God Grant Me the Wisdom To Know The Difference About Alcoholism

SPECIAL 2014 EDITION

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NO PART OF THIS BOOK MAY BE REPRODUCED IN ANY FORM
WITHOUT THE WRITTEN PERMISSION IN WRITING
FROM THE PUBLISHER
PRINTED IN THE U.S.A.
Sober Living Publishing
Twelve Step Productions
CopyrightISBN: 978-1-941568-39-2

Table of Contents
CHAPTER 1
INTRODUCTION
CHAPTER 2
PORTRAIT OF THE ALCOHOLIC
CHAPTER 3
DRINKIN' OR S TINKIN THINKIN'?
CHAPTER 4
MAN OVERBOARD
CHAPTER 5
ONE AGAINS T THE WORLD
CHAPTER 6
"LADY" DRUNKS
CHAPTER 7
ROCK BOTTOM
CHAPTER 8
GETTING WELL
CHAPTER 9
ALCOHOLICS ANONYMOUS
CHAPTER 10
S TAYING WELL
CHAPTER 11
WHAT S HALL I DO?
CHAPTER 12
FOR ALCOHOLICS
CHAPTER 13

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THE LES S ONS OF ALCOHOLIS M

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Chapter 1

Introduction

For almost fourteen years, doctors, lawyers, judges, nurses, public

administrators, social workers, psychologists, and men and women who can
only be identified here as alcoholics, have been teaching me about
alcoholism. This book is a statement to them of what I have learned.
Through these years I have talked with many hundreds of alcoholics. I can
remember only one alcoholic who refused to talk with me and another who
said afterward that he wished he hadn't.

This is remarkable because usually I had nothing to offer them. My

introduction went something like this, "I'm interested in people who have
problems like yours. As far as I know talking with me won't do you any
good or any harm. However, it will help me. What about it?"

My gratitude to those who helped me to learn is sincere. My motives for

studying alcoholism have always been quite selfish, so it was usually they
who did favors for me. I study alcoholism because I find it a tremendously
interesting subject, one which has so many ramifications, so many subtleties,
that to understand it all is to understand virtually all about human behavior.

Naturally, one can't be in contact with suffering without becoming

emotionally involved. At times it has been difficult, but I have tried to keep
some degree of scientific objectivity.

Certain individuals and groups ought to be singled out because I am

especially indebted to them. Members of the Montpelier, Vermont,
Alcoholics Anonymous group took me in hand when I arrived as consultant
to the Governor's Commission on Alcohol Education. "If he is to be useful,"
they reasoned, "he ought to know something about alcoholism." They
proceeded to teach me, and I believe they taught me well. Mrs. Elizabeth D.
Whitney, Executive Director of the Boston Committee on Alcoholism, has
always been a source of practical information on alcoholism and alcoholics.
Dr. Joseph Thimann of the Washingtonian Hospital has helped me in many
ways. My colleagues at Tufts University, both past and present, have
listened and argued with me through the years. Kent Geiger and Bob Sokol

4
have been long suffering. Harold Demone, Jr., who was at Tufts and who is
now Assistant for Alcoholism to the Commissioner of Public Health,
Commonwealth of Massachusetts, has been a good collaborator. Two
important women in my life, Mabel Adams, secretary to the Department of
Sociology at Tufts, and my wife, Althea, have helped with typing. Althea
has read and criticized each page as it came out.

I wish it were possible for me to ask the man who started me in this field,
the late Dr. A. Warren Stearns, to read the book and comment on it. His
pioneering work at Boston Psychopathic Hospital before the First World
War anticipated much that is being done today.

My brother Vic has encouraged and helped me in my work.

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Chapter 2

Portrait of the Alcoholic

At best, alcoholics are a nuisance. They take up time, break appointments,

borrow money without repaying, lie, quarrel publicly, pass out. Yet, they
cannot be ignored or eliminated. There are approximately 17.6 million
people, or one in every 12 adults, who suffer from alcohol abuse. There
are also several million more who engage in risky drinking patterns. Even
if we ourselves are not among them, we cannot look very far in our circle of
friends, relatives and co-workers without finding one. Most are married,
have children, hold a job. To take them out of society would represent too
great a price to pay for relief from the troubles they cause. Alcoholics are
with us. They will be with us in the foreseeable future.

Nor is there any point in attempting to eliminate alcoholism by attacking

alcohol. When Prohibition came into existence, it was hoped that
alcoholism could be wiped out. However, we Americans wanted to drink.
With the repeal of Prohibition, we saw that we should have to live with
alcohol and alcoholism.

During the Prohibition period, almost no one was seriously studying

alcoholism. Since its repeal, a group of investigators and therapists have
directed their attention to the alcoholic. However, in light of the fact that
alcoholism is considered one of America's largest public health problems,
the number of professionals concerned has been small, and they are poorly
supported.

These workers consider the enemy to be alcoholism, not alcohol. They

operate on the premise that most people drink and that some of these—about
6 percent—become problem drinkers. Their goals are to help those already
afflicted to lead sober, useful lives, and to prevent new candidates from
joining the ranks of alcoholics.

Even if they did have all the resources needed, the experts would not be
able to handle the problem of alcoholism without help from the general
public as well as from alcoholics themselves. Alcoholism is a condition
which affects all aspects of the life of the sufferer. His inability to live with

6
his fellow man arouses attitudes which militate against his treatment as a
sick person with all the health resources at the community's command. In
turn, punishment and ridicule serve only to drive the alcoholic deeper into a
way of life that has failed him and society.

An enlightened public which recognizes alcoholism for what it is creates the

climate in which treatment and prevention can occur. Alcoholics
themselves, drawn from the ranks of this public, can learn to recognize the
symptoms of illness and get help before disaster overtakes them. If only one
fact reaches the general public—that alcoholism should be treated as an
illness—then a major step forward will have been taken.

The disease view of alcoholism is relatively new. Although it has been

suggested by isolated individuals for centuries that this might be true, it is
only in the last few decades that the notion has had any general acceptance
among those who work with alcoholics. Only very recently has the
American Medical Association accepted alcoholism as a disease in which
the medical profession has responsibility in treatment and research.
American hospitals have only recently begun to accept the alcoholic for
treatment of his alcoholism. Previously, being an alcoholic was reason for
excluding one from a hospital unless he was suffering from some other
disease or condition that required treatment. Now, being an alcoholic is
sufficient cause for admission, although many hospital administrators are
still reluctant to participate in treating alcoholics.

The word "disease" has been used here as if all the modern experts were
agreed that alcoholism is a disease. This is not so. However, the important
point for us is that alcoholism is now treated by those who are responsible
for the health of the community rather than by those who are responsible for
the community's morals.

At this point, we should have a definition of alcoholism. Many have been

offered. The one we shall choose is presented by Mark Keller of the Yale
Center of Alcohol Studies. The definition has a complex parenthood which
includes a committee of the World Health Organization. Here is what Mr.
Keller says,

Alcoholism is a chronic behavioral disorder manifested by repeated

drinking of alcoholic beverages in excess of the dietary and social uses of
the community and to an extent that interferes with the drinkers' health or his

7
social or economic functioning.

The significance of various parts of this definition will come alive as we

describe the alcoholic in detail. What most people find so incredible about
the alcoholic is that he does not respond to ordinary pressures and
punishments. He apparently is immune to slur, insult, loss of love, as well as
to physical abuse. He appears determined to disregard the common
responsibilities of life. Consequently, he arouses antagonism from those
who do not understand what drives him. Most of us look at the alcoholic
from the vantage point of the normal drinker. We know that when we take a
drink, we have taken a step toward satiation. And we know that when we've
taken a certain number of additional "steps," we'll stop drinking. It is natural
for us to reason from this that if we can stop when we have "had enough,"
then the alcoholic can, too. When he continues to excess, we consider it
evidence of being bad and we try to punish him for excessive drinking,
expecting him to stop. However, we soon learn this doesn't work.

Probably the hardest thing for non-alcoholics to accept is that their picture
of the alcoholic as one who is able to stop drinking when he wants, but who
doesn't want to, is false.

The alcoholic, having taken one drink, is usually compelled from within to
keep on drinking until either the supply is exhausted or he can no longer lift
glass to lips. On a certain evening, he may decide, or his wife may decide
for him, that he will only have a drink or two. Instead, he finds himself
drunk as usual at the end of the evening. Here we have one of the major
characteristics of the alcoholic—loss of control over how much he will
drink on any occasion. The point is vividly made in the book Alcoholics
Anonymous:

The fact is that most alcoholics, for reasons yet obscure, have lost the
power of choice in drinking. Our so-called will power becomes practically
non-existent. We are unable at certain times to bring into our consciousness
with sufficient force the memory of the suffering and humiliation of even a
week or a month ago. We are without defense against the first drink? Neither
punishments nor good resolutions help the alcoholic. Once having taken that
first drink, resolutions disappear along with the memory of previous
disasters.

Not only has the alcoholic lost control over the amount he will drink at any

8
time, but he usually loses control over the number of occasions on which he
will drink. He may decide that he will drink only on weekends, or once a
month, only to find that there are sufficient reasons for drinking on other
occasions as well.

A friend, not an alcoholic, who teaches in a large university often has work
to do in the evening. For several years, he typically came home from his
office, had a couple of cocktails with his wife, dinner, and then went up to
his study for work. A number of times, he just didn't feel like working, and
he ran behind schedule. He discovered that when he omitted cocktails he
still enjoyed his dinner and could work effectively after it. Having made this
discovery, he acted on it in the manner which one would expect—he
eliminated the cocktails on those evenings during which he had to work.

The likelihood of an alcoholic coming to this decision and being able to live
up to it is remote. He would be much more likely to react as this man, a
member of a group in therapy with Raymond F. McCarthy of the Yale Center
of Alcohol Studies. He says:

I mean, you might start out to do a job and you take a drink and you say,
"Boy, I can do it better now," and you start working at it. You take two, you
continue to work on it, you take three, you continue to work on it, you take
five, six, seven and eight, and you say, "To hell with it.

"We may be sure that after a time "To hell with it" will come even before
starting to work. This, then, is what separates the alcoholic from the normal
drinker. He cannot control his drinking and there isn't any point in telling
him to do so. Once we accept this as true, we have removed the problem of
alcoholism from the moral field and are ready to deal with it on a realistic
basis. The strange behavior of the alcoholic begins to take on new
significance when we observe it to be motivated by something different
from ordinary social drinking. Alcohol means something different to the
alcoholic.

The alcoholic may fear drinking, but he also loves and needs it as one loves
and needs his mother or wife. Perhaps the best way to illustrate this is to
describe a scene the writer once witnessed. It was almost the very moment
when an alcoholic in the early stages of his treatment stopped drinking. He
was talking. "I just can't quit cold turkey like some guys. I'm not like them. I
need it. I can taper off, cut down.

9
"There was a long silence. On his face there was the realization of the
hollowness of his own words. He knew he couldn't "cut down." He had
tried often enough. The choice was to go on as he had been or to stop
drinking entirely. The man's eyes darted from side to side as if looking for
an escape route. Then, he looked down. His face crumpled; in a moment,
tears came. He looked up at a wall calendar, seeming to fix the date in his
mind. Then, in a small, tight voice he asked for the time. He was told. "All
right," he said, "I'll give it a try.

"As I watched, scenes of parting flashed through my mind: a man leaving his
office for the last time as he enters into unwilling retirement, a soldier at a
railroad station kissing his wife good-by, a child standing beside his
parent's fresh grave. They were scenes of separation from something
precious. Another description of what alcohol means to the alcoholic is in
the answer of a man who was asked what he got from drinking. At the time,
he was living under great strain—life was closing in on him. A number of
serious problems he had been living with for years were coming to a crisis
simultaneously. He says this:

It (drinking) seemed to give me the feeling—well, to hell with it. If it is

going to happen, it's going to happen. Previous to that I'd feel, "Gee, what
am I going to do if it does happen.

"Then he goes on to say, You may wonder why I wasn't worried about
drinking. I didn't like it; I knew I shouldn't be. It was the only answer to me.
I didn't know how to get that worry out of my mind— the things that were
going to come up. It's like you knowing, "Gee, next week you are going to
lose your wife and child and everything else." If you are a type of character
like me, probably you would drink and just say, "After all, to hell with it."
So the drinking didn't bother me. I knew I shouldn't be, but it was a craving,
a desire, that's all.

In saying "It was the only answer to me," this man is telling us as clearly as
possible what alcohol means to the alcoholic. For him there is no other
answer to the problems of life. Other solutions, other sources of emotional
security are gone—only the bottle is left. Another man from McCarthy's
group puts it this way:

This gentleman over here said something about how it was when you felt so

10
tough you won't live until 5 o'clock at night, and then at 5 o'clock you stand
at the bar. Certainly it is an emotional factor. You're tense. All day long you
hold yourself tense because you don't feel good. You've got a hangover from
the night before. You do your job and when you get out of your job at the end
of the day, at 5 o'clock, you take two deep breaths and say, "Thank God, that
day is over," and you forget it and then you go out to the bar and stand there
for 5 hours and have a few quick ones, and after you got these and relaxed,
emotional tenseness was gone. Why is it . . . why is it you say, boy—at 10
o'clock in the morning—I'll wait until 5 o'clock tonight, and when I get
through my day's work, I'm going to go to bed at 5:30. Then around 5:30 you
know that tension of the day's business is over, and you say, "Well, I did a
good job today, I think I'll go out and take a few quick ones. Pat myself on
the back.

"One of his companions put it only a little differently. You take one drink for
relaxation. The next time you take it for the same reason, or you take it
sooner; and it keeps building you up until you're taking it to avoid problems,
and then finally you're taking it to just blot out all outside stimuli.

Here, then, is where we start to understand the alcoholic. We see him as an

unfortunate individual in the grip of something he cannot understand or
control. Drinking is ruining his life and injuring those around him, but he
sees no way out. Drinking is the only way of life for him. Our task is to see
how this comes about and how one can break up this destructive pattern.
The handle which we shall seize is the meaning of alcohol to the alcoholic.
If we can understand how this comes into being, we can understand
alcoholism.

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Chapter 3

Drinkin' or Stinkin Thinkin'?

If alcohol means something different to the alcoholic than it does to the

normal drinker, then perhaps we can determine its significance. Just
knowing that this difference exists doesn't help much.

One thing is certain. We can't blame alcohol for the difference. The stuff
alcoholics and non-alcoholics drink is the same. Even the government
cooperates in seeing that this is so—scotch must be scotch and bourbon,
bourbon.

Whatever makes for the unique attitudes of the alcoholic must lie within
him. Howard J. Clinebell, Jr., in a book written for counselors of alcoholics
said it neatly; "... the evidence seems to point to the fact that alcoholism
comes Let's assume we are at a party where liquor is being served, but, for
some reason, we are not drinking. (As long as we are going to make
believe, let the reason not be that we want to watch the others make fools of
themselves. Instead of being "students of human nature," we'll suppose that
the ulcer has been kicking up—a condition which produces sobriety about
as fast as any can. As the party moves along, we notice things happening to
the group as a whole. Everyone seems to be speaking more loudly. Gestures
are broader. Topics of conversation are more intimate. Many of the
individuals we had pigeonholed as "the shy one," or "the nice guy" also
have changed.

The shy one started the evening in the corner, not uttering a word, and,
indeed, blushing when one was tossed his way.

Now he is holding forth in the middle of the floor as his audience comes and
goes, sometimes having difficulty in freeing lapels from his hands. Over in
the corner, his best friend with whom he came to the party is glaring at him
and telling a disinterested stranger that his pal is basically a heel. The
vivacious young woman who kept the conversational ball rolling when the
evening began is staring moodily at a rubber plant, muttering an occasional
word that permits us to understand the fates have picked her out for special

12
persecution—her rubber plants always die. From the kitchen comes the
sound of a loud voice we identify only with difficulty as belonging to a
mild-mannered little fellow who is now telling his host just what he would
do to the head of the firm that collects garbage on his street if he had his
hands on him now.

Are these the same people who showed up at the beginning of the party? Of
course they are, and yet their outward behavior doesn't bear this out. They
differ from one another as the amount of alcohol in them climbs, but they in
people, not in bottles."

Thus, anyone who wants to also differ radically, in some cases, from what
they were before they began drinking. Even if they were all to dip into the
same punch bowl, as great a variety of reactions would be there. Everyone
at the party {except us) is affected in some degree, depending upon the
amount drunk and other less important factors such as food in the stomach,
emotional upset, and fatigue.

All these changes are indications of what is going on in the nervous system
as alcohol reaches it. Alcohol is an anesthetic which acts like its very close
relative, ether. What we are observing at our party is the same process
which occurs more quickly when someone sniffs ether through a cone. We
recognize this when we speak of a person under the influence of alcohol as
"feeling no pain.”

Alcohol reaches the brain, where it has its chief effect, in the blood stream.
Consequently, the amount of anesthesia present depends on the amount of
alcohol in the blood. If we take a bantam of 112 pounds and give him a shot
of whisky, he will have more alcohol, proportionately, than the 200-pounder
who takes the same amount of whisky but who has more blood, thus making
the solution weaker.

Physiologists have carefully figured out the degree of an aesthetic effect any
amount of alcohol may have. In the table prepared by Leon Greenberg, we
see what certain amounts of drink will do to an average-size person—one
weighing about 150 pounds—and how long it will take for all the alcohol to
leave the body. Obviously, the greater the amount of alcohol in the blood,
the deeper its effect on the drinker’s behavior.

This doesn't account for the differences in its effects on various people at

13
the party. The shy man becomes bold, the loud woman quiets, the gentle
person gets aggressive, and so on as each gets progressively more
anaesthetized. The study of alcoholism must avoid the error made by the dry
propagandists decade after decade. They assumed that everyone who drank
was "on the road to ruin," if not al-ready there. The issue of alcoholism was
lost in the shuffle.

Every fact we gather increases the certainty that we must look at differences
of various kinds, between alcoholic and normal drinker, rather than assume
that drinking and its effects are the same for everyone. Drinking only takes
off the coverings that hide what is already there. It doesn't put anything into
the package. The shy person was shy because he was afraid to be anything
else. The bold one had discovered advantages in behaving this way.
Perhaps they were compensating for the effort needed to act in a way that
was not easy or natural for them when they drank. The man who ordinarily
"sat" on his aggressive impulses did so because it is dangerous to do
otherwise. All alcohol did was knockoff the control by fear or anxiety that
prevents people from behaving as they would like to had they no fear of
consequences. What was already there came out.

Maybe someone could argue that these people were better off expressing
themselves under the influence of alcohol and that they should drink more
often. Perhaps we can even remember a time in which we performed better
after taking a drink than we did before. Maybe we think we drive a car more
skillfully while slightly high than when sober. The answer depends on what
kind of person you are talking about. If you start with someone who is too
tense to perform any task, say typing or pitching a baseball, at his highest
level of efficiency, then it is probably true that the relaxation coming from
alcohol may temporarily permit better performance. The risks involved, as
we shall see, and the relative inefficiency of this technique make it
dangerous and undesirable.

Perhaps we'd better leave the party before the rubber plant is torn out and
used as a weapon, or before lifelong friendships are temporarily destroyed.
They'll be renewed in the morning when the apologies are passed around.

The excuse that sets everything right again is, "You know me when I'm
drinking!" But let's hold onto the role of observer. A quiet walk home will
give us time to think further about what we’ve seen. Here were a lot of
people under the influence of alcohol. The differences in the way they

14
behaved couldn't be explained on the basis of one having had more to drink
than another. It's puzzling, but almost inevitably the idea comes to mind that
they acted with such variability because there are physical differences
among them. "

Maybe, “we reason, "what happens to alcohol in the body of the fellow who
gets sad when he drinks is different from what happens in the man who
becomes angry." The idea has been looked into.

If differences in body chemistry did produce unique ways of behaving when

drinking, then we could go a long way toward answering the riddle of
alcoholism. We could just assume that the alcoholic is a person whose body
chemistry is in some way faulty so that he becomes addicted to alcohol.
Through the years a number of first-rate researchers have worked on just
this theory. A number of years ago one investigator reported that he found
the trouble in endocrine abnormality. He then predicted that in five years he
would be able to cure alcoholics, even have them drinking like normal
people. The press picked up this story, and it must have seemed to the
problem drinker and his family that for him the millennium was about to
arrive. The five years came and went with no apparent progress toward the
goal. This has been true with all other flashes of hope of a discovery of a
physical basis for alcoholism. Today it is safe to say that we know a good
deal about the action of alcohol in the body, but we see nothing of a physical
basis for alcoholism. The differences in body chemistry, the damage to
organs of the body that are found in alcoholics are the results of long
periods of heavy drinking. We can be reasonably certain that these disorders
did not exist before heavy drinking began.

Failure in this area has been a great disappointment. If only a physical

reason for alcoholism could be discovered, then some physical technique
for its cure or management would follow. Just because such efforts have
failed up to this point is no reason not to continue them. The physiologists
have given us a good deal of important information, even if they have not
come up with the answer to the main question.

By this time our stroll has taken us to our own front door. We're probably
ready for a nightcap of warm milk (to keep the ulcer quiet) and a good
night's sleep filled with dreams of white-coated scientists triumphantly
brandishing bottles of pink pills while shouting, "Eureka, eureka" But as we
settle down with glass in hand, another idea just as inevitable as that related

15
to physical differences among drinkers will come to mind. This is the notion
that people react differently to alcohol because their personalities differ.
Indeed, if we rule out the physical factors, there isn’t anything else left.
We've already said that alcohol removed inhibition so that what comes out
is the uninhibited personality. We could argue about it, but we are not
suggesting here that this is the "true" person. A real personality is made up
of many habits and attitudes including the habits of inhibiting certain
impulses. But it is just as true that alcohol doesn't put anything into the
personality; it takes something out.

This still doesn't help us in distinguishing between alcoholics and normal

drinkers. Presumably, most people we see at most parties are normal
drinkers. They get drunk conduct themselves in a variety of ways, but
drinking doesn't ordinarily interfere with their lives, nor is their drinking in
any way compulsive.

Maybe we can move a step nearer to the problem of alcoholism by noting a

relatively common kind of drinking.

This is drinking to "drown one's sorrows." If we were to describe a lovers'

quarrel up to the point where the hero claps his hat on his head and storms
out the door, and if then we were to ask a hundred people where he was
going, the chances are that a majority would say, "To the nearest bar." Even
though the aggrieved lover does a thorough job of drowning his sorrows, we
are not justified in thinking of him as an alcoholic. The conscious decision
to get drunk is very different from the alcoholic's hope and fear that he
won't. What we are dealing with in the case of disappointed lovers, job
losers, and grief-stricken people, is a situation which is painful, and from
which one can get relief through an anesthetic. When the lovers' quarrel is
patched up, a new job is found, or the pangs of grief lessen, the saloon sees
these persons no more.

Situational drinking bears only a surface resemblance to the alcoholic's

spree. The significance of the event is far different. This is not to say that
one who resorts to drinking in a growing number of situations may not
become an alcoholic. The progress of alcoholism involves just such
happenings. Supposedly, for the situational drinker who is not an alcoholic,
clearing up the problem means straightening out his excessive drinking.

Most workers in the field of alcoholism regard the alcoholic as one who

16
perpetually faces a difficult situation.

The problem comes from within, they reason. In other words, the alcoholic
is one who is suffering from a deep-seated personality conflict which has an
effect as painful as that of a temporary problem such as the rejected lover's.

The alcoholic has the conflict before he becomes an addictive drinker.

Drinking is the way he solves it.

In all fairness to the reader it ought to be said that this majority opinion is
not one with which the writer agrees.

Reasons for disagreement will be presented, but the most popular opinion
must be presented fairly. It is important to do this because it is possible that
the majority is right. Of immediate concern is the fact that most
professionals who treat alcoholics have to act on some theory. When the
suffering alcoholic comes to you, it does him little good to tell him that you
don't think you know what you are doing.

The largest number of therapists, believing that an underlying personality

disorder is responsible for the trouble, try to get at the so-called roots. They
may treat the immediate situation, but their goal is usually to get at the cause
as they see it.

Just as some researchers have looked for a single physical cause of

alcoholism, so psychiatrists and psychologists have searched for a conflict
situation which would be typical for all alcoholics. For example, it was
once suggested, by a psychoanalyst, that all alcoholics are suffering from
deeply buried homosexual tendencies. The notion was picked up by others
and is still heard. In actual practice, nothing like this is found generally. The
theory is not useful despite the fact that some alcoholics (and some normal
drinkers) do show conflicts about homosexuality.

Still another suggestion was that all alcoholics are afflicted with a mental
disease something like a manic-depressive psychosis. Their drinking is
symptomatic of the psychosis. Again, the variety of alcoholics appearing
before private physicians and in treatment centers is so great that this idea
has also been abandoned. There are patients who have psychoses and who
drink excessively, but they don’t represent all alcoholics. In fact, most
psychiatric studies of alcoholics show that the majority have no diagnosable

17
mental illness. All the patient presents to the doctor is alcoholism and its
complications.

Single-cause theories of alcoholism have been largely abandoned by those

who treat alcoholics. Most psychiatrists and others now believe that there
are many types of problems and conflicts in alcoholics. Only study of each
individual alcoholic will tell you what is disturbing him. But, says the
majority opinion, without such a problem or conflict, you get no alcoholism.

It's easy to see that when you talk about the underlying causes of alcoholism,
you are thinking that alcoholism is a symptom, not a disease. In Chapter 1,
we mentioned that there was controversy on this point. This is the time to
look into it.

For at least two hundred years, there has been an occasional person who
took issue with his times and spoke of alcoholism as a disease. In more
recent years, when alcoholism has become "respectable," the idea has
gained strength. Large numbers of alcoholics and their families and friends
now sincerely believe that alcoholism is a disease. Perhaps the distinction
between disease and symptom seems like hair-splitting, but many people
take it very seriously. Some alcoholics feel more comfortable about their
problem if they feel they are suffering from a disease and are, therefore, sick
people who are no worse morally than other sick people. For example, a
man who only recently began treatment for alcoholism heard that alcoholics
sometimes have damaged livers. He seized on this as an explanation of the
blackouts and rum sickness he was having. He wanted to believe that there
was a physical problem that was responsible for his peculiar behavior.

This gave him something he could understand. His behavior when drinking
was then not irrational but inevitable. Moreover, no one could call him a
bad or weak person. He was just sick.

To the therapist, whether he deals with alcoholism as a disease or a

symptom makes a very real difference. If you consider it to be symptomatic
of an illness, then you treat the illness and wait for the symptom to go away.
If you believe alcoholism "stands alone" as an illness, then the approach is
more likely to be toward drinking itself.

Whether it is a disease or symptom, the main point for the nonprofessional

is that alcoholism is not within the control of the person involved. He is not

18
willfully drinking.

There are medical, psychological, and sociological problems involved in

alcoholism no matter what your view of it maybe. The alcoholic usually
needs help in all three areas, as we shall see later.

Now, let's look at the reasons for the writer's belief that alcoholism is not
basically a symptom of an underlying personality disorder. Again, let the
reader understand that most professional workers in the field of alcoholism
will not agree with what is said here.

First, we don't have any real facts that tell us the alcoholic has any unusual
psychological or psychiatric problem.

Unfortunately, the psychiatrist, general practitioner, or alcoholism clinic

does not see the alcoholic until he already is in trouble. There is no
opportunity to know what he was before he became an alcoholic.
Consequently, one cannot decide if the abnormal person who faces the
doctor became that way as a result of alcoholism, or if his abnormalities
caused alcoholism.

A second objection to considering alcoholism as a symptom of emotional

problems is probably more important in the practical world of treating
alcoholics. If the object of treatment is to make the alcoholic free of his
basic, underlying illness, and if that treatment is successful, then the
alcoholic should be able to drink like anyone else. But, if there is one thing
we are sure of in the field of alcoholism it is that once alcohol addiction is
established, the alcoholic can never drink normally again. This is why we
never speak of an alcoholic as being "cured." We may say he is
"rehabilitated," or "dry," but never "cured." At Alcoholics Anonymous
meetings, speakers who may not have had a drink for ten years will start
with the declaration, "I am an alcoholic." Use of the present tense is
recognition that something has happened to the person that is irreversible.

Now, where does this leave us? If alcoholism is not the result of some
physical abnormality or a psychiatric condition, what is its cause? About all
we have left after eliminating the other areas is the actual experiences one
has with alcohol. This means that alcoholism must be studied by the same
techniques that are used to investigate the formation of habits and attitudes.
What we do is to trace what the alcoholic has learned in his contacts with

19
alcoholism from the very beginning and make comparisons with the normal
drinker. If we see that there is a difference in the quality of experience the
alcoholic and non-alcoholic have had with drinking, then we may have a
new basis for understanding addiction. We should come to look at addiction
as a kind of habit. But, and in this case it is a very big word, the kind of
experience and learning that is significant is that which occurs before the
alcoholic became an abnormal drinker. Naturally, there are differences in
the drinking experiences of the two groups after alcoholism develops. What
we've now done is to decide to investigate the experiences which produce
this unique meaning of alcohol and drinking to the alcoholic. As the
members of Alcoholics Anonymous often say, "It's not the drinkin' that
makes you stinkin', it's the thinkin'." "Thinkin' " doesn’t occur in a vacuum. It
stems from the experiences one has, or from those experiences he learns
about from others. It is the great advantage of the human being that he does
not have to learn all the solutions to the problems which have faced mankind
all by himself. He can depend on the accumulated knowledge of the
generations. Sometimes he approaches new experiences with his attitudes
and expectations already set as a result of learning from others.

Every society which has had contact with beverage alcohol has its
accumulated ways of acting, believing, and feeling toward alcohol and
drinking. If the society is stable and has had a long history of use of alcohol,
its ways with it may be quite well established. Within a society such as that
of the United States, made up of diverse groups with various attitudes
toward drinking as well as other things, there are many ways of handling
drinking and alcohol. In one group, the use of alcohol may be an everyday
occurrence not worthy of notice; in another, its use may be forbidden.

Societies and groups within develop a characteristic "thinkin' " that

influences its members.

The use of beverage alcohol is about as old and widespread as agriculture

itself. Almost every material that will ferment has been used to make
alcohol, ranging from choice grains to animal droppings. Beer and wines
have been important parts of the lives of a number of primitive peoples.
Usually for them drinking took place on some special occasion. They had no
way to store their drink, so they made up a batch and drank it. When the
liquor ran out, the party was over, a procedure not unlike that of some
civilized peoples. As the primitives became acquainted with the white
man's stronger liquor, they still followed the old drinking patterns.

20
Not having a constant supply of alcohol on hand meant that the primitive
partygoer couldn't drink daily, nor could he go on the alcoholic's
compulsive spree. Among them, as among early civilized peoples such as
the Egyptians and Greeks, there was drunkenness reported, but we have no
evidence of addictive drinking. It really wasn't until distillation, a process
which produced a beverage five or six times as potent as early wines and
beers, became common that addictive drinking came into its own. A result
of the new process was that a man could carry enough alcohol on his hip
pocket to stay drunk for a day, and he could do it every day of the week.

Each nation has developed its own ways with alcohol.

In many, particularly in the countries of Europe, the established ways were

changed under the impact of the new distilled drinks, but their ways were
still distinctive. There is a difference in the kinds of decisions one makes
about drinking if he comes from one country or another. An African
tribesman sitting in the shade waiting for the process of fermentation to
reach just the right point feels differently about drinking from an American
in an air conditioned bar waiting for the bartender to twist the lemon peel
just so. For each of these drinkers there are questions of appropriateness of
the time of drinking, or the place, or his companions. Each group develops
its own answers to such questions. Imagine the subtlety involved in the
behavior of an American salesman who passes up a drink at lunch because
he has to make a call, knowing full well that he and the customer are going
to conduct their business in the nearest bar! This isn't entirely a matter of
being on one’s toes in the business wars. It is more likely that the salesman
recognizes that you don't make a call with liquor on your breath.

When alcoholic drinks are part of the life of a people, customs regarding its
use develop and change with the years. Sometimes, when the country has a
long, unbroken history of experience with alcohol, most people feel the
same way about it. This is probably fairly close to what is true in most of
Italy. In other cases, the customs are not so clearly defined, or they involve
contradictions with other aspects of living, with other customs. Consider,
for example, a young American football coach in the early stages of
alcoholism. He tells of his boyhood devotion to sports.

His body was regarded as an instrument for athletics. When very young he
made a vow that he would always see to it that he was in the best possible

21
physical condition. He would never sully this "temple" by drinking coffee,
touching alcohol in any form, smoking, or getting physically involved with a
woman. The last part of his vow was first to be broken. He got married. The
rest fell soon after.

Such promises to oneself may seem foolish, but they are consistent with
some very important beliefs in America.

We consider physical fitness to be a matter of great importance. Not to be

"in shape" is particularly bad for the young man, although men of all ages
are concerned with the problem. And, indeed, we do teach our young men
that drinking coffee and alcohol is undesirable, and that smoking and sexual
intercourse are also to be avoided. In other societies, some or all of these
restrictions are unthinkable.

The point is that here in America, as elsewhere, there is a distinctive set of

customs, a unique pattern of emotional reactions to drinking. Bourbon is just
as characteristically American as baseball and the hot dog. France has her
champagne and crepes suzettes. But simply recording these differences
would be an academic exercise if it weren't for one other thing: along with
differences in drinking customs go differences in rates of alcoholism. The
information we have is far from complete, but there is enough to show that
there is an important relationship between drinking customs and the amount
of alcoholism found in any group.

Estimates of rates of alcoholism in a few countries where information was

available show France to be "champ" in the field of alcoholism, followed
by the United States, Chile, Sweden, Switzerland, Denmark, Canada,
Norway, Finland, Australia, England, and Wales, and Italy with the lowest
rate of alcoholism.

These are not the only clear statistical differences among groups. We know
that in the United States there are eleven men who are labeled as alcoholics
for every two women in the same category; in Great Britain, the proportion
is two to one; in the Scandinavian countries, about twenty-three to one.

For researchers, such findings are blessings. It is these differences in

alcoholism rates that give us an indication that looking into the drinking
custom to uncover the conditions under which addiction occurs will be
profitable. When we do this, we see that what appears to be the most

22
important consideration is the extent to which drinking customs fit into the
entire life of a people. That is, if there is consistency in drinking customs
and all other aspects of life such as the ways of the family, of work, or of
religion, then there will be little alcoholism. If there are contradictions,
there will be a good deal of alcoholism. Let’s go back to the football coach
who vowed never to smoke, drink coffee or alcohol, or have anything to do
with women. In taking these vows, he had placed himself in a game he could
not win. No matter what he did—if he kept to his promises or violated them
—someone had to think he was wrong. We can be reasonably certain that his
parents and high school football coach applauded his decision not to smoke,
but we can be equally certain that his friends put some kind of pressure on
him at least to try a cigarette. In a society in which there are conflicting
views about smoking, choosing to smoke means allying oneself with a
certain group against another. This, in turn, involves a conflict which goes
on within the individual.

Whichever course of action he chooses, he is in some degree uncertain.

We can also be sure that, under the influence of hormonal flow and the
stimulation of locker room stories, our friend had some doubts about his
decision regarding women. And when his college football squad broke
training at the end of the season with a mammoth beer party, he might have
solaced himself with the thought that his minister and mother approved of
his abstinence, but he also needed some reassurance. The cost of keeping to
the promises he made to himself was the disapproval of many people whose
approval he coveted.

If there were universal agreement among all members of the society on

smoking, drinking, sexual intercourse, and other matters, then there would
be no problem. Only when there is disagreement can we say that we have a
social problem. Moreover the problem only exists for a certain person if he
is in contact with others who have differing feelings about an issue. So, the
person who feels that it is wrong to drink has no problem if he associates
only with those who feel the same way. It is when he meets, likes, or even
admires others who do drink that a problem is created for him. The same is
true of one who drinks and associates only with those who have no "anti-
drinking" feelings. Only when he comes into contact with those who are of
the opinion that drinking is bad does a problem exist.

At this point, the reader may feel that we are not talking solely of

23
alcoholism, but about any kind of activity in which there is confusion of
feeling. As we shall point out later, this is exactly the case. The process of
becoming addicted to alcohol is probably little different from becoming
addicted to anything else. Only the substance or activity changes. But to
catalogue the kinds of situations which produce confusion in customs having
to do with sex, smoking, eating, work, and other activities to which men and
women have become addicted is a massive task. Just to show some of the
sources of confusion in drinking is enough for us to attempt here.

