Fortune, Mav 1968

THE BEGINNING OF WISDOM ABOUT ALCOHOLISM It’s a disease as well as a personal and social The year 1968 thus becomes the time catastrophe. That discovery makes the big when alcoholism finally receives recognition as difference in treatment. Gorporate programs can the personal and social catastrophe that a be critical in salvaging executives and workers’ quarter-century of sustained research effort has shown it to be: an illness of the magnitude of By Herrymon Maurer heart trouble, cancer, and severe mental disorder. A body of knowledge, remarkable in During the past year alcoholism has size for the small amount of research money come out of the shadows. Major government expended, has been put together on its reports have dealt with it on an objective basis, characteristics, causes, and treatment. No one and large amounts of federal and state funds expects that the incidence of alcoholism will have been voted for research and treatment. A diminish in the foreseeable future. There are no decision by the U.S. Courts of Appeals, the drugs available now or in prospect to work the rationale of which is under review by the kind of cure that has all but eradicated polio. supreme court, changes alcoholism from a crime lndeed, recovery rates from alcoholism are to a disease, a diagnosis already made by such abysmally low. But the only direction to go is up. diverse authorities as the World Health The highest recovery rates, surprisingly, Organization in 1951, the American Medical are to be found not in clinics and hospitals, but Association in 1957, the American Psychiatric in offices and factories. By putting the body of Association in 1965, the Department of Health, knowledge about alcoholism to work in company Education and Welfare in 1996, and a national programs, industry is achieving recovery rates commission in 1967. as high as 65 to 70 percent – higher than those The general acceptance of alcoholism as for other major diseases and far higher than any a disease not only reflects a new concept of the imagined only a short time ago. This illness, but also requires a new public approach achievement represents not only a successful to its treatment, postulating as it does that use of research, but a major contribution to it as alcoholics be handled in clinics and hospitals well. Alcoholism is one disease in which laymen, instead of in jails. New ward space is being notably men in executive posts in business, play opened and new institutions are being built; a role as diagnosticians and therapists as well medical schools are beginning to add the as sufferers. Moreover, the simple fact that subject of alcoholism to their curriculums. The business is increasingly willing to admit that its federal government is now asking Congress to executives can themselves be alcoholic increase substantially its current $20-million demonstrates an important gain in knowledge program, of which $13,500,000 is marked for about the nature of the disease. research, training, and education’ State There are some 80 million drinkers in the expenditures are running about $10 million. U.S., and of this number there are five million There are, in addition, federal plans in the works alcoholics, give or take a million, according to to treat alcoholics among civil servants, and estimates of the Rutgers Center of Alcohol state plans are being drafted in California and Studies. Such estimates have meaning, Pennsylvania. however, only if it is agreed that all statistics on alcoholism, are rough far rougher than

