The Facts About Alcoholism
exclusive interview with Dr. Selden D. Bacon, Foremost Authority on Alcoholism How extensive? What cures? What teachings to youth? How shall employers deal with problem?
The center of Alcohol Studies at Yale University has just completed several surveys on the problem of alcoholism--as it affects industry, education, highway safety, government as well as family life:
What makes an alcoholic? Is it drinking to excess or is it something else? What are the symptoms--and how can anyone tell whether he or she is in danger of becoming an alcoholic? What are the States and cities doing about the problem, especially as it affects traffic accidents? How is industry, troubled sometimes by heavy absenteeism, handling the alcoholic?
To get the answers to these and other related questions, the editors of U.S. News & World Report interviewed in their conference room for two hours Dr. Selden D. Bacon, Director of the Center of Alcohol Studies, Yale University.
As far back as 1930, interest in the study of alcohol began at Yale in the Laboratory of Applied Physiology with the issuance of scientific papers and the collection of information amassed in previous years. Biochemists, researchers in sociology, economists and psychologists began to make surveys and to seek scientific answers to the many questions people were asking about the use and effects of alcohol.
In 1943 the pressure of public interest led to the establishment of a summer school of studies at Yale which has been operating ever since. It is usually attended by representatives of the distilling and brewing industries, five or six professional temperance people, a dozen physicians, and about the same number of nurses, 25 to 30 ministers, 30 to 40 social workers and probation officers, 30 to 40 who are engaged in education, a few judges, and a few members of "Alcoholics Anonymous" who are engaged in teaching or in industrial personnel work.
More than 1,600 have graduated from the school and a large proportion is making use of this training in State and local, voluntary and governmental agencies dealing with problems of alcohol and alcoholism. At least 75 have become executive directors of such groups.
With the co-operation of the Connecticut Prison Association, an outpatient clinic just for alcoholics was begun in 1944, and a year later the first State Commission on Alcoholism was established by Connecticut and Dr. Bacon has been its chairman ever since. In 1940 the Quarterly Journal of Studies on Alcohol was started. The Center also published a series of 15-page pamphlets that have been in unusual demand for such technical material.
The Yale Center now has six major divisions and is primarily interested in popular education on the subject of alcohol and research in certain areas of social and health problems, such as drunken driving, the problem drinker in industry and related subjects.
The interview with Dr. Bacon follows:
Q: Is yours the only center of scientific studies on alcohol in this country, Dr. Bacon?
A: It is the only one. We think it would be a healthier thing if there were two in the country. We had hoped that one would start down in Texas. Dr. Jellineck left us to go there and start such a center, but it finally broke up. He has since become the head of the World Health Organization Committee on Alcoholism.
Q: What is the alcohol problem?
A: There are several types of problems. There are scientific problems, there are group problems, and there are individual problems. But it is pretty impossible to separate them. Take, for example, the particular problem of alcoholism: If anybody wants to say it is a mental problem, Iíd day they are absolutely correct; if anybody wants to say itís a legal problem, they are absolutely correct--or an economic problem or a medical problem or a social problem.
Q: Most people are not alcoholic, are they?
A: We would say that there are approximately 60 to 70 million drinkers out of a population of 110 million people of 15 years of age and over. We would suggest that there are just short of 4 million out of that 60 to 70 million who are patently losing, or have lost, their control, and their lives are beginning to show, or have already shown, damage in one or more aspects.
Q: Then the difference between the heavy drinker and the alcoholic is that the alcoholic has lost control?
A: Yes, but there is no real line between them, no clear-cut example.
Q: But only 1 person out of 16 who drinks is an alcoholic, is that right?
Q: Is that proportion rising?
A: The best-known estimate is that developed by Dr. Jellineck which shows that between 1940 and 1948 there seemed to be a rather regular increase, and that in Ď49 and í50 it reached, so to speak, a plateau, and may show some indication of going down. However, remember this, that it takes from 6 or 7 to 20 years for alcoholism to develop, so if you are trying to think of a rise between 1940 and 1947 donít think of what happened between 1940 and 1947 alone, although what happened then might have speeded it up.
Q: It could go back to the depression years?
Q: Does your research show that alcohol is injurious to the human body?
A: Alcohol oxidizes when it gets into the human system. It oxidizes at the rate of an ounce in two or three hours. For 100-proof whisky, which is 50 per cent alcohol, that means that 8 ounces of whisky would be all gone from the system in less than 12 hours, most of it breathed away, some lost through sweat or urine. This proportion would vary with an individualís weight and also with the amount of food he had in Ďhis stomach. Then the alcohol is gone. Even in the most pronounced binges, you lose it all in 48 hours. Chemical tests show that.
Q: What does it do to the body? Why cirrhosis of the liver and so on?
A: The actual answer to cirrhosis is not known, but I think the most prevalent theory is this: The liver under certain circumstances will tend to develop what is called "fatty tissue." In other words, you get fat mounting up there, which cuts down the function of the liver. Now there is an agent--probably this is over simplified--that counteracts this tendency, so that the fatty tissue doesnít last and finally take over the whole organ.
Some of us have stronger counteragents and some of us have weaker counteragents. Those who have weaker counteragents are very likely to develop cirrhosis of the liver--and they may never have had a drop of alcohol in their lives! Or they could be persons who take a drink once or twice a year, at wedding ceremonies or something, and they get cirrhosis.
Some have very strong counteragents and they can drink the alleged fantastic amounts that they say they do--a quart and a half every day of their lives, and so on.
Anyway, when you take a person who may be just below average in his counteragent effect, alcohol does--this is one theory--so reduce the effect of this weaker counterpart that this fatty tissue begins to form a little more and a little more, especially in the case of people who drink a great deal and continuously.
It may take 10 years before it begins to show up. Then you begin to get hobnail liver and the like so that just by palpation (touching the body from the outside) you can feel these hard spots where this fatty tissue has developed.