In the last chapter, we noted that there are differences among nations in their
rates of alcoholism and in the degree to which drinking customs are
consistent. In a melting pot nation such as ours, each new nationality group
has brought with it a distinctive set of attitudes and practices in drinking.
The peculiar situation of the growth of our nation with the impact of the
frontier has produced other attitudes and practices. So, just as our nation's
history involved a babel of tongues which came to be dominated by our own
brand of English, so it also involved a babel of drinking customs which are
still evolving toward a distinctive American way of handling alcohol. There
are still differences to be found, and differences among rates of alcoholism.

Let's look at some examples of nationality groups with extreme rates of

alcoholism: both extremely high and extremely low. By doing this, we can
sharpen the distinction between those factors conducive to alcoholism and
those which prevent it. In a very real sense what we are doing is pointing
out the chances of an individual becoming an alcoholic. Presumably anyone
who drinks has a chance to achieve this "distinction," but we know only a
few do. Predicting it is something like betting on a horse race. Before we
put our money on anyone's nose, we want to know certain things about his
chances of winning. It is possible for any horse entered to win, but some are
more likely to than others. We should want to know something about the
horse’s breeding, previous performances, the length of the race, weight
carried, condition of the track, reports of recent workouts, and so on. Each
piece of information serves to narrow the choice.

We do the same in trying to guess who are the few persons among all those
who drink that are going to be the alcoholics. One of the pieces of
information we should want to have is the nationality. We know, for
example, that if one is Irish-American, his chances of becoming an alcoholic
based on previous rates of alcoholism for this group are probably dozens of
times the chances of one of Jewish-American background.

24
The late distinguished psychiatrist Abraham Myerson gave his impressions
of the relation between nationality and alcoholism in these words:

When one views the flow of American young men through an induction
station, the distribution of inebriety takes on the direction of a formula, viz.,
there are a few alcoholics, almost none, amongst the Jews, Italians, Greeks,
Armenians, Spaniards, and their American-born-descendants—in other
words, among the people of the Mediterranean littoral: and there is the
greatest amount of inebriety among the Irish and English and their
American-born descendants, with intermediate inebriety among similar
groups of French, Germans, Norwegians and Slavs. Moreover, in a group
which has been Americanized for generations, such as the New England
Yankees, the alcoholic rate is low, and a declining rate is becoming
perceptible in the case of the American Irish.

Numerous other studies have supported Dr. Myerson's impressions, although

there is still not enough information to enable us to rank all nationalities in
this respect.

These distinctions in rates of alcoholism have led to attempts to explain

them. So, we now have detailed analyses of the use of alcoholic beverages
by certain American nationality groups, by various Indian tribes, and, in
fewer cases, by other civilized nations. We can use some of these
investigations to describe the cases of relatively high rates of alcoholism
and of relatively low rates. Irish and Jewish-Americans are satisfactory for
this purpose. Donald G. Glad, a psychologist, did one of the most interesting
comparisons of these two groups.

Part of his report consisted of sample interviews of a Jewish and an Irish

young man, each about seventeen years old at the time. Here are some of the
questions and answers, chosen to show differences in attitudes toward
drinking and associated problems.

In answer to a statement by the interviewer to the effect that he just wanted

some general impressions from young people concerning their attitudes
toward the use of alcohol, the Jewish subject said, As far as I'm concerned I
don't think it's good to drink too much. I've tried most drinks. The folks
thought that after 14 or so I should try it to see how it is. When we go to a
party, I drink a little. I don't make a habit of it, and I can go for months

25
without it. I've never been drunk myself. I should try it though—a fellow
should know how it affects him so when he comes to it he should know
whether he can do it or not. Drinking all the time is bad. It's bad for the
health and for the body—it's bad to get too much alcohol into your system.

Contrast this answer with the relatively brief reply made by an Irish youth
who says,

I don't think it's bad. I'm not against it. At times you feel better with it.

Although we only have a single representative of each group here, these

reactions seem to be characteristic of the attitudes toward drinking of each
group. Note that the Jewish-American youth speaks of drinking in relation to
his family. Their opinions about drinking apparently matter to him. Indeed,
he says he started drinking at their instigation! He is concerned with what
alcohol does, and he looks with disfavor upon drunkenness, but not upon
drinking itself. The Irish-American youth speaks as if defending the practice
of drinking. It is obvious that he is well aware of the fact that there are some
who feel that drinking is bad; however, he does not feel that way. Also note
particularly the statement, "At times you feel better with it." Here we have
emphasis on drinking for its effect, rather than drinking as an activity
engaged in solely for the sociability involved.

This comes out still more clearly in answer to a question, "Do you think it
makes any difference to how a person gets along socially whether he drinks
or not?

"To this the Jewish boy replied, It depends on the kind of people. If he has
to meet in business he should be able to drink. If he goes with a crowd of
ministers, he wouldn't drink. But I couldn't see going with fellows who do a
lot of drinking.

The Irish youth's answer was as follows, with some people it does. Some
who drink and make fools of themselves, it hinders them; but when a person
is drunk—if he's not throwing up—it helps them, builds up self confidence.

Again we see two points of view; using alcohol as part of social intercourse
in the appropriate situation, and using alcohol for its anxiety reducing effect.

A question was asked which attempted to determine if drinking practices of

26
the parents were different from those they prescribed for their children. The
Jewish young man said,

My parents drink. Father does when he is out. Father had a nervous

breakdown, so I don't know about his drinking before. But they think I
should try it—because if not—then I might get into the habit. It makes more
of an impression when you're a kid, and I didn't like it. They think it's my
business but I shouldn't do it to excess. Mother doesn't drink at all.

His Irish-American counterpart says,

No. They wouldn't want me to drink. Drinking straight is what I mean by

that. They don't mind my drinking wine or beer. I drink wine at home.
They've found out that I get drunk, though—they wouldn't let me go out, or
play football, or anything, after they found out.

Although the interview with the Irish boy may be somewhat extreme, it does
present in exaggerated form some of the attitudes that are associated with
high rates of alcoholism. Glad has demonstrated in his report that the Irish-
American youth is more interested in getting some effect from his drinking
than is the Jewish-American. He comes in greater conflict with authorities,
such as parents, than does the Jewish youth. In other words, his social
environment is much less consistent in its attitudes toward drinking than in
the case of the Jewish youth.

Naturally, if we want to get a clear idea of the sources of the differences in

attitudes of the two groups: Irish-Americans and Jewish-Americans, we
must go into the background of these people prior to their migration to the
United States. In the former case, that of the Irish-Americans, we know that
many came from the rural areas of Ireland. So, the immigrant brought with
him the drinking habits and attitudes of those regions. The impression that
one gets from a number of sources is that for the young male, living on the
farm with his parents, unable to achieve even the independence represented
by marriage until his father died, gathering in the local tavern with his
compatriots was a major source of recreation. One authority even points out
that if a young man were not in the tavern with the others, he might be
suspected of hanging around the girls. Both drinking and drunkenness appear
to have been fairly common. Not only that, but the attitude toward
drunkenness was such that a person under the influence was treated
sympathetically. His behavior was excused even though it transgressed the

27
bounds of what would normally be called good behavior.

Furthermore, for this group sexual outlets were highly restricted, but the
possibilities for expressing aggressive impulses under the influence of
alcohol abounded.

We see, then, that for the Irish male coming from a rural area drinking and
getting drunk were not uncommon, but getting into serious difficulty as a
result was relatively rare.

We have very little information about the rates of alcoholism in Ireland, but
the impression one obtains is that they are not as high as one would expect
unless he equates drunkenness with alcoholism. It also appears that the
general attitudes toward drinking and its results in rural Ireland were
relatively clear cut and that no great disagreement among segments of the
population was to be found.

However, we can see some pressures in the situation. For example, it was
considered ill mannered to refuse a drink when offered. When one person
bought a drink, everyone in the group was expected to reciprocate. This
made for a certain amount of uneasiness on the part of those unable to keep
up. Here, the urgency to drink "like a man" is great. We might also expect
that the poor timid soul concerned about the aggressive tendencies which
are released under the influence of alcohol might find the drinking situation
distasteful. If drinking leads to fighting, then being afraid to fight leads to
being afraid to drink.

The pressures which exist when the same habits are transplanted to the
United States were probably greatly intensified. The evidence is that the
Irish-American drinks for the effect that alcohol has on him instead of, or in
addition to, the social needs met in the drinking situation. But in this attitude
he runs squarely against that of other groups in the United States. He comes
in contact with a number of people who feel that drunkenness is bad. Even
among those who tolerate drinking, many consider drunkenness to be
distasteful. One who gets drunk isn't "drinking like a gentleman.

"The dilemma that the Irish-American drinker faces is that he has both a
tendency or desire toward achieving intoxication and a tendency or desire
against it. The result is that drinking has a deep significance for many
members of this group. It is not an activity to be passed off lightly but is a

28
kind of "big deal." We are still not saying that every Irish-American who
drinks becomes an alcoholic.

Nor are we stating that every Irishman who has confused attitudes about
drinking and who feels some strain in the drinking situation will become an
alcoholic. At the moment, all we are saying is that here is a group of people
with a relatively high rate of alcoholism in whom these mixed attitudes
toward drinking and drunkenness occur. The contrasting group at the other
end of the scale of alcoholism—the Jewish-Americans—presents a very
different picture. In the first place, all studies of the number of drinkers of
alcoholic beverages among Jews show that compared to almost any other
group in the nation they have a high percentage of drinkers. Furthermore, for
some groups of Jews, particularly the Orthodox, drinking begins at a very
early age and occurs more frequently than in most other groups.

But what is important about Jewish drinking is the consistency of attitudes

toward it. They are attitudes which, though not identical with those groups
having highest prestige in our society, are not in opposition to them.

What is probably the key to drinking by Jewish-Americans is that it has

tended to be relatively unimportant. That is, drinking may take place in the
course of a religious ritual, or on a special occasion, or as part of a social
situation, but is always as an accompaniment to something else—never for
itself alone. Drinking is a way of taking note of an event, it doesn't become
an event in itself.

Drunkenness is frowned upon by Jewish-Americans, and those who get

drunk are not treated tolerantly except insofar as they may be considered
sick. To set out to become drunk is something which is foreign to the main
stream of Jewish tradition. As we have seen in quotations from Glad’s study
of Irish and Jewish-Americans, drinking among Jews tends to be a family
affair rather than a social group activity. Furthermore, it appears that Jews
are very respectful of the effects of alcohol, even to the point of desiring, as
in the case of the Jewish youth who was quoted above, that some controlled
experience with alcohol be had in order that difficulties can be anticipated.
We'll see later that the same "respect" for the effects of alcohol is held by
women generally in our society.

A group whose drinking habits are very different from the Jews and Irish,
but one in which there is very little alcoholism, is the Italians. For the most

29
part, those Italian-Americans who are still close to the habits of the mother
country tend to do their drinking as part of the meal. Only as they move
away from Old World influences do Italian-Americans begin to drink
somewhat differently, using alcoholic beverages at times other than meals.

Change away from the old ways is typical of all nationality groups as
succeeding generations are born and raised in this country. So, the Irish-
American's drinking attitude and habits tend away from the old patterns
which we have described. Among Jewish-Americans, the swing is away
from Orthodoxy to a way of life which is more nearly similar to that of the
dominant groups in the nation. We can note parenthetically, at this point
because we shall discuss it more fully in Chapter 14, that the rates of
alcoholism for each of these groups change along with the changes in
attitude and drinking customs. That is, those groups with high rates of
alcoholism move down toward the average, while those with low rates
move up.

We have already mentioned in passing "the dominant group" in the United

States. What is meant here is that there are some nationality groups who by
virtue of their time in the United States and the prestige which their
members have attained in the life of the nation, exert an influence over all
the rest. The effects of this influence are to set standards of behavior in
education, business, dress, as well as in drinking. Seldon D. Bacon of the
Yale Center of Alcohol Studies has given a vivid description of the drinking
customs and attitudes toward drinking of this group. While Bacon made no
attempt to present them as the dominant nationality group in the United
States, it is very likely that his description is quite accurate in this respect,
too. He speaks of its representative as the "United States American of the
northeast quarter of the nation, Protestant, middle class, urban, white, from
Anglo-Saxon background of three or more generations in this country.

"The description of his drinking customs and attitudes areas follows:

The social functions of drinking are rather vaguely and somewhat

defensively described: they concern drawing people, both family members
and also complete strangers, together, often for purposes of "fun," often to
allow relaxation from . . . moral norms . . . The rules and procedures are on
occasion rather specific, but also show enormous variability so that a given
individual may follow one set of rules with his family, another with
business or professional associates, and the third on holiday occasions, and

30
show even different patterns when away from the hometown.

Sanctions for violations are extremely irregular . . . Parents, employers,

priests, physicians, and other agencies of sanction are most uncertain
sources, both in formal statement and in actual behavior, many of them
avoiding the issue whenever possible . . . Sometimes the learning stems not
from parents, ministers, physicians, elders, and teachers but from other
adolescents, sometimes on trains, in cars or in commercial places. The
custom is not significantly entwined with family and religious institutions . .
. There is great emotional feeling about the problem on the mass level as
well as by the individuals, feeling that has run rampant for generations.
Activating the custom, especially by the young, is often attended with
feelings of guilt, hostility, and exhibitionism and may occur as a secret
practice insofar as parents or employers or elders are concerned.

Notice that in his description of these drinking customs and attitudes, Bacon
is presenting a picture which lies somewhere in between the situation of the
Irish-American and of the Jewish-American. A good deal of ambiguity and
contradiction is to be found in this setting.

Another important point is implied in this description.

Remember that Bacon is talking about city dwelling Protestant middle class
persons. No matter what our religion, social class position, or nationality
background may be, we are to some extent influenced by the beliefs and
attitudes of this particular group. But this is a group which settled on this
continent when there wasn't much in the way of cities. Their drinking
behavior was governed in part by strong religious feelings that any
indulgence of the senses was bad, and partly by the inaccessibility of
alcoholic drinks. It was a way of life that has sometimes been described as
"ascetic Protestantism." The sociologist Thorne has pointed out that for such
people a good deal of anxiety was attached to drinking activity.

One sees this even today in the rural area dominated by ascetic
Protestantism when drinking does occur. It tends to be drinking of a rather
explosive kind, involving drunkenness. In a sense it may be used as a revolt
against persons surrounding the drinker or against his way of life generally.
What frequently saves the rural drinker from serious difficulty is the fact that
drinking occasions are rather few and far between.

31
When we take this attitude toward drinking to the city (and this is precisely
what has happened as the ascetic Protestant gravitated toward the city with
the growth of the great urban centers as we know them today), anxiety about
drinking still exists, but there is also the opportunity for drinking and
pressure to drink. So, the Old American tends to have a set of influences
brought to bear on him which are unlike those on the Catholic or Jew, most
of whom do not feel any such stirrings of conscience in the drinking
situation.

Yet, remember Dr. Myerson's observation that among the young men he saw
at an induction center who were in trouble because of their drinking, there
were relatively few Old Americans. Probably what has happened over the
course of the generations in the city is that the asceticism of the nineteenth-
century rural Protestant has disappeared.

In the city we now find asceticism is a rare phenomenon as a way of life. As

a philosophy, it seems to be out of fashion.

With the gradual disappearance of the rural area under the impact of the shift
of population from the rural to the great metropolitan center, and under the
impact of mass communication breaking down the differences between city
and country folk, it probably won't be many generations before this kind of
person with these kinds of attitudes toward drinking will be extinct.

One other religious group holds our interest because of its attitudes toward
the use of alcoholic beverages: the Mormons. We know that the Mormon
attitude toward drinking is very clear—one should not drink. However,
investigation has shown that a small percentage of Mormons do break away
from this tradition and that they do drink. What is most interesting about this
is that a very high percentage of Mormons who drink have troubles as a
result. Certainly the conflict that faces the Mormon drinker who goes against
his beliefs and his people must be acute.

Other examples of groups that are forbidden to drink but who have members
who do would probably show the same finding, but we have very little
evidence to go on.

So far we have dealt with some of the major kinds of groupings in our
society such as nationality and religion.

32
We have seen that there are factors involved in these groupings that affect
the attitudes toward drinking, tending to produce either confusion and
variability or consistency. There are other known factors, and probably
some that we are not aware of as being important at the present time. One
clear cut difference which must be mentioned is another essential difference
between men and women. In the United States, for every woman alcoholic
there are five or six men. In other countries the relationship changes,
although in all those about which we have information, there are
considerably more male alcoholics than female. By and large, the American
woman is under less pressure to drink than is the man. We know that there is
considerably more shock expressed at seeing a woman drunk than a man.
The woman is not faced with the same pressures to drink "well “as is the
man. Drinking like a lady usually involves taking only small amounts of
alcohol. Women in our society can abstain from drinking under more
circumstances and with less conspicuousness than can men.

All evidence adds up to the fact that for women drinking is less of a "big
deal" than it is for men. Furthermore, the strength of attitudes for and against
drinking are weaker in women, and, therefore, women tend to be faced with
fewer contradictions.

We are gradually narrowing our interest to the specific individual. So far

we have talked about nationality, religion, locale, and sex. All these factors
imply membership indefinite groups or segments of the population. Further
more, they imply certain expectations regarding our behavior as a result of
this membership. These expectations and influences have become effective
in directing the individual only through constant contact with those who hold
the expectations and wield the influence. Certainly the most important
personality and attitude shaping contacts are those within the immediate
family. One is not only German, Protestant, city dweller and male, but he is
a German, Protestant, city dweller, and male of a certain family. Conditions
within that family may be such as to produce inconsistencies in one's
feelings toward drinking.

For example, suppose that we have grown up in a home in which the parents
are both prohibitionists. In our early years, we undoubtedly will be
prohibitionists, too. But as the years go on and our circle of contacts
enlarges, we are going to be influenced by other points of view. We shall
discover that prohibitionists are sometimes treated with ridicule. We shall
be urged to drink. It may also be that in the important adolescent years, we

33
shall discover that taking a drink is a peculiarly effective way of defying our
parents.

We need not think that we violate our parents' teachings without cost. The
child who has been influenced by such a prohibition cannot be so easily
converted to the other side that his attitudes will be consistent and clear.
One frequently hears of the child of a temperance worker becoming an
alcoholic. Sometimes the case is presented with a vicious satisfaction by
those who are less "righteous" than the prohibitionist. A psychologist who
studied a group of prohibitionists found that the use of alcohol was strictly
forbidden, but that it did come to be used by some individuals as a revolt
against their parents.

A similar situation exists for the child of an alcoholic. He goes into the
drinking situation with some fear. In talking with such persons we often find
they wanted to show themselves and the world that they were not
"weaklings" like the parent. Certainly, such a drinker could not go into the
drinking situation without anxiety. It would have to be an important event.

More common than either of these extremes, however, is the lack of

consistency within ordinary homes. It may be that the father takes drinking
as a matter of course while the mother fights against it. Or it may be, as the
Irish-American youth quoted earlier said, that the drinking behavior of the
parents is different from what they expect from their children. Here again,
we have circumstances which serve to emphasize the importance of drinking
and which present the individual drinker, particularly the young one, with a
conflict.

What we have here is what Selden Bacon referred to in his description of

the middle class, Protestant American when he said that "custom is not
significantly entwined with family and religious institutions."

The young person is faced with contradictions in the drinking customs

among the various important groups to whom he looks for guidance. Whose
view should he take? Is it that of the teacher about whose personal life he
knows nothing and who expresses abhorrence for drinking? Is it his parent
who tells him to do one thing but then who does the opposite himself? Is it
the advice of a contemporary who steals a bottle of Dad’s whisky and who
drinks it as an indication of his “manhood" as well as being a way to get
even with his parents? As long as there are mixed feelings in society as a

34
whole about drinking, there will be mixed feelings within at least some
individuals.

So often, the youngster wants to drink, or thinks he should drink, and feels a
little anxious or reluctant about it.

The term "ambivalent" describes his confusion of feelings. Webster defines

ambivalence as "simultaneous attraction toward and repulsion from an
object, person, or action.

"Jimmy Durante describes it in his song "Did Ya Ever Feel That Ya Wanted
to Go But Still Ya Wanted to Stay."

We see, then, that ambivalence is the psychological product of a social

situation in which there are mixed attitudes toward drinking. As we shall
see later on, ambivalence is an essential feature in producing addiction to
alcohol. We know that there are elements within our society and
consequently within ourselves that urge us against drinking. But we also
know by the very fact that there are more of us in the United States who
drink than there are those who do not, that the attraction is stronger than the
repulsion. One way to observe the importance of ambivalent feelings
toward drinking is to trace its influence from the beginning of an
individual's experience with alcohol. We have already seen that there are
basic disagreements among various groups in our society in the way they
feel about drinking, and that in many cases disagreements produce doubts in
the minds of drinkers. These facts show us that ambivalence in the drinking
act may be present even before one has his first drink. We can guess that the
nature of that very first drinking experience would be colored to some extent
by pre existent attitudes.

Suppose we were to test this assumption by asking a roomful of people

about their first drink. The chances are pretty good that a bare majority of
those present would answer yes to the question, "Do you remember the very
first drink of an alcoholic beverage you ever had?" But if our group is
composed of alcoholics and others, we should find that an overwhelming
number of the alcoholics would say they remembered that very first drink.
Indeed, experience indicates that it is a rare alcohol addict who does not
remember this event. The fact that the first drink is an event to be recalled is
in itself revealing about the importance of drinking. Drinking marks one of
the major steps in the growing up process, ranking with one's first cigarette,

35
graduation from high school, first sex experience. There is an emotional
aura about all of them; were there not, it is unlikely they would be
remembered. The emotionality attached to these activities comes from the
fact that they are behaviors forbidden completely to the young, and
permitted to adults of our society only under certain conditions. Thus, to
smoke or drink is not only to be mature, but it is also to do something
wicked. Wicked things are saved for the mature. Neutral events such as
one's first steak or first automobile ride are too unimportant to impress
themselves on one, or are not reserved for only a part of the population.

If someone does not remember his first drink, we can choose from two
explanations. Either it was so innocuous an experience that it did not
register, or it was so terrible that memory of it is repressed—pushed into
the subconscious.

There seems to be no evidence that the latter is true. Most alcoholics

remember their first drink, and, as we shall see, alcoholics often describe
difficulty at the time of the first drinking experience. For the alcoholic, the
first drink tend*to have been an important occasion. We can say with
confidence that the first drinking experience is not remembered by those to
whom drinking is relatively unimportant (non-ego-involving), and we can
also say that those who do not remember their first drink are unlikely to
become alcoholics. However, we cannot say that those who do remember it
will develop an addiction to alcohol. If all those in the United States who
remember their first drink should become alcoholics, they would outnumber
the non-alcoholics.

From those who remember their first drink, alcoholics or not, we can obtain
still further information. We can learn much of the nature and meaning of the
experience to them.

As an example, here is a description of her first drink and of the complex

attitudes associated with drinking provided by an attractive coed of twenty.

I went to a fraternity open house party and got a drink by mistake, because I
don't drink. The kids said, "Hurry up Drink it, because we're leaving." So I
did. They were teasing me because they knew I didn't drink. It was some
kind of cocktail. It didn't have any effect on me. I had another drink about a
year later. I don't remember what it was. I was with some people I didn't
know well, and it was easier for me to take it than refuse it. I didn't drink

36
until this time because my mother and father don't and they feel very strongly
that I shouldn't drink.

You sort of build up a self-image, and I don't like to think of myself as

drinking. I know I feel this way because of my parents, but I don't feel as if I
am doing them a wrong. I don’t feel that I shouldn't drink because it would
disappoint them if I did, although it really would. Rather it's because that’s
the way I think of myself. My religion (Congregational) is in it somehow. It's
not a case of violating my religion, but what I think I should be. That's partly
religion. It also has something to do with what other people think of me, like
a previous boy friend. The boy I'm pinned to now doesn’t drink, so with him
I'd be more likely to take a drink if he did. With the other boy friend, he
drank, but it meant a lot to him that I didn't.

Her description gives us some feeling of the complexity of the place of

drinking in the life of a young woman. It illustrates the ambiguity, conflict,
and ambivalence involved in drinking customs as described by Bacon in the
previous chapter. The girl's own feelings about herself come into the picture
as well as what she imagines the feelings of her parents, boy friends,
religious group, and other contemporaries, to be. The final resolution has
not been made in this case. There is, however, no strong motivation to drink,
and she feels it easier not to. When the situation arises that it is inconvenient
to not drink, then she meets it by taking one.

She has never had enough to drink to have any effect from it, and the entire
experience of drinking has mildly unpleasant connotations for her.

Contrast the description of this girl's first drinking experience, an almost

accidental event which had only slight emotional impact, and that clearly
negative, with the story told by the famous Lillian Roth. Although Miss Roth
says nothing of her attitudes toward drinking prior to this occasion, she does
describe enough of her family situation to reveal that her father was a
problem drinker. We can also assume that, being Jewish, Miss Roth was a
little unusual in not having had her first drink until a relatively late age.

This is what she says.

I have a vivid memory of my first drink. I had just turned seventeen. A few
minutes before midnight, 1928, I stood excitedly in my new formal at the
"Vanities" stage door. Inside, the cast were wishing one another a riotously

37
Happy New Year. (Only an hour before the performance. C. Fields almost
broke us all up by grabbing a broom and chasing a process-server up and
down the empty aisles, yowling at the top of his voice.) I was waiting for
Leo Fox to pick me up. Katie had given me permission to stay out late that
night for a New Year's Eve party with our classmates from Clark, and to
greet 1929 with a class breakfast. There was Leo, jaunty in a new tuxedo,
holding open a cab door. "Come on, Lil. We're late."

"Gosh, you look slick, Leo," I said admiringly, and I thought how lucky I
was, because all the girls admired him, but he had eyes only for me. On the
way over in the cab,

Leo pulled out a flask. "Lil, I've got something here. We’ve got to catch up
with the other kids."

Leo and I had never drunk anything but ice cream sodas together. But this
was an occasion. He put the flask to my lips. "Have a nip." I took my first
drink. It burned my throat, and I felt the blood rush to my face. "Gee, Leo,
that’s great. What is it?"

"Fermented prune juice," he said. It was his own prohibition home-brew, he

added proudly. I thought, it's probably good for my complexion. Sure speeds
up the circulation. I feel warm all over. As we stopped before the Hotel, I
said,

"I think I'll have another one of those just before we get in, Leo."

When we reached our table, someone said, "Have a drink." I drank. This
was much stronger. I coughed and sputtered, but again I felt wonderful.
Suddenly the sirens sounded, the bells rang, the horns tooted; it was
midnight.

People hugged and kissed each other. Gaily colored streamers shot through
the air, the orchestra became alive, and the lights went out.

I loved everybody. My shyness vanished. The clock in my head slowed

down. "Oh, this is glorious," I thought. "I’m walking on air. I'm going to hug
every person in this room and disappear. I'll vanish. Leo will have to search
for me."

38
I began to weave my way through the enormous ballroom, amid the flying
streamers, the voices shouting "Happy New Year," the music rippling and
throbbing and cascading all about me. At each table it seemed my arm was
grabbed. "Come on, little girl, down the hatch" I drank with everybody and I
drank everything they gave me. I glowed; an indescribable sense of
freedom, a desire to open my heart and enfold the whole shining rapturous
world overwhelmed me.

The room began to spin. Then I was sitting in the dimly lit lobby, violently
sick over my beautiful dress, over Leo’s new tuxedo. The music was far
away, in the ballroom two flights above, and a bellboy was trying to help
Leo clean me up. I was utterly ashamed.

Whatever Lillian Roth's attitudes toward drinking had been prior to this
occasion, we can be sure that they were changed by the actual experience. It
was one which contained both joy and misery. The sense of elation, of
release that she described was intensely pleasurable. The shame and misery
of the sequel was just as intensely unpleasant.

We can guess that the next time Miss Roth drank she hoped to achieve the
pleasantness and avoid the unpleasant.

But we can also guess that she was ambivalent about the situation.

A theme that appears frequently in stories of their first drinking experience

by alcoholics is that of having been with persons who are superior in age or
social standing when the event occurred. Here is a man in his late forties,
highly intelligent, but from a poor family living in a relatively low section
of the city. He answers the question, "Do you remember the very first drink
you ever had in your life?" as follows:

Yes, it was while I was in high school. If I remember right it was a dinner
we were having, some function we were going to. I can't place that, but I
know there were a bunch of us together: a bunch of fresh—we thought we
were smart kids. We had some wine, if I remember right, before we went to
this particular dinner or dance. We drank it in the car. We traveled in town
and in those times there were speak easies. We bought a gallon of what I
think they called guinea red. I think there were four or five of us on the way
to the place of the affair. We drank wine, and then we were feeling very
mellow. The boys thought we were just the boys and the life of the party.

39
That was the first drink I remember. We were just the big shots. We were
men.

He goes on to describe in some detail just why he drank and how he felt
about it.

I used to not want to drink. They never held my throat and opened my mouth
for me, but I don't know, they were out of my class entirely in the sense of
social standing. A lot of them come from well-to-do families. I just didn't
feel as though I belonged, although it was they who asked me to attend these
affairs with them. I don't know whether they liked my company or whether I
was easy to get along with, or what. I was one of the crowd although they
were in another social level.

Here we have another good example of ambivalence in the early drinking

experience. His family did not permit him to drink at this time, and he was
forced to hide his activity from them. He indicates above that he was
somewhat fearful of drinking and that he was uncomfortable in the group.
But he felt under compulsion to drink.

It was as if you didn't take a drink or you couldn't drink, well, you were just
a killjoy. You weren't invited with the group. Clearly, then, this man's
introduction to drinking and his early drinking took place under conditions
of anxiety. He found drinking his ticket of admission to a certain group, one
whose composition was such that he was proud to be a member but which
also made him feel inferior. Thus, we see several problems facing him when
he drank: he was violating his parents' wishes, he was afraid of liquor, and
he was fearful of his position in the group. Now, we can see what the magic
of alcohol is when it wipes out all these problems! Here is what our friend
says,

I was one of the group when I had the whisky in me. We were talking the
same language and I liked it.

The sense of well being that comes when one is anxious and his anxiety is
knocked out by the action of the alcohol is an important element in early
drinking as reported by many alcoholics. Many describe an early drinking
setting in which the compulsion to drink came from the feeling that, in a
group which drank and which represented a higher social level, one had to
drink in order to belong. Still more, however, tell of the importance of being

40
with older boys or men when they drank for the first time. Here, the attempt
is to prove that he is able to keep up with the bigger boys or even surpass
them. A man, now in his sixties, gives us these answers. He was
interviewed in a public hospital.

1. U.: Do you remember the first drink you ever had?

Patient: I've been drinking since I was in the sixth grade of

grammar school. I was around when the kids got out of school.

We'd go down to the brewery with older fellows.

We'd sit out by the railroad tracks or something and get beer or
something.

1. U.: How old were you?

Patient: Maybe twelve.

1. V.: Do you remember what effect it had on you?

Patient: I can remember when I was a youngster, when I first

started drinking, even when I was a little older and we went
out and really drank, I used to wonder how people got drunk.
Because I never seemed to. I'd hear older fellows talking
about big heads and things like that.

At this point the interviewer had the impression that the

patient felt inferior to the older boys because he couldn’t
boast of being drunk and having a hangover. As he goes on,
he finally achieved equality with the others.

1. U.: Were you usually with older fellows?

Patient: Oh, yes. All my life I've been with them

because I was big for my age, and it seemed I wanted to

41
 be with them.

The other smaller kids didn't interest me.

1. U.: Was there much talk about getting tight?

Patient: Well, when I graduated from grammar school I

was fifteen years old. I was a big boy in long pants, and
the older boys around the corner where I lived, they
used to do a lot of drinking, and I'd join in with them at
night. But it would never seem to affect me. And they'd
all be tight, and the next day they'd all be talking about
how they were sick from it, and. ... I bet I drank for five
years before I knew what it was like to be sick from
drinking. But then it seemed to progress through the
years and now, why it's just ... I get so sick, it's just
terrible.

Although this experience and particularly the setting

which involves drinking with older boys or men is an
extremely common one among alcoholics, one can go
through a variety of cases and find a variety of
experiences all of which involve some anxiety about
drinking. Here is still another man also around sixty at
the time he was interviewed who answered in this way
to the question, "Do you remember the first drink you
ever had?

"Oh sure, when I was about fourteen years old, maybe

sixteen. My father used to make home brew, but beer is
nothing for a young fellow once he starts drinking. But
as you go through life, you want more and more. Well, I
used to go to dances like many young fellows and we'd
have something before the dance. All the boys were
about the same age. The first time, when I had home
brew, I didn't ask my father for it. I stole it.

Another man who didn't have his first drink until he was
twenty-one years old, describes it as follows.

42
It was a joke. I was working piecework at the time.
Now, we have a fellow who is a truck driver who is a
practical joker. Piecework meant so much to me in
those days we didn't stop for a drink of water. We
stayed thirsty.

He was the type of fellow who drank quite a bit. So I

says to him, "—, get me a drink of water on the way
back, will you."

"Sure.” So I drank it. To this day I don't remember

getting home.

It was pretty potent. Notice that if we examine the age at

which most people do begin to drink, we find that it
comes in the middle or later teens. To go to the age of
twenty-one without ever having a drink of alcohol is
relatively unusual. A comparison of the age at which
alcoholics and others had their first drink reveals that
the alcoholics tended to have theirs at a later time than
the non-alcoholic drinkers. These results are only
tentative, however, and need further research.

Here is another case of a man who began his drinking at

a relatively late age and under difficult circumstances.
He answers the now familiar question as follows.

Oh, my, let's see. It's either 1910 or 1911. I was about
twenty or twenty-one years old. It was through the first
girl I went with, and we had a break-up, and I just took
one drink, I took a drink—a fellow much older than me,
he asked me. I said, "No, I never drank a drink of liquor
in my life.

"So he said, "Would you have some?"

I says, "I wouldn't mind taking it."

And I just took, you know, one drink. It was out in the

43
country. It's a small town, a couple of stores in it, a post
office, that's all. We used to come down to the country
store, and we was all talking, and some of the fellows
were there.

It did something—well, I don't know—well, have you

ever had a—it worked the same with me, just the same
as swinging in a hammock—that kind of dizzy. But it
wore away after awhile.

"One more example is that of a doctor who did not have

his first drink until he had been in practice several
years. He reports that he liked the effect of it and kept
on "trying" it until he finally lost control.

As we continue to study the first drinking experiences

of alcoholics we see that no matter what the particulars
of the situation in which they began drinking, they show
emotional arousal—ambivalence—about drinking even
at that time. Usually, the drinking means something to
them beyond the act itself. That is, it is associated with
acting like “a man" or achieving emotional comfort as a
result of the action of alcohol. If one has doubts about
being able "to act like a man" or "to act one's age," and
if he sees drinking as a test of his virility and maturity,
ambivalence is present in the situation. Then if he
drinks enough, he will be comforted. He will feel just
the way he wants to feel. Here we must point out that
the neurotic individual is likely to be worried about his
ability to act as he should. When other conditions such
as his group's attitudes focus his attention upon
uncertainty about drinking, then the situation is highly
charged emotionally, and the relief obtained from
drinking is greater. Thus, one has greater fear
concerning drinking and more to "gain" from it. In part,
we are now supporting the view that alcoholics are
suffering from personality disorders, but we are also
showing that the neurotics more likely to be ambivalent
about drinking and that ambivalence is what is
important in developing addiction.

44
The normal drinker who remembers his first drinking
experience most commonly reports that it took place in
his own home or at some family gathering. Perhaps it
was the glass of champagne that he had at his cousin's
wedding, or the New Year's Eve toast drunk by the
entire family. Or, if it was not in the company of his
parents, it probably was with his friends in a situation
in which all were experimenting, and one in which
drinking was more or less expected.

Thus, the example of the girl who had her first drink at a
fraternity party illustrates this.

What we notice when we examine the first drinking

experiences of persons who are not alcoholics is that,
as we have said again and again, it was something
which happened more or less as a matter of course. But
we can do more than this with the first drinking
experience. Remember at an earlier point we discussed
the different rates of alcoholism which accompanied
different attitudes toward drinking by various groups.
Remember, too, that we said the drinking experience
was more "central" to the boy than to the girl in our
society. And remember also that the rates of alcoholism
show eleven male alcoholics to every female.

If, as we state, these attitudes toward drinking and the

early experiences in the drinking situation are important
for the establishment of addiction to alcohol, then we
should be able to find differences in the first drinking
experiences between those who have high rates of
alcoholism and those who have low rates. That is, if by
examining the first drinking experiences of alcoholics
we can determine that there is something unusual or
even traumatic about the experience, then we should
expect to find more of this sort of thing among those
people who are going to contribute more heavily to the
population of alcoholics. We should expect to find that
boys have their first drink under more tension producing

45
circumstances than do girls. Even if we deal only with
people who are in the early stages of their drinking and
who as yet have not drawn attention to themselves as
problem drinkers, we should expect to find more of
these unusual circumstances among those who are going
to produce more alcoholics.

