all occupational groups. It is used to act when he had a little too much, he limited to certain age groups, yes, largely begins to be more out of control in his immediate because it is a slowly (10-15 years) developing behavior. condition; it is most common between 35 and You all know that inhibitions go down 55. It differs by sex, yes–5 or 6 men to 1 with drinks–one forgets the immediate worries, woman. the immediate fears. For instance, you’re all And in ethnic, cultural background–we being very polite here, but if we were at a find that the Mediterranean people–the Italians cocktail party, I couldn’t get all this attention. I’d and the Greeks, for example–will tend to have have to talk a little louder; my jokes aren’t really ‘low rates. The Jews, almost all of whom use very funny, but after two or three drinks they alcoholic beverages, have an extraordinarily low really begin to seem to me to have that rate, a fact which has been recognized for over particular flavor that would make Noel Coward three centuries. jealous, and even you may forget a bit and laugh The so-called native white American at some of my jokes. group will have quite a high rate, as will the Irish, But this is still within the range of social Scandinavian, English, and Polish people. acceptance of that group. This man, however, begins to go beyond that. He starts to be a big

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shot–spends a lot of money, sets them up for personality jolt or lift through acquiring a the boys in the back room; he get noisy; certain significant and rapid concentration of alcohol in words which are limited perhaps to times when I his system–just a little bit doesn’t get him hit myself with a hammer begin to come out started. He begins to know that at the Jones more and more in general conversation. In a house he will only get a couple of martinis, so variety of ways this man’s behavior more and before he goes to the Joneses’ he usually has a more often becomes obvious, irritatingly couple of quick ones–he’s the fellow who has to obvious, to the other members of the group help the hostess, and incidentally get a few when he is drinking. slugs on the side. He is learning that he must have more. Dangers in a Blackout Now, these are early symptoms.

Another thing of considerable Q: Can they be corrected? Can he stop? significance is the appearance, often very early A: Yes. in the game, of what is called “the blackout” or “pulling a blank”–this is sort of temporary Q: Could you give him some rules, Dr amnesia. The man is drinking along about 7, Bacon? 7:30 or 8. Now the blackout begins, but, if you’re A: To know that next he goes into the man you don’t know it–You’re still around, alcoholism–that that is the next step–the first you’re having drinks, you’re talking–you may get great crucial point, the loss of control. He meant in a car, and drive 50 miles, you may take a to have two drinks, he winds up drunk. We find room at a hotel, but memory has stopped that he begins to need special rationalizations to completely and one cannot recall anything that explain his drinking, because people begin to has taken place since 8:30. notice he is drinking more. And these You can imagine the terrific impact this rationalizations cover the waterfront–everything will have on women in our society, because you have ever heard of. there is immediately the thought: “I may have At this time he may show a few had a sexual experience–or other people will instances of drinking alone. Drinking alone can think I have, which is just as bad.” It is be all right under a doctor’s prescription, or terrifying—less terrifying for a man. some people use it to go to sleep, or there may You get situations where a man has a be a religious ritual. But I’m not talking about any blackout which lasts 36 to 48 hours–he ends up of those. He begins to drink alone and. likes it. in another city, he doesn’t know where he is. He He doesn’t need all these other people pressing learns to have a newspaper sent up to his room in on him, he may become a “loner.” This is to discover the date and what town he’s in. I now quite usual with women alcoholics for whom of one man who when he came out of the social conventions don’t allow as many socially blackout remembered that he was to have acceptable opportunities for drinking. Not all signed a $400,000 contract the previous day at alcoholics are ‘loners.” 10 a.m. Quickly making himself presentable, he Somewhere along in here–it may wait rushed in to the corporation president with whom until the later stages–some dear, dear friend or he was to have closed the deal, made some even a physician may advise him during a hanglame apologies, and hoped the whole thing over–and he gets more hang-overs than others wasn’t off. The corporation president looked at and they hurt him far more than they do other him rather strangely and then stated: “Mr. C., people–that a “quick one” at the beginning of the you were here yesterday at 10 a.m. and we day will help. Many, many times it becomes signed the agreement.” Not all blackouts have humanly impossible for him to think of getting up this type of surprise for the end of the story. and going to work and so on without this Then there is the gulping and sneaking— fortification. this is an indication that it is not social drinking We begin to find some asocial behavior. I any more–the fellow has to do more than the am not talking about anything marked. But we social pattern will allow. He needs to get this do find a little trouble on the job, a little trouble at

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home, a little trouble here and there, automobile ingenuity on protecting his secret supply. I call it trouble, or what not. It’s more than he had been wasted–sometimes the mental exercise equals having in the past. It is reported on–quietly. But Thomas Alva Edison at his best. most of his friends tend to hush up comments I might say that one of the most tragic about it. Trying to be helpful perhaps, many things in the world is to see an alcoholic who people try to cover up for him. Of course, he has a half bottle left for the morning which he tries to do so also. Naturally, the day of puts away where the little woman isn’t going to reckoning gets worse as it is postponed. And find it–only to discover in the morning that he about this time he may say, “I’ve got to do had been in a blackout when he did the hiding. something about this.” So he tries to change the What a frantic, maddening search will follow! pattern–a little shift from rye to gin, or he will stop drinking before 5 in the afternoon, or he will Finally, a Breakdown only drink at home, never in a commercial place. We finally begin to see a social Q: Does that help? breakdown which is really manifest. His friends, A: No. It isn’t drinking patterns that are if they are still in that category, find it harder and his trouble; it is the excessive ingestion of harder to cover up. Now he loses the second or alcohol. And he can fit that into any pattern of third job, and even though he got in to the office drinking. Being an alcoholic, he will. Pretty soon- first and resigned, too many people know he -and it will be the end of what we call “the early was fired. Trouble with the wife and kids begins stages”–he may go to get help from a minister, to come out in the open, and so on. Social friend or someone outside the family, or he may difficulties mount rapidly. He begins perhaps to even go to a sanitarium or a doctor or a hospital. show some physical symptoms, tremors; more He tries them all out. and more often he’s in a physically run-down condition, which was perhaps present earlier in The Binge an acute fashion but over in two days–now it becomes chronic. And his rationalizations to Now we come to the beginning of the last himself–no longer can he find explanations in stage, which is the “binge.” We have our own the culture that will satisfy even him, to say way of talking about a “binge.” A person can be nothing of others. He is beginning to give up. His completely “blotto” for 48 hours or for a week fears and his guilt and his remorse, instead of and we might not call it a binge if this fellow, let’s being pinpointed to what he did last night, or to say, is drunk over the week end, but on Monday his attitude toward his wife over 6 years, or 16 morning he gets to the job. He may be on a two- years, now become generalized without week vacation and he is “blotto” for three or four definition. days, but perhaps he has not completely There is undefined fear, undefined disrupted social expectancy and social habit of remorse that he can’t even explain–he has this his group. But this bird, who has started his black depression. It is called the blues week-end drinking about Friday at 2 p.m. and sometimes–the real blues because you can’t slowly slides off only about Monday noon and identify it. That’s the difference between the real doesn’t get around to the office till Tuesday–this blues and a sentimental blues–you can always four days is much more significant than six days say it’s because Mama went away—but with the on a vacation. The man begins to go on binges real blues you can’t identify what it is that is so which clearly disrupt and insult the society. painful, so threatening. That’s what’s so At this point, the alcoholic may start horrifying. And at this point the fellow may give getting secretive about his drinking. By now he up socially on the grand scale, may slip down will have surely learned the morning drink into Skid Row. Now the “DT’s” may appear, and business, and he learns to keep a supply for the so on. morning. He starts hiding his supply and he may develop all the tricky, tricky habits of the Q: What can you do to help–in the early confirmed alcoholic and waste extraordinary stages particularly?

