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:i,llill. Alcoholism: New Victiffis, New Treqtment .,, .;i;:’ : From the day man first sipped the stitute on Alcohol Abuse and Alcohol- have found evidence suggestiag that exliquid collecting around honey or fruit ism (maaa). “Youths are moving from cessive use of alcohol may also quietly ,iililil’ll ” left too long in a warm place, alcohol a wide raage of other drugs to the most contribute to certain kinds of heart disi,ii,l,ll,l…..l,’., has played an imporCant role in his life. devastatiag drug*the one most widely ease, and that it eventually damages the irilt ,,:,1 ‘,,. Early in history, wine berame-and still misused of all-alcohol. ” braia (see box page 77). is-an integral part of religious ceremo- The upsurge of problem drinking > In half of all murders in the U.S., nies. The Bible acknowledged the “wine among the young is only part of a more either the killer or the victim—or both that makettr glad the heart of man” disturbing oationwide and even world- been drinking. A fourth of all (Psalms 104: |il, and Pasteur called it wide problem. I! the past few years al- -have suicides are found to have significant “the most healthfrrl and hygienic of bev- coholism-among youttrs and adults amounts of alcohol in their blooderages.” In the hectic modern world, alike-has at last beeo recognized as a streams. People who abuse alcohol are hundreds of millions of people drink Ii- plague.From 1950 to l97Q per capita seven times more likely to be separate.d quor, beer or wine for tnjoyment, so- consumption of alcohol in the U.S. in- or divorce.d than the general population. lace and traoquillity. Yet today, as it creased 26%o-to the equivalent of 2.6 > The dollar cost of alcoholism may has throughout history, alcohol is also gal. ofstraight alcohol peiadult per year. be as much as $15 billion a year, much troubling mankind. For in almost every It is now at an alltime high, probably of it from lost work time in business, insociety, there are those who cannot en- surpassing the levels during such noto- dustry and the Government. joy alcohol without becoming its slave. riously wet eras as the pre-Civil War > At least half of each year’s 55,500 In the U.S., the age-old problem of and pre-Prohibition years. Moreover, automobile deaths and half of the 1 milexcessive drinling is taking a disturbing accordiag to the NIAAA, about one in lion major injuries suffere.d in auto acnew turn and affecting new kinds of ten of the 95 million Americans who cidents can be traced directly to a drivyistims. On a New York subway train, drhk is now either a full-fledged alco- er or pedestri.ran “under the influence.”* a school-bound l5-year-old holds his holic or at least a problem drinker (de- Many of the deaths and injuries are books in one hand, a brown paper bag 6ned by NrAAA as one who drhks caused by the under-Zl age group, and containing a beer bottle in the other. He enough to cause trouble for himself and arrests ofyoung people for drunken drivtakes a swig, then passes bag and bottle society). Uncounted thousands of the tng have skyrocketed since states began to a classinate. In a San Francisco sub- problem drinkers are under 21 and, in lowering the drinking age from 21. In urb, several high school freshmen show fact, the approximately 9 million exces- the year following its lowering of the up for class drunk every morning, while sive drinkers are represertatives others sneak offfor a nip or two of whis- *and affect-the whole spectrum of of drinking age, for example, Michigan reported a LAlVo’ncrease in such arests. ky dudug the lunch recess. On the cam- American society. But parents seem relatively unconpuses the beer bash is fashionable once The facts gathered by MAAA about cerned about their children’s drinking. again, and lowere.d ddnking ages have alcohol abuse are as depressing as they In fact, children who drink are often made liquor the high without the hassle. are impressive: simply following the example set by In one sense, it is good news: across > After heart disease and cancer, al- their fathers and mothers. Teen-agers the U.S., the young are turning away coholism is the country’s biggest health know that their parents make scene,s if from hard drugs. Irr another sense, it problem. Most deaths attributed to alcould not have been worse news: “The coholism are caused by cirrhosis of the *In virtually all states, that infiuence is legally set switch is on,” says Dr. Morris Chafetz, liver (13,000 per year). An alcoholic,s at a blood conceotration of .lVo or more alcohol. director of the Departmeflt of Health, life span is shortened by ten to twelve A 150-lb. man can reach this level if he takes three one-jigger 1lt/, oz. per jrgger) drinks within Education and Welfare’s National In- years. Recently, medical researchers an hour.