Q: What do you mean by "a great deal"?
A: You have to consider the personís weight and so on, but letís say he is drinking pretty regularly a pint of whisky every day. It will vary with the liver, of course. Even with the weakest liver in the world, you are not going to get cirrhosis automatically.
Q: What about the heart?
A: I am no expert on that, but I will leave some suggestions on it. Your question is out of my field and this answer certainly should not be regarded as authoritative from a medical viewpoint. But there is an action on the arteries from alcohol which will make it easier for blood to flow. So that if you begin to get a condition similar to, letís say, arteriosclerosis a certain amount of alcohol--and I donít recommend alcohol as the best way of doing this--may grant one a certain amount of relief from the hardening-artery situation, and there will be a little less effort on the part of the heart to pump and keep the blood going.
Diseases of Alcoholism
Q: Is that why patients with a heart condition are given alcohol?
A: I donít think so. I donít think many physicians know much about alcohol as such, anyway. Why should they? They donít get any training on it. It isnít mentioned in medical schools, except for the alcoholic diseases which are found in probably less than 25 per cent of the alcoholics in some countries and I think a smaller proportion in this country.
Delirium tremens, alcoholic hallucinosis,
chronic avitaminosis, chronic gastritis, other things--and these are recognizable conditions, illnesses that would be discovered and labeled by any competent physician--which follow upon years of excessive drinking--are called the diseases of alcoholism. If you find delirium tremens in 18, 19 or 20-year-olds, I think you have good grounds for suspecting a psychotic condition set off or merely aggravated by alcohol.
Q: From the ordinary use of alcohol, what would you say is the effect on the heart? Is it helpful or harmful?
A: I wouldnít say that it was particularly one or the other until you get into conditions relating to certain ages, as, say, 50 beyond, in which it may serve a useful function.
Q: Doesnít it cause an immediate palpitation of the heart? Doesnít a drink cause the heart to beat faster?
A: I canít answer that question. By the way, you can see almost any bad reaction you want to see after the injection of alcohol following certain situations, but whether that is caused by alcohol or notó
Where Textbooks Mislead
Q: Physiology books in school used to warn against the use of alcohol, and one of the ways they did it was to tell you that it caused immediate stimulus and as soon as the stimulus had worn off you would have a certain fatigue and a certain reaction. Therefore, alcohol, in stimulating the heart, was harmful. That was in the textbooks in the old days. Is the modern theory any different?
A: We made a survey in 1940 of all the textbooks being used. I think what was done was to pick out 10 common fallacies--such as alcohol is a stimulant, alcohol causes certain diseases, alcohol does something to the brain tissue, drinking causes shortening of life, and so forth--all beliefs that have been disproved by objective and empiric evidence that could be repeated in any laboratory--and checked the tests against these fallacies.
Q: This was a survey you conducted on those fallacies?
A: Well, first, we know the fallacies. We had worked on them in our own laboratory. Then we went out and, as far as we could, -studied every text that was used in a school system, whether parochial or State, all the manuals put out by the State bureaus on alcoholic education, all the temperance stuff and checked to see how widespread these fallacies were. And about 98 per cent of the books had these fallacies.
Q: What does alcohol supply? What is it that people seek?
A: There is one very good answer: Alcohol--and I donít care in what form you get it as long as itís ethyl alcohol--is what is called a "sedative." I am merely repeating their statements of the pharmacologists, the physiologists and the biochemists. Under the sedatives they would sub classify it as a "depressant." This means that it tends to produce sleep finally. But it does so in a very special way--namely, that you can take just a little bit and it will have a slight depressant action. No matter how little you take, it will hit certain central nervous functions.
Incidentally, the outward behavior of the person may seem just the opposite of being "depressed"; what happens is that certain controls are reduced; it is more like releasing a brake; it is not a stimulant, not stepping on an accelerator.
Then you drink a little more and it hits the central nervous structure more; a little more, it hits still more; and finally you will go to sleep. If somebody should then inject more while your are asleep finally the heart would "forget," if you like, and you would drop dead. You already will have been dropped, however, before that takes place.
Itís lucky, shall we say, that it is very difficult to drink yourself to death. You could do it, but it takes quite a few minutes for the alcohol to get into operation. Drinking at any ordinary speed would result in oneís passing out before a fatal amount was consumed. But if you drank a quart or a quart and a half just as fast as you could, possibly injecting it into your system, you might kill yourself.
Q: Alcohol is a poison?
A: On the basis that any substance you take can kill you, yes. But this is also true of mashed potatoes.
Why People Drink
Q: Well, why do people drink? If it is a sedative, why would people go through all this just to go to sleep?
A: In the early stages, alcohol has this reaction: You relax, you operate more slowly, or you operate with less efficiency and exactitude and discrimination. This takes place first in those areas in which "learning" is recent or difficult or painful. Now as to this learning, if we had an experiment here and sat here and went around learning the names of the States or 15 varieties of flowers, that might be interesting and prove the point. If you were tested on this learning you might get a score of 95. After one or two small drinks, however, you would only score perhaps 85. If geography or the study of flowers had always been painful or difficult for you, your sober score might be 88, but after one or two small drinks it might drop to 65.
But for human beings, this sort of learning is not too important.
Learning that is important for us in the sense that it affects our daily lives and carries heavy emotional impact would concern such things as, perhaps, oneís perception of oneís self. "Am I a pretty reasonable sort of guy? Do most people think Iím a stinker? Am I weak? Am I stupid? Am I sexually rather impotent, so that no woman would ever be interested in me?" --or, if a woman--"Would any man ever look at me," and "I can never be a mother." This sort of learning is very painful. It may take over 15 to 20 years to learn, and it is horrible to live with. Or there is the matter of not being able to assert oneís self, to stand up in competition with others.
