During 1943 Americans spent $6,000,000, 000 for alcoholic beverages. This expend­iture was 17 percent greater than the amount spent in 1942 and 80 per cent greater than that for 1939. The 1943 liquor bill equals 7 percent of the total money spent in the United States for goods and services of all kinds. It amounted to an average of $46 for every man, woman, and child in the country.¹ Basing his estimates on re­ports of registered distilleries, Partlow² states that the production of alcoholic beverages in America increased from an annual average of 2,000,000 gal­lons a year between 1920 and 1930 to 200_.000,000 gallons in 1937.

Haggard and jellinele estimated that 44,000,000 persons in the United States used alcoholic bever­ages in 1942. Out of these, approximately 600,000 should be classed as abnormal drinkers. Dr. Win­fred Overholser,⁴ superintendent of St. Elizabeth's Hospital, Washington, D. C., speaking at the an­nual meeting of the American Association for the Advancement of Science in 1940, presented statis­tics which indicated that more than 100,000 per­sons are arrested annually for drunkenness. Of these, about 27,000 are charged with driving an automobile while under the influence of liquor. Dr. Horatio M. Pollock,⁵ of the New York Depart­ment of Mental Hygiene, speaking at the same meeting of the American Association for the Ad­vancement of Science, estimated that alcoholic mental disorders cost the people of the United States $178,191,272 a year. At the time of his report approximately 31,220 patients suffering from alcoholic mental disease or alcoholism were in the mental hosiptals of the United States.

According to statistics compiled by the Bureau of Census,⁶ the deaths from alcoholism in the United States numbered 3,907 in 1917. In 1920, when prohibition enforcement was at its best, this number dropped to 900. With the reaction against prohibition the number increased to a high of 4,627 in 1928. The figure for the last year mentioned in the report (1937) was 3,305.

In a statistical review of alcoholic mental dis­ease in the State of New York for the 30-year period ending 1938, Pollock⁷ showed that the number of first admissions during 1917 (just prior to prohibition) reached a total of 594. By 1920 (dur­ing the enforcement of prohibition) this annual total had dropped to 122. Since 1920 the total has been gradually rising to reach a new high in 1934 of 884. The totals for the years 1937 and 1938 were 877 and 831, respectively.

Parkhurst⁸ estimated that the first admissions for alcoholism to public and private mental hospi­tals throughout the United States increased 700 percent between 1920 and 1933. There was a continued increase of 117 percent between 1930 and 1934, and there has been a steady increase since the latter date. It is obvious, therefore, that the number of cases of alcoholic mental disease runs quite parallel to the number of deaths from alco­holism, and that both these factors are dependent upon the general consumption of alcohol.

Realizing the magnitude of the alcohol problem, a group of outstanding scientists in Washington, D. C., recently established the Re­search Council on Problems of Alcohol. The Coun­cil was incorporated January 5, 1938, and on June 27 of the same year was officially adopted by the American Association for the Advancement of Science.⁹

The members of the council have been very ac­tive in compiling data and reporting research that pertains to the many phases of alcohol imbibition and alcoholism. Their work has been or a strictly scientific quality. Most of the articles prepared by members of the council have appeared in the Quarterly Journal on the Study of Alcohol—a most reputable journal which was established in 1940. A complete file of this journal is available in most medical libraries and in many public libraries. Anyone interested in the problems of alcohol would do well to peruse these volumes.

Many studies have been made of the effects of alcohol on reaction time. For instance, Cor­radinil¹⁰ remarks that the normal reflex time for a muscular response to a visual stimulus is one fifth of a second. After one cocktail, or a little less than two bottles of 4 per cent beer, this reac­tion time is slowed to two fifths or three fifths of a second. In terms of automobile driving this means that the driver who has imbibed the stated amount of liquor would travel thirty feet farther than the sober driver ^-before bringing his 50-mile­an-hour automobile to a halt.

Robert E.Corradini,¹³ executive secretary of the Foundation for Narcotics Research and Informa­tion, Inc., points out that "our nervous system de­velops in this order : the control of circulation, respiration, large muscles, the senses, and the intel­ligence. Alcohol affects the system in the reverse order ; that is, the intelligence and the judgment are affected first of all." Although it was formerly assumed that alcohol was a stimulant, it is now admitted by all scientists that it is actually a de­pressant. It has been suggested that alcohol pro­duces its depressing influence by way of reducing the normal processes of oxidation within the tis­sues of the brain."

