Consumer Reports. Nov. 1960

Alcoholism …the problem brought up to date

One of the most difficult problems that Even defining the clinical features of any family may be called upon to face is alcoholism as a disease is not simple. The alcoholism. The nature of this illness is such that physical signs of alcoholism, such as cirrhosis of the alcoholic is unable to overcome his problem the liver, occur only very late in the disease alone, yet he often finds it difficult to accept the after years or decades of uncontrolled drinking. help he needs from his physician, or Alcoholics Before this stage is reached, there may be few Anonymous, or other private or community or no signs of physical deterioration. The World facilities. Health Organization in attempting a description That his family, too, may be slow to seek simply says that alcoholics are “those excessive the necessary outside help is not particularly drinkers whose dependence upon alcohol has surprising. Only in recent decades has attained such a degree that it shows a notable alcoholism come to be recognized as an illness mental disturbance or an interference with their instead of a moral problem, and it still has not bodily and mental health, their interpersonal fully ceased being either a source of ridicule or relations and their smooth social and economic socially unmentionable. Moreover, the members functioning; or show the prodromal [premonitory] of an alcoholics family are very likely to be signs of such development.” While attempts fighting pangs of guilt, either conscious or have been made to arrive at a more exact, unconscious, arising from a nagging worry over, measurable definition, this seems to describe “what did I do to drive him to drink?” the condition adequately. Today it seems plain that an alcoholic is Medical authorities are well aware of a sick person whose illness has its basis in what an alcoholic does, even if they don’t know psychological or emotional factors, the precise the fundamental cause of his disease. His nature of which are as yet undefined. The conduct and actions are almost predictable. The alcoholic turns to alcohol to ease psychic pain or individual whose life is becoming unmanageable distress. We know that present methods of because of alcohol will need a morning drink, or treatment for alcoholism do not “cure” the drinks, to get going; he may sneak drinks, using condition, in the sense that the alcoholic can all sorts of subterfuges and devices to cover up continue “controlled” drinking. The patient must his secret. He may fail to return to work after shut off the use of alcohol completely and lunch. He will begin to come in late for work, and permanently. Ail the evidence points to that then will build up a record of absences with course of action as the only basis on which the flimsy excuses. He will slip out on one pretext or disease can be arrested and the alcoholic another for a quick one, carry a bottle on his returned to a constructive, useful life. person, or keep one in his desk or locker. He will be very sensitive to criticism, both of his drinking Where to draw the line? and of his work. He is very likely to have blackouts (complete loss of memory); and such An estimated 75,000,000 persons in the blackouts may cover extensive periods. An United States consume alcoholic beverages in alcoholic may even wake up in a strange city one form or another. Over 5,000,000 of them and be unable to account for his presence there. can be designated as “problem drinkers” – that His relations with his family, friends, and fellow is, as alcoholics. workers will show signs of disruption. His eating

habits probably will change, and late in the ln most communities, the possible disease he may go for long periods without sources of help for a family facing alcoholism eating anything at all. are varied, and it is impossible to predict which Such signs arc a clear indication that it of them will prove most useful in any one is time to discontinue the use of alcohol instance. But it is worth noting that some forty completely and forever. lt is a fact that a few states now have tax-supported programs incipient alcoholics are able to do just that of covering help for alcoholics, and in such a state their own accord. But, more typically, such a reference to the state or local health department person will insist that he has no problem and usually can make this resource available. reject all offers of help. For him the need for Also, the National Council on liquor eventually will become compulsive. One Alcoholism, lnc. (2E. 103rd Street, New York 29, drink of anything containing alcohol and a chain New York) has local affiliated councils in 64 reaction follows over which the alcoholic has cities in the United States, most of which provide absolutely no control. He finds it impossible to Alcoholism lnformation Centers where those stop drinking. who are interested can get personal consultation At that point, his moral standards just and literature, and referral to other community about disappear. His promises mean nothing. resources, such as hospital clinics specializing He becomes extremely artful and develops the in the ambulatory or in-patient treatment of most plausible excuses and explanations to alcoholism. avoid coming to grips with the reality of his situation. The physician’s role in treatment This pattern stays with the drinking alcoholic all his drinking life. Furthermore, long Often the first attempt of an alcoholic at periods of abstinence seem to have no effect self-help is to arrange a visit to the family doctor whatsoever on his inability to regain control of for a check-up and a discussion of the problem. his drinking. A week, a month, a year, even 10 So much the better if the physical examination years after he has “gone on the wagon,” the first can be given by a physician who is experiences drink will activate the devastating compulsion, in treating alcoholics or is familiar with and he returns to his old pattern, usually in an community resources for managing alcoholism. aggravated form. What about treatment? lt has become increasingly clear that alcoholics are prone to Why outside helP? addictiveness. Barbiturates and tranquilizers, which are still prescribed for some alcoholics A person who has reached the stage of because researchers once hoped they would alcoholic sickness must not be judged by the ease the emotional distress underlying usual conventions. His actions should be alcoholism, hold implicit dangers of addiction regarded as symptomatic, and accepted as part and toxic reactions and are best used in a of a disease process. And that’s not easy. lt is controlled situation. Antabuse, however, is a very difficult for the non- alcoholic to grasp the successful drug adjunct. This drug makes the depth and complexity of the emotional factors body react with acute distress if alcohol is taken involved in compulsive drinking; to appreciate in any form. But Antabuse tablets have serious that the socio-economic, intellectual, or drawbacks. They should be used only under the professional background of the victim does not continued supervision of a physician who is help him to resist the progression, once the thoroughly familiar with the drug’s properties. compulsive phase of the malady has asserted They must be taken daily; but, if responsibility itself. Help in such cases requires patience, skill, for taking Antabuse is left to the patient, he often and a depth of understanding that can be will skip it. More serious is the very real developed only by long experience with the possibility that the alcoholic may be tempted to problem. That is why an alcoholic’s family – or rely solely on the drug and avoid dealing the alcoholic, himself, if he can bring himself to realistically with whatever emotional and social do so – must look to assistance from the outside. problems are associated with his trouble.