We know of people who are frightened in these ways. They may have the capacity, the ability, and so forth, to live adequately and happily--but they canít exercise it.
Q: So they take to alcohol to forget all this?
A: Well, this is what happens--this is the sort of learning that is first realized: Hereís a fellow who is very shy in a group. He has a couple of drinks and loses some of that very painful learning (shyness or exhibitionism are learned modes of behavior) temporarily, so that now he can talk a little more freely. He suddenly forgets that he is incompetent or frightened.
Q: His inhibitions are gone?
A: They are not gone--they are temporarily reduced.
Q: Would you consider, then, to that extent that alcohol can serve a useful purpose?
A: Well, you selected the word "useful." I didnít. Letís take an example: This man on my left may be my boss. I think he is an awful stuffed shirt and I want to punch his face in and tell him heís an old jackass. However, I have learned to control such impulses. But now I have a few drinks and say, "Youíre an old jackass." Well, that probably didnít turn out very useful.
Q: But couldnít it be the opposite? Couldnít it relax the fellow who is too shy to stand up and address a group and help him to forget about his shyness?
A: Well, here is a classic example: There was the man in Germany in 1888 or so who moved to a new town. He was quite a shot, and they have a rifle club there and they go out to see Herr von Whatís-his-name and ask him if he can shoot. He says, "Sure," and goes boom, boom, boom, and gets 20 bullís eyes out of 20 shots. So they ask him if he would like to join the team when they go over and play Von Sedlitzville. All right. So they make him anchor man down there, but old Boom-boom-boom gets 12 on the bullís eye, 6 on the outside, and so forth. "Oh, well. He was upset, he was new." So they try him again, and again heís a failure. But in the interim he is out on the range practicing and hitting 20 out of 20. One day somebody by mistake or something happened upon this: "Just before the meet we will give him a couple of drinks." He goes up and, instead of hitting only 12 out of 20, he gets 17.
How Score Can Rise, But Ability Fall
Now what has happened is this: The alcohol has reduced his acuity, his reaction time, his discrimination, so that he could not get 20 out of 20, but it has also reduced his inhibition, his fear, or whatever it was that was bothering him in competitive situations, so that he doesnít drop way down to 12. Alcohol actually seems to improve his ability, but it has also actually brought his abilities down. Is it useful?
The problem here is not the answer. It is the question. Americans always want black-and-white, or yes-and-no, answers to questions concerning good and bad, or true and false. Most questions, unfortunately, cannot realistically be answered in such simplicity. Alcohol is not either useful or non-useful. It is clearly both, depending on the person, situation, amount and many other variables.
What Makes An Alcoholic
Q: What is your answer to the question as to what makes an alcoholic? Most people donít know what the word means. Most people donít understand why, since they can take a drink every day in their homes and never get drunk, all of a sudden somebody comes along and takes one drink and heís under the table. Why is that?
A: I canít accept the example of one drink and under the table. An alcoholic might pass out after taking one drink while you watched him. He would have had 20 drinks previously without your knowledge. Sometimes people who are utterly inexperienced will act, following a drink, in ways they think to be "tight" or "high." Adolescents experimenting with alcohol may show behavioral responses utterly inexplicable from the action of the small amounts they have consumed. However, itís hard to believe that even they would fall under a table with one drink.
Q: What about the difference between the person who takes a drink every day and is not an alcoholic and the person who drinks a little now and then and is an alcoholic?
A: We would say that there are probably two important criteria to distinguish the alcoholic from what might be termed the "heavy drinker." One of them is this: the lack of control exhibited by the individual over, first, when or if he will drink. That is, "Will I drink this afternoon, or not?" Of course, he is going to drink sometime. Second is the loss of control over the extent to which he will drink. That is, sometimes he has decided he will sit down for two and suddenly finds he is having his sixth drink. And when I say, "decided," I mean that this can even be announced. It is not only internal, which can be discovered by an objectively trained observer, but he may even say, "Iíve got this meeting coming up," or "My kidís having a birthday party and Iím not going to take a drink." Then to his own amazement, shock and horror, he finds himself having drinks.
The other is that he plans to have three drinks but--not every time, but with increasing frequency--he takes 30 or 40 and is drinking to oblivion. Heís out of control. That is one aspect.
The other we would say--and this must happen eventually--is that this excessive drinking, through drunken behavior, begins to create problems of itself--remorse, anger toward others, guilt, feelings of inferiority, helplessness, and so forth, within the individual, and manifest signs appear of trouble in his relations with his social environment, that is with friends, family, on the job and the like.
This man is having his "status quo" as an individual regularly damaged because of this drinking. Now, it is those two thingsóchronic and increasing damage directly related to drinking, and the lack of control over drinking--which mark the alcoholic from the "heavy drinker."
Q: Do you think that a person who is a chronic drinker inevitably becomes an alcoholic?
A: No, that isnít so. There are millions of regular drinkers who arenít and wonít become alcoholics.
Q: Well, then, what is it that encourages the chronic drinker into the alcoholic stage?
A: But the alcoholic doesnít have to be a chronic drinker. Of course, if I could give you the answer just like ABC, we wouldnít have to be here, because it would be something we would know how to fix. We have some ideas about it, however.
Letís say that we have a number of people who meet these two criteria--they are out of control, which has gone on over some period of time, and some socially or emotionally significant aspect of their lives has been damaged thereby. I think we will find that there are quite a few different types.
Major Problem for Some is Psychotic
One type I would call "adjunctive" alcoholism. That is not a technical term; I just use it. Here is a man who from the point of view of the depth of his condition, the difficulty of treating it, and its impact on his whole life is more importantly affected by something other than his drinking problem. He is what the psychiatrists call psychotic or protopsychotic, if there is such a term. And he has found, or thinks he has found, that getting drunk relieves the horrible feelings of psychosis. His psychotic symptoms are not extreme, so the manifestations donít strike you or the man on the street or the cop on the corner, except in rare instances.