TIME, APRIL22,1974 75

BEI.IAVIOR from welfare to upper middle class, and less than a pint a day who are dying,” the drinkers come from all categories.” says Harold Swift, of the Hazelden The under-2ls are not the only ones Foundation’s model treatment facility in who are drinking more. Reversing past Minnesota. “Yet we see men who go patterns, which showed middle-aged tbrough better than a flfth a day and men the most prone to alcoholism, there still function well.” has recently been a marked increase in An alcoholic does not necessarily alcoholism among people in their 20s know that he is an alcoholic. The steand 30s and among women. In the’50s, reotype of the stumbling, mumbling by National Institute of Mental Health Bowery bum applies to no more than estimates, one of every five or six al- atr:ut SVo of the alcoholics in the U.S. coholics was a woman; the ratio is now Most alcoholics hold jobs, raise families, otre woman for every four men. These and manage to hide their addiction from fuures may in fact be understating tle everyone, ofLen even from themselves. problem for women, because a nonwork- An alcoholic may go on for years, iming woman, who does not have to punch bibingtlree martinis at lunch, two more a time clock or stand scrutiny in the of- on the way home and three when he fice, finds it easier than her husband gets there. One day, however, he may might to hide her habit. One alcoholic wind up in a hospital with a broken leg housewife in Miami admitted stashing and, deprived of his daily quota, may Clorets in every jacket pocket and down- suddenly fnd himself in the middle of stairs drawer to disguise her liquor the DTs (delirium tremens), which are hreath from unexpected callers. Others characterized by extreme agitation, contry to hide their alcoholic breath by sip- fision and ftightening hallucinations. ping tist€fue, ftope or vanilla extract. Sociol Guslom. The National In some places the ratio betweon Couneil on Alcoholism, a voluntary UOUON |NDUSIRY ADYERIEEME!|I nen and wometr problem ddnkers i8 81- health orgnnization, has drawn up a ready equal. Fc example, in Florida’E checklist of 26 questions for drinkers. they catch them smoking marduana. Dade @uaB C,op. 1,385,000), author- In its vievl, a yes answer to any one of Bua if the youneBtors come h(me ities estimate that thsre are 78,000 al- tten waros of possible alcoholism. drunk, moot ofthsn are n€r€ly smt qui- cohohcs.+nd almost half are wonsn Soare of the eouacil’s questions: Do you etly to bed. “O(tsn when we r€port to a At the Women’s Alcohol Edueatioa drirk heavly after a disappointment or oaient that his kid isa’t actiog tte way Oenter in South West Miami, pati€nts aquarrcl? Did you ever wake up on t&e Le shouldand smellsofliquor,” 8&5/8 Don caa relax in a pool or on a patio a^ail morning aftor and diseover you could Samuels, a Miami drug+ducation coor’ their ldds can play in a garagp fifl of not trmembor part of the evening bedinator, “th€ l€action is: ‘Thask ff! I tola and live aniaab. The ceater is opea fore, even though you did not pass out? thought he was o,n dnrgs.'” AcfuallY, ftom 9 a.m. to 11 prn., aad has a daily Do yotr try to have a few extra drinks man! teon-agers use bothmarijuana and avelagg of 18 womon visitors. when others will not know it? Are you alcohol. Srho is an alcohotic, and who is secretly iritat€d when yor family or The alcoholic tide has been Pushed “oerely” a problem drinker? The def- friends discuss your drinking? Have you hiehsr by tte fast-selling, iner’pensive iaifion depends 6n &e dsfaor. Thus often ftiled to keop the promises yott poi win*, whioh diseuise their alcohol- I\,t& Fr€C froue, head of the National have made to yorsclf about conholling ic iontsnt with sw€et ftuit flavorg’ Those Woman’e Ctdstiao Temper,ance Union, or cutting down on your ddnking? wines nake the tmnsition from soda pop maintainc that an alcohoHc is “anyone The Rutgors Univorsity Center of to alaoholjust ooe easy step’ “Kids s€om who drinkg abohol. As soon as they start Alcnhol Studies offers a msre concise to look on the stufr as a z;PPY, soehis’ to drink they’re on that road doc,n- definition: “An alcoholic is one who is ticated soft drink,” says Ilouston’s Bru’ ward.” By that defnition many of the re- unable consistently to choose whether ner fBe, education director for the Texas searchers in alcoholism would be prac- he shall drink or not, and who, if he Council on Alcoholism. “But this’kid- ticing alcoholics themselves. dritrks, is unable consistently to choose die stuff’this pop wine, contains 97o al’ Quantity consumed is only one cri- whether he shall stop or not.” Yet the cohol-about twice as much as be,er'” terion-and not aecessarily the decisive more researchets study alcoholism, the After the pop wine Phase is over, the one. “We see little old ladies who drink more c.omplex they realize it is. There kids often go on to much stronger drink’ Vonillq Exlroct. Most school offi- POTTCC SURVEY SCENE OI FOUR.CAN, FIVFFAIAI,IIY ACGIDENT CAUSED BY DRUNI(EN DRIVER cials are too embarrassed by the alcohol problem to do much more than reluctantly admit that it exists. One system that has faced up to it and conducted reliable surveys is in the suburban county of San Mateo, south of San Francisco. There, in 1970, school officials found, , ,-! | i:’: I llTo ofthe ninth grade boys (13- and 14- ‘”.:,’..,): : I year-olds) said that they had drunk some kind of alcoholic beverage 50 or more lrl

