Sickness in a bottle

George is an outstanding citizen, a pillar of the community in almost every respect. He makes a good living, has a nice family, and is a lay leader at his church. However, things have not been going well at home. Increasingly concerned about his drinking, George's wife has threatened him with divorce unless things change. Frightened, George turns to his pastor for advice, and he promptly informs George that excessive drinking is sinful and that he should "cut it out." Unfortunately George cannot simply cut it out. He has crossed the invisible line. George suffers from the potentially fatal disease called alcoholism.¹

Alcoholism pervades America

The above story sounds familiar to every counselor who deals with alcohol ism (or dependence on other mood-altering chemicals), because alcoholism has risen to epidemic levels in this country. Alcoholism is a "democratic disease"; its victims can be male or female, young or old, successful or unsuccessful.

Some alcoholics drink daily. Others only "allow" themselves one bout a week. But there is a common denominator. All alcoholics both need to drink and are unable to control their drinking. ² Currently, in the United States, one in ten who attempt social drinking will develop alcoholism. Churches that take a stand against drinking have, naturally, fewer drinkers per capita than the average population. However, the members of those churches who violate their beliefs and attempt social drinking face a risk factor not of one in ten, but of one in two. ³ Indeed, I have never been involved with a church, as either a layperson or a pastor, in which alcohol ism was not present. It may have been hidden, but it was there. Conservative estimates place the number of alcoholics in the United States at ten million. Alcoholism exacts a terrible price. The death rate from all causes among alcoholics is two and one-half times that of the normal population. The rate of death by accident exceeds the norm by seven times. ⁴ And these figures do not take into account the nondrinkers physically injured by drinkers; nor do they reflect the massive emotional damage the families of alcoholics suffer. Clearly, pastors need an awareness of what alcoholism is and how it works in order to meet the needs of their flocks effectively.

How alcoholism begins

To understand the problem drinker's plight, we must discover how alcoholism begins. Basically, alcohol allures because "it works, and it works every time."⁵ The future alcoholic soon discovers that whatever his mood, ingesting alcohol makes him feel better. With it he can brighten a bad day or enhance a good day. Graph number one demonstrates the effect.

"The X represents the mood state of the subject before he begins drinking. A few drinks bring on a dramatic change that tends rapidly toward feelings of euphoria. He "sobers up," or returns to the normal state, as his body processes the alcohol. Naturally the positive effect is even more pronounced if the subject begins the drinking episode in a negative, or depressed, state. ⁶ The very dangerous attraction of alcohol is that the drinker can produce the positive mood swing at will, with no more trouble than a stop at the local liquor store.

Certainly, overdoing it brings obvious disadvantages--hangovers, injuries, and embarrassments. But the drinker can readily deal with these by the "never again (until the next time)" attitude he characteristically takes. However, something else happens at a far more subtle level. As his alcohol-induced euphoria fades, the drinker's mood tends to fall below the level it held when he began to drink. As graph number two indicates, sobriety becomes decreasingly desirable. ⁷

Naturally, as the drinker begins the drift toward the negative end of the scale he ingests increasing amounts of alcohol to find euphoria. But the euphoria that originally motivated his drinking becomes increasingly difficult to achieve. In fact, the later stages of alcoholism finds the individual drinking simply to return to what was once his normal mood state. (See graph number three.) At this point, apart from the chemical, life seems unbearable. ⁸

Now the subject begins to drink at what he once considered inappropriate times (mornings, at work, while driving, et cetera). Alcohol has become his "best friend." Apart from it, the alcoholic feels lost. He can no longer choose--he now feels that he must have the very thing that is destroying his life.

Symptoms of addiction

Although addiction to alcohol produces myriads of symptoms, they fall into seven basic categories:

1. Excessive and inappropriate use, such as the morning "eye-opener."

2. Harmful consequences, such as bent fenders and offended friends, from drinking episodes.

3. Loss of control--just one becomes a dozen.

4. Good intentions, such as "never again" or "I'll quit tomorrow."

5. Denial. (I once knew an individual who would admit that anyone who behaved as he did must have a drinking problem. But when asked if he had a problem, his answer was a clenched-teeth no. Denial in its various forms is a central issue in recovery. We will examine it more closely in the next article.)