Because of its depressant action on the brain, the immediate effect of alcohol is to produce a re­duction of efficiency. This is evidenced in a defi­nite impairment of skilled performances such as target shooting, typewriting, typesetting, and the operation of automobiles and other machines. Var­ious attempts at measuring the impairment of skilled performances following the ingestion of al­cohol have given results varying, under different circumstances, up to 121 percent of impairment." Obviously the amount of impairment will depend upon the quantity of alcohol ingested and indi­vidual susceptibility to alcohol. It is this reduc­tion of efficiency that makes alcohol such a hazard in industry and traffic.

Mental efficiency, as well as motor efficiency, is quickly impaired by alcohol. Under its influence there is a prompt reduction in the speed and accu­racy of adding digits.⁴ Animal experiments have indicated that simple learning processes are defi­nitely impaired by alcohol. Experiments by vari­ous workers have uniformly indicated a reduction of memory in human subjects up to an impair­ment of 44.2 per cent."

It has been repeatedly emphasized that the more complex mental functions suffer more from alcoholic indulgence than the simpler functions. It is to be expected then that judgment and reason will be adversely influenced.

"More important, however, than the intellectual im­pairment which may follow excessive use of alcohol is its deleterious effect on the individual's affective reac­tions and personality structure as a whole. More seri­ous than the alcoholic's loss of memory is his loss of goal; long before he shows measurable signs of mental deterioration he gives ample evidence of being less ef­ficient socially."

Under the influence of alcohol the individual's awareness of his environment is reduced to the extent that he loses all sense of responsibility and obligation. He also becomes indifferent to his per­sonal problems and assumes a characteristic atti­tude of euphoria. In this state of mind he becomes self-centered and loses all consideration for other individuals. He also loses his sense of obligation to any code of morals—his conscience is in neutral. This blending of euphoria, egotism, and emancipa­tion from ethical standards produces an attitude which readily explains the tendency of alcoholics toward crimes of license and violence.

In many individuals the immediate effects of al­coholic indulgence are unpredictable. As an ex­ample of this type of reaction, Banay¹³ reports the case of a young man who as a boy had developed an overwhelming interest in aviation. During his spare time he built model airplanes and watched the arrival and departure of commercial planes at the local airport. Following his graduation from high school, he expressed a desire to become a pilot in the Government air force, but was re­jected because of some minor physical defect. This rejection constituted a major disappointment so that he became rebellious and depressed. His efforts to obtain satisfactory employment only made him more keenly aware of his disappointment in being deprived of the opportunity to become a pilot. Finally he took recourse to alcohol and followed the custom of drinking to excess at least once a week. This continued for about six months. One day while under the influence of alcohol he walked into a neighborhood store and without any provocation drew a revolver and fatally shot the proprietor and two customers. When he became sober he had no memory of the shooting and could barely recall that he had been intoxicated. With persistent indulgence of alcohol, permanent changes in the personality gradually develop. Eugene N. Boudreau says:

"There grows a progressive self-centeredness, and apparent selfishness, and a dulling of the sensibilities. The individual becomes less considerate. He loses his capacity for business and is negligent or impatient be­cause of his preoccupation with his avocation of drink. He becomes irritable, rigid in his ideas and social atti­tudes, or he may begin to show excessive sensitiveness or paranoid [accusatory] tendencies. Later, he becomes obtuse, his moral and ethical values change, and he gets into unfortunate difficulties with his business clientele. His behavior, when called to his attention, he blandly excuses with evident unconcern."'

The subtlety of alcoholic indulgence lies in the fact that the mental attitudes incident to intoxi­cation render the individual unaware of his per­sonal problems, and thus more satisfied with himself than when he is sober. When, after an alco­holic bout, he finds himself confronted again with the same gruesome reality from which his alcohol gave him refuge, there develops a tantalizing tend­ency toward repeated indulgence. When sober, the alcoholic will agree that his indulgences are harmful. But even the humiliation of this knowl­edge disappears during intoxication. Thus he seeks recourse again and again to the "universal solvent" for his troubles.

Subsequent contributions by Doctor Shryock on the psychology of alcoholism will be concerned with "Why People Drink" and "Help for the Alcoholic."—Editor.

References

¹Associated Press Dispatch, March r, 1944, Washing­ton, D. C.

² W. D. Partlow, "Habitual Use of Alcohol in Ala­bama," The Journal of the Medical Association of the State of Alabama, Vol. IX, November, 1939, PP. 145­-148.