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

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injury to the drinker’s health or to his social and he quickly began spree drinking and ended by economic functioning.” By that definition, there is touring hospitals and jails. Dr. George N. one alcoholic for roughly every sixteen persons Thompson of the University of Southern in the country who ever consumed alcohol. California reports another case: “A patient who Some years ago men outnumbered women by had continued a desk job fairly successfully for about five or six to one, but it may be that the twenty years while he drank two fifths of ratio is now four to one or even lower. bourbon daily. He finally succumbed to hepatic The sufferers divide into three principal cirrhoses but never seemed to suffer from toxic types: effects to his nervous system.”

 The loss-of-control alcoholic. In this type  The dependent-but-unaddicted alcoholic. preponderant in the U.S., Canada, Great Britain, This type does not drink compulsively, but and Northern Europe, increased tissue tolerance heavily enough to cause eventual damage to his to alcohol and alteration in cell metabolism family and work relationships, and sometimes to produce an addiction that makes control over his health. Often he progresses into out-ofdrinking either difficult or impossible. This leads control alcoholism. What happens to him both to compulsion to drink and to harrowing depends less on the quantity he drinks than on physical symptoms when coming off drink. his drinking behavior. He can cut down if he is Typical of the out-of-control drinker is an aware that he is heading for trouble. It is not executive vice president of an industry trade always easy to spot this type of drinker, and the organization who lost family, friends, home, and difficulties are increased because so many job, who sobered up in one hospital only to get alcoholics delude themselves into believing that drunk and land in another, and whose recouping they are heavy drinking nonalcoholics. of losses and rise to his present post came only after his recovery. But just as typical is a senior Executive suite and skid row officer of a company with $300 million in sales who hid everything and lost nothing tangible at The alcoholic reinforces his delusion that all (although he figures his drinking cost his he is some other sort of drinker by adhering to company more than a million dollars’ worth of the popular notion that alcoholism has a definite business) and who surprised his colleagues location – skid row. But, in fact, only about 3 when he told them of his alcoholism a year after percent of all the alcoholics in the country are to his recovery began. be found there. Only recently has the general public been willing to acknowledge that  The unable-to-abstain alcoholic. Physical alcoholics are also to be found in the bosoms of addiction also characterizes this type, which their families, the arms of their churches, and predominates in France and other wine- the management rosters of their corporations. In producing countries where heavy drinking fact, alcoholism has been found to be more of a throughout the day is socially acceptable. problem in the executive suite, in professional Addiction leads, however, not to the offices, and in workshops than on skid row. uncontrolled-spree behavior typical of American Generally speaking, the more educated, the alcoholics, but to an inability to get off drink for more urban, and the better salaried Americans even a day or two. are, the more likely to drink. Social protection for such alcoholism is The skid-row myth, says Dr. Selden D. common in France but rare in the U.S. The Bacon, director of the Rutgers Center of Alcohol president of a small business organization in Studies, grew out of the old controversy New Jersey built his own kind of social between the wets and the drys. Many persons protection around his drinking. He had escaped both camps by avoiding the problems secretaries, subordinates, bartenders, and of alcoholism altogether; they came to believe family trained to help him keep a relatively that such problems simply did not exist in nice constant volume of liquor in his system. But families or in good neighborhoods, but only in when he was suddenly separated from his family out-of-sight areas where they could be handled

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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.I. 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, In 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, Institute, “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. It 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 Irish 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, “Is 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, segments of the population, can now be defined how it sedates – producing in the process an roughly. There is, for instance, ample working initial misleading euphoria, but subsequently data on alcoholism among factory and white depressing and anesthetizing – and how it collar workers with reasonably precise studies leaves behind that jittery sense of excitation that on work performance, absenteeism, accidents, often prompts the alcoholic to another drink or and the like. There is also an increasing body of another bout. Established are such facts as data about alcoholism among executives, a topic alcohol’s ability to induce hyperactivity of the not generally discussed only a few years ago. brain through its effect on the brain’s reticular There is, moreover, a good deal more activating mechanism. The ancient surmise that that is known about alcoholism’s sundry alcohol in the bloodstream is the agent of the complications. An HEW study of 1,343 patients alcoholic’s compulsion to keep on drinking has