6. Progressive maladjustment. The individual finds it increasingly difficult to function effectively at work, home, etc.

7. Repeated occurrences of the above.' (One readily available diagnostic tool can be found in appendix B of Toby Drews's book Getting Them Sober. ¹⁰ This series of specific questions was designed to help determine the likelihood of dependency.)⁹

Past approaches to treatment

Three different models have guided those who have tried to help alcoholics defeat their problem. The first, and oldest, is the moral model. It views alcoholism as a sin and simply says the drinker must stop. It points out that nobody forced the alcoholic to drink. At some point in the past he made choices that led to alcoholism. ¹¹ And so the alcoholic is responsible for his own condition--and its correction.

But the "Big Book" of Alcoholics Anonymous notes, "Though there is no way of proving it, we believe that early in our drinking careers most of us could have stopped drinking. But the difficulty is that few alcoholics have enough desire to stop while there is still yet time." ¹²

The major problem of the moral model is that once someone has become alcoholic, he does not possess the energy of will necessary for change and recovery. (That energy must come from a "Higher Power.") In fact, this approach is most often counterproductive because it adds to the guilt that the average alcoholic already carries. And the alcoholic knows one surefire way of relieving that kind of emotional pain.

Others rely on the psychological model. They hold that people take mood-altering chemicals to escape the emotional pain from some past traumatic event. ¹³ Once the alcoholic identifies and deals with the source of his pain, the alcoholism will "go away. " However, there is simply no evidence that this is the case. 14 And this view presents three additional problems. First, it creates a sort of permission for use. The alcoholic can excuse himself by saying things like, "Yes, I drink too much. But it is my parents' fault--they abused me when I was a child." Second, the psychological model fails to take into account that mood-altering chemicals create their own form of insanity. The person who is under the influence of alcohol is not himself. Consequently, treatment of that individual without first establishing sobriety does not effectively help the real person. Third, it may lead the alcoholic to believe that once the emotional problem is dealt with he can safely resume social drinking. Nothing could be further from the truth.

In comparison to the other approaches, the disease model has proved to be extremely effective in treating alcoholism. Simply put, it views chemical dependency as "an identifiable illness--a pathological entity in and of itself--and [states] that it is a primary problem, not secondary to either psychiatric or moral problems." ¹⁵ Indeed, the alcoholic has made moral choices. But even if he chooses to do so, he cannot quit. Perhaps he experienced emotional trauma. But even if that trauma was addressed, his drinking would continue. Questions of how, or why, or who is to blame are secondary to recovery. The alcoholism itself is the primary problem. It is to drinking what lung cancer is to smoking.

It must be dealt with directly if the victim is to survive. As the next article in this series will show, we must confront the drinker's alcoholism and aid him to sobriety before we can address his spiritual or psychological needs.

The disease model of treatment also recognizes that while alcoholism can be put into remission it can never be cured. "Chemical dependency is a chronic illness. It never goes away. Once developed it continues for the remainder of a person's life, and there is no known cure. It can be arrested or inactivated, however, through appropriate treatment which teaches affected individuals how to remain chemically free." ¹⁶

In short, the problem is always there. In Alcoholics Anonymous language, the alcoholic must find a power greater than himself that can restore him to sanity. Without that power the alcoholism will come out of remission with vengeance.

Tests such as the Minnesota Multiphasic Personality Inventory (MMPI) verify this by revealing that alcoholics retain an elevated chemical dependency pat tern even after many years of sobriety. ¹⁷ The disease model works. Hazelden Foundation reports a significant improvement in 75 percent of the clients treated under this approach. ¹⁸

Hope for healing

Hazelden is not alone. By March of 1976, Alcoholics Anonymous reported a worldwide membership of more than 1 million in twenty-eight thousand groups active in more than ninety countries. And what pastor has not witnessed the healing that comes with a spiritual awakening?

There is indeed hope. The concluding article of this series will deal with intervention and recovery. As it reveals, the road to healing is essentially a spiritual one. At first the alcoholic may not understand--but he does not have to. When he risks reaching out to God, he will find the strength for recovery. "What seemed at first a flimsy reed, has proved to be the loving and powerful hand of God." ¹⁹