And so we find that more boys than girls became

intoxicated at the time of their first drink, and we find
that more boys than girls had their first drink outside of
the confines of the home and with persons other than
their families. In short, we find about what we would
expect if our notions concerning the importance of the
early drinking experiences and the difference between
the early experiences of alcoholics and others are true.

Much the same condition exists when we look at

various nationality groups. Those which have the high
rates of alcoholism also show more individuals who
remember their first drink, who had their first drink
under somewhat unusual circumstances, who first drank
with persons other than the family, who became
intoxicated at the time of the first drink, and who,
generally, found drinking a more emotionally important
occasion than did members of the groups with low rates
of alcoholism.

Being able to identify groups and individuals who are

vulnerable to alcoholism would be a great step forward
in preventing the condition. As we shall see later, the
line we have followed in this chapter leads us to a
consideration of prevention techniques. Early Signs
Starting with the finding that societal conditions or
customs may foster ambivalent attitudes toward
drinking, we have looked at the specific beginnings of
drinking both for normal drinkers and alcoholics. In so
doing, we have recognized that some persons are
anxious about it, feeling that they should not drink, but,
for a variety of reasons, also wanting to. We noted that
the setting in which drinking occurs may in itself be

46
stressful, as in the case of the youngster who drinks in
the company of older persons or with his social
superiors. We also saw that what happens in one
drinking experience influences how one feels about the
next.

And we have seen that taking in enough alcohol when

under stress serves to anaesthetize the drinker against
the pain and tension involved. Now, we are finally
narrowing our attention to the individual who is or will
become a problem drinker.

Although the ground may in part be prepared for

alcohol addiction even before one has ever had a drink
of an alcoholic beverage, it takes a number of
experiences of a particular kind before any
recognizable addiction occurs. From what has gone
before, we can summarize the characteristics of these
addiction making experiences.

There must be some desire to drink accompanied by

anxiety about it. The anxiety may be caused by anti
drinking attitudes learned from others, or as a result of
earlier drinking experiences.

There often occurs at the same time a problem which is

made more acute in the drinking situation: for example,
being afraid that one will not act in a manly fashion
when drinking.

Enough alcohol must be taken in on such occasions that

relief from anxiety stemming from any cause
whatsoever is obtained.

Just how many experiences containing these elements

are necessary to establish an addiction cannot be said.
However, there probably is a tendency for succeeding
unfortunate drinking experiences to be more difficult
and more addiction provoking, than the earlier ones.
Thus, when one has not handled a drinking party well

47
and is about to goon to the next, he is more concerned
than the person who had no difficulty. At this stage, it is
unlikely that the drinker or anyone else is aware that a
serious problem is in the making.

It used to be that experts on alcoholism spoke of it as "a

disease of middle age." More recently, those who treat
alcoholism are seeing addictive drinkers in their early
twenties and even in the teens. In several states,
agencies charged with the care of juvenile delinquents
have in their custody a number of children in their early
and middle teens who already are problem drinkers.
There is no evidence that the situation is worsening and
that more children are becoming alcohol addicts, nor is
there any evidence that this is not the case. What is
clear is that as more is learned about alcoholism, and as
clinical experience in its treatment increases, trouble is
recognized at a much earlier point in the alcoholic's
career.

Another piece of folklore among the experts was that

alcoholism takes years to develop. While it is true that
it takes years for the alcoholic's situation to deteriorate
noticeably, and for someone to recognize alcoholism for
what it is, it also is true that most alcoholics have been
in trouble for along while before coming into contact
with someone who diagnoses the difficulty. Addiction
itself comes before the alcoholic’s behavior is
sufficiently unlike that of most drinkers to have serious
attention called to it.

We come to see the alcoholic's drinking as abnormal

when something happens that would make it desirable
for him to stop drinking and he does not. If a logging
crew comes out of the woods on payday and its
members proceed to drink themselves into insensibility
for the weekend, we may be distressed but we have no
knowledge of whether we are dealing with the normal
drinking pattern of a particular occupational group or
with alcoholism. However, if on Monday morning all

48
the men, complete with hangovers, are back on the job,
we should conclude that no evidence of alcoholism was
presented. If, however, one man stays in town to drink
as long as his pay and credit hold out, if he is drunk for
a week or two instead of the "normal" weekend, then
we may have some justified suspicion that we are
dealing with an alcoholic.

Deciding that a particular act or episode of drinking is

abnormal must be done against the background of
knowledge of what is typical or normal drinking. If the
town banker were to drink on a weekend like a
lumberjack, tongues would rightfully wag. He might be
showing signs of alcoholism even though he drank no
more often and in no larger quantities than the
lumberjacks. Because he shows a degree of
preoccupation with drinking that is excessive for his
particular group, the banker's friends are concerned.

Usually it is those close to the drinker who first notice

something out of the way in his behavior. It may appear
to a wife, mother, or friend that the drinker is not
exercising “good judgment." They may point out to him
that he is drinking too much and that he ought to cut
down. Probably they will be surprised that the drinker
resents the implication that he is not drinking well. He
may even make them feel guilty for bringing up the
subject. Although he often will categorically deny that
anything is wrong, he may also try to control his
drinking somewhat more carefully now that he knows
others are concerned about it. However, he will feel
that the trouble is with them, not with him. He can point
out that others get drunk, too, or behave badly, so that he
really isn't any different!

Mention of early signs of alcoholism implies that there

are later signs as well. Much of what we know about
the sequence of events in alcoholism is based upon an
investigation reported by E. M. Jellinek, then director
of Yale’s famous Center for Alcohol Studies.

49
He analyzed questionnaires on their drinking history
filled out by members of Alcoholics Anonymous. The
importance of this effort becomes more apparent as one
gets deeper into the study of alcoholism. If it is possible
to know what happens in the "natural history" of
alcoholism, then it can be identified earlier and steps
taken to initiate treatment. As a result of studies such as
Jellinek's, the picture of the alcoholic as a Skid Row
bum, helpless and hopeless, has been destroyed. We
know there are alcoholics on Skid Row, but we also
know that the typical alcoholic is elsewhere.

With ignorance of the course of alcoholism the rule, it

usually is the case that the problem drinker's situation is
well along its downward path by the time someone is
alerted to the problem. That is, he already has lost
control over his drinking: he is an alcohol addict. Not
only ignorance is involved here. The wife or husband
may not know the signs of alcoholism, but he may also
be unwilling to admit to himself that this could be
happening to someone he loves. Alcoholism happens to
other people, not to us. The sense of moral guilt and
shame that alcoholism engenders only adds to the
psychological need to deny its existence.

Jellinek's work and its sequels gives us a basis for

education about the symptoms and development of
alcoholism devoid of any moral connotations.

The questionnaire filled out by members of Alcoholics

Anonymous contained thirty-six items. Each started
with, “At what age did you first ..." So, the first
question is, “At what age did you first get drunk?"
Another is, "At what age did you first begin to lose
control of drinking?" Or, "At what age did you first
develop abnormal and unreasoning resentments?"

In the light of present knowledge, there are many gaps

and flaws in this pioneering study, as one should expect.

50
For example, we should now like to know when each
respondent first drank at all. But Jellinek's analysis of
the questionnaires gave students of alcoholism a starting
point for additional work, while his data have remained
useful.

One thing which is immediately apparent when we note

the ages at which various problems associated with
drinking appeared is that symptoms of alcoholism
showed up well before middle age: that is, men in their
twenties and early thirties reported they already were
behaving abnormally with respect to drinking. Indeed,
men reached what was called "the lowest point" in their
drinking careers at an average age of 40.7. This
represented a period closer to the end than to the
beginning of their drinking careers. We must suppose
that they had been having trouble for years preceding
this "lowest point." The average age of the respondents
was 43.2, so that the crucial aspects of their drinking
careers actually appear to have been phenomena of
young adulthood.

Jellinek's interest in this important area for

investigation continued, and some years later, as part of
a report for the World Health Organization, he analyzed
drinking histories of over 2000 male alcoholics.

Naturally, there was considerable variety in histories,

with the order of events occurring differently, or some
incidents not appearing at all in the individual case.
However, Jellinek was able to identify four basic
phases in the drinking history: 1) the pre-alcoholic
symptomatic, 2) prodromal {meaning the forerunners of
the condition), 3) crucial, and 4) chronic. In this chapter
we shall deal only with the first two: pre-alcoholic
symptomatic and prodromal.

In this report, Jellinek points out, referring to the pre-

alcoholic symptomatic drinker, that "The very beginning

51
of the use of alcoholic beverages is always socially
motivated in the prospective addictive and non-
addictive alcoholic." Although our concern is primarily
with the addictive drinker, we shall have something to
say later about the non-addictive alcoholic.

Jellinek goes on to say that the future alcoholic very

soon gets gratification or relief in the drinking situation
that the typical social drinker does not. Thus, the
difference in the meaning of alcohol to the alcoholic
soon becomes a fact. Jellinek makes another important
and related point about attitudes toward drinking and
the drinking situation.

Initially this drinker ascribes his relief to the situation

rather than to the drinking and he seeks therefore those
situations in which incidental drinking will occur.
Sooner or later, of course, he becomes aware of the
contingency between relief and drinking.

The position we are taking is only slightly different

from Jellinek's. We emphasize that the potential
alcoholic as opposed to the social drinker who may
drink just as often and as much, achieves awareness of
the effects of alcohol in providing relief from tension at
an earlier point. Of course one of the facts about
alcohol that is already known to the adult drinker is that
it results in intoxication. Small children who, in some
societies, are permitted to drink, do not have any such
knowledge. We shall have more to say on this point in
discussion of prevention of alcoholism.

For some, knowing that the effect of alcohol is

intoxication, means that it is dangerous, for others,
desirable. We suspect that the potential alcoholic sees it
as both—he is ambivalent.

Jellinek points out that in the pre-alcoholic symptomatic

stage, some changes do take place in the way this matter
of intoxication is handled.

52
In the beginning he seeks this relief occasionally only,
but in the course of six months to two years his
tolerance for tension decreases to such a degree that he
takes recourse to alcoholic relief practically daily.

Nevertheless his drinking does not result in overt

intoxication, but he reaches towards the evening a stage
of surcease from emotional stress. Even in the absence
of intoxication this involves fairly heavy drinking,
particularly in comparison to the use of alcoholic
beverages by other members of his circle. The drinking
is, nevertheless, not conspicuous either to his associates
or to himself.

What Jellinek speaks of as a decrease in "tolerance for

tension" is simply a greater tendency to use the
anaesthetizing effects of alcohol to cope with problems.
Thus, a constantly widening range of less and less
serious problems are adequate to call forth drinking.
For the alcoholic, this process extends to all problems,
until there are no events which are not also reasons for
drinking.

A case which shows this increasing dependence upon

alcohol is shown by Gibbins and Armstrong of
Canada's Alcoholism Research Foundation.

They describe a man who had his first drink at the age
of eighteen. He did not get drunk at this time, but he felt
somewhat disappointed in alcohol. This means that he
had some ideas on what to expect before he took his
first drink. The next time he drank, a year later, he took
in more and became quite drunk.

From that point, Gibbins and Armstrong report, he

sought many occasions to drink, drank as much as he
could on each occasion. After a couple of years, he
stopped relying upon parties and gatherings of friends
for drinking excuses, and purchased a daily supply of

53
liquor with a friend, drank and was drunk every day.
This pattern was to last for seven years.

The more research in this area we have, the more likely

it is that we shall be able to identify the problem
drinker at an early stage of his development. In the pre-
alcoholic symptomatic phase things are happening
which the sensitized observer would note as crucial.
For example Trice and Wahl in another study of the
order in which symptoms appeared in the histories of
252 male alcoholics was quite revealing.

Only one man could not remember his first drink. Over
one third said they had their first drink and got drunk for
the first time at the same age. Thus, it could have been
that there were two separate occasions involved. In the
present writer's experience, however, it frequently
occurs that the first drinking episode was also the first
intoxication for many alcoholics.

The potential problem drinker, as Jellinek says, seeks

out occasions and circumstances in which he is sure
there will be some drinking. If he finds himself in a
situation in which drinking is not a "sure thing," he may
try to exert influence to change it. For example, if a
group of men are trying to decide on where to lunch,
one member, and the potential alcoholic is most likely
to be the one, will try to make sure liquor is sold at the
restaurant chosen. Or, when at neighborhood card
parties it is not the practice to serve drinks, the future
problem drinker may be the one who sets a precedent
and tries to get others to follow. This is not to say that
only future alcoholics do this, only that future
alcoholics are more likely to do it than others. Such
behaviors are signs, if one is sharp enough to recognize
them and the pattern in which they occur in a single
individual, that some persons are more interested or
even preoccupied with drinking than others. They may
not as yet be alcoholics, but they may also be on the
way.

54
Excessive interest in drinking or preoccupation is
associated with the second phase of the drinking history
of alcoholics by Jellinek. This occurs in the prodromal
phase in which behaviors more closely related to
alcohol addiction itself appear. For example, a young
graduate student who was better off financially than
most of his friends often found that he could not get a
drink when visiting them. Many simply could not afford
liquor. He met the problem by keeping a bottle in his
automobile. If he found he was not going to be offered a
drink, he would excuse himself, go to the car, return
with the bottle. He always shared the bottle with his
hosts, even if he drank the largest part himself.

Common sense definitions of alcoholism often take this

matter of preoccupation into consideration as a major
factor. So, it may be said that alcoholism exists when
the drinker worries more about whether his other
activities are going to interfere with his drinking than
the drinking with the other activities. What often, or
even usually, happens at the time that the potential
alcoholic is thinking this way is that persons other than
himself are concerned with his drinking. If he becomes
concerned, it is only to defend it against hostile attack.
As we shall see later, this may result in his becoming a
solitary drinker, thus avoiding criticism.

Most alcoholics will report that someone else first

became upset about their drinking. Most will also state
that they were the last to notice anything wrong. What
they did see was that otherwise understanding relatives
and friends had become fanatics on the subject,
persecuting the drinker.

For example, an unmarried man of twenty-two, already

with two arrests for drunkenness, feels there is nothing
wrong with his behavior. When asked if anyone had
ever complained to him about his drinking, he
answered,

55
 Yes. Well, I guess it was my mother. That's the real
reason,

I guess you might say, why I'm not living at home. I

guess it was really when I came out of the service that
she started noticing it—about a year and a half ago.

Another whose problem was more fully developed as

evidenced by the serious domestic problems his
drinking had created, who had at least a dozen arrests
for drunkenness said,

I never worried about my drinking. I could never get

enough. I could take it or leave it. I could have a couple
of drinks today and get feeling good today and leave it
for a week or two or three days. Whenever the occasion
comes up, why, I'll take it, but I don't go looking for it in
the morning if that is what you mean. Oh, I might have a
couple of beers a day or something. If I was hanging
around and met some acquaintances, I might drop in and
have a couple of beers with them. But I don't go looking
for it. I might go a week; I might go two weeks without
having anything.
This man shows no insight at all into his situation at this time of his life. His
history shows that he actually did have opportunities and that he "took
advantage" of them, when he did not drink for weeks at a time. But these
periods occurred when he was in jail!

Still another man with a long history of alcoholic drinking reports that he
never worried about it in his life, but that others did.

That's my ex-wife. She said I was overdoing it, and that was after the
business was gone. When the business was going good, them things were
ignored. But she told me afterwards that the liquor was breaking the house
up and all that. That was her argument, so she probably was right. I couldn't
see it at the time because I was making money.

A similar case is that of a man whose work gave him access to liquor
without need of payment.

56
As I say, the drinking at home was so important. My wife was disgusted
with it and she showed it many times. I never understood why she was so
concerned about it when I was providing a home. I was seeing that things
were kept up in the home. I was not spending money on drinks; it wasn’t
costing me a dime and I couldn't see why she objected. I was starting to get
drunk frequently, coming home drunk, and it was just something she was
getting ashamed of. At the time, I couldn't see it.

While this man's attitude seems odd to the normal drinker, most alcoholics
would understand his point of view. They might even go so far as to reason
that the wife is so unreasonable that she must be driving him to drink!

Sometimes it appears that the man is lying about his drinking and its effects
when, in fact, all that has happened is that he has succeeded in deluding
even himself that he is drinking normally. The man whose family broke up
because of his excessive drinking was not lying when he said that although
he drank too much, other people didn't know about it. A high school teacher,
male, first worried about the way he was drinking after some twenty-two
years of in sobriety.

During the school year, he used to get drunk on Friday and stay that way
until Sunday night. Summer vacation enabled him to alter the pattern; he
stayed drunk virtually continuously because there was no reason, he thought,
to be sober.

Eventually it penetrated his consciousness that he had no control over his

drinking. Perhaps an incident or series of occasions when he was not able to
be sober when his job required it were responsible. He expressed his
concern to his wife and children and was sincerely amazed to discover that
they had been worried for years. This was simply the first time that he
accepted the fact.

Still another man saw nothing wrong with his way of life which for the last
thirty years had been dominated by excessive drinking, followed by
complaints and nagging from his mother, wife, and employers. He lost
several jobs, was arrested a number of times. Finally, he reports, he noticed
that his financial condition was different from that of many friends with
whom he had once been on even terms. He said, "All my friends owned
houses and cars; I had nothing in the bank." Until he noticed this, he had no

57
realization that he was drinking any differently than anyone else, nor did he
think anyone else thought so.

We can be fairly certain that the early alcoholic in the prodromal stage will
be under attack from others as a result of his drinking. There are only a few
things he can do to defend himself, the very last and least of which (in his
view) is to stop drinking. He can lash back at his detractors, and he can
conceal from them the fact that he is drinking.

This often leads to the phenomenon of solitary drinking.

The sociologist Joan K. Jackson found that many alcoholics become solitary
drinkers rather early in their drinking careers and that they represent
approximately 60 percent of all problem drinkers. She points out that
solitary drinkers do not necessarily confine their activity to a room with a
locked door, although many do, but that they tend not to have any contact
with others present. Thus, they may seek out strange taverns or bars where
they are not known and are not required to be friendly with other patrons or
staff.

For example, here is a man describing his own behavior at a relatively early
stage of his drinking career.

When I was going with my wife, I'd leave her in the evening and I wouldn't
be drinking when I'd be with her. Occasionally I would have a couple of
drinks, but the minute I’d leave her I used to beat it down to the corner. It
wasn't a tavern or a restaurant but it was really a drinking place. I’d stay
there until they closed—until one o'clock in the morning. I'd make sure she'd
get home around eleven, and then I wouldn’t go home. I'd go down for the
drinks and drink alone. I never went in with anyone or bothered with any of
the girls or anything like that. I never have. I'm not saying I’m a purist or
anything. It was just—well, I wanted to be alone.

Often there is a variation of solitary drinking in the prodromal phase that

Jellinek describes as "surreptitious drinking." One often notices that the
early problem drinker is very helpful to his hosts at a party where liquor is
served.

He may offer to take over the duties of a bartender, particularly if the bar is
in a separate room. Under such conditions he may insist that he needs no

58
help. Apparently, he drinks no more than anyone else, and it may seem
surprising that he gets drunker than most.

A variation of this behavior is the alcoholic's insistence that everyone drink

a great deal. Although it is characteristic of drinking Americans that they are
vaguely suspicious of one who is present but not drinking, or who keeps a
level of decorum higher than the drinkers', the alcoholic carries this to
extreme. He can become insistent that everyone be as bad as he. If
successful under such circumstances, he has a perfect defense for his own
behavior.

The observer may note one other sign in the relationships of the early or
potential alcoholic with others. Whereas he used to enjoy discussing, even
boasting about drinking, he now avoids the topic. This is another form of
withdrawal from situations in which his right to drink is questioned.

From this tendency to protect his drinking, we can infer its importance, its
increasing importance, to him. At this stage, the drinker is still functioning
more or less adequately even though he may be subject to some pressure to
cut down his drinking. He may have created some embarrassing situations
for himself and his family, but serious deterioration has not yet occurred. At
worst, he is labeled as a "heavy drinker," but not as an alcoholic or
uncontrolled drinker. Those around him expect that he can behave himself
properly, and he, too, believes it. Unless they know something of the
developmental sequence in alcoholism, his family and friends are no more
than irritated with him. Even those who would have some compassion if
they thought he was becoming an alcoholic are not yet sympathetic to the
drinker.

In many ways, this is a crucial period in the development of alcoholism.

Alternative ways of coping with the anxieties and tensions of life are being
closed off. The mild punishment imposed upon the drinker at this stage
serves only to increase the total load of concern he carries and to focus his
attention upon what he is getting from drinking. The sweet release of even
mild intoxication is so clearly preferable to anything else, that he feels he
would be silly to choose otherwise, even if something else were available
and he knew choice was possible.

Although changes are taking place in the drinker's emotional life which are
reflected in changing attitudes, we are unlikely at this point to be able to

59
investigate his feelings.

What is immediately accessible to us is the drinker's behavior. Comparisons

of the problem drinker's performance with normal drinkers and with his
own earlier behavior show what is taking place. One of the major
behavioral events in the drinking history which characterizes the prodromal
stage is the so-called "blackout." These are periods of amnesia during
which the drinker may be operating at reasonable efficiency with few signs
of severe intoxication.

When he comes out of the blackout, he has no knowledge of what he has

done, good or bad. For example, hearing that someone has been killed by a
hit-and-run driver may set the drinker to worrying whether he was driving
when in his blackout.

Blackouts are not all reserved for alcoholics or pre-alcoholics. Sometimes

the normal drinker will experience amnesia while drinking. It may occur
when he is particularly tired, physically or emotionally, and it happens only
rarely.

As Jellinek points out, the potential alcohol addict may have frequent
blackouts after taking in only medium amounts of alcohol. We shall have
more to say about blackouts in the next chapter.

In addition to the blackout, the potential alcoholic may be observed to be

changing in his habits of drinking and living. He may be gulping his drinks,
trying to get them down as soon as possible in order to get the effect as fast
as it can come, he may be sneaking drinks, evading his usual drinking
companions because they do not drink enough to suit him. If he drinks with
friends, he drinks more than they do and gets drunk more often. All of these
activities are part of the increasing abnormality of the potential alcoholic's
behavior. The capstone of this development is loss of control—loss of
choice over the amount he will drink on any occasion, followed by loss of
control over the number of occasions.

Sometimes the differences between a drinker who has lost control and one
who has not are subtle but meaningful.

A top executive in one of America's major corporations, a man who had

achieved what most would consider an exalted position in industry before

60
the age of forty, showed very few signs of deterioration in his behavior at
home and at work while in the prodromal stage of his drinking. The key
change in his behavior went almost unnoticed by his wife. It was very
simple; he began bringing the cocktail shaker to the dinner table. During the
evening, he usually became sufficiently drunk to be inaccessible, but he was
not called on for very much in the evening. When the situation required that
he be alert, he was able at this time to meet the need. At this point in his
drinking history he had not lost control. We can speculate whether he could
have been helped to maintain control if the symptoms of developing
alcoholism had been noted.

A contrasting case is that of a man who became an uncontrolled drinker very

early in the game. He had his first drink at the age of fifteen, shortly after his
father's death.

When the father died, it was necessary for the boy to take a great deal of
responsibility in the family business. His work brought him into the
company of his father's cronies, a hard bitten, heavy-drinking group. Every
few months all would go off on a business trip, always with the same finale:
a weekend spree. Before he was out of his teens, T was joining them trying
to be the man his father was. If Thad followed the others' pattern of
drinking, there would have been nothing worthy of comment. He would have
been normal. However, when the weekend spree was over, the others would
go back to their families and businesses.

As T said, "They'd get loaded and get off; I'd keep going." He would "keep
going" for about ten days, which was about what it took for him to get so
rum sick that he could drink no more. This boy had lost control over his
drinking a very short time after he had his first drink.

For T and others like him who lose control the words "potential alcoholic"
no longer apply. Once they have crossed the dividing line represented by
loss of control, we must speak of them as alcoholics, suffering from alcohol
addiction. The alcoholic usually resists the notion that he cannot control his
drinking; he fights to regain control and fights to protect himself against the
knowledge that he cannot drink normally. Perhaps as we learn more about
the development of alcohol addiction and as this knowledge is widely
disseminated, we can identify the potential alcoholic before he crosses the
line. At present there is sufficient knowledge of the behavior and attitudes
involved in drinking to spot the alcoholic much earlier than we generally

61
do. The guideposts are there; we need to develop the techniques of using
them.

62
CHAPTER 4

MAN OVERBOARD

What happens from the time of loss of control carries with it a sense of
inevitability that becomes more and more evident as one sees more and
more alcoholics. To a very large extent, the persons who are in the pre-
addictive phases of drinking can be seen as individuals. Their patterns of
drinking, and their problems may have a good deal of similarity, but the
individuals themselves stand out distinct from one another. With loss of
control, alcoholics begin to look more and more alike. They have entered
into the “crucial phase" of alcoholism.

As Jellinek says,

Loss of control means that as soon as any quantity of alcohol enters the
organism a demand for more alcohol is set up which is felt as a physical
demand by the drinker. This demand lasts until the drinker is too intoxicated
or too sick to ingest more alcohol. The physical discomfort incumbent upon
this drinking behavior is contrary to the object of the drinker, which is
merely to feel "different." As a matter of fact, the bout may not even be
started by any individual need of the moment, but by a "social drink."

Although, as we have already seen, the pre-alcoholism phases may include

some concern with the results of drinking, losing control is often a
frightening event. Usually at this stage, the alcoholic will experiment in
order to prove to himself that he can control the drinking. If he is able to get
by with only a certain amount taken in on any occasion, he will use this as
evidence that everything is all right. He can’t be an alcoholic. The dangers
of this situation are expressed by a fifty-seven year-old man who had his
first drink at the age of twenty-six, got drunk on that occasion, and continued
to get drunk every weekend following, until weeks had no more ends and the
time between drinking bouts was determined by the amount of time he had to
spend under arrest.

The trouble with having a few drinks now and then, you’re bound to overdo
it sometimes, so the best for you is to stop it altogether. It's not a craving; I
don't know whether any man has a craving for it. I don't think they have. If

63
you become bored, you have nothing to do, the first thing you do is to have a
drink. You meet friends in there, you know, and you drink worse. If you don't
know where to stop when you reach the borderline, pretty soon you'll go
over it. You might just see it, but you might be with friends, and you can't
stop at that time without making yourself unpleasant or impolite.

His final sentence describes the situation which is so often responsible for
setting off another and another drinking episode. It is not that the drinker
feels a "craving" for alcohol at this stage of his development; it is that when
the normal kinds of situations occur in which he normally drinks, he tries but
finds he no longer can drink in a controlled fashion. Each time the result is
the same: intoxication and a prolonged drinking bout.

This is the first area in which control is lost: control over the amount one
will drink on any occasion. Members of Alcoholics Anonymous describe
the condition in a saying,

"One drink is too many; a thousand aren't enough." An alcoholic who was
hospitalized for a respiratory infection had been sober for almost two years.
The nurse brought him some cough syrup, poured it from a bottle into a
"shot” glass and handed it to him. He sniffed it, recognized that alcohol was
a major ingredient and asked the nurse, "Will you please take this shot away
or else leave me the bottle?"

Some of McCarthy's group in therapy had the following exchange throwing

more light upon the problem.

HOWE: ... I don't drink every day and I'll go weeks without drinking. Then
when I think I'm on top of the world and everything is going swell, I flop
like a dope. Why? What causes it I don't know When I really should get
drunk is after I've sobered up and I've got all kinds of problems.

When I start drinking is, when I don't seem to have any. Everything looks
fine and rosy and everything.

Another man in the group points out that this is different from the way
drinking bouts are "triggered off" for him.

LANE: I'm just the opposite. I'll stay sober when things are good and then,
when they get bad, I'll go out and drink—When I am down lower, I drink.

64
A third member of the group sums it all up.

COLLINS: I'll take my drink when things are either good or bad."

These three points of view show us some of the conditions under which
people in our society think of taking alcohol: when things are good, in order
to celebrate; when things are bad, for comfort; or both. The alcoholic is
fully capable of developing ingenious rationalizations for his drinking. The
number of occasions on which he drinks is not dependent upon any "real"
situation but upon his ability to convince himself that drinking is appropriate
on this occasion.

Sometimes the living conditions are such, as in the case of the man to be
quoted below, that it is hard to avoid drinking situations even if one wants
to. It may be that one's job involves a great deal of drinking. Here is an
alcoholic caught in such a situation. He works in a wholesale food market.

In the market, ninety percent of the fellows are heavy drinkers. Working
conditions are such that you're in and out office boxes, of course. These are
walk-in refrigerators, and you’re subject to colds and everything else. You
more or less drink—at times you're drinking when you don't even want it.

It's just like a coffee break. You're probably not even thinking about a cup of
coffee, but because you're getting a break you go out and get a cup of coffee.
Well, it was the same thing down there. A lot of times you'd go down to
have a drink yourself, you'd meet someone who came in and that you’d
probably helped load his truck or did a favor for him without thinking
anything of it, and he'd offer to buy you a drink. Even if you didn't want it,
the theory was down at the market that if you refused once, you were never
offered again. So, you took it whether you wanted it or not. In other words,
you never said no in the market to anybody. So, then somebody would say to
you, "Take it easy," or "You've got quite a gagful," or—of course when you
were in that condition you thought you were sober, and sometimes you might
stop. Sometimes you might say, "Ah, the devil with him!” only in different
words, and you go on drinking maybe a little more.

The reactions of people are different. Some take it as an insult when

someone tells them they're drinking too much, and some take it as a direct
compliment that someone's interested to tell them to stop drinking. I was in

65
between. It never insulted me, but I drank a lot at the market.

The reader may see from this story that some of the problems of helping
alcoholics involve treating the "way of life."

We shall have a great deal to say about this in a later chapter.

Losing control over the amount one drinks on any occasion is meaningful to
the alcoholic in another sense. It is a circumstance which tends to be
interpreted by him in the same way as by anyone else. Indeed, we often
forget that the alcoholic comes from the same society as the non-alcoholic
and, therefore, has the same prejudices about drunks and drunkenness as
anyone else. When he finds himself unable to control his drinking, he
considers himself a weakling who doesn't have enough will power. He
cannot understand what it is that happens when he drinks, and assumes that
if "he really wanted to" he could stop. Getting drunk whenever he drinks is a
source of shame, discouragement, and loss of self-respect. He resents his
own weakness and fights it continuously.

Losing control over the amount one drinks on any occasion is meaningful to
the alcoholic in another sense. It is a circumstance which tends to be
interpreted by him in the same way as by anyone else. Indeed, we often
forget that the alcoholic comes from the same society as the non-alcoholic
and, therefore, has the same prejudices about drunks and drunkenness as
anyone else. When he finds himself unable to control his drinking, he
considers himself a weakling who doesn't have enough will power. He
cannot understand what it is that happens when he drinks, and assumes that
if "he really wanted to" he could stop. Getting drunk whenever he drinks is a
source of shame, discouragement, and loss of self-respect. He resents his
own weakness and fights it continuously.

Under these circumstances we can begin to see that the lies and
protestations of better behavior that the drinker makes are, to him, important
attempts to get back the lost control that means so much to his ego.

Part of the reason this attempt is so desperate is that the very conditions
which have urged the potential alcoholic onto drink are the same conditions
that cause such pain to the alcoholic. We have seen that alcohol means
something different to the alcoholic than it does to the normal drinker, and
that this difference in feeling is expressed in part in the ambivalence the

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drinker who may become an alcohol addict feels toward the whole matter.
For him, as we have said, drinking is not a simple social act. It is in part an
act demonstrating his virility or maturity. Now, when he finds he cannot
"drink like a man," his virility and maturity are under attack all over again.
Now, instead of giving up and resigning himself to the fact that he cannot
"drink like a man," the alcoholic butts his head against the wall in his
attempts to be what he feels he ought to be. Later on, if he is lucky, he will
learn what most people already know, that one can be a man without
drinking at all.

The alcoholic's rationalizations can be seen as attempts to convince himself

that even if everything is not all right at the moment, it lies within his power
to make it right.

The people who deal with the alcoholic may find his rationalizations
maddening, but when seen in the light of his psychological needs of the
moment, they at least make a crazy kind of sense. As Jellinek says, "These
rationalizations are needed primarily for himself and only secondarily for
his family and associates."

Sometimes the rationalizations are amusing. Quoting again from Raymond

McCarthy's group, we have a description of an alcoholic who tried to
maintain the semblance of control in a unique manner. Well, I knew of a
fellow who. ... I think this is interesting because this fellow makes it a habit
or practice not to have more than one drink in a place. But he's always very
busy.

He comes in, and he has just one drink and it's straight, with water, and off
he goes. There may be only two or three blocks before he stops off for
another one. The reason for that is because he doesn't want to hurt his
reputation by being in a bar too long.

Although this is behavior clearly designed to throw others off the scent, in
its own strange way it gives the drinker a spurious kind of control. He
actually does succeed in controlling the amount he drinks in any one place.
Such rationalizations may seem feeble to the normal drinker, but to the
alcoholic they make excellent sense.

These rationalizations serve to protect the self-concept of the alcoholic. A

man whose behavior was well known to all in the small town in which he

67
lived used to console himself with the idea that his nice friends never read
the section of the newspaper that listed arrests for drunkenness, and in
which his name frequently appeared.

In interviewing alcoholics, one is often met with the question, "What are you
interviewing me for? I'm no alcoholic!" As "proof" of the fact that he is no
alcoholic, the drinker may offer something like the statement, "I can stop
drinking any time I want to." The chances are pretty good that this simply
isn't true, that the drinker has tried to stop and been unsuccessful for any
prolonged period.

Indeed, when for one reason or another the alcohol addict does manage to
go for a period of time without drinking, he uses this occurrence as evidence
that he is not an alcoholic and that he actually can stop whenever he wants
to.

It may be that the reason he stopped and was able to go for a period without
drinking was that he was in a jail or hospital where nothing was available
to drink. But he may take the fact that he felt no craving for alcohol during
most of this time to be evidence on his side.

Sometimes, for reasons that are far from clear, the alcohol addict may
actually go for a matter of weeks or months without drinking under
conditions that approach normalcy.

That is, he may be out in the community where he has access to alcohol and
chooses not to drink. When this happens, the alcoholic has the perfect
answer to anyone who says, "You are an alcoholic." The answer is, "I am
not. I can stop drinking when I want to, and the proof is that I did stop
drinking once." What one would expect to be a source of strength to the
alcoholic, a period of abstinence, actually becomes a source of weakness as
he uses it to support his rationalizations for drinking. This is particularly
troublesome in the case of the spree drinker—one who goes on periodic
benders.

A woman who had had several periods of sobriety interspersed with her
usual drinking was asked to tell about these dry periods. This is what she
said. I’d just make up my mind I'd stop and that's all. I would. And then it
would overtake me in about a week, and then I’d be sick, and nervous and
toss and turn all night long. For weeks I wouldn't even sleep. I couldn't.

68
Then I'd gradually quiet down and then. ... I know one day in particular I
vowed I was never taking another drink. Then, I'd worked on and off that
week for a while, and my girl friend came in—she didn't know that I hadn't
been drinking—she ordered a couple of drinks. I didn't want to say anything.
It was a bar. So, a couple of more people joined our party and, talking
along, the first thing I knew I looked at the glass and the thing was empty. I
drank it and didn't even realize it. Then I hate myself I call myself all kinds
of names. I’ll never do it again, and, it's something I can't explain, I—
something that draws like a magnet. And then there'd betimes I'd go along
and it would never even enter my head.

And then I'd start, and have a drink, and pretty soon I'd be drinking again.

In this and other quotations from alcoholics we see that loss of control takes
place not only over the amount one will drink on any single occasion, but
over the occasions themselves. This is the problem stated by the woman,
part of whose story is presented in the above quotation. Her pattern was
such that she would drink for a period ranging from a few days to a few
weeks, the entire bout triggered off by the first drink. As she says, I’d be all
right until I'd get all upset and nervous or something. I mean if everything
went along all right I'd be all right. But if anything got to upsetting me, or
getting nervous or excited, well, I'd start drinking right off, and it would
always be a time when I shouldn't. There'd be something coming up that
needed my attention, and I'd be drinking.

