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 An
Oasis Called Al-Anon-Reader's Digest, September
1976 |
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ALCOHOLICS ARE JUST LIKE YOU AND ME
EXCEPT THAT THEY’VE DISCOVERED ALCOHOL
by
Philip Marchand
There
is no health in us, according to the Book of Common Prayer.
That reference is, of course, to the spiritual corruption
of fallen humanity, but it might as well be to North American
society in the late twentieth century, a society overwhelmingly
addicted to drugs of various descriptions. A curious situation,
certainly. In this society, few members have any reason
to fear the traditional scourges of humanity - famine, plague,
the devastation of war, even backbreaking physical labor.
The citizens do not live under any blatant tyranny or terror.
There is no obvious reason why most of them should feel
deeply unhappy. But it is true nonetheless, that the people
in this society who feel vigorous and free, who do not flee
regularly from the grim business of life into some opiate
- drugs or television or gluttonous consumption of food
- are a minority. One of the most common of these opiates,
and socially, the most dangerous of them all, is alcohol.
Nothing indicates the depths of unhappiness in the society
more than the fact that the alcoholism within it is becoming
more widespread every year.
In
1963 there were about 237,000 total alcoholics in Canada.
Ten years later, there were about 525,000. That means that
in 1963 for every 100,000 Canadians over the age of twenty
there were 2,190 alcoholics; in 1973 there were 3,850. Alcoholics,
specifically male alcoholics - may be defined as those who
consume more than fifteen centiliters of absolute alcohol
every day, which means about fourteen ounces of whisky,
thirty-two ounces of wine, or nine bottles of beer. Another
index, the sale of alcoholic beverages, is equally discomforting.
The total annual volume sold in Canada increased, of course,
is accounted for by our growing number of youthful drinkers.
In the United States the Director of the National Institute
on Alcohol Abuse and alcoholism has informed us that the
number of American teenagers who get drunk has doubled over
the past twenty years.
Encouraging
male teenagers, at least, is the persistent macho image
around drinking. If the thought of a man's drinking heavily
were disgusting, Dean Martin would never come on as a lush.
But the thought is not disgusting. A "hard drinking"
man is still a slightly romantic figure, usually, "hard
living" and "two fisted" as well. (Although,
curiously enough, belligerent drunks are usually timid and
rather submissive when sober.) Women have no such encouragements,
since a hard-drinking woman has never been a charming figure
in popular mythology - she's either sad and lonely or somebody
like a rich heiress in a Palm Beach mansion with a voice
like Lauren Bacall's. (This does not prevent women from
drinking, of course, but it may inhibit them from seeking
treatment - it is only in the past year or so, for example,
that woman have been joining Alcoholics Anonymous in numbers
nearly equal to men.)
Alcoholism
may be our largest drug problem, then, not only because
it is the most readily available drug in our society, but
because our culture seems to have an ambivalent attitude
towards alcoholism. Drunkards are disgusting, but on the
other hand boys will be boys - if you’re an Irishmen
and a poet, for example, it's almost obligatory to be a
boisterous and winning drunk. In some special grows I like
the Canadian Armed Forces, or teenagers in northern mining
towns, heavy drinking is so much a part of expected behaviour
that an abstemious drinker, not to mention a teetotaler,
runs the risk of being an outcast.
Even
when drinking is not openly encouraged, it is still fatally
easy, in all social groups, for a man or woman to become
an alcoholic without ever becoming noticed as a person with
a problem. The alcoholic, unlike the junkie or the speed
freak, can indulge his vice in the best social situations
and still fit in like the priest at the Communion breakfast.
These people are often the "functioning alcoholics"
- Men and women whose daily consumption of alcohol is well
above those fifteen centiliters, but who still have their
families, their high-salaried jobs, their position in society.
They don't fall into alcoholic stupors, they never even
become involved in loud alcoholic scenes. They're not drunkards
– most people, including themselves, would never think
of them even for a moment as alcoholics.
Sooner or later, however, they run into problems. A successful
thirtyish lawyer, say, wakes up in the middle of the night
in a state of approaching panic. He goes downstairs, notes
the car parked in the garage, the children sleeping in their
rooms, the lights off in the kitchen and the living room.
Only one thing keeps troubling him; he cannot remember going
to bed. He remembers the party he attended, but he doesn't
remember driving home in his car, coming into the house,
taking off his clothes, and climbing into bed. He has suffered
a "black-out", a mild case of amnesia.