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A: I would like to answer that in the first support. If they could have some of the instance by pointing out that the behaviors situational factors–such as the wife, who has called “early symptoms” are not by themselves been doing the wrong thing even with the best symptoms. They have been ridiculed by some motives, triggering the guy into his alcoholism— newspaper commentators, and if they are when they could receive just a little help, they considered as separate instances, such ridicule could help themselves quite effectively. may be O.K. It is when they are patterned and If you could relieve those pressures and repetitive and increasing that they are early give this man just a little support, a little hope, a symptoms. For instance, among your friends little help, then he didn’t have such a hard time. may be some who have had a blackout. Does that mean they’re alcoholics? No. It may have to Q: Could the people in the middle do with the improper utilization of alcohol by the stages, who had lost control, stop drinking? body. Your friend may have gotten drunk several A: So far as we know, they can’t stop times, he may have sneaked drinks once in a permanently without help. Now, there is going to while, he may have said at parties a couple of be a case here and a case there where they times, “Let’s have one for the road,” or he may can. Ordinarily we don’t know in such cases stop at your house to have a nightcap, or he whether they really were alcoholics before they may stop at a tavern on the way to a party. stopped–just that they said so or their doctor, or Taken by themselves, these need not be Aunt Mathilda or the judge said that they were symptoms. It is only when these things get into a alcoholics. Then you may find out that this judge pattern and become repetitive, that they make or mother-in-law thinks anybody who has two sense as early symptoms of alcoholism. beers a week is an alcoholic. Naturally, drunkenness may occur many times without any of these things being present at all. Q: In that group he isn’t out of control, then? Giving Up Drink A: That very control is the crucial point in getting into alcoholism. Q: What can be done about it? A: For the people in the later stages you Q: Can he stop at that point’ and later on need almost a re-forming of life–particularly in be a moderate drinker? social adjustments–and, for some people, also A: So far as we know he cannot become in the emotional sphere. Drinking will have to be a controlled drinker. There may be some people given up permanently. Some may need who manifest some of these behaviors for a physiological care beyond remedies for variety of reasons and later on drop the variant temporary acute ills. Originally, some 10 years behavior without dropping the drinking. and more back, it was the late-stage alcoholics However, to date there is no well-recorded case who came looking for help, and so rather drastic that has been followed over as little as seven steps were needed. months, of a person who had–by consent of two Now, as “Alcoholics Anonymous” and our or three outside observers going over the clinics began to be more widely known, some of record–been an alcoholic, no matter what the the frightened people in the middle and earlier stage, who was later on, say for a period of stages came in. In fact, today they are the roughly a year, found to have been a controlled largest groups we see. drinker.

Q: What are you going to do for them? Q: What about before he loses control A: First, we began to find they are and sees some symptoms, what does he do in different types. Some of them were way back in that period? the first stages, some of them needed a little A: He can keep control. knowledge and a little guidance from a neutral and a respectable source; when they could see Q: How does he do it? where they were and could be given a little

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A: As a matter of advice, I would say to Joe over here. A couple of weeks go by, and him: “Buster, you’d be awfully smart to play it then, flop, Joe’s drunk again. Well, they try again safe. The safe way is for you to have a look and he flops again–and the answer is “Joe around at your life, find out what you’re getting wasn’t ready.” amusement from, where your job is, where your I don’t want to throw any blame in one friends are, and see in what areas drinking direction alone. Let’s say that a psychiatrist seems to press itself, socially, upon you, and works with an alcoholic, or a clinic that really start manipulating those situations a little. Maybe knows something about alcoholics–they work you can control it.” with Charlie. And he flops, not once, but again Here is a typical way to find out–I’ve ever and again. What’s the professional explanation? proven this, but it sounds reasonable and was “He’s a psychopath.” suggested to me by a member of “Alcoholics These are both ways of saying, “I don’t Anonymous,” or “AA’s,” as they are called. To know,” and “I’m not to be blamed.” The answer find out if one is an alcoholic or not, you get the that he isn’t ready yet isn’t an answer–it’s is-he-or-isn’t-he person to tell you what he thinks merely a restatement of a problem. sort of average, social, moderate drinking is. At certain times, at certain places, with Let’s say he decides a highball every night and certain people, under certain situations, this man two cocktails three times a week. You say, is more ready or less ready–and the need of the “O.K., that’s what it is. Now, every night for one therapist, “AA”’ psychiatrist, or other, is to be month you’re to have one highball–never more, able to recognize and manipulate these more never less. And Thursday, Friday and Saturday favorable situations. There are certain ways of you have two cocktails–never more, never less.” dealing with certain alcoholics so that the If he can keep that up for 30 days, the chances readiness can be brought further forward. And are he is not an alcoholic. this is what I was coming to when you asked me This is, of course, a rule-of-thumb thing, about stopping the condition. and I can see where some wiseacre alcoholic Originally the Yale Clinic and the “AA’s” would do it and get away with it. I’ve known were getting the real McCoy. In the late ’30s and alcoholics to go through the aversion treatment– early ’40s you hit the “AA’s” with a wham. The and a horribly painful course it is–they go right candidate did not have shoes that matched, had through the treatment, kidding the doctor the been in 12 jails, 6 workhouses, reform schools, whole way through. Going out in between State hospitals, sanitariums, had lost his wife, sessions and drinking and drinking till they can etc.–the works. “Alcoholics Anonymous” started take it without becoming sick to their stomach, about 1934. About 1938 or 1939 two things and then going back for the next treatment, happened–they got some people who hadn’t because they are showing off. They’re showing gotten that far–they still had a necktie, a job, a that the doctor is a damn fool. They’re showing wife. And the answer was: “Go on, go back out, Aunt Martha, and they are showing themselves you’re not an alcoholic–you don’t know what how clever they are, and so on. Of course, drinking is–scram.” they’re fooling no one but themselves, but with a But some of the others said: “No, that motivation like that I suppose, some alcoholic attitude is bad as far as “AA” is concerned. could pass this 30-day test. It would be a terrific Maybe you’re right–maybe this guy isn’t a real strain on him. alcoholic, but he should have a chance. We cannot determine who is and ain’t. We have got Help For ‘Early’ Cases to help.” So they tried it. Exactly the same thing happened when a Q: You can’t reach any of these people woman showed up. This was a man’s unless they want to be helped, can you? organization and the idea of women brought in A: As far as therapy is concerned, I think the idea of pink ladies, that sort of drinking, and this is a potential excuse for failure that is very brought in fears that, having women around, dangerous for progress in this field. Even “AA’s” even if they had been real lushes, would ruin the use this excuse. For example, they try t o help whole fellowship. But they said, “We’ve got to try

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it.” And just as in the case of the men who hadn’t from helping alcoholics averaging 45 years of hit real rock bottom as drunks, it worked in an age to those averaging 36 or 38 years of age. amazing proportion of the cases. It was noticed that these people with a Q: What have you found in the clinics? milder, shorter history (a) probably had just had A: We have found the same thing in the a binge, and (b) that they probably had just had clinics. Because of the availability of help, a nasty shock–mother died, for which they because of the anonymity, because of the blamed themselves indirectly, or they had been lowering of the stigma around alcoholism people kicked off their job, or they had been divorced, are willing to come in and ask for help. This is a or they had had their first jail experience. It was hard thing for the alcoholic to do, partly because a shock to them. And so, they talked about that in the back of his mind is just what was in your shock as a bottom, and called it a “high bottom.” psychology textbook—the horrible implications And, lo and behold, by 1950 the high bottoms in of this disease and the moralizing that “AA” almost certainly outnumbered the low accompanied it. But now there are places where bottoms. they don’t believe in these horrors and don’t In the clinics we’ve had the same thing. preach at you. In fact, in “AA” there may be In the early days we got the real ones, the men many who think drinking is just dandy, but that who had touched low, low bottom. Then we got they’re sick and they can’t take it–it’s like more and more who were in the middle stages diabetes, “I can’t take sugar,” or “I’ve got an and then some in the earlier stages. allergy to sweets so I can’t take them.” This is Here’s something else. When people making the condition respectable and the began to come to “AA” who were 25, 26, 29 possibility of seeking help less painful. So they years of age, they came in all right, but some come in. couldn’t stand it–they liked the “AAs,” they liked the philosophy, they liked the program, they Student Interest know they had been helped, but they couldn’t stand going in two nights a week to listen to Q: Do you find that young people are these old timers yack-yack-yack about “what I interested in the work of the “AA” and the did at Armentiers” or about their 25 years of wild clinics? drinking, or something of the sort. A: Yes. The high-school and young college people who had suddenly gotten very Development of ‘Junior AA’s’ interested in “AA” speakers or those from clinical centers. We note at the Yale Center that our This was far from their own experience. people get an almost fascinated response from So you begin to have a development in the these youngsters. The students even ask to larger cities of so-called “Junior AA’s.” A have them come, and no one has to take different sort of re-socialization or modified attendance. Their reaction would appear socialization was needed. The “AA” are very strikingly different from that shown to classical flexible and very empiric, and they found that for temperance lectures. many of the youngsters this worked. They Now, some of these students need what picked up a lot more screwballs in this group– I would call intellectual knowledge and guidance. that is, youngsters who were deeply neurotic, They’re not personality-problem kids, they’re not perhaps psychopathic, who were also drinking alcoholics, but they’ve been receiving this excessively, and who got a terrific bang out nonsense–that is the way they look at it–about of“AA”’ and went along beautifully for six weeks. alcohol. For instance, they’ve been told: ‘The group over, and going wild. first drink–it’s the first drink that’s the dangerous So they have had some difficulty with one–you’re one drink away from a drunk. A little such groups, but there is no question that they beer here and there, and this horrible social have helped a great many of them. The drinking will lead to death, disgrace, disease. significant thing is the change from late-stage The liver will turn purple, the brain shrink, and so alcoholics to middle and early-stage alcoholics, on.”