)n ‘r rr

times in the past year; in 1973 the figure had jumped to237o. Among senior class boys (17- and 18-year-olds) the percentage of such relatively frequent drilkers rose during the same time sPan from 27Vo to 40Vo. Senior class girls drank less, but they are catching up fast: 297o said that they drank 50 or more times in 1973, compared with ottly l4Vo in 1970. Notes Paul Richards, an ddviser at a San Mateo high school “This school represents a socioeconomic background 76

are, in fact, almost as many “alcohol- while others don’t. What’s the’glue’that serves MAAA’s Morris Chafetz: “There isms” as there are alcoholics. Behavioral binds some people to their alcohol prob- are houses where they don’t even say Scientist Don Cahalan of the University lems?” Adds Marty Mann, the woman anything to you when you come in the of California at Berkeley objects to even who founded the National Council on door before they ask, ‘What will you attempting a strict definition. Drioking, Alcoholism: “No one has ever found the have to drin-k?’ ” I{e also notes that “in he says, is a continuum, and no ofle can way to turn a non-alcoholic into an al- our crazy-quilt value system, masculindraw an exact line between an alcohol- coholic. There is a basic di.fference in ity means that if you can hold a lot of alic and a severely troubled dri:rker. “The people.” cohol and seemingly not show its effects, issue,” he states, “is why some pe,ople ap- For those who are susceptible, U.S. that’s somehow a sign of strength.” parently waste their lives on alcohol society offers powerfiil temptations. Ob- Chafetz points out that in some other irii’i;lilii:rll.Jl ,-l .it,,i :. lllji: nrii

can have both immediate and possibly long-range deleteri- The Effects of Alcohol l*i’:.i ous effects on the body. Accordingto Dr. Peter Stokes, a psychobiologist at Cornell University Medical College, the fiver Almost immediately after it hits the stomach, alcohol is becomes fatty and therefore less efrcient after only a few coursing througb the bloodstream to the central nervous sys- weeks of dssTning three or four drinks a night. But in the tem, where it starts to slow down, or anaesthetize, brain activ- early stages, at least, the condition can be reversed by abity. Though it is a depressant, the initial subjective feeling that stinence. More moderate imbibing-two dri.nks I night with it creates isjust the opposite, as the barriers ofself-control and meals, say-alrnost certainly does no harm to most people. restraint are lifted and the drinker does or says things that his New studies link drinking to heart-muscle damage and dewell-trained, sober selfusually forbids. Only later, after a num- terioration of the brain. Research by Dr. Ernest Noble of the ber of drinks, are the motor centers of the brain overtly affect- University of California at Irvine shows that alcohol inhibits ed, causing uncertain steps and hand movements. the ability of the brain cells to manufacture proteins and ri- IIow quickly the alcohol bonucleic acid (nNa), which takes efect depends on mElny – some researchers believe play a iilirrii,r factors. One person may be bombed after a glass, while an- Alcohol Leveh in the Blood role in learning and memory storage. After 20 or 30 years, After drinks ioken on on empty stomoch by o l5o-lb. person other stays relatively sober says Dr. Noble, two or three after several. Because alcohol drioks a night on an empty is diluted in the blood, a 200- stomach may impair a person’s lb. man can usually tolerate more liquor than a 110-lb. (( )r’ learniog ability. Both Stokes and Noble cite studies showing woman. Food also retards abl)lr) premature and irreversible desorption of alcohol from the struction of brain cells after gastrointestinal tract, and a years of heavy drinking. few ounces taken with a meal Time Such fightening studies of are less powerfirl than an equal olcohol to the results of drinking have not amount downed an hour be- the yet been accepted throughout Hourr fore. By the same token, some lo 0.r5 the medical profession, but the drinks with food in them Gross infoxicqlion 5 highbolh (tVz oz.whish ea-)or physical effects on an alcoholic 5 cockioils (t/t oz.whisky eo.) ot made with eggs, of very heavy drinking are -egsogs milk and cream, for example 2V/z oz. ordinow wina or 7r pi. whisky beyond dispute. A pint of whisslightly less wallop ky a day, enough to make eight -have than straight drinks. The to- Clumsinessunsl€odiness in highbolls or or ten ordinary highballs, pro- 4 cocktoils or mato juice in a Bloody Mary sionding or wolking 22 oz. ordinory wine or vides about 1,200 calories or the orange juice in a screw- 8 bohles beer(I2 oz. eo.] half the ordinary driver is not enough to make Exoggoroted emotion 0.09 -roughly erergy requirement-without 3 highbolls or any appreciable difference. & behqvlor- 3 cocktoils or any food value. As a result, an tolkolive, noisy or The total quantity of alco- morose 16l9 oz. ordinory wine or alcoholic usually has a weak 6 bottles beer hol in a drink and the rate of 4 0.06 appetite and often suffers from consumption determine the al- Feeling of wormlh 2 highbolls or matnutrition and vitamin decohol level in the bloodstream. menlol reloxqtion 2 cockioils or ficiency. The slack cannot be ll oz. ordinory wine or Thus a Scotch and water would 4 bottles beer taken up by popping vitamin pack the same punch as Scotch o.o3 pills; heavy alcohol consumpon the rocks or a Scotch and Slight chonges tion impairs the body’s utilizain feeling soda if all three were druok at tion of vitamins. At the same the same speed; drinking more time, excessive intake of alcoslowly gives the system a hol also affects the production chance to eliminate some of and activity of certain diseasethe alcohol. The mixing of dif- flehting white blood cells, giv- lr Source; Dr, leon A. Greenberg ferent types-beer, wine, whis- TIME Chod by W, Horlens ing the alcoholic a particularly i