When asked how long she kept drinking after starting, she said, Sometimes I
can stop in a couple of days if I'm lucky. And then sometimes it'll go on for
weeks, and I'll gradually push myself away from it. And lots of times I'd
take a bottle of beer and put it in the icebox and leave it there. I'd see how
long I could leave it there. And then somebody would come up, perhaps,
and then I'd have it. Perhaps I'd have a little, that's the way I would start.
And then I'd get so I'd be weak—don't know how I'd make the corner.
Shaking, I’d have to hold the glass with two hands. Then I'd see how long I
could keep away from it before I'd take another drink. I couldn’t—I tried
stopping right off short, and couldn't. My heart would pound, and I'd be all
full of shakes, and then I'd have to go out and get a drink to stop shaking.
And then I'd leave it alone, and sit there and talk to people, 'til I'd feel shaky
again. I'd have to do it gradually; I couldn't stop real quick.

Obviously, this woman is still drinking, searching for some painless way to

69
stop. (Millions before her, and no doubt millions coming after her have
hoped and will hope for the same.) The important thing about this case for
our purposes is that the woman knew she was in trouble with her drinking
but was trying to protect it against the only thing she knew would help—
stopping.

In contrast to the spree drinker, there are others who drink daily and who
maintain almost constant intoxication in some degree. Often the spree
drinker points to them as the "true" alcoholics, not like himself. Alcoholics
drink every day, and he doesn't. Even though there tend to be similarities
among alcoholics in their general problems and outlook, there are great
differences in the patterns of drinking. The spree drinker is only one kind of
alcoholic, and there is great variety in this group. The sprees may occur at
varying intervals, and these intervals may change over the course of the
years. The reports of the alcoholics themselves as to the reasons for the
change may not be accurate, but the fact of change is usually unmistakable.

A man in his middle forties, married, a father, and holding a responsible

job, reports that from his late teens he had been a spree drinker. The spree
would last ten days to two weeks, and then he would be all right for about
five months. In between sprees there was no difficulty in refraining from
drinking. As he grew older, the strain imposed on his family, job, and on his
physical well being was greater.

According to the man, he consciously changed his drinking pattern in order

to get out of the rut he was in. The change consisted of going from a pattern
of sprees to daily drinking. There is no way of knowing if the story is
accurate.

What usually happens is that the time between sprees gets so short that it
disappears and the alcoholic is drinking on a daily basis. In the case being
described, the result was the same. He came to drink every day, and found
himself getting drunk every day or evening. When he realized that this was
no improvement over what had occurred earlier in his drinking career, he
began looking at the entire problem more realistically and became amenable
to approach by those who could help him.

A member of alcoholics Anonymous, a dentist, describes his own drinking

like this.

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I was the type of drinker who drank a little often. Getting a little glow
burning and keeping it burning. Very seldom getting staggering drunk. Never
having been arrested, never having spent any time in any institution or
drying out place.

So, I didn't know that the thing was grabbing me as rapidly as it was.

He goes on to tell how everyone other than he knew that something was
wrong. This probably is more often true of the daily than of the spree
drinker. The latter's episodes of drunkenness are explosive experiences that
even the drinker cannot fail to be aware of. The steady, daily drinker keeps
going at some level of intoxication and is chemically insulated against being
aware of his difficulties.

It takes time for businesses to be lost, for medical practices to disappear,

and for all the signs of deterioration to become so evident that the drinker
himself knows he is in trouble.

The pattern of the daily drinker varies from one drinker to another, but it
tends to be constant for a person for a period of time. Something may
happen to cause the pattern to change. Here is the description of the days
drinking by a male alcoholic in his middle forties who had been drinking
"seriously" for five or six years at the time this pattern was prevalent.

I'd have a cup of coffee in the morning, and I always made it a practice
before I went to work to drop in at the corner tavern and have a couple of
ales. I was due at work at 9 o’clock. Well, instead of running down to the
streetcar, I’d grab a cab and go to work. Then, around 10 o'clock when I’d
be stepping out for what we call a coffee break now, I’d sneak down to a
hotel bar where I knew the bartender and have a whisky sour. That was a
drink I liked at that particular time. Then, at noontime probably the same
thing: one or two, depending upon the time that I had. The one I got from this
particular bartender that I knew was equivalent to two good ones anyway.
And at noontime I'd have lunch and a couple of more whiskies.

On the way home I'd generally pick up, oh, half a pint of whisky or a quart
of wine. My evening drinking before I got home would be in the back room
of a drugstore. I think in the course of a day I would probably consume
about: well, I had my two glasses of beer which would be equivalent to
pretty near a quart at that time, and I'd have about a pint of whisky during the

71
course of the day. In the evening, I'd drink at home if we had company and
we generally had company quite often.

Another alcoholic would describe his day's drinking differently. The

similarity would rest in the fact that in this and in most other cases of steady
drinking by alcoholics, the day’s activities center in drinking. Everything
else is incidental to it. As social pressure against drinking mounts, the need
to protect his line of supply also mounts. One of the things he fears more
than anything else in the world is that he will be without a drink when he
needs one. Laying in a large stock, and hiding it in unlikely places, is
characteristic. The writer recalls having automobile trouble on a lonely
country road. As he started to walk back down the road to a service station,
a man appeared and offered to accompany him. As we walked along, the
man switched the conversation from automobile engines to drinking. He
explained that his wife was dead set against his drinking, not permitting him
to have any liquor in the house. It was obvious from the man's speech that
this had not prevented him from drinking. As we went down the road, he
exclaimed, as if the most amazing idea had suddenly struck him,

“How about a beer?"

I explained that my problem was car trouble not thirst and that I was most
anxious to get some help with my car.

"Won't take any time at all!" was his rejoinder. While I watched in
fascination, he took a sight on the end of a broken wagon tongue lying beside
the road and the corner of a barn. He walked down this imaginary line,
searching in the tall hay. Then, he pounced into the grass and came up
triumphantly bearing two cans of beer.

Ingenious battles between drinker and spouse to control the supply are part
of the folklore of alcoholism. A dignified lady in her early sixties related
that her husband confiscated her bottles just as soon as he found them in the
house. They lived in a northern state where a typical winter meant heavy
snows. The wife devised a strategy of hiding her bottles in snowdrifts in the
back yard. She described coming out of a blackout one night. She was in her
yard, attired in a thin nightgown, digging in a snowdrift while more snow
fell on her.

The parents of a girl barely out of her teens were delighted when, after a

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number of episodes of intoxication, their daughter began to spend more time
at home in her cellar workshop. What they could not understand was how
she could stay drunk when they had searched the workshop and “knew"
there were no bottles there.

The fear of being without alcohol and the lengths to which the alcoholic will
go to insure the protection of his supply, provide amusing stories at
Alcoholics Anonymous meetings or among other groups of sober alcoholics,
but at the time the alcoholic is going through this part of the struggle, it is
anything but amusing to him and to his family. Despite the fact that he may go
for various periods without drinking anything at all, the obvious difficulties
he is having point up to him the fact that he is abnormally troubled. He faces
up to this situation not by deciding that drinking is not for him, but by
blaming everything else for his problems. Thus, instead of stopping drinking
entirely, something he cannot do, he makes changes in his ways of drinking.
One of the things most alcoholics will do is to change the substance they
drink. Thus, a man who for twenty-four years had drunk nothing but rye and
ginger ale decided, when he was waking up every morning with nausea and
the shakes, that it was this combination that was doing the damage. He
shifted to vodka and orange juice.

The vitamins presumably made this a healthier drink.

All the maneuvers or rationalizations that the alcoholic goes through have as
their goal the protection of drinking.

Usually he knows by this time that he is not a normal drinker, but he tries to
suppress the knowledge. He knows of no substitute for drinking as a way of
life, and to recognize that he is an alcoholic means recognizing that his way
of life is hopeless. This event will come in time, and it is this which marks
the beginnings of the rehabilitative process.

We see the alcoholic making extravagant promises about what he is going to

do. Some of the promises concern drinking; others are of a nature to enhance
the drinker's self-esteem. A man who held a series of responsible positions
in industry periodically counteracted his feelings of inferiority by calling an
interior decorator and having his apartment redone in a most expensive
manner. Eventually, conflict with credit departments of furniture stores led
to trouble with the police. Picking up the check, buying drinks for the house,
making unnecessary but spectacular long distance telephone calls, taking

73
taxis on long trips, are all things the alcoholic will do to prove to himself
more than to others that he is a strong, functioning person who is in charge
of his own destiny.

The blackouts that were infrequent in the early phases of alcoholism are
quite usual now. A man who had been sober for nine months as a result of
his affiliation with Alcoholics Anonymous tells of how he happened to
drink at the end of this period of sobriety and how he blacked out after only
a few drinks. At one time he held important white-collar jobs, but at the
time of which he speaks, his employment record was such that he could only
obtain temporary manual work. I was working on a truck with this fellow
and he said, "Let’s go in and have a couple of drinks." And I said, "Sure." It
was a hot day and I went in with him for no reason—not planned, and had a
couple. The next thing I knew I woke up in a hotel room and I was being
shaken awake by this fellow that I had met in A. A. It seems that after I'd had
a couple of drinks I had contacted them down there and told them where I
was and asked someone to come down. They did come down and put me in
a hotel to sober up, then took me home that night. I don't remember calling
them. I don’t remember passing out or anything.

The same man tells of starting out in the morning to go to work. He was
aware that he had a particularly important job to do that day. He had his
usual stop in a barroom on the way to work, and remembered no more until
the following morning when he woke up in his own bed. Assuming that he
had missed work, he was ready for anything when he arrived at his place of
employment. Instead of the expected discharge, his supervisor
complimented him on the excellent work he had done on the previous day!
He had, in fact, reported to the job at the proper time, worked hard and
accomplished the task at hand. He was unable to fill in what happened from
the time he drank until he woke up the following morning.

Sometimes the events which occur in a blackout are not so happy. The
alcoholic never knows what he has done. He doesn’t know with whom he
has disgraced himself this time, or, indeed, if he has disgraced himself at
all. A naval officer used to go to great lengths to discover on the morning
after a night ashore just what he had done, to whom apologies had to be
tendered, what enlisted men had to be joked with about his "condition" the
night before.

One of the very terrible things about the blackout is that sometimes things

74
happen during them that have the gravest of consequences. Here are the
words of a man serving a life sentence for murder.

About two years ago I had a very good job, a nice family, a wife and a nice
son. I started to drink not because I had to, but because I couldn't help
myself. Every time I smelled anything alcoholic I was lost. I would start out
with a glass of beer with the intentions of going home. Wind up three weeks
after that. I would find myself in New York, Chicago, on some Skid Row.

This particular time I found myself in New York City. I was in Skid Row. It
was on a Sunday morning. How I got there I do not know. I do not remember
when I went there or how I got up in that hotel. But I was sick. I could
hardly walk and I started to think about home. I left the hotel with intentions
of going back home, but I went back to that barroom. I started to drink
muscatel. It winds up that the next day I find myself in my hometown. I still
don’t know how I got back there. All that day I wanted to go home and I was
ashamed to go home. It winds up I started to drink that morning. I said,
"Well, if I drink I may pull myself together." But it was just the opposite.
When I started drinking I had this here—I don't know what you call it—
maybe a blackout. I didn't know what I was doing. That evening I went home
and then I committed this crime.

I am just thanking God that I didn't kill my son. Why I killed my wife I do
not know because I loved her. She is the best woman I ever knew in my life,
but it happened and God can only tell you why I did it. Anyone who works
with alcoholics knows that among the most active rationalizations are those
serving to keep guilt feelings in check. One mechanism employed with
regularity is that of denial. The alcoholic simply denies that he is an
alcoholic. He believes this. He accomplishes this by defining alcoholism in
such a way that his own behavior does not match. For example, a woman of
forty-five, arrested a number of times for drunkenness and neglect of her
children, says,

I'm no alcoholic. By no means. The most I ever drank was four days. Then
I'd say to heck with it, and that was that. I wouldn’t touch it again for months
—months before I even think of it. If I made up my mind I didn't want it, I
didn’t want it, and that was it!

All the facts give the lie to her protestations of control over her situation.

75
A man who has had twenty years of misery as a result of drinking and who
has avoided any suggestion that his behavior is abnormal says that he will
"slow down" when he leaves the hospital in which he was interviewed. He
says he is not an alcoholic because "I don't go around looking for it, or drink
rubbing alcohol or anything like that." Instead, he makes sure that he is never
very far from a bottle except when he is locked up.

Many persons, alcoholics and others, consider the act of taking a drink in
the morning the true test of alcoholism.

By defining alcoholism in this way, many an alcohol addict denies his own
dependence upon alcohol. A seventy-four-year-old man with a record of
forty years of problem drinking says proudly, "I drank every night, not every
day. I never took a drink in the morning no matter how sick I was."

Another man asserts rather shamefacedly that he took a morning drink only
on Tuesdays. He excused this by explaining that he was paid on Monday, so
that Monday night was an especially big one. Further questioning revealed
that he also was drunk on every other night of the week, but felt somehow
justified in taking the Tuesday morning drink although on no other morning
would it have been permissible. In telling of this pattern, the alcoholic was
asserting that he was in control.

In the case of another man who actually had become convinced he was an
alcoholic and who suffered overwhelming feelings of guilt about his
drinking, an unusual twist is presented. Because he now considered himself
an alcoholic, and because he knew that alcoholics drink in the morning, this
man felt he, too, should want a morning drink. It was part of the self-
castigation he underwent after every drinking episode. In his words,

I knew that if I took a drink—I knew that, even after I wake up in the
morning even if I've not been drinking or I’m not too sick, I feel I have to
have—I need a drink. I feel as though I must need it; that I had been drinking
and that I should be sicker than I am, or I will be sicker if I don't have a
drink. That's the worst part of the sickness. Until I do have that drink, I'm
very remorseful, and then, of course, there’re things I can't remember, and, I
don't know, and I'm all mixed up. Until I do have that drink, well, it sort of
evens things off.

The mixture of remorse and real or expected physical misery is portrayed in

76
these words. This drinker regarded the hangover as just punishment for his
sins. When he had no hangover, or at least one not severe enough to warrant
taking a drink in the morning, his feeling is one of disappointment. Thus, the
morning drink does a number of things for him: it answers his guilt, it
confirms his belief that he is depraved and because he is depraved he is
expected to drink, but it relieves all these feelings by it’s an aesthetic action.

This complicated motivation is not at all unusual. Another man talks about
getting sick in the morning as a desirable event. He says, "You'd lose your
feeling of guilt when you were getting sick."

For him, the illness of the hangover was the proper punishment for his
behavior. Once punished, he felt better.

Much drinking during the crucial phase of alcoholism represents an attempt

to maintain some contact with the world. Norman Brokenshire in his
autobiography describes the situation vividly.

I did the Philadelphia job under severe nervous tension. At times like this
the alcoholic drinks in an effort to keep normal. This will no doubt seem
paradoxical to the average person, but, oh, how sadly true it can be! In
trying to be right for a task the alcoholic may try not drinking at all and find
that he falls apart, nervous, hesitant, weak, afraid. I was walking a tightrope,
my job at stake; a certain amount of alcohol was necessary even to
contemplate the type of work I had to do, for my voice must be solid, my
timing sure, my decisions positive. And so I drank—not to be carefree, not
to shed inhibitions, but to gain composure, to become "normal."

Brokenshire's reason for drinking in this instance—to restore his

equilibrium long enough to do his job, is probably the same reason most
alcoholics take a morning drink.

They need to end the misery of the hangover and to get going again. When
this occurs, they clearly are in the vicious circle of addictive drinking:
drink, feel badly as a result, drink to get rid of the bad feeling. This is no
longer a self-deceiving activity. The alcoholic knows what he is doing, that
drinking has him in a box, but at this stage he depends upon the drink to
make his life bearable. His struggle to support this kind of life is often
valiant, but he will learn he cannot win. Eventually, he will lose confidence
that the bottle can save him.

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Of all the punishments that are devised for the alcoholic, probably none
seems more thoroughly impressive than the hangover. For example, a doctor
says,

But I progressed to the stage where I was drinking every night and I
progressed to the stage where after a particularly good night or bad night,
when I got up in the morning the Alka Seltzer or the cold shower or the
tomato juice or whatever had been doing the trick could no longer take care
of it. I couldn't rid myself of the dry heaves and the shakes and anybody who
knows what the problem of alcoholism is knows what I'm talking about. I
then resorted to a drink to straighten me out and more times, rather than
straighten me out, it brought me back on to another toot.

Karpman has pointed out that little study has been done of the hangover
which, he says, offers some prized opportunities for insight into the
motivations of the alcoholic. In his book The Hangover, he says,

Like Shakespeare's "one man" who "in his time plays many parts," the
confirmed alcoholic usually experiences many types of hangovers in his
progressive alcoholic career. The majority begin as "social drinkers" and
are subject to early mild hangovers; however, with time the physical factors
diminish or at least are overshadowed by increasing emotional components,
and the original mild reaction yields place to the complicated emotional
hangover. Chronic alcoholics are practically unanimous in agreeing that this
shift in emphasis occurs and that the increasing misery of the hangover is not
due to the headache, the nausea, the cold sweats, the chills and fever, or
even the "shakes," but to the emotional pain which accompanies them—the
guilt, anxiety, self-accusation, the sense of hopelessness and despair which,
like a theme song, run through the alcoholic drama.

A description of the meaning of the hangover not very different from

Karpman's is offered by Lolli, another psychiatrist who has devoted effort
to the study of the hangover.

Dr. Lolli says,

In the non-addictive drinker the hangover is an occasional but not inevitable

consequence of overindulgence, and rarely above the significance of a
nuisance. In the alcoholic, however, the hangover is an almost inevitable

78
although transitory episode. The fall of the alcohol concentration in the
blood to low values or the complete disappearance of alcohol from the
blood is prerequisite to that realization of external and internal dangers
which marks the beginning of the hangover period and is enhanced by the
bodily disturbances consequent to the bout. The alcoholic's fears at this
moment betray his awareness of the grave situation in which he finds
himself. The period of the hangover is terminated when the alcoholic returns
to a condition similar to or only slightly worse than that immediately
preceding the last bout, or when he again resorts to alcohol in order to wipe
out his mental and physical pain. Thus the hangover constitutes an
emergency fraught with threats to the patient and his environment because of
the possibility of a new bout or some other violent crisis.

The emergency of which Lollie speaks is also an opportunity. The attitude of

those who are around the alcoholic and their knowledge of the nature and
course of alcoholism, can alter the events which follow the hangover. The
alcoholic's vulnerability at this point can make possible positive action
leading to rehabilitation, or it can confirm to him the hopelessness of his
situation. So often the latter is true.

By this time, the alcoholic is a social isolate convinced that the low esteem
in which he is held by others is the true measure of his worth. His loss of
belief in himself is but a reflection of the loss of human contact he has
suffered as a result of his behavior.

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CHAPTER 5

One Against the World

The typical alcoholic is married, holds a job, and has responsibilities to

spouse, children, parents, employers, friends, just as anyone else does. One
estimate is that each alcoholic’s drinking directly affects sixteen other
persons. For this reason, the physical breakdown we see occurring in the
crucial phase of alcoholism, as serious as it is, is revealed as relatively
minor compared with the breakdown in relationships with others, many of
whom are important to him and to whom he is important.

Developing addiction means that the number of problems, not necessarily

big, that are "solved" by drinking increases. The alcoholic's resources
shrink, and the sole remaining device that makes living bearable for him is
constantly under attack. Alcoholics come from the same society as their
relatives and friends. They have the same beliefs about God, baseball, and
drunks. His uncontrolled drinking is as much a matter of disgust to him as it
is to others. But there is nothing else! Consequently, rationalization is
necessary to make his behavior acceptable to himself as well as to others.
The deep remorse we shall speak about later is self-condemnation more
punishing than anything others can plan for him.

With nothing else to do, the drinker must protect his actions from the rest of
society. He can do it by trying to interpret his drinking to others in such a
way as to make it seem harmless, or by hiding it from all others. An
example of the former approach is the alcoholic who jokes about his
drunkenness, trying to appear as if he were a gay young fellow who
occasionally, in his innocent gaiety, went a little too far.

Two men, Mr. Smith and Mr. Jones, met in the course of their business
activities. Mr. Smith has a brother, an alcoholic, in another city engaged in a
related business.

Mr. Jones had recently met the brother and reported as follows: "We spent a
wonderful evening together. He's a lot of fun. We had a few drinks, maybe
more than a few, then dinner. After that I had to go back to the hotel. I
couldn’t keep it up. But your brother wanted to go on and on. He's some

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drinker,

"Mr. Jones had only one experience with Smith's brother and that was
incomplete because he did not follow the drinking episode through to its end
several days later. To him, the alcoholic appeared charming and
entertaining, although a heavy drinker. But Mr. Jones, like most Americans,
actually admired that capacity to drink. For Smith, the picture called up by
this description of an evening with his brother was quite different. He
thought of the wife and children, of the lost opportunities and financial
embarrassment, of the "drunk" ward in the city hospital and the private room
in the sanitarium. There was nothing charming in his memories of his
brother's drinking.

Because the alcoholic finds that he cannot control the picture he presents to
others when he drinks, he often finds it easier to hide his drinking. As an
executive in a large company states,

I didn't want to be with people. First of all, of course, if I was in need of a

drink, I didn't want them to know it if I could help it, and, secondly, and I
think this is true of most alcoholics—it is true of those I have talked with—
your friends, your non-alcoholic friends don't want to drink as often as you
do. Sitting around sociably and making a drink last for an hour, and then you
have another or perhaps not, that’s no help. You avoid that type of thing if
you can.

Sociologist Joan K. Jackson has investigated the setting in which a number

of alcoholics drank. She points out that most Americans consider the person
who drinks alone an alcoholic.

Among the particular group of alcoholics she studied, some 60 percent were
solitary drinkers and the other 40 were what she called "sociable" drinkers.
Her findings suggest that becoming a solitary or a sociable drinker depends
in some measure on the attitude of those around you toward your drinking.
That is, if you have been punished for drinking, then it is likely that it is less
trouble to drink alone. Thus, there is a kind of "choice" about the pattern
which emerges when the individual finds that he is an uncontrolled drinker.
Under some conditions he will choose to be a solitary drinker; under others,
a sociable drinker.

One of the surprising things about Dr. Jackson's findings is that there were

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very few additional differences between the solitary and the sociable
drinkers, at least as far as their backgrounds were concerned. She says,
When factors in the childhood home were examined, it was found that there
were no significant differences between sociable and solitary alcoholics
with respect to country of origin of parents, education, broken homes,
absence of mother from the home, absence of father from the home, rating of
happiness of the childhood home, attitude of father toward drinking, attitude
of mother toward drinking, extent of agreement between the parents about
drinking, authority in the home, preference by the child for either parent, and
shyness as a child.

Whether we deal with the solitary or the sociable drinker, we still find that
the alcoholic has a sense of isolation from the rest of mankind. It is
dramatized by solitary drinking, but even in the case of the sociable drinker,
apartness is there. Here is a man whose wife gave up after several years of
drinking troubles.

When I roomed alone, I got fed up reading or waiting around. I'd go out
walking around, and get lonesome. I’d see a bunch in some cafe laughing
and having a great time. I’d go in. With the sociability, the time goes like
lightning.

This pitiful little statement reveals the need for sociability, but it must be a
special kind of sociability—easy, non-critical companionship such as one
can find in a barroom. Intimacy involves the right to criticize. A member of
Mc-Carthy's group says,

I think that alcoholics have the ability to get along with people, but there
seems to be a terrific inability to get along with the immediate family.
Perhaps because they are alcoholics they shun relatives because they know
they are going to be disapproved on the grounds of drinking, whereas when
they are outside the family, well, it's easily camouflaged with a hail-fellow
attitude.

One can be hurt by one's family in a way which no casual acquaintance can
approach. Similarly, one can do harm to the family. If one is no good, so the
alcoholic rationalizes, then the best thing he can do is to stay away from
loved ones as much as possible. In so doing the alcoholic also lifts some of
the strain imposed by pressures against his drinking.

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As the years go on, the alcoholic finds himself with less and less "drinking
room." The number of persons who will have anything to do with him is
decreasing. He has attempted to hide his problem from friends, and in the
effort he has been helped by an embarrassed family. One by one, the friends
drop away or are abandoned. A man who at the time he spoke these words
had been sober for about six months says,

I got so I avoided people, to some extent. Good friends of mine—I would

avoid them when I was drinking. And then I got to the point where during
these periods of blackout, or even not in them, I would borrow money or
write checks—any way to get money. Then, of course I'd get into real
difficulty. But I didn't avoid those people later. I'd let them know what
happened. I didn't think people were noticing I avoided them. They always
used to call on me in a lot of activities in the community, then they got so
they didn't.

People who used to come to me for advice and so on were staying away
from me. Apparently it must have been that when I thought I was doing all
right, I wasn't giving them the information I thought I was. I don't know that.
I've never talked to any of them to make sure. I'm going to when I feel a little
more secure myself, which I don't as yet.

His present lack of security in interpersonal relationships persists even into

the period in which he has not been drinking. This is a rather common
finding.

Alcoholics seem to resent their isolation, and they lash back by blaming
others for their apartness. This statement reveals the feeling.

I come from a nice family. I've got seven brothers and three sisters, so there
could have been plenty of help right there, if I would let them. I ended up by
almost killing one of my brothers because of drink and trying to throw him
out of the house. Of course I didn't blame myself for it. I blamed my family
and my friends. Well, I left my family and my home and the town I was
living in and I thought that if I went someplace else, where no one knew me,
I could start out fresh and then I would be able to go straight.

He goes on to describe his move and the renewal of conditions existing in

the old residence. It never seemed to occur to him that it was his drinking
that made him inaccessible to the outside world.

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Losing friends creates resentments and is evidence to the alcoholic that his
self-esteem is in danger. So, he changes companions. An illustration of this
is provided by a man in one of McCarthy's groups.

As I told you, Mr. McCarthy, I'd get going for 3 or 4 days or a week and of
course, if my ordinary acquaintances wouldn’t have much to do with me, I'd
go and seek out these panhandlers and drifters and they would look up to me
if I had money. I had to be above somebody. Because alcoholism does not
show up in recognizable form until the drinker is mature, the typical
alcoholic's closest relation is his wife. It is the wife or husband who bears
the brunt of the social problems created by alcoholism. Making excuses,
lying about the spouse's condition, trying to keep him from getting into
difficulty, interpreting to the children what is happening, all these and more
are the tasks of the person married to an alcoholic. For her or for him, the
dashing of hopes for the good life that their marriage was to have provided
is the stuff of which real tragedy is made.

One of the many problems facing the marriage of an alcoholic is the

drinker's incapacity to fulfill his sexual role.

He is indifferent, to be sure, but his impotence in the sexual act is another

source of destroyed self-esteem, particularly for the male. When this occurs,
as it usually does sometime during the middle or latter stages of the
alcoholic’s drinking career, the deficient one tends to lose interest in sex or
to act as if his wife had lost interest. It may very well be that she has. The
"drunk" is not a very attractive person. When this occurs, the alcoholic often
protects his own esteem by blaming the wife for sexual failures, even
accusing her of being unfaithful. Even if he does not take this tack, he may
become aggressive toward his wife. A man who reports that, in the recent
stages of his drinking, he was uninterested in sex in contrast to the early
years of his marriage before drinking became such a problem, goes on to
say,

I think, probably through an unquestionable guilt complex, that I was getting

to the point where I was the critical one.

Rather than going on the defensive, I would be on the offensive and meet
problems that way. The same man describes his guilty feelings about his
wife.

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He had gotten into a series of financial messes as a result of bad judgment
exercised while drinking, and his wife had been the one who had taken over
and righted matters.

His feelings were those of guilt and resentment. Early in their marriage,
there were two business failures, then the alcoholic contracted tuberculosis
and had to live for a protracted period in a sanatorium. (This did not
interfere with his drinking. Most tuberculosis sanatoria have a relatively
high percentage of alcoholics among their patients, and the problem of
controlling their drinking is one of the serious administrative
considerations.) He speaks this way of his wife:

I don't know whether to call it "over understanding" or not, but she has been
through a great deal with me. We were only married not quite three years
when I went in the sanatorium. I was in the business at the time and closed
up two establishments absolutely broke. She was only twenty at the time.
She had to get the complete load for about seven years, and I usually got into
a great deal of financial trouble through drinking, and still she went all the
way with me until this summer. So my wife has probably been the person
who held things together and kept me from going completely into the stage of
not caring at all. And, of course, there is a point where—she was reaching
the point where she didn’t feel it could continue forever.

Another man, a former college teacher, reveals some of the alcoholic's

feelings about marriage in both its sexual and companionship aspects. He
did not marry until relatively late in life, after having had treatment for
alcoholism and having been sober for a number of years. His uncontrolled
drinking began early in his career, eventually leading to his departure from
the teaching profession. This is what he says.

I think the true alcoholic isn't bothered too much about women or girls. They
interfere with the drinking. I can remember an older man who was much
older than I, who said that alcohol might make you feel more amorous but it
didn’t do much to help you. In other words, it increased the desire, but
without increasing any ability. But my personal thought on it is that just as
one doesn't want to go around with people who don't drink or want to drink
as you want to when you're drinking, the same way with girl friends or sex.

I can't speak of the marriage end of it because I wasn't married. It's just

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something that interferes with your drinking.

The troubles a marriage involving an alcoholic runs into are as varied as the
couples involved. But all show many of the same characteristics. A series of
crises caused by drinking places an intolerable strain on both partners to the
marriage. The husband who has to go looking for his wife when he comes
home from work, or who has to clean up both the home and his wife, who is
constantly fearful for the physical safety of his children as well as that of his
wife, who finds her unattractive most of the time, eventually reaches the
point at which he refuses to go on. The wife who finds her husband
inattentive to anything but his drinking, unreliable in financial matters,
impossible with friends, feels the enforced isolation and damage to her
pride until she, too, decides she has had enough. All events are attributed to
drinking. A man whose wife had stayed with him through all kinds of
troubles says this about one period of their marriage. I was starting to get
drunk frequently—coming home drunk, and it was just something she was
getting ashamed of. At the time, I couldn't see it. That went on for a year or
so. We had our little spats, fights, and everything. I remember when the baby
was born, she was in the hospital a couple of weeks.

I drank continually all the time. I guess I was drunk when I went up to the
hospital a couple of times.

Eventually, the couple decided that things would go better if they changed
their living arrangements. They had been living with the husband's mother,
now they bought a house in the suburbs. A new home, and we were very
happy out there, but it didn’t stop my drinking, and I used to go home the
very same way: half drunk. After we were there about a year, we were
going to have another baby. We were coming into town one evening; we
landed up in the hospital—my wife did. That baby died. We just made the
hospital, but it was too late. And then after that, it seemed as far as my
family life went that was the end of it. My wife called me a murderer and
everything else. She never got over that, and I don't think she ever will. I
drank more and more and got in deeper and deeper.

Even after this man had been sober for several years, his wife, though
continuing to live in the same house with him, did not live with him as his
wife.

Financial problems represent one of the most frequent causes of trouble

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between husband and wife, whether alcoholism is involved or not. Drinking
usually is an expensive pastime, and the earning capacity of the drinker is
usually reduced. Consequently, the family finds itself without funds to live
normally. A man who admits to being inept in the handling of money says, I
didn't handle money very well at all. Never did, in fact.

What I was doing was fooling myself. My wife, I would give her what was
expected out of my salary, and then that someday, probably, be borrowing
money. For a period of four or five years it was very easy. I could keep
borrowing and then borrowing a little to make that up, and then I got to
where I couldn’t make it up, so she went to bat for me. Got three thousand
dollars, and within six months I was back two thousand dollars in debt
again. About all drinking money—wasn't doing any gambling or going out
with anybody else.

This is in no way an unusual story. The number of alcoholics who get into
difficulty with the law as a result of attempts to obtain "drinking money" is
large. Check forgery, stealing, breaking and entering, are all crimes
alcoholics have frequently committed when they were at the point where
there simply was no more money for liquor.

Usually the family will cover up for him if they are financially able. If they
are not, or if they reach the point at which they refuse, the police take over.

Somewhat surprising at first glance is the manner in which alcoholics are

able to go on with their jobs for long periods of problem drinking.
Employers will report that, when sober, Joe is a wonderful employee,
cooperative, highly productive, an asset to the company. His undeniable
worth saves the alcoholic, in many instances, from immediate discharge. We
can almost guess from what we already know that the alcoholic would do
well on the job when sober, provided his work is of a nature that does not
involve delicate manual skills. The man whose hands are shaking as a result
of a weekend bender does not turn out a high quality product. Wastage from
inaccuracy, breakage, and other aspects of quality control may make the
alcoholic an expensive employee.

Even in this instance, however, the employer tends to "go along." The
drinker does not show up as a problem until things have been bad for
several years. During this time, he may have been doing his work well,
trying hard to overcome the fears of losing his job that his drinking creates,

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and he may have worked his way into a responsible position in the
company. Therefore, the company's investment in him is large enough so that
it tends to overlook difficulties with drink as something temporary that the
man can get over if he wants to. We know that the worker himself is
worried, and that he tries to make up for his deficiencies when he is in
condition to do so. When he does a good job, comes through on an
assignment, the employer, like a wife, hopes that this is the way things are to
be. But also like a wife, the employer reaches the end of his patience. The
alcoholic tends to become skillful at determining when this time has been
reached. Often he resigns in order to prevent being discharged. Here is an
example.

I didn't give up the job, the job closed. It was a war job, and the war was
over in August, and I was laid off. I got a job in another place immediately. I
was doing very well on the job.

It was another kind of work entirely. After I had been working about five
months, I started drinking again, and after a few months, I just blew that job.
I gave it up rather than be fired from it. I figured that was coming. And then I
got two other jobs and it was the same thing: drinking and quitting the jobs
before they fired me. They'd find out I was drinking.

I figured they would. Another man, a car salesman with a good income, had
an accident in which a demonstration car was demolished.

Then, when the police picked him up in another demonstrator for drinking
beside the road, his employer decided that was enough. Such a man usually
finds himself able to get only poorer and poorer jobs as his work record
becomes worse.

We already know that most alcoholics are married and have children. And it
is the children, as is usual in any serious problem affecting adults, who are
the major sufferers.

Their situation is such that they may know little about the parent’s difficulty
with drinking, or they may try, perhaps unconsciously, to keep from
acknowledging to themselves that their parent is in any way inadequate. Of
course the husband or wife of the alcoholic tries to keep the full impact of
the situation from the children. Even with this attempt, the non-alcoholic
parent may find himself forming an alliance, perhaps unconsciously, with the

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children against the alcoholic.

Joan K. Jackson has described the child's situation as follows:

The child of an alcoholic is bound to have problems in learning who he is,

what is expected of him, and what he can expect from others. Almost
inevitably his parents behave inconsistently towards him. His self-
conception evolves in a situation in which the way others act towards him
has more to do with the current events in the family than with the child’s
nature. His alcoholic parent feels one way about him when he is sober,
another when drunk, and yet another during the hangover stage.

What the child can expect from his parents will also depend on the phase of
the drinking cycle as well as on where he stands in relation to each parent at
any given time. Only too frequently he is used in the battle between them.
The wives of alcoholics find themselves disliking, punishing or depriving
the children preferred by the father and those who resemble him. Similarly,
the child who is preferred by, or resembles the mother is often hurt by the
father. If the child tries to stay close to both parents he is caught in an
impossible situation. Each parent resents the affection the other receives
while demanding that the child show affection to both.

The situation is still further complicated by the fact that unhealthy attitudes
toward alcohol and drinking are being developed by the child. As we have
pointed out in an earlier chapter, the child of an alcoholic feels a high
degree of ambivalence toward drinking. He is fearful, but he also wants to
see if he is as weak or as vulnerable as his father or mother was. When he
drinks and, apparently, has no trouble, then he may feel a vague sense of
superiority but also of guilt. Certainly, the evidence is that the child of an
alcoholic needs particular help in his introduction to drinking. Alcoholism
may "run" in families, or it may appear in successive generations, but we
know that it is the behavior system that is transmitted. There is no biological
inheritance of alcoholism.

This, then, is the condition of the alcoholic in the depths of the problem. The
downward drift in occupational status matches the decline in his fortunes in
marriage, and in friendships. We see him at this point as impotent in all
aspects of living. He resents others {and himself); he fights to preserve
some semblance of inner control and self esteem. His words and behavior
may become bizarre as he boasts and promises and fights back against a

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hostile world. Each move takes him further from the rest of mankind, until
he is truly alone. As Jellinek says,

Throughout, the crucial phase presents a great struggle of the addict against
the complete loss of social footing. Occasionally the after effects of the
evening's intoxication cause some loss of time, but generally the addict
succeeds in looking after his job, although he neglects his family. He makes
a particularly strong effort to avoid intoxication during the day.
Progressively, however, his social motivations weaken more and more, and
the "morning drink" jeopardizes his effort of complying with his vocational
duties as this effort involves a conscious resistance against the apparent or
real “physical demand" for alcohol.