statistics on atherosclerosis, cancer or alcoholics, but to an inability to get off drink for tuberculosis – and that precise definition of the even a day or two. disease is as yet impossible. Unlike other Social protection for such alcoholism is diseases, alcoholism is discovered primarily common in France but rare in the U.S. The through study of the behavior of the persons president of a small business organization in who are attempting to hide their behavior, not New Jersey built his own kind of social primarily through the study of invading protection around his drinking. He had organisms or infected organs. For statistical secretaries, subordinates, bartenders, and purposes, it can be thought of as a disease, in family trained to help him keep a relatively the words of Rutgers’ Mark Keller, “causing constant volume of liquor in his system. But injury to the drinker’s health or to his social and when he was suddenly separated from his family economic functioning.” By that definition, there is he quickly began spree drinking and ended by one alcoholic for roughly every sixteen persons touring hospitals and jails. Dr. George N. in the country who ever consumed alcohol. Thompson of the University of Southern Some years ago men outnumbered women by California reports another case: “A patient who about five or six to one, but it may be that the had continued a desk job fairly successfully for ratio is now four to one or even lower’ twenty years while he drank two fifths of The sufferers divide into three principal bourbon daily. He finally succumbed to hepatic types: cirrhoses but never seemed to suffer from toxic effects to his nervous sYstem.” o The loss-of-control alcoholic. ln this type preponderant in the U.S., Canada, Great Britain, o The dependent-but-unaddicted alcoholic. and Northern Europe, increased tissue tolerance This type does not drink compulsively, but to alcohol and alteration in cell metabolism heavily enough to cause eventual damage to his produce an addiction that makes control over family and work relationships, and sometimes to drinking either difficult or impossible. This leads his health. Often he progresses into out-ofboth to compulsion to drink and to harrowing control alcoholism. What happens to him physical symptoms when coming off drink. depends less on the quantity he drinks than on Typical of the out-of-control drinker is an his drinking behavior. He can cut down if he is eiecutive vice president of an industry trade aware that he is heading for trouble. lt is not organization who lost family, friends, home, and always easy to spot this type of drinker, and the job, who sobered up in one hospital only to get difficulties are increased because so many drunk and land in another, and whose recouping alcoholics delude themselves into believing that of losses and rise to his present post came only they are heavy drinking nonalcoholics. after his recovery. But just as typical is a senior officer of a company with $300 million in sales Executive suite and skid row who hid everything and lost nothing tangible at all (although he figures his drinking cost his The alcoholic reinforces his delusion that company more than a million dollars’ worth of he is some other sort of drinker by adhering to business) and who surprised his colleagues the popular notion that alcoholism has a definite when he told them of his alcoholism a year after location – skid row. But, in fact, only about 3 his recovery began. percent of all the alcoholics in the country are to be found there. Only recently has the general o The unable-to-abstain alcoholic’ Physical public been willing to acknowledge that addiction also characterizes this type, which alcoholics are also to be found in the bosoms of predominates in France and other wine- their families, the arms of their churches, and producing countries where heavy drinking the management rosters of their corporations. ln ihroughout the day is socially acceptable’ fact, alcoholism has been found to be more of a nddiction leads, however, not to the problem in the executive suite, in professional uncontrolled-spree behavior typical of American offices, and in workshops than on skid row’ Generally speaking, the more educated, the

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more urban, and the better salaried Americans segments of the population, can now be defined are, the more likely to drink. roughly. There is, for instance, ample working The skid-row myth, says Dr. Selden D. data on alcoholism among factory and white Bacon, director of the Rutgers Center of Alcohol collar workers with reasonably precise studies Studies, grew out of the old controversy on work performance, absenteeism, accidents, between the wets and the drys. Many persons and the like. There is also an increasing body of escaped both camps by avoiding the problems data about alcoholism among executives, a topic of alcoholism altogether; they came to believe not generally discussed only a few years ago. that such problems simply did not exist in nice There is, moreover, a good deal more families or in good neighborhoods, but only in that is known about alcoholism’s sundry out-of-sight areas where they could be handled complications. An HEW study of 1,343 patients by the police, the courts, the jails, and the state at alcoholism treatment centers in California mental institutions. Dr. Morris E. Chafetz of reveals that accidents kill seven times as many Massachusetts General Hospital has shown alcoholics as nonalcoholics, cirrhosis ten times statistically that admitting physicians in hospitals as many, influenza and pneumonia 6.2 times, tend to diagnose alcoholism as if it were a and suicide (a new research area) 3.5 times. A disease confined to the unwashed and the ill sampling of 922 drinkers (532 known to be and clad. When a disease is socially unmentionable, 390 thought to be alcoholics) and 922 medical research in that disease is stymied by nondrinkers at E.l. du Pont de Nemours want of support. The new recognition that indicates that various other degenerative alcoholism is also found among respectable diseases, including some not popularly people is a fact possibly more important for associated with alcohol, strike drinkers with research than was the similar recognition of measurably greater frequency than nondrinkers: cancer about a generation ago. e.g., hypertension 2.3 times as frequently, ln short, social considerations are as cerebrovascular disease 2 times, stomach ulcer much a factor in alcoholism research as are the 1.9 times, asthma 1,7 times. “More alcoholics,” physical and psychological characteristics of its declares Dr. Edwin Boyle of the Miami Heart victims. A concatenation of sociological, lnstitute, “die of cardiovascular catastrophe than biochemical, and psychiatric happenings, from all other causes combined.” alcoholism has to be studied by specialists in Other studies, supported bY A.A. many fields. Moreover, it is an illness whose experience, yield an equally important and far patients band together in great numbers more heartening discovery: alcoholism can be 400,000 of them in 14,154 groups throughout arrested much earlier in its course than was the world as Alcoholics Anonymous to treat – previously thought possible and with much one another. Multiple approaches to the problem better likelihood of recovery than in its later often commingle but sometimes conflict. The stages. lt was once believed that only those fact, for instance, that alcoholism is far less alcoholics who had gone down through the prevalent among Jews than among the lrish is whole bitter sequence of the early, middle, and explained in terms of cultural or psychodynamic late stages would accept therapy. Today an conditions, but some physiologists explain it as estimated 50 percent of A.A. members join the consequence of genetically determined body during the early and early-middle stages. “An chemistry. Such diversity of approach is actually alcoholic,” explains a vice president of a an important research aid, and it has already company headquartered in New York, “ls produced a very considerable body of constantly building up a wall of defenses around knowledge about the nature of the illness, a his illness. Early in the process when the wall is good deal of information about its treatment, and low, it takes much less suffering to convince him plenty of speculation about its causes. to clamber over it than it takes when the wall is The observable sYmPtoms of the high.” disease, its course from early manifestation all Physiological research also has been the way to recovery or death, together with its yielding detailed information on the way alcohol incidence and characteristics in various acts in the human body, how it is metabolized,