As
time goes on, he notices he suffers more and more of these
blackouts. He knows that it is a warning sign that he is
drinking too much, that he may, in fact, be an "alcoholic."
But he can always brush this thought aside. An alcoholic
is a woman who spends all day in bed with a bottle, who
has spare mickeys of gin hidden in the breadbox. Alcoholics
are men like the
character Jimmy Cagney played in some movie from the 1940's,
sweating and writhing on the floor from a bad case of delirium
tremens. Alcoholics are not like him, a responsible person
who plays bridge, goes to the Caribbean on skin diving holidays,
and never gets drunk.
Of
course he would have to admit that by the time eleven A.M.
rolls around he becomes a little restless in his office,
waiting for lunchtime and a few officially sanctioned martinis.
And in mid-afternoon he usually rewards himself for a hard
day – or consoles himself for a rotten one –with
a few drinks from the built-in bar in his office, and then
goes home and has a drink or two before dinner, and then,
while he's getting dressed for a party, he has another one,
and of course at the party knocks back a few, and coming
home afterwards treats himself to a stiff nightcap. If he
counted up all those centiliters of absolute alcohol on
his pocket calculator, starting at lunchtime, he might indeed
come up with an alarming figure, but who bothers to count?
The important thing, really, is that he's steady on his
toes -he'll start to worry about his drinking
when he slobbers on the hostess and walks around with a
lampshade on his head at parties.
The
warning signs are by now well known, but they are easily
ignored by people like this lawyer. He usually has powerful
rationalizations on hand to quiet the doubts. If he gets
really jittery he can go on the wagon for a couple of weeks
and absolutely, definitely, prove to himself that he has
no problem with liquor. (Ignoring the fact that during these
two or three weeks he is always mindful of the reward in
store for him when he hops off the wagon - ignoring, too,
the tranquilizers he turns to now and then to help him over
the dry spell.) Usually such people continue for years before
they start descending the long alcoholic slide into more
serious drinking –when their work definitely does
suffer
and their family starts to fall apart from the general unhappiness
solidifying into outright misery. It's a melodrama too familiar,
by now, to recount in detail.
But
it is still a North American melodrama that increasing numbers
of people regularly play out. The cost to society is staggering.
(A billion dollars a year to the Canadian people, according
to the LeDain Commission of Inquiry into the Non-Medical
Use of Drugs.) Nobody is sure how to ease this cost. And
the suspicion keeps arising in people who have to deal with
the problem that the epidemic of alcoholism, frightening
though it is, may be just the most noticeable and dangerous
form of addiction in a society of many widespread addictions.
In the end, all addictions - whatever their source - may
be alike.
This
point will become more important in future considerations
of alcoholism. If it generally accepted, the social view
of alcoholism will doubtless be revised - revised a second
time. The first great revision occurred sometime in the
1930's with the establishment of Alcoholics Anonymous. A.A.
was heavily responsible for spreading the notion that alcoholism
was an illness, and that drunkards were not primarily moral
failures who succumbed to the bottle through lack of willpower
but sufferers from a mysterious but very real disease, perhaps
an "allergy" to booze or a metabolic imbalance
or a chemical deficiency of some kind in the body. This
was an entirely commendable achievement on A.A.'s part.
In effect, it immediately raised the status of alcoholics,
at least in respectable circles. But the A.A. view also
raised a few questions. There is still no way you can predict
whether a child will have trouble with alcohol from a biochemical
examination of his or her body. And, practically speaking,
A.A. itself treats alcoholism more as a spiritual dilemma
than a disease. (The key notion of A.A. is that the first
step towards recovery for any alcoholic lies in his admitting
that he is powerless over alcohol, and that only a reliance
on a Higher Power - sometimes referred to as a Power greater
than ourselves - can restore sanity to his life.)
There
were certain consequences of this view. One of the consequences
was that alcohol itself became kind of personification of
evil for the alcoholic - a force in itself that has taken
hold of the sufferer's life like a plague bacillus and will
not let go. As a writer in the Big Book, a kind of operating
manual for A.A. says; "Remember that we deal with alcohol
-cunning, baffling, powerful." Other consequences are
an insistence that an alcoholic can never take another drink
as long as he lives (the fatal-glass-of-beer syndrome) and
the general feeling that many alcoholics cannot free themselves
from this disease - this enticing, relentless disease until
they hit "rock bottom."
