What Can We Do for the Alcoholic?

The monthly Medical Missionary article.

By HAROLD SHRYOCK, M. D., Assistant Professor of Anatomy, C. M. E., Loma Linda

A Drowning man 'is supposed to rise three times before he finally gives up his fight for life. A typical alcoholic, however, falls into and rises from his alcoholic tendency so many times that his falling and rising becomes proverbial.

After each debauch he feels so humiliated that he solemnly promises never to touch another drop. But those who know him realize that he lacks the stamina necessary to keep such a promise.

When sober, the alcoholic can be readily con­vinced that his craving for alcohol lies at the foun­dation of every misfortune that has overtaken him and his family. He is full of remorse when told that his indulgences have deprived his wife of the happiness she deserves. He seems heartbroken at the thought that his aged mother has almost grieved her life away because of his wayward tendencies. He mourns to think that a stigma hangs over his children because their father is a drunkard. His sorrow is so profound that anyone not acquainted with alcoholics is sure that he will remain on the "water wagon." But he is totally unable to carry out his resolve. In fact, if he is made too keenly aware of the sorrow and misfortune which his drinking has caused, he will actually become so depressed as to take immediate recourse to alcohol, which is the only agent he has found which gives him solace from the awareness of his deficiencies.

The typical alcoholic is so helpless in his struggle to overcome the use of intoxicants that many a psychiatrist has become discouraged and has drawn the conclusion that there is no permanent cure for alcoholism." 5 Henderson says, "Frankly, we know of no specific, specialized form of treatment for chronic alcoholism which we can wholeheart­edly recommend." Others have been more opti­mistic in their attitude and have agreed that carefully selected cases may be cured. Jellinek 5 as­sumes that 40 per cent of "abnormal drinkers" are addicted to alcohol because of an underlying personality deficiency such as feeble-mindedness, psy­chosis, or severe psychopathy. For these he has no hope of cure. But the remaining 6o per cent are amenable to cure, provided the conditions are favorable.

Of all the criteria which indicate whether a given alcoholic is a proper candidate for therapy, the victim's own desire to overcome his drinking is doubtless the most important." Knight reports that he has had uniformly poor results in cases who were not interested in being cured. Durfee re­fuses to accept an alcoholic for treatment unless it is the drinker himself, rather than his relatives and friends, who desires emancipation from alcohol. One of the conditions for acceptance into the Alcoholics Anonymous group is that the individual being accepted have a definite desire to be cured.' One of the premises upon which Alcoholics Anony­mous was organized is that complete cure will result in any case where there is a genuine desire to be free from the habit.

Another basis upon which it may be determined whether a man can be cured of his alcoholism is his willingness or unwillingness to agree to a pro­gram of total abstinence rather than controlled drinking-.7 In discussing the treatment of alcohol­ics, Strecker remarks:

"There can be no recovery until there is an intelligent and mature decision that the future must be a non­alcoholic one." "There is unanimity among therapists that in the course of treatment absolute abstinence must be maintained, and, with very few exceptions, therapists also agree that the patient must become a total abstainer and that he cannot be trained to become a social drinker."

"The highest hurdle that the alcoholic patient must finally succeed in clearing is that of the accept­ance of a completely nonalcoholic future.. .. It has been said as illustrative of the firmness of the nonalcoholic decision, that should the individual pass beyond this vale of tears and be welcomed by the guardian of the heavenly gates proffering a cup of heavenly ambrosia, it would be automatically declined upon the suspicion that it might contain alcohol."

Members of Alcoholics Anonymous have com­mitted themselves to the dictum : "We can never safely use alcohol in any form."

Inasmuch as psychiatrists, who specialize in handling personality disorders, have failed to effect cures in many of their alcoholic patients, it is not surprising that an alcoholic will look to a minister for help. Among his reasons for going to a minister is the observation that he, above all others in the community, is accustomed to helping those who are struggling to make difficult adjustments. It is generally recognized that a large number of alcoholics have obtained a cure through access to divine power. Often the alco­holic has found very little solace in his contacts with relatives and employers. He craves the sym­pathy and understanding that only a Christian can give. Many alcoholics long to be freed from the shackles of their alcohol habit. They are sufficiently acquainted with Christ's ministry when on earth to know that—

"Often He met those who had drifted under Satan's control, and who had no power to break from his snare. To such a one, discouraged, sick, tempted, fallen, Jesus would speak words of tenderest pity, words that were needed and could be understood. Others He met who were fighting a hand-to-hand battle with the adversary of souls. These He encouraged to persevere, assuring them that they would win; for angels of God were on their side, and would give them the victory."

The minister thus has a rare opportunity to fol­low Christ's example in rendering help to those who are victims of one of Satan's most subtle devices. It is most gratifying to read the favorable comments made by eminent psychiatrists with ref­erence to the help which the alcoholic may expect from conversion.

