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Alcoholism
...the problem brought up to date
One
of the most difficult problems that any family may be called
upon to face is alcoholism. The nature of this illness is
such that the alcoholic is unable to overcome his problem
alone, yet he often finds it difficult to accept the help
he needs from his physician, or Alcoholics Anonymous, or
other private or community facilities.
That
his family, too, may be slow to seek the necessary outside
help is not particularly surprising. Only in recent decades
has alcoholism come to be recognized as an illness instead
of a moral problem, and it still has not fully ceased being
either a source of ridicule or socially unmentionable. Moreover,
the members of an alcoholics family are very likely to be
fighting pangs of guilt, either conscious or unconscious,
arising from a nagging worry over, "what did I do to
drive him to drink?"
Today
it seems plain that an alcoholic is a sick person whose
illness has its basis in psychological or emotional factors,
the precise nature of which are as yet undefined. The alcoholic
turns to alcohol to ease psychic pain or distress. We know
that present methods of treatment for alcoholism do not
"cure" the condition, in the sense that the alcoholic
can continue "controlled" drinking. The patient
must shut off the use of alcohol completely and permanently.
Ail the evidence points to that course of action as the
only basis on which the disease can be arrested and the
alcoholic returned to a constructive, useful life.
Where
to draw the line?
An
estimated 75,000,000 persons in the United States consume
alcoholic beverages in one form or another. Over 5,000,000
of them can be designated as "problem drinkers"
- that is, as alcoholics.
Even
defining the clinical features of alcoholism as a disease
is not simple. The physical signs of alcoholism, such as
cirrhosis of the liver, occur only very late in the disease
- after years or decades of uncontrolled drinking. Before
this stage is reached, there may be few or no signs of physical
deterioration. The World Health Organization in attempting
a description simply says that alcoholics are "those
excessive drinkers whose dependence upon alcohol has attained
such a degree that it shows a notable mental disturbance
or an interference with their bodily and mental health,
their interpersonal relations and their smooth social and
economic functioning; or show the prodromal [premonitory]
signs of such development." While attempts have been
made to arrive at a more exact, measurable definition, this
seems to describe the condition adequately.
Medical authorities are well aware of what an alcoholic
does, even if they don't know the fundamental cause of his
disease. His conduct and actions are almost predictable.
The individual whose life is becoming unmanageable because
of alcohol will need a morning drink, or drinks, to get
going; he may sneak drinks, using all sorts of subterfuges
and devices to cover up his secret. He may fail to return
to work after lunch. He will begin to come in late for work,
and then will build up a record of absences with flimsy
excuses. He will slip out on one pretext or another for
a quick one, carry a bottle on his person, or keep one in
his desk or locker. He will be very sensitive to criticism,
both of his drinking and of his work. He is very likely
to have blackouts (complete loss of memory); and such blackouts
may cover extensive periods. An alcoholic may even wake
up in a strange city and be unable to account for his presence
there. His relations with his family, friends, and fellow
workers will show signs of disruption. His eating habits
probably will change, and late in the disease he may go
for long periods without eating anything at all.
Such signs are a clear indication that it is time to discontinue
the use of alcohol completely and forever. It is a fact
that a few incipient alcoholics are able to do just that
of their own accord. But, more typically, such a person
will insist that he has no problem and reject all offers
of help. For him the need for liquor eventually will become
compulsive. One drink of anything containing alcohol and
a chain reaction follows over which the alcoholic has absolutely
no control. He finds it impossible to stop drinking.
At that point, his moral standards just about disappear.
His promises mean nothing. He becomes extremely artful and
develops the most plausible excuses and explanations to
avoid coming to grips with the reality of his situation.
This
pattern stays with the drinking alcoholic all his drinking
life. Furthermore, long periods of abstinence seem to have
no effect whatsoever on his inability to regain control
of his drinking. A week, a month, a year, even 10 years
after he has "gone on the wagon," the first drink
will activate the devastating compulsion, and he returns
to his old pattern, usually in an aggravated form.
Why
outside help?
A
person who has reached the stage of alcoholic sickness must
not be judged by the usual conventions. His actions should
be regarded as symptomatic, and accepted as part of a disease
process. And that's not easy. It is very difficult for the
non- alcoholic to grasp the depth and complexity of the
emotional factors involved in compulsive drinking; to appreciate
that the socio-economic, intellectual, or professional background
of the victim does not help him to resist the progression,
once the compulsive phase of the malady has asserted itself.
Help in such cases requires patience, skill, and a depth
of understanding that can be developed only by long experience
with the problem. That is why an alcoholic's family - or
the alcoholic, himself, if he can bring himself to do so
- must look to assistance from the outside.
In
most communities, the possible sources of help for a family
facing alcoholism are varied, and it is impossible to predict
which of them will prove most useful in any one instance.