But he gets drunk 30, 40, 50 times a year, and the "drunkenness" behavior is noticeable. This, if you like, is a facade, the appearance of the condition. He may well be called a "damned drunk" or "inebriate," or whatever the term happens to be. He is haled into court, the social worker will see him, the minister will see him, his wife will scream, his boss will fire him, and so forth, and he will be called an alcoholic. And maybe he is developing alcoholism, but his major problem is something else. We find this with certain types of psychotics.
Q: Are there quite a few of that type?
A: I would say that, although our figures are not too good, there are quite a few. I would say that a number of epileptics can be found here, because alcohol apparently reduces the strength of the trigger mechanism that sets off the epileptic seizure.
People who have brief epileptic seizures like that--3-second attacks, so that all you notice is that sometimes the person doesnít seem to be paying attention to you--may gain some relief from using alcohol. The man may not understand it, but he drinks and he feels better. And he had better look out. Because the day one starts using alcohol as a medicine for a chronic condition, he is using a sedative for-privately defined purposes.
Q: Then arenít you finding that mental-hygiene problems are closely related to alcoholism?
Q: So that some people who have mental or emotional aberrations of one kind or another become alcoholics?
A: Yes, they might try to find relief in this way. However, I would say that the larger number of people who are neurotic--and I mean here psychiatrically determined neurosis--although they have the opportunity to drink, do not become alcoholic. While excessive drinking may have relieved some emotional pain, it was not acceptable to them for a variety of reasons. Maybe their own neurotic pattern was functional enough for them to meet their troubles. Maybe they were brought up to believe that getting drunk is a horrible evil, far worse than their neurotic pain.
Let me say that the likelihood of a woman who is neurotic becoming regularly and often rather drunk, perhaps even developing into an alcoholic, is much less likely than in the case of a man, because the social pressures on drunkenness are much heavier against a woman than a man in our society. As a result, it is a less likely sort of adjustment to problems for women in our society.
Q: Letís take it in reverse. Arenít the people who are trying to cure alcoholism aware
today of the fact that they have to cure the mental problems as well?
A: This calls for a lot of comment. First, Let me say none of us accepts the word "cure."
That is one of these words I would like to eliminate because we say that no alcoholic is ever cured--it is merely an arrested condition.
Q: Does that mean that alcoholism is a disease?
A: Only to this point--that to our knowledge it cannot be helped to the extent that the person can relearn how to become a social, temperate, moderate drinker.
Q: He must give it up completely?
A: Absolutely, forever, in any form, in any amount. We have cases of people who had stopped for 15 years and who thought it was safe, or some naive doctor told them a beer isnít really drinking, and so they go on againó
Q: And it takes very little quantity--
A: Itís the alcohol. The quantity doesnít matter, no. If they are unaware that they are taking alcohol, if they donít even know about it, or in some circumstances if the ingestion is interpreted in so ritualized a fashion that it has nothing whatsoever to do with "drinking" as that is interpreted by the individual, then there might--and I emphasize the "might"--be no effect. I still wouldnít be surprised if it did start him off again.
Take the Catholic priest who is a recovered alcoholic. At Mass, as I understand it, nobody gets any wine at all except the priest; sometimes he may have to take quite a little because it all has to be used. I have heard, and I would believe that in the case of certain priests who were recovered alcoholics, that this ingestion of alcohol--because chemically that is what it is--did not cause the man to revert to alcoholism. Certainly a sincere priest wold not interpret this act as "drinking." However, it would seem a great risk to run.
Alcoholism in Feeble-Minded
Q: Well, do you think that if we make progress with mental hygiene in America we will tend to reduce alcoholism?
A: We will reduce that proportion that I was speaking of. I started off with the worst, the psychotics and pronounced neurotics.
Q: What are some of the others?
A: There is a certain proportion that are feeble-minded. We would say that the proportion of alcoholism in the feeble-minded is much higher than it is in the general population. But, altogether, itís a small number. The feeble-minded, the psychotic and the epileptic are three categories in what I termed adjunctive alcoholics. The person who begins to act like an alcoholic at 17, 18 or 19 presents at least a strong suspicion of a major neurotic or approaching psychotic situation, perhaps schizophrenia.
Ordinarily alcoholism will take anywhere from 7 to 15 years to develop from the early -symptoms to the final full-blown appearance But with major neurotic conditions the development may take less than a year.
Q: Are these the only groups who are likely to turn from social drinking to excessive drinking?
A: On, no. This is just one small segment. I would say that we have some people that are called "neurotic." Now, what I mean by "neurotic" is approximately this: His peer group--we will say "his" and not "her" because we run 5 l/2 males to one female--thought at the time, say during the teens, that the individual was clearly peculiar.
They are "screwballs," or whatever the popular word is among their group, and they are known as that by the others. Theyíre frightened, theyíre shy, they donít get along well in interpersonal relationships, they donít know how to fight, they donít know how to date, they donít know how to dance, they donít know how to dress, and so forth. They may study excessively, they may be highly overcompensating athletes who are terrified of other people, they may be "motherís boys." And the others recognize it, and it is noticeably interfering with their day-to-day life. This person at 16, 17 or 18 may discover alcohol. He may not even know that he has discovered it. He may go to his first party and have some drinks and simply know that, "Gee, when I go to the Joneses on Saturdays I have a wonderful time!"
But after several experiences he canít help making the correct discrimination because he went to Greenís house and it was Thursday and there were drinks and he had a wonderful time, and the next Saturday he went to the Joneses, had no drinks and he felt awful. This person, then, begins to find that with drinks he can act more like a human being, that he his accepted by others, and there is this tremendous relief--"My God, I can be a human being after all!"