how it sedates – producing in the process an labor with other alcoholics. Such propositions, initial misleading euphoria, but subsequently whose principal intellectual ancestor is the depressing and anesthetizing and how it pragmatic philosopher William James, are not leaves behind that jittery sense of excitation that subject to quantitative measurements and are often prompts the alcoholic to another drink or often troubling to outsiders. What is more, only another bout. Established are such facts as about one alcoholic in fifteen in the country is a alcohol’s ability to induce hyperactivity of the member of A.A. lts one requirement for brain through its effect on the brain’s reticular membership – a desire to stop drinking – is activating mechanism. The ancient surmise that thought by some to limit its therapeutic efforts to alcohol in the bloodstream is the agent of the a relatively select few. alcoholic’s compulsion to keep on drinking has Sociologists come under cross fire from been confirmed by a variety of experiments, some of the other professionals for focusing on including a thirty-one day test conducted by nonmedical aspects of alcoholism. Their basic Harvard’s Dr. Jack H. Mendelson, in which proposal for treatment is the prevention of alcoholic volunteers were subjected to twenty- alcoholism by social and cultural change, a four days of controlled drinking and seven days proposalwhose value can be determined only at of observed withdrawal, in the course of which some time in the future. Moreover, they offer classic and unmistakable signs of physical both statistical studies and cogent etiological addiction were manifest. arguments. “lt has been noted,” says sociologist Dr. Seldon Bacon of Rutgers, “by almost all Why it comes and how it goes observers for decades that by and large Americans are anxious, confused, ambivalent, at Certain facts about the treatment of times guilt-ridden about their attitudes toward alcoholism are indisputable. As rooted, it has drinking.” Sociologists have delineated such been established as a disease treatable by uncertainties in detail and have re-created in the physical, psychological, and A.A. therapies. process the history of drinking in the U.S., Medical authorities have perfected the hospital replete with such intriguing facts as nearly handling of its agonizing withdrawal symptoms – identical per capita consumption rates between the physician has a whole battery of variously 1850 and 1968, despite the intervention of the acting drugs at his command – and withdrawal is industrial revolution, urbanization, and world now rated no more of a risk than minor surgery. WATS.

