November 1960

As to the surprise that alcoholism attested by the thousands and thouis treated as a disease, I submit to you sands of members of Alcoholics again that there should be no surprise Anonymous who are living proof of at all. Let us quote the definition of the above statement. Thus, the disdisease from the dictionary: “In gen- ease is preventable. eral, any departure from a state of The alcoholic has been variously health; an illness or a sickness. More described as infantile, recessive, neuspecifically, a definite morbid process rotic, selfish, irresponsible, and even having a characteristic train of symp- homosexual. He has been accused of toms. It may affect the whole body or being a derelict and of lacking in By C. Anthony D’Alonzo, M.D., any of its parts, and its etiology, moral substance. He has been linked F.A.C.P. pathology, and prognosis may be to various and sundry psychiatric dis- Dr. D’Alonzo is Assistant Medical known or unknown.” orders and patterns. It has been our Director, E. I . du Pont de Nemours experience that the alcoholic, when and Co., Wilmington, Delaware Certainly, the idea that alcoholism sober, is just like the sober nonis a disease is quite compatible with alcoholic. He is the person working T has always been surprising to us I in the Medical Division of the du Pont Company that so many peothis definition. However, unlike some or living next to you. When he is other diseases, the disease alcoholism sober, and not drinking at all, he is is under the control of the will in that generally undistinguishable by perple show amazement at the fact that one does not have to drink if he does sonality, appearance, mannerism, or we have alcoholics in our employ; not want to. But this does not alter character from the other people that we treat the problem of alco- the fact that the great drive to drink about the office or home. He is not, holism as a disease; that we have a is present. And, be it psychological, in our opinion, a type, a character, or plan to bring the alcoholic back to psychiatric, biochemical, or some a particular build, but just a person. sobriety; and that our doctors are other kind of drive, it is abnormal When he is drinking, however, he is trained and urged to bring these and certainly it is there. Truly, alco- apprehensive, anxious, jittery, perproblems into the open when they holism fits the definition more ade- spiring, suspicious, easily swayed, . occur. quately than some other diseases ac- and weak. The end degree.of this is There should be no surprise at all cepted as such without question, but well known to you. for, as the late Dr. George Gehr- based on less fulfillment of the defimann, our former Medical Director, nition. We have had a plan to combat the repeated over and over again, problem for sixteen years, its having “Where you have people and alcohol, Our concept of alcoholism as a been inaugurated by Dr. G. H. Gehryou have alcoholism.” That we have disease is that, contrary to many mann in 1944. It is a simple plan, and people in our employ is an estab- other diseases, alcoholism is self- it is fundamentally a plan to teach all lished fact, and a recent year’s study induced. We must assume the con- employees to recognize alcoholism we made covered the problem know; cept that one who cannot drink does and, when it is discovered, to bring it to exist among 87,131 employees. not have to, or at least he should not. into the open rather than to sweep it That alcohol is readily available to all The cause of the disease, alcoholism, under the carpet. It is dealt with honis without dispute. Therefore, we is known. That one has the power to estly and the employee is given the have both raw materials for the end refrain from drinking whenever he solid and clear offer to have it treated product. develops the will to do so is firmly both openly and honorably. One