The group of alcoholics with this background, I would say, is more sizable than the psychotics. But I would not say that they are all the alcoholics by any means. Anybody who tries to explain alcoholism entirely in terms of basic or character neurosis faces an impasse.
Q: If we should make more progress in mental hygiene will we make more progress in the field of alcoholism?
A: As mental hygiene is able to do something about the prevention of psychosis, for this percentage, yes. As it is able to do something for the prevention of neurosis, or social or emotional deviation, obviously for a bigger percentage, yes.
But, then, take this even large group of alcoholics who donít give evidence of early neurosis. You only discover them when they are 40. You go back through their life histories and you canít find in the school record any evidence that they were peculiar--they were just like everybody else.
Now everybody--and this is pertinent to the mental-hygiene question--everybody has personality difficulties. We all of us have stronger and weaker spots in emotional and social adjustment by definition. Some of us are quite well adjusted in relationships with the opposite sex on a series of levels, whether it refers to actual sexual intercourse or whether it refers merely to talking to secretaries. Some of us are average and some of us are a little more or a little less well adjusted. Some of us in the matter of competition and assertion and dominance are stronger or weaker. All of us have certain weak spots. We are not robots.
Letís say that I am weak when it comes to asserting myself with people in a higher status or with older men. Maybe it has something to do with early experiences with my father or my older brother. Anyway, it is a common thing. It is found in personnel problems all the time. You promote a good man and he collapses. Why? He cannot give orders on a higher level.
A boy is, let us say, now 23, 24, 25, and he has all the ambitions that most young American men have, and he feels a little more at ease, a little more relaxed, and loses a little of this restraint after a few drinks. Well, he says to himself, so do a lot of other people. So what!
Along about age 25, 26, 27, this particular problem becomes even more significant to him. The boy is no longer in the school or college situation and canít fall into one of those nicely defined categories where this is the faculty, these are my elders, these only lower classmen, and begins to realize that he is a competitive person, too.
He, too, can get up there and can even disagree with those people. In fact, the situation demands that he compete. This makes him somewhat ill at ease, but over the week end when he has a cocktail, some highballs, or whatever it may be, he loses some of his fears and anxieties on this score, and this loss becomes highly important.
There would seem to be a point, as we recapture the life experience of the alcoholic, where there suddenly is an increase in the intake. Letís say that in his group they usually have, say, three cocktails two nights a week and on Saturday nights. This manís intake jumps up
When Drinking Gets Serious
Q: Is this suddenly?
A: It would seem so. At least the man remembers it, and so do some of his friends. Then he begins to show all sorts of symptoms, but I will skip all of them and go right into the possible mental-hygiene aspect of it. He begins to increase the time of drinking and may have a couple in the afternoon. He may even shift jobs so that he may get into a position where this sort of thing is more possible. He may shift friends so that he associates frequently with those among whom heavier drinking is socially acceptable.
And we will find that he is making certain decisions and is meeting certain people particularly at the times when he can have a few drinks--not that he is going out and hanging on to lampposts. He may tie one on now and then if the people in his group tie one on. But he is regularly drinking more. Perhaps he is meeting problems with his wife or his kids that have made him very uneasy. He canít stand the kids at supper time, and he is afraid his wife expects him to do things he canít do, but if he has two cocktails every night he no longer notices their criticisms, their requests for his attention. He may be abrupt and even a little sarcastic with them, and doesnít know that he is doing it.
This is a very slow, gradual process. We call it the "pampering effect" of alcohol. There was a weak spot in his personality armament and, instead of trying something new and learning through variation, no, he protects himself more and more by alcohol. The needs for the personality go on and new needs come up, especially in the weakest areas, and this fellow is not learning, he is not growing, he is not changing, but more and more is covering it up.
Then, if the situation develops whereby he is put under some special pressure, he may--and it is three oíclock in the afternoon--say, "If only I had a couple of drinks!" And heís right--because he has those couple of drinks and it doesnít bother him so much. Then occasionally begins to get drunk. Now, when he gets drunk, he has not only the remorse that any might have who experience a -hang-over, but also has this awful remorse about the situation which he didnít resolve and about what he did while drunk, plus the fact, "Iíve done it before and before and before, and I canít stop it!" He experiences a monumental psychological effect from the hang-over.
A vicious-circle process can now be seen. As the individual more and more depends on alcohol to meet certain situations--and for a while he is successful, for it does work--he is, through lack of exercise, so to speak, reducing his basic equipment to meet other people and particular types of situations effectively. As this happens, he needs a little more. As he begins to take a little more, he begins to make "drunkenness" mistakes. In other words, he could be overly aggressive and doesnít even know it; you can be critical of him, and he doesnít even notice.
Pretty soon the liabilities of drinking -overtake the assets. Furthermore, occasionally he oversteps and really gets drunk and does things that create new, major difficulties, so he has to get over this additional problem. To cover up this new problem created by the excessive use of alcohol, he uses more alcohol, and so the nice little vicious circle becomes a bigger vicious circle.
It may be that a definition of psychological addiction" would be the use of alcohol to overcome the effects of alcohol, whereas when you are merely using alcohol to overcome situational problems or neurotic problems, this is not the case. Then you are drinking to overcome shyness or inferiority feelings, which are not created by alcohol.
Q: Now, where does mental hygiene fit in?
A: We would say two things. First, letís note this fact. Over the past 50 years, which is at longest the reign of modern psychiatryóand perhaps you would prefer 25 years--psychiatrists have been peculiarly unsuccessful with alcoholics. The psychiatrists know this and dislike the alcoholics; the alcoholics know this and dislike the psychiatrists. And so the hope of doing anything, one with the other is, of course, very low. Psychiatrists are not alone in that, however--it covers everybody else, too.
Slips In Psychiatry
Q: But why have the psychiatrists, if this is a mental-hygiene problem, not done better?