It is universally agreed that the one way to arrest the illness is to get the patient off drink Knowledge th rough no-knowledge altogether. And it is known that the alcoholic can’t get off drink through his own will power, Physiologists and psychologists, highly that he must seek outside helP. vocal about the causes and treatment of At this point, however, the various alcoholism, have contributed another body of sociologists, psychologists, physiologists, and facts, and also have delineated important areas the A.A. laity tend to part company. Alcoholics of ignorance. Dr. Peter Stokes, research Anonymous is widely conceded to have physician at Payne Whitney Clinic of the New produced more recoveries than have all other York Hospital and co-discoverer of the effect of therapists put together, but it suffers in the alcohol on white-cell mobilization, remarks minds of some professional research men from confidently, “We don’t know anything about the being insufficiently scientific. A scientist can causes of alcoholism; we can’t identify the hardly quarrel with the fact of 400,000 recovered susceptible individual; we can’t treat specifically alcoholics, but he can nonetheless feel uneasy or chronically; and we can’t prevent it.” This about a fellowship whose program begins with state of knowing what one does not know, Dr. an admission of abject surrender of one’s life as Stokes emphasizes, is essential for solid future unmanageable, follows with belief in “a Power discovery. Medical research in general has to greater than ourselves that can restore us to explore areas of ignorance before arriving at sanity,” and prescribes constant meetings and areas of new information. Cancer research,

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more advanced than research in alcoholism, Almost all alcoholics, of course, would developed its virus theory only after assiduous welcome any pill or any procedure that would exploration of the unknown. not deprive them of liquor. For fifteen years a Physiologists, of course, examine New Jersey management consultant read complex cellular, metabolic, glandular, and like selectively in the professional literature to biochemical events, while psychologists and convince himself that he was a neurotic drinker psychiatrists apply a body of concepts ranging who would be able to drink normally as soon as from learning theory and conditioned reflex his neurosis was resolved. He persuaded his formulations to personality testing and physicians and psychiatrists to let him try out a psychodynamics. Almost all researchers in whole series of new treatments, from these fields believe it is likely that alcoholism barbiturates to LSD. Despite repeated rests on a physical base upon which is built a hospitalization, he believed fervently that his psychological structure, but research knowledge emotional health was improving – up to the very both of base and structure is as yet not very moment when desperation eventually convinced deep. Alcoholism indeed coexists with various him he was a common out-of-control alcoholic. types of mental and emotional illness that As U.S.C.’s Dr. Thompson says, “lt is axiomatic require specialized medical attention. Until very that it is useless to attempt psychotherapy on a recently it was believed that predisposing patient who is continuing his drinking.” psychological factors played a causative role of The new social acceptance of alcoholism some sort in the development of alcoholism. as a disease rather than as a stigma of sin, say Alcoholics, after all, are so frequently separated the professionals, should help break down the from reality that they can be called schizoid, so massive defenses alcoholics develop against regularly low in mood they can be called yielding to treatment. Acceptance is providing a depressed, so often unsure they can be called cultural climate in which they may be more dependent, and so obviously devoted to the readily helped and a long needed financial base bottle they can be labeled obsessive-compulsive for an important burst of new research. and orally fixated. But these characteristics did not necessarily pertain to their condition before Crisis precipitation they became alcoholic, and the same characteristics, moreover, are not uncommon There is already enough knowledge for among nonalcoholics. Today there is less dealing effectively with the problems of enthusiasm over predisposing factors. alcoholics on the job. An HEW study estimates Enthusiasm plays a key role in medical that 70 percent of them, indeed, are still on the research, but in the search for remedies for job and have been there for fifteen to twenty-five alcoholism, it is now much more subdued. ln the or more years. An alcoholic’s job, in fact, is the past, various therapeutic devices, based on last great bulwark of his defense against various etiological theories, were put fonruard admitting his illness; the threat of its loss can with considerable ardor as fhe therapies for often produce the inward crisis that is required alcoholism, but they turned out later to be at before he will submit to treatment. Wellbest adjuncts to standard therapy. Among these conceived company programs, moreover, can are psychodrama, group therapy, and hypnosis speed up the precipitation of such a crisis, in the as well as individual counseling. The list also process rescuing men from unnecessarily long includes the barbiturates (useful but themselves suffering at a cost to the company that is far less addictive), aversion therapy, vitamins and sound than the amount it is already losing through poor diet, Ayerst Laboratorles’ Antabuse (still widely productivity, absenteeism, severance or used), ACHT, tranquilizers (also useful and also retirement payments. addictive), LSD, Searle & Co., Flagyl, and latest Successful comPanY Programs of all, niacin, proposed for use in massive doses programs that succeed with two out of three as an adjunct to therapy to deal with alcoholics, as they do at Equitable Life, Eastman hypoglycemia and schizoid conditions. Kodak, Consolidated Edison, Allis-Chalmers, and du Pont – are still rare, although more than