But it is worth noting that some forty states now have tax-supported
programs covering help for alcoholics, and in such a state
reference to the state or local health department usually
can make this resource available.
Also, the National Council on Alcoholism, Inc. (2E. 103rd
Street, New York 29, New York) has local affiliated councils
in 64 cities in the United States, most of which provide
Alcoholism Information Centers where those who are interested
can get personal consultation and literature, and referral
to other community resources, such as hospital clinics specializing
in the ambulatory or in-patient treatment of alcoholism.
The
physician's role in treatment
Often
the first attempt of an alcoholic at self-help is to arrange
a visit to the family doctor for a check-up and a discussion
of the problem. So much the better if the physical examination
can be given by a physician who is experiences in treating
alcoholics or is familiar with community resources for managing
alcoholism.
What
about treatment? It has become increasingly clear that alcoholics
are prone to addictiveness. Barbiturates and tranquilizers,
which are still prescribed for some alcoholics because researchers
once hoped they would ease the emotional distress underlying
alcoholism, hold implicit dangers of addiction and toxic
reactions and are best used in a controlled situation. Antabuse,
however, is a successful drug adjunct. This drug makes the
body react with acute distress if alcohol is taken in any
form. But Antabuse tablets have serious drawbacks. They
should be used only under the continued supervision of a
physician who is thoroughly familiar with the drug's properties.
They must be taken daily; but, if responsibility for taking
Antabuse is left to the patient, he often will skip it.
More serious is the very real possibility that the alcoholic
may be tempted to rely solely on the drug and avoid dealing
realistically with whatever emotional and social problems
are associated with his trouble.
In
any event, it is only when the patient has obtained medical
and psychological management that the real recovery process
truly begins. And achieving this first goal is a long-term
process.
Alcoholics
Anonymous
As
a method of dealing with emotional and personality problems
of the alcoholic, group therapy appears to be more promising
than private therapy. On this score, many patients, as well
as their physicians, lean heavily on Alcoholics Anonymous
(A.A.) to help out. Indeed, this organization is almost
universally recognized as the one type of group therapy
which has been most successful in helping alcoholics.
As most readers are undoubtedly aware, A.A. is an informal
fellowship of alcoholics who are joined together to help
themselves and others to maintain sobriety. The only requirement
for joining the organization is the serious desire to quit
drinking.
At the same time, the family of the alcoholic who has not
yet accepted the fact that he must stop drinking altogether
(or even of one who has accepted that fact and is acting
upon it) can get comparable help for themselves from another
organization, called Al-Anon, which is separate from, but
closely identified with, A.A. (For information, write to
Al-Anon Family Groups Council, 40 East 40 Street, New York
17, N.Y.)
The membership of one or more of his immediate family in
an Al- Anon group has been an important factor in many an
alcoholic's recovery. These groups emphasize the fact that
they do not discuss the case histories of the alcoholics
in whom they are interested, but confine themselves to the
tensions and anxieties that are inherent in their own situations.
Those who are within the family circle of an alcoholic suffer
extreme anxiety, anguish, and frustration, since their attempts
to help come to nothing; they feel beaten, hopeless, and
angry - with overtones of guilt. It is only when they clearly
realize that alcoholism is a disease, and that they are
not responsible for its development, and when they understand
and master their own feelings of guilt and hostility through
group discussion, that they can cope effectively with the
vagaries of the alcoholic's conduct and eventually help
him get back on his feet.
A
look to the future
So
far, this report has devoted itself to a program which,
in effect, locks the barn door after the horse is stolen
- that is, to treatment of the alcoholic after he is in
trouble and is seeking help. Another sort of program - aimed
at detecting alcoholism early in the disease - is being
pioneered by a few industrial concerns. The companies recognize
that valuable personnel who might otherwise be lost to alcoholism
can be kept productive if help is provided soon enough.
Their program begins with a general educational program,
aimed at both employees and management. Supervisors, in
particular, are trained to sense the existence of problems
in the lives of the employees under them. A channel is set
up through which workers who may be succumbing to alcoholism
can be referred, with a minimum of embarrassment, to a qualified
group of therapists. In most instances, this group is composed
of a physician, a psychiatrist, and counselors who are members
of Alcoholics Anonymous.
There is growing acceptance of such an approach within the
medical profession, and even by alcoholics themselves. The
success of such programs depends, of course, on the wisdom
and patience of the counselors in dealing with highly personal
situations. They must neither exhort nor lecture; and they
must gain the confidence of the alcoholics with whom they
deal.
Today,
alcoholism ranks among society's major health threats. It
is widely felt that the prevention and control of this disease
will come in the course of time, but only through the same
methods and efforts which have proved successful in combating
other public-health problems: a vast program of public education,
and of intensive research and study.
(Source:
Consumer Reports, November 1960)
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