This statement by Jellinek affords us a summary of the position of the

alcoholic at the end of the crucial phase of alcoholism. From this point on,
the course of events can be tragic or hopeful, in part dependent upon the
knowledge and wisdom of those with whom the alcoholic comes in contact.

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CHAPTER 6

"Lady" Drunks

Women alcoholics arouse more disgust, amazement, and concern than any
others. Tied up with our beliefs about the sanctity of womanhood and the
feeling that women, despite their emancipation, are something "special," is
fear that she may not be worthy of our trust. Sayings like "The hand that
rocks the cradle is the hand that rules the world,” show our expectations.
We entrust the care of children almost entirely to women. We look to them to
safeguard the moral structure of our society.

Therefore, to think of a woman as so depraved that she cannot control her

impulses is to fear for our entire system of morality. We assume that the
woman who cannot control her impulse to drink cannot control other
impulses. We automatically link alcoholism in women with sexual
immorality. In short, we consider the woman alcoholic to be worse than her
male counterpart, and we reserve special censure for her.

What is more, even experts believe that the woman alcoholic is sicker than
the man. In the introduction to his book The Alcoholic Woman, Dr. Benjamin
Karpman says, By clinical observation, alcoholic women are much more
abnormal than alcoholic men; in common parlance, when an alcoholic
woman goes on a tear, "it is terrific." The reason for the difference probably
lies in the fact that even in this sophisticated age women are still subject to
more repressions than men, and in attempting to solve their conflicts, they
must seek outlets that are still within the limits of conventional social
acceptance of their sex. When, therefore, the pressure becomes so great as
to make it beyond control, and the usual means fail of their intended
purpose, it may break out in the form of alcoholism which naturally must be
more vehemently expressed, being in proportion to the tension behind it.
And it must be further stated that as alcoholic women are more abnormal
than alcoholic men, they are, by the same token, also more difficult to treat.

But we must remember, with the woman as with all alcoholics, that they are
members of the same society that condemns them and believes them to be
good or poor prospects for treatment. If the society as a whole has

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particularly strong feelings about women alcoholics, we may be sure that
women alcoholics share the belief that they are more depraved, and that is it
more difficult for them to get well than for male alcoholics. Were it not for
this, there would be no reason to single out the woman alcoholic for a
special chapter in this book. She becomes an alcoholic in the same way the
male does, and the course of her alcoholism is as predictable as the male's.

Karpman's book presents the case histories of three women, all profoundly
disturbed alcoholics, who can in no way be considered typical. Yet, they are
interesting for our purposes. Take the matter of introduction to alcohol: the
first drinking experience. The first woman, Elizabeth, was by clinical
observation, alcoholic women are much more abnormal than alcoholic men;
in common parlance, when an alcoholic woman goes on a tear, "it is
terrific." The reason for the difference probably lies in the fact that even in
this sophisticated age women are still subject to more repressions than men,
and in attempting to solve their conflicts, they must seek outlets that are still
within the limits of conventional social acceptance of their sex. When,
therefore, the pressure becomes so great as to make it beyond control, and
the usual means fail of their intended purpose, it may break out in the form
of alcoholism which naturally must be more vehemently expressed, being in
proportion to the tension behind it. And it must be further stated that as
alcoholic women are more abnormal than alcoholic men, they are, by the
same token, also more difficult to treat.

But we must remember, with the woman as with all alcoholics, that they are
members of the same society that condemns them and believes them to be
good or poor prospects for treatment. If the society as a whole has
particularly strong feelings about women alcoholics, we may be sure that
women alcoholics share the belief that they are more depraved, and that is it
more difficult for them to get well than for male alcoholics. Were it not for
this, there would be no reason to single out the woman alcoholic for a
special chapter in this book. She becomes an alcoholic in the same way the
male does, and the course of her alcoholism is as predictable as the male's.

Karpman's book presents the case histories of three women, all profoundly
disturbed alcoholics, who can in no way be considered typical. Yet, they are
interesting for our purposes. Take the matter of introduction to alcohol: the
first drinking experience. The first woman, Elizabeth, was the mistress of a
married man some ten years older than she. Dr. Karpman quotes her on the
subject of her first drink.

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He was drinking regularly, and I had never come in contact with any
drinking person before. I could not understand the attraction that liquor held
for him, and why he wanted it, when it took away his consciousness and
separated us. I told him that I was going to try it in order to find out what it
held for him. He begged me not to, but I was eager to know, and by taking
sips whenever we were in the office where I could do so, I gradually found
out all about it, but by that time I had forgotten my original purpose.

Vera, the second case, describes her first drink.

The first drink I ever took was with a group of so-called friends as we were
riding about town in an automobile operated by an apparently prosperous
fellow who didn't drink whisky, but freely imbibed in champagne. I was
rather disappointed in the taste of the stuff and oh, so nauseated I was hardly
able to retain it. But nevertheless, I felt important and proud of the fact that I
was now a member of this group who frankly enjoyed the privilege of riding
around in luxurious cars.

In the third case history, Karpman does not give us the woman’s own words,
but he describes her family situation in detail. Frances' father was an
alcoholic. She herself began to drink at about fifteen. Karpman says, "She
first drank needled beer with a married man with whom she thought she was
in love and from whom she escaped after he made sexual advances to her."
Certainly these were no moderate, anxiety-free introductions to drinking! In
all three cases we find the beginnings of the drinking career to be what we
have come to expect; there is something unusual or anxiety arousing in that
experience, something that makes it an important experience for the drinker,
something that fixes his attention upon drinking. We have already seen this in
the men; it is also true of the women.

Evidence is beginning to mount that there is more alcoholism in the

immediate family of the woman than of the man alcoholic. A study of cases
known to the New Hampshire Division of Alcoholism of the State
Department of Public Health shows that just about twice as many women as
men had alcoholic parents. Compared with male alcoholics, the women
more frequently had a sister who was also alcoholic, while the men more
often had a brother with the same problem.

Another study, this one from an alcoholism clinic located in a general

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hospital, shows that almost 40 percent of the women seen at the clinic were
married to alcoholics.

In all these statistics there is an indication of the influence of others as

models for the behavior of the woman—of others who are sources of
attitudes about drinking. That is, the sister who drinks abnormally can
transmit her ways to the younger girl who is just coming into the drinking
situation. Similarly, the boy whose older brother is an alcoholic may have
the same attitudes toward alcohol and may feel ambivalence in the drinking
situation. He may be afraid to drink, but wants to be a "good" drinker. Even
though the brother or sister is not that "good" drinker, they may convey the
feeling that one ought to be competent, and that it is difficult or dangerous.

In an earlier chapter we indicated that girls are under less pressure to drink
than boys. Generally, drinking is less important to her than to the boy, but we
see that there are situations, such as having an alcoholic in the family, in
which the casual attitude toward drinking is destroyed and the girl is just as
anxious to prove herself as the boy.

It looks as if the female alcoholics from the beginning take male attitudes
toward the use of alcohol. This can be only a suggestion in the absence of
research; however, an occasional case gives us some support for our
suspicions.

Psychiatrists from Bellevue Hospital in New York report on a young woman

alcoholic who began with a "medicinal" drink given by her mother when, at
the age of sixteen, she was nervous about her appearance as a night club
singer. She found she could more easily face the audience with a drink in
her. The doctors report, "All we know about her father is that he was a
severe alcoholic, but the patient sees him as very masculine."

Moreover, as work with the patient proceeded, it became clear that the
patient regarded herself as very much like her father. Thinking of oneself as
masculine can also mean that one tries to drink like a man, and is subject to
the same tensions in drinking as the man.

We have already mentioned that much of the concern with women

alcoholics, whether it is voiced or not, has to do with sex. They are thought
either to be promiscuous or in danger of becoming so. Although in some
cases, she lends support to this belief, the woman alcoholic is more likely to

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feel the same way about sex that the male alcoholic does: it interferes with
drinking. If she does get involved in incidents of sexual promiscuity, it is
probably through failure to resist exploitation while drinking and not
because she has actively sought sexual contacts.

If a woman has no family to protect her, and if her supply of alcohol is not
adequate, she may find herself in situations in which she pays for liquor
through sexual favors. When she does get sexually involved, she may do so
as a result of feeling herself unwanted and unattractive—feelings often
based upon reality—and she accepts the attentions of men who offer at least
a caricature of a truly warm relationship.

In her isolation, it may be so important to her to feel needed that she does
not question the need she fills.

In the case of a woman alcoholic who is promiscuous, her sexual behavior

is secondary to the real problem. She differs from the truly promiscuous
woman who drinks to provide herself with an excuse for having an affair
—"I didn’t know what I was doing"—or who drinks to reduce guilt feelings
about her behavior. These are not usually addictive drinkers, even though
such women may later become alcoholics.

Sexual promiscuity, or what looks like it, is a problem for only a small
number of women alcoholics. Most are married, have children and the
responsibilities of the home, and a place in the community. Just as the
typical male alcoholic is protected by those around him, the woman is taken
care of by those who love her. The reluctance on the part of members of the
alcoholic woman’s family to recognize the problem is even greater than in
the man's case. Because they cannot believe or accept the fact that their wife
and mother is a "drunkard," family members hide and protect her—often
protecting her drinking as well. Lacking knowledge of alcoholism, they
permit the situation to become worse before they accept reality. A woman
alcoholic describes this situation.

I think it is important to realize that our pattern of drinking is quite different

from that of the man. Down through the ages, we women have been more or
less put on pedestals and for us to have slipped completely from that
pedestal—our relatives and our husbands and our friends finding out that we
have feet of clay, that we are not only alcoholics, but not good citizens—
well, I know that my "Waterloo bouts," my great misery with alcohol, was in

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my own home. The men, of course, can go out among their own kind, but I
was ashamed to do that. I wasn't ever hospitalized and I never happened to
get behind prison bars, but it was only because I had wonderful cushions. I
had the experience of all of those things in my own home. The bars I raised
around myself were just as real to me as though they were material ones.

The "cushions" this woman speaks of are what enable one woman alcoholic
to remain at home under conditions of low visibility, while another, lacking
them, is apparent to all. In "The Case of Mary Doe," social worker Jean E.
Markham describes a case which in many ways is the opposite of the
woman quoted above.

Mary Doe was divorced, but not until she had borne three children. Her
own mother, presumably the only relative able to lend either emotional or
financial support, finally refused to have anything to do with her. Mary Doe
and her children were supported by welfare agencies. Having no one to
look after her, Mary Doe's behavior became openly immoral. If she had still
been living with her husband, or if her children had been old enough to take
care of her, subsequent events would in all probability not have occurred.
When Mary Doe acted in a manner thought to be detrimental to the welfare
of her children, outside agencies stepped into the picture. As Miss Markham
says, There was concern about the effect of Mrs. Doe's alcoholism on all of
the children, for she had gotten to the point of dragging them with her from
bar to bar where she picked up various men. Particularly was there concern
about Dorothy. She was showing definite signs of disturbance and was
approaching adolescence when her difficulties could be expected to
increase. It was agreed by all the agencies that the children needed to be
placed in other homes.

The fact that there are so many women with drinking problems who, unlike
Mary Doe, never come to the attention of outside agencies has led to
conjecture about the total number of women alcoholics. Some have
reasoned that there are many more than current estimates indicate.

Because women at home have access to alcohol throughout the day, and
because women are supposed to be under great tension, one psychiatrist
suggested that there must be more women alcoholics than previously
thought, and in his own practice he found this to be true.

Some alcoholism clinics report that they are seeing more women than they

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used to, but they also say that the women are coming to them at an earlier
stage in their alcoholism than are the men. This evidence, too, is
inconclusive at the moment.

On the face of it, one would expect that we should see more women
alcoholics as time goes on. More women are drinking; therefore there are
more "prospects" for alcoholism. Based on the theory of alcohol addiction
presented in this book we should not expect proportionately more women
alcoholics even if more women drink, except for one point. Much has been
written of the ambiguous role of women in our society. They are expected to
be able to operate in a male world on terms equal with the male, yet they
are also supposed to be glamorous, clinging females.

Confusion in what is expected of women results in confusion among women

in what they try to do. The housewife versus career girl choice is an
oversimplified version of the problem.

When dealing with young unmarried women, one sees doubt about the
future, but less trouble with the present.

During the dating and courtship years, events assure the young woman of her
femininity. Although she may have a job in the man's world, she is also
supreme as the desirable object of the young man's attention. When she
marries, has children, and the role of sought-after "queen" is no longer
appropriate, other considerations come along.

Emphasis on being a companion and intellectual equal to her husband

creates doubts as to her ability to function in this new role. Most often, the
young girl went from the protection of her father to that of her husband. Even
though she might have held a job during the early years of marriage,
emotional dependence upon her husband replaced emotional dependence
upon her father. As a mother and as a companion to her husband,
dependency and, indeed, femininity are no longer primary motivating forces.

The situation may be made still more acute by the wife’s dislike for the jobs
of mother and wife.

Under these conditions, it may also be that attitudes toward alcohol and its
use undergo alteration. In being a companion to her husband, the wife may
try to be his drinking companion. As with Dr. Karpman's Elizabeth, the wife

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may try to understand and go along with her husband’s heavy or even
compulsive drinking. If her experience with alcohol begins at this time and
under these circumstances, she may also become a problem. As women in
our society are increasingly concerned over their role of wife and mother,
there will be an increasing tendency to take the male as a model. We suggest
that this may lead to an increase in alcoholism among women.

Naturally, this is speculation. Other factors may be operating which may

make the situation better or worse. But what does seem to be true is that
once addiction to alcohol has been established in a woman, her behavior, as
far as drinking is concerned, is no different than the man's. Her alcoholism
will produce a constantly deteriorating situation which, if unchecked, will
drop her just as low as the man with the same problem.

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CHAPTER 7

Rock Bottom

There appears to be a point in the drinking life of every alcoholic at which

he loses hope of being able to drink normally and of ever having anything
approaching a normal life. Maybe it comes when he is really as far down as
a person can go: when he is physically or mentally ill, when he has been
cast off by his family, when liquor no longer can give him any relief from
doubts and fears, or when he can see that any or all of these things are going
to happen.

This condition which alcoholics, particularly members of Alcoholics

Anonymous, call "bottom," is usually reached during the final stages of
alcoholism: what Jellinek refers to as the "chronic phase." However, under
some circumstances, an alcoholic may see that the course of his life is taking
him to this "bottom" and get help before any of the terrible things mentioned
above actually occur.

With all the things that can and do happen in a drinking career, just what
represents the "bottom" to an individual alcoholic is sometimes odd. A very
beautiful woman relates that, despite years of problems with her parents and
husband as a result of her alcoholic drinking, she never accepted the fact
that she drank unusually. Then, one day, she was returning in her car from an
afternoon of drinking with some friends. She was not heavily intoxicated,
and she was aware of having to be home when her husband returned from
work. She was involved in an accident, was injured and taken to a hospital.
Anesthesia was required, and the anesthetist was having difficulty putting
her under. Alcoholics build up tremendous resistance to some forms of
anesthesia. Just before she became unconscious, she heard the doctor say,
"Why didn't someone tell me this— was an alcoholic!" For her, these words
marked the beginning of a realization of her true condition.

A man whose wife and children had put up with over fifteen years of
hardship and disgrace as a result of his drinking, had been threatened almost
constantly with the ultimatum that his wife would leave him. She had even
consulted an attorney; there had been conferences about divorce. However,
her husband never accepted the threats or even the action of the attorney as

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real. He "knew" his wife would not leave him, just as he "knew" the bottle
would never let him down. But when his wife went to another lawyer, to
whom he referred as "the best in town," he knew she was serious. At that
time he saw the end of the road, and took action which led to his sobriety.
For him, knowing he would lose his wife was "rock bottom." For another,
even the loss would not have meant the same.

During the chronic phase of drinking, all the things that have been building
up for the alcoholic usually come to a head. The complete loss of control
over the time when the alcoholic will drink occurs. Prolonged drinking
bouts or “benders" terminated by physical illness or incarcerations are the
usual thing. A man who had been a city employee reports the end of such a
bender. I remember being locked up in the city prison, and the lieutenant
down there, a friend of mine that I had met when I was working in the
department; he had to lock me up. He kept me in his office rather than put me
in a cell overnight. I remember being locked up half a dozen times during
that year, being brought up to court, the judges in the court giving me
lectures and everything else. All of them I knew; it was an awful thing; I
knew all these people.

Because he can no longer hold his head up with the people he used to know,
the alcoholic seeks lower and lower companions, until he may end up doing
his drinking and his living on Skid Row. He drinks anything he gets his
hands on. If no ordinary alcoholic beverage is available, he may in
desperation try substitutes like rubbing alcohol or Canned Heat. He finds
that he actually needs less alcohol in order to achieve an effect, and the
effect is often more pronounced than in the earlier years of his drinking. A
man asked about the latter stages of his drinking career says,

I had gone down a little—cut down the amount of drinking, but I was
spending more of my time in barrooms and I really got drunk more
frequently.

He goes on to relate that the usual, almost the inevitable result of his
drinking was a blackout. He was frightened by these, but knew of nothing he
could do to help.

Sometimes the physical punishment in the hangover is what represents

"bottom" to a man. One speaks of having to crawl to the bathroom where he
takes four drinks before one stays down. After one such episode, he had the

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feeling that this was the end. Fortunately, he knew where to go for help; it
was at this time that he was ready. Still another says, about an incident that
was crucial in leading him to accept treatment,

I had an experience about a year ago last fall where I went out and left a
note that I would be gone for four days and not to look for me. I went by
myself. I went where other people were, and I stayed drinking about four
days, and during that period I had some—I don't think I ever really had the
idea at all of committing suicide. I think it was just a little act that I put on
for everybody else's benefit except my own. But, anyway, I was successful
in getting everybody pretty well stirred up, and that was the time I did stop
drinking for about ten days. I got out of one financial mess. And last summer,
well, I think probably my wife told me that she had gone just about as far as
she could. The two older boys, she was going to tell them the situation. And
I went on one drinking spell—not a drinking spell, either. I just went out one
afternoon, don't remember exactly what happened, but I came to the next
morning in the office in the bathroom, sleeping on the floor. And I think that
was at the point where I really convinced myself that I had gone just about
as far as I could possibly go. It was fortunate that I woke up before anybody
came to work.

In this man's case, a series of episodes led to his reaching or seeing bottom:
that "suicide attempt," the threat that his wife would leave and tell their sons
who, strangely enough, did not know the extent to which their father’s
drinking was a problem, and, finally, the likelihood that those who worked
with him would find out what was going on. Here he was hit in all areas: his
own safety, his family’s loyalty to him, and the job situation. For him, there
was nothing to do except take the help that, luckily, was offered to him about
this time.

What happens to the alcoholic who just keeps on drinking is usually not very
pretty. Somewhat less than 10 percent of all alcoholics are afflicted with the
horror of alcoholic psychoses. These are mental diseases, forms of insanity,
which result in commitment to a mental hospital. More often than not, the
damage is reversible so that when the patient is dried out and built up
physically, symptoms of the psychosis disappear. "Seeing things," as in
delirium tremens, is one such condition.

Most of the physical diseases of chronic alcoholism, as well as the

psychoses, turn out to be caused by dietary deficiencies. The alcoholic in

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the chronic phase does not eat regularly if at all, and even if his food intake
is reasonable, the result of taking in the alcohol is to destroy the necessary
balance between calories and certain vitamins.

Where psychoses or serious nutritional diseases such as beriberi do not

appear, there may be what Jellinek refers to as persistent "indefinable fears
and tremors." These feelings are present only when there is no alcohol.
When the alcoholic gets a drink, the feelings and the tremor appear to clear
up. A number of years ago the writer was called by a friend, an alcoholic
who had been sober for several years, and asked to look out for a young
woman who had just moved into the city. They had met in Alcoholics
Anonymous. All the writer was asked to do was to let her know she had a
friend in the area, and to help her get settled. After calling, I went to see her.
Things did not sound right on the telephone. She had taken a room in a
boarding house but was in the process of being evicted because she had
been such a nuisance in the few days of her stay. She had been drinking and
appeared to be quite disoriented. I contacted the Central Service Bureau of
Alcoholics Anonymous. Another young woman responded to the call.
Together we decided our friend should not be left alone, that she should
probably be put under medical care in some protected environment such as
a sanitarium. Contact was made with a nearby sanitarium that had a great
deal of experience with alcoholics.

Then came the task of persuading the patient-to be ready to go to the

sanitarium. This was left to me. The sick girl related her craving for a beer;
she would not consider going to the sanitarium unless she could get some
beer. Finally, a deal was made. I went out and purchased two cans of beer.

During my absence the woman began to pack an overnight case. When I

returned, I turned one can of beer over to her. Immediately, her anxiety, her
confusion and trembling seemed to cease. She took the can, put it down, and
went on with her packing. When that was completed, she began looking for
a beer can opener, all the while carrying on a sprightly, sensible
conversation. After locating the opener, she then took a glass from a
cupboard, washed, and carefully dried it. Then, after doing one or two little
things such as snapping shut the clasps on her overnight case, arranging her
hat and coat, she sat down and poured some of the beer into a glass. We
continued to chat while the alcoholic took an occasional sip of her glass of
beer.

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Once she had the beer in her hand, all signs of disturbance, of craving
disappeared. When the physician from the sanitarium arrived, she was
composed and ready. All her anxiety had gone into the wanting of liquor.
Once it was available, everything else was all right.

This fear is something more than fear of loss of supply, although this is
certainly involved. One man says, If, for instance, I might know that a week
from today I had to be someplace where I couldn't have access to it, I'd get
panicky right then, and I'd say to myself that I couldn't go there in this
condition. And I'd swear I was going to taper off during the week so that I
could make that appointment. It never worked. Usually I drank more because
of the panic.

Along with this kind of fear there sometimes comes, during the chronic
phase of alcoholism, the fear that alcohol will no longer do the trick—
anaesthetize the drinker.

What this means to the alcoholic is that he has put his entire trust, indeed,
his life, in drinking, and that it now appears that drinking may let him down.
With this possibility comes the sense of the utter forlornness of his position.
This may be what Jellinek is thinking of when he refers to the weakening of
rationalizations during the chronic phase of alcoholism. He says, Finally, in
the course of the frequently prolonged intoxications, the rationalizations
become so frequently and so mercilessly tested against reality that the entire
rationalization system fails, and the addict admits defeat.

Selden Bacon's description of the state of the alcoholic at this point is vivid.

Characteristics of the final phases of alcoholism are so exotic, whether

concerning drinking or any social behavior, they need only be mentioned:
binges—a complete rejection of social reality—physical tremors,
hallucinations and deliria, horrifying but unidentified fears and hatreds,
collapse of all former social status, compulsive hiding and storing of drinks
against probable hangovers, surrender of all rationalizations, early death.

During the time of the waning power of the rationalizations, the alcoholic
may have some thoughts about religion that are new to him. They may be
simply a childish wish for a miracle that will get him out of his situation. At
this stage of the game, the alcoholic will try anything, "even “prayer. A man
who had reached the end of his rope, who saw nothing ahead of him despite

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the fact that he was married, had a child, and was able to earn just enough
money to supplement his wife's earnings, describes turning for help to
religious authorities. It came about almost by accident.

I was walking in town one day. Passed the shrine down in the center of
town. I thought I'll try this. I'd been going to church, but it hadn't meant
anything. It was more for appearance’s sake than anything else. Then out of a
clear sky this particular day—I was half stewed at the time—I went into the
office and asked to see one of the Fathers.

He goes on to relate several days of contact with two priests—days during

which he continued to drink and during which his hoped for miracle failed
to appear. At the time he blamed one of the priests for not understanding his
needs.

He was more interested in the home conditions; how my wife was getting
along, and my child, and so forth, and could he see my wife? My actions and
everything else had also hurt my wife as far as church was concerned. So I
said, "Sure, you can see her." He was interested in getting her to go back to
church. In other words, I had laid everything on the table, hadn’t hid
anything back. I was looking for help and I had bared everything. And I said,
"I don't see how you can see her. She won't come down to see you if I say
anything." It went on like that, anyway, and the result was that he was
working with B, and getting B back to church. We both had been away for
quite a while. I wasn't getting any help at all.

This situation illustrates both the bitterness of the husband-wife relationship

under years of the weight of alcoholism, and also something of the
forlornness of the alcoholic's position—to him almost like that of the
deserted child. This man had taken what he thought was a step toward
getting help, but no miracles occurred. Indeed, by showing interest in the
wife's situation, the priest was underlining the fact that she had been
wronged by her unworthy husband. Instead of comfort, the alcoholic only
received more punishment. It took years to wipe out the bitterness resulting
from this experience. As is so often the case, sobriety had to come to this
man before he was able to go back to his church.

Just how bad do things have to get before the alcoholic sincerely wants
help? Some will say that he must go as far down as it is possible to go. The
Skid Row of every moderate-sized city is thought to be the place from

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which the alcoholic must fight his way back. Yet, those who have worked on
Skid Row distinguish between its occupants who are there because they are
addictive drinkers and those who drink heavily but through choice. These
are men and some women who have found that on Skid Row they can exist
with a minimum of demands to fulfill, but with the psychological support
and companionship offered by the bottle and the peculiar way of life
characterizing all Skid Rows.

Even those Skid Row residents who are alcohol addicts are not typical. As
we have already seen, the typical alcoholic is a middle-class man who
holds a job, whose wife and children have not yet left him, and who has a
tentative place in the community. Such a man may look with scorn upon the
Skid Row bum, using him as the example of the “true" alcoholic. In a way,
he is right. The only thing two such individuals may have in common is
addiction to alcohol. This is sufficient, however, to make their behavior
similar in many respects.

The larger number of men and women who end up on Skid Row are from
families whose financial and intellectual resources were limited. They are
persons whose endowment often was low, and who lack the support of
others in their attempts to cope with the disaster of chronic irresponsibility
and illness. This is not to say that there are no formerly "respectable"
alcoholics on Skid Row. Any examination of case histories will reveal a
number of persons who have drifted down from middle-class respectability
to this, the bottom of the social order. But for the middle-and upper-class
alcoholic, whose cultural and financial resources are so much greater than
that of the typical Skid Roader, it is difficult to imagine himself becoming
the bearded panhandler dressed in castoff garments, sleeping in doorways,
stealing hub caps to sell for about the amount needed for a pint of wine,
drinking bay rum or canned heat, in and out of police court, local jail, drunk
farm, with occasional interludes in the city hospital. Pointing to the derelict
and saying, "This is what will become of you if you don't stop drinking,"
seems to do little good. That "bottom" is too far away for the typical
alcoholic to comprehend.

Furthermore, we know it is not necessary for alcoholics to go through all

this himself in order to get well, as we shall see in a later chapter. Bottom
can be brought to the alcoholic in whatever stage or phase of his drinking
career he may be. Along with the realization that the only place he goes is
down as long as he continues to drink, the alcoholic needs an alternative.

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One may think that anything would be better than what he is doing, but not
the alcoholic.

Drinking, as we have said time and again, is everything to him. All

problems are solved, all needs are met, all relationships are secured for him
in the bottle. He needs nothing more as long as he can keep the world
outside his consciousness. For him, the real tragedy is that he cannot be
drunk all the time.

We see alcoholics making pitiful attempts to right the situation without

giving up drinking. For example, a man consents to accompany his wife to a
psychiatrist's office. He has been drinking addictively for years, hates the
condition in which he finds himself, but sees no way out. All he wants is
someone to tell him how to continue drinking without getting into trouble,
having blackouts and hangovers. He describes his visit as a ten minute
conversation at the end of which some money went from him to the
psychiatrist. At no time did he feel that the psychiatrist could help him,
because to him anything that meant not drinking was no help. He says, "I
didn't think he was going to wave a wand or anything, but I couldn't see
wasting money going to a doctor like that." He might just as well have said,
"I couldn’t see wasting good drinking money going to a doctor like that."

Another man, at his wife's urging, went to see a psychiatrist. He reports, "I
didn't mention anything about the drinking. I didn't want to bother him with
trivial matters!" This attempt to quiet the nagging wife is one of the
commonest reasons for going to doctors, clinics, or to Alcoholics
Anonymous. Here is an example.

My wife and I had reached the point where I had to do something. Things
were really rough at home. I left the (Alcoholics Anonymous) literature on
the table, and the next day my wife wasn't talking to me. I went down to the
A.A. that evening. Now, when I went in and left the literature—that was the
time I started using it as a crutch more than anything else. The literature at
home—my wife read it, and it gave her some feeling. I was planning this
each day as it went along. It took the pressure off me at home.

He actually did stay sober for nine months, but, as he said, he had never
really intended to give up drinking. In a way, it was a demonstration of his
love for his wife. Not drinking for nine months represented a gigantic
sacrifice.

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But, at this time he could not visualize a whole life completely without
alcohol, even for his beloved wife.

We have said that bottom can be brought to the alcoholic, thus making
unnecessary what used to be thought of as the required amount of suffering
before the alcoholic could be helped. The literature, such as was mentioned
in the quotation above, visits to psychiatrists or others who know something
about alcoholism, all can serve a purpose.

It is that they bring home gradually to the alcoholic the knowledge that
something is known of the course of his disorder, that others have suffered
in the same way from the same thing, that alcoholism runs a course like
other diseases or disorders, and that the course can be interrupted. Thus, the
alcoholic comes to see where he is, where he is going, what he can hope
for, and what can be done if he tries. Then, there comes a moment, and the
more the alcoholic knows of his situation the sooner it appears likely to
come, at which he says, "I'll try," and means it.

Because therapy for alcoholism has only one major goal—total abstinence
for the alcoholic—the alcoholic is being asked to give up something of
basic value to him. Naturally, he doesn't want to give it up. For this reason
he will go from doctor to doctor, social worker to social worker, and as
long as he hears, "You ought to cut down your drinking, “or, "You ought to
pull yourself together," or, "Don't you see what you are doing to your
family," he knows he is not being seriously considered as one who has a
real problem. Advice of this sort simply tells him that he is weak, unkind,
foolish, not sick. The person who gives it has no comprehension of what he
is asking the alcoholic to do, how great the sacrifice is that he is demanding.

Let such a moralist, scoffer, "backbone stiffener" imagine that on a black

night he is standing on the edge of a cliff.

He has never been there before, and knows nothing of what lies below. He
has been stumbling around in the dark and is bruised and bleeding. All
around him are voices saying,"

Jump Jump! Jump!" They tell him to jump in order to save himself, his
family, to get rich, to be happy. Would the “pull yourself together, Old Man"
type have the courage to jump? This is in effect what he is asking the

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alcoholic to do. As bad as it is for the alcoholic, he knows where he is.

It is not a nice place to be, but he does not know if by launching into the
night he will better his lot.

When we look at the alcoholic's position in this way, we no longer wonder

that many never "jump." But some are fortunate enough to hear another voice
saying, "I once stood where you now stand. I, too, heard the voices. I shared
your fear. But it was so bad where you are that I jumped.

The fall wasn't pleasant, but it was bearable. It's better down there. I know."

It need not always be another alcoholic who has “jumped" who can give this
advice. Perhaps it is a doctor who has treated alcoholics and knows they
can get well.

But, whoever it is, he is asking the alcoholic to surrender, to abandon

himself to the effort to get well. He asks him to believe that it can be done,
and that the alcoholic will be better off from his point of view than he is
when drinking.

The difference between the man who was dry for nine months in order to
please his wife, and the alcoholic who just wants help and is not making
"deals" which will relieve the pressure on him is this matter of surrender.
For the alcoholic it is the end of something and the beginning of something
else which, at the moment, he does not understand. It is significant that the
first of the Twelve Steps which constitute the program of alcoholics
Anonymous involves this notion of surrender. It reads, "We admitted that we
were powerless over alcohol—that our lives had become unmanageable."
How different this is from the alcoholic who says, "I can quit any time I
want to," and then just does not want to! The psychiatrist Harry Tiebout has
been particularly interested in the phenomenon of surrender, the conditions
under which it occurs and what it really means. He has contrasted surrender
with compliance, showing that the latter is what one does when he goes
along with outside pressure without actually changing inside. True
surrender, Dr. Tiebout feels, involves an experience like religious
conversion. It involves a turning about of one's beliefs, so that he actually
makes new beliefs a part of himself.

When we described the man who stayed sober for nine months in order to

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keep his wife happy, we were talking about an instance of compliance. As
he himself said, he had not really given up drinking. Alcoholics may agree
intellectually that they should not drink; they may and usually do promise
themselves and others they will not drink; but this is all an intellectual,
conscious adjustment to the reality. Subconscious needs and desires to drink
are not touched. Here is the basic difference between compliance and
surrender. One is conscious, somewhat forced evaluation of and agreement
with the reality of the alcoholic’s life; the other is emotional, unforced,
deep-down acceptance of the reality.

Reaching or seeing bottom is part of this phenomenon. A description by Dr.

Tiebout of one of his cases shows us more clearly than anything else what is
involved.

The patient is a man in his early fifties, highly successful in his business and
referred to by his associates as Napoleon because of his autocratic methods
when stirred up. For years he drank heavily to the point of frequent
intoxication. This interfered to some extent with his efficiency but never to
the degree that his business really suffered. My first contact with this patient
occurred some 6 or 7 years ago when he came to Blythewood to "dry out."
Pursuant to our policy of trying slowly and from time to time to educate the
patient about the danger of his condition, we permitted this man to remain
just for the drying out, at the same time telling him that, in our opinion, he
was headed for trouble if he continued on his present course. Without
putting any pressure on him and thus arousing his resistance, we placed the
facts before him and let it go at that.

We continued the policy of letting him come and go pretty much as he

pleased, always, however, keeping uppermost before him the need to do
something about his drinking and always making it evident that we were not
interesting in drying him out but in the real problem of helping him stop his
drinking. Later on and in retrospect the patient, in referring to these tactics,
said, "I used to like to come here. You didn’t always argue with me, yet I
always knew just where you stood and knew I wasn't fooling you any."

During all this time, however, I was working on his life situation so that
ultimately it would provide the necessary dynamite to jar him loose from his
whirl of self-centeredness.

Gradually his wife gave up her protectiveness and, before the time of his

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last admission, nearly 2 years ago, she had determined to leave him if his
drinking continued. Moreover, as a result of some discussion with me, his
business partner, who was really a junior in the firm, had decided that he
with several key members of the company would tender their resignations if
the patient did not make a real effort to mend his ways.

After a particularly severe bout the patient was again induced to seek
admission to Blythewood. This time, however, I told him firmly that he must
sign himself in for 30 days or go elsewhere; we were through, once and for
all, with letting him run his case. He looked startled, picked up his hat,
fingered it, and then put it on his head, saying, "Where’s your pen? I'll go to
Hilltop where I belong," referring to the cottage where he had sobered up on
previous occasions.

Within 3 or 4 days he was no longer drinking and could think reasonably

straight. He was then informed of his wife’s decision. Instead of ranting and
making clear where she could go, he discussed for the first time the hell he
had put her through and really seemed regretful. By the end of the first week,
quite prepared for trouble, the partner told him of the pending resignations if
the drinking persisted, only to be surprised and pleased with the patient's
quiet acceptance of the decision and an acknowledgement of his own real
wish to be different. The patient soon joined Alcoholics Anonymous and is
now an active member of that organization in his home community. He has
stayed sober up to the present.

Recently, in discussing his experience, he said, "You did something to me

when you made me sign that card. I knew you meant business. I knew my
wife was getting sore and that Bill (his partner) was fed up; but when you
showed you were through fooling, that was a clincher. I knew I needed help
and couldn't get out of it by myself. So I signed the card and felt better right
off for doing it. I made up my mind I wasn't going to run my own case any
longer, but was going to take orders. Then later I talked with Chris (his
wife) and learned how she felt, and then Bill came along, and I knew deep
inside my heart they were right. But I didn’t mind. I didn't get angry and
want to argue like I used to. I kind of surprised myself by agreeing with
them.

It sure was nice not to have to fight. I felt calmer and quieter inside and have
ever since, although I know I'm not out of the woods yet."

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We see in the handling of this case a dramatic instance of the process of
bringing bottom to the alcoholic. The reality of the situation was that if he
did not change his way of life, the alcoholic would lose his family, his
business, and his refuge. What the doctor did was to bring all this home to
him, but with an alternative way of life offered at the same time. This is the
difference between trying to punish an alcoholic out of his drinking, and
treating him. Certainly punishment is involved here, and the punishment is
immediate. What is more, it is the alcoholic himself who is being punished
and who can do something about it himself by accepting a new way of life.
He has previously been immune to tales of the suffering he was causing his
family and business associates. Now, it is he who is hurting.