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200 companies have some sort of program or introduced him personally to members of an some statement of policy. Because alcoholics A.A. group. A few weeks before, the physician are so skilled in avoiding anything that looks like had handled a case involving a maintenance a trap, some programs are little better than no man employee in precisely the same way. programs at all. lmplementing a program based on crisis Good basic company Procedure is precipitation requires a marked amount of relatively simple. lt depends on early recognition organized wisdom, experience, and good sense of the alcoholic, employee or executive, by his in dealing with the tortured complexities and immediate supervisor on the basis of his work resistance’s of the alcoholic mind. For example, performance and on his referral by the it is essential that the confidential relationship supervisor to the company physician. The between doctor and patient remain inviolate; physician has to be – or has to become – one of othenvise the whole program will be bypassed the small and select group of specialists in by the alcoholic. lt is not necessary for the word alcoholism, though he does not usually treat the alcoholism to appear in company records. man himself. He refers him after diagnosis to Equitable Life’s Dr. Luther A. Cloud finds it wise Alcoholics Anonymous, to a psychiatrist, a hosp- even to avoid using the word in his conversation ital, or a rehabilitation center. Follow-up is in the with a patient until the patient himself does so. hands of the company physician. And in all At Eastman Kodak, executives not infrequently cases, willingness to accept treatment is a refer themselves to Dr. John L. Norris, associate criterion for determining whether an employee medical director, who is also the nonalcoholic continues to hold his job. chairman of A.A.’s general service board. The mechanics of this operation are Among all employees about two out of ten are straightfonruard. lt is not difficult to spot self-referrals. alcoholics on the job; usually they are One pitfall to avoid, warns Dr. Harrison recognized long before they think they are. Most M. Trice of Cornell’s School of lndustrial and of them can be identified simply by running Labor Relations, is a company plan that is through work records on absenteeism and designed to take care of alcoholism only among performance. But getting a supervisor to refer a wage and salary workers. Alcoholics are so man to the medical department is a different notably thin-skinned, whatever their level of matter. lt is almost impossible if the program is employment, that it is advisable to handle all of not well conceived, difficult when even a good them as if they were executives. If a plan works program is new, though relatively easy when the smoothly with executives, it will work smoothly program is widely understood. with others down the line.

Removing resistance Atmospherics and the chief executive

When the medical director of a billion- Obviously a companY Plan cannot be dollar company was summoned one day to his rigid-Practicing alcoholics respond far better to a company’s executive offices, he found himself in general atmosphere than to an inflexible system. the presence of two senior officers. He was told At Equitable, atmospheric considerations include by one of them that the other was beginning to easy and unobserved access corridors to Dr. get into such trouble with drinking that he would Cloud’s office. Although Eastman Kodak is a have to report him to the board of directors pioneer in company alcohol problems, Dr. Norris unless he accepted medical help. The medical and the company management still feel no urge director simply said, “Since this is a health to commit all of the program to paper; it is simply matter, we will treat this conversation as if it discussed between Dr. Norris and the top never happened.” He then took the sick executives who frequently drop into one executive back to his office, talked with him, got another’s offices to talk informally about a wide him into the hospital for a two-day checkup, range of company and community health dispatched him to a rehabilitation center for a matters. Olin Mathieson’s Dr. J. Ray Chittum four-week “vacation,” and on his return holds that his program should not even be called