A: One answer to that would be that the psychiatrist, quite correctly, sees that this person has personality difficulties and in some instances they see a long-lasting character neurosis, one thatís been in the developmental stages for years, perhaps since the age of 4 or 5. So the psychiatrist says that, unless we get rid of this thing at the bottom, we are just playing games with the thing at the top.
So the alcoholic comes into the office and the psychiatrist starts needling back into this, perhaps, adolescent problem, and then back to the 7 or 3-year-old period. The alcoholic looks at the psychiatrist and wonders, "Which one of us is screwy?" Here he is; his wife is going to toss him out on his ear, he canít hold food on his stomach, his glasses are smashed, he has lost his papers, he is going to lose his job. He has this horrible feeling of fear, of additional worry about this alcohol business, and here this weird character is asking him what dreams he had about his great-grandmother when he was 4 years old.
Q: Thatís an exaggeration, of course--
A: Yes it is, but it is significant of a very important thing: The psychiatrist, very correctly, proceeds on the premise that there were underlying difficulties much more significant than the actual effect of the alcohol. And so they begin to talk about alcohol as a symptom, but I would suggest to you that, as the alcoholic Ďhas gone through alcoholic experiences for many years, he is no longer merely a neurotic type B or a neurotic type C. He may once have fitted such a label, but now he has added alcohol-dependency and has fused the two into something new. He has problems, demanding problems, problems that have gone so deeply into his insides that this alcohol will trigger him off even 15 to 20 years later, even if he never takes a drink in the interim. The alcohol dependence is terribly important in itself. It is a new thing. It is what we call "alcoholism."
Q: So you do have your original problem in personality and mental hygiene?
A: Yes--and perhaps you can tie this original to poor neighborhoods, unresolved Oedipus complexes, lack of affection, and so forth, yes. But, unless there is also understanding of the impact of excessive and chronic alcohol ingestion and what it can do to an emerging, growing personality, therapy wonít get very far.
In the first place, you will have a lot of alcoholics who wonít have what you would call a neurosis, and yet they are just as bad as the other fellows in the end. When you get the one who has this real neurotic problem you probably canít reach him by the usual psychiatric technique because, as the psychiatrist would put it, he is an objectionable, un-co-operative person--and that is right.
Q: Is there any inherent tendency to become an alcoholic? You hear of people referred to as a natural for alcoholismó
A: Letís put it this way: Acquired characteristics are not inherited--that is, you cannot inherit a taste for alcohol. You do not inherit drinking. Alcoholism? There is an inherited structure which is closely related to oneís potentiality to develop an effective personality. So, since weaker personalities are prone to maladjustments of all sorts, including alcoholism, yes.
We say that alcoholism is found to a higher degree among the feeble-minded than the rest of the population. Certain of the feeble-minded probably have a structured, organic deficiency which can be inherited. However, they inherit feeble-mindedness, not alcoholism.
Q: I want to clear up this heredity question a little bit. Do I understand you to say that, while there is no acquired taste, if a parent has a personality defect, and that defect is reproduced in the child--
A: It couldnít be personality--it would have to be an organic defect.
Q: Well, does that cause the child to take to drink?
A: The organic defect does not cause the individual to drink. The organic defect has an effect on their ability to intellectually or in reaction time or in emotional spasms or in certain diseases, say, tuberculosis.
Q: If that is reproduced in the child, then the child will be susceptible to the same thing?
A: It will be susceptible to personality disorders, sometimes alcoholism, sometimes delinquency or neuroses. Now, I should add one more thing--that alcoholism runs in families.
Q: What is the reason that it runs in families?
A: Because the father or the mother who is an alcoholic finds it almost impossible to give love and affection and attention and responsibility to anybody, especially to a child, who may well make him feel guilty and the like. This is, of course, particularly true of the mother. The situation in which the alcoholicís children live, the way they are brought up, just everything, tends to make them upset people. Sometimes they will become extreme, wild "drys," ascetics; sometimes they will become extreme drunks. Sometimes they may be moderate drinkers. But they experience hardships of an emotional nature during infancy, childhood and adolescence if the parent is an alcoholic.
I might add something else here. Alcoholism cuts across all social groups, all educational groups, all occupational groups. It is limited to certain age groups, yes, largely because it is a slowly (10-15 years) developing condition; it is most common between 35 and 55. It differs by sex, yes--5 or 6 men to 1 woman.
And in ethnic, cultural background--we find that the Mediterranean people--the Italians and the Greeks, for example--will tend to have Ďlow rates. The Jews, almost all of whom use alcoholic beverages, have an extraordinarily low rate, a fact which has been recognized for over three centuries.
The so-called native white American group will have quite a high rate, as will the Irish, Scandinavian, English, and Polish people.
One noticeable thing is the difference between the sexes. In this country the ratio is about 5 l/2 or 6 to 1; in England for many years, 1890 to 1940, it was running about 2 men to 1 woman; in Scandinavia at the same time it was about 27 men to 1 woman. But it is interesting to note that, after three generations in this country, the Scandinavian rate began to descend to about 11 or 12 to 1, the English to come up to about 4 to 1. Those Jews who have more and more become secularized, gotten away not only from the Orthodox but also from the Conservative or the Reformedóespecially if their parents have also--their rate has begun to go up.
In other words, the Americanization process is gradually working in this sphere as well as others.
Q: What are the pre-alcoholic symptoms?
A: Well, thereís an increase in intake--we have the man who is drinking just like the other people in his group. The quantity doesnít matter--it may be six sherries a week, or two highballs a night. This man starts increasing his intake, and he begins to show some of these behaviors--and remember it is the repetition of these behaviors and their patterning with the others, not just their occasional appearance.
The first thing it suggests is an increase in gross, drunken behavior--that is, when he has a little too much, instead of acting the way he used to act when he had a little too much, he begins to be more out of control in his immediate behavior.