ky and brandy, for instance low resistance to bacteria. make a drinker sick, but it would not make him any Inevitably, xhe alcoholic develops a fatty liver, aad his -might more drunk than the same alcoholic measure of just one of chancesof developingcirrhosis,aconditioninwhichlivercells thesedrinks. have been replaced by fibrous scar tissue, are at least oae in So far medicine has found no cure for the hangover, a1- ten. A severely damaged liver cannot adequately manufacture :

though aspirin can alleviate the headache. Despite a pleth- bile, which is necessary for the digestion of fats; as a conseora of folk cures (oone of them really effective), the best pol- quence, the alcoholic often feels weak and suffers from chronicy is to avoid drinking in excess the night before. Actually, ic i:rdigestion. This may be made worse by gastritis, which is no one knows exactly what causes the hangover’s unpleasant caused by alcohol irritation of the sensitive linings of the stomsymptoms of headache, nausea, depression and fatigue, which ach and small intestine. The troubles of a heavy drhker do not many drinkers experience at one time or another. end there, and through damage to the central nervous system Some recent research indicates that even social drinking and hormonal imbalance, alcohol may even cause impotence.

IIME, APRIL?z,1974 77 1,1.,l, .,, ,’. .,1 , . l .,,ill ,r;r ,ti “

BEHAVIOR countries-Italy and Israel, for example plaia precisely why, al- –drinking is an accepted social custom, though Irish American sobut there is little alcoholism. Why? The cial life has often centered reason, he thinks, is that alcohol in those around the pub or bar, and countries is a companion to a happy oc- heavy drinking has been a casion, not the occasion itself. culturally accepted means t\ Many other countries, however, for temporarily getting have a much worse problem with alco- away from problems. Jews, hol than the U.S. France, for instance, by contrast, have a relative- i “ir has the highest rate of alcoholism in the ly low incidence of alcohol- ll

world (an estimated lUVio to lzEo of the ‘sm, though it is rising population, including some children), among them too. Jews have and the Soviet Union may not be far be- always frowned on public hind. Soviet newspapers now blame 60Vo druokenless a5 lsing a bad of their country’s murders, holdups and reflection on their entire burglaries on that old demon vodka. So- culture, and drinking has viet Party Chief Leonid Brezhnev gave not been the accepted way tacit recognition to tho problem when to relieve problems (“Jews U.S. Secretary of State Henry Kissinger eat wben- they have probvisited him recently. Discussing with lems,” quips one Jewish 1(igsinger plans for a U.S.-built soft- psychiatrist in Manhattan). drhk factory h the Soviet Union, Brezh- Although alcoholism, nev mused: “Maybe we can teach our when it occurs, often follows sHocK AVERSIoN lN CALIFoRNTA* people to drink less vodka and more ten years or so of problem ‘HERAPY Pepsi-Cola.” drinking, there are also alcoholics who been a remarkable change in progposis. Bqd Refleciion. Some experts be- apparently skipped even the social- No miracle cure, no equivalent of the lieve that alcoholism may be encouraged drioker phase. They passed from total Salk.vaccine is in sight for the alcoholby the destruction oftraditional values. abstinence directly into chronic alcohol- ic, and none is ever likely to be found; Buttressing this notion is the experience ism. This may be due in some cases to a but for every one of the many alcoholof the American Indians and Eskimos, biochemical imbalance of some sort. isms there is at least one treatment or whose cultures have been disrupted “There have been people I sall’instant combination of treatments that offers a more than those of any other ethrric alcoholics’who are in trouble the min- good chance ofcure. groups on the continent. “The major ute they drink,” says Marty Mann. The common element ia most of the problem is one ofsocial disintegration,” There may be some yet unknown he- cures is group support. Explains Jim says Dr. Charles Hudson, chief of psy- reditary factor that fosters alcoholism. Bryan, director of therapy at Chit Chat chiatric services at the U.S. Public Dr. Donald Goodwin, a psychiatrist at Farms, a highly successfirl alcoholic Health Service’s Alaska Native Medical Washington University in St. Louis, treatment center west of Reading, Pa.: Center. “The original social structure in studied the case histories of 133 Scan- “We tell the patients it can be done, and many places in rural Alaska has been dinavian men who had been separated you don’t have to do it alone. The pablown apart, much as it has been in cen- ftom their natural parents and raised tients help each other get well.” Half tral cities, the ghettos and Appalachia. by foster parents. The sons of alcoholic the staff-including Bryan himself-are The things that were important to peo- fathers were four times as likely as the recovered alcoholics, providi.og even ple have been taken away, and when sons of non-alcoholics to be alcoholics more credence to the support they give there’s nothing to do, they’ll take their themselves. Similar studies by Goodwin to patients during Chit Chat’s 28-day, last buck to get a bottle and stay drunk of twim raised by different families seem $840 treatment. “We do not look into all the time.” to offer even stronger support for some the whys of their drinking,” says Bry- Blacks and Chicanos are also par- genetic explanation. Most researchers an, “but how they can stop.” ticularly prone to alcoholism, possibly are reluctant to accept such biological No ln-Depth Theropy. At Lutherfor similar reasons. Among whites, the determinism as the sole cause, but many an General Hospital northwest of Chi- Irish Americans probably rank highest agree withGoodwin that there may very cago, where the treatment runs 21 days on the alcoholic scale. No one cafl ex- well be some errant gene that makes at and costs $1,827, there is also an emleast some alcoholics more phasis on interaction between patients PATIENT DRINKTNG IN,,DUFFY,S IAVERN,, vulnerable than the rest of and staff and among the patients themhumankind to the bottle. selves. For most patients, there is no in- “There is no one overall an- depth therapy. “We’re off this kick of slyei,” concludes Don Caha- using psychotherapy,” says Medical Dilian. “We are trying to exor- rector Dr. Nelson Bradley, a psychiacise a devil, but there is no trist, echoing the general opinion ofexone devil. There is a host of perts that classical psychoanalysis is of demons.” limited help for most alcoholics. There is also a host of The patient at Lutheran General is treatmeflt centers-7,500 by treated for withdrawal symptoms latest count-and treat- can range from the shakes and ments. Until recently, -alco- -which hallucinations to convulsions and fullholics were thought to be all blown DTs-and given a medical assessbut incurable, afficted with ment during his first five days. On the ij 1$l a kind of psychic leprosy. Doctors would scarcely touch sixth day he is assiped to one of three 25-patient teams. They meet three times them (many still refuse to a week-in many cases with wives, hustreat them), and the law bands, children and even employers-in looked upon them as human sessions designed to bring the alcoholic vermin who had to be swept back into society lla6rrgh lectures, edoff the streets and thrown ucational films and discussions about into drunk tanks. Old atti- drinking problems. Lutheran General tudes still persist, but within *The patient receives an electric shock from a dethe past five years there has vice on the’bar when he sips liquor.

