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Yale to Rehabilitate Alcoholics
Condensed
from The American Weekly
Howard
W. Haggard
Director,
Laboratory of Applied Physiology, Yale University
RECURRENT
trips to jail for the poverty-stricken inebriate, recriminations
and preaching at the well-heeled drunkard will soon be replaced
in New Haven and Hartford by a trip to the clinic.
In each city, a diagnostic and guidance clinic will be opened
in the near future, to be known as the Yale Plan Clinic,
under the sponsorship of the Laboratory of Applied Physiology
of Yale University and the Connecticut State Prison Association,
where alcoholics, rich and poor alike, will be offered scientific
help.
No new “cure” for inebriety has been discovered;
the clinics will approach the problem from the point of
view that the alcoholic is a sick man and should be treated
as such.
The alcoholic is either led to his excessive drinking by
a sickness of his personality or his personality has become
disordered in the course of many years of heavy drinking.
Unless the alcoholic realizes that he is sick, and unless
his friends and relatives, and the general public, realize
that excessive drinking is a disease and not just “weakness”
or “pure meanness,” there is little hope for
the rehabilitation of the alcoholic.
Threats and punishment, scandal and divorce do not cure
the alcoholic; they may even drive him deeper into his habit.
What he needs is help – physical and mental help in
solving the problems which have given him his disease.
Unfortunately, the popular belief that the alcoholic merely
lacks strength of character is much the same as was the
attitude toward the mentally ill a century ago, when the
insane were put in prisons, or whipped.
From time to time the public hears that some “cure”
has been found for excessive drinking. This is never true,
for there is no specific remedy for helpless dependence
upon alcohol, in the sense that there is a cure for diphtheria,
or in the sense that there are definite means for controlling
the consequences of diabetes.
There can be no cure for alcoholism. The treatment must
be fitted to the cause.
There are however, various ways and means by which the problem
drinker can be helped to overcome his habit, provided always
that he wants to be helped.
The ways and means used are as many as there are kinds of
problem drinkers; there is no “medicine” which
will cure the craving for alcohol, nor is there some standard
method which can be used in the treatment of any problem
drinker.
Today there are probably 600,000 men and women in this country
who need medical aid because of their excessive drinking.
While this seems like a large number, it is nevertheless
true that only a small percent of those who drink become
alcoholics, and there are some 45 million people in this
country who use alcoholic beverages. Out of every 1,000
users about 13 eventually become problem drinkers –that
is, no more than 1.3 percent.
Between one and a half and two million people drink heavily
enough to be in danger of becoming problem drinkers. Wide
dissemination of the scientific facts about the excessive
use of alcohol and the reasons behind excessive drinking
may help to prevent at least some of these people from continuing
on their dangerous paths to alcoholic doom.
The 600,000 problem drinkers should not be thought of as
a group of like people. They are no more alike in their
temperaments and personalities than a group of people who
contracted typhoid fever would be. And, unlike typhoid fever,
in alcoholism it is not the “germ” which must
be treated but the man himself.
Just as all kinds of personalities are represented among
problem drinkers, so are all social, economic and educational
levels. The fact that most of the "“common drunks”
we see on the streets are from the lower economic levels
does not mean that such people are more liable to become
heavy drinkers; there are simply more people on this level.
The well-to-do produce an even greater proportion of inebriates,
on a basis of population. We know, for instance, that about
20 percent of those admitted to hospitals and sanitariums
for mental disorders are able to afford the relatively high
costs of private institutions, which means that they come
from the upper income brackets.
The most familiar alcoholic is the “bum” on
the dreary treadmill: he gets drunk, is arrested, sentenced
to a few days in jail, released, gets drunk, is arrested
-–and so it goes. After a time, the sentences may
grow longer, perhaps a few months.
But no matter how long he is in jail, he resumes his career
of drunkenness as soon as he is freed. The jail sentence
is definitely not a remedy for inebriety.
The “bums” clog up the jails and are a burden
on the courts, the police, and the taxpayers. A solution
to their problem is imperative.
Less well known to the general public are the inebriate
playboy and the glamour girl, who do their too heavy drinking
in the comparative privacy of nightclubs, from which they
are regularly carried home in taxis or in their own limousines,
or their maids and valets may know of their disease.