If proof is needed of the efficacy of the religious approach to the problem of alcoholism, it may be had in the success which has attended the Alco­holics Anonymous movement." This organization now has members in many large cities. It consists entirely of men and women who have conquered their alcoholic cravings and who are now devoting their spare time, without remuneration, to the helping of alcoholics. This group maintains that one who has overcome the habit is in a better position to help an alcohol addict than one who has never experienced the insatiable craving for drink, that is, craving the effect of alcohol. And the alcoholic will have more confidence in someone who tries to help him when he knows that this person speaks from personal experience. Even though the Alcoholics Anonymous group is non­sectarian, it freely admits the necessity of trust in divine power. Their published program of recov­ery is as follows:

"1, We admitted we were powerless over alcohol—that our lives had become unmanageable.

"2. Came to believe that a Power greater than ourselves could restore us to sanity.

"3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

"4. Made a searching and fearless moral inventory of ourselves.

"5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

"6. Were entirely ready to have God remove all these defects of character.

"7. Humbly asked Him to remove our shortcomings.

"8. Made a list of all persons we had harmed and became willing to make amends to them all. -

"9. Made direct amends to such people wherever pos­sible, except when to do so would injure them or others.

"10. Continued to take personal inventory, and when we were wrong promptly admitted it.

"11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

"12. Having had a spiritual experience as the result of these steps, we tried to carry this message to alco­holics and to practice these principles in all our affairs."

Hewitt summarizes his impression of what has been accomplished by the Minneapolis chapter of the Alcoholics Anonymous group by remarking:

"One cannot predict how successful Alcoholics Anony­mous will be over a long period, or whether the fellow­ship will be able to maintain its present vitality and freshness. Its success thus far, however, augurs well for the future. The average member is forty-four years old, began drinking occasionally to excess when he was nineteen years old, and has been drinking to excess continually for a period of about thirteen years. The average length of tune that the members reported in this study have remained abstinent is ten months. If some of these had not had one or two lapses since joining, the average time would be much longer. Ten months of abstinence is not proof of cure ; but the Minneapolis group is only two years old, and for an alcoholic who has enjoyed few sober periods in a large part of his adult life, this represents a change for the better that has seldom been equaled by more scientific procedures." 5

Thompson reports that seventy-two of his pa­tients voluntarily joined the Alcoholics Anonymous group. "Of these, forty-one have made an excellent adjustment, although many were among the pa­tients with the gravest prognosis."

It is certain that if the Master were on earth at the present time, He would do more for an alco­holic than merely assure him of forgiveness. He would put Himself out to give aid in making ad­justments to undesirable circumstances. It is there­fore proper for the minister to give attention t the means by which the alcoholic may help himself to overcome his weakness. The first attention should be given to his physical needs. He is en­titled to adequate medical care and to a correction of any factor which tends to undermine his general health. He should be provided with a nonstimulat­ing but a nutritious diet which is not only appealing to the appetite but adequate in vitamins and min­erals.

Inasmuch as the typical alcoholic has resorted to alcohol in order to escape from the tension of some conflict within himself or within his environ­ment, "successful therapy depends on the recog­nition of the exact problem facing each individual ; it must provide a better means of relieving tension than the patient unconsciously found in alcohol." This statement is easier to make than to follow. For one reason, the alcoholic is very reticent to give accurate answers to questions. He has many ways of furnishing logical explanations for his aberra­tions of conduct. He is also clever in disguising his motives. It may even be that he has fallen into such deceitful ways of thinking that he is not actually aware of the background for his conduct.

Thus it takes a great deal of patience to unravel his history sufficiently to reveal the basic motives behind his resort to alcohol. To discover these motives may require a series of interviews. It is best to allow the individual to make spontaneous reference to his recourse to alcohol rather than to irritate him by frequent direct references to the problem.

Once the therapist has discovered the underlying cause of the alcoholism, the next step is to convince the victim that this is the basis of his difficulty. When he finally realizes this he will co-operate in an effort to arrive at a proper adjustment of the conflict. This approach may temporarily distract his attention from the alcohol, but regardless of how co-operative he may be, there will be "slough of despond" experiences during which the old habit patterns will become active and will coax their victim to take recourse to the solvent for all difficulties. If he can survive these experiences without breaking over "just this once," he is on the road to genuine recovery. But if he permits one exception it will be, as Thompson remarks, like the proverbial spark to the barrel of gtinpowder. One exception is like dropping a ball of twine.

Once the source of conflict has been discovered and admitted the struggle is only begun, for the conflict usually centers around some inflexible situ­ation. It may involve an intolerance among per­sons within the home, or it may involve a sensi­tiveness and feeling of inferiority because of failure in a chosen lifework. If personalities are involved the therapist may need to take the other party or parties-into his confidence and solicit their co-op­eration. Many of the most difficult personality clashes are those involving persons who are entirely unaware of being party to such a situation. They may even involve an overindulgent mother, a jealous wife, or an overly ambitious father. If the conflict centers around failure in one's chosen lifework it will probably be necessary to persuade the individual that a person of his make-up must be content as a lesser light. He might better succeed in a humble role than to attempt big things in a field which requires too great an adjustment.