78 TIME, APRIL22, I974

follows up its patients for two or three aftpr six monttrs, approximately half of tories and admit to themselves and each montis, some of them with psychother’ the group members were either dry or other that they are powerless to control apy, and it estimates its succ.ess at about drinking le.ss than twice a we,ek. their drinking. Members attend meet- 50Vo aftr’r ttrree years. “Beyotd 50Vo,” Almost everyone else who works ings as often as they feel the need. “My says Bradley, “youive got to have the in’ withalcoholics regardsttris study as her- name is Jobn,” a member will intone at :j r”ii,,, rfr l volvement ofthe family and the employ- esy against the almost universally ac- each meeting, “and I am an alcoholic.” ers. Then the success rate can go as high cBpted belief that a recover€d alcoholic Saysan Atlanta executive who has been ;.,: r ti, as807o;’ can never ever drink again. “Out of a member for 25 years: “I am deeply ,li : ti,’ ll .iir I A variant of the Lutheran General 3,0fi) alcoholics treated a1 this hospital convinced that A.A. is the only way. ‘,’ lrri’i. and Chit Chat models is the treatment and another 12,fi)0 consulted, I have Doctors cannot cure alcoholism because rl’ t ll’ ‘ center tlat combines group therapy and never s€eo one retufir safely to social it is not simply a sickness of the body. ‘ ”li”: -‘

hypnotic suggestion with a behavioristic drinking,” says Richard Weedman, Psychiatrists canoot do it because it is kind of aversion treatment: electric head of an alcoholic treatmetrt cetrter not simply a sickness of the mind, and shocks or drugs to make the very odor at Chicago’s Grant Hospital. “One drink ministers cannot do it because it is not of Iiquor abhorrent. At Seattle’s Schick’s won’t push him ofr the wagon, but if he a sickness of the spirit alone. You must Shadel I{ospital, which offers an eleven- takes another three weeks later, bang! treat all three areas, and that is what day, $1,5fi) program, each Patient is He’sgone.” A.A. does.”* taken to “Duff’s Tavern,” a small room Most ofthe methods owe a large debt Eosy Cop-Oul. Even A.A. requires decorated with enough bottles of whis- to Alcoholics Anonymous, the oldest, the alcoholic’s commitment to change. ky to lubricate a regiment. The patient the biggest (650,000 to 750,000 mem- Many workers in the field are now tryis given a nausea-inducing shot and then bers) and stjll the most successful or- ing to downplay the idea-espoused by handed a glass of his favorite brand. He ganizatton by far for helping alcoholics. Marty Mann 30 years age-that alcosnifis the aroma, takes a sip and swirls “Until the researcher is able to dem- holism is a disease. The label may make it around in his mouth. Then, sickened, onstrate some better practical tech- problem drinking worse by absolving he spits it out into a handy container. niques, the A.A. approach continues to the drinker of responsibility. An over- Fqlql lllness. The Patient goes merit our admiration and endorse- emphasis on the psychological causes of througI a similar process four more ment,” says Gottheil, And, write Soci- alcoholism can have a similar effect. “A times during his stay at Schick’s Sha- ologists Harrison Trice and Paul search for the roots ofthe personal probdel, at the end of which he will Pre- Roman: “Despite lay leadership, A.A. lems that cause a person to become adsumably associate nausea with liquor has apparently achieved a success rate dicted can become an easy coP-out,” have a long-ternr aversion to the that surpasses those of professional says Psychiatrist Robert Moore. “The -and stuff. “Aversion conditioning is not fun therapies.” classic therapy game becomes a techat al7,u Schick’s Shadel’s Director Dr. An A.A. member is anyone who nique of protecting his alcoholism.” James W. Smith tells incoming patients, considers himself a member. There are What about the alcoholic who does “but you are dealing with a fatal illness. no required dues, and lest riches cor- not want to change-or does not even In other fatal illnesses, such as cancer, rupt the fellowship, no one is allowe.d recognize his problem? For many there surgery is often called for if it gives the to contribute more ttran $300 a year. In- is still no answer, no lifeline that can be patient the best fighthg chance for sur- stead of using professional therapists, thrown to them. For many others, howvival. At the moment this is the best we the members help each other; one al- ever, there is new hope in an old and know of-the method that will do the coholic is always on call to.come to the hitherto unacceptable technique-arm best job in the shortest time.” aid of anottrer. The treatment is noth- twisting by the boss. Recogoizing that Aversion therapy has been widelY ing more sophisticated than the gath- alcoholic employees are costing them citicized. Says one social scientist: “I ering together of a dozeo or more other countless billions 4 y@r, many compathink doctors who emphasize aversion alcoholics who share their drinking his- nies are investing money and effort in afconditioning are misguided. They claim firmative action. Since the that they are curing alcoholics by gv- THERAPY 3ESSION AT PENNSYIVANIA,S CHIT CHAI FAR’IIS late’40s, when the fust ining them a shot in the behind, which dustrial programs started, makes them sick. But how long does that some 200 6rms, including really last?” A program that draws even General Motors, Hughes more fue is one in which doctors study Aircraft and even Hiram alcoholism by offering drinks to alco- Walker, the distiller, have holics. Indeed, Dr. Edward Gottheil, jumped on the bandwagon, who oversees such a researgh project at the majority of them in the I lll,tilt.l . ! the Coatesville Veterans Administration past five years. Many of the r.,l;irr” ]lii riliiiiiit’ I Hospital in Penasylvania, admits that firms have written the plans I