You all know that inhibitions go down with drinks--one forgets the immediate worries, the immediate fears. For instance, youíre all being very polite here, but if we were at a cocktail party, I couldnít get all this attention. Iíd have to talk a little louder; my jokes arenít really very funny, but after two or three drinks they really begin to seem to me to have that particular flavor that would make Noel Coward jealous, and even you may forget a bit and laugh at some of my jokes.
But this is still within the range of social acceptance of that group. This man, however, begins to go beyond that. He starts to be a big shot--spends a lot of money, sets them up for the boys in the back room; he get noisy; certain words which are limited perhaps to times when I hit myself with a hammer begin to come out more and more in general conversation. In a variety of ways this manís behavior more and more often becomes obvious, irritatingly obvious, to the other members of the group when he is drinking.
Dangers in a Blackout
Another thing of considerable significance is the appearance, often very early in the game, of what is called "the blackout" or "pulling a blank"--this is sort of temporary amnesia. The man is drinking along about 7, 7:30 or 8. Now the blackout begins, but, if youíre the man you donít know it--Youíre still around, youíre having drinks, youíre talking--you may get in a car, and drive 50 miles, you may take a room at a hotel, but memory has stopped completely and one cannot recall anything that has taken place since 8:30.
You can imagine the terrific impact this will have on women in our society, because there is immediately the thought: "I may have had a sexual experience--or other people will think I have, which is just as bad." It is terrifyingóless terrifying for a man.
You get situations where a man has a blackout which lasts 36 to 48 hours--he ends up in another city, he doesnít know where he is. He learns to have a newspaper sent up to his room to discover the date and what town heís in. I now of one man who when he came out of the blackout remembered that he was to have signed a $400,000 contract the previous day at 10 a.m. Quickly making himself presentable, he rushed in to the corporation president with whom he was to have closed the deal, made some lame apologies, and hoped the whole thing wasnít off. The corporation president looked at him rather strangely and then stated: "Mr. C., you were here yesterday at 10 a.m. and we signed the agreement." Not all blackouts have this type of surprise for the end of the story.
Then there is the gulping and sneakingóthis is an indication that it is not social drinking any more--the fellow has to do more than the social pattern will allow. He needs to get this personality jolt or lift through acquiring a significant and rapid concentration of alcohol in his system--just a little bit doesnít get him started. He begins to know that at the Jones house he will only get a couple of martinis, so before he goes to the Jonesesí he usually has a couple of quick ones--heís the fellow who has to help the hostess, and incidentally get a few slugs on the side. He is learning that he must have more.
Now, these are early symptoms.
Q: Can they be corrected? Can he stop?
Q: Could you give him some rules, Dr Bacon?
A: To know that next he goes into alcoholism--that that is the next step--the first great crucial point, the loss of control. He meant to have two drinks, he winds up drunk. We find that he begins to need special rationalizations to explain his drinking, because people begin to notice he is drinking more. And these rationalizations cover the waterfront--everything you have ever heard of.
At this time he may show a few instances of drinking alone. Drinking alone can be all right under a doctorís prescription, or some people use it to go to sleep, or there may be a religious ritual. But Iím not talking about any of those. He begins to drink alone and. likes it. He doesnít need all these other people pressing in on him, he may become a "loner." This is quite usual with women alcoholics for whom social conventions donít allow as many socially acceptable opportunities for drinking. Not all alcoholics are Ďloners."
Somewhere along in here--it may wait until the later stages--some dear, dear friend or even a physician may advise him during a hang-over--and he gets more hang-overs than others and they hurt him far more than they do other people--that a "quick one" at the beginning of the day will help. Many, many times it becomes humanly impossible for him to think of getting up and going to work and so on without this fortification.
We begin to find some asocial behavior. I am not talking about anything marked. But we do find a little trouble on the job, a little trouble at home, a little trouble here and there, automobile trouble, or what not. Itís more than he had been having in the past. It is reported on--quietly. But most of his friends tend to hush up comments about it. Trying to be helpful perhaps, many people try to cover up for him. Of course, he tries to do so also. Naturally, the day of reckoning gets worse as it is postponed. And about this time he may say, "Iíve got to do something about this." So he tries to change the pattern--a little shift from rye to gin, or he will stop drinking before 5 in the afternoon, or he will only drink at home, never in a commercial place.
Q: Does that help?
A: No. It isnít drinking patterns that are his trouble; it is the excessive ingestion of alcohol. And he can fit that into any pattern of drinking. Being an alcoholic, he will. Pretty soon--and it will be the end of what we call "the early stages"--he may go to get help from a minister, friend or someone outside the family, or he may even go to a sanitarium or a doctor or a hospital. He tries them all out.
Now we come to the beginning of the last stage, which is the "binge." We have our own way of talking about a "binge." A person can be completely "blotto" for 48 hours or for a week and we might not call it a binge if this fellow, letís say, is drunk over the week end, but on Monday morning he gets to the job. He may be on a two-week vacation and he is "blotto" for three or four days, but perhaps he has not completely disrupted social expectancy and social habit of his group. But this bird, who has started his week-end drinking about Friday at 2 p.m. and slowly slides off only about Monday noon and doesnít get around to the office till Tuesday--this four days is much more significant than six days on a vacation. The man begins to go on binges which clearly disrupt and insult the society.
At this point, the alcoholic may start getting secretive about his drinking. By now he will have surely learned the morning drink business, and he learns to keep a supply for the morning. He starts hiding his supply and he may develop all the tricky, tricky habits of the confirmed alcoholic and waste extraordinary ingenuity on protecting his secret supply. I call it wasted--sometimes the mental exercise equals Thomas Alva Edison at his best.
I might say that one of the most tragic things in the world is to see an alcoholic who has a half bottle left for the morning which he puts away where the little woman isnít going to find it--only to discover in the morning that he had been in a blackout when he did the hiding.
What a frantic, maddening search will follow!