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The students, to be sure, know this is not to know the difference between drinks. They true. I say that they know this for the following would like to know: “What does this drinking do reason–some 60-odd million people, most of as far as athletics are concerned? Is it them parents, use alcoholic beverages. These necessary to take drinks on a date? And how beverages are in the icebox or they’re in the many drinks should you take, and what, and cupboard or they’re at the party, and the where and under what situations? How is it youngsters know that their dad drinks, and so going to hurt me?” on. They also know that he isn’t drunk and he isn’t crazy and he isn’t going to be. Furthermore, What to Tell Youth I don’t think kids care much about warnings which refer to the senile part of the population– Q: What do they want to know? those who are past 32 or 33. Alcoholics are A: I think what a good many of them usually portrayed as being even older than this. have in the back of their minds–the girls won’t A certain proportion of teenagers, let’s ask the question but they want to know–is what say 20 per cent, do not consider these classic happens from a certain number of drinks, does temperance talks to be nonsense. In their one get sexually excited? Is drinking on dates families, their neighborhood and their church necessary, is it wrong, and so on? But what they and so on they have always heard these beliefs hear about from the classic temperance and assertions, and the message fits into their speakers are the general things, crime, divorce, life; it may reinforce their belief. Of course, 99 bad housing, the fall of Pearl Harbor, murder-per cent of this particular group weren’t going to they see pictures of deaths on the highway drink anyway. where the kids are drunk. But the others–and this is a very But the people who give these talks and regrettable point–may react so negatively to the make these pictures often know so little about unrealistic part of the classical temperance talk drinking and alcohol that they make ridiculous that they reject all notions of any danger in mistakes–the youngsters know better than the drinking and even become intolerant of “drys” do; sometimes they show a person taking abstainers. I would go to the extent of saying three drinks and then acting like a maniac. that, though it may be -unconscious on the part There must be, in a group of one hundred 16 of these very sincere well-meaning “drys,” they and 17-year-olds, 30 persons who have had are doing something which is unmoral. I criticize three drinks several times. They know that the “drys” and not the “wets” on this point, nothing like that took place at all. And another because the “drys” have a program and the 30 who have had only one drink or so look at the “wets” don’t have anything–they just have three-drink fellows and begin to think “Well, I “shhhh” when anyone mentions that there are guess I can take three drinks too.” Kids don’t like real problems. the morally superior person looking down at But the “drys,” by over exaggeration, by saying them saying, “Don’t, don’t, don’t.” things that are utter nonsense, unfortunately get Q: What should you tell them? across the idea to the nonabstainers, who A: I think they want to know something. happen to be the majority, that everything they Probably most interesting to them would be say is unrealistic. There happen to be some very knowledge of the psychological effects of real dangers attached to drinking and anybody drinking. I think they should be given the who doesn’t think so is affected by certain physiological facts of alcohol. I think they should biases of an antidry philosophy. be told something about the customs of drinking. There are some groups in which the drinking of But very little factual information about alcohol starts at about the time of weaning. alcohol is given to the younger people. They There are some groups in which drinking is a would really like to know something about normal, expected and in some ways a socially alcohol, but what they want to know, and what significant aspect of life–you’ve got to be able to the “drys” are anxious to tell them are two know the difference between certain types of different things. The younger people would like wines, how many cocktails to serve, etc., etc.

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In this group the person who says that he drinking, just as they should learn something doesn’t drink–especially if he says he doesn’t about oxygen and carbon tetrachloride or the drink and indicates that you shouldn’t either—is form of government in Idaho, or something else. going to be such a deviant in that group that he In addition, drinking is something that is going to build social problems for himself, just hits across more aspects of life than carbon as the drinker in the abstaining group is going to tetrachloride or government in Idaho–it affects do. marriage, birth and death–it can be involved in To try to repress this person is to almost all social phenomena except the suggest certain social disabilities of all sorts. activities demanding immediate, high-tension However, there are obviously points at which discrimination and responsible action. Drinking, certain types of ingestion of alcohol go beyond for example, is not related to tight-wire walking any customs for an individual and are frightfully or piloting an airplane, at least not on American dangerous for that individual, to say nothing of lines. this future, family, job, etc., which is only All the students are going to have to theoretical. make a decision about drinking–as to their own Any drinking may be bad for some. Other behavior, also with their wife, their things being equal, I see no advantages to neighborhood, their kids, their religion, their drinking by teenagers that couldn’t be gained in government, and so on. And in 90 per cent of other ways. However, what I personally think our educational institutions they learn nothing and what millions of teen-agers do may be two except what 8 out of 10 of them recognize is different things. Telling them nothing, telling silly. them nonsense, or talking down to them with nothing but negative commands—these are all Drinking Habits of Students ineffective and rather escapist types of education, especially since the students want In this connection, I’d like to mention our education on the matter. recently completed study of the drinking habits and attitudes of about 16,000 college students Q: What do the students say about the the country over–private, parochial, and State “AA” speakers? colleges, co-ed and man or woman only A: The student loves the “AA” colleges, big and little, and so on. Here we presentation because that is the “Horatio Alger” report on who drinks, what they drink, when, story amid blood and amid tears, and so forth, where, with whom, when they started, what they and you come out of the slime as Sir Galahad think about drinking and about abstainers and and rise to the top–and that goes big in this about sex activity and drinking, what problems country. And the “AA’s” laugh at the negative they may have experienced, what their parents, authorities who are pressing on the kids. They their church, the college authorities, their friends are real, experienced “he-man” drinkers, and at and others say and do, and so on. It is the first the same time they seem to have achieved a objective study of drinking habits ever made in morality. And this the teenagers like, too. And this country, and it may well help to build a when they have this message with its emotional, better foundation for teachers and teaching sincere feeling–and often the “AA” speakers are materials. We certainly hope so. a little exhibitionistic anyway and so they are often magnificent speakers–the students love it. Q: Could you tell us something about it? For that matter so do a lot of adults. A: Most assuredly, but it is covered comprehensively in a book, entitled “Drinking in But I don’t think that fundamentally College,” by Professor Robert Strauss and knowledge about alcoholism is a major need in myself, just out. an educational program. Of course, it is important to learn that, if one has an alcoholism Alcohol In Business problem there is hope–but I think the students should learn something about alcohol and about

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Q: What about the alcohol problem one plant, the absenteeism rate after a year and particularly in industry and business? a half with the first 100 alcoholics who went A: There is the same feeling there as in through–and they had success with 100 out of other parts of the society. They want to cover it 120–was cut to about 2.3. The average up and hide it and so on. It has a stigma. But absenteeism rate of the plant was 4.8, and for there is getting to be a gradual perception by an three years before they came in for help it was increasing number of companies that “Yes, there running for these 100 alcoholics at about 10. is a problem and why don’t we do something about it?” Of course, it doesn’t show in their Q: How do they help them? What does records, it’s always hidden, but the problem is an industrial establishment do? there. And there are now techniques of dealing A: The first thing to do, briefly, is to get with it. top management to recognize that there is a problem and not to be scared of it and to be Q: Is it a growing problem? looking into what can be done about the A: I don’t think we can say that it is a problem. The second thing is to decide to give growing problem, but we can say this–that the responsibility to a department, probably age range is 30 to 50. Industry and business industrial health or personnel, to do something. and agriculture employ 60 million, of whom a Next, the thing to do is to appoint a man to get large proportion must be in that age group, and special training in addition to his already so they have a great number of them. But most acquired training. We have four or five-day of them are back in the early stages. They don’t training sessions just for this purpose. have any drunks. Oh, they have them now and then, but they are fired. They don’t have the Q: What are they trained to do? psychotics, the “Skid Row” bums, and so forth. A: These people go back and do two things. They may have had them when they were 23, First, they offer counseling, often making but they got rid of them. What they do have is referrals to already existing resources in or the slowly developing, carefully hidden outside the plant. They must go out in the condition, usually hitting a man as he gets to be community and find out what resources there about 40 and is just reaching his peak are in the plant–the plant probably already has productivity in the company, a peak he never resources to take care of this, but it has never achieves. been done. Q: How does absenteeism stand with Then they start helping a few people. these people? The first ones they get are often going to come A: We have a few clinics started in some from the disciplinary board and are going to be industries, and their records show that the the worst cases and have to be sold the idea. alcoholic’s absenteeism rate runs a little better When they find that this has helped six or seven than twice that of the average of the whole plant. fellows–and you know two of them and you know three of them and so on–the word goes Q: Would you call that high or low? out and management says, “Now, look. Our A: Twice as high as the rest of the whole policy is not coddling–this is not a home for plant. For instance, if the absenteeism runs 4 drunks–but when we think alcoholism is per cent for the whole plant, it will run 8 or 9 per involved, we are going to treat it as any other cent among the alcoholics in that plant, among problem. We are going to try to help this person the early problem drinkers or incipient alcoholics and give him every possible chance. If he won’t in that plant. live up to it, then–out. We will change our retirement, our disability, our pension policy–we Fortunately for business and industry, are going to keep an open, flexible mind on this.” therapy is easier with this group than with any The man in charge will try to change other. Success expectancy is fantastically high, negative attitudes in the medical and other partly explained because the motivation for departments. Something can be done, and this recovery among these men is tremendous. In is shown most clearly through the successful