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been confirmed by a variety of experiments, Sociologists come under cross fire from including a thirty-one day test conducted by some of the other professionals for focusing on Harvard’s Dr. Jack H. Mendelson, in which nonmedical aspects of alcoholism. Their basic alcoholic volunteers were subjected to twenty- proposal for treatment is the prevention of four days of controlled drinking and seven days alcoholism by social and cultural change, a of observed withdrawal, in the course of which proposal whose value can be determined only at classic and unmistakable signs of physical some time in the future. Moreover, they offer addiction were manifest. both statistical studies and cogent etiological arguments. “It has been noted,” says sociologist Why it comes and how it goes Dr. Seldon Bacon of Rutgers, ”by almost all observers for decades that by and large Certain facts about the treatment of Americans are anxious, confused, ambivalent, at alcoholism are indisputable. As rooted, it has times guilt-ridden about their attitudes toward been established as a disease treatable by drinking.” Sociologists have delineated such physical, psychological, and A.A. therapies. uncertainties in detail and have re-created in the Medical authorities have perfected the hospital process the history of drinking in the U.S., handling of its agonizing withdrawal symptoms – replete with such intriguing facts as nearly the physician has a whole battery of variously identical per capita consumption rates between acting drugs at his command – and withdrawal is 1850 and 1968, despite the intervention of the now rated no more of a risk than minor surgery. industrial revolution, urbanization, and world It is universally agreed that the one way to arrest wars. the illness is to get the patient off drink altogether. And it is known that the alcoholic Knowledge through no-knowledge can’t get off drink through his own will power, that he must seek outside help. Physiologists and psychologists, highly At this point, however, the various vocal about the causes and treatment of sociologists, psychologists, physiologists, and alcoholism, have contributed another body of the A.A. laity tend to part company. Alcoholics facts, and also have delineated important areas Anonymous is widely conceded to have of ignorance. Dr. Peter Stokes, research produced more recoveries than have all other physician at Payne Whitney Clinic of the New therapists put together, but it suffers in the York Hospital and co-discoverer of the effect of minds of some professional research men from alcohol on white-cell mobilization, remarks being insufficiently scientific. A scientist can confidently, “We don’t know anything about the hardly quarrel with the fact of 400,000 recovered causes of alcoholism; we can’t identify the alcoholics, but he can nonetheless feel uneasy susceptible individual; we can’t treat specifically about a fellowship whose program begins with or chronically; and we can’t prevent it.” This an admission of abject surrender of one’s life as state of knowing what one does not know, Dr. unmanageable, follows with belief in “a Power Stokes emphasizes, is essential for solid future greater than ourselves that can restore us to discovery. Medical research in general has to sanity,” and prescribes constant meetings and explore areas of ignorance before arriving at labor with other alcoholics. Such propositions, areas of new information. Cancer research, whose principal intellectual ancestor is the more advanced than research in alcoholism, pragmatic philosopher William James, are not developed its virus theory only after assiduous subject to quantitative measurements and are exploration of the unknown. often troubling to outsiders. What is more, only Physiologists, of course, examine about one alcoholic in fifteen in the country is a complex cellular, metabolic, glandular, and like member of A.A. Its one requirement for biochemical events, while psychologists and membership – a desire to stop drinking – is psychiatrists apply a body of concepts ranging thought by some to limit its therapeutic efforts to from learning theory and conditioned reflex a relatively select few. formulations to personality testing and psychodynamics. Almost all researchers in

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these fields believe it is likely that alcoholism hospitalization, he believed fervently that his rests on a physical base upon which is built a emotional health was improving – up to the very psychological structure, but research knowledge moment when desperation eventually convinced both of base and structure is as yet not very him he was a common out-of-control alcoholic. deep. Alcoholism indeed coexists with various As U.S.C.’s Dr. Thompson says, “It is axiomatic types of mental and emotional illness that that it is useless to attempt psychotherapy on a require specialized medical attention. Until very patient who is continuing his drinking.” recently it was believed that predisposing The new social acceptance of alcoholism psychological factors played a causative role of as a disease rather than as a stigma of sin, say some sort in the development of alcoholism. the professionals, should help break down the Alcoholics, after all, are so frequently separated massive defenses alcoholics develop against from reality that they can be called schizoid, so yielding to treatment. Acceptance is providing a regularly low in mood they can be called cultural climate in which they may be more depressed, so often unsure they can be called readily helped and a long needed financial base dependent, and so obviously devoted to the for an important burst of new research. bottle they can be labeled obsessive-compulsive and orally fixated. But these characteristics did Crisis precipitation not necessarily pertain to their condition before they became alcoholic, and the same There is already enough knowledge for characteristics, moreover, are not uncommon dealing effectively with the problems of among nonalcoholics. Today there is less alcoholics on the job. An HEW study estimates enthusiasm over predisposing factors. that 70 percent of them, indeed, are still on the Enthusiasm plays a key role in medical job and have been there for fifteen to twenty-five research, but in the search for remedies for or more years. An alcoholic’s job, in fact, is the alcoholism, it is now much more subdued. In the last great bulwark of his defense against past, various therapeutic devices, based on admitting his illness; the threat of its loss can various etiological theories, were put forward often produce the inward crisis that is required with considerable ardor as the therapies for before he will submit to treatment. Wellalcoholism, but they turned out later to be at conceived company programs, moreover, can best adjuncts to standard therapy. Among these speed up the precipitation of such a crisis, in the are psychodrama, group therapy, and hypnosis process rescuing men from unnecessarily long as well as individual counseling. The list also suffering at a cost to the company that is far less includes the barbiturates (useful but themselves than the amount it is already losing through poor addictive), aversion therapy, vitamins and sound productivity, absenteeism, severance or diet, Ayerst Laboratories’ Antabuse (still widely retirement payments. used), ACHT, tranquilizers (also useful and also Successful company programs – addictive), LSD, Searle & Co., Flagyl, and latest programs that succeed with two out of three of all, niacin, proposed for use in massive doses alcoholics, as they do at Equitable Life, Eastman as an adjunct to therapy to deal with Kodak, Consolidated Edison, Allis-Chalmers, hypoglycemia and schizoid conditions. and du Pont – are still rare, although more than Almost all alcoholics, of course, would 200 companies have some sort of program or welcome any pill or any procedure that would some statement of policy. Because alcoholics not deprive them of liquor. For fifteen years a are so skilled in avoiding anything that looks like New Jersey management consultant read a trap, some programs are little better than no selectively in the professional literature to programs at all. convince himself that he was a neurotic drinker Good basic company procedure is who would be able to drink normally as soon as relatively simple. It depends on early recognition his neurosis was resolved. He persuaded his of the alcoholic, employee or executive, by his physicians and psychiatrists to let him try out a immediate supervisor on the basis of his work whole series of new treatments, from performance and on his referral by the barbiturates to LSD. Despite repeated supervisor to the company physician. The

