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)