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cases. Then the man will try to get to some of be answered from the point of view of a the foremen or the floor supervisors, because particular ethical system. One ethical system will they are the men who know just who the say, “Yes,” another will say, “No.” problem drinkers are. If they will co-operate, cases will be gotten sooner, the therapy success Q: Do you have a personal opinion on rate will rise, a lot of cases will never get to the that? disciplinary committee, and so on. A: I don’t have any great opinion on that But the supervisors and foremen have to because I think your second question makes the be shown that something can be done, that this first one–for our society in this century, will be more effective than hiding the cases, that particularly–academic. it is not a snooping, “dry” movement, that it is not a sentimental, coddling program, that it will not Q: You mean it is impossible to get rid of result in firing the man nor in interfering with it? production, and so on. A: I would say at this time we don’t know This problem drinker is almost never at of any technique by which you can get rid of it. the plant when drunk’ by the way. He’s there in a rather late hang-over, beautifully masked, doing Q: Looking at the thing in its broadest nothing or sometimes making mistakes, a possible angle, we’ve developed in America two horrible public-relations liability. His friends points of view about the liquor problem. One is cover up, and nobody says anything. frequently expressed under the word So we suggest certain ways of talking “prohibition,” and the other one under the with the supervisors, maybe giving them one or heading “moderation.” In your studies, do you two pages of statements, showing them a 10 or feel that we would solve this liquor problem by 12-minute movie, giving them some idea of the complete prohibition, the extinction of the problem and the program. Maybe half of them manufacture of alcohol? will catch on and will start sending a couple of A: Let’s put it this way: If there were no people in–anonymously, quietly, and not even alcohol, there would be no problems related to connected with the records. alcohol–period. There is no question about that. If you could eliminate alcohol, there couldn’t be Q: Where does a company find out all such a thing as an alcohol problem. the things necessary to institute a program like this? Q: Do you mean that you would really A: We at the Yale Center run special 3 remove all the problems related to alcohol, or do and 5-day courses just for industrial people. you mean the problems that people think they solve by alcohol? Q: Can this be found anywhere else in A: I mean that you would eliminate any the United States? function that alcohol plays in crime, poverty, A: No, but certain plants are doing their disease, death, disgrace, alcoholism, and so own work. forth–by definition.

Q: Then you are the center of information Q: But you wouldn’t remove those on this whole subject. Can anyone get literature problems, would you? from you? A: Oh, no. In some of them I would say A: Yes. that the use of alcohol plays a larger role than in others. For instance, I would say that you would Prohibition? eliminate the biggest crime of all–drunkenness. That is the single biggest crime in the United Q: Should we do away with alcohol? Can States except for traffic violations. we do away with it? I think that among the others you would A: “If we should” is a question that has to unquestionably eliminate a certain amount of disorderly conduct, and you would eliminate a

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considerable amount of petty assault. For We have had two major problems example, you and I get mad at each other, and blocking greater control and growing prevention we were probably going to get mad at one of this problem: lack of quick, easily another, alcohol or not alcohol, but with a few administered, reliable tests to establish how drinks in us, or in either one of us, it is more much alcohol is in a person’s system at the time likely that we are going to get into physical of the accident and the general tendency to violence, because the inhibition or control of lump all alcohol problems together as just one, aggression is reduced. Instead of just swearing simple problem. The first barrier had to be at you, I throw something at you–perhaps I overcome so that police, courts, legislators and won’t throw with any great accuracy, perhaps lawyers would have a means to allow concrete you won’t duck with usual speed or accuracy. distinction between the driver under the But the emotion and behavior that went into a influence and the person who was not. Walking fight, let us say, could have been dissolved a straight line, the odor of the breath, and through more socially acceptable avenues than disorganized behavior after an accident are not those opened up by alcohol. good evidence of “being under the influence.” Until a useful means was developed, the courts Traffic Accidents and police were effectively blocked from efficient enforcement. Q: What would you say the effect of We now have means for gaining factual, successful elimination of alcohol would be on undeniable evidence of the amount of alcohol in traffic accidents? the brain. The best of these techniques—I might A: Granted than no substitute came in– be a little biased on this–was developed by Dr. like bootleg liquor–I would say that all sorts of Greenberg at our laboratory, and is being accidents would be cut down. For instance, you increasingly used by courts and police. Its use would eliminate the effect of fatigue as it lowers will not only end the “two beers, Judge” alibi, but acuity and discrimination. You would reduce the will also protect the innocent, such as the man expression of aggression in driving. Alcohol, so with concussion or the diabetic in insulin shock to speak, allows extended fatigue and who is arrested for drunk driving or anything else aggression in driving and these are major and is tossed in the police lockup–sometimes to factors in auto accidents. die–because he acts and looks like a drunk. Distinguishing this problem from the Q: Are there statistics that show that other alcohol problem is, I believe, on the way. It traffic accidents are primarily due to alcohol? is not the “Skid Row” bum or the late-stage A: I would not say “primarily.” alcoholic who is involved in these automobile accidents. Q: Would you say that they are incidentally due to alcohol? Tests for Drunken Drivers A: I would like it larger than that. Figures have been put out fairly regularly by the National Q: Who is? Safety Council from which it would be fair to A: No one has ever reported just what state that alcohol is involved in 20 per cent of all the social and personality characteristics of this fatal automobile accidents. I would say that is a category consist of. The public is probably 99 gross underestimate. per cent united against driving under the influence. However, they are far from 99 per Q: What can be done about this, or is anything cent against drinking. Once we can separate being done? these two, so that the public can attack the A: This is one of the problems related to specific problem without getting involved in the alcohol about which a great deal could be done. old “wet-dry” fight, then the way will be much A start in this direction can be seen, although – clearer to overcome this menace. this particular cloud is still little bigger than a Some legislative changes are needed in, man’s hand. perhaps, 30 States. The real need today is to

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give the facts to the driving public so that they period. Advertising isn’t going to change can realize in ordinary language just what “under alcoholics one way or another. the influence” means and how one gets to that point. The insurance companies could play a big It might affect them in that, if you keep part in developing such information, as could saying a certain brand name, the next time they driving schools, automobile associations and, go in and ask for a shot they may ask for that after the program was set up, the police and brand. I doubt it will have much effect, because courts. Without such education, mere use of the after they have had a considerable amount of new gadgets is not likely to be too effective. alcohol, 75 per cent of them will be short of cash. Q: What’s blocking use of the new devices? Q: Then you would say that the stimulus A: Well, time is needed for the police and for drinking wold have to be looked for courts to try out the new techniques and learn somewhere else than the advertising of the application problems. So far, their experience product? has all been highly favorable. Then, lawyers and A: Yes. doctors interested in these cases must learn that none of their rights or privileges is being hurt. Q: How would you list the order of General education, plus experience, is needed. I stimuli? For instance, are social gatherings and think that an enormous reduction of this really social customs the primary thing today? unnecessary death, destruction and misery A: Well, I will start off with the word could be achieved in as short a period as five “custom’‘–but then remember that I am one of years if people got behind the police and courts, these academic specialists, so I will want to supported studies and helped in dissemination hedge on what I define as “custom.” There are of the facts. Further, I think the motivation for certain groups in which there has been a custom this sort of progress is good. At that moment it of drinking for generations. Now, when the father needs leadership. This one of the alcohol- and the mother and the close friends of the related problems is in large measure susceptible father and mother–they may be in the to successful attack here and now. neighborhood or not–when they ordinarily drink and their drinking is fitted into the daily routine of What Stimulates Drinking their life (not the “whoopie-whoopie–aren’t-webeing-daring” type of drinking), then their kids, Q: What would you say is the greatest other things being equal, are going to use stimulus to the drinking of alcohol? Is advertising alcoholic beverages. a major factor? If you go to the other extreme, where A: We can show that advertising has had father and mother not only do not drink but also little or no effect on large segments of the have expressed strong, negative feelings about population and never has had. drinking and, to make it stronger, these are backed up by the church and the school and the Q: For purposes of stimulation in social clubs, then that person is not going to extreme cases? drink until, and unless, he gets away from that A: For any purposes. In extreme cases it social milieu. If he does drink, he will be has no effect whatsoever. For those people who rebelling from or simply moving away from his are susceptible to be affected, yes, it may have group. His drinking, by the way, when he starts some effect. And then if those people become is going to be more experimental, less well extreme uncontrolled drinkers, I cannot tell you modeled, characterized by more mistakes, just what proportion that ad played, for, once they because he has no background for it. He is not have become extreme drinkers, I don’t care if fitted for a drinking society any more than you or you have a sign on every window in the city or if I are fitted for an Eskimo society. there isn’t a sign within a thousand miles, they are going to go on being extreme drinkers– Effects of Religion