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physician has to be – or has to become – one of otherwise the whole program will be bypassed the small and select group of specialists in by the alcoholic. It 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 straightforward. It 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 Industrial 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. It 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 introduced him personally to members of an an alcoholism program, maintaining that A.A. group. A few weeks before, the physician alcoholism should simply be considered one of had handled a case involving a maintenance the various illnesses that his company helps man employee in precisely the same way. treat. Implementing a program based on crisis One manufacturing company with a precipitation requires a marked amount of number of scattered plants in the Midwest has organized wisdom, experience, and good sense no organized plan at all and uses outside in dealing with the tortured complexities and physicians instead of company doctors. But it is resistance’s of the alcoholic mind. For example, known confidentially to a good many men both it is essential that the confidential relationship at headquarters and down the line that both the between doctor and patient remain inviolate; president and their personnel head are

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recovered alcoholics active in A.A., and as such precipitation can be mitigated in some part, the company’s authorities on alcoholism. This however, by the chief executive taking two company has probably one of the lowest rates of steps: first, making it clear to employees that active alcoholism in the country. acceptance of treatment for alcoholism is a Most of the information required as the defense against loss of job, and, second, basis of sound and successful company separating alcoholics when necessary from the programs can be found at four institutions where company on an on-leave basis, it being the problems of alcoholism in industry have understood that they will be taken back been under scientific and professional study for whenever they accept therapy. many years. Dr. Milton A. Maxwell, of the Rutgers Center of Alcohol Studies, is an expert Pragmatic synthesis on problems of accidents and absenteeism. At Cornell, Dr. Trice is knowledgeable about For its successful crisis-precipitation problems of early identification and crisis approach to the problem of alcoholism, industry precipitation. At the National Council on clearly owes a debt to research. Scholarship, Alcoholism, Lewis F. Presnall has installed however, owes a debt to industry programs, not practical programs in a number of specific simply for the statistical, psychological, or companies. And at the Christopher D. Smithers medical data they yield, but also for showing the Foundation of New York, the organization that way to the pragmatic achievement of the higher has given research in alcoholism most of its recover rates known. These results suggest that private financial support, R. Brinkley Smithers the synthesis of research findings with working pays special attention to company programs. industrial programs may be more significant than Smithers is the foundation’s president and either the research or the programs alone. president also of the National Council on Important in this synthesis is industry’s Alcoholism. use of Alcoholics Anonymous as the chief Obviously, the experience of particular therapeutic agent of company programs. men or particular companies cannot be overlaid Business proved a new challenge to A.A. on the organizational pattern of other through its methods of crisis precipitation that companies. Such patterns typically represent a sent men and women for therapeutic help long company’s unique way of doing business, and before they might otherwise have gone, and any change in them is a matter for the chief thus provoked a new response. Now that the executive officer. The chief executive, indeed, is dimensions of the disease of alcoholism are the one person in any company who must take becoming widely known, it may well be that responsibility for an alcoholism program, not many physicians and psychiatrists, simply because it is advisable to have top psychologists and social workers, together with backing for good ideas, but because it is their hospitals and clinics, will develop new essential for him to do the actual tailoring of any forms of crisis precipitation and share their system to the company cloth. therapeutic load more widely with A.A. Today On the chief executive falls further there simply are not enough professionals in the responsibility for the alcoholics the program country to handle the number of alcoholics does not help. To be sure, two men in three can needing treatment, and there are 350,000 Recover and often achieve levels of members of A.A. available anywhere and at any performance not previously reached, but there hour in the U.S. and Canada. remain the men who refuse therapy or abandon Whatever else A.A. may be, it is a it. Some of them pass on to other companies, successful method of treating a disease, and a end up on early retirement, relief, or skid row. study of methods of recovery can lead to Moreover, it has now become known that an important facts about the nature of the disease alarming percentage of alcoholics commit itself. A.A. recovery for one man, the executive suicide upon losing a job or separating from vice president of a research and development family. Such negative consequences of crisis

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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: Fortune, May 1968

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