would not conceivably want to con- advisor on alcoholism, himself a by the doctor as to our concepts of best results. We have also learned ceal a fellow employee who had member of AA and a dynamic indi- the problem as a disease, and after a from experience that, when our psysyphilis or diabetes. Why then would vidual, one or two people will remain discussion with our advisor on alco- chiatrists work closely with this he want to conceal a fellow employee after the talk and say to him, “I may holism, or some member of Alcohol- program, the results are further enwho had the disease alcoholism? The have a drinking problem myself and ics Anonymous, usually another hanced. This program is effective and ravages and sequelae of alcoholism I want to talk to you about it.” employee of the same sex and very we know of no other program to are no less than the others. As for Supervision most often is aware of often in the same department. The equal it. talking to a man about his drinking, the situation and will call and talk to amount of time given the employee to We have a full-time employee, this is not the job for the inexperi- the Medical Division about it. straighten out, and whether or not himself a recovered alcoholic and a enced-it is one of the hardest jobs in Friends or coworkers will frequently a leave is given, will vary with the member of Alcoholics Anonymous, the world. Many cannot do it. And it call and discuss the case with us, or age, years of service, previous oppor- who works under the guidance of our is rare that a man comes to the con- an examining physician will see all tunities given, nearness to retirement psychiatrists, who gives talks to plant clusion all by himself that he has a the evidences during periodic exami- agl:, complications of the disease, groups, and who assists in the han-. drinking problem. When it is ade- nations. whether these complications are per- dling of these cases. quately explained to him, the victim manent or temporary, the employee’s The literature pretty well estab- ‘is often relieved to be shown the way attitude toward his problem and his lishes proof that the alcoholic loses out of his dilemma. sincerity of effort. In the absence of about twenty-two working days a Our plan is simply that the alco- medical complications, it is rare that year more than the average em- I holic is given every opportunity to more than two weeks away from ployee; he loses two more days for lick his problem, and he is fired only work are necessary, and then only other illnesses than the other em- . if he is unwilling to overcome it after for institutional treatment, and more ployees; he has twice as many accidue consideration of time and effort. often no lost time from work at all is dents as other employees; and his life This applies to any disease producing desirable. Experience has taught us expectancy is twelve years less than disability, curable or amenable to that alcoholics do better with surveil- that of the non-alcoholic. How then therapy, to the extent that perform- Of interest, I believe, to you, and lance on the job. can an employer, friend or fellow ance is affected to the point where the certainly reassuring to those of us in We have found that close coopera- employee, or we in the Medical Diviindividual cannot do his job properly the Medical Division, is the increas- tion with the program of Alcoholics sion t u r n o u r backs o n s u c h or safely. Further, one who chooses ing number of unsolicited calls we Anonymous has given us by far our a problem? not to overcome any progressive dis- receive from wives or husbands of order is a liability, not only to him- employees calling our attention to a self but to his fellow employees-and potential problem and asking our we have a responsibility to all em- advice and help. Sometimes there is ployees. exaggeration, sometimes the problem Many have asked us what is our is minimized. and sometimes there is Source of information as concerns no problem. Our approach is always those with a drinking problem. direct and sincere but firm, and we Ideally, of course, but too infre- always try to be fair. quently, the employee will talk to the Our plan is to ferret out the cases physician and say, “I think I have a and to bring them to the fore. They drinking problem.” Invariably after a are all given a satisfactory time to stirring talk to plant groups by our rectify the situation after orientation 1

L5″ That our doctors are trained and We physicians too need to repenturged to bring this problem into the repent for shunning and avoiding, open is just part and parcel of the from the medical viewpoint, the alcopractice of good medicine. No good holic for so long a time, and for perdoctor, be he a general practitioner mitting him to shift and flit about or an industrial physician, can fail to from pillar to post. I believe this situappreciate not only these facts, but ation has now changed. The success the so-called hidden aspects of drink- of the various methods of handling ing, a staggering problem not yet the alcoholic problem has given to us doctors the shot in the arm we needed to develop a medical interest in the problem of alcoholism and to put the treatment back where it belongs, in medicine. There will be few here today, I believe, who will doubt this. Note the tremendous amount of medical, psy- phyees, we have uncovered 950 al- another 23 per cent; and the remainchiatric, and biochemical research coholics up to the present time. This ing 11 per cent are either unchanged now being done and the increasing is a prevalence rate of 1.09 per cent. or their present status is uncertain. number of doctors who now accept We are confident that an undetermined number has not yet been The controlled alcoholic is a good adequately explored. Although I do and treat the alcoholic. As proof and reached or uncovered. And we, like employee, and he is good for other not have the statistics, I can assure support of this renewed medical in- others, have not yet solved the many employees. He is, in brief, worth you that the hidden aspects of alco- terest, I would call your attention to facets of the hidden problem of alco- saving. Our program is effective. holism far outweigh the obvious the fact that, during the preceding holism. Our job in this respect is There is nothing complicated about aspects. The unhappy marriages, the ten-year period, the problem of alco- certainly not done, nor can I foresee it. No large outlay of funds is neceshigh divorce rate, the suicides, the holism was the subject of no less than the time when it will be. However, sary for it. We would certainly recconcomitant psychiatric or social sixteen editorials in such a sound and among the known 950 alcoholics, we ommend such a program to any other problems, the toll of liver disease and scientific medical journal as the New have found that we have rehabilitated organization which employs people cirrhosis, the flare-up of peptic England Journal of Medicine, a med- 66 per cent; we have helped and im- and which wishes to face a problem ulcers, the obscure convulsions, the ical journal which I consider to be proved, but not totally recovered, which is almost certainly there. nutritional deficiencies, and the re- second to none. current breakdowns of such chronic In consideration of all of these, diseases as tuberculosis, respiratory how then can any physician say that diseases, arthritis and others, are so he is not interested in the problem of closely wrapped with and allied to alcoholism? The problem of alcothe problem of alcoholism in so many holism is the problem of people, and instances that if these could be calcu- the problems of people are the provlated and appraised, for the alcoholic ince of the doctor. as well as industry and his family, the In a survey of our company, we resulting figures would certainly be ascertained that, out of an average staggering. company population of 87,131 em-