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refers to all the controls we have adopted– Q: Is he more intemperate in his drinking whether we approve or not, or even recognize then? them or not. But where the inhibitions, the A: Let’s take two extreme groups to taboos, the restraints don’t upset more than 5 or make it simple: For example, the Mormon group, 6 per cent of the group, I don’t believe it would which is a very well-integrated group with a follow that mere numbers of inhibitions would religious system penetrating right through family, create rebellion. government, economics, neighborhood, However, if you have a series of everything; and then orthodox Jewry, which is different groups in a society (and this means also very strong with an all-penetrating religion there would be differences in the patterns of so that we don’t know quite whether to call it a learned controls in each) and where there is religion as such–it is a total way of life. mobility for individuals, as in the case of war In the Jewish group, more than 90 per when all the young men may go out from home cent will use alcoholic beverages and will use and meet others, then you may have people them certainly more than 50 times a year. They suddenly finding out, “By golly, I am inhibited.” will probably use wines, distilled spirits, beer. In They may become, though not necessarily, very the other group, the Mormon group, a very large bothered about this. percentage (compared with all other such A lot of young men, 17 or 18 years old, groups in the country) will not touch the stuff. may think: “Here I am in a uniform, but I am not I would say that, of the drinkers in the really a man. All these others in the camp think Mormon group, which will be a small number, I’m a damned sissy and maybe I am.” you will find a high percentage of problem drinkers and later on alcoholics. Amongst the Q: And then he may take a drink? Jewish group, with almost all being drinkers, you A: He may feel that he has to show off, will find a very, very low percentage of problem one way or another, but he doesn’t know how. drinkers and alcoholics. He may, like any young person taking on a new Now you shouldn’t jump from this and pattern (whether it’s dancing or bowling or say, “Well, let’s start everybody drinking at the getting a job), overshoot the mark or do things age of three!” That doesn’t follow at all. differently from everyone else, and then may have superguilt. Q: Do you think the segment of society in Here’s the fellow who has come up in a which the inhibition is great due to religious and society where drinking is quite ordinary. When other environmental factors produces a greater he starts drinking, he might overdo and even get number of rebels, or is the number incidental drunk. He will be punished one way or another. who go out and deviate late from their However, this experience does not have a teachings? terrific impact on him. He doesn’t feel that he A: Rather than the number of inhibitions, has been singled out by God to be cursed, that I would say that whether these sanctions he is essentially evil. Another fellow from the worked, were acceptable, were easily adopted Mormon society, where drinking is held a sin, if by the individual, was the more pertinent he experiments and gets drunk, he may well feel question. For example, it is an inhibition that super-guilty, he may feel that Satan is none of us here may go around without clothes, responsible. So that it is not only that he drank but I don’t think it bothers one person here. too much, it is his reaction, his interpretation of Maybe it would bother one out of a hundred. the event. It may mean he feels: “Now I am Where inhibitions are not putting the person in a through with my family, my religion, I can never position of conflict, where his life is satisfying go back.” His response to the act is just as enough so that he wouldn’t call them inhibitions, important as the act itself. then inhibitions are not creating rebels. To most of us, inhibitions are strong, ‘Wets’ and ‘Drys’ unconscious controls against actions we think we might like to perform. Actually, the term Q: I can understand why the “drys” don’t

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like your work, but why is it that the “wets” don’t A: It may result in there being worse like it? liquor, but alcohol is alcohol. It is a chemical, A: We have been discussing here at and goodness and badness doesn’t enter into it. length alcoholism, drunkenness. When stories. As for bootleg liquor, there is no question that it On alcoholism, drunken driving, excess drinking is produced in the most unsanitary and the like appear in the papers, everybody in circumstances, that it gets very little attention, the industry shudders— you get it loaded with who-knows-what. It has in some places a most mysterious sacred Q: Afraid it is going to lead to prohibition” character, however–“I know Old Joe up in the again? hill over there and he makes the original white A: Yes. It is implied that discussion of mule,” and things like that’ and everybody such subjects is nasty–there probably isn’t any around there starts buying it and feeling, “Wow, such problem; it has been vastly exaggerated, in that’s wonderful stuff,” and if the market goes fact, alcohol binds the family together, etc., etc. up, they start producing it faster and they are Then one of the companies about 6 or 7 years under pressure of being caught, so there has to ago, to the shock and horror of the rest of the be a rapid turnover. There are no ‘controls by industry, came out and said some people should health authorities or otherwise. not drink. Wow! Well, it turned out to be all right: When the situation gets really tough, you they’re still in business. Doing very well, I may be getting half water, one quarter ethyl understand. alcohol and who-knows-what else. It is an irresponsible group operating without controls, Q: Have you any facts as to whether without the law, in business for the sole purpose conditions in States where they have full State of making dough and making it fast, with no control are any better than in the States where necessity of figuring out “Will my customers like they license retail distribution? me five years from now?” A: You get what might be called a “lip The big liquor people are under a reading” or “false correlation” on this. The tremendous pressure from that alone. The difference between the monopoly and the bonded people have to start, say, in 1950 to licensed States is not particularly great. When decide what they are going to make. By 1951 or you take the States in which local option is very ‘52 it is whisky, but then goes into a warehouse widespread–like North Carolina where of 100 for five years and then they can sell it. Imagine counties perhaps are dry–or take the two dry the pressure they are under to maintain good States, from our estimates there is a lower relations with their customers. Their capital is degree of alcoholism and there are fewer tied up in the customer’s response five years in drinkers. However, we would call this a false the future. correlation. The reason you have prohibition is obviously because you have social groups and Q: Do you think the bootleg situation is categories who are “agin” drinking— getting worse? A: I really don’t know. Q: They wouldn’t be drinking even if it were there? Q: The argument in Congress is, of A: Right. And their numbers are course, that the high taxes will drive the country significant enough so that they get political into bootlegging-action. But if you go into Kansas or Mississippi A: And, theoretically, I believe that it is a or Oklahoma, you will find the “AA” groups good argument. Whether in practice it is true or everywhere. not, I can’t say. To my mind this is one of those little conflicts way off in left field, just as in my Q: What about the tax situation? Do you mind the advertising issue is way off in left field. find that the bootleg liquor creates worse They happen to be the two things that the “wets” conditions? and “drys” are fighting about–one about one, the other about the other.

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I would like to see a check on the outpatient clinics, an inpatient facility, an bootlegging matter from an unbiased source, education program with schools, and so on. through the revenue reports. But in my memory, Also, since then about 40 of the States and this is most casual–for the revenue records developed some type of alcoholism program-have figures on how much illegal stuff was there was nothing prior to this. seized, the size of the place, the amount of the In 1946, some of the people who had alcohol, the potential production per day–it been at the School, and others interested in seems to me that for some places, like New alcoholism, said to us: “Look. You people are England, there is no striking change. trying awfully hard, but you can’t effectively get But this is not a conclusive argument, your information out to a wide public. The because the size of the agency and its finances scientific journal is just dandy, but who reads for going out and making the arrests has not scientific journals? And how many will read gone up, so maybe they’re just operating to full these lay pamphlets or the popular book of the capacity and their records have reached a top. American Association for the Advancement of But I am very suspicious of the liquor industry’s Science, ‘Alcohol Explored’? We need statistics, just as I am very suspicious of the community organizations to educate the public statistics of the “drys.” about alcoholism Will you help?” We created the National Committee for Q: What about clinics? Education on Alcoholism. A: In 1944 we decided to start an Soon we found ourselves to be a outpatient clinic just for alcoholics. We had had popular health movement, like mental hygiene or laboratory and library studies, but no clinical cancer associations. Once this got started, we studies of our own. With the co-operation of the pulled out of it, since this sort of work is not an Connecticut Prison Association, we were able to appropriate function of a university research set up two such clinics, one in Hartford and one department. in New Haven. These were to be research It is now called the National Committee clinics, but in about five weeks it was obvious on Alcoholism and is an independent that a different purpose was being served. They organization. The clinic movement was more weren’t research clinics–they were service and more taken over by an increasing number of clinics. They were mobbed, mobbed by what we State commissions, and they soon started a would -call “late-stage alcoholics.” National States’ Conference on Alcoholism.