Today
most theorists of alcoholism don't even bother to debate
the question of whether alcoholism is a disease; when not
even medical doctors seem able to come up with an acceptable
definition of "disease." It hardly seems a fruitful
topic for debate. That some of the implications that have
been widespread because of the general selling of alcoholism
as a disease
are now being challenged-the implications, chiefly, that
a return to controlled drinking is always impossible for
a true "alcoholic," and that a man cannot free
himself from the "disease" of alcoholism until
the abyss beckons and he realizes that spiritual means are
the only means left to fight it. Perhaps the most important
implication being challenged is that there is something
in the nature of alcohol itself - the "subtle ease."
as A.A. writers call it - that causes addiction. If this
idea is false, reasons those who question it, the possibility
arises that alcoholism may have the same roots as the behavior
of a person who deals with life by "TVing it,"
getting glued to his set for forty hours a week -or, for
that matter, a person who goes on eating binges.
The
people who are leading the attack on these very beliefs,
and thereby intending to revise accepted notions of alcoholism,
are those Trojans of the rat labyrinths, the behavioral
psychologists. In a way it is inevitable that they would
stake out pieces of turf traditionally associated with groups
like A.A. The Alcoholics Anonymous approach - heartfelt,
exhortatory, spiritual-was bound, sooner or later, to clash
with the clinical, empirical human-engineering approach
of the psychologists. Nobody denies that A.A. has been the
most effective group by far in dealing with alcoholics,
and its unlikely that any government or private program
in the foreseeable future will help alcoholics give up their
dependence on alcohol to the extent that A.A. has done.
But ours may be a time when the most significant contributions
to understanding alcoholism will come from other than A.A.
To
the clinical psychologists alcoholism is not a medical problem
but a learned behavior. "The way most psychologists
would view excessive alcohol consumption," says Howard
Capell, a psychologist at the Addiction Research Foundation
of Ontario, "is that, for whatever reason, it's something
that's learned, just the way a lot of other things are learned,
and that in some sense it's an adaptive response. A lot
of people thing that what it's adaptive to is conditions
of stress, and that what alcoholics are really doing is
medicating themselves for anxiety." This in spite of
the fact that it has been clinically demonstrated that large
quantities of alcohol actually make a person less able to
handle tension, stress or anxiety. (But of course, the first
few drinks always do seem to lighten a man's load - the
only problem being that a man who depends heavily on alcohol
for this purpose never knows when to stop.)
In this view, alcohol is a kind of problem solving technique
that is too easily and too accessible - despite its disastrous
conseq- uences - for the person to give up, once he has
learned to depend on it. Dr. Martha Sanchez-Craig, who formerly
directed a residence for alcoholics in Toronto for the Addiction
Research Foundation speaks passionately for this view and
its efficacy in treating alcoholics. It is a view that
does, in its own way, invest the alcoholic with a certain
amount of dignity. "Look," she points out, to
say "you have a problems is very different from saying
You are sick." To say, "everybody has problems,
but you, unfortunately, have discovered alcohol." "You
would feel more comfortable in knowing that you and I are
not different. You have problems, I have problems, everybody
has problems. But you have discovered alcohol."
Dr.
Sanchez-Craig tried a simple experiment to shed some further
light on the uses of this problem solving technique. "I
sat with numerous people and asked them to describe in very
specific terms the last time they drank in excess. This
had to be in specific terms –I held them to that.
Second, I asked them how they felt about the event. How
did they interpret it? How did they come to a decision to
drink? How did they rationalize it? How did they feel the
alcohol was going to function? Ninety-five per cent of the
respondents, according to Dr, Sanchez-Craig, were reacting
to what she termed, using the odour-free language of the
social sciences, an "aversive" social situation
- where the boss picked on them, or their lover walked out
them. "They were feeling depressed, lonely, anxious
– the negative feelings. The thinking was rigid and
catastrophic. They would think.
This woman has rejected me. Therefore no one will ever love
me. I will be alone for the rest of my life."
That
people will turn to booze when they feel hit hard by life,
or when they succumb to what the A.A. folks term "stinking
thinking" –the low, sweet descent into despair
and self-pity - is hardly news and yet if alcoholic behavior
can be traced back, as Dr. Sanchez-Craig and other psychologists
feel it can, to this kind of habitual response, gradually
imprinting itself on the nervous system of an alcoholic
–the response of seeking relief from painful situations
in the soothing touch of alcohol - then it may be possible
to imprint new responses, new awareness of different choices,
on that same nervous system. Alcohol itself is not the problem.