Tiebout points out in another article that compliance may actually interfere
with the achievement of sobriety.

As he says, because the drinker is outwardly agreeing and inwardly

disagreeing, feelings of guilt and inferiority are emphasized.

Compliance makes the problem more acute without offering anything in the
way of solution. It serves to protect the alcoholic against the realities of his
life conditions.

The tragedy of alcoholism does not lie so much in the number of instances of
compliance which deteriorate into further drinking episodes. The real
tragedy lies in instances of readiness for surrender when the alcoholic does
not have available to him at that time the resources of those who understand
his problem. There is no one present at the time of surrender, or the
alcoholic knows of no resource to which he can turn at this moment of
vulnerability and hope. We shall see that modern developments have made
this tragedy less frequent in those parts of the country having adequate
educational and treatment programs.

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CHAPTER 8

Getting Well

We have seen that drinking is the alcoholic's way of life.

In surrendering, in admitting that he is an alcoholic he exchanges his

drinking for the mere promise of something better. For the alcoholic who
had been an established adult before his drinking interfered seriously with
his life, the promise has some content. He remembers that there is something
to which he can return. The fuller and richer his pre-alcoholic life, the better
are his chances for recovery.

The opposite is also true. The young alcoholic who becomes a problem
before he has established an adult position in society offers difficulties in
treatment that are often the despair of experts. Take the case of a young
veteran whose first drinking occurred while in the service. He went into
town with his buddies, had his first drink and became drunk for the first
time. From this point on, he was fascinated by the challenge of "drinking
like a man." Despite all his efforts to be a "good drinker," almost every
episode ended in drunkenness. His friends had to return him to barracks, but
being young and strong, he was always able to function in the morning even
though he often wished he could avoid duty. Eventually he was shipped
overseas with a combat unit, and like most young men, served competently
in combat. He had a few opportunities to drink and met them with the same
results. Fortunately, the life of a combat soldier in war does not provide
unlimited opportunities to drink, so his behavior went unnoticed.

The real problems did not come until the fighting ended and he found
himself in the occupation forces in Europe.

Now, drinking was regular instead of occasional, but the pattern remained
the same. Blackouts were soon coming regularly. During the occupation he
met a girl native to the country, lived with her a while, and then obtained
permission to marry. At the end of his time in service, he brought her back to
the United States.

Although he was trained as a mechanic and was unusually competent when

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not drinking, he had the alcoholic's trouble keeping jobs. Eventually, he
deserted his wife and two small children. They were interfering with his
drinking.

He was arrested for desertion and non-support, found guilty, and given a
suspended sentence to a county house of correction. The conditions of the
suspension were that the prisoner follow the direction of a supervising
probation officer who required the prisoner to report to him once a week,
get a job, and turn an adequate portion of his earnings over for transmission
to the wife. He was also required to go to someone—Alcoholics
Anonymous, a private physician, or a clinic for alcoholism—for treatment.
Although the alcoholic went through the motions, even contacting a member
of alcoholics Anonymous who made himself available right at the
courthouse for alcoholic prisoners, nothing seemed to touch him. He was
picked up again, his sentence which had been suspended was now executed;
he was sent to the house of correction for six months. During his time his
wife and children were supported by the welfare department. When he was
released from the house of correction, the same thing occurred, and he was
back behind bars in three weeks.

This pattern was to continue for years, but during all this discouraging round
of failures something was happening. The no longer young man was learning
and growing.

His periodic contacts with psychiatrists, other professionals, and laymen

who were trying to help him eventually led to the establishment of the
notion, only that, that there was a way of life that did not include drinking.
For him, it was particularly difficult because he had had no experience in
living a normal adult life with acceptance of the usual responsibilities. He
is still not "well," but he now sees some hope.

For another man who did not take his first drink until he was in his late
twenties, already established in his profession, with a wife and children to
support and who supported him emotionally, the situation was entirely
different. When his drinking led to the point at which he sought help, he was
still working and living, in a very strained manner, with his wife and
children. With the help, in this case, of psychiatrist and social worker, the
home began to approach normalcy.

Because the chief characteristic of the alcoholic's drinking is that he cannot

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control it, the first task which pervades all programs of treatment is to keep
him from taking the first drink. The long-range goal is to enable him to have
a happy life without drinking, but this is dependent upon his not drinking at
all.

Contrast this aim with the advice so often given the alcoholic by unknowing
physicians, friends, employment managers, wives: "You ought to cut down
your drinking. It's all right to take a drink or two; it may even be good for
you; but you ought to leave it at that." This kind of statement or advice is
convenient for the alcoholic's own system of rationalizations, but it does not
help dry him up.

For this reason, teaching the drinker that he is an alcoholic is one of the
steps which are part of any form of treatment of alcoholism. Wives will
sometimes ask, "Isn’t there some drug that I can drop in my husband's coffee
when he isn't looking that will make it impossible to drink?" There actually
is a drug, disulfiram, which, as we shall see, does make it difficult for the
alcoholic to drink when he has it in him, but it cannot be used in this way.

In order to achieve results that are more than momentary, the alcoholic must
know something about alcoholism from more than his own distorted point of
view. He already knows how serious it is, how miserable and degrading the
results of drinking are, but what he usually does not know is how he shares
with others—millions of others—a condition over which he has no control
and which he cannot defeat without stopping drinking.

The alcoholic must have something to which to surrender before he can give
up. This "something" may very well be the realization of what his situation
is: that he cannot drink. We have already seen how this is expressed in the
program of alcoholics Anonymous. Once the alcoholic accepts himself as
such, the possibility for improvement of his situation exists. Without such
acceptance, the future is unpromising.

When the alcoholic goes for treatment of his condition, the nature of the
treatment depends upon how the treating agency regards alcoholism. At this
point, the existence of conflicting views of alcoholism mentioned in an
earlier chapter, becomes relevant for us. If a treating physician considers
alcoholism to be an organically determined condition, then his treatment
will be organic. If treatment is by a psychiatrist who considers alcoholism
to be symptomatic of an underlying personality disorder, then treatment will

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attack the disorder. If alcoholism is regarded as a psychologically produced
compulsion, then treatment will attempt to break up the compulsion.

But, whatever the point of view, the actual treatment programs bear certain
resemblances to one another. Fully developed alcoholism involves all
aspects of the addict’s life: his physical, mental, emotional, spiritual, and
social being. One can have almost any point of view regarding alcoholism
and still recognize that these areas of life are involved once alcoholism has
developed.

This does not alter the fact that the steps the treating agency takes differ from
place to place. For example, one may go to a clinic run by a physician who
believes that alcoholism is caused by malfunctioning of the adrenal glands.
The treatment, particularly insofar as drugs are used, will be designed to
improve the functioning of the glands. However, the probability is that along
with the specific treatment designed to deal with the specific problem that
the doctor thinks is the cause of alcoholism go a number of things. The fact
that the alcoholic has come in for treatment indicates either compliance or
surrender, to use Tiebout's terms. If it is the latter, then the alcoholic wants
the treatment to work, whether he understands it or not. He has given up
trying to run his own life; he has turned it over to someone else. So, the
desire to be helped works for the patient. Furthermore, the patient's asking
for treatment for alcoholism means that the doctor and others are working
for the patient, not for his family or employer or anyone else. Alcoholics are
fond of saying that they are selfish. By this they mean that they got drunk for
themselves and that they are now sober for themselves.

Appeals for the wife or children don't sober up addictive drinkers. The
complaint of the alcoholic who, when he sought help from clergymen found
that they wanted to help his wife and child, is an example of this. The doctor
helping the alcoholic is working with him on his own problem. They are
dealing first with the drinking, not with matters secondary to drinking. By
helping the alcoholic to stay away from the first drink, the doctor helps him
to be accessible for help with problems resulting from drinking.

Some systems of treatment try immediately to interfere with the possibility

of taking the first drink. We have already mentioned disulfiram, more
familiarly known by its trade name "Antabuse." This drug must be
administered under medical direction. Certain persons because of physical
conditions such as heart ailments cannot take the drug.

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Furthermore, dosage has to be fitted to the patient. This can only be done by
a responsible physician.

What Antabuse does is to prevent anyone who has taken it from drinking.
Once the proper level of Antabuse in the blood has been achieved, if one
takes a drink, there is an unpleasant reaction. The drinker flushes, his heart
beats irregularly, he gets sick. This prevents the cycle of drinking in which
one drink is the start of a binge. Having taken the first drink, he cannot keep
it down and he is unlikely to take another. Moreover, the effects of Antabuse
last several days, so that the alcoholic cannot succumb to a momentary
impulse to drink. If he doesn't drink, there is no effect.

Many alcoholics report a feeling of comfort, or security in the knowledge

that they cannot drink. They themselves do not have to battle when taking
their Antabuse; the issue has been settled before it begins.

As with any other treatment of alcoholism when new, Antabuse was

regarded as the answer to the problem of alcoholism. All we had to do was
to have all alcoholics take their Antabuse regularly, and the problem was
ended, except for the comparatively few who couldn't take Antabuse for
physical reasons. It was soon learned that Antabuse was another tool, not
the whole kit. Alcoholics found ways of avoiding taking Antabuse.
Occasionally one would want so badly to drink that he drank right over the
Antabuse reaction. Using Antabuse was recognized as a complicated
process involving more than seeing to it that a man swallowed the drug. It
became necessary to have him want to take it. Here, older programs and
techniques play their part.

If the alcoholic had truly surrendered, if he had reached some kind of

emotional bottom and wanted to change the situation, then Antabuse (or
probably any of the other systems of treatment) was successful. If he had not
surrendered, then nothing helped. A group at the University of Cincinnati
College of Medicine contrasted the attitudes toward Antabuse of two groups
of patients taking the drug while undergoing group therapy. One group was
made up of patients who were successfully treated (they stopped drinking),
the other of unsuccessful patients. Here are some of their quotations from the
latter."Antabuse makes me feel like a mouse.”

“The members of the group are guinea pigs for Antabuse.""It isn't good for

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alcoholics on Antabuse to hear of failures on it; this makes them doubt its
power." These and other statements are expressions of hostility and distrust.
They indicate that the alcoholic is doing what he is told, but that it is not
what he wants to do. Compliance rather than surrender characterizes his
behavior.

Contrast these with statements from patients who suffered no relapses while
in treatment.

"I can't take a drink now; I don't want to get deathly sick."

"Taking Antabuse is just like going to work; you've just got to."

"Any other pills I'd have thrown away by now, but I keep taking these."

"We need this stuff; it doesn't need us."

Here we have statements that indicate true surrender.

These alcoholics know what their situation is, and they accept it and
Antabuse's part in it. However, as the doctors from Cincinnati point out,
even those who are successful in the treatment went through phases of
hostility and resentment. Those who failed, never went beyond these
feelings.

Another approach to preventing the first drink in use many years before
Antabuse came on the scene is based on the development of an anti-drinking
habit. It is variously known as "aversion treatment" or the "conditioned
reflex treatment." The alcoholic is given a drug which will make him
nauseous and at the same time he is given a drink. Eventually, the
association between drinking and nausea is so strong that the sight of a
bottle is enough to make the patient feel queasy. A number of variations on
this pattern are used, but the general outline is as related.

An alcoholic who had been through a course of aversion treatments

describes it like this. What happens—I should know the names of the things,
but it doesn't make any difference—you take a couple of pills before you go
in to step up the heart and, I think, the other one is more or less of a
sedative. And then you take a capsule, and you get this drug injection. They
start by setting the liquor in front of you and you take a drink. First he (the

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doctor) tried to find out what liquors I drank the most and in the order I
would drink them. And then I would take just a sip of the liquor I happened
to be playing with at that particular moment. I would be told to swallow
some of it, and at about that point it was beginning to taste something awful
anyway, but about the time you swallowed it, of course, you were violently
ill. There was a bucket there fixed on a chair. And that goes on for half or
three-quarters of an hour. Apparently it was the timing of the drug. If you get
to the point where it is going to work, you try to drink some liquor and it just
doesn't go down, and it begins to taste and smell distasteful. It is interesting
to me that a couple of times I would go in and if they opened up the cabinet
door where the liquor was, I mean even before I had any drug of any kind, I
would become ill. Even now [months after his last treatment] I get a feeling
of nausea sometimes when I see liquor.

The treatment takes place over several days or even weeks during which
sessions of associating drinking with illness occur. Even after this
procedure has been completed, the patient is not through. He will return to
the hospital periodically during the next year to go through a brief, one-day
version of the treatment he has already undergone. These are referred to as
reinforcements and serve to strengthen or maintain the original aversion.

Because the entire conditioned reflex treatment involves a major

commitment by the alcoholic, experts in this method have stressed the need
to select only certain alcoholics for admission to it. Some comments by Dr.
Lemereof the Shadel Sanitarium in Seattle, one of the most experienced
agencies in the use of conditioned reflex treatment, illustrated what the
doctor looks for in treating the alcoholic this way.

A genuine desire on the part of the patient to stop drinking is the sine qua
non of any treatment of alcoholism.

The alcoholic must have reached the point in his drinking career where the
pain of drinking becomes more powerful than the pleasure of alcohol escape
before he can be treated successfully.

The fact that the patient pays several hundred dollars for treatment acts as a
deterrent against relapse.

A hospital devoted solely to the treatment of alcoholism is highly desirable.

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Lemere also stresses the need for contact with the patients, saying that the
reinforcement sessions provide the doctor with such an opportunity. At the
Washingtonian Hospital in Boston, Dr. Thimann, its medical director, has
intensively developed this technique. Regular meetings are held with
"graduates" of the conditioned reflex treatment.

These men and women meet as often as twice a month to discuss the
problems they are having in staying sober. As the years go on, they develop
keen insight into their earlier and current problems. Some in attendance
have been as long as seventeen years without a drink but still come in order
to receive the support given by the hospital and their fellow alcoholics.

Both systems of treatment, Antabuse and conditioned reflex, serve to break

into the compulsion to take the first drink. They interfere in the one case
because the drinker knows how sick he is going to feel if he drinks, and in
the other, because the drinker feels sick at the thought of drinking. However,
all experts in the use of these forms of treatment agree that they do not stand
alone. Each must be combined with some other form of treatment in order to
obtain lasting results. Most frequently spoken of is individual
psychotherapy. This involves talking with some one, a psychiatrist,
psychologist, social worker, or other trained person, in order to get insight
into the problems bothering the drinker. Of greatest concern are those
problems which have been with the drinker a long time—which are deep
seated. Remember that the majority opinion on the causes of alcoholism
holds that it is a person’s way of coping with a personality disorder. The
emotional stress causes one to drink, and the relief one gets keeps him
drinking. From this it follows that treatment to remove the personality
disorder would effectively eliminate the need to drink compulsively.

We know things do not work out this way. Whatever it may be that caused
the person to develop addiction to alcohol, once it is there, treating the
personality disorder is not enough to restore the alcoholic to normalcy in the
sense of permitting him to become a normal social drinker.

The record of success in treating alcoholism by individual psychotherapy

alone is relatively poor. Not the least of reasons for this is the fact that
alcoholics rarely stay sober long enough to enable the psychotherapist to
treat them. As Clinebell has pointed out, "intensive psychotherapy is along
and psychologically painful process. The alcoholic, with his low
frustration-tolerance, cannot tolerate the anxiety accompanying the therapy.

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When it becomes painful he retreats to his painkiller, alcohol."

Here is where some who treat alcoholism find Antabuse and the conditioned
reflex treatments useful. They keep the alcoholic from drinking long enough
for the reconstruction of his personality and his way of life to take place.

Most formal individual psychotherapeutic work with alcoholics is done

either by psychiatrists or under their direction. Dr. Sidney Vogel has
described what the psychiatrist does.

The psychiatrist has no magic or mystical method up either sleeve. Based on

his knowledge of human drives and behavior, he attempts to understand the
origin, dynamics, development, and causes of the patient's feelings and
behavior. With this knowledge he tries to make the patient examine and
understand himself in a clear, objective light in order to mobilize the healthy
and eliminate the unhealthy feelings, attitudes, and behavior.

Translating this into terms relevant to alcoholism, what the psychiatrist does
with the patient is to look into all aspects of his adjustment to the world.
Included in this, naturally, is the patient's use of alcohol. The patient learns
what alcohol means to him, and, of equal importance, he also learns that
things do not have to be this way with him.

The drinker gets insight into his problems, the way he has typically met
them, and the way he can change so as to meet them more effectively. In
short, a reconstruction of the personality takes place if the therapy is
effective.

Not all individual psychotherapy takes place over long periods of time or
plumbs the very depths of personality. Sometimes the situation calls for
limited contact with the psychiatrist during which the alcoholic gets some
insight into what is going on in him, and learns of ways of helping himself.
Often this involves going to some other facility for treating alcoholism,
including the fellowship of Alcoholics Anonymous. The psychiatrist then
depends upon changes in personality occurring as a result of the alcoholic's
sobriety and his contact with other agencies such as A.A. Often the only
psychotherapy consists of instruction on the nature of alcoholism. This is
most often the first step, no matter what follows. The alcoholic is made to
feel that he is an acceptable person who has a problem that others have had,
a problem that runs a certain course, and that can be solved.

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Paradoxically, some of the most effective therapy is done with alcoholics
who are not as yet ready for treatment—who have not surrendered. The
therapist, by skillfully relating the drinker to the problem of alcoholism, by
convincing him of the sureness of a disastrous future unless things change,
often makes the recalcitrant alcoholic available for help. Even if it does not
"take" on that try, it may very well have a cumulative effect that will show
up later.

Sometimes what is effective in the relationship between psychiatrist and

patient is unpredicted. An example of this is an alcoholic, already
mentioned in Chapter 2, who came to a clinic and, after his admission
interview with the social worker, was seen by the psychiatrist. The
alcoholic was not at the clinic because of surrender, but because he had
been forced to come by the medical director of his company. During the
course of the interview, the man related that in the last few months he found
himself getting drunk, blacking out, having severe hangovers even though, he
said, he really was not drinking much. He said that a change had come on
rather suddenly. Later on, in discussing alcoholism and what can be
expected, the psychiatrist mentioned that alcoholics frequently have
damaged livers. His patient seized upon this as the explanation for his
recent drinking troubles. He decided that he was unable to control his
drinking because his liver was not functioning properly. Being a logical
person, despite the seeming illogicality of seizing upon a very doubtful
explanation of his troubles, he told himself that a person with an already
damaged liver who was having his kind of problems, could no longer drink!
It made sobriety necessary and meaningful to him.

For this man, surrendering to what he felt to be the realities of his physical
condition was more readily done than surrendering to the realization that
any emotional problems were involved. To him, any mental or emotional
problem was a sign of weakness. Furthermore, he was not going to stay
sober for anyone other than himself. Thus, his version enabled him to keep
his self-respect intact. What the future holds for him is not clear. Certainly
other alcoholics have stayed sober in part because of false pictures of the
physical nature of alcoholism. The important thing is that they believed
certain things to be true.

The development of clinics such as we have just mentioned is one of the

most interesting and important newer aspects in the treatment of alcoholism.

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The basic team usually involved consists of psychiatrist and social worker,
although others are brought in as they are needed. The location of clinics in
general hospitals assures the possibility of getting treatment for the many
medical problems which face alcoholics.

Among those who treat alcoholics there is controversy on specialized

versus general facilities for treatment. Some feel that the clinic which
handles the alcoholic should be the general psychiatric clinic and not one
which specializes in alcoholism. They regard alcoholism as just one more
psychiatric problem to be treated the same as others. Further more, they
reason, the alcoholic ought not be singled out by having a special kind of
clinic for him. He ought to feel that he is coming to the hospital, specifically
to the psychiatric clinic, just as any other sick person comes and that his
condition has the same respectability and acceptance as other illnesses.

At the other extreme are those who believe that alcoholism should be
treated in separate facilities entirely. Dr.Lemere whom we quoted above is
an example. Instead of going to a general hospital, they say the alcoholic
ought to go to a special hospital for alcoholics. The feeling is that most of
the treatment gains are made as the result of contact with specialists in the
field of alcoholism and with other alcoholics with whom the patient can feel
a kinship.

Furthermore, new specialists can be trained more easily in this atmosphere.

Typical of such institutions are the Shadel Sanitarium and the Washingtonian
Hospital, both of which have already been mentioned.

The most "popular" practice is the inclusion of a special alcoholism clinic

in the general hospital. In addition, many hospitals which accept alcoholics
as patients have separate facilities in the form of special wards or a given
hospital wing. What this amounts to is a special hospital within a general
hospital. The argument here is that the alcoholic patient can have the
advantages of associating with others who have the same difficulty but is not
stigmatized by going to a hospital which treats only his kind, and he also has
all the general hospital resources available.

Although the typical clinic for alcoholics operates in a general hospital

setting, some are established in as unlikely places as a courthouse, the
medical department of a large company, in a social agency, or in any one of
a number of different settings. However, all bear a resemblance to one

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another.

Treatment of the alcoholic in a clinic tends to be a combination of a number

of forms of treatment. Conditioned reflex treatment is not used under these
circumstances because, as we have seen, it requires hospitalization.
However, Antabuse may be prescribed and an alcoholic may go through
individual or group psychotherapy. But what is added in the clinic setting
for psychiatric treatment is the possibility of a team approach. Having a
social worker in partnership with the psychiatrist means that not only the
alcoholic himself is treated, but his total situation. That is, while the
psychiatrist is seeing the alcoholic, the social worker may find it desirable
to talk with the alcoholic’s wife. Just as the alcoholic needs insight into his
condition, so does his wife need help in understanding what is happening to
herself and to her family. She has to learn the nature of the process her
husband has been going through, what he has been suffering, and what can
be expected in the future. She will learn not to be overly impressed with
immediate results, but to have respect for whatever progress her husband
does make. She will find that she has a part to play in the reconstruction of
her husband's way of life. Furthermore, it may develop as work with her
proceeds, that she has actually been contributing to her husband's problem.
A study of wives of alcoholics at the Washingtonian Hospital conducted by
Miss Gladys Price, Director of Social Service, is summarized by her.

The wife, a basically insecure person, brought to her marriage feelings of

insecurity which she hoped would be met by her husband. She expected him
to be a strong, dependable, responsible person. As his responsibilities
increased, however, he proved to be likewise a dependent person, unable to
bear his wife's insecurities because he himself needed someone on whom he
could lean. As he failed to be a strong, supportive person, able to manage
the family responsibilities and meet his wife's needs, she felt unloved,
resentful, and aggressive. She therefore put more demands on her husband
and, as a result, he was less and less adequate. Thus the vicious circle
began. When the wife felt unloved because her husband was unable to let
her be the dependent person, she became hostile and aggressive, and strove
to prove that he was inadequate in order to justify his seeming lack of love
for her. The wife found some outlet, frequently using the children as the
focal point of the difficulties between them.

In some instances she went out to work, and sometimes she found
satisfaction in being able to perform adequately in other areas. The strain,

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however, continued to exist and, unconsciously and perhaps even
consciously, she fought treatment for her husband because she used his
drinking as one more way in which she could prove him and keep him
inadequate.

An interesting aspect of Miss Price's study is revealed in the two case

histories she reports. In one case she saw the wife at the request of the
patient who wanted to enlist her aid in getting his wife to do just what he
wanted. In the other, the physician who was treating the husband asked her
to see the wife. The use of social service to help the wife (or husband) of
the alcoholic was a relatively new practice when Miss Price started. Now,
the place of the social worker in the clinic for alcoholics is what makes it
so important and effective a treatment agency. If the alcoholic is to get well,
then all aspects of his life which have been damaged as a result of years of
abnormal drinking must be repaired.

For one family, the combination of resentment of her husband’s alcoholism

and the tragedy it had brought them, as well as her distaste for sexual
relations led to a situation in which the wife, either consciously or
unconsciously, created conditions for her husband that made it almost
inevitable that he return to drinking. She had refused to have any sexual
contacts with him during the time he was drinking, but this refusal continued
even after he had been sober months and years. Furthermore, she began
keeping liquor in the house whereas she had avoided this practice earlier.

Eventually, the "gains" of sobriety were questioned by her alcoholic

husband. It took several years for this to occur because of the heavy guilt he
felt for what he had done throughout his drinking career. He, too, considered
that he was being justly punished, but after several years of sobriety,
successful in every aspect except his life at home, this rehabilitated
alcoholic began drinking again. Had his family’s situation been such that the
treatment of the alcoholic had been handled by a team, so that someone
would have been working with the wife, loss of sobriety by this man might
never have occurred.

What this case and hundreds like it shows is that it is necessary to take the
entire picture of the alcoholic's life into consideration in treating him. If his
behavior is to be altered, reactions of others to him have to be changed. The
closer to the alcoholic someone is, the more important to the eventual
recovery of the alcoholic is his understanding of the situation and his own

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reaction to it. So often, the parents or spouse behave with a mixture of
unfortunate indulgence and equally unfortunate punishment. Nagging,
recriminations, and emotional deprivation are the expected daily lot of the
alcoholic. Often accompanying this, however, is indulgence which shows in
coddling, taking over responsibility for the alcoholic, and putting up with
more than one should or must. This becomes particularly destructive when
the alcoholic can be made to see bottom, but is protected from it by a well
meaning relative or friend.

One such man had had a long and "distinguished” drinking career, involving
a number of hospital and sanitarium stays for drying out, visits to private
physicians, as well as several arrests which usually resulted in a fine or
probation. In all these events, the bills were paid by an older sister who
worked hard, earned a good salary, and was financially able to provide
assistance. She took over many of the responsibilities of their dead parents,
not because she enjoyed it, but because she felt she should.

Every effort had been made to get the brother to take his situation and the
attempts at treatment seriously. Nothing seemed to touch him. Finally, he
was arrested again and, as usual, an officer of the court called the sister to
come and take care of him because he was physically run down and needed
hospitalization. But the sister had finally had enough. Her own life was
being destroyed; she felt she had to turn her back on her beloved brother.
Not only was the alcoholic surprised, but the court personnel were
astonished I They tried to influence her to take care of the man just as she
had in the past. Despite pressure she refused, feeling almost as if she were
pronouncing a death sentence on her brother.

For the first time in his drinking career, this man was on his own. He had no
one to soften any blow for him; no one to provide bail, pay hospital bills,
get him new clothes, find him a job. Instead of going to a private drying-out
place where he could stay comfortably drunk or under sedation for a couple
of weeks, he went to a jail. He felt abandoned, lost. But he also remembered
something of previous attempts to help him with his drinking. When he was
back on his feet and released from jail, he went for help. He obtained it and
achieved sobriety. After he was established again, he renewed his
relationship with his sister, but this time on a different basis. Now they were
two adults who liked one another, and one did not have to pick up the pieces
for the other.

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This case illustrates that it is possible for those who live with the alcoholic
to make it virtually impossible for him to get well. By preventing life's
realities from impinging upon him, or by behaving in so inconsistent a
fashion that he has nothing to hold onto, the alcoholic's loved ones insure the
very condition that he and they abhor. Social service workers in the program
of hospitals and clinics treating alcoholism take steps to create the social
conditions under which the alcoholic will get well. The alcoholic’s husband
or wife, his children, parents, friends and employers are taught that
kindness, fairness, and, above all, honesty are necessary in treating
alcoholism.

Honesty in treating the alcoholic simply means that people do what they say
they will do. If the wife says, "The next time you come home drunk I'm
leaving," it has no effect unless she really means just exactly that. If the
employer says, "Once more and you're through," it means nothing unless the
drinker really is "through." What is more, if the alcoholic can go from one
who means a lot to him to another and get a different reception from each,
then he is able to exploit his surroundings without having come to grips with
the realities of his situation.

This point of view has nothing to do with punishment, even though to the
drinker it may look as if the motivation is to punish him. Honesty and
consistency provide the alcoholic with a base point from which he can make
judgments of his situation. Obviously, someone who has been partially
befuddled for years is not in a position quickly to grasp any changes in his
condition or the condition of those around him. In some respects, he is a
retarded learner, just like any school child with an emotional problem who
fails to learn as rapidly and efficiently as his unimpeded intelligence would
permit. More than anything else, the alcoholic needs repeated, consistent
experiences with the same attitudes and treatment from all those who are
important to him.

So often consistency has been achieved when everyone finally gets fed up
and rejects the alcoholic. Wherever and to whomever he goes he receives
the same punishment of being cast out. This is really hitting bottom—when
the alcoholic has no one left. Once it was thought that this was the only way
that an alcoholic could finally be helped—by abandoning him so that he felt
he had to crawl back to the human race which had given up on him. The
suffering in such cases is overwhelming and sometimes unnecessary. Losing
contact with others who are important to him means that the alcoholic has

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also lost contact with resources for help. When we see how alcoholics
come to the treatment agency, how often it depends upon chance contact, we
can see that loss of human relationships can mean loss of opportunities for
effective help. A consistent attitude toward the alcoholic based on a
comprehension of his situation, is something that he will eventually
understand. This coupled with knowledge of resources available for
treatment, increases the opportunity for the correct suggestion to come
together with the right moment in the alcoholic's drinking career—for the
desire for a way "out" to occur when that way opens.

Take, for example, a man who found his sobriety through the combination of
conditioned reflex treatment, individual and group psychotherapy. When
things came to a head both at home and on his job he was able to take steps
himself to right the situation. As he says, There is a gentleman that I worked
with who was here [at the Washingtonian Hospital for treatment of
alcoholism] fourteen years ago, and I knew him when he was a drinker and
he was the type of drinker that these fellows talk about that would have the
shakes so that they couldn't stand it.

And he was down here, and he has told me about it over the years, and then
about a year ago I talked to him about the place but he didn't pressure me at
all. This night that my wife and I had this understanding in a way, I told her
to get hold of this fellow C, and he came over. I told him I was ready to try
anything, and so the next morning I was down here. I knew nothing about the
place except that he had been—and was sold on it and was successful with
it.

Another man who was treated in the same hospital and who had some
seventeen years of sobriety behind him describes the way in which he came
to find treatment. He tells of his troubles with drinking over many years,
during many of which he knew he was an abnormal drinker but didn’t know
what to do about it. He had just been transferred from one city to another by
the firm which employed him.

After I'd been here for a few years, there was a man that I’d worked with in
New York and he was my superior. I'm pretty sure he knew of my trouble
from New York, so he apparently started wondering what he could do with
the problem. For all I know he might have been told that he was going to
have the problem; I don't know. My mother had been dead then for about a
year. When my mother died I had a sister living in P, and I went down there

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to live with her. She was single. I commuted. Apparently this boss of mine
and she got together. Maybe it was while I was on one of my benders and
had not shown up for work.

Anyway, he had just moved here and was living in a suburb of B. He was a
Lutheran but he was going to a church, not Lutheran, because it was the
nearest one. And he got talking with the minister about whether there was
anything that could be done for an alcoholic. And just by chance the minister
had another parishioner who had been to the Washingtonian and had taken
this conditioned reflex treatment.

The minister told my boss of it, and he and my sister put their heads
together. They did check on the Washingtonian as far as they could. The only
thing they could find out from the Massachusetts Medical Society was that it
was an accepted institution. They didn't know about any treatment they gave
or anything. So, I guess I came off that bender, and I can remember talking
with my sister, and she said that if they could find any treatment for me
would I take it? And I told her yes, and, incidentally, I meant that. I meant it
entirely without reservation. I had no hopes of any treatment, but I would
take one. Anyway, in October I went on one [a bender], and when I came
back my money was all used up. And when I came home she said they had
found a treatment for me and would I take it? I said I would. I remember it
was a Saturday morning. It was 1942, the thirty-first of October. I came
home and she said they’d found this place in Boston and would I go. So we
came the next day. I came in here to take the treatment. I didn’t know what it
was. I didn't know anything about it, but I came in to take it.

Notice that in both these cases, contact with the hospital occurred almost by
chance. The fact that there were recovered alcoholics who had achieved
their sobriety with the help of the hospital meant that two new recruits were
obtained. In the second case, the man who came to the hospital in 1942, he
was indeed fortunate. There were not many facilities available for treating
alcoholism at that time, nor were there many persons who had sufficient
information to provide guidance to the alcoholic and his family. We can see
the necessity of having knowledge about alcoholism and its treatment
widespread in the community so that "accidents" of getting patients and
treatment together at the right time are more likely to occur.

We shall have more to say on this crucial matter in a later chapter. For some
alcoholics, no pieces of family life are there to be picked up when they

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achieve sobriety. The man or woman living in a part of the world distant
from his family, whose family has left him, who has left them, finds himself
at a loss during the time he is building a new way of life without alcohol.
Often, the bar or tavern has been "home, “and it is no longer appropriate.
Such persons find it extremely difficult to maintain sobriety mainly because
the results of sobriety are not gratifying. There is no wife or parent to
rejoice with them in their new physical and mental wellbeing. The comfort
and warmth of intimate human relationships are not available.

For the homeless, a relatively new device has been developed with some
success. It involves part time hospitalization, or part time residence in an
institution known as a “Halfway House." A few hospitals permit alcoholic
patients to go out into the community during the working day. The patient
gets a job and works at it, but he comes “home" at night and spends his
weekends at the hospital.

Similar arrangements are being made available by public welfare and even
correctional agencies. Here, the technique is the same, only the sponsoring
agency differs.

Thus, the institution offers the support of providing a friendly,

understanding, and somewhat protected environment.

The very fact that the Halfway House is so frequently successful shows the
importance of the social setting in helping the alcoholic. In the next chapter
we shall see this in dramatic form when we look at the program of
Alcoholics Anonymous.

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CHAPTER 9

ALCOHOLICS ANONYMOUS

There is no greater resource in the treatment of alcoholism than the already

recovered alcoholic. He stands as living proof that alcoholism can be
treated—that alcoholics can be restored to useful lives. We have seen
earlier that the recovered alcoholic is one to whom others can go when they
are ready for help. He can speak to the drinker with the authority of
experience, and the doctor or therapist can use him as an example of what
the drinker can achieve.

Because of its numbers and dramatic impact, the organization or fellowship

known as Alcoholics Anonymous occupies a unique position in the effort to
assist alcoholics. A.A. now consists of several hundred thousand persons
held together by the knowledge and acceptance of the fact that they are
alcoholics who are doing something about it. Members describe the
fellowship as an organization "started by drunks for drunks."A.A. took
shape in the latter 1930's when two alcoholics came together and
recognized that their fellowship was keeping them sober. One of them, Bill
had had a vivid religious experience which he felt was responsible for
achieving sobriety, but he as well as his companion Dr. Bob knew that a
program of some kind was necessary in order to maintain sobriety. Their
collaboration led to attempts, unsuccessful at first, to help other drunks.
Gradually a program emerged from their early experiences, and it came to
be described in the book Alcoholics Anonymous.

Growth of the movement was slow; it took four years to acquire one
hundred members. But from this discouraging start in Akron, Ohio, the
fellowship has developed to its present membership of around a quarter of a
million collected in approximately seven thousand groups in the United
States as well as several foreign countries. A kind of loose connection
among the groups is provided by a central foundation which publishes the
book and other A.A. literature and which acts as a central point for the
maintenance of A.A. traditions.

More than an organization, Alcoholics Anonymous is a point of view and a

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program. The alcoholic who comes into A.A. does so because he wants to,
not because of any compulsion provided by members. His ticket of
admission is a problem with alcohol and a desire to do something about it.

The program, largely summarized in the Twelve Steps we shall hear more
about later, is the shared experience of alcoholics who have gone before.
The new member can do things his own way, but he finds he benefits by the
experience of others.

The best way to begin to see what happens in A.A. is to attend a meeting.
There are two kinds: closed meetings for alcoholics, and open for
alcoholics and interested persons.

When we attend meetings we see that the members are devoting themselves
to the maintenance of their own sobriety.

They have no more important task than this, because without their own
sobriety they can help no one. But by sharing their experiences, they are also
reaching out to the alcoholic who has not yet found his way.

The meeting has a chairman, a member of the group. After a preliminary

statement of welcome and perhaps a brief description of A.A., he turns to
the first speaker. The talk starts with the formula, "My name is Jim, and I am
an alcoholic." From this point, the speaker tells his "story," an account of his
own experiences as a drinker and of his life in A.A. He may stick to a
recital of the facts as they occurred, and he may interject some of his feeling
about what has happened to him and his interpretation of A.A. Although
there is similarity, there is also infinite variety in the stories and their
telling. Some speakers are glib orators who obviously have done this
before; others are awkward and shy. Usually in a meeting three stories are
told. Between them, the chairman for the evening makes suitable additions
about A.A. and may even tell his own story in installments. The meeting
ends with the Lord's Prayer.