How Clinics Progressed Q: How many years have you been studying in this problem? Q: Seeking relief— A: I got interested in it because I was a A: Yes, willing to try anything new to potential criminologist; I’ve been with the escape the pain of the alcoholic life. This began Laboratory since 1942. to be pretty successful from the point of view of service. But from the point of view of research– Q: You’ve been exposed to all phases of well, I can’t say they accomplished “nothing,” but this in 10 years or so–has it made you a it was a very minimum. However, by the end of teetotaler? that year people in the Connecticut Legislature A: We at the Yale Center are kind of rigid approached us with a bill, which we strongly on answers to this question–maybe a little opposed, setting up an alcoholism program, unnecessarily so–I don’t know. However, we which was to be operated in the form of a feel that either the facts, researches and specialized hospital for long-term care of conclusions are right or are not–and are committed alcoholics. effective or not on there own merits. And the fact This legislation was changed to allow a of our own drinking or nondrinking we feel, program emphasizing voluntary outpatient doesn’t make any difference. Certainly no one clinics, and Connecticut’ in 1945, established the on the staff is an extreme teetotaler or an first commission on alcoholism. Today it has six extreme drinker.

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say that in 20 of those 40 other countries they Alcoholics Anonymous are Americans who happen to be over there. This business of clubs and voluntary Q: How extensive is the “AA” movement associations–Elks, Chamber of Commerce, or in America? the like–is an American phenomenon. It clicks A: There is no organization to this group. pretty well in the British Isles and in There are no officers. There is no treasury. Scandinavia, Australia and New Zealand. But There are no minutes. For each group there is a you get over into France–well, I think there is chairman, theoretically revolving every month or one French member. Of course, there are two. But they find that as soon as you set up a Americans in Paris who are permanent fixtures. typically American hierarchy with “Mr. Big” at the But the French and Italians simply don’t have top, then some of the boys, as soon as they get such organizations. There is no feel for it. It is a up there, fall over into the bottom again. This typically American thing. matter of being the big man, big ideas, big expansion, responsibilities, building this clique Q: Do the other countries have the up and that clique down–that has been found a alcoholism problem at all? nice way to get back to alcoholism, not a way of A: Oh, sure. recovery from it. Significant Role of ‘AA’ Q: Do you have statistics on how extensive a group it is? Q: If the psychiatrist has been stymied A: Their figure can be determined from treating the alcoholic, what has “Alcoholics their paid-up membership–I think theoretically Anonymous” been able to do? each local group is supposed to give a dollar per A: Now, I think the psychiatrist can play a person per year to the central agency for the significant role. I think that “Alcoholics publication of the book, information, intergroup Anonymous” can–in fact, anybody that knows service and the like. They pass the hat at them at all knows that they do–play a most meetings to pay for the rent of the hall and for significant role. the coffee and cokes and stuff. Some feel they must be drinking something, and sweets seem Q: Then why is it that “AA” can succeed to be necessary for some. and the psychiatrist can’t? This paid-up membership of groups A: Take a certain alcoholic who is pretty amounts to about 130,000. Their membership–I well along in his alcoholism. He shows certain don’t know what a member is–is a man a acute physiological problems. They will usually member the moment he walks in? Does he have pass away in four or five days. He also has to be in one month, two months, three months? psychological problems. By the time he’s gotten There is no definition. I would say there may be into this whirlwind he is frightened, in a world of in the neighborhood of 175,000— pain, sometimes beginning to act in a very immature fashion, usually very egocentric, Q: Out of about 4 million alcoholics in the interested only in himself as though a wall had U.S.? grown up to separate him from others. Let’s say A: Yes. that there is a wall within all of us protecting our ego, but there are doors and windows through Q: How many groups are there? which you go out to people and people come in A: I would say that in this country there to you. are, perhaps, 3,000. With the alcoholic it seems those doors and windows are getting smaller and smaller–he Q: Then is this same movement true of isn’t interested in other people. And if an other countries? alcoholic begins to show interest in you or your A: They will show you groups in 40 or job or what you are doing, all I can say is “Look more other countries. As a wild guess, I would out!” He’s going to touch you pretty shortly–for a

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drink, for money, or something. He is not Differences in Treatment interested in you. He is not interested in ideas and things or people. He tends more and more– Q: What does the psychiatrist do and many of them–to become an isolated drinker, what does “Alcoholics Anonymous” do? often a lone drinker. He has terrific A: The psychiatrist goes back to the ambivalences and many of them show as psychological roots. He may or may not give the incompatible drive, like, “I want to be Napoleon,” man some immediate physiological help which or “I want to be Casanova,” or “I want absolute means rest, food, some sort of sedation so that dominance,” and at the very same moment, “I he can get over the hang-over. And it doesn’t want to be like a little baby in its mother’s arms, work’ because he is only trying to hit one wheel loved because I should be loved.” out of a five-wheel vehicle or a four-wheel These are absolutely incompatible vehicle–except in extraordinary cases. needs, and yet that incompatibility can be “Alcoholics Anonymous” does a series of resolved temporarily in alcohol because things. One of the psychological, social, discrimination, judgement, self-criticism fall personality problems of the alcoholic in the later down and the man gets to live more and more in stages is that he gives up hope–hope in himself, a world of his own, unhindered and unfrightened hope in people, hope in the world, hope in God. by ordinary -people, ideas and situations. It seems to him all useless. In addition to physiological and psychological And it is impossible for him to get out of it troubles, there are social problems also. The unaided. He has tried everything. He has tried a man gives up ways of doing things and does hospital, he has tried three doctors, he has tried less and less. He is less and less interested in a sanatorium. He has been to ministers, priests, attitudes, ideas, beliefs, intellectual questions judges, and they have all given such “damned and problems around the community and he fool” advice as “Look, old boy, why don’t you be becomes increasingly afraid of close, a man; look what you’re doing to your wife. Why emotionally meaningful, interpersonal groups, don’t you control your drinking?” such as a friendship group, a marital group, This man knows what he had done! He parental group, and that sort of thing. And it is has cursed himself more vitriolically than anyone from such groups, of course, that we get our else could. He had been cursing himself for major stimuli to do things, our major years. But the “AA”’ from the very first contact, punishments for doing wrong. From and inside expresses to this man the feeling that he, too, such groups we get our very reasons for living. was there. Charlie cannot only match him story With the decrease in activities, in ideas and in for story but he has been in 10 jails that this new primary group membership, the man becomes fellow never even heard of. He has had desocialized, so to speak. everything this guy has had and more, and here And, by the way, those social and he is–his coat matches his pants, he has shoes psychological characteristics are just the reverse on, and all that. But, most significantly, he sides of the same coin. The man who feels he is seems to be happy. He seems to be amused going to be the greatest writer, who is going to about the whole thing. There are some who make the biggest sale, who is going to swear off aren’t, of course. liquor for life, or who is excessively cynical or I am building up an ideal picture. There aggressive, is just the man who can’t long may be a few “AA’s” who are just like the old remain a member of a primary group. sawdust-trail boys. But the new candidate for Membership in such groups punishes wild “AA” begins to see that he can do it. Here’s a activity or non-activity, punishes extreme man who did it. “It can be done!” idealism or cynicism. So you have these physical, social and Q: In other words, the approach varies psychological problems, and the drinking dramatically from the psychiatrist’s? problem itself that have to be met. A: Yes, the “AA” talks to the man. This approach is often the opposite to the nondirective therapy of the psychiatrist—the