It could just as well be Valium the alcoholic loved, if
that alcoholic had grown up in a culture where there were
two or three Valium bars on every city block. Alcoholics,
or "problem drinkers," once they are taught new
responses to the painful stimuli that drove them to drink,
could conceivably even learn to drink moderately again.
This
suggestion infuriates many workers in the field of alcoholism
who feel that one of the greatest enemies of the recovering
alcoholic is the delusion he often cherishes that one day
he will be able to drink again - drink again and handle
liquor like a gentleman. For alcoholics one drink will always
be too many and a million not enough. But sometimes the
issue of just who is, and who is not, an alcoholic becomes
almost metaphysical
in its elusiveness and remoteness from specific, concrete
touchstones. A.A. for example, insists that any "alcoholic"
who subsequently learns to drink moderately and never goes
on a binge for the test of his life was not a true alcoholic
in the first place - a formulation that obviously begs the
whole question.
Part
of the problem is that most alcoholics do not seek any form
of treatment until they are in their forties, in which case
they've usually had about twenty hard-drinking years behind
them. If you have been drinking heavily for that long, your
brainstem is pretty-well shell-shocked anyway, and obviously
not capable of resisting the lure of those first few drops
of Alcohol. The critical question revolves around young
people in their twenties who are clearly on the road to
alcoholism. Dr. Gordon Bell, president of the Donwood Institute
in Toronto, a hospital that treats mostly alcoholic patients,
concedes that "many of the patients we've had, had
they been fortunate enough to come to us much earlier, would
have had another alternative besides total abstinence. "If
a program of teaching controlled drinking were ever launched
successfully, it would have a great deal more impact on
this group of budding young alcoholics than programs that
had total abstinence as their only aim.
Dr.
Sanchez-Craig, who is very much interested in such a program
of controlled drinking, insists that people who enrolled
in it would have to meet very definite criteria - they would
have to be young, intelligent, in good health, strongly
motivated to overcome these drinking problems, and strongly
attached to things like jobs or families they knew they
stood to lose from chronic heavy drinking. No one who has
been abstinent for any length of time, even somebody who
was under thirty, would be submitted into the program.
The
concept of controlled drinking for "problem drinkers"
is one fruit of the approach to alcoholism that treats it
as a learned response rather than a disease. Another fruit
is the concept of "constructive coercion" wherein
alcoholics are confronted by their employers or their spouses
or someone else, who threatens them with severe consequences
if they don't enter treatment for their alcoholism. According
to this concept, you don't have to wait for the alcoholic
to recognize one morning, through the mist of his pain,
the awful unmistakable image of his utter helplessness.
This coercion implies, in a way, that alcoholism is no big
deal. It is based on the premise that people, unless their
nervous systems are completely warped, will respond the
way you want them to when you make it absolutely clear to
them what they have to do and what will happen to them if
they don't do it. Clinical psychologists tend to feel that
if you could just apply constructive coercion to the alcoholic
on a daily basis you would have the means once and for all
to reduce or eliminate his drinking problems. Arrange it
so that the spouse has to spend fifteen minutes in an isolation
booth before he can take a drink, things like that; a few
"behavioral interventions" imposed upon him. Enough
behavioral intervention and you've probably got the problem
licked, supposing the subject is not too far gone at the
start of the project.
Of
course this means that you've got to have many allies, agents
so to speak, in your struggle to tinker with the environment
of the individual alcoholic. Dr. Capell sums up the perspective
of the behavioral therapist in this way; "When you
start to talk about effective individual interventions you're
probably going to end up having to think of ways to intervene
that involve more than just interaction between a patient
and a therapist. Rather we'll have to recruit the environment.
It's probably the case, as with most things, that effective
treatment will involve more than one approach to the same
individual but my basis is that behavioral interventions
of the type that experimentally oriented psychologists advocate
look like the way to go. They look like it to me because
people have actually been able to demonstrate their effectiveness,
at least in the laboratory. The argument against that is,
well, the laboratory isn't the real world. My counter argument
to that is, do you have something better? I mean, at least,
they've been able, in some cases, to show that if you're
clever enough to figure out for an individual how you can
actually work on a person's environment to help them cope
with their drinking, it can have an effect.
(Source:
Saturday Night, June 1978)
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