Finally, a Breakdown
We finally begin to see a social breakdown which is really manifest. His friends, if they are still in that category, find it harder and harder to cover up. Now he loses the second or third job, and even though he got in to the office first and resigned, too many people know he was fired. Trouble with the wife and kids begins to come out in the open, and so on. Social difficulties mount rapidly. He begins perhaps to show some physical symptoms, tremors; more and more often heís in a physically run-down condition, which was perhaps present earlier in an acute fashion but over in two days--now it becomes chronic. And his rationalizations to himself--no longer can he find explanations in the culture that will satisfy even him, to say nothing of others. He is beginning to give up. His fears and his guilt and his remorse, instead of being pinpointed to what he did last night, or to his attitude toward his wife over 6 years, or 16 years, now become generalized without definition.
There is undefined fear, undefined remorse that he canít even explain--he has this black depression. It is called the blues sometimes--the real blues because you canít identify it. Thatís the difference between the real blues and a sentimental blues--you can always say itís because Mama went awayóbut with the real blues you canít identify what it is that is so painful, so threatening. Thatís whatís so horrifying. And at this point the fellow may give up socially on the grand scale, may slip down into Skid Row. Now the "DTís" may appear, and so on.
Q: What can you do to help--in the early stages particularly?
A: I would like to answer that in the first instance by pointing out that the behaviors called "early symptoms" are not by themselves symptoms. They have been ridiculed by some newspaper commentators, and if they are considered as separate instances, such ridicule may be O.K. It is when they are patterned and repetitive and increasing that they are early symptoms. For instance, among your friends may be some who have had a blackout. Does that mean theyíre alcoholics? No. It may have to do with the improper utilization of alcohol by the body. Your friend may have gotten drunk several times, he may have sneaked drinks once in a while, he may have said at parties a couple of times, "Letís have one for the road," or he may stop at your house to have a nightcap, or he may stop at a tavern on the way to a party.
Taken by themselves, these need not be symptoms. It is only when these things get into a pattern and become repetitive, that they make sense as early symptoms of alcoholism. Naturally, drunkenness may occur many times without any of these things being present at all.
Giving Up Drink
Q: What can be done about it?
A: For the people in the later stages you need almost a re-forming of life--particularly in social adjustments--and, for some people, also in the emotional sphere. Drinking will have to be given up permanently. Some may need physiological care beyond remedies for temporary acute ills. Originally, some 10 years and more back, it was the late-stage alcoholics who came looking for help, and so rather drastic steps were needed.
Now, as "Alcoholics Anonymous" and our clinics began to be more widely known, some of the frightened people in the middle and earlier stages came in. In fact, today they are the largest groups we see.
Q: What are you going to do for them?
A: First, we began to find they are different types. Some of them were way back in the first stages, some of them needed a little knowledge and a little guidance from a neutral and a respectable source; when they could see where they were and could be given a little support. If they could have some of the situational factors--such as the wife, who has been doing the wrong thing even with the best motives, triggering the guy into his alcoholismówhen they could receive just a little help, they could help themselves quite effectively.
If you could relieve those pressures and give this man just a little support, a little hope, a little help, then he didnít have such a hard time.
Q: Could the people in the middle stages, who had lost control, stop drinking?
A: So far as we know, they canít stop permanently without help. Now, there is going to be a case here and a case there where they can. Ordinarily we donít know in such cases whether they really were alcoholics before they stopped--just that they said so or their doctor, or Aunt Mathilda or the judge said that they were alcoholics. Then you may find out that this judge or mother-in-law thinks anybody who has two beers a week is an alcoholic.
Q: In that group he isnít out of control, then?
A: That very control is the crucial point in getting into alcoholism.
Q: Can he stop at that pointí and later on be a moderate drinker?
A: So far as we know he cannot become a controlled drinker. There may be some people who manifest some of these behaviors for a variety of reasons and later on drop the variant behavior without dropping the drinking. However, to date there is no well-recorded case that has been followed over as little as seven months, of a person who had--by consent of two or three outside observers going over the record--been an alcoholic, no matter what the stage, who was later on, say for a period of roughly a year, found to have been a controlled drinker.
Q: What about before he loses control and sees some symptoms, what does he do in that period?
A: He can keep control.
Q: How does he do it?
A: As a matter of advice, I would say to him: "Buster, youíd be awfully smart to play it safe. The safe way is for you to have a look around at your life, find out what youíre getting amusement from, where your job is, where your friends are, and see in what areas drinking seems to press itself, socially, upon you, and start manipulating those situations a little. Maybe you can control it."
Here is a typical way to find out--Iíve ever proven this, but it sounds reasonable and was suggested to me by a member of "Alcoholics Anonymous," or "AAís," as they are called. To find out if one is an alcoholic or not, you get the is-he-or-isnít-he person to tell you what he thinks sort of average, social, moderate drinking is. Letís say he decides a highball every night and two cocktails three times a week. You say, "O.K., thatís what it is. Now, every night for one month youíre to have one highball--never more, never less. And Thursday, Friday and Saturday you have two cocktails--never more, never less." If he can keep that up for 30 days, the chances are he is not an alcoholic.
This is, of course, a rule-of-thumb thing, and I can see where some wiseacre alcoholic would do it and get away with it. Iíve known alcoholics to go through the aversion treatment--and a horribly painful course it is--they go right through the treatment, kidding the doctor the whole way through. Going out in between sessions and drinking and drinking till they can take it without becoming sick to their stomach, and then going back for the next treatment, because they are showing off. Theyíre showing that the doctor is a damn fool. Theyíre showing Aunt Martha, and they are showing themselves how clever they are, and so on. Of course, theyíre fooling no one but themselves, but with a motivation like that I suppose, some alcoholic could pass this 30-day test. It would be a terrific strain on him.
Reprinted from: U.S. News & World Report© October 2, 1953