The stories or case histories usually stress different aspects of the life of an
alcoholic in and out of A.A. Variety is desirable because much of what is
going on at the meeting is aimed at the new or prospective member. The
more variety among the persons speaking and in their experiences, the more
likely it is that one of them will provide a story in which the "prospect" can
see himself. Thus, the process of relating himself to A.A. through another

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alcoholic can frequently be started at the meeting.

Often this process has begun even before the alcoholic comes to his first
A.A. meeting. It may be that he has been seen in his home or even in an
institution by members of A.A. who were doing what is called "Twelfth
Step Work. “This step refers to the experience of members of A.A in
carrying the message of A.A. to other alcoholics. The alcoholic may have
attended his first A.A. meeting in a prison, jail, mental hospital, tuberculosis
sanatorium, or in any other type of institution that receives alcoholics among
its clientele. Hundreds of groups now exist in such places.

The original edition of alcoholics Anonymous contained twenty-nine stories

of alcoholics, plus that of Bill W, one of the founders. In almost every one
there is reference to someone who was important in bringing the A.A.
program to the alcoholic seeking help. In many of the stories, the teller first
was in contact with A.A. at a hospital while recovering from the effects of a
drinking bout. This tends to be a time when the drinker is at a low point and
when he is looking for help. In an impressive number of instances, it was a
doctor, himself an alcoholic and an A.A. member, who introduced the
alcoholic to A.A.

Here are some of the ways persons telling their stories speak of the
"someone" who was the necessary link to A.A.

The Doctor Bob of "The Doctor's Nightmare" said of his friend, of far more
importance was the fact that he was the first living human with whom I had
ever talked, who knew what he was talking about in regard to alcoholism
from actual experience. In other words, he talked my language.

The "European Drinker" describes this experience. Then occurred the event
that saved me. An alcoholic came to see me who is a doctor. He didn't talk
like a preacher at all. In fact his language was perfectly suited to my
understanding. He had no desire to know anything except whether I was
definite about my desire to quit drinking. I told him with all the sincerity at
my command that I did. Even then he went into no great detail about how he
and a crowd of alcoholics, with whom he associated, had mastered their
difficulty. Instead he told me that some of them wanted to talk to me and
would be over to see me.

This doctor had imparted his knowledge to just a few other men at the time

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—not more than four or five—they now number more than seventy persons.

The central figure of "The Business Man's Recovery" described the

influential person in his introduction to A.A. like this.

The first thing that Bill told me was his own story, which paralleled mine in
most respects, and then said that for three years he had had no trouble. It
was plain to see he was a supremely happy man—that he possessed a
happiness and peacefulness I had for years envied in men.

What Bill had, the businessman wanted. Moreover, because Bill had lived
through experience very much like his own, "Business Man" saw that it was
possible for him, too, to achieve what Bill had. Bill was the proof that he
could do it.

Bill was important in still another case. Just at this time my wife heard of a
doctor in another city who had been very successful with drunks. She
offered me the alternative of going to see him or her leaving me for good
and all. Well ... I had a job, and I really wanted desperately to stop drinking,
but I couldn't, so I readily agreed to visit the doctor she recommended.

That was the turning point of my life. My wife accompanied me on my visit

and the doctor really told me some things that in my state of jitters nearly
knocked me out of the chair. He talked about himself, but I was sure it was
me.

As one goes through the stories of recovered alcoholics in the first edition
of alcoholics Anonymous, he sees something of the wonder of the
coincidence that brought drinker and A.A. together. After all, there were so
few A.A. members when that book was written, and so many alcoholics! By
the time the revised edition was prepared, it was possible to relate many
additional stories. The Preface shows what has happened during the time of
first printing in 1939 and the appearance of the revision in 1955.

When the book was first printed, we had scarcely 100 members all told, and
every one of them was an almost hopeless case of alcoholism. This has
changed. A.A. now helps alcoholics in all stages of the disease. It reaches
into every level of life and into nearly all occupations. Our membership
now includes many young people. Women, who were at first very reluctant
to approach A.A. have come forward in large numbers.

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The process of establishing a relationship between an existing member of
A.A. and a prospective one, a "newcomer” and guiding him into the
program is referred to as sponsoring. With many new prospective members,
the initial contacts between them and A.A. are made on person-to-person
basis. Thus, a team of two members called on a patient in a mental hospital.
Each spoke with the woman briefly. They gave her some literature and
offered to escort her to the next A.A. meeting in the vicinity. When she
attended the meeting with the permission of the hospital authorities, they had
already made the beginnings of a relationship.

In areas where there is a Central Service Committee with an office and

telephone listing, contacts are often made with the A.A. personnel available
there. The alcoholic himself or a relative or friend may call asking that
someone come to see him. When a request is made for an A.A. member to
visit the alcoholic it is not always granted, although groups differ in the
practice. A.A. personnel may make inquiries to establish the fact that the
alcoholic himself desires the help.

If he does, they will call on him. Others may feel that even if the
"newcomer" is not sincerely interested in stopping drinking, calling on him
and presenting the A.A. story will hasten the day when he will really want
the kind of help that A.A. can give. A.A. members often disagree among
themselves as to the possibility of hastening surrender in one who is not
ready. Often the point of view depends upon the member’s own experience.

Here is a woman who, after a number of years of heavy drinking,

discovered that other people knew about her problem. Apparently, this was
a terrible shock to her. A newspaper article appearing at about this time had
a profound effect on her.

I read an article written by one of our sports writers about one of our fine
baseball players who had to leave the game because he was an alcoholic;
and through the great fellowship of alcoholics Anonymous, he had been able
to go back to the game and do a wonderful job. Being a baseball fan from
way back, this made a great impression on me, and after a long bout of a
weekend of drinking; I thought I would look into A.A. to see just what this
was all about.

I didn't want to stop drinking; I wanted to control it. I find that most

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everyone who comes to A.A. comes with that one idea—not to quit entirely,
but to govern it. And so I looked into A.A. I thought I was going to sit
around with my friends and company and have two or three drinks and quit,
but I found that was wishful thinking. I found it was total abstinence. So, I
wasn't interested, and I had to give many, many more months of great misery
and great unhappiness before I came back.

The A.A. member who is telling her story here first contacted A.A. through
the Central Service Committee in the city in which she lives. As she points
out, she was not ready to stop drinking and soon found that A.A. was not
going to help her achieve her major goal—to drink socially. But, when
things came to the point at which she was ready, she knew where to go.

This time I came back with great humility and complete surrender. I was
willing to listen to the suggestions that were made. When I got up there
[Central Service Offices] that morning, that early morning, the girls tell me I
had a dress on that was all right, but I had bedroom slippers on. You see, I
had to go. I had been hallucinating through the night, and I knew I was going
to have a lot of horrible trouble.

This was the end of a long, long siege, and when the girls invited me in they
were so fine and so gentle with me, and so understanding. I was having to
be taken care of physically because I was very sick. They took care of me
that way and then they allowed me to rest a while. And then when I began to
feel a little better, they very gently outlined the program of A.A. I stayed
with them a good part of the forenoon, and then one of the girls suggested
that I go home and take it easy. They gave me some literature to read. They
told me not to try to take it all at once, to take it in small doses, and that is
exactly what I did.

In these experiences, we see the operation of sponsorship. It involves a kind

of parental effort in seeing the newcomer through a rough period. There is
also a teaching aspect to sponsorship. It is through the sponsor that basic
information about A.A. is transmitted. The woman who told part of her story
above continues:

When the fog began to lift a little bit from my consciousness, they outlined
this great program to me. They asked me if I believed in a power greater
than myself that would make me stay sober for just twenty-four hours. They
asked me if I believed in this power to such an extent that I could ask this

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power in the morning to keep me away from one drink. And I looked at them
as though they were out of their minds because I wanted a drink right then.
But they said they thought I would be able to make it because they had done
it and they felt just as I did when they first came in. And then they told me
that this great power was keeping 250,000 alcoholics sober just a day at a
time, and by asking in the morning, sincerely, with faith, and, with success
during the day, at night saying a prayer of thanks, they thought that just
possibly, in trying very hard I might make it.

Through her contacts with the workers at the Central Service Committee's
offices, literature prepared for the purpose, and A.A. meetings, she learned
about the program.

Sponsorship has a third aspect in addition to the caretaking or parental, and

teaching functions. This is to provide a personal model for the newcomer.
The fact that the women in the Central Office could say to the newcomer that
they knew how she felt, that they had felt the same way, meant that a bond
was established between them. She, because she was like them in her
feelings about drinking, could also be like them in becoming sober.

Of great importance in choosing one's sponsor is similarity in the drinking

patterns. As the newcomer sits in a meeting or talks with A.A. members
before and after the meeting, he hears a number of drinking histories.
Usually, if he hears enough stories, he will find someone whose history
parallels his own, and who, he feels, understands him and whom he
understands. Discovery of the importance of this led, in the revision of
alcoholics Anonymous, to an increase in the number of stories included. It
was done to "secure maximum identification with the greatest number of
readers."

An attorney tells of his early contacts with A.A. They came about as a result
of his call upon a physician whom he had known as a boy, but whom he had
not seen for a longtime. In the intervening years, the physician had had
considerable experience with alcoholics.

He evidently saw in me some of the things he had seen in those patients in

the hospital. So, he was the most understanding fellow that I know in regard
to this problem who is not an alcoholic himself. And I opened up to him
more than I had to anyone in this world up to that time. The result of our chat
was that everything was suggested. That’s the way you have to deal with an

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alcoholic; suggest things easy, because an alcoholic doesn't like to be told
what to do.

He had two copies of the big book Alcoholics Anonymous in his office that
he used for people like me, fellows and girls that came there with a
problem. He advised me to read the book; he prescribed sedation; and I was
supposed to report back to him in a week. Well, at the end of the week I felt
fine. I didn't go overboard on the sedation; I had read the book and thought it
was a very interesting thing—for the people that needed it.

Rather than return the book in person, he mailed it to his friend and resumed
his drinking. In six months he was back at the doctor's office, looking for
more sedation. When the doctor suggested that the time had come for him to
try A.A., he acquiesced. The doctor put him in touch with an A.A. member
who, as the attorney now says, "was particularly suited to this work." Even
though there were several drinking episodes during the first year and a half
in A.A., complete sobriety eventually was achieved. For him, meeting
someone who "was particularly suited for this work” was the turning point
.A.A. groups often take on certain characteristics so that one may have to
"shop around" before he finds one whose members are congenial to him.
Some groups may consist of professional persons, while others, because of
their location in a certain part of a city, may attract those from one economic
level. Special groups have been created for young people. The more like
himself the membership of the group is, the more likely one is to find a
suitable sponsor.

The matter of sponsorship is being stressed in this book to a much greater

extent than by most A.A. members. Although certainly well aware of
sponsorship, members of A.A. are probably less consciously aware of the
dynamic relationship between newcomer and sponsor than the present
account indicates. Often, the sponsor and his "child" in AA. grow apart as
parents and children do. As in any kind of growth one must achieve a
measure of independence in A.A. It is particularly necessary in A.A. in case
the sponsor starts to drink again and the newcomer's own sobriety is
threatened. Sometimes it happens that this independence is slow in coming;
the bird must be pushed from the nest. The demands of the newcomer may
be so great that they threaten the sponsor's own stability. In such an event, he
has no choice but to require that the responsibility be shifted back to the
alcoholic himself or to another older A.A. member.

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Here is an example of an unsuccessful introduction to A.A. The man
involved did later achieve sobriety for a period of many years, but it
seemed a forlorn hope at this time.

I became interested in Alcoholics Anonymous through another drinker. I

remember he was drinking with me in a bar. He didn't know me, and I'm half
stiff; he is, too. The fellow takes an interest in me and tells me that I
shouldn’t be drinking, I ought to have more sense, an awful thing to be doing
to my family, et cetera. I'll never forget that night. It was raining like a baby
hurricane. He took me to the table.

"You wait here. I'm coming back." He went out in the pouring rain without
an overcoat or anything, and came back with a lot of A.A. stuff, and we got
to talking about it and made an appointment to meet the next night and he
would take me down and see if he could get me straightened out.

I didn't forget that night, but to show you how I was planning I remembered,
"Well, I'm going to meet this fellow and have a few shots together." I met
him; he remembered what had happened the night before. We went down to
A.A. and had a talk with somebody. He was half drunk; they wouldn’t let
him stay. They let me stay. I had a discussion with some of the men there. I
wasn't in a condition where I grasped the whole thing. I didn't know what it
was all about. They gave me literature and told me to come back there if I
was interested enough in it after I read the literature.

The materials they gave him proved to be very useful. He left them on a
table at home where his wife would see them. She was then easy to
convince that he was doing something about his drinking, and things were
easier for him at home. He even returned to several meetings. After all, they
did not last very long, and there was a good bar nearby! At no time did he
meet anyone he felt close to.

This may have been due to his own reluctance to enter into a warm,
meaningful relation with anyone. It may have been in part due to the fact that
he felt the other members were too rich and "fancy" for him. He attributes
the failure to this point.

Using A.A. as a device to take the pressure off at home and work is fairly
common. One goes to meetings, or say she does, to quiet others. Sometimes
at a meeting, one sees a grim faced wife and an obviously unhappy husband.

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She is “doing something" about his drinking by forcing him to attend the
meeting. His chances of accomplishing anything in this way are small.

Sometimes one who does not like or understand what goes on in A.A. turns
to something else and is successful with that. So, the man who was seen in a
clinic had attended A.A. meetings a number of years earlier. After about two
months, he stopped going. Finding women at the meetings distressed him
considerably. Perhaps it was in some way related to the fact that the first
girl he was interested in, with whom he kept company for eight years,
became a problem drinker while they were together. He thought he had
obtained no help from attendance at A.A. meetings, but he did learn that it is
possible for an alcoholic to stop drinking. When the time came that he
wanted to stop, he was able to accept help, even though it was not from
A.A.

Sometimes it works the other way. Contact with a clinic, physician,

hospital, may prepare the alcoholic for A.A. He then goes to it with positive
feelings about what can be done or at least with readiness to be shown.

The early relationship to A.A. and to certain members who may become
sponsors is important for getting one started in the program. From that point
on, it becomes a matter of living an A.A. way of life. An important feature
of this is the idea that one only has to take his drinking problems one day at
a time: the twenty-four-hour program.

As a member of several years' standing says, It [the program] was given to

me with the idea that a person can do anything for twenty-four hours, if you
have to. You could hang by your fingernails for twenty-four hours if you had
to, if your life depended on it. And they said that my problem was not all the
liquor that's so beautifully displayed in all these liquor stores, and all the
lovely surroundings in cocktail lounges with the beautiful bottles and all the
stuff that the breweries and distilleries are making. They said my problem
was only as big as the first drink, and that all I had to do was to stay away
from something only that big for twenty-four hours. In addition, they told me
I didn't have to do it alone; that wasn't the way to do it. The way to do this
was to ask for help; and they said ask a power greater than yourself to help
you to stay away from the first drink just for today, just twenty-four hours.
That's all! And at night, say a little prayer of thanks to that power that has
kept you sober during the day. And that broke it down to something I could
handle.

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Setting the program up on this basis—just staying sober for a day at a time
—leads to an emphasis upon getting full “mileage" out of each day of one's
life. It is to be found in such sayings as "First things first," and "Easy does
it." Even the prayer now known as the A.A. Prayer asks for things that
enhance the possibility of meeting today's problems adequately. It reads,
"God grant me the serenity to accept the things I cannot change, courage to
change the things I can, and wisdom to know the difference. “Thus, in A.A.,
one tries to live in such a fashion that he is sober at present. The past is
gone, and the future is nothing one can do anything about. To stay sober for
the moment, the A.A. member feels he must orient his life around the Twelve
Steps suggested activities that were helpful to the founders of A.A. in their
efforts to achieve and maintain sobriety. Here they are as described by a
woman who has had several years in A.A. Her interpretation is personal,
although it is also typical.

The first three steps—this is my interpretation—are the admission steps.

The first one is that we admitted we were powerless over alcohol—we
have been licked pretty well by that—and that our lives had become
unmanageable. And the second one is that we came to believe that a power
greater than ourselves could restore us to sanity. I had a lot of trouble with
that sanity business. I thought, "I am not insane!" But it is not that kind of
insanity; it's the kind of insanity where we are forced to do things we don't
want to do under the banner of John Barleycorn. And certainly they were not
normal; we are not sane. The third one is that we made a decision to turn
our will and our lives over to the care of God as we understood it. That to
me was the big step: to "let go and let God."

Now the next steps, five, six, seven, eight and nine, I call the housecleaning
steps. Here we are. We have come in and now what do we do about it?
We've got to start to clean house. We made a searching and fearless moral
inventory of ourselves. Just what has this stuff been in our lives and meant
in our lives, and what is causing it? And we admitted to ourselves, and to
God, and to another human being the exact nature of our wrongs. In the
Catholic faith it is wonderful because the confessional is available; in the
Protestant faith, of course, the minister or the physician or a close friend in
whom we have confidence can be used. In other words, we have to get rid
of the wreckage of the past; we have to cut loose these old dead horses that
we have been dragging along, and that step is one of the hardest to take.

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But if we take it, we are free then. We have sense of freedom; we know then
that we can start anew. And then we were entirely ready to have God
remove all our defects of character. It has been these defects of character in
practically every instance keeping us drinking. Because we don't like
ourselves and we are trying to get away from it, we used liquor as an
escape from ourselves. And we humbly asked Him to remove our
shortcomings. Again comes that faith we have in this great power. And we
made a list of all persons we had harmed and became willing to make
amends to them all. That scared me almost to death. I thought give me five
or six sheets of paper and I'll start, but when it was all thought out I didn't
find I was important enough to make too long a list. It was only my close
relatives, my loved ones, and only a few friends, so it wasn't difficult. On
the other side of the ledger I put many acquaintances, but I don't think they
ever remembered that I did anything too bad to them. And then made direct
amends to such people whenever possible except when to do so would
injure them or others.

I felt that my coming into Alcoholics Anonymous was a daily example to

those I had harmed. This new life I was trying to live was certainly making
direct amends.

The last three steps, ten, eleven and twelve. The tenth is to continue to take
personal inventory and when we were wrong, promptly admitted it. In other
words, we've got to live and let live. We have to listen to the other fellow's
viewpoint on things and not have these preconceived ideas that we are
always right; and if we are wrong just say, 'Well, you’re right. I'm sorry, I
guess I was wrong about that. That isn’t easy for an alcoholic because we
are all arrogant people. And then the eleventh one is that we sought through
prayer and meditation to improve our conscious contact with God as we
understood it, praying only for knowledge of His will for us and the power
to carry that out. It is still a consecration every day to this great power we
call God as we understand Him, and just asking each day to be guarded and
guided through that day according to His will. Not our will, but His will be
done.

And the last step is the twelfth. Having had a spiritual awakening as the
result of these steps, we try to carry the message to alcoholics and to
practice these principles in all our affairs. That is the three-part step. Our
spiritual awakening to need was when we desired strongly to do something
about this horrible thing that had happened to our lives, and in turning those

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lives over to the care of God. And the second part is that we try to carry the
message to other alcoholics who are suffering from this same disease we
have, then to practice these principles in all our affairs. It isn't just being
sober. It's living the kind of life—bringing the A.A. program into every
single act of our lives, and making them a little bit richer, a little bit more
rewarding. And so, those are the twelve steps. They are not easy and we
don't try to do them at once, but they are a wonderful lesson for us to try to
learn.

As one can see from this account, the religious or spiritual aspects of the
program are highlighted. The frequent references to God and to a higher
power indicate the importance of religious feeling in the program even
though a particular form of religion or religious practice is not specified.
However, A.A. members insist that no matter what one’s religious beliefs or
lack of them may be, the program has something of a spiritual nature to offer
that can be useful to any alcoholic. If one does not believe in God, they say,
he may believe that the whisky bottle is more powerful than he. At least, the
alcoholic has been "licked" by the bottle.

In some respects, what is emphasized is not so much religion as it is

surrender. One cries out his helplessness in the face of his drinking problem.
That many will cry to something or someone, and that that something or
someone will be his understanding of God, is to be expected. As one visits
A.A. groups and talks with a variety of members he forms the impression
that most members, as with most persons in our society whether alcoholics
or not, have had religious training. In part what they are doing in A.A. is to
return to it. But in addition to this impression, the visitor comes away with a
feeling he shares with the members themselves,

"Whatever it is, it is working and we are grateful for it."

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CHAPTER 10

STAYING WELL

Almost every alcoholic has been sober for some periods in his drinking life.
To be sober is not the real problem. But to stay sober, to regain control or
choice over whether one is sober or drunk is something else again! We help
alcoholics get sober by putting them in jails, in hospitals, by giving them
drugs, by scaring them for brief periods, but none of these things keep them
sober. The processes of achieving sobriety we have described in earlier
chapters are unending. They depend upon the development of new ways of
life. This is, indeed, a rebirth such as many an alcoholic describes.

As we have learned more about alcoholism, we have become less naive

about what constitutes success in its treatment. The alcoholic who, by sheer
will power, manages to stay sober and completely miserable for a period of
time technically may be described as "Improved." For himself and those
who are close to him, his sobriety is anything but a success. A member of
A.A. who has been sober for many years describes his situation in the early
months and years of his sobriety. His description of the desire for a drink is
typical of many, even most, alcoholics before the need to drink fades into
unawareness.

To me the desire for a drink is a very concrete physical thing. It isn't some
figment, some intangible something that’s going on in my mind or intellect.
To me it's a physical concrete thing: I want a drink. It has an effect on me
where I would be away from a drink for a long period of time, the alcohol
out of my system, I mean months away from a drink, and the day would
come when I'd think it was a good idea to take a drink. When I'd be trying to
fight that idea and saying, "No" or to postpone it or put it off, I would be
shaking, perspiration would appear on me, and it was quite a soul shaking
experience to stay away from a drink. Giving up alcohol to an alcoholic is a
big deal. I don't minimize it one single bit.

He goes on to describe the change which occurred over the course of the
years in A.A.

When I first came to A.A. and I wanted a drink almost everyday, I would

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hear people get up and say at meetings that they had lost the urge and no
longer cared whether they had a drink or not. I'd be thinking that they were
different than I was, because right then I would like to have a ball! I never
thought the day would come when I would be able to say that I have lost the
urge to drink, and yet I have. But I can tell you this also, and I think it is
important, I have gone over it in my mind many times—the details—and
tried to recall them. On those days when I drank after coming into A.A., I
can't recall asking for help on those days.

Since he has achieved consistent sobriety, this A.A. member reports, he has
daily prayed for help. That act, he feels, is what makes the difference
between being able to get by without drinking and having to drink. Whatever
it is, we see that maintaining awareness of oneself as an alcoholic, who can
lose whatever progress has been gained with a single drink, is essential to
continuing sobriety. One doesn’t get over being an alcoholic; he simply gets
over drinking.

A woman member of A.A. tells of the kind of incident that spells danger to
the alcoholic.

I went along about four years without a conscious desire to drink, but to
show you how insidious this thing is, I was out at my daughter's one
afternoon—a very hot day in August. She asked me if I would like a cold
drink. She knows I am in A.A., so of course she meant something in the way
of a non-alcoholic drink. And I said no, that I would read the paper while
they had their cocktail hour, an established custom with them. I said while
they enjoyed their drink I would read the paper. She came in with a glass of
sauterne. In my drinking days I would consider that despicable stuff, only to
drink with dinner or something like that.

I never was a wine drinker; I was a whisky drinker. But she frosts her
glasses before she serves her drinks, and this glass came in and sat down
within a few feet of me, and it was dripping cold, and it was beautiful: a
lovely amber color.

And all of a sudden, just as fast—faster than a second, I had my hand ready
to reach out and take that glass of sauterne, and it scared me almost to death.
This is the first instance I had of this insidiousness since I was in A.A. I just
closed my eyes and tried to look away, but they kept wandering back to that
beautiful glass. And finally I knew that I had that frightening urge that I had

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heard about. So I got up very quietly, and I went into one of her rooms, and I
started to pray. I asked that the desire be taken away from me just that one
time. I became quiet, and the urge passed. Two things are important in this
story. First, this alcoholic had something to do when she felt this almost
uncontrollable urge. She prayed that it would pass. But, equally important,
she knew that it would if she just held out. This is one of the greatest lessons
alcoholics learn in the course of their treatment as a result of living through
such experiences: the urge will pass. The increasing strength one gains with
successfully meeting such challenges makes it all the more likely that future
crises will be overcome.

All kinds of evidence suggest that the importance and meaning of alcoholic
drinking to the alcoholic does not disappear when he no longer drinks.
Many alcoholics report dreams about drinking in which they either drink or,
as in terror dreams in which one wakes up just before final disaster strikes,
they wake just as they are about to drink. An alcoholic who had been
several years without a drink described a recurring dream. He would find
himself in a bank-like building, with all the usual trappings of a bank.

Instead of money, however, the tellers were dispensing beer. As the dreamer
approached a teller's window, he would slam it shut. Then the dreamer
would go to the next one, and to the next where the same thing would
happen.

He wanted the beer, but there was something between it and him.

Knowing that he is vulnerable to the urge to drink, the alcoholic in the early
days of his sobriety tries to avoid the kinds of situation he feels are likely to
give rise to the urge.

He may try to reconstruct his way of life in the minutest detail. For example,
changing the route one takes to and from work may help get one past a
familiar tavern. One alcoholic describes what he did in the days following
the end of his drinking. He had his last drink on Saturday afternoon. Monday
came; I left to go to work. We opened at half-past eight, and I didn't have to
go to work until then. But I always used to make it a point to be in a bar at
eight o’clock and have a couple of drinks before I went to work. On this
particular morning, I deliberately went out of my way to go a roundabout
way to get to work. I avoided the bar, and I was as nervous as a witch that
day. As noontime came when I normally ran out and had a couple more, I

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sweated it out.

It was hard for the first week; it really was. For about a week after I
decided I was going to stop I had to fight; I had to fight myself. I was tickled
to death when a quarter past five came and time to go home. My wife would
meet me and I'd hop in the car and get away. Then I was good until the next
morning. But after a week or ten days, it wasn't bad. I didn't go out on my
lunch hours. I ate in, took lunch with me, ate it and read the papers. I think I
spent about six months where I didn't leave my place of employment for
dinner to go to a restaurant or anything.

And after that period, then I went around like a normal person would. Had
his wife not been there to meet him, had he not been able to spend his
evenings and weekends with his family, it is unlikely that this man could
have remained sober through the early months.

In an earlier chapter, we described a family situation in which the wife

found she did not like her husband's sobriety and acted in a manner which,
from the outsider's point of view, was calculated to force him into drinking
again.

The case was mentioned when we were talking about the importance of the
social worker in providing treatment not only for the alcoholic but for his
family and social setting.

Recognition of the importance of those who love and are important to the
alcoholic in his treatment has led to an enlistment of their help in planning
for the alcoholic's sobriety. However, it was always recognized that those
who had to put up with the alcoholic needed personal help for themselves,
not only to help keep the alcoholic sober, but to enable them to achieve
some understanding of their own reactions to alcoholism and the situation
into which the alcoholism of a husband, wife, parent or close friend had
driven them.

One response to this need was the formation of the Al-Anon Family Groups,
"a fellowship of the wives, husbands, relatives and friends of members of
alcoholics Anonymous and of problem drinkers generally, who are banded
together to solve their common problems of fear, insecurity, lack of
understanding of the alcoholic, and of the warped personal lives resulting
from alcoholism. The primary purpose of the Al-Anon Family Groups is to

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carry their helpful experience in gaining greater happiness to the non-
alcoholic who seeks personal understanding of the problem of alcoholism
and how to cope with the consequences."

As we shall see in more detail, the Al-Anon group exists not for the
alcoholic, but for those who need help in living with drunk or sober
alcoholics. Members stress that they are helping themselves in their
meetings, in the Twelve Step program which has similarity to that of
Alcoholics Anonymous, even though what they do may also help the
alcoholic. A woman whose husband had been in and out of A.A. groups,
psychiatrists' offices, "drying out" sanitaria, and finally back into A.A.
where he was successful, says this about her own feelings toward her
husband's sobriety:

He went on to uninterrupted sobriety, but I found that even though he had

sobriety, the same problems were with me. As T progressed, the sobriety
and the changes in his personality. He had a serenity about his life that I was
not part of. I couldn't understand it and I resented it very much because I felt
that I had shared his misery with him and I couldn't understand why I
couldn't share this new peace of mind that he had. And so it was about two
years ago that we first heard of Al-Anon and T was aware of my need for
something, and he suggested that I look into it. I am a great procrastinator; I
am always "going to." He did meet someone who told him about a meeting
of Al-Anon, and I did go to that meeting. I did feel that here was something
that was useful for me and for many of the people whom I was meeting, for
T was at that time becoming quite active in Twelfth Step work.

One interesting thing about this story is that it was the alcoholic husband
who "dragged" his reluctant wife to the meeting, much as the wife forces the
drinking husband to attend his first A.A. meeting. One can assume that
having her involved in the Al-Anon program was helpful to him as well as
to her. This comes out more clearly in the wife's answer to the question,
"Does the Al-Anon program help you to keep your husband sober, or is it
for you?" Her answer shows that although it was primarily for her, it also
helped her husband.

The Al-Anon program is for me. That is one of the biggest factors we get out
of Al-Anon. We understand for the first time that our husband's sobriety
depends entirely upon him.

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There is the first step: We admit that we are powerless over the alcoholic
and it is our lives that have become unmanageable. I think most of us have a
tremendous sense of guilt about our husband's drinking. We felt that we had
failed them; we had failed in our marriage that we very definitely had
contributed to the drinking problem. So, it's a tremendous relief to find that
although there are many things I feel we can do to precipitate a drunk, that
when their tensions are high there are many things we can do. We know we
can help break the alcoholic. So, as we begin to understand these tensions,
we begin to avoid them, and also we begin to accept the fact that the
decision to drink is the alcoholic’s and not ours, and these things that we do,
they are just some of the things that they must face in life. If they make the
decision to drink, it is not because of what we did; it is because they again
wanted to drink.

She goes on to tell of the relaxation which follows upon the realization that
the decision to drink is the alcoholic's.

Prior to this, she had lived in the fear that something she might do would
cause her husband to drink. This made for unnatural strain in the home, even
to the extent that her fear infected the children. No longer feeling
responsible, she was able to relax and provide her family with an
atmosphere that was actually less likely to contribute to the build-up of
tension in her husband than when she frantically tried to avoid any action
that would "upset" him. She had learned what to expect and what her
limitations were.

A woman whose husband was a spree drinker prior to going into Alcoholics
Anonymous tells of her attempts to protect their several children from
knowing about their father’s behavior. She says of her oldest child, the only
one who remembers this period, that "she can remember more incidents of
my hysteria than she can of her father's drink-tag.

"What we learn from members of alcoholics' families is that they adjust to

alcoholism over the years and develop a life that takes the alcoholic into
consideration. Then, when things change and the alcoholic no longer is
drinking, the way of life that had been torturously worked out during his
drinking must be thrown away. For this reason, work with the families,
helping them gain insight into what is going on is necessary. It does little
good to achieve the sobriety of one member of the family at the cost of the
adjustment of another. Basically, the Al-Anon program deals with just this

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problem. A wife says, in relation to the step of the Al-Anon program which,
as in Alcoholics Anonymous, states, "Continued to take personal inventory
and when we were wrong promptly admitted it,

"That's a big step for the wife of an alcoholic because she’s been right for
so long. Society makes you right, too, because you’re always "Poor, L ," and
"How could she take this.

"So they encourage you in your righteous attitude. The wife who has been
carrying the burden of the family now finds her husband asserting his
masculinity in many ways. She no longer is the head of the family. In some
ways, the adjustment of the non-alcoholic husband to the alcoholic wife is
considerably easier because the one who normally does carry the burden
has been doing so all along.

Sexual adjustment sometimes has to be achieved all over again, or it must

begin for the first time. In one case, that of a spree drinker, the husband had
fairly long periods of sobriety between drinking bouts. Through most of that
time, his sexual relationship to his wife although not without strain was
relatively normal and adequate. When he finally stopped drinking entirely,
this couple had something to return to. In another case, a wife answers the
question, "How long after you were married did your husband's drinking get
rough?"

A day later he started right in. Of course he was drinking before, but I don't
think I realized how much he was drinking. I knew he drank; we both did. It
was the accepted thing. We went with couples who did drink, and I would
never have married him if he didn't drink because I thought it was a terrible
waste of time to go anyplace and not be served a drink. That was dull and
boring. I began to realize that our friends and other couples were slowing up
a bit as they were married. They had responsibility, many of them had
children, and they didn't drink as much. They measured it, or they had to get
up the next day, and things were changing, all except he was the one that was
drinking more and more.

He was the one who would have one drink and be running out to the kitchen.
We'd go out and he'd disappear every once in a while. We'd be sitting in a
cocktail lounge and he’d be running around to the bar drinking in between. I
think I realized this, but I didn't really accept it.

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For the first two years of their marriage, there was virtually no sexual
contact between them. Furthermore, the wife was working and supporting
her lawyer husband, thus in every way assuming the responsibility for the
little family.

When he finally achieved sobriety, they had to start from the beginning, or
from worse than the beginning. They had to wipe out the years of trouble
before they could be at the point where most couples start the adjustments of
marriage.

In this case, the husband achieved his sobriety through Alcoholics

Anonymous. The fact that he was so involved in A.A., first in going to
meetings almost every evening, and later in his Twelfth Step work, came as
a shock to the wife.

She had thought that all their troubles would be over when her husband
stopped drinking, that he would be as attentive as she imagined other
husbands to be, and, above all, he would be a companion. Instead she found
herself seeing him as little as when he had been drinking. She felt shutout of
his life and of his struggle to maintain sobriety. She fought the narrowing of
their circle of acquaintances to those connected with Alcoholics
Anonymous. When she herself joined Al-Anon, some of the resentment was
siphoned off and she began to accept and even enjoy the situation.

Sometimes the alcoholic's family has to learn that it is unfair to use his
former behavior as a weapon in the daily stress of family living. The wife
who, when she disagrees with her husband, attributes his opinion to "his
alcoholic thinking," finds that she is building up a situation that can lead to a
break, either in her husband or in their marriage.

Part of the husband's growth consists of learning to take such events with
equanimity or even humor, but they represent an additional burden. Not
permitting the alcoholic to forget "what he has done" makes it difficult for
him to keep from wondering why he is sober. An alcoholic in group
psychotherapy puts it this way, I’ve noticed among husbands of alcoholics
and wives of alcoholics, that the fact that they have used means outside the
home to get sober and stay sober, and wouldn't do it for the little woman, is
perhaps one of the chief causes of a lot of misunderstanding in the home life.
It's a jealousy. And I've heard husbands say to their alcoholic wives,

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"You wouldn’t quit for me but you'll quit for A.A., or for a psychiatrist."

Sometimes, in the early stages of sobriety, the alcoholic may be a source of

irritation to his family because of the very qualities which have brought
about his sobriety. In giving up, surrendering, the alcoholic places himself in
someone else's hands. Particularly if his religious convictions are such that
he does not feel that he is putting his life in God's hands but into the hands of
another or other persons, he may become a passive, dependent person in all
facets of his life. He looks to others to make decisions for him; he looks to
others for confirmation of the rightness of his actions. He leans so heavily
on others that they begin to resent it. What usually takes place in such cases
is that the treatment agency, psychiatrist for example, also is aware of this
state and is working with his patient or client to overcome it. Eventually, the
alcoholic will assume more responsibility and the particular problem
disappears.

Getting rid of one problem, or passing through one phase of the treatment
process does not mean that all one's troubles are over. Neither the alcoholic
nor his family eliminate the troubles of living by not drinking. As the
memory of the bad times during the alcoholic's drinking years fades away
and the pain is blunted, it may seem that current troubles are worse than the
old ones. All that happens with sobriety is that one has the opportunity to
face his other problems again. Quarrels with one's wife, difficulties on the
job, sickness in the family, bad weather, all the trivial and the important
problems of life are there for the sober alcoholic as for anyone else. The
only change which has taken place is that now the alcoholic cannot, or dare
not resort to the temporary solution of intoxication. He knows it will not
work.