Even less exposed to the public eye is the business executive
who drinks either in his exclusive club or at his private
bar. His associates anxiously guard his secret and squelch
whatever rumors get out.
There is no single reason why people seek intoxication;
alcohol can fulfill so many conditions that it can be taken
for many reasons.
It may be baffled ambition, with consequence disgust for
the world and a desire to escape from it. A man may be a
square peg in a round hole – and drink to escape himself.
Drunkenness seems to be a rather coarse and bestial pastime,
but there are many highly sensitive souls among the excessive
drinkers – people whose ideals are so much in conflict
with the hard necessities of life that they have to drink
themselves into a stupor before they can tolerate existence.
The great Edgar Allan Poe was one of these. Such people,
despite their genius, suffer from an inner lack of self-confidence
which bars them from productive work. Only when the barrier
is removed by alcohol can they shed the fetters of self-critique
and, feeling “On top of the world,” produce
the literature or art or music which was locked up inside
themselves.
Alcohol does not create this things; it merely releases
them, possibly in a less perfect form that some means of
release other than alcohol might have given them. Alcohol
does not stimulate genius. It puts to sleep the forces which
have held it down.
Most people are not geniuses; they are led to excessive
drinking by boredom, by frustration, by social problems,
by economic difficulties and family troubles. But all the
excessive drinkers, sooner or later, develop a common characteristic
– that of damaged physical and mental health.
Deficiency diseases develop from improper nutrition: and
all excessive drinkers fall victims to other ills because
their bodies have lost their normal resistance. Their moral
stamina is undermined.
They become unreliable, an increasing burden to their friends
and relatives and to the community. They disrupt their families
and expose their children to misery as well as to the example
of intemperance.
When the alcoholic finally realizes that he cannot continue
his injurious course of life, he seeks for ways and means
by which he can drink without doing harm, or by which he
can drink less and still satisfy his longing.
There are no such ways and means. For the inebriate there
is only one way out, and that is never to drink again.
As a rule, it takes him long to realize this. And it takes
even longer before he will admit to himself that he can
not achieve this without help from the outside.
When the inebriate enters the clinics (he must be sober,
for these are not sobering up stations or hangover cures)
he will be interviewed by a psychiatrist who will endeavor
to discover those deeply hidden conflicts, disappointments,
anxieties, disaffection’s or boredom which led him
to his craving for intoxication.
Then social workers will endeavor to reconstruct the life
history of the patient from records and sources including
the family.
Psychologists will determine the picture of his abilities
and limitations. A physician will give him a thorough physical
examination.
The psychiatrist will then combine the results of all these
examinations, which would give him a picture of the type
of man or woman he has before him, the influences which
contributed toward the excessive drinking, and the psychological
resources and liabilities of the patient.
According to the total picture thus presented, he will determine
the kind of treatment which promises the best prospects
and successful results.
The treatment, of course, will depend on the temperament,
personality, family, and social situation of the patient.
It will not be given by the clinics; the psychiatrist will
recommend what treatment the patient should receive.
There may be some among those referred to the clinics who
are found to have mental disorders in which heavy drinking
is quite incidental. In such cases, treatment for the mental
disorder in a state mental hospital is the only possible
recommendation. They cannot be treated for drinking, since
this is merely a symptom of the disease.
The psychiatrist may find in some individuals a certain
readiness for religious experience. If such readiness is
developed into its full possibilities the religious experience
may offer a solution.
In a case of this sort, the patient may be referred to a
minister.
Occasionally a patient with a readiness for religious experience
may be referred to that courageous group of men and women
known as Alcoholics Anonymous.
Those who have contracted the disease of inebriety through
compliance with the customs of a hard drinking social set,
rather than through inner difficulties, may be referred
to a physician skilled in what is known as the “aversion”
or conditioned reflex treatment.
In this type of treatment, an aversion to alcoholic beverages
is created in the patient by means of certain drugs, and
when the aversion is well established, psychological pressure
is applied to reinforce the newly acquired habit of abstinence.
There may be cases in which it appears to the psychiatrist
that all the patient needs is to be given a chance to use
certain unemployment abilities or ambitions.
In such cases the patient will be put in touch with agencies
which can offer the opportunities. In some cases the clinics
may help to establish contact with an appropriate employer.
(Source:
Science Digest, June 1944)
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