,rj.ilii :: I r . his work is “extremely controversial.” into their udon contracts. r ,’i StiJl, he argues, traditional centers ei- Although the programs are I I

.rli t’r ther study alcoholics without their al- costly, they actually save t;rlr’i:i!l l ii cohol or alcohol without the alcoholics money in the long run be- I

cause they can salvage valu- :i i iir. ,:.._:

not drinking itself. “The idea that l

-but complete abstinence is the only treat- able careers. ment interferes with research,” he says. An alcoholic employee At Coatesville, patients are not only is absent 2% times as often ‘:r i,.l I’ll given individual psychotherapy, Sroup as a non-alcoholic. Indeed, therapy, music therapy and antidrinking he is partially absent’even seminars but are also allowed one or when he is working, often ,,ri.,1,l]!,li

two ouflces of pure alcohol (ethanol) demonstrating much less efonce ao hour on the hour, from 9 a.m. ficiency than his nonalcoto 9 p.m., simply by asking for it. If he hotc colleagues. If he is drinks the allowable maximum every fired, the investment that hour, a patient can achieve a consid- the company has put into erable buzz by 9 p.m. More important, fuis flaining is lost altogethl3 times every day he must make a con- er. “The company of any scious decision: to drin-k or not to drink. +If a member’s physical problems In a follow-up study of their fust group, are acute, A.A. gets him admitted Gottheil and his associates claim that, to a hospital.

TIME, APRIL 22. ‘I974 79

-= BEHAVIOR size that says it does not have an al- couraging, and in most programs about es for outpatient treatment. Because cohol problem is kidding itself,” says 90% of the-alcoholic employees do elect L^q.nC makes a strenuous effort to reach Ray Kelly, an Illiaois state mental treatment. When a company puts its alcohol abusers early, the centers can health official. In any typical group of weight behhd an employee’s rehabili- usually help improve the physical conworkers, 3Vo to 47a are likely to be dis- tation, the chances of success are better dition, earning ability and family situruptive drilkers. than 2 in 3, say doctors at Lutheran Gen- ation of their patients. In the typical industrial program, a eral, which works with 52 companies in Sparked by fowa’s Senator Harold supervisor, noticing an employee’s work the Chicago area. Hughes, who is himself a rehabilitated slipping, alerts a counselor. If the coun- Holfwoy Houses. Government at alcoholic, the Government has begun an selor’s investigation finds that alcohol is all levels has become sensitive to the al- expensive program to combat alcoholthe culprit, he calls the man in and rec- coholic’s plight-and the enormous ism through research, education and ommends a treatment-and-rehabilita- damage that he wreaks. Since 1970, funding of local programs. Starti:rg with tion plan that falls under the compa- when Congress demonstrated Washing- $70 million ia 1971, federal spendi:rg has ny’s medical insurance coverage. There ton’s changed attitude by passing an al- now reached $194 million. Eighty-five will be no stigma attached if he enters cohol abuse and alcoholism act, a score percent of this amount is allotted to the plan, the counselor tells him, and if of states have enacted laws that remove treatment, rehabilitation centers and he successfully completes it, his career drunkenness (thoueh not diunken driv- halfirayhouses, many of which would no will not be hurt. “If they do not want to ing) from the criminal statutes. Thus doubt still be only token efforts without go for treatment,” says Jack Shevlin, an drunks are no longer put in jail. Other substantial federal funding to the states. alcohol counselor in Illinois Bell Tele- places, however, must be provided to re- The liquor industry has awakened phone’s pioneering program, the answer ceive them. These are called Local A1- to the problems that excessive use of its is in effect: “Of course you do-if you coholism Reception Centers (or tanc), products causes. Some of the companies want your job.” where the alcoholics are detoxified. have been promoting moderation The results have been more than en- They then graduate to “halfway” hous- through advertising and posters. Sea-