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ln any event, it is only when the patient they are not responsible for its development, has obtained medical and psychological and when they understand and master their own management that the real recovery process truly feelings of guilt and hostility through group begins. And achieving this first goal is a long- discussion, that they can cope effectively with term process. the vagaries of the alcoholic’s conduct and eventually help him get back on his feet.

Alcoholics Anonymous A look to the future

As a method of dealing with emotional So far, this report has devoted itself to a and personality problems of the alcoholic, group program which, in effect, locks the barn door therapy appears to be more promising than after the horse is stolen – that is, to treatment of private therapy. On this score, many patients, as the alcoholic after he is in trouble and is seeking well as their physicians, lean heavily on help. Another sort of program – aimed at Alcoholics Anonymous (A.A.) to help out. detecting alcoholism early in the disease – is lndeed, this organization is almost universally being pioneered by a few industrial concerns. recognized as the one type of group therapy The companies recognize that valuable which has been most successful in helping personnel who might otherurise be lost to alcoholics. alcoholism can be kept productive if help is As most readers are undoubtedly aware, provided soon enough. Their program begins A.A. is an informal fellowship of alcoholics who with a general educational program, aimed at are joined together to help themselves and both employees and management. Supervisors, others to maintain sobriety. The only in particular, are trained to sense the existence requirement for joining the organization is the of problems in the lives of the employees under serious desire to quit drinking. them. A channel is set up through which workers At the same time, the family of the who may be succumbing to alcoholism can be alcoholic who has not yet accepted the fact that referred, with a minimum of embarrassment, to a he must stop drinking altogether (or even of one qualified group of therapists. ln most instances, who has accepted that fact and is acting upon it) this group is composed of a physician, a can get comparable help for themselves from psychiatrist, and counselors who are members another organization, called Al-Anon, which is of Alcoholics Anonymous. separate from, but closely identified with, A.A. There is growing acceptance of such an (For information, write to Al-Anon Family Groups approach within the medical profession, and Council, 40 East 40 Street, New York 17, N.Y.) even by alcoholics themselves. The success of The membership of one or more of his such programs depends, of course, on the immediate family in an Al- Anon group has been wisdom and patience of the counselors in an important factor in many an alcoholic’s dealing with highly personal situations. They recovery. These groups emphasize the fact that must neither exhort nor lecture; and they must they do not discuss the case histories of the gain the confidence of the alcoholics with whom alcoholics in whom they are interested, but they deal. confine themselves to the tensions and anxieties Today, alcoholism ranks among society’s major that are inherent in their own situations. Those health threats. lt is widely felt that the prevention who are within the family circle of an alcoholic and control of this disease will come in the suffer extreme anxiety, anguish, and frustration, course of time, but only through the same since their attempts to help come to nothing; methods and efforts which have proved they feel beaten, hopeless, and angry – with successful in combating other public-health overtones of guilt. lt is only when they clearly problems: a vast program of public education, realize that alcoholism is a disease, and that and of intensive research and study.

Source. Consumer Reports, November 1960.