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psychiatrist must keep his mouth shut and the “All right, I’m licked. Can you help me?” That’s a patient must let out. The “AA” violates that horrible thing to have to say for a frightened, principle. He just sits down and says, “Well, let egocentric alcoholic, and he may only half say it. me tell you about me,” and may not let the other The “AA” gives him something to help fellow get a word in edgewise. him immediately, right now–none of this claptrap But it is convincing to some that there is about “Can you come around next Tuesday at 4 hope–and this he never got from a psychiatrist p.m.?” That is perfectly ridiculous. because the psychiatrist doesn’t know about Any time we get people trying to come alcoholism as this “AA” knows it. The recovered into our clinic from New Mexico, or somewhere alcoholic may not know about Oedipus far away–they all have long-distance complexes being resolved, but he does know telephonitis–if we don’t want them, or can’t take about drunks and butterflies tromping around in them or see that they are half potted anyway, we your stomach and all that. He has had bigger tell them, “Now, you come around next Thursday butterflies and has conquered them and is at 3 p.m.” They won’t show up. happy about it. The alcoholic’s problem is for him The “AA” doesn’t tell the potential new tremendously immediate, and his feeling of “I member that he must go through a terrific would accept help if I could get it” is right here, regime, he must control himself, he must fight now, 4 p.m. Tuesday afternoon. By 6 p.m.–“the the good fight, and so forth. No, this “AA” has hell with them!” more fun out of life than the candidate has ever But the psychiatrist has to give them a had and even has dough in his pocket, his wife future appointment. He can’t just say, “I am here likes him again, and so do his kids. The thought any time for you boys.” Both his professional that “Maybe I could do the same” can strike the and personal life would be smashed. But the potential new member very realistically. Now “AA” is ordinarily there at the time and he offers that is one aspect of it. some immediate, practical support. He knows Another is that the psychiatrist is some techniques of helping out a hang-over–at inevitably talking downhill. He is on one side of least he thinks they work. the desk and the alcoholic is on the other side. The physiologist may look at such He is well dressed, professional, of techniques and say, “This does not change the tremendously high status, and authoritative, and oxidation rate of alcohol by 10 seconds.” But this the alcoholic is very often scared to death of “AA” thinks that it does, and helps this guy and authority and so forth. thus gives him the kind of magic that makes him feel better. He then gives him something to do– Finding Pals in ‘AA’ and this is tremendously important, because here’s a man who has been holding himself Q: The “AA” is more like an equal? away from everybody and everything–“Come on A: Yes. He could be a recovered banker over to the meeting tonight!” or a ditchdigger, though ordinarily a banker will This alcoholic is terrified, but he goes to work with a banker and a ditchdigger with a the meeting and he sees 15, 25, 50 fellows-ditchdigger. There is hope; there is a certain and they all seem happy! They look at him and amount of happiness; there is this interplay. That say, “Come on in, boy!” personality wall has been broken down a little. Remember, this alcoholic had to let the “AA” talk to him. The “AA” is not going down the street to Friendship, Not Rejection find a drunk and help him. He may try that a few times, but after he has been rejected regularly Q: It’s a different treatment? he will quit that process and will go only when A: Why, he hasn’t had that sort of asked and when he sees that there is really treatment–maybe ever. Anyway, for a long time some hope of doing something. He can help it has been: “Look at that drunk! Get him out of only when the man has, so to speak; tentatively, my office! Out! Out! Out!” Nothing but arrogance, partially temporarily surrendered a little and said,

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holier-than-thou business–even by those who A: For a few, perhaps, but this man have been trying to help and be sympathetic. probably regards Army shelters as a place for These “AA” people seem happy. He may drunken bums who are religiously a little hear something about the “God stuff,” but a lot of peculiar. He does not consider himself a bum, the boys will tell him: “Don’t you worry now doesn’t want organized charity, and is very about the ‘God stuff.’ Some of us are having hot scared of religious appeals. Where can he go? flashes and messages from mountain tops. But He is all too apt to land in a hotel room looking some of us just don’t seem to get it, so don’t let at the four walls and feeling greater and greater it worry you.” The only thing is this: “Do you think need for a drink. And getting the drink, perhaps you could keep from taking one til 6 o’clock after a great struggle, is a pretty sure thing for a tomorrow?” drunk because self-pity is going to get bigger Ah! He has heard about six-week deals, and bigger and bigger and the personality walls swearing off for life, and all that sort of thing. separating him from society and its values will “Well, I don’t know–” “Now, wait a minute. Here get higher and higher. are some ways.” And so they force chocolate But with “AA” he has a place where he bars or coffee or some pet remedy down the can go, where there is a bunch of fellows sitting man and give him something to do during the around batting the breeze–some of them are day. They ask: “Where are you going to sleep shooting craps, some are talking about the last tonight?” six hopefuls they picked up, and it may even He hasn’t any place to sleep at all–or, look like a barroom with cokes and coffee, with worse, he has a place to sleep–home. He has to his kind of people standing and sitting around. go home to the little woman and this is going to Some of this prayer stuff comes, but that is a make him drink. small price to pay–it only lasts three or four So maybe they will find some place for minutes. He sees a lot of men who look just like him, just for that 24 hours, and he will come him, and he can go there seven nights a week. back the next day. The haze has been partially And if, when he’s home, he suddenly gets that lifted, and these people were friendly. Now he feeling, “I’ve got to have a drink,” he has two or has friends and he has hope–a very glimmer of three phone numbers and somebody will come a hope, perhaps also a: “These fellows may over to him and use one of hundreds of have something. I’ll get it in about six weeks and techniques. They talk, plead, curse them, slap then I will be able to drink like a gentleman them, coddle them–some kind of help to get again. ‘ over that feeling they have to have a drink. The other boys will know he may feel this Pretty soon this alcoholic begins to get because they went through the same deal, and some new ideas in addition to immediate help, hey accept it. All right. So they help him in very something to do and association with friendly simple, material ways. They know a fellow who people. knows a fellow and so he may be able to get a Because this “AA” program suggests that job, a bed, somebody who will hold his wife and there are certain things that he has to do about kids off of him for a while, whatever it may be. himself mentally and emotionally. They tell him And there is something for him to do at night. to look at himself and to take inventory. “What’s Now, this man has sworn off before. He wrong with you, anyway?” has been on the wagon once or twice before, and what did he do? He couldn’t go around with A Power Greater than Self his usual friends. Should he go to the church social a couple of nights a week? He wasn’t the The 12 steps of “AA,” by the way, only kind of fellow who would fit into that. He wasn’t mention alcohol or alcoholism twice. Once they interested in what they talked about, what they say, “I admit that alcohol has come to dominate did, or what they looked like. Where else could my life,” or something like that. “I admit” is the he have gone–the club? first. The last step suggests, “I will go out and help other alcoholics.” Other than that, the word Q: The Salvation Army? “alcohol” does not appear, and that last is pretty

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incidental as you can see. “I’ve got to look at charity, or ask for dues. It does offer a sponsor, myself. I’ve got to study myself. I’ve got to do it a man to lean on during the first days or weeks. as honestly as I can. I’ve got to try to find out But pretty soon “AA” requires a man to do more what are the forces that seem to be, impinging than receive and lean–not that there are any on me.” written specifications. As many “AA’s” will say: “We think that The new man has to make a selffinally all these forces can be stated in terms of analysis with another man. He listens at a power greater than the self, which many of us meetings, is encouraged to speak with the call God. Gall it what you will, but there is this others at closed meetings. Then he is asked to power; it affects you; and you have to learn how speak at an open meeting and to help another to manipulate it. The first thing you have to do is candidate. These things are helping to break to study yourself. Get some other member to sit down the old self-protective walls. And in the down with you, probably your sponsor, and try to process he may get some very real awards. figure it out. How many people have you hurt, for Now he is not only leaning on his sponsor, but instance?” another fellow is leaning on him. He is moving Oh, boy, here he can flatter himself with back slowly into emotionally meaningful group self-pity and guilt and make himself out the membership and doing it without his alcohol biggest alcoholic of the bunch. He can take a crutch. telephone book and check off almost every He is also getting new ideas, not only name all the way through. “Do you think you can from mixing with others while sober, but from the make amends to these people without hurting self-analysis and from figuring out how to help anybody?” And here is another chance for this is new baby (candidate) and what to say at the self-pity, exhibitionism, grandiosity. But it is a meeting. He may even read the “big” book called controlled, positively useful way for the man to “Alcoholics Anonymous.” He is gradually capitalize on certain personality weaknesses–of refinding ways of doing things, ideas and course, not all alcoholics will have these primary group membership. Also he is getting particular problems. the benefits of sober living in health, jobs, etc. Other steps concern getting into more He has change in his pocket, his wife is effective contact with this higher power, which beginning to think that she has a human being some of them call God, and with furthering self- for a husband again. Some people note, “Gee, understanding. Finally, the 12th step suggests George is sober; he even seems to have fun that, after having had a spiritual experience, or a doing things he never had fun doing before.” basic change in thinking and feeling, they will try to carry the new principles into all aspects of Help at Any Time their lives and, also, extend them to help other alcoholics. Q: Can the alcoholic always find the Well, some of them, of course, jump from “AA’s”? step 1 to 12 and they are out there beating the A: “AA” isn’t 24-hour a day therapy, but it drum to save other alcoholics too soon, but that is always available. Then, when the man begins is understandable. to get the idea of living again and begins to like some other people and is going out to help Joe Q: The first method of approach of the and identifies himself with Joe, then all of a “AA’s” then, is to be friendly on an equal footing? sudden his whole psychological picture has A: Yes, to give realistic evidence that changed. As Dr. Harry M. Tiebout has pointed there is hope of recovery, to help with, out, instead o f just complying with “AA,” he immediate problems, if possible, to present the accepts “AA.” He may never have gotten down newcomer with a possible place to go, things to to the basic psychiatric problems; however, I do, and a program. Let’s note that “AA” doesn’t would say–just for an arbitrary figure–that for 50 preach, doesn’t ask for pledges, doesn’t blame, per cent of the alcoholics, deep psychotherapy doesn’t ask for conversion, doesn’t postpone, is probably contraindicated and might well doesn’t interview or take records, doesn’t offer trigger off more troubles than there were during