The Price of Alcoholism: Five Cqse Histories * tFF If m fr.ll through Harvard and the service, but stumbled and cut her forehead on the

*&, gl?i*x”: i”$””3f1H.T,;#1J,””$ mantel. Her date found her bloodied and blearyand walked out. This shocked her

”,’,]I !'{; l1:ffifl1l’1″‘3fi3Js3:J *? ffi ffi: l,i the aversion was only temporary. *o Drir:ting, borrowing money, being so much that she went to A.A. Elizabeth dried out for a while and then had a relapse, drinking more heavily than before. Finally she returned to t u.ro”t”Illt#ffi1y; at 2Thewas so far the A.A. program, wtrich she has fol- S gone that he was not able to write his lowed successfully for five years. “Mile :l name. In December 1948 he went to Al- was one hell of a binge,” she says, “and coholics Anonymous but fell off the I consider my sobriety precious. I wagon after only two months. In March wouldn’t do anythiog to jeopardize it.” he was back in A.A., and has been goiag to meetings ever since. tAY,45, a Montreal journalist, says that “People there welcomed me,” he he began drhking heavily “out ofa serse says. “My goal was to live. Survival, of fatalism”; his father, mother and that’s all. They told me that if I helped brother are all alcoholics. other people, I would receive and be “I turned into a chronic liar and helped myself. A funny thing happened. charlatan, trying to cover up my aflic- I got better. In two or three months I tion. I made raucous scenes and picked was in better shape than I had been in fights for no reason. f often wet my pants for five years. I needed a miracle and and vomited all over myself in public. I got it. But it’s not over yet. It won’t be went to doctors and got tranquilizers, over until f die.” which I proceeded to combine with liquor, which made me even worse. I went EUZABETH, 44, a Manhattan advertis- to private clinics, public hospitals and wOIliEN DRINKING IN TIAANHATTAN BAR ing woman, was a fierce teetotaler be_ even ended up in a mental home. I went to a priest and then to Alcoholics Anon- No one is a typicat atcohotic, and the ffiffi”iJtl i:l r::filitff::,ij:ll”# ymous. They were well-meaning people, only thing all alcoholics have in contnxon mastectomy, Elizabeth went to her psy- but their piety seemed too facile to me, is their addiction. That fact was ,’e- choanalyst. The doctor proposed that and I usually had to rush to the nearest emphasized by the reports of Ttt’ttt cor- she try a drink to calm her fears. “I’ll bar every time I came out of a meeting. respondents who interviewed many of never forget thg fgsling,” Elizabeth says. I was thrown into jail, mugged, and slept them across the U.S. and Canada, in- “It hit me instantly. This was sqrnsfhing in the gutter. f stank, my gums bled, cludingthefollowing: I’d been waiting for without knowing and my hands were too shaky to shave it, ar;ld I never wanted to be without it without a couple of drinks.” JOE, 52, an Atlanta stockbroker, began again. I felt so warm and calm and safe.” The turning point for Jay came his career as an alcoholic at 15 when he It turned out that she did not have when he awoke in a seedy hotel with went camping with his brothers. One of cancer, but she went on drhking any- the DTs. “My eyes were bulging from the boys opened a bottle of wiae, and Joe way, “right around the clock.” Although their sockets. My arms and legs flailed instantly discovered his weakness. “That she srpped almost a fifth of Scotch a day, about like windmills. Then those black night was it for me,” he says. “I went it did not seem to affect her work. “I dots started spreading across the walls lookiag for a drink in the morning, and I never got really drunk, never had a 1nd ssilings, and I had to choke back a drank all the way through high school. I hangover.” One night while waiting for scream. This was the point at which I was in the grip of an insidious, progres- a date she took an extra slug of Scotch finally decided I wanted to live, trot die, sive disease.” Joe continued to drink “to be brigbt and special.” Instead she and forced myself to go get cured.”