Durfee18 advocates that a small farm is the best place for him to find psychological freedom.

It may not be necessary for a particular alcoholic to seek an entirely new environment in order to get away from his alcohol, but it is very desirable that he be encouraged to take up some all-absorbing avocation—some hobby or philanthropy—that will consume his leisure time and leave no spare mo­ments during which he may entertain the old crav­ing for alcohol. Even those who have never used alcohol find it desirable to develop some extraneous interest—music, art, literature, community politics, welfare work, gardening. Why should not the person with an alcoholic tendency resort to the same technique in order to ensure his stability? The Alcoholics Anonymous organization requires its members to engage in active welfare work for those who are still in the throes of alcoholism.

He who assumes the responsibility of being the confidant and adviser to an alcoholic may expect a tedious ordeal. He will meet resistance to his attempts, he will experience periods of ingratitude, and there may be times when the alcoholic he is trying to help will relapse into a condition which seems worse than any previous episode. However, persistence may win where carefully planned strategy fails. Dealings with an alcoholic must be deliberate and continuous. Even after an apparent cure has been realized, occasional contacts must be maintained. These should serve to remind the rescued person of the pit from which he was digged, and to make him aware of the many advantages of abstinence which he now enjoys.

Is it worthwhile to try to help an alcoholic? —Try it and see!

References

1 G. H. Stevenson, "The Psychological and Medical Aspects of the Excessive Use of Alcohol," Canadian Medical Association Journal, 1940, No. 42, PP. 57-61.

2 Walter A. Thompson, "The 'Treatment of Chronic Alcoholism," American Journal of Psychiatry, May, 1942, PP. 846-856.

3 R. P. Knight, "Psychoanalytic Treatment in a Sana­torium of Chronic Addiction to Alcohol," Journal of the American Medical Association. Oct. 15, 1938, pp. 1443­1448.

4 D. K. Henderson, "Chronic Alcoholism and Its Treat­ment," Edinburgh Medical Journal, 1933, No. 40, p. 1.

5 E. M. Jellinek, Alcohol Addiction and Chronic Alco­holism. (Yale University Press, New Havan, 1942.)

6 Edward A. Strecker, 'Chronic Alcoholism : A Psy­chological Survey," Quarterly Journal of Studies on Alcohol, March, 1942, pp. /2-17.

7 Charles H. Durfee, "Observations on the Handling of Problem Drinkers," Journal of Criminal Psycho­pathology, October, 1941, pp. 278-288.

8 Edward E. Strecker, "Alcoholism," Hygeia, Septem­ber, 1940, PP. 761-762, 828.

9 E. G. White, Ministry of Healing, p. 26.

10 W. E. Masters, The Alcohol Habit and Its Treatment. (H. K. Lewis & Co., London, 1931. Cited by Jellinek.)

11 0. Graf, Moglichkeiten mid Grenzen der Heilbehand­lung von Alkoholikern. (Neuland Verlag, Berlin, 1929. Cited by Jellinek.)

12 E. Gabriel, Worin besteht die Beliandlung von Trin­kern? (Wien. klin. Wschr., 1937, 5o : p. 637. Cited by Jellinek.)

13 R. Fleming, "The Treatment of Chronic Alcoholism," New England Journal of Medicine, Nov. II, 1937, pp. 779-783.

14 " Alcoholics Anonymous. (Works Publishing Co., New York, 1939.)

15 Charles C. Hewitt, "A Personality Study of Alcohol Addiction," Quarterly Journal of Studies on Alcohol, December, 1943, PP. 368-386.

16 0. K. Timm, "Psychodynamics of Alcoholism and Its Relation to Therapy," Medical Bulletin of the Vet­erans' Administration, Washington, 1943, No. 20, pp. 42-48, as abstracted in Quarterly Journal of Studies on Alcohol, December, 1943, P. 474.

17  Charles H. Durfee, "Re-education of the Problem Drinker," Connecticut State Medical Journal, October, 1938, p. 486.

18To Drink or Not to Drink. (Longmans, Green & Co., dew York, 1938.)

19 Otic R. Rice. "Religion and the Church in Relation to Alcohol Addiction," Quarterly Journal of Studies on Alcohol, December, 1942, PP. 393-399.

20 Medical Journal of Australia, December 29, 5934, p. 840. (Autobiographical sketch by a physician who became an alcoholic and then, with the aid of an older physician, broke the habit.)

21 K. M. Bowman and E. M. Jellinek, "Alcohol Addic­tion and Its Treatment," Quarterly Journal of Studies on Alcohol, June, 1941, PP. 98-176.

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By HAROLD SHRYOCK, M. D., Assistant Professor of Anatomy, C. M. E., Loma Linda

October 1944

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