For some alcoholics, getting through the day without a drink is such an
accomplishment in itself that whatever else happens, good or bad, is
secondary. One man used to cross off each sober day on his calendar. He
kept it up for a year or two, then found that when he forgot about it, his
daughter would cross out the day for him. For some alcoholics, the sheer
wonder of sobriety is exhilarating enough to compensate for all else that
goes wrong, as for persons who have been at the brink of death and been
reprieved there is excitement just in being alive. Oddly enough, many such
persons take pleasure in talking about their drinking days.

They constantly remind themselves of the contrast between their present

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state and their previous lot. The alcoholic who is still drinking and who
comes into contact with them is irritated. "All they talked about was what
big drinkers they used to be," says one. At the stage in which he was,
laughing about old drinking stories seemed callous. Getting sober was much
too serious a business for this.

Even remembering the good parts of drinking may serve a purpose: to

remind the alcoholic of the pull toward drinking that is likely to be exerted.
A man at an A.A. party after looking out over the scene of fifty or sixty
alcoholics, their families and friends dancing, eating, drinking non-alcoholic
drinks, said to one of the visitors, "Don't tell me this wouldn’t be a helluva
lot better party with a couple of bottles of bourbon going around!" He was
not indicating that he intended to leave and get a drink, but he was pointing
out the lift, the gaiety, the elation that sometimes went with the social
drinking he remembered. He was being realistic in pointing out to himself
that he had lost something, even though, in the total picture, what he had lost
was not terribly important.

Sometimes there is a feeling of disloyalty as one changes his way of life and
thereby changes his friends after achieving sobriety. The old drinking
companions, whether alcoholics or not, no longer are appropriate friends.
An alcoholic puts it this way, For instance, one of my dry friends got ahold
of me and said to me, he said, "Do you still — are you still around your old
drinking companions?" I said, not much. He says,

"Why?"

Well, I said, when I quit drinking, our interests were not the same. My
palling with those fellows was over the bottle, that was our common
denominator, and I said, when I quit drinking they lost interest in me, and
certainly my interests weren't in drinking. "Oh, you are afraid," he said.
Well, I said, initially, yes. He said, "Do you go into saloons now?" Well, I
said, I don't make it a practice, but, when the occasion requires it, I go into
saloons. I buy drinks, I said, not too many, because I'm Scotch, but I don't
runaway from anybody, and I know I can't run away from liquor. I tried to
tell him that I had reached a stage, I thought, in my drinking where it wasn't
always a formidable problem for me. That I couldn't run away from liquor,
it would always be around me, but that I couldn't accept it.

Of course, I can see why he didn't understand.

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As public education on alcoholism increases, the number of those who do
not understand the alcoholic's situation will be fewer, and some of the
pressures on the alcoholic trying to stay sober will be reduced. A member
of A.A. relates an incident which is almost commonplace at present but
which will become less so.

Three years ago my class at college had their twenty-fifth reunion, which is
a big thing as reunions go, and some of the fellows I hadn't seen for twenty-
five years. Of course there is quite a little drinking going on. We had three
or four days, I guess, and one fellow in particular—"Come on, J, you were
always such a heck of a guy when we were at school. Come on, have one.
Why aren't you having one?

Well, here take this one and just have one." He had quite a few and he kept
insisting. There were a lot of other fellows around, and I said, No, thank
you, I'm not drinking. So he said, "What's the matter? Your twenty-fifth, and
it only happens once in a lifetime." I said, No, I don't care for any.

He insisted, so I said, Look. One drink is too much for me and a barrel isn't
enough. And so he opened up his eyes and said, "What's the matter?" I said,
Gee, I had to give this stuff up a long time ago, and in fact I'm in A.A. And
then, of course, the whole picture changed. Of course, he moved away from
me as if I had the plague.

This little story illustrates many of the problems of staying sober. In the first
place it involves recognition and acceptance by the alcoholic of the fact that
he is different from others in that he cannot drink. The difference is
constantly being emphasized as most of those with whom he comes in
contact can and do drink. It means further that one may be somewhat
uncomfortable in many situations in which drinking is part of the regular
course of events. Pressure to drink will be placed upon the alcoholic and,
should this external pressure coincide with an urge coming from within, the
results may be troublesome. Most other persons will not understand the
alcoholic's problem and his situation, so they are made uncomfortable by
him. The alcoholic may find himself somewhat isolated from "normal”
persons, with his circle of friends consisting largely of those who have the
same problem. It is particularly likely to happen if the alcoholic himself is
easily hurt by the lack of undemanding he finds and withdraws into a group
that will not hurt him, just as members of minority groups find themselves

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more comfortable with those who are similar.

Under all conditions, knowing what to expect and being ready for the
unusual event or impulse is the alcoholic’s best protection. Having a family
that can provide the satisfactions of living enables him to go along without
pressures building up to a new surrender, this time to the urge to drink.
Knowing that through the years additional strength will be gained also is
helpful. To gather experience and strength, one need be in contact with those
who work with alcoholics or with alcoholics themselves. Alcoholics
Anonymous, or a club consisting of ex-patients of a hospital treating
alcoholism, are examples of vehicles for helping some alcoholics maintain
their awareness of their situation and to learn from the experiences of
others.

But what if the alcoholic after a period of sobriety goes off again? Although
this is not to be expected, and one obviously hopes it will not happen, it is
sufficiently common so that experienced workers in the field expect that a
large but unknown percentage of those under treatment will relapse or
"slip." If the alcoholic does slip, one can either bemoan the fact and
consider that all the good work has been wasted, or he can recognize that,
whatever the period of sobriety, the alcoholic was sober for a time, and that
by this experience he may have learned something which will help in future
attempts at treatment. Discussions with personnel from various agencies
treating alcoholism—hospitals, clinics, A.A.—reveal that each of the
agencies feels it is getting the others' failures. They say, "If only we could
get the alcoholic sooner, we could save all this suffering." What many do
not recognize is that the "failures" are not failures at all, but patients at
various steps in the therapeutic road. Suppose we were dealing with an
alcoholic who, prior to treatment, had been drunk three hundred days a year.
And let us further suppose that he had some treatment, but that the treatment
was not completely successful: he was drunk twenty days a year. Despite
the fact that he cannot be considered a completely successful case, this
alcoholic and his family are probably so much better off than they were
before that one must consider the whole effort worth while.

Furthermore, it is likely that improvement will continue to take place.

Experienced workers in the field of alcoholism will grant that there are
some alcoholics who die before they recover from alcoholism. But, when
asked to predict which of a group of alcoholics will not make the grade,

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they will decline. So many seemingly hopeless cases have turned out well
that all one can really say is, "There is no such thing as a hopeless
alcoholic." This is the faith of the worker in the field, and it often becomes
the faith of the alcoholic as well.

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CHAPTER 11

WHAT SHALL I DO?

For most alcoholics in the United States, help is no further away than the
local telephone book. Agencies helping alcoholics and their families are
listed there: for example, in many cities one can find a listing for Alcoholics
Anonymous and another for the local Committee or Council on Alcoholism
where information on facilities is available. Because there are so many
facilities in so many places now, the best answer to the question, "What
shall I do?" is "Go to someone who can help."

The answer is simple to make, but it tends to be confusing to the one who
hears it. "Who helps alcoholics?" he asks. "How do I know who is good at
it?"

Throughout this book, we have been describing types of specialists and

others who treat alcoholics. All of them have certain things in common.
They have special knowledge of alcoholism and alcoholics gained through
contact with them. They have put their talents to work in agencies like
clinics and hospitals where alcoholics are treated as alcoholics. In some
places, alcoholics actually get treatment, but it is for another condition
which may be unrelated or secondary to the alcoholism. This usually
indicates lack of sympathy and understanding of the alcoholic.

Today, with all the educational work that has been done with the medical
profession, the probability is quite high that most doctors will know a great
deal about alcoholism.

The American Hospital Association, American Psychiatric Association, and

the American Medical Association all have taken the position that the
medical profession has a responsibility in this field. One may be fairly
certain of obtaining an understanding hearing and good advice from most,
but not all, physicians. The doctor may not want to treat the alcoholic
himself, but he will recognize the nature of the problem and will refer the
patient and his family to some one who will take over. After all, alcoholism
is not the only disorder or disease that a specific doctor prefers not to treat.

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The general practitioner calls upon specialists in surgery, internal medicine,
pediatrics, psychiatry, and so on. Why should he not do the same with
alcoholism?

As experience in the treatment of alcoholics has increased, patterns begin to

take shape. Communities organize their facilities even without being aware
that they are doing so. Treatment needs are met when the pressure for them
is felt. A local community develops a unique system for coping with one
aspect of the problem; other communities imitate and produce their own
innovations. However, the alcoholic, his wife or child are not concerned
with how programs for helping them came into being. They want to know
how to get "Dad" involved, and what to do from then on.

Despite this, we must pause for a moment on one aspect of the problem of
alcoholism that has proved to be crucial in case after case and in community
after community. That is, the extent to which general education of the
citizenry has led to the knowledge that alcoholism is treatable and that there
are agencies which do the treating. Without this knowledge, the alcoholic
and his family do not even know that there is anything to be started. The
slogans of many alcoholism information centers affiliated with the National
Council on Alcoholism reveal what is the beginning of any effort with
alcoholism: "Alcoholism is an illness," "The alcoholic can be helped," and,
finally, "The alcoholic is worth helping.

"Given the idea that alcoholism is treatable, all else follows logically.
Without such a notion situations involving alcoholics are permitted to drift
on to chaos and degradation for an individual or a family. With some
knowledge that alcoholism can be treated, individuals reach out for help.
The tendency in most cases is to go to well-meaning friends for help or
advice. Women who look to the correspondence columns of the newspapers
—sections in which readers bare their problems to one another
anonymously—may write to the world at large for help. An example from a
daily newspaper that has an active group corresponding with one another
through this medium follows.

Life without Onions — Does your name really mean Life Without Tears? It
caught my eye, and as your problem is one which is close to my heart, in
welcoming you, as you request, I am in turn asking your help—how do we
help the alcoholic mother? Routine answers like "join the AA" simply don’t
work in her case because she will not initiate treatment. But surely there is a

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way to help her despite herself, and it would mean so much to her devoted
husband and saddened children, plus returning a superior girl to her rightful
place in life. Thanks—and good luck on your second "halfway.”

"We may criticize Ebb-Tide for not taking advantage of the extensive
resources close at hand in her part of the country, but we also recognize that
her action is unusual only because she communicates with her friends
through a newspaper. Several studies have shown that alcoholism is like
many other problems in this respect. Persons involved often need the
encouragement obtained from consulting with friends before they go to the
professional for help. It is as if the effort must be made in two stages: first,
talk with someone who you know will be sympathetic, even if he knows
little about the problem, and, second, with the strength gained from the
friend, consult the stranger who is in a position to do something.

Still, the problem remains, "Whom shall I consult?" Lists of agencies

treating alcoholics are available from a number of sources. For example, the
Licensed Beverage Industries publishes a listing of most public and some
private facilities for the treatment of alcoholism. Their list has been kept
reasonably current by annual revisions.

A directory of local committees on alcoholism which provide information

and referral services can be obtained from the National Council on
Alcoholism.

A recent statement from this private organization indicates that there are
sixty such information centers available throughout the United States.

Suppose such a center is available. Who should call? The alcoholic

himself? A member of his family? What would he expect to find? The only
reasons for asking who should call is that the expectations and hopes of the
caller influence the kind of question he asks and the manner in which he
approaches the information center. The wife who has had years of trouble
with her alcoholic husband may be calling to see if someone will take him
off her hands. Or she might have heard about a drug that can be dropped in
an alcoholic's coffee that keeps him from drinking, and she wants to know
where she can buy some. The child of an alcoholic may be calling because
mother has left the house drunk and the child is afraid something may happen
to her. The alcoholic himself may call because his wife has been nagging
him to do something, so "If she calls you will you just tell her I've been in

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touch with you?" Or he may be looking for someone who knows how he can
keep on drinking without getting so rum-sick. And it may be that he drops by
the center for a handout.

Alcoholism information centers, clinics, hospitals, private physicians who

treat alcoholics, and even members of A.A. do not take the place of general
medical facilities, religious leaders, welfare agencies, the police, or any of
the many agencies providing services needed at times by alcoholics and
their families. They exist to dispense information on alcoholism to all who
want it.

Many times calls come into a center or visits are made on behalf of a
"friend." The alcoholic or his family are still ashamed to admit that the
problem can be theirs. Once the camouflage is dropped, and this usually is
done very quickly by the visitor or caller who realizes he is dealing with
people who know something of his difficulties and have understanding
sympathy for him, then progress is made.

What the information center has to offer is just what the name promises. But
there are roughly three kinds of information the alcoholic and his family
want. First, they want to know something about the nature of alcoholism.
Second, they want a specific suggestion for action. Third, they want to know
what to expect—another way of asking if there is hope.

The very fact that they have come to the center is an indication that their
attitudes toward alcoholism have been turning toward recognition of
alcoholism as an illness. Now they want to know something of the course of
the illness.

Thus, in giving information, workers at the information centers are helping

place the alcoholic on the road toward recovery. What they do in the center,
the kind of advice given, but, even more important, the attitudes of the
personnel manning the centers all serve to activate hope and understanding
in the alcoholic and his family.

Of course not everyone, even those who have an information center in their
own home town, begins the treatment process through an information center
affiliated with the National Council on Alcoholism. Often the first contact is
made with a recovered alcoholic. The question is, "You were in bad shape a
few years ago. How did you get well?"

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The recovered alcoholic may give the same advice and recommend the
same forms of treatment that helped him.

If he found sobriety in Alcoholics Anonymous, then the probability is that he

will recommend the same course. If he was treated in an outpatient clinic at
the local general hospital, then he will put the new candidate for treatment
in touch with that agency. Because of their personal involvement, recovered
alcoholics usually know a great deal about the community's resources for
the treatment of alcoholism, but they are also biased in favor of the form of
treatment that helped them. Occasionally a recovered alcoholic is so
convinced of the worth of his treatment that he may leave the impression that
nothing else will help! Then the alcoholic who is not successfully treated in
this way again feels there is no hope for him. To some extent this problem is
another facet of the general community attitude toward alcoholism. Because
alcoholism is something of which one must be ashamed, it is difficult for the
alcoholic who has not had treatment to come into contact with those whose
treatment has been successful. The very anonymity which is today so
essential in programs like that of alcoholics Anonymous narrows the list of
recovered alcoholics the active alcoholic meets. Surprisingly enough, it is
Alcoholics Anonymous which has the greatest "visibility" in the community.
When an alcoholic wants to meet others who have been through the same
mill and now are better, he is almost forced to go to an A.A. group for such
contacts. In a few treatment agencies such as specialized hospitals or clinics
where group psychotherapy is part of the procedures of treatment, he may
meet other alcoholics. But it is the anonymous fellowship of A.A. that
publishes schedules of meetings including times and addresses, and which
is so often written up in the newspapers.

A man who through most of his life was a somewhat solitary person, who
even in marriage held to himself in that he never gave up that last corner of
privacy to which so many cling, who drank either alone or with strangers
who meant nothing to him, became an alcoholic. His illness progressed at a
steady rate, and eventually he had to be hospitalized and received some
individual psychiatric treatment. When he was released from the hospital,
he was soon drinking again, but concerned about what was happening to
him. He contacted Alcoholics Anonymous, characteristically, through their
literature and the book Alcoholics Anonymous, but not directly. What he
read interested him, even though the emphasis on religion grated on him. He
tried to approach A.A. as he did most things, intellectually.

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In reading and thinking about A.A., he saw some things about it that
interested him and which he felt were worth investigating. Finally, he went
to an A.A. meeting, although for him it was a most unnatural thing to do.

The result was as one would expect—he hated it. The religious emphasis,
listening to others tell publicly of their drinking experiences, and the notion
that he would ever do the same, all revolted him. And yet at that very
moment he longed to talk about alcoholism with someone, perhaps an
alcoholic whose experiences might have been very much like his own,
perhaps someone else. As he was not able to talk to alcoholics in A.A., and
his few attempts with others were abortive, he was not able to do it at all.
As the patient of a private psychiatrist, he had no other alcoholics to whom
he could turn. Unlike some, the hospital in which he had begun treatment had
no "club" consisting of former patients who met together for mutual
assistance, nor was group psychotherapy practiced there.

This man had a solution to the problem, but one which was unrealistic. We
mention it here because some day it will be important. Very simply, he
wanted it to be unnecessary for an alcoholic to be anonymous. He reasoned
that if there could be acceptance of alcoholism and open discussion, men
and women whose psychological makeup was similar to his would not be
isolated. They could even be in occasional contact with other alcoholics. By
this he did not mean to form an A.A. group without the anonymity, but to be
free and open enough about his alcoholism so that everyone with whom he
came in contact, including those who had not known of his problem, could
know he was an alcoholic, and he could talk about it, just as other sick
people discuss their illness.

Our "lone wolf's" point has other interesting ramifications. One reason for
the existence of differing forms of treatment is that they are all successful to
some degree. One clinic’s orientation may be completely different from
another's, and both may have about the same rate of success with alcoholics.
It may be that the reason both can be successful is that one form of treatment
is suitable for one group of alcoholics and less so for another. The alcoholic
who does not "make it" at Clinic A or Hospital B or in Alcoholics
Anonymous is not necessarily doomed. It may be that Clinic D or Hospital E
or even a different A.A. group will produce the desired effect.

Sometimes taking the narrow view of what does and does not work retards

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seriously the effort to help alcoholics. The judge who has many alcoholics
appearing before him day after day, who accepts the fact that they are sick
and who wants treatment for them, may, as a condition of probation, advise
that the alcoholic get treatment. But without knowing the range of treatments
available, or having had experience limited to alcoholics who recovered in
only a certain way, the judge may be too specific in his recommendations.

He may insist that the prisoner go to A.A., when A.A. will not be effective
in this case. The judge may have his probation officers make appointments
at a local alcoholism clinic when for some of his "clients" A.A. would work
best.

Thus, much of the preliminary work of treatment consists of matching the

patient with the treatment which is right for him. In this work the information
centers have played an important role. State and municipal agencies, too,
are increasingly available for assistance. At the moment, we do not know
how most alcoholics happen to go where they do go for treatment.
Sometimes they are sent by the judge or the company personnel or medical
officer. It used to be thought that forcing an alcoholic to go for treatment is
useless—that he must want to go himself before anything constructive can be
done. But agency after agency is now reporting that they have good success
with alcoholics who have been compelled to seek treatment. Whether they
are doing better or worse with them than with voluntary patients is
impossible to state at this time.

Doctors, nurses, social workers—indeed, anyone who meets alcoholics—

are all sources of referrals to treatment agencies. Alcoholics or their family
members come to a place for help because they heard a radio program on
alcoholism, read in the newspaper of a meeting or conference on
alcoholism, because of a magazine article, or of any other mention of
alcoholism and treatment facilities in the mass media of communication. No
blueprint can be made up for someone to follow in seeking treatment for
alcoholism.

However, we can now say that the vast majority of citizens of the United
States can find trained help for their alcoholics if they look for it. Whenever
new treatment facilities are opened up, the rush to use them soon overtaxes
them. This shows that knowledge of the availability of treatment centers
produces more alcoholics seeking treatment. But almost always, with the
openings of such centers, there is publicity or public education on the

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treatability of alcoholism.

Thus, the news that the local general hospital has just opened a clinic for
alcoholics and will see patients by appointment two afternoons and one
evening a week is, for some, news that alcoholism can be treated.

We have already seen that it takes some courage to make the move toward
help. Actually calling and making an appointment to see the doctor at the
clinic comes when some preparations have already been made. In many,
many cases, the preparation consists in part of reading suitable material on
alcoholism and its treatment. Books, pamphlets, movies, all are available
for this purpose. Properly used, they can be of tremendous use in motivating
the alcoholic to go for help. Alcoholics are interested in alcoholism, even
though they are not ready to admit this is what is wrong. Having good
literature on alcoholism where the alcoholic can see it is almost sure to lead
to his reading it at some time or other. He may read a pamphlet on
alcoholism only to try to "prove" to his wife that he is different from the men
and women discussed in it. But some of the ideas may stick with him, and at
a future time they will be re-examined and found useful to the alcoholic.

Sometimes certain pieces of literature are not useful.

Many tracts are still available which were written before alcoholism was
recognized as an illness. Other materials are contradictory. "Look," says the
beleaguered alcoholic, “there isn't any point in my seeing a doctor about my
problem, if you want to call it that. You can't find two of them who agree. If
the experts can't agree, then it shows nobody knows anything about it, and
they can't help me, assuming that I need help.”

The alcoholic who defends himself in this way has some truth on his side.
We have already seen that there are many points of view on the causes of
alcoholism, and we have noted a variety of techniques in treatment. In view
of the short period of time, only about three decades, that more than an
occasional solitary researcher has been interested in alcoholism, the fact
that we know as much as we do is remarkable. When we see that funds
expended for research on this, one of the great public health problems of the
world, are so paltry as to be laughable, then our wonder grows at how much
has been accomplished, how much agreement there actually is.

The problems of alcoholism are so extensive, and are intertwined in such a

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complicated fashion, that any researcher or group of researchers can pick
out one facet of the problem and occupy himself with it for years to come.

Not until many hundreds of years have been spent in research on alcoholism
will unanimity be possible. All we know about alcoholism is but a tiny
particle of what we need to know.

The doubting alcoholic can be doubtful, indeed, but he cannot explain away
the recovered alcoholics all about us.

They are testimony that something is going on which is effective. The

experts disagree on what it is, but this only means they have not as yet
identified the basic elements that make for success in treatment. There is
something in what they do that helps many alcoholics. With research, that
"something" will be identified, and the rate of success increased.

Until that time, we must do the best we can with what we know and with
what facilities we have. An alcoholic and his family, faced with an
immediate problem, want to believe that there is something useful to be
done. They want a course of action plotted for them—a course which will
give them the feeling that they are doing something constructive.

This book does not pretend to be a "do-it-yourself" manual for the treatment
of alcoholism. However, throughout the preceding chapters suggestions have
been made which provide some guidelines for action. We summarize them
here.

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Chapter 12

FOR ALCOHOLICS

If there has been a problem with drinking, that is, if any aspect of your life is
interfered with by drinking, you should assume that alcoholism already
exists or is imminent. (If you are wrong, the experts will tell you so and
refer you to the correct place. Most alcoholics err on the side of assuming
there is no alcoholism when, in fact, there is.)

1) Find out as much as you can about alcoholism. Consult the extensive
literature published on this subject. The public library will have some
books. (See the selected list in the Appendix.)

2) Find out where in your community alcoholism is treated. Ingenuity may

be required, but a few minutes' work will turn up the right places.

3) Put your fear and pride in your pocket and consult the experts.

4) Follow the specific recommendations made.

5) Be ready to work at the program to maintain sobriety.

6) Learn as much as you can about the problems involved in staying sober
so that you can anticipate and avoid trouble.

7) Rely on the experience of others who know what difficulties you are
likely to have.

8) Teach those who matter to you as much as you can about alcoholism and
your individual problems so that they can help you anticipate trouble or help
you get through rough periods.

FOR THOSE TO WHOM THE ALCOHOLIC IS IMPORTANT

(1-3), These are the same for those to whom the alcoholic is important.
Non-alcoholics, too, tend to avoid admitting that drinking is a problem.
They, too, need knowledge, both of alcoholism and resources for its

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treatment.

Put your fear and pride in your pocket and consult the experts whether the
alcoholic goes with you or not. (Experienced workers are familiar with the
problem of getting alcoholics to accept help. They know what may be
effective in making it happen.)

Have the courage to be helpful by keeping your hands off the situation unless
you can definitely be helpful. This is the alcoholic's show.

Accept counseling from experts. If treatment of your alcoholic includes

treatment of you, be grateful for the opportunity to learn more about
alcoholism, your alcoholic, and yourself.

Recognize and be grateful for even limited success. (Don’t expect too much
too soon.)

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Keep learning about alcoholism and the problems of staying sober so that
you can help anticipate and avoid problems. (This does not mean that you
should wrap your alcoholic in cotton batting and meet his problems for
him.)

Help your alcoholic to understand your problems in relation to him.

There is no magic in these steps—not even a guarantee of success. Some

day we shall be able to give more specific recommendations and shall
predict success in treatment more frequently and accurately than we now do.
Scientific research will tell us surely what causes alcoholism, how to treat
it, and, most important, how to prevent it.

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CHAPTER 13

THE LESSONS OF ALCOHOLISM

The Lessons of Alcoholism Almost the only persons who have been actively
presenting a program of prevention of alcoholism are the advocates of total
abstinence, the so-called "temperance" workers. Their program is simple
and vivid. The only trouble with it is that it does not take into account the
fact that the majority of Americans drink. Therefore any attempts at
preventing’ alcoholism must cope with a complicated situation. We can
predict that many millions of adults will drink; we can further predict that
some of them will become alcoholics. The problem is similar to automobile
driving. Millions will use the highways; some will be killed or injured. We
can prevent it by banning the automobile, but there is little chance of this
occurring. So, we try to live with the fact that people will be driving, and
we try to teach them to drive in a manner which will reduce accidents.

In recent years we have turned to our schools to reach the greatest number of
persons most effectively in driver education, just as many decades earlier
we demanded of the schools that they teach about the "evils of drink."
Motivation for setting up such educational programs—they exist in some
form by law in all fifty states—came originally from the "Drys." During the
agitation for Prohibition and during the life of the Prohibition Amendment,
legislation was introduced in almost every state requiring that children be
taught about the immorality and the dangers in drinking. Teaching materials
were unrealistic, and the "facts” presented were often incorrect.

Along with the current revival of interest in alcoholism and its treatment has
come a revision of educational efforts pertaining to alcohol. The automobile
and the dangers of drunken driving have made a new place for alcohol
education. Everyone who drinks and drives must know what the effect of
alcohol is upon such things as judgment and the speed of response. There is
nothing moralistic about this material, but the message comes through "loud
and clear."

We have no way of knowing how successful these efforts at alcohol

education may be. For one thing, they have not been going long enough for
us to see clear-cut results. But even if they had been, no one would know

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what the results are. The writer knows of no piece of research under way or
contemplated which will evaluate the effects of alcohol education.

It would seem that alcohol education is far afield from the problem of
alcoholism, but this is not so. In the early days, in teaching children not to
drink, the educators were trying to prevent alcoholism. Then, the efforts
were converted to more realistic goals such as accident prevention.

Still more recently alcoholism has returned as part of the subject matter of
alcohol education. The emphasis differs from that of the Prohibition era.
What counts are facts about alcoholism: who, what, how. Those who teach
about alcoholism do so with the expectation that it will do some good, but
are not sure how. Alcohol educators when they meet nowadays always get
into arguments about what they are doing. Some feel that their aim should be
to stop or prevent drinking by teenagers; others, that they should be
preventing alcoholism. The former group has an easier time of it because
their goal is simple and immediate. They measure success by the reduced
number of students showing up at high school dances with liquor on their
breaths.

The latter have nothing to point to but the future.

Occasionally, however, the alcohol educator who deals with alcoholism

renders a service he may never know about.

With almost five million alcoholics in the United States, not many of our
school children have been without contacts with alcoholics. Their interest in
the subject is intense.

Sometimes the school is the medium whereby a family hears for the first
time that alcoholism is more than a moral issue and that treatment is
desirable and possible. As poignant and useful as this situation is, it is still
not prevention.

We simply do not know whether what is done in the schools will reduce
alcoholism.

But certain facts are available to us, some of which have already been
related in this book, which provide us with another approach to the task of
preventing alcoholism. This approach moves the problem out of the school

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and into the home. We have already seen that different drinking customs are
accompanied by differential rates of alcoholism.

What these statistics mean is that "natural experiments" in the production

and prevention of alcoholism have been going on for centuries in the various
countries of the world and, indeed, in the United States. When we examine
the introduction to alcohol provided by the Italian-American family which
as yet has not been assimilated into the more nearly typical way of doing
things, we see certain characteristics of that experience which seem to make
it difficult for the Italian-American child to grow up to be an alcoholic. We
can describe this child's introduction to alcohol as occurring when he is
very young, perhaps too young to know about it. He is provided with some
wine of such low alcohol content, and which may in addition be diluted
with water, that no intoxication occurs. The event takes place in conjunction
with meals; it is so unimportant an event in the child’s life that he cannot
recall it and he thinks nothing of it. Under these circumstances there can be
no ambivalence in drinking for this child.

By the time this child gets to be an adolescent, the use of alcoholic

beverages has assumed such a regular, but unimportant, place in his life that
he goes through no crisis with reference to drinking as do many of his
contemporaries coming from other ethnic groups. For him, drinking is not
tied to being an adult. It is not a vice in which he can indulge only when he
reaches adult status. Nor is he attempting to prove that he is an adult when
he drinks. For him, drinking proves absolutely nothing.

We dwell upon this particular case because we can learn something from it:
a kind of a model for other groups to follow in their introduction of their
young people to alcohol.

The process of addiction to alcohol appears to be one in which a group of

problems come together simultaneously.

That is, the future alcoholic, as we have already seen, is worried about
something else at the same time he is worried about drinking. When he
drinks he gets relief from all the problems that are facing him. Thus,
problem elimination, in the sense of not feeling or being concerned with an
existing difficulty, becomes associated with drinking.

But if one already has had dozens or even hundreds of contacts with alcohol

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without this association, the likelihood of his turning to alcohol in times of
stress is remote. It can happen, but it requires a complete turnabout of the
individual in his relationship to alcohol.

When one is vaccinated, he has placed within his bloodstream a controlled

amount of disease microbe. The body thus is encouraged to develop
antibodies which in effect "do battle" against the dangerous germs. But
because of the controlling of the dose of the disease germs, the fight is
“fixed" in favor of the antibodies.

Let the reader not assume that this analogy to the use of alcohol suggests that
some physical change occurs in theory of the young child who has had some
alcohol that makes him immune to addiction. The analogy simply refers to a
psychological state which reduces the likelihood that drinking alcohol will
be a person's response to stress. It does not say that there are no Italian-
American alcoholics or that all those who start drinking under other
conditions will become alcoholics. We are discussing probabilities, which
is another way of saying the chances of becoming an alcoholic.

From these remarks it can be seen that some conclusions about prevention
inevitably force themselves on our consciousness. Again assuming that we
are concerned with preventing alcoholism among those who will drink, we
can see that control over the early drinking experiences may be vital to this
task. To suggest that young children be give nearly and frequent contacts
with alcoholic drinks, but inasmuch small amounts as to make the question
of intoxication irrelevant, is to shock and outrage most Americans. Yet, this
suggestion is the only one which evolves from what has already been
described. It involves a great moral decision on the part of parents, some of
whom will not want to take it upon themselves to make it. The decision is
that one's child will drink. As things stand now with most American
children, they make the decision themselves somewhere in adolescence.
Although they are in part governed by the feelings about drinking held by
their parents, and still more influenced by what their parents actually do, the
greatest determinant of choice is likely to be the action of their friends of
like age.

Let us be perfectly clear on this point. If no one drinks, there will be no

alcoholism. Some experts have argued that those who suffer from
alcoholism would have developed some other set of symptoms just as bad.
There is absolutely no evidence that this is true. On the other hand, we

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comeback again and again to the fact that the majority of Americans drink,
and that the number of those who drink is likely to increase.

Thus the parent's dilemma is an acute one. He knows that if his child never
drinks the child will never become an alcoholic. We are suggesting that if
the child does drink he is considerably less likely to become an alcoholic if
he has been introduced to alcohol early by his parents. Perhaps if the parent
could guess in advance whether or not his child would drink, his problem
would disappear. As it is, the suggestion that the parent be in control of the
early drinking experiences takes the decision out of the child's hands. The
parent may well reason, "If he ever becomes an alcoholic, I'll never forgive
myself because I gave him his first drink."

Or he may also argue, "The probability is that my child will drink some day.
His chances of becoming an alcoholic will be reduced if I introduce him to
alcohol in a particular way." The first parent is gambling that his child will
never drink; the second, that his child will never become an alcoholic.

In speaking of the model of drinking behavior offered by groups having low

rates of alcoholism, we are not taking into account the fact mentioned in
Chapter 3 that customs of such groups change rapidly as their members are
longer in the United States. Studies of Italian-Americans have shown that
within a generation or two the drinking habits change so that hard liquor is
introduced into the diet, and some drinking not associated with meals may
occur. Similarly, Jews, as they move away from Orthodoxy, change in their
drinking habits. Jews and Italians are showing up in increasing numbers in
institutions treating alcoholism, even "though their rates are still very low.

We can guess that the same thing in reverse is true in groups like Irish-
Americans who have high alcoholism rates. As they become more like the
predominant social groups, their drinking habits change and one can expect
a reduction in alcoholism rates. It should be possible for one more
competent in this area than the writer to analyze the population for such
changes and thereby to predict the alcoholism rates of the future.

Probably those showing greatest increase of alcoholism, in addition to low

alcoholism ethnic and religious groups such as Italian-Americans and Jews,
will be those Protestant denominations whose members are enjoined not to
drink, but who are under counter-pressures to drink. For example, the
percentage of those who drink is lower in the South and Midwest than in

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other parts of the United States. These regions have heavy representations of
Methodists and Baptists. If these groups follow the trend that has already
been set, more and more members of these denominations will drink. But
their drinking will offer some problems. As we have seen, if one is taught
not to drink and then does, he is ambivalent about it. Thus, according to the
theory presented in this book, he is more likely to become an alcohol addict.
One example of this situation is the drinking of Mormons whose religion
does not permit drinking. When such individuals do drink, they tend to get
deeply involved in it.

For the future, then, we can predict some shifts in the number of drinkers
and alcoholics among various parts of the population. Rates of alcoholism
will go up for some, down for others. Meanwhile, further education on the
problems and early signs of alcoholism will be going on. If it is at all
effective, it will reduce the amount of alcoholism by some unknown
quantity. Moreover, the possibility of anew wave of total abstainers
growing up in our society is not to be overlooked. If the suggestions
concerning early introduction of alcohol to the child is examined carefully,
one can see that the main reason for it is to eliminate the notion that drinking
proves something. If we are successful in preventing young persons from
feeling that they have to drinking order to be adult or to be virile, then we
leave them free also to abstain from drinking. Young persons may simply
decide that they do not like alcoholic beverages or that they do not feel it
makes sense to take the admittedly small risk of becoming alcoholics. This
choice, based upon knowledge of the situation, the risks and alternatives,
can be a mature decision relying upon preferences of individuals rather than
pressures of groups.

As it now stands, what we have related concerning the causes of

alcoholism, particularly the notion that alcoholism occurs among those who
are ambivalent about drinking, can be applied to other kinds of addiction as
well. Smoking, for example, has many of the implications for the adolescent
that drinking does. He smokes because it is something adults do, and when
he does it he believes he is being adult.

We teach our children that they ought not smoke, just as most of us teach
them not to drink. These are the conditions for the establishment of
addiction. However, the social consequences of addictive smoking are so
minor compared with addictive drinking that there is little of the kind of
pressure placed on the smoker that we find placed on the drinker.

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The likelihood that compulsive eaters are food "addicts” is great. One
would need to know something of the eating history of the obese person who
finds himself unable to reduce his food intake. Are there things that happen
to him which reproduce conditions suitable for addiction?

Whether there is a parallel or not, we can learn from the alcoholic’s

situation just how desperate is that of the compulsive eater. Whereas the
alcoholic does have the possibility of not drinking at all, the compulsive
eater must eat in a controlled fashion. All available experience with
alcoholics indicates that they can never drink in a controlled fashion; the
compulsive eater has to try to control his eating.

Lessons about treatment of other troubled people have been learned from
experience with the alcoholic. The program of alcoholics Anonymous, or
some version of it has been found useful for all kinds of problems. Thus, we
have groups made up of drug addicts, compulsive eaters, compulsive
gamblers, potential suicides, divorcees, and others. Their members are
persons with like problems who come together for mutual support,
companionship, understanding, and knowledge. Members learn that they are
not unique in their troubles; they obtain emotional support in crisis from
those who have gone through the same crisis.

It would seem that anyone who has been separated from his fellow men as a
result of being unable to manage certain impulses can be helped by joining
with others having the same problem.

Because treatment and education on alcoholism has led the way in this kind
of disorder, even if the way is still very short, the drug addict and other
"compulsives" are viewed in a new light. Their situation is seen as one
outside the realm of punishment for misdeeds; the possibility that the
sufferer is unable to do anything about his situation and behaves as he does
unwillingly is brought home to many.

Sympathy and understanding can be extended by those who now see

themselves as fortunate either in the kind of addiction they suffer, or in being
without compulsion. One suspects that the latter are few in number. There
probably is a touch of the compulsive in us all.

This book was Remade from ALBERT D. ULLMAN in Know The

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