February 1963

ness more often produced by mental affections than corporeal diseases? The seeds of this disease (the habit of inebriety), I suspect, like many others, are often sown in infancy. I do not merely allude to moral education. It is to be remembered that a bodily infirmity is not the only thing to. be corrected. The

habit of drunkenness is a disease of the mind. The soul itself has received Alcoholism impressions that are incompatible with its reasoning powers. The subject, in all respects, requires great should be permitted to continue doaddress; and you must beware how ing so undisturbed.” by Donald W. Brodie, M.D.* you inveigh against the propensity, History of the alcoholic pattern is for the cravings of appetite for the essential in treating an alcoholic . . . poisonous draught are to the intem- the extent of his drinking pattern and perate as much the inclinations of prior treatment in rest homes, pri- “Withdrawal symptoms of alcohol are more severe nature, for the time, as a draught of vate treatment centers, and hospitals than withdrawal symptomsof morphine.” cold water to a traveler panting- with . . . how he has reacted to withdawal thirst in the desert.” in the past, may be very important Withdrawal symptoms of alcohol to his future management. If he HE past twenty-nine years have and women who share their common are more severe than the withdrawal states that he does fairly well for 3-4 T produced what may be termed a revolution concerning our thinking experiences, strength, and hope which may, in turn, allow them to symptoms of morphine. These facts were proved by Dr. Isbell’s experidays and then has convulsive seizures and blackouts, you had better about alcoholism, and also, in turn, arrest their disease. ments at the Addiction Research believe him and manage him with our unusual success in the arrest of (3) The National Council on Al- Center at Lexington, Ky. Delirium this in mind. Frequently we see.a man alcoholism in a growing population. coholism organized in 1944. tremens and convulsions are serious who is not in too bad a shape, but Major factors in this change of atti- All three of these forces, each in symptoms of withdrawal, and un- who—after twenty-four hours of abtude and encouraginging results have its own way, have resolutely ac- treated, result in death in from 5-15 stinence-becomes a raving madbeen : cepted the fact that the alcoholic is per cent of the cases. Many of these man. (1 ) The Center of Alcohol Stud- a sick person, that the alcoholic can alcoholic deaths occur in our general The patient usually presents himies started at Yale University, 1930 be helped, and that the alcoholic is hospitals in patients who have been self when “he’s hurtin’.” He has by Dr. Howard Haggard. (Now at worth helping. admitted for other reasons and alco- physical symptoms of his drinking- Rutgers University, New Brunswick, These facts have enabled the al- holism is not known to exist. shakes, tremors, sweats, dry heaves, N. J.) coholic to gain insight into his per- General attitudes of the profession etc. He may be in your office to get (2) Alcoholics Anonymous, sonal problems and give him the ex- and the laity alike continue to be that your signature on an insurance blank started in 1935, a Fellowship of men amples of recovery. Thomas Trotter, “Akoholics were weak-willed, self- because of absence from work, or for a British Navy physician, wrote in pampered, spineless drunks, who nothing more than to get his wife off Reprinted from the Journal of the In- were digging their own graves, and his back by pretending that he is diana State Medical Association. 1788: “Are not habits of drunken-

seeking to do something about his nagging about his drinking-he will is not my intent, but if he wants to Alcoholics Anonymous is mentioned drinking. Regardless of his reason begin to sneak drinks and hide his do something about his drinking, I’ll as the best specific help for this disfor being in the office, he-at this supply. He will have adjusted his help him all I can. If he wishes to ease (and it is well for you to be time-may be more vulnerable to the pattern of drinking to allow him to drink himself to death it will be his acquainted with this fellowship in pin-pointing of his problem because continue his drinking as long as he problem. I’ll lose no sleep over it. your communities). If it is possible, -at this particular time–he knows can. He will only drink after 6 P.M.; There is nothing more effective than allow this man to make a contact he is in trouble. I prefer the patient only drink beer; only drink at home; placing the responsibility in his with a member of AA before giving to make his own appointment at my even mt drink for a week, a month hands-for anyone can sober up an him medication or allowing him to office after the routine patients are or a year to try to prove that he can alcoholic, but the alcoholic who leave the office. If he is allowed to taken care of, and not sandwiched handle the problem. He has prom- wants to is the only one who can get over his sickness before making . in with other patients. The reason ised his family time after time that stay sober. contact, he may never do it, and you for this is certainly clear. he will quit drinking-only to find The severe alcoholic who has had may never see him again. The husband or wife should ac- himself drunk within twenty-four D.T.’s or convulsions should be hos- Medications are given to the relacompany the patient, for in this way hours. pitalized. Others, less severe, may be tive and are to be dispensed by them both understand what is said, what The alcoholic has no use for the placed on medication controlled by -with “no refill” on the prescripthe problem is, and what has to be individuals whom he can “con” con- some member of his family. The al- iton. Since we are dealing with an done about it. The patient is given cerning his situation. Even though, coholic will take medication the addict, it is important that sedative a chance to read and answer diag- when you confront him with your same way he drank-to oblivion, if relief of his anxieties by medication nostic questions and arrive at the impression, he may become very bel- possible. Never give an alcoholic any should not be continued in the aver- . diagnosis of his situation . . along ligerent, he will, nevertheless, respect more medication than you want him age case longer than 5-10 days, bewith the diagnostician. In the usual you for your frankness and under- to take all at once. cause of the fact, as mentioned by typical case the patient breaks out standing. For underneath his beliger- I will not go into details of medi- Lovell & Tintara in 1948: “It is as in a grin when he is asked: “Where ent attitude he knows you are right, cations which might be given to cor- essential for an alcoholic to refrain do you hide your liquor?” I d o not even though he will not admit it. rect the disturbed physiology. Treat- from sedation as it is to refrain from ask him IF he hides his liquor, b e I usually tell him that medical care ment of the withdrawal symptoms is drinking.” The alcoholic knows that cause I know that if his wife is pour- to improve his well-being so that he clearly outlined in the various medi- the simplest solution is to quit drinking out his supply-or is continually can get drunk over and over again cal texts. Prior to any medication, ing, because “he has done it thou-

sands of times”; and he knows that His institutionalization should not the toughest thing is to try to play just be domiciliary care, but educawith it as a social drinker. It is well tional-to give him insight as to the to point out to him that each drink- medical, physiological, psychologiing episode gets worse, and that it cal, psychiatric and spiritual nature takes less and less to give him of his illness . . . hence frequently trouble. There was a time when he the facilities are referred to as “The received, or seemed to receive, en- College.” joyment out of drinking. But now he Alcoholics Anonymous has had finds nothing but misery-mental by far the most outstanding success and physical. in the solution of the problem of the It is well to establish a therapeutic alcoholic. Why? Take a look at the team for this patient; you-as his program of Alcoholics Anonymous, physician, a contact with AA, a considering the twelve steps of that clergyman of his faith, an attorney, program. an employer (Personnel Man or We must accept the challenge be- Medical Director), and a represen- fore us concerning this public health tative of any other areas where his problem, and perhaps we, as a proproblems have become obvious. fession, in our time may be able to This statement I believe: “An al- pass on to the oncoming generations coholic should never be treated in some evidence of our contributions a penal, mental, or religious institu- to the solution of his problem–each tion” . . . but as a particular entity. in our own way.