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the alcoholism. He needs to stop drinking. He over water. They put the rats on a very limited, needs support. He needs psychological help. He almost starvation diet to allow testability. Some often needs physiological help. He needs of the rats went for the alcohol and then seemed resocialization. to want to go on with it. Some persons drew the conclusion from this experiment that some rats How Alcoholism Starts were physiologically “set” to like alcohol. This was sufficiently challenging to the physiologists Q: Of several alcoholics I have known, I in our laboratories, Greenberg and Lester, to asked one of them what it was that got him – make them check such a conclusion. started after a long period of years during which We happen to know that there are no time he didn’t touch liquor, and he told me that vitamins in alcohol. Vitamins don’t pass over the he had been employed as an assistant sales distillation process. But alcohol is full of calories. manager and was making great progress. Then These rats were on a starvation diet. Greenberg all of a sudden one day he came in and they had and Lester said: “Let’s run that test over again changed his office, removed his name from the and give them a little bit more choice.” So we door and put him at the end of the hall and gave them water, another liquid with calories in demoted him. He went right out and got drunk it, but not alcohol, then just alcohol. Then the and attributed it entirely to the disappointment. Is rats were put through the same tests as in the that a typical cause for this return to alcoholism? earlier experiment. A: Tension, shock, or sudden changes The original conclusion was shot to for some of these people is too much and they pieces. The rats were hungry! They took the are less able to adjust or adapt themselves to material loaded with calories. This time there painful stimuli. However, I would want to ask a were two choices with calories. They took the lot of questions about the case you cite. Who non-alcoholic type, perhaps because it didn’t stated that he had “been making great have the sharp taste-effect of alcohol. What was progress”? What had he been doing the there in the alcohol itself in the first experiment? previous weeks, which led to the demotion? It had calories and so the rats could drink their Why had he been acting that way? Was his meals. That is what many alcoholics are doing. demotion a great surprise to others? Was it really a surprise to him? Was it a useful excuse Q: But why are they usually emaciated, to get drunk? Did he get drunk because he was then? shocked, or because this was his way of getting A: That is because of the life they lead, back at the boss? Anything can serve as an not alcohol, although since alcohol is by itself a excuse. It is worth noting that a great many most unbalanced food for human diet and since people have been demoted, and even though for some, during binges, nothing but alcohol is they are regular drinkers they don’t go out and ingested, they are undernourished. But this is get drunk. By itself a demotion cannot explain not true of all. In fact, I don’t think you’d know an drunkenness. alcoholic when you saw one, unless (a) you’d known him over a good period of time, or (b) he Q: Could any physiological deficiency was on a binge. cause it? A: I don’t know just what that would be. Q: We’ve all known some persons who seem to There have been some experiments with rats, have a compulsion–if they take one drink, they by the way, to discover whether physiological have to keep on, so that they themselves have differences would accompany differences in said, “Well, I’ve just go to lay off the stuff acquiring a taste for alcohol. But a rat having no altogether.” Now is that compulsion culture can’t be called neurotic. They have no psychological? personality problems, although some of them A: There have been those who tried to are more aggressive and others more pliable figure out that this uncontrolled drinking did have and all that. Well, these tests were made to find a physiological base. I would say that they may out if any would show a preference for alcohol some day discover such a base. But to date they

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have not. Their evidence, we would say, is not lower X factor who drink and who do not evidence. One or two may have gotten a lot of become alcoholics, and that we will find a large publicity–anything which comes along in this number of alcoholics who do not have this “X” field is publicized. When people are very run factor. In other words, it may be significant, but it down, as during a binge, they show a lot of will not be a sufficient cause! maladjustments, some physiological. Dr. X sees one thing that seems to look awfully consistent, Aid From Drugs appears in all his cases, for example, a certain type of glandular action. Q: Is there some drug you can give Now Dr. X begins to compare the people to stop their drinking? alcoholics who come into his clinic with other A: One of our great problems has been people, and he finds that 99.4 per cent have a to get increasing segments of the public to tremendous glandular deficiency–or imbalance– discriminate a little more. They have a tradition for example, an adrenalin deficiency. The of 100 years in which a highly organized, very alcoholics he sees have an adrenalin deficiency, sincere, emotionally powerful, beautifully much more so than nonalcoholics. I know some effective organization has told people again and other things about adrenalin deficiencies–they again that alcohol, drinking, drunkenness, the have a way of making people depressed, tired, other problems related to drunkenness and unhappy and weak. The major trouble with the alcoholism are all the same thing. And we say: obvious conclusion to this finding is itself rather “This is not so.” obvious: Does the alcoholic have an adrenalin You ask: “Can you get a drug to stop deficiency because he has been out on a binge, drinking?” Yes, you can–I don’t know whether or has he been out on a binge because of the the word “drug” is quite correct. Take adrenalin deficiency? “disulfiram”–most popularly known under the Suppose we go back and look at the trade name of “Antabus”–I don’t believe there is population age 15 and separate between the complete acceptance as to just what the greater and lesser adrenal-structural people. physiological process is, but, anyway, you take Then observe all those who drink for the next 40 this pill and any time within the next 24 hours if years and see if the alcoholics among them you take even a small amount of alcohol you are were all or chiefly from the weak-adrenal group. going to approach death–the eyes begin to Some people have alleged adrenal disfunction bulge out, the face becomes horribly flushed, the to be the cause, and also alleged that correcting blood count goes down to zero, and so on, and this condition is the cure. you know pretty soon you are going to stop I must admit we have to laugh a little at kicking. some of these reports, because they state: “Yes, we fix the alcoholics up and they go out of here Q: That’s a conditioned reflex, isn’t it? sober and in good health, saying, ‘We’ll never A: No, it is a direct chemical effect which have a drink again.“’ Well anybody who has ever will occur the first time. Whether there is in known alcoholics is not peculiarly impressed by addition a conditioned response following one or that. Practically all alcoholics have sobered up two experiences is a very moot point. But let me and sworn they would never drink again–done assure you of this: If just by chance you forget to so many, many times. We like to see them six take the pill and start drinking and then take a months later. We like to see them a year later. pill or two, there will be a most unpleasant result. We like to see them four years later. There is a difference between drinking and Now I don’t doubt that we may find a alcoholism. “Antabus” affects the drinking–not physiological difference in function, in structure, the alcoholism. in growth, which will be different from many alcoholics compared to the nonalcoholic Q: Oh, yes, but I thought the main idea population. But I would also make this forecast– was that these alcoholics wanted to stop the that if we do, we will also find that there will be a drinking-considerable proportion of people who have this A: Yes, they may decide, “My life is being

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ruined by drink’ so I will stop drinking.” That sort here. Knowing the alcoholic’s guilt, remorse, and of rational control is just what an impulsive so forth, he forgets, on purpose -or not, to take drinker can’t accomplish. That’s why he’s called his “Antabus,” and he suddenly finds himself in a “impulsive” or “uncontrolled.” bar and he has had two drinks, maybe three. He is very upset, he’s got alcohol in him now. He Doctor’s Care Needed rushes home and says, “I’d better take three of the things.” And he’s going to drop dead. Q: But does this mean that a person who Or there is somebody else in the house, gets started in alcoholism can’t stop? too–old Aunt Mathilda, who has nice strong A: There are certain so-called ideas about this. She might think: “What a clever “prealcoholic symptoms.” In that phase we know idea it would be if George were to stop drinking, people can stop themselves. But once this too. It is helping Harry.” So she is not by itself a “control” factor is lost, they cannot stop sufficient remedy for decides to give the pills themselves without help. secretly to George. And a death can follow from that. Q: They can use this drug, “Antabus,” The use of “disulfiram” is a little can’t they? dangerous, but under a doctor’s care it is not. A: Yes, but there is no question but that it However, it is not by itself a sufficient remedy for can be a dangerous thing. Let’s say you go to, alcoholism. It can help toward a remedy by the doctor and he gives you a supply of 12 of the aiding the individual to stop drinking. Without tablets, and you go back six weeks later and get other changes in the individual, it can do little. some more, and now you have this little horde. There are two or three things that may happen

Source: U.S. News & World Report, October 2, 1953

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