an alcoholism program, maintaining that On the chief executive falls further alcoholism should simply be considered one of responsibility for the alcoholics the program the various illnesses that his company helps does not help. To be sure, two men in three can treat. Recover and often achieve levels of One manufacturing company with a performance not previously reached, but there number of scattered plants in the Midwest has remain the men who refuse therapy or abandon no organized plan at all and uses outside it. Some of them pass on to other companies, physicians instead of company doctors. But it is end up on early retirement, relief, or skid row. known confidentially to a good many men both Moreover, it has now become known that an at headquarters and down the line that both the alarming percentage of alcoholics commit president and their personnel head are suicide upon losing a job or separating from recovered alcoholics active in A.A., and as such family. Such negative consequences of crisis the company’s authorities on alcoholism. This precipitation can be mitigated in some part, company has probably one of the lowest rates of however, by the chief executive taking two active alcoholism in the countrY. steps. first, making it clear to employees that Most of the information required as the acceptance of treatment for alcoholism is a basis of sound and successful company defense against loss of job, and, second, programs can be found at four institutions where separating alcoholics when necessary from the the problems of alcoholism in industry have company on an on-leave basis, it being been under scientific and professional study for understood that they will be taken back many years. Dr. Milton A. Maxwell, of the whenever they accept therapy. Rutgers Center of Alcohol Studies, is an expert on problems of accidents and absenteeism. At Pragmatic synthesis Cornell, Dr. Trice isknowledgeable about problems ofearly identification and crisis For its successful crisis-precipitation precipitation. Atthe National Council on approach to the problem of alcoholism, industry Alcoholism, Lewis F. Presnall has installed clearly owes a debt to research. Scholarship, practical programs in a number of specific however, owes a debt to industry programs, not companies. And at the Christopher D. Smithers simply for the statistical, psychological, or Foundation of New York, the organization that medical data they yield, but also for showing the has given research in alcoholism most of its way to the pragmatic achievement of the higher private financial suppotl, R. Brinkley Smithers recover rates known. These results suggest that pays special attention to company programs. the synthesis of research findings with working Smithers is the foundation’s president and industrial programs may be more significant than president also of the National Council on either the research or the programs alone. Alcoholism. lmportant in this synthesis is industry’s Obviously, the experience of particular use of Alcoholics Anonymous as the chief men or particular companies cannot be overlaid therapeutic agent of company programs. on the organizational pattern of other Business proved a new challenge to A.A. companies. Such patterns typically represent a through its methods of crisis precipitation that company’s unique way of doing business, and sent men and women for therapeutic help long any change in them is a matter for the chief before they might otherurise have gone, and executive officer. The chief executive, indeed, is thus provoked a new response. Now that the the one person in any company who musf take dimensions of the disease of alcoholism are responsibility for an alcoholism program, not becoming widely known, it may well be that it simply because is advisable to have top many physicians and psychiatrists, backing for good ideas, but because it is psychologists and social workers, together with essential for him to do the actual tailoring of any their hospitals and clinics, will develop new system to the comPanY cloth. forms of crisis precipitation and share their therapeutic load more widely with A.A. Today there simply are not enough professionals in the

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country to handle the number of alcoholics study of methods of recovery can lead to needing treatment, and there are 350,000 important facts about the nature of the disease members of A.A. available anywhere and at any itself. A.A. recovery for one man, the executive hour in the U.S. and Canada. vice president of a research and development Whatever else A.A. may be, it is a successful method of treating a disease, and a corporation in the South, included listening to nonalcoholic friends, scientific colleagues, and more than 1,000 case histories during the first business associates. A.A.’s response to the two years of his membership, getting to know challenge of still-suffering alcoholics is the intimately the life histories of more than fifty combined response of cohorts of such men persons, introducing fifteen newcomers directly striving to maintain their own recovery through to A.A. and twenty-five more in partnership with helping the recovery of others. Working with others, and discussing the problems of A.A., business has worked wonders. alcoholism with more than a hundred END

Source: Foftune, May 1968

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