grams, for example, last year spent Still, for an industry that has rev- do so, adding treatment centers and S250,000 for hard-hitting magazine ads enues of $18.3 billion a year (after fed- halfway houses on the Minnesota modagainst excessive drinking. Licensed eral, state and local taxes), such expen- el. Third, more companies should start Beverage Industries, Inc., the public rep- ditures are probably only a fraction of alcoholic rehabilitation programs, lookresentative of the disti.llers, spends what they should be. Contrasted with ing upon money spent combattiag al- $150,000 a year on research projects and this are all the ads pitched toward the coholism as almost an efficiency meaallots $250,000 each year for a national young, implying that not even a week- sure, which it certainlY is. advertising campaign, promoting “re- end in the country can be truly eojoy- How is the battle against alcohoLism sponsible” drinkhg. (“Know when to able without drinking. The industry going? Agail, there is good news and say when” is the theme of one ad. “ff could no doubt change its pitch-use bad news-with an emphasis on the latyou can’t stop drhking, don’t start driv- older models and show people drinkiag ter. Senator Hughes, who, more than ing” is the message of another.) Last only at parties-without cutting sales or anyone else, was responsible for the week Iiquor industry leaders and state profits. turnabout in the Government’s attitude, beverage-control officials met in Miami Public Awqreness. What else can is as good a judge as any. He is happy with experts from the Rutgers Center be done? For a starter, the Nixon Ad- that tax dollars are joining the fight of Alcohol Studies to consider other ministration should give Chafetz’s agen- against alcoholism, and that the public measures that could or should be taken. cy the entire 9137,947,000 it has request- is finally becoming aware that alcohol- Jack Hood, board chairman of the Na- ed for the coming fiscal year, instead of ism is a treatable condition from which, tional Alcoholic Beverage Control As- attempting to cut it to $99,800,000. The with dedicated help, two-thirds or more sociation, told conferees of plans to use money would be well spent on research, of its victims can recover. But he sees “the unmatched power of education to {,14ining, community health services and even that as only limited comfort. “I’m conviace every American, young and pubtc education. Second, the 30-odd not optimistic that we’re gaining on the old, that responsible dri::king is the only states that have not yet removed drunk- problem,” he reckons. “Instead, it’s kind that anyone should tolerate.” enness from the criminal statutes should gaining on us.”

The cure came at Toronto’s Don- from one of the male patrons. He in- it was wine, I would get very mellow. If *sod Tnstitute, where he went into vited her to stop at his apartment for a it was whisky, I was sure to go wild and group therapy and was put on a dailY drink. She had to fend off a rape at- get hto a fight.” dose of Antabuse, a drug that causes tempt, suffering a broken jaw and scar- Kicked out of sehool for fighting a nausea, palpitations and anxiety at the ri:rg cuts on the face. “I thought I’d hit guidance counselor in what he calls a first whiff of liquor. To eusure his long- the bottom before,” she says through the “temper blackout,” Bob was sent to term sobriety, a six-month supply was wire.s that still hold her teeth together, Bellevue Hospital for a psychiatric eximplanted under the skia of his abdo- “but now I realized that this was it.” amination. “At the nut house they told men. “I finally walked out—-cured, tin- After attending a Dade County al- me I wasn’t an alcoholic because of my gling with life and vigor and atmost hy- cohol rehabilitation center for the past age. I was told that if I haadled my emopersensitively aware. But as I saw a bar, tbree months, Barbara is sober and plans tional problems, I would be able todrink the craving hit me so hard that I bent to remain tlat way. She fears, however, normally.” Bob nonetheless tried A.A., double. Was this t1e way it was going to that her drinking may have permanent- not once but three times between bingbe all my life? The answer apparently is ly hurt her children. “They remember es. “I just hadn’t decided that I wouldn’t yes. The desire would fade, but some- my wine-drinking days when I’d throw drinkanymore.” where-in the clink of glasses or the up in their wastebasket. Now if they see Finally the A.A. “cure” took when sight of good red wine-is the trigger. It me drinking a Coke, my older glrl wil Bob was at the ripe age of 15. Sobriety is a trigger that I dare not Pull.” come over and taste it and then reas- has not been easy. A well-meaning sosure the younger one: ‘It’s O.K.’ ” cial worker pressured Bob to take tran- BARBARA, 26, aMiami divorce,e with quilizers to relieve his tension. He retwo young children, started drinking BOB, 18, a New York City carpenter, firsed. “If I did that,” he asks, “then why when she was 13. “My mother was a started offon a bottle of Canadian whis- not drink? I was tired of being told that heavy drir:ker,” she says, “and we al- ky from the family liquor cabinet when l) I’m alcoholic, and 2) I need to take ways had lots of liquor around the he was twelve, and from that moment tranquilizers to survive. If I had takeo house.” Married soon after high school, would drir:k whatever and whenever he drugs, I would have been in the nut she became pregnant and-at doctor’s could. “Ifit was beer, I laughed a lot. If house again in a matter of months.” orders-began downing a shot of braudy to help her sleep. “I didn’t like the CHITDREN PTAYING WHllE ITTOTHERS ARE IREAIED AT FTORIDA ATCOHOTIC CENTER taste, but before my baby was boro I was drinking half a bottle a night.” Sheand herhusbaod eventually sep arated, and Barbara started to vary her drinking habits. “The kids were one and three, and I sipped wine while I prepared their lunch. Within six montls, I went from a small bottle a day to a gallon, then on to martinis and Scotch. It could be blowing ablizzard, and I’d trek through anything to get my bottles.” “People are so drink-oriented,” she adds. “It’s the acceptable thing to do. You never go to a party or dinner without drinks.” Guidelines that she set for herself-never drink in the morning or before driving-were discarded, and arrests for drunkenness began to pile up. Sent to a detoxification center after one eight-day binge, she sneaked out to a bar, then, at 